WebDSHS 10-362 (10/2004) BOARDING HOME RESIDENT CHARACTERISTIC ROSTER ATTACHMENT D TOTAL CENSUS: BOARDING HOME NAME: LICENSE NUMBER: INSPECTION DATE: LICENSOR NAME: Inspection Type: Initial Full Follow up Monitoring Complaint: # s Resident Room h Admit Date s e is Name s) ion in s ing The ue V d n-n s … WebDSHS 10-363 (REV. 07/2015) • Costs. Are residents here informedby the facility about which items and services are paid by Medicare or Medicaid? Are you aware of any …
Fillable Online dshs wa Assisted Living Facility Resident ...
WebDSHS, Aging and Long-Term Support Administration Residential Care Services, Region 2 Unit D 20425 72nd Avenue S, Suite 400 Kent, WA 98032 ... Review of the facility's 'Resident Characteristics Roster", dated 05/09/2024 showed the fac¼i admitted Resident 4 in 2024, With multiple diagnoses which included ... Webthe past. Review of the residents' Characteristic Roster, last updated 01/07/20, did not identify the resident as having an open wound or weight loss issue. Review of the resident's assessment and negotiated service plan, dated 1 1/11/19, noted the resident was independent with ambulation with use of a walker and received some care and creative depot blog
Resident Characteristic Roster and Sample Selection
WebDSHS, Aging and Long-Term Support Administration Residential Care Services, Region 2, Unit D 20425 72nd Avenue S, Suite 400 ... Review of the facility's "Resident Characteristics Roster" dated 04/15/19, showed the facility . Statement of Deficiencies Plan of Correction Page 3 of 4 admitted Resident #4 in and Licensee: WebRESIDENT ROOM ADMIT DATE DSHS 10362 (REV. 07/2015) RESIDENT ID NUMBER RESIDENT NAME Other Home Health / Hospice / Private Caregiver Oxygen / Respiratory Therapy Recent Hospitalization Pay Status:. ... Completing Assisted Living Facility Resident Characteristic Roster And Sample Selection - Attachment D - Dshs does not … WebDSHS 10-363 (REV. 07/2015) Attachment E . Assisted Living Facility Resident Group Meeting . ASSISTED LIVING FACILITY NAME . LICENSE NUMBER . INSPECTION DATE . LICENSOR NAME CONDUCTING MEETING . ... Refer to resident characteristic roster / sample selection form as needed to identify residents. creative depot stempel weihnachten