Dhsr ac 4207-2025

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4.8 out of 5

105 votes

The document is a Resident Register form used by facilities to collect and maintain essential information about residents upon their admission. It includes sections for identifying information, personal details, medical history, assistance required, community involvement, requests for assistance, and discharge/transfer information. The form must be completed and signed by the Administrator or Supervisor-in-Charge and the resident or their responsible person within 72 hours of admission.

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Click ‘Get Form’ to open the dhsr ac 4207 in the editor.
Begin by filling out the 'Identifying Information' section. Enter the name of the home/facility, followed by the resident's full name, date of admission, and former address. Ensure you check the appropriate box for where the resident was admitted from.
Continue with personal details such as birthdate, birthplace, and insurance information. Make sure to provide accurate data for Medicare and Medicaid numbers.
In the 'Personal Information' section, indicate any assistance required by checking relevant boxes. This includes daily activities like dressing or bathing.
Complete sections regarding community involvement and personal habits. This helps in understanding the resident's background and preferences.
Finally, ensure that all signatures are obtained in Section F after reviewing all completed sections with the resident or responsible person.

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2011	4.8 Satisfied (105 Votes)

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