The Arkansas Office of Long Term Care uses the DHS-703 to decide whether an applicant meets medical need criteria for nursing home care, ICF/ID placement, PACE, TEFRA or home and community waiver programs. A nurse records functional status, continence, medications, diagnoses and the expected duration of need. For new assessments and transfers, the examining physician or advanced practice nurse signs to certify the information.
A licensed DHS RN, or a nursing facility RN, LPN or counselor, completes Parts I to III and signs; the client or guardian signs the release in Part I. The examining physician or advanced practice nurse signs Part III, certifying they examined the patient within the past 30 days.
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Evaluation of Medical Need Criteria
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For new assessments and transfer applications, yes: the examining physician or advanced practice nurse must sign, certifying they examined the patient within the past 30 days and reviewed the form. For reassessments and change-of-condition applications, the administrator, examining physician or advanced practice nurse may sign.
The form is shared across programs: nursing homes, intermediate care facilities for individuals with intellectual disabilities, the Autism waiver, PACE, TEFRA, and Division of Aging and Adult Services waivers such as ARChoices and assisted living. The assessor marks the program at the top before completing the assessment.
The instructions say an RN or LPN completes and signs the assessment for all nursing facility admissions, including the brief medical history, prognosis and estimated duration of need. The examining physician or advanced practice nurse then reviews the form and signs to certify its accuracy after examining the patient within the past 30 days.