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DOEA Forms by Rule Chapter

Select a rule chapter from the list below to view available DOEA forms incorporated by reference in the selected rule. Click on the section title in the table below for details of the selected rule chapter.
Adult Day Care, 58A-6, F.A.C.
Rule 58A-6.016, Adult Day Care Center Training Provider and Curriculum Approval, F.A.C.
  • DOEA Form ADC/ADRD-001, Application for Alzheimer’s Disease or Related Disorders Training Provider Certification
  • DOEA Form ADC/ADRD-002, Application for Alzheimer’s Disease or Related Disorders Training Three-Year Curriculum Certification

Assisted Living Facilities, 58A-5, F.A.C.
Rule 58A-5.0181, F.A.C., Admission Procedures, Appropriateness of Placement and Continued Residency Criteria.
  • AHCA Form 1823, Resident Health Assessment for Assisted Living Facilities.

Rule 58A-5.0191(10), Staff Training Requirements and Competency Test, F.A.C.
  • DOEA Form ALF/ADRD-001, Application for Alzheimer’s Disease and Related Disorders Training Provider Certification
  • DOEA Form ALF/ADRD-002, Application for Alzheimer’s Disease and Related Disorders Training Three-Year Curriculum Certification
Community Care for the Elderly Program, Administration of, 58C-1, F.A.C.
Rule 58C-1.0031, F.A.C., Lead Agency Dispute Resolution

Federal Aging Programs, Administration of the, 58A-1, F.A.C.
Rule 58A-1.010, Program Forms, F.A.C.
  • DOEA Form 701A, Department of Elder Affairs Prioritization Assessment Form
  • DOEA Form 701B, Department of Elder Affairs Assessment Instrument
  • DOEA Form 701C, Department of Elder Affairs Congregate Meals Assessment
  • DOEA Form 701D, Department of Elder Affairs Assessment Instructions (701A, 701B, 701C)

These forms are also referenced in the following rule chapters: 58C-1, 58D-1, and 58H-1, F.A.C.

Guardianship, 58M-2, F.A.C.
Rule 58M-2.001, Professional Guardian Registration, F.A.C.
  • DOEA/SPGO Form 001, Statewide Public Guardianship Office Professional Guardian Registration Form
  • DOEA/SPGO Form 002, Statewide Public Guardianship Office Professional Guardian Employee Registration Form

Home Care for the Elderly Program, Administration of, 58H-1, F.A.C.
Rule 58H-1.003, Program Administration, F.A.C.

Home Health Agency Alzheimer’s Disease and Related Disorders-Training Requirements, 58A-8, F.A.C.
Rule 58A-8.002, ADRD Training Provider and Curriculum Approval, F.A.C.
  • DOEA Form HH/ADRD-001, Application for Alzheimer’s Disease and Related Disorders Training Provider Certification
  • DOEA Form HH/ADRD-002, Application for Alzheimer’s Disease and Related Disorders Training Three-Year Curriculum Certification
Hospice, 58A-2, F.A.C.
Rule 58A-2.005, Administration of the Hospice, and 58A-2.012, Hospice Reporting Requirements, F.A.C.
  • DOEA FORM H-002, Department of Elder Affairs Hospice Demographic and Outcome Measures Report

Rule 58A-2.0232, Advance Directives and Do Not Resuscitate Orders (DNRO), F.A.C.
  • Form SCHS-4-2006, Health Care Advance Directives—The Patient’s Right to Decide.
  • DH Form 1896, Florida Do Not Resuscitate Order Form. Available from Rule 64E-2.031, F.A.C.

Rule 58A-2.026, Comprehensive Emergency Management Plan, F.A.C.
  • DOEA Form H-001, Comprehensive Emergency Management Plan (CEMP) Format for Hospices.

Rule 58A-2.028, Hospice Training Provider and Curriculum Approval, F.A.C.

Long-term Care Ombudsman, 58L-1, F.A.C.
Rule 58L-1.007, F.A.C., Complaint Investigations

Nursing Home Training, 58A-4, F.A.C. (Alzheimer’s Disease and Related Disorders)
Rule 58A-4.002, Nursing Home Training Provider and Curriculum Approval, F.A.C.
  • DOEA Form ADRD-001, Application for Alzheimer’s Disease or Related Disorders Training Provider Certification
  • DOEA Form ADRD-002, Application for Alzheimer’s Disease or Related Disorders Training Three-Year Curriculum Certification

Training Requiring Provider and Curriculum Approvals, 58T-1, F.A.C.
Rules 58T-1.205 and 58T-1.207, F.A.C.
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