Medical History/Physical/Functional Assessment
Updated September 2023
Use Briggs Medical History/Physical/Functional Assessment to document a tenant's/resident's medical history as well as physical and functional status prior to moving into the AL/residential community. This form can also be used for annual assessment/reassessment.
Section 1 is designed to be completed by the individual; Section 2 is completed by a healthcare professional. Includes a summary of conditions and the individual's functional status with determination of appropriateness for this level of care.
Size: 11" x 17" - folded to finished size of 8 1/2" x 11
Ink: Black - prints 2-sides
Punching: 5-holes top and side
Paper: White 20# bond
Packaging: 100 per pack
Ink: Black - prints 2-sides
Punching: 5-holes top and side
Paper: White 20# bond
Packaging: 100 per pack