DOEA screening and assessment forms:
- 701A Condensed Assessment (English; Spanish)
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)
A 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 (English; Spanish; 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:
- 701B Comprehensive Assessment Form Online Training
Before administering the new assessment and screening forms, except the 701C, assessors and case managers must complete this online training and retain a certificate to demonstrate that they successfully passed the final examination. For helpful tips on how to avoid common mistakes when completing the 701B assessment, please see the presentation video at the following link: 701B Training Video
- 701C Congregate Meals Assessment Training
Training information for the 701C Congregate Meals Assessment.
- 701D Assessment Instructions
- DOEA Priority Score Calculation
- Guidance for completion of the Department of Elder Affairs 701B Comprehensive Assessment.