Form 8584 PDF Details

Form 8584 is a tax form used to report and calculate the ownership percentage of a partnership or S corporation. The form is used to determine whether the partnership or S corporation meets the passive activity loss (PAL) rules, which can limit the amount of losses that can be deducted. Understanding Form 8584 and its use is important for taxpayers who own interests in partnerships or S corporations.

Below are some specifics about form 8584. Before you decide to fill out the form, it's definitely worth checking out a little more about it.

QuestionAnswer
Form NameForm 8584
Form Length19 pages
Fillable?Yes
Fillable fields1121
Avg. time to fill out38 min 10 sec
Other namesdads form 8584, form 8584 dads, form 8584 nursing comprehensive assessment, 8584 nursing

Form Preview Example

Texas Department of Aging

Form 8584

and Disability Services

June 2014

Comprehensive Nursing Assessment

To be performed by a Registered Nurse

Individual

Date of Birth

Today’s Date

I. Review

Review of Health Care Team

Health Care Practitioners

Date Last Seen

Comments

Primary Care

Psychiatrist

Neurologist

Dentist

Optometrist

Natural Supports

Relationship

Telephone No.

Client Responsible Adult (CRA)

Guardian

Health History

Axis I:

Axis II:

Axis III:

Axis IV:

History of Major Medical/Surgical Occurrences:

RN

Form 8584

Page 2 / 06-2014

Individual

 

Date

Review of Current Medications

Include OTCs, vitamins and herbs

Allergies:

Medication

Dose

Freq.

Route

Purpose/Rationale

Side Effects/Labs

RN

Form 8584

Page 3 / 06-2014

Individual

 

Date

 

 

 

II. Current Status

Current medical and psychiatric history

Briefly describe recent changes in health or behavioral status, hospitalizations, falls, seizure activity, restraints, etc., within the past year.

What is of primary concern/greatest expressed needs of the individual, legally authorized representative (LAR) or client’s responsible adult (CRA) from their own perspective?

Vital Signs

Blood pressure

Pulse

Respirations

 

Rate

Rhythm

Rate

Rhythm

 

 

 

 

 

 

 

Temperature

Pain level

 

Blood sugar

Weight

 

Height

 

 

 

 

 

 

 

Comments

RN

Form 8584

Page 4 / 06-2014

Individual

 

Date

 

 

 

Labs

Briefly review ordered labs, dates and abnormal values within the past year.

Fall Risk Assessment

Has a fall risk assessment been completed?

No

Yes (attached). Fall risk due to:

Neurological

Musculoskeletal

Unknown

Comments

III. Review of Systems

Neurological

Abnormal Involuntary Movement Scale (AIMS) Assessment:

Attached

 

Deferred

 

 

 

Y

N

 

Y

N

Y

N

 

 

 

Pupils equal and reactive to

 

 

 

 

Headaches

light and accommodation

 

 

Tremors

 

Dizziness

Tremors

 

 

Heat/cold reflex

 

Impaired balance/

 

Numbness/tingling/

 

 

 

 

 

coordination

 

Paresthesia

 

 

Extrapyramidal symptoms

 

Medication side effects

 

Paralysis

 

 

 

 

 

Y

N

 

Y

N

Y

N

Seizures

Petit Mal

 

 

Clonic (repetitive jerking)

 

 

 

 

 

 

 

Frequency

 

 

Absence

 

 

Tonic (muscle rigidity)

 

Duration

 

 

Myoclonic (sporadic jerking) ...

 

 

Atonic (loss of muscle tone)....

