Web-based Level I Screen Examples
- Arizona: https://des.az.gov/search/node
- Oregon: http://oregonhelps.org/
- Virginia: http://www.virginianavigator.org/
Level II Assessment Examples
- Continuity Assessment Record and Evaluation (CARE) Tool – Admissions: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/CARE-Item-Set-and-B-CARE.html
- Colorado ULTC Initial Screening and Intake: http://www.nasuad.org/hcbs/article/colorado-screening-tool-ultc-1002
- interRAI – HC: http://www.interrai.org/
- Inventory for Client and Agency Planning (ICAP): http://icaptool.com/
- Kansas Uniform Assessment Instrument: https://www.kdads.ks.gov/docs/default-source/General-Provider-Pages/oaa-provider-documents/ss-005-uniform-assessment-instrument.pdf?sfvrsn=2
- Maine Medical Eligibility Determination (MED) Tool: http://www.maine.gov/dhhs/oads/provider/med.html
- Massachusetts Real Choice Functional Needs Assessment: http://www.nasuad.org/sites/nasuad/files/hcbs/files/68/3387/MA_Real_Choice_Functional_Assessment_Tool_-_FOR_REVIEW.pdf
- Minimum Data Set (MDS): https://www.cms.gov/NursingHomeQualityInits/30_NHQIMDS30TechnicalInformation.asp#TopOfPage
- Minnesota MN Choices: http://hcbsstrategies.com/clients_state.php?id=11
- New York COMPASS – Comprehensive Assessment for Aging Network Community-Based Long Term Care Services: hhttps://aging.ny.gov/ContractsandGrants/RFP/Attachments/COMPASS%20Form%202014.pdf
- Outcome and Assessment Information Set (OASIS): http://www.cms.gov/oasis/
- Supports Intensity Scale: http://aaidd.org/sis#.U-LN0PldWC5
- Virginia Uniform Assessment Instrument (UAI): http://vda.virginia.gov/pdfdocs/uai.pdf
- Washington Comprehensive Assessment Reporting Evaluation (CARE): http://www.nasuad.org/hcbs/article/comprehensive-assessment-reporting-evaluation-care-tool
- Wisconsin Long Term Care Functional Screen: http://www.dhs.wisconsin.gov/ltcare/FunctionalScreen/
- Wisconsin Functional Eligibility Screen for Children’s Long Term Support Programs: http://www.dhs.wisconsin.gov/ltcare/FunctionalScreen/
- Wisconsin Functional Eligibility Screen for Mental Health and AODA (Co-Occurring) Services: http://www.dhs.wisconsin.gov/ltcare/FunctionalScreen/
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