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Commenting homepage for 701 Assessment Forms

The Department of Elder Affairs (DOEA) and aging network partners use a suite of screening and assessment forms to determine the needs of prospective and existing clients.

Various professional types use these forms to collect data for the purposes of:

  • Determining nursing home level of care;
  • Identifying the needs and resources of individuals seeking publicly-funded supports and services;
  • Reporting demographic information to federal partners; and
  • Reassessing clients to maintain their eligibility for services.


Beginning August 6, 2018, the Department is collecting feedback on proposed changes to the 701 suite of forms.

If you use these forms and would like to comment on proposed changes, find the form you use most in your current position from the list below, and click “Survey” to access the electronic survey:


701 B Comprehensive Assessment Form

This form is a comprehensive assessment to be administered face-to-face to identify resources and deficits in case-managed clients. Proposed additions are reflected in red.

701 A Condensed Assessment Form

This form is a shortened assessment instrument that is administered face-to-face for non-case managed clients in general revenue local services programs and federal OAA programs. Proposed additions are reflected in red.

701 S Screening Form

This form is administered over the telephone for the initial screening of applicants for long-term care programs. It is also used as an enrollment management tool to re-screen individuals on the assessed priority consumer list (APCL) and not active in any program. Proposed additions are reflected in red.

701C Congregate Meals Assessment

This form is used to assess individuals for congregate meals and nutrition counseling services in the OAA Title C1 program. This form is used off-line, and has been mailed to selected meal sites for staff input on the proposed additions reflected in red.

701 T CARES Non-Community Placement Form

This form is a shortened assessment instrument designed for use by CARES staff in determining level of care for individuals with no intent or capacity to remain in, or return to, the community. Proposed additions are reflected in red.

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