 

Comments

 

 

 

 

 

 

 

RN

Form 8584

Page 5 / 06-2014

Individual

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Eye, Ear, Nose and Throat

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Eyes/Vision

 

 

 

 

 

 

 

 

 

 

 

Clear

Red

Right impaired

Left impaired

Adaptive aid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ears/Hearing

 

 

 

 

 

 

 

 

 

 

 

Normal

Ringing

Right impaired

Left impaired

 

Adaptive aid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nose/Smell

 

 

 

 

 

 

 

 

 

 

 

Within normal limits Smell:

intact

not intact

Nose bleeds

Frequent sinus congestion

Frequent sinus infection

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oral

 

 

 

 

 

 

 

 

 

 

 

Within normal limits

Difficulty chewing

Mouth pain

Halitosis

Dentures

Edentulous

Involuntary tongue movement

Dry mouth from medications

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Throat

 

 

 

 

 

 

 

 

 

 

 

Within normal limits

Sore throats

Difficulty speaking

 

Difficulty swallowing

Tonsil enlargement

History of choking

Thyroid enlargement

 

 

 

 

 

 

 

Swallow Study:

Yes

No

Date:

 

Results:

 

 

 

Comments

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cardiovascular

Y N

Edema.................................

Chest pain ...........................

High/Low blood pressure.....

Normal range

Comments

Y N

Cool/Numb extremities...........

Activities of daily living (ADL)

limitations...............................

Y N

Capillary refill less than or

equal to two seconds...............

Compression stockings ...........

RN

Form 8584

Page 6 / 06-2014

Individual

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Respiratory

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Breathing:

Slow

Normal

Rapid

Shallow

 

Painful

 

 

 

 

 

 

 

Y

N

 

 

 

 

Y

N

 

Y

N

Short of breath

....................

 

 

Feeding tube

...........................

 

 

 

Tracheostomy

 

 

 

 

 

 

 

 

 

 

 

 

Continuous positive airway

 

Wheezing

 

 

Positioning orders

 

 

pressure (CPAP)

 

Fatigue

 

 

Aspiration history

 

 

Inhalation agent

 

Cough

 

 

Pneumonia history

 

 

Oxygen @

 

Productive

 

 

 

 

 

 

 

 

 

 

 

Comments

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gastrointestinal

Gastrostomy

Bowel sounds

Jejunostomy

No tube

Last bowel movement

Bowel habits (frequency and description)

 

 

Y NY NY N

Continent.............................

Frequent nausea .................

Frequent vomiting ...............

Indigestion...........................

Heartburn ............................

Appetite loss........................

Comments

Reflux......................................

Straining pain..........................

Diarrhea..................................

Odd stools...............................

Hemorrhoids ...........................

Independent toileting...............

History of risk constipation .......

History of risk impaction ...........

Bowel program .........................

Medications influencing bowels (laxatives, anti-diarrheals, Iron, Calcium, Anticholinergics, etc.)

RN

Form 8584

Page 7 / 06-2014

Individual

Musculoskeletal

Pain.....................................

Weakness ...........................

Stiffness ..............................

Comments

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

N

 

Y

N

 

 

Y

N

 

Prosthesis

 

 

Impaired range of motion

 

Deformity

 

 

Impaired gait

 

Contractures

 

 

Adaptive equipment

Genitourinary

Y N

Incontinent..........................

Stress.......................

Urge .........................

Bladder program ................

Frequent urination ..............

Cloudy/dark urine ...............

Bloody urine .......................

Comments

Y N

Flank pain ...............................

History of urinary tract

infections ................................

Noctouria ................................

Discharge ...............................

Itching .....................................

Hemodialysis ..........................

Peritoneal dialysis...................

Y N

Sexually active.....................

Prostate issues ....................

Menstrual cycle regular........

Date of last menstrual period:

Menopausal:

If yes, date of onset:

Integumentary

Skin Assessment:

Attached

 

Deferred

 

 

 

 

 

 

 

Skin:

Normal

Moist

Dry

Cyanotic

Warm

Pale

Jaundice

Cold

Dusky

Flushed

 

 

 

Y

N

 

 

Y

N

 

 

Y

N

Open wound

 

Rash

 

 

Blemished

............................

 

Bruising

..............................

 

Diaphoretic

 

 

Poor skin turgor

 

Breakdown related to

 

 

 

 

 

 

 

 

 

 

adaptive aids/prosthesis

 

Risk for breakdown

 

History of breakdown

 

Comments

RN

Form 8584

Page 8 / 06-2014

Individual

Endocrine

Y N

Thyroid dysfunction ............

