Florida Department of Elder Affairs Forms

This Form is used for submitting referral requests to the Florida Agency for Health Care Administration (AHCA) Med-Serv 3008 program.

This form is used for claiming monthly reimbursements in the state of Florida. Submit your expenses and receive reimbursement.

This form is used for employees in Florida to acknowledge their understanding of privacy policies in the workplace. It ensures that employees are aware of the privacy protocols and regulations that apply to their work.

This Form is used for authorizing the use or disclosure of health information in the state of Florida.

This form is used for requesting restrictions on the use and disclosure of medical information and/or confidential communication in the state of Florida.

This Form is used for requesting access to medical records and protected health information (PHI) in the state of Florida.

This Form is used for requesting an amendment or correction to a health record in Florida.

This form is used for requesting an accounting of disclosures of protected health information in the state of Florida.

This Form is used for revoking authorization to release protected health information (PHI) in the state of Florida.

This document is a complaint form used in the state of Florida. It can be used to file a complaint with the Department of Economic Opportunity Appeals Section.

This form is used for logging client disclosures in the state of Florida.

This Form is used for transmitting protected health information (PHI) securely through fax in compliance with the Health Insurance Portability and Accountability Act (HIPAA) regulations.

This Form is used for a condensed assessment in the state of Florida. It helps provide a summarized evaluation of a particular subject or situation.

This type of document, Form 701C Congregate Meals Assessment, is used in Florida for assessing and monitoring congregate meals provided to individuals in a group setting.

This document is an enrollment roster for the Adult Care Food Program (ACFP) in Florida. It is used to keep track of and manage participants in the program.

This document is used for the monthly certification of eligibility for Title XIX proprietary adult day care centers participating in the Adult Care Food Program in Florida.

This Form is used for case investigations in Florida regarding confidential matters. LTCOP-001 is specifically designed for this purpose.

This form is used for applying to become an Impartial Decisionmaker in the state of Florida.

This document is used for registering as a professional guardian in the state of Florida.

This form is used for applying to become a registered core training provider for Assisted Living Facilities (ALFs) in Florida.

This form is used for Alzheimer's Disease and Related Disorders Training Three-Year Curriculum Certification in Florida.

This Form is used for applying for certification as an Adult Day Care Training Provider in Florida for Alzheimer's Disease or Related Disorders Training.

This form is used for Alzheimer's Disease and Related Disorders Training Provider Certification in Florida.

This form is used for applying for certification as a home health care training provider in Florida specifically for Alzheimer's Disease or Related Disorders training.

This form is used for applying for Hospice Training Provider Certification for Alzheimer's Disease or Related Disorders Training in Florida.

This Form is used for applying for hospice three-year curriculum certification specifically for Alzheimer's Disease and Related Disorders Training in the state of Florida.

This type of document is used for applying for certification as a nursing home training provider for Alzheimer's Disease or Related Disorders training in Florida.

This Form is used for employers in Florida to file an Affidavit of Compliance. It is a document that verifies the employer's compliance with certain employment laws and regulations.

This Form is used for employees in Florida to attest their compliance with certain requirements.

This document explains how your personal information is protected and used by healthcare providers in the state of Florida. It outlines your rights regarding privacy and provides details on how to file a complaint if your privacy has been violated.

This Form is used for conducting a comprehensive assessment in the state of Florida.

This form is used for determining financial eligibility and calculating co-payment for services provided by the Florida Department of Elder Affairs (DOEA). The form includes a financial worksheet and assessed co-payment information.

This form is used for applying to designate a home health agency as a teaching agency for home and community-based care in Florida.

This document is used for registering professional guardians who are employees in the state of Florida.

This form is used for registering as a professional guardian in the state of Florida.

This document is a monitoring tool used by the state of Florida to track and monitor training providers that offer Alf Core training.

This document is used for tracking and recording monthly expenditures for the Adult Care Food Program in Florida.