CAPDA Screening Tool free printable template
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Date CAP/DA SCREENING TOOL / / THE SERVICE AND SERVICE OUTCOME SCREEN (Duke Long Term Care Resources Program) (Form 2) Fax Referrals: 704-331-0859 Mail Referrals: Attn: Intake Dept.-249 Willingly
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How to fill out CAPDA Screening Tool
How to fill out CAP/DA Screening Tool
01
Begin by gathering all relevant personal information of the individual being screened.
02
Review the sections of the CAP/DA Screening Tool, familiarizing yourself with the required information.
03
Fill out the demographic information section accurately, including name, date of birth, and contact details.
04
Assess the individual's functional abilities by completing the sections that pertain to daily living activities.
05
Evaluate medical history and current health conditions to provide a comprehensive overview.
06
Include any necessary supporting documentation or additional notes as needed.
07
Review the completed tool for accuracy and completeness before submission.
Who needs CAP/DA Screening Tool?
01
The CAP/DA Screening Tool is needed by individuals seeking long-term care services.
02
Care coordinators and case managers who assess eligibility for the CAP/DA program.
03
Healthcare providers who are referring patients for potential inclusion in the CAP/DA program.
04
Family members or guardians of individuals who may qualify for assistance through the CAP/DA program.
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People Also Ask about
Who is eligible for cap C in NC?
CAP/C is available to any child from birth through 20 years of age who meets both the NC Medicaid and CAP/C eligibility criteria which includes: Lives in a private residence. Is able to be cared for safely at home. Requires the same level of care as a child in a nursing home or hospital.
Who qualifies for cap c in nc?
CAP/C is available to any child from birth through 20 years of age who meets both the NC Medicaid and CAP/C eligibility criteria which includes: Lives in a private residence. Is able to be cared for safely at home. Requires the same level of care as a child in a nursing home or hospital.
What is the income limit for the cap program in NC?
NC considers both the applicant's income and assets. Individual applicants will qualify automatically if their monthly income is no greater than $1,133 (effective April 2022 – March 2023). For married applicants with both spouses applying, that limit is $1,526 per month (effective April 2022 – March 2023).
How to apply for CAP program in NC?
Application Process Applicants must be eligible for NC Medicaid, and if not currently enrolled in Medicaid, must apply. Persons can apply via North Carolina's Department of Health and Human Services' Division of Social Services. Contact information can be found here.
What is cap benefits in NC?
The Community Alternatives Programs (CAP) allow North Carolina to use Medicaid funds to provide home-and community-based services to Medicaid beneficiaries who require placement in a nursing facility, but for whom care can be provided cost-effectively and safely in the community with CAP services.
What are cap services in NC?
The Community Alternatives Program for Disabled Adults (CAP/DA) is for adults with disabilities who prefer to remain in their primary private residences rather than nursing home placement.
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What is CAP/DA Screening Tool?
The CAP/DA Screening Tool is an assessment instrument used to determine eligibility for the Community Alternative Program (CAP) for Disabled Adults (DA) in North Carolina.
Who is required to file CAP/DA Screening Tool?
Individuals seeking services under the CAP/DA program or their representatives are required to file the CAP/DA Screening Tool.
How to fill out CAP/DA Screening Tool?
The CAP/DA Screening Tool is to be filled out by gathering personal and medical information about the individual, answering specific questions regarding their needs, and submitting the completed form to the appropriate authorities.
What is the purpose of CAP/DA Screening Tool?
The purpose of the CAP/DA Screening Tool is to evaluate individuals' needs and to determine their eligibility for receiving assistance under the Community Alternative Program for Disabled Adults.
What information must be reported on CAP/DA Screening Tool?
Information reported on the CAP/DA Screening Tool includes personal identification details, health and functional status, support needs, and any other relevant information for assessment.
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