Atypical antiphychotics or other medications affecting blood sugar.........................

Pre-Diabetic hypoglycemic/

hyperglycemic episodes .....

Comments

Date

 

 

Y

N

 

Diabetes

 

 

If yes, type

Management:

Diet

Oral medications

Insulin

Other injectable medication to manage diabetes Desired blood sugar range:

IV. Additional Health Status Information Immunizations: Date last received

DPT

TOPV

HIB

MMR

TD

TDS

Flu Shot

Comments

Nutritional Assessment

How receive nutrition:

Therapeutic diet

Food texture

Orally

Via gastrotomy tube if residual

Liquid consistency

Reason/date/ordered by:

Via jejunostomy tube Other

YN

Recent weight change ...............................................

Recent changes in appetite/medication.....................

Satisfied with current weight......................................

Food use as a coping mechanism.............................

Assistive devices with eating .....................................

Use of medications that can cause difficulty

swallowing (e.g., Abilify, other psychoactives)...........

Knowledge of 4 basic food groups.............................

Access to healthy/appropriate diet.............................

Dietary deficiencies ...................................................

Adequate fluid intake.................................................

Nutritional supplements .............................................

Interactions with medications and food......................

Comments

lbs. gain

Desired weight range

Number of meals/snacks per day

loss over

RN

Form 8584

Page 9 / 06-2014

Individual

 

Date

 

 

 

Sleep Patterns

Average number of hours per night; difficulty falling asleep; number of times awake at night; number of naps during a day

Activity Level/Exercise

Substance Use/Abuse

Caffeine, tobacco, alcohol, recreational drugs, history of non-compliance with prescribed medications

Home Life

Satisfaction/Desires

Work/School/Day Activity

Satisfaction/Desires

Social Life

Satisfaction/Desires

Spiritual Life

Satisfaction/Desires

Coping Skills

RN

Form 8584

Page 10 / 06-2014

Individual

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mental Status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appearance

 

 

 

 

 

 

 

 

 

 

 

 

 

Posture:

Normal

Rigid

Slouched

Other:

 

 

 

 

 

 

Grooming and Dress:

Appropriate

Inappropriate

 

Disheveled

Neat

 

 

 

Facial Expression:

Calm

Alert

Stressed

Perplexed

Tense

Dazed

 

Other:

Eye contact:

 

Eyes not open

Good contact

 

Avoids contact

Stares

 

 

 

Speech Quality:

Clear

Slow

Slurred

 

Loud

Rapid

Incoherent

Mute

Mood

 

 

 

 

 

 

 

 

 

 

 

 

 

Cooperative

Excited

Irritable

Other/Describe

Uncooperative

Agitated

Scared

Depressed

Anxious

Hostile

Euphoric

Suspicious

Angry

Cognition

Y N

Cognitive impairment

Mild.....................................

Moderate ............................

Severe ................................

Profound.............................

Y N

Oriented

Person....................................

Place ......................................

Time .......................................

Y N

Attention span

Easily distracted ......................

Memory

Remote...............................

Recent ................................

Immediate recall .................

Emotions

Y N

Euphoric .............................

Happy .................................

Apathetic ............................

Sadness .............................

Y N

Depressed..............................

Anxious ..................................

Irritable ...................................

Y N

Hostile feelings .......................

Emotional lability ....................

Inappropriate affect.................

RN

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completing 8584 nursing step 1

Write the essential data in the Dentist, Optometrist, Natural, Supports Relationship, Telephone, No Client, Responsible, Adult, CR, A Guardian, Health, History Axis, I Axis, II and Axis, III part.

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In the part, identify the valuable particulars.

Finishing 8584 nursing part 3

You'll have to spell out the rights and obligations of both parties in paragraph Date, Review, of, Current, Medications Form, Page Include, OTC, s, vitamins, and, herbs Dose, Fr, eq Route, Purpose, Rationale Side, Effects, Labs Individual, Allergies, and Medication.

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