The admission forms, in plain words: physician forms, the DOH-3122, and the PRI and SCREEN

Why there are forms at all

A community is licensed to care for people whose needs fit its license. The forms are how the state makes sure of that before someone moves in, and how the community writes the first care plan. None of them are filled out by the family. Your job is to get the person to the doctor and to know which form the community needs.

The physician's forms for assisted living

Assisted living residences in New York use a state form called the DOH-3122, the Assisted Living Residence Medical Evaluation. A physician, physician assistant, or nurse practitioner completes it after an exam. It covers vital signs, diagnoses, allergies, diet, flu and pneumonia vaccines, a tuberculosis screening done within the 30 days before admission, continence, how much help the person needs to walk, transfer, and eat, whether they can manage their own medicines, and whether there are signs of dementia or a mental health condition. The same form is used again at twelve months and after a big change in condition.

Communities also ask for a signed medication list and often their own standing orders. Ask the community how recent the exam must be; the answer varies, and a form that is too old has to be redone.

The PRI and SCREEN for nursing homes

A nursing home admission needs two state assessments. The Patient Review Instrument (PRI, form DOH-694) describes medical condition, daily needs, and behaviors, and it must be completed by a registered nurse who has finished the state's training for it. The SCREEN (DOH-695) is completed alongside it and checks whether a nursing home is the right level and whether a mental health or developmental disability evaluation is needed first. In a hospital, the discharge team arranges both. At home, a certified assessor comes to the house; the nursing home or a home care agency can tell you who does this locally.

The PRI has a shelf life; nursing homes will tell you when it needs to be redone. Assisted living usually does not need a PRI, because the physician's form does that job there.

What CarePair does and does not do

• We tell you which forms a community needs and put the request on your calendar.
• Physician forms and assessments pass from the clinician to the community you are applying to. CarePair does not store them and does not keep a copy.
• We never complete, edit, or score a PRI, a SCREEN, or a physician's form. No Cardinal staff member will ever ask you to fill in a medical form.
• Documents you own, like the health care proxy and insurance cards, live in your encrypted vault and go only to the communities you choose.

How to make it go faster

• Book the doctor visit as soon as you are seriously looking. Most delays in an admission are waiting on the exam.
• Ask the office to fax or upload the form straight to the community, and ask the community to confirm receipt.
• Bring the medication list and the community's own forms to the appointment so everything is signed in one visit.
• If the person is in the hospital, ask the discharge planner on day one whether a PRI and SCREEN are being done and by whom.
• Ask which vaccines the community requires and whether the tuberculosis screening can be done at the same visit.

What the forms are not

They are not a judgment of your person or of your caregiving. They are a snapshot for the people who will care for them next. If a form says needs are higher than you thought, that is worth a conversation with the doctor, not a reason to shop for a friendlier form.