text size A  A  A 

Assessment Forms, Instructions, & Training

The Department of Elder Affairs uses a set of assessment forms, updated in 2013, to determine the needs of prospective and existing clients. Other agencies that are part of Florida’s aging network also use these forms to collect data for the purposes of:

  • determining nursing level of care,
  • identifying the needs and resources of individuals seeking publicly-funded supports and services,
  • reporting demographic and asset information to federal partners, and
  • reassessing clients to maintain their eligibility for services.


DOEA screening and assessment forms:

  • 701A Condensed Assessment
    Shortened assessment instrument based upon the 701B Comprehensive Assessment to be administered face-to-face for non-case managed clients in Local Services Program and OAA programs.

  • 701B Comprehensive Assessment (English; Spanish)
    Comprehensive assessment that is administered face-to-face to assess all case-managed clients regardless of the program in which they are enrolled.

  • 701C Congregate Meals Assessment; 701C Congregate Meals Assessment (Scorable Version)
    Shortened assessment instrument used to assess individuals for congregate meals and nutrition counseling services in the OAA Title C1 program.

  • 701S Screening Form (English; Spanish)
    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 who are on a waiting list and not active in any program.

  • 701T Non-Community Placement Assessment
    Shortened assessment instrument for use by CARES staff for individuals residing in a nursing facility with no intent to return to the community or for individuals residing in the community intending to enter the nursing facility.

DOEA assessment form instructional materials:

Return to Top