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ASSISTED LIVING RESIDENCE MEDICAL Evaluation York State Department of Health Division of Assisted Living ALL SPACES MUST BE FILLED OUT Residents Name: Date of Exam: Facility Name: Date of Birth: Sex:
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Gather all necessary documents such as identification, medical records, and financial information.
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An assisted living residence is a type of housing designed for seniors or individuals who need assistance with daily activities, such as bathing, dressing, medication management, and meal preparation, while still maintaining a level of independence.
Assisted living residences must file documents or applications as required by state or local regulations, which typically involves owners or operators of the facility.
To fill out the application for assisted living residence, applicants must provide accurate personal information, financial details, a description of services offered, staffing levels, and compliance with health and safety regulations as per local guidelines.
The purpose of assisted living residences is to provide supportive services to seniors and individuals who require assistance, ensuring they have access to care while promoting their independence and quality of life.
Information that must be reported includes the facility's licensing details, resident population statistics, staffing levels, safety protocols, and compliance with health regulations.
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