The New York State Department of Health's Division of Assisted Living has developed a comprehensive form known as DOH-4397, designed for the evaluation of residents in assisted living facilities. This form covers various aspects of a resident's health and daily living capabilities, aiming to provide a thorough assessment to ensure that individuals receive the appropriate level of care and support they need. It begins with assessing the resident's ability to communicate effectively in English, whether they can speak, read, write, and understand instructions, considering any speech impairments, dental, vision, and hearing issues they may have. Further, it delves into the resident's customary routine, including their sleeping, bathing, and eating habits, as well as their social activities and continence management. The form is detailed in its approach to evaluating physical functions, requiring information on the level of assistance needed for various tasks such as eating, ambulation, transferring, toileting, bathing, and dressing. Prosthetic needs, any podiatric concerns, and the resident’s ability to engage in housekeeping, shopping, and the use of a telephone are also examined. Additionally, the form screens for cognitive impairment, inquiring about the individual’s orientation, comprehension, concentration, memory, and any notable behaviors that could indicate cognitive decline. This evaluation instrument is critical for the tailored care planning and successful integration of residents into the assisted living community, ensuring their health, safety, and well-being are adequately addressed.
| Question | Answer |
|---|---|
| Form Name | Doh 4397 Form |
| Form Length | 6 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 30 sec |
| Other names | 4397 b form, doh 4397, residence resident 1, nys doh 4397 form |
