The AHCA 1823 form is a five-page health assessment document. Use FormsPal's free online PDF editor to fill it out and download it. Follow the steps below to complete the form accurately.
Step 1: Click the "Get Form" button at the top of this page to open the AHCA 1823 form in the PDF editor. The form loads with all sections ready to complete.
Step 2: Complete the patient and facility information in Part I. Enter the resident's full name, date of birth, address, and the name of the admitting assisted living facility or nursing home. Include the attending physician's name, license number, and contact information in the provider section.
Step 3: Fill in the medical history and diagnosis sections. List all current diagnoses, medications with dosages, known allergies, and relevant past medical history. This information helps the facility understand the resident's ongoing health needs.
Step 4: Assess the resident's activities of daily living (ADLs) and functional status. Indicate the level of assistance needed for bathing, dressing, eating, mobility, and continence. This determines the level of care the facility must provide under Florida regulations.
Step 5: Complete the dietary, behavioral, and cognitive assessment sections. Check all applicable boxes for special dietary needs, behavioral concerns, and cognitive impairments. The attending physician or ARNP must sign and date the form to make it valid for submission.
Once complete, click "Done" to save your AHCA 1823 form. You can download it as a PDF, print it, or send it by email directly from FormsPal. For other related Florida health forms, see the AHCA Form 3020 and the medical history form.