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Nursing Facility Long Term Care Services and Supports (LESS)INTERIM DOCUMENTATION OF SUNSCREENING DETERMINATION INSTRUCTIONS: This form serves as documentation by the nursing facility staff of the
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01
Obtain the LTSS screening form from the appropriate department.
02
Fill out the personal information section, including name, date of birth, and contact information.
03
Answer the screening questions honestly and to the best of your ability.
04
Submit the completed form to the department for review and processing.

Who needs ltss screening - department?

01
Individuals who require long-term services and supports (LTSS) may need to undergo screening by the department to determine eligibility for these services.
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The LTSS screening department is responsible for determining the eligibility of individuals for Long-Term Services and Supports.
Individuals who are in need of Long-Term Services and Supports are required to file with the LTSS screening department.
To fill out the LTSS screening form, individuals must provide information about their medical history, current health status, and any support services they may require.
The purpose of the LTSS screening department is to assess the needs of individuals and determine if they qualify for Long-Term Services and Supports.
Information such as medical history, current health status, and support services needed must be reported on the LTSS screening form.
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