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Assessment Forms, Instructions, & Training

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:


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