ASSISTED LIVING RESIDENCE MEDICAL EVALUATION Persons who, by reason of age and or physical and or mental limitations who are in need of assistance with activities of daily living, can be cared for in adult residential care settings listed above, or if applicable, an EALR or SNALR
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NY DOH-3122 2012-2026 - Fill and Sign Printable Template Online Filling out the NY DOH-3122, the Assisted Living Residence Medical Evaluation form, is a crucial step in ensuring proper care for individuals in assisted living facilities This guide provides clear, step-by-step instructions to help you navigate the online completion of this important document
3122 form: Fill out sign online | DocHub The document is a medical evaluation form for residents of assisted living facilities in New York State, detailing the resident's personal information, medical history, vital signs, diagnoses, medication needs, and assessments of daily living activities
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Adult Care Facilities Forms Assisted Living Residence Medical Evaluation (DOH-3122, Rev 5 12) (PDF) Assisted Living Residence Resident Evaluation Form (DOH-4397 Part B) (PDF **ALR Resident Personal Data and ALR Resident Evaluation Instructions (Rev 09 12) (PDF) Assisted Living Residence Resident Personal Data Form (DOH-4397 Part A) (PDF)