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DHS 1147 Level of Care and at Risk Evaluation Form

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What is the DHS 1147 Level of Care and At Risk Evaluation Form

The DHS 1147 Level of Care and At Risk Evaluation Form is a critical document used to assess the needs of individuals requiring care and support services. This form evaluates the level of care necessary for individuals who may be at risk due to various factors, including health conditions, disabilities, or other social determinants. It is designed to help agencies determine eligibility for services and support based on the specific needs of the individual.

How to Use the DHS 1147 Level of Care and At Risk Evaluation Form

Using the DHS 1147 form involves several steps to ensure accurate assessment and eligibility determination. First, gather all necessary personal information, including medical history and current health status. Next, complete each section of the form carefully, providing detailed information about the individual's needs. It is essential to be thorough and precise, as this information will guide decisions regarding care and services. Once completed, submit the form to the appropriate agency for review.

Steps to Complete the DHS 1147 Level of Care and At Risk Evaluation Form

Completing the DHS 1147 form requires attention to detail. Follow these steps:

  • Begin by entering personal information, such as name, address, and contact details.
  • Provide a comprehensive medical history, including any diagnoses, treatments, and medications.
  • Detail the individual's daily living activities and any assistance required.
  • Include information about support systems, such as family or community resources.
  • Review the completed form for accuracy before submission.

Legal Use of the DHS 1147 Level of Care and At Risk Evaluation Form

The DHS 1147 form is legally recognized for evaluating eligibility for care services. It complies with state and federal regulations, ensuring that the information collected is used appropriately in determining the level of care needed. Proper use of this form is crucial for protecting the rights of individuals and ensuring they receive the necessary support and resources.

Key Elements of the DHS 1147 Level of Care and At Risk Evaluation Form

Several key elements are essential when completing the DHS 1147 form:

  • Personal Information: Accurate details about the individual being evaluated.
  • Medical History: Comprehensive information regarding past and current health issues.
  • Functional Assessment: Evaluation of daily living activities and support needs.
  • Support Systems: Information about family, friends, or community resources available to the individual.

How to Obtain the DHS 1147 Level of Care and At Risk Evaluation Form

The DHS 1147 form can be obtained through various channels. Individuals can request the form from local health departments, social service agencies, or online from official state websites. It is important to ensure that the most current version of the form is used to avoid any issues during the evaluation process.

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Related links to DHS 1147 Level Of Care And At Risk Evaluation Form
STATE OF HAWAII Level of Care (LOC) and At Risk ...

DHS 1147 (Rev. 0. ) DO NOT MODIFY FORM. Page 1 of 3. Legible photocopies and facsimiles will be acknowledged as original. 1. PLEASE PRINT OR TYPE. Initial ...Read more

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DHS FORM 1147. Rev. 01/09. LEVEL OF CARE (LOC) EVALUATION. Check the appropriate box for the evaluation: Check type of request - initial, annual or other ...Read more

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