Assisted living forms can be downloaded and viewed with Adobe Acrobat®.

• Resident Specific Level of Care Waiver Application
• Licensure Standards Waiver Application
• Assisted Living Uniform Disclosure Statement Form
  (Adobe Acrobat Program required to save form after completion)
• Assisted Living Uniform Disclosure Statement Form (Print Only)
• Please Read:
  Memo - January 18, 2008 - Electronic Version of the Uniform Disclosure Statement

• Health Care Practitioner Physical Assessment
• Assisted Living Manager’s Assessment
• Assisted Living Level of Care Scoring Guide
• Understanding and Using the Assisted Living Assessment Tool and Level of Care Scoring Guide
• Assisted Living Cuing and Coaching Video Order Form
• Assisted Living Sample Resident Agreement Form
  

  Microsoft® Word can be used to view the sample resident agreement form. It was developed by the Department and meets all requirements of the new regulations. The Department is not requiring that all assisted living homes use this specific agreement. It is being provided to reduce implementation costs, if you choose to use it. Small homes in particular may want to use the sample instead of developing their own agreements.