Senior Care Act (SCA) Forms

NOTICE REGARDING FORMS:

  1. All forms have been changed to reflect KDADS, however you may need to refresh your screen (F5 on the keyboard) to display these changes.
  2. The form number at the bottom of the pages will still reflect "KDOA-..." This is as intended by the agency.

Adobe Acrobat File Format - Adobe Logo
Microsoft Word File Format - Word Logo
Format Not Available at this time - NA

File Format Form Name
Acrobat Reader Document N/A Aging Taxonomy - Activity Definitions, Codes, Funding Sources and Unit Definitions
Acrobat Reader Document N/A Sliding Fee Scale - FY 2013
Acrobat Reader Document N/A Abbreviated Uniform Assessment Instrument
Acrobat Reader Format MS Word Format Corrective Action Plan - (SS-046)
Acrobat Reader Format MS Word Format Customer Choice - (SS-024)
Acrobat Reader Format MS Word Format Customer Code of Conduct - (SS-043)
Acrobat Reader Format MS Word Format Customer Fee Agreement - (SS-011)
Acrobat Reader Format N/A Customer Rights and Responsibilities - (SS-012) - NEW 01/11/2013
Acrobat Reader Format N/A Physician/RN Statement for Customer Directed Attendant Care - (SS-051)
Acrobat Reader Document N/A Plan of Care Only
Acrobat Reader Document N/A Standard Intake
Acrobat Reader Document N/A Uniform Assessment Instrument (complete form)
Acrobat Reader Document N/A Uniform Program Registration
N/A N/A Waiting List Notification of Customer Closure - (SS-019)

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Page Last Updated: January 12, 2013