NL Long Term Care Adult Needs Assessment Form

Newfoundland and Labrador's regional health authorities use this 28-page tool to assess an adult's needs under the Long Term Care and Community Support Program, from home support and respite to personal care and long-term care homes. An assessor documents health, cognition, daily living, behaviour and environment, then records the level of care required. The client's primary physician is consulted for diagnoses and screening referrals.

Who completes it

A regional health authority assessor completes and signs it, recording their name and profession, with the client and family taking part. The client's primary physician may be asked to confirm diagnoses and receives referrals when a chest x-ray is needed or tuberculosis is suspected.

Submitting and payment

How to submit it
The assessment is completed and kept within the regional health authority's Long Term Care and Community Support process rather than submitted by a clinician. The assessor obtains the client's written consent for release of information under regional health authority policy.

Good to know

  • For respite, personal care home or long-term care home placement, the client's last chest x-ray must be within the past year; if one is needed, the assessor refers to the primary physician.
  • A cough over 4 weeks, fever over a week, weight loss, night sweats or bloody sputum flag possible active tuberculosis and require immediate referral to the primary physician.
  • The full assessment is used at entry and after a significant change in condition; the shorter Adult Needs Reassessment is done yearly when there is minimal or no change.
  • The assessor records the level of care required, from L1 to L4, for facility respite or long-term placement, and whether a physician has requested any needed medication special authorization.

Get the official form

Download the current version from the source each time; forms change without notice.

Long Term Care and Community Support Program Adult Needs Assessment

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Who fills out the NL Long Term Care and Community Support Adult Needs Assessment?

The regional health authority's assessor, who records their name and profession and works through it with the client and family. The program's reference manual tells assessors to consult the client's primary physician when diagnoses are unknown, and to refer to the physician when a chest x-ray is needed or tuberculosis symptoms are present.

When is the Adult Needs Reassessment used instead?

According to the reference manual, the full Adult Needs Assessment is completed at the initial assessment and whenever there is a significant change in the client's condition while services are still needed. The shorter Adult Needs Reassessment is completed annually, and only when there is minimal or no change and services are still required.

Which services does the Adult Needs Assessment lead to?

It is the single-entry assessment for home support services, respite care, personal care homes, long-term care homes, alternate family care, board and lodging, independent living arrangements and other residential options. The assessor matches documented needs to available services and records recommended home support hours, respite and placement preferences.