Navigating the intricacies of long-term care in Wisconsin mandates a thorough understanding of various forms and procedures, among which the Wisconsin F 00366 form is pivotal. This document, meticulously designed by the Department of Health Services' Division of Long Term Care, serves as a foundational touchstone for evaluating the needs of individuals seeking long-term care. The form embodies an array of sections starting from basic screen information, which captures details about the screener and the individual in need, including names, gender, social security number, contact information, and much more. Its design allows for the recording of crucial initial or rescreen information and encapsulates exhaustive details about the referral source, primary source for screen information, and a comprehensive analysis of the individual's condition relating to a specific target group which might include frail elders, those with physical or developmental disabilities, irreversible dementia, severe mental illness, or terminal conditions. Additionally, the form probes whether the condition is expected to persist beyond 12 months or if the individual is suffering from a terminal illness, alongside determining if a disability determination exists from authoritative bodies. This form not only guides the screening process but also ensures that individuals are aptly categorized for the most suitable care pathway, marking a critical step in the journey towards receiving tailored long-term care services.
| Question | Answer |
|---|---|
| Form Name | Wisconsin Form F 00366 |
| Form Length | 18 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 4 min 30 sec |
| Other names | ADLS, yyyy, CIP, assistive |
