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.

58A-1 : ADMINISTRATION OF FEDERAL AGING PROGRAMS – Florida Administrative Rules, Law, Code, Register – FAC, FAR, eRulemaking (flrules.org)

Adult Day Care, Florida Administrative Code Rule 58A-6

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, Florida Administrative Code Rule 58A-5.

Florida Administrative Code Rule 58A-5.0181, Admission Procedures, Appropriateness of Placement and Continued Residency Criteria.

• AHCA Form 1823, Resident Health Assessment for Assisted Living Facilities, March 2017

Florida Administrative Code Rule 58A-5.019, Staffing Standards

• AHCA Form 3180-1006, June 2016

Florida Administrative Code Rule 58A-5.0194, Alzheimer’s Disease or Related Disorders Training Provider and Curriculum Approval

• DOEA Form ALF/ADRD-001, Application for Alzheimer’s Disease and Related Disorders Training Provider Certification, November 2013
• DOEA Form ALF/ADRD-002, Application for Alzheimer’s Disease and Related Disorders Training Three-Year Curriculum Certification, November 2013

Community Care for the Elderly Program, Administration of, Florida Administrative Code Rule 58C-1.

Florida Administrative Code Rule 58C-1.0031, Lead Agency Dispute Resolution

• DOEA Form CCE-001, CCE Impartial Decision maker Application, May 2010

Federal Aging Programs, Administration of the, Florida Administrative Code Rule 58A-1.

Florida Administrative Code Rule 58A-1.010, Program Forms.

• 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: Florida Administrative Code Rule 58C-1, 58D-1, and 58H-1,

Guardianship, Florida Administrative Code Rule 58M-2.

Florida Administrative Code Rule 58M-2.001, Professional Guardian Registration.

• 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 Health Agency Alzheimer’s Disease and Related Disorders-Training Requirements, Florida Administrative Code Rule 58A-8.

Florida Administrative Code Rule 58A-8.002, ADRD Training Provider and Curriculum Approval.

• DOEA Form HH/ADRD-001, Application for Alzheimer’s Disease and Related Disorders Training Provider Certification, May 2005
• DOEA Form HH/ADRD-002, Application for Alzheimer’s Disease and Related Disorders Training Three-Year Curriculum Certification, May 2005

Hospice, Florida Administrative Code Rule 58A-2.

Florida Administrative Code Rule 58A-2.005, Administration of the Hospice, and Florida Administrative Code Rule 58A-2.012, Hospice Reporting Requirements.

• Department of Elder Affairs Hospice Demographic and Outcome Measures Report

Florida Administrative Code Rule 58A-2.0232, Advance Directives and Do Not Resuscitate Orders (DNRO).

• 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 the Florida Department of Health.

Florida Administrative Code Rule 58A-2.026, Comprehensive Emergency Management Plan.

• DOEA Form H-001, Comprehensive Emergency Management Plan (CEMP) Format for Hospices.

Florida Administrative Code Rule 58A-2.028, Hospice Training Provider and Curriculum Approval.

• DOEA Form Hospice/ADRD-001, Application for Alzheimer’s Disease or Related Disorders Training Provider Certification, September 2003
• DOEA Form Hospice/ADRD-002, Application for Alzheimer’s Disease or Related Disorders Training Three-Year Curriculum Certification, September 2003

Long-term Care Ombudsman, Florida Administrative Code Rule 58L-1

Florida Administrative Code Rule 58L-1.007, Complaint Investigations

• DOEA Form LTCOP-001, Case Investigation-CONFIDENTIAL, March 2010

Nursing Home Training, Florida Administrative Code Rule 58A-4, (Alzheimer’s Disease and Related Disorders)

Florida Administrative Code Rule 58A-4.002, Nursing Home Training Provider and Curriculum Approval.

• DOEA Form ADRD-001, Application for Alzheimer’s Disease or Related Disorders Training Provider Certification, November 2001
• DOEA Form ADRD-002, Application for Alzheimer’s Disease or Related Disorders Training Three-Year Curriculum Certification, November 2001

Training Requiring Provider and Curriculum Approvals, Florida Administrative Code Rule 58T-1.

Florida Administrative Code Rule 58T-1.205 and 58T-1.207.

• Assisted Living Facility Minimum Core Training Curriculum, June 2009
• Application for Assisted Living Facility (ALF) Core Training Provider Registration, June 2009