Assessment Forms, Instructions, & Training

Isometric Flat Vector Concept Of Online Exam, Questionnaire Form, Online Education, Survey, Internet Quiz.

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: