Long Term Care Forms - Oklahoma State Department of Health

Long Term Care Forms

Assisted Living Resident Assessment Form

An IIDR can be requested for deficiencies with a Scope and Severity of G or greater
CMS may collect imposed Civil Monetary Penalties (CMPs) and place them in an escrow account
You must request the IIDR within 10 calendar days of CMS Initial Imposition Notice

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	email \| print Long Term Care Forms Assisted Living Resident Assessment Form IDR Request ODH Form 833 IIDR Request Form 833A An IIDR can be requested for deficiencies with a Scope and Severity of G or greater CMS may collect imposed Civil Monetary Penalties (CMPs) and place them in an escrow account You must request the IIDR within 10 calendar days of CMS Initial Imposition Notice LTC Facility Complaint Poster LTC Incident Reporting ODH Form 283 Notification of Nurse Aide, Abuse, Neglect, Mistreatment or Misappropriation of Property ODH Form 718 Instructions for ODH Form 718 Tuberculosis (TB) Risk Assessment Worksheet Evaluation of TB Risk

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