Within 30 days prior to admission, the facility shall collect, on a standardized form approved by the Mayor, the following information regarding each applicant:
(1) Level of functioning in activities of daily living including bathing, dressing, grooming, eating, toileting, and mobility;
(2) Level of support and intervention, including any special equipment and supplies, required to compensate for the individual’s deficits in activities of daily living;
(3) Current physical or psychological symptoms of the individual requiring monitoring, support, or other intervention by the ALR;
(4) Capacity of the individual for making personal and healthcare related decisions;
(5) Presence of disruptive behavior or behavior which presents a risk to the physical or emotional health and safety of self or others;
(6) Social factors, including:
(A) Significant problems with family circumstances and personal relationships;
(B) Spiritual status and needs; and
(C) Ability to participate in structured and group activities and the resident’s current involvement in such activities.
(June 24, 2000, D.C. Law 13-127, § 803, 47 DCR 2647.)