DAL 14-10: Revised ALP Medical Evaluation

April 21, 2014

DAL: DAL 14-10

Dear Administrator:

The purpose of this letter is to inform you that the Assisted Living Program (ALP) Medical Evaluation – Interim DSS- 4568 (Rev. 04/16) was revised to eliminate content that is no longer required, to include information relevant to the Uniform Assessment System for New York (UAS-NY) and to standardize the appearance of the form to be consistent with other Department forms. The following revisions were made to the form:

  • Elimination of any reference to a 45 day reassessment
  • Inclusion of the UAS-NY Community Assessment

The ALP Medical Evaluation – Interim was approved as an alternate to the more in depth ALP Medical Evaluation (DSS 4449C) for the six month reassessment. During the six month ALP reassessment, the UAS-NY will be updated by the assessor and sent to the resident's physician who will complete the Medical Evaluation form and sign the physician certification.

The Division of ACF/Assisted Living Surveillance will continue to review and update existing forms and notify you of changes. If you have questions regarding the revised forms, please contact the Division of ACF/Assisted Living Surveillance at (518) 408-1133 for further clarification.

Sincerely,

Valerie A. Deetz, Director
Division of ACF and Assisted Living Surveillance

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