Sources
Sources behind this course
Each lesson lists the sources it uses. Open the original for the exact rule, form or instruction that applies to your work. The source library describes each one in more detail.
DHCS 0062, Assisted Living Waiver Freedom of Choice Form (Revised 12/2019)
The person's written choice to accept or decline ALW services as an alternative to nursing facility care, the right to choose a waiver provider, and when an authorized representative signs.
Where to look: Page 1 (the letter and the two numbered statements) and page 2 (the Accept and Decline sections).
Open the DHCS 0062 Freedom of Choice form (PDF)DHCS 1322, Assisted Living Waiver Patient's Rights (Revised 2/2024)
What the person confirms with the care coordinator: free choice of services, providers and where they live, the setting options discussed, contact details, and where rights concerns go.
Where to look: Page 1 (the checklist and contact lines), page 2 (signatures) and page 3 (the Ombudsman and CRISISline notice).
Open the DHCS 1322 Patient's Rights form (PDF)ALW Care Coordination Agencies (DHCS dataset, data as of 1/1/2026)
The DHCS list of Care Coordination Agencies by county, and the DHCS description of what a CCA does: assess eligibility, evaluate referrals, perform assessments and submit enrollment packages.
Where to look: The dataset description and its fields (county, names, address, phone, fax, contact, website).
Open the DHCS list of ALW Care Coordination AgenciesALW Assisted Living Facilities (DHCS dataset, data as of 1/1/2026)
The DHCS list of homes enrolled in the ALW, and the DHCS statement of who is eligible (Medi-Cal, nursing facility level of care, no share of cost). It is not a list of openings.
Where to look: The dataset description and its fields (provider names, enrolled capacity, location, counties, phone).
Open the DHCS list of ALW enrolled homes42 CFR 441.302, state assurances for home and community-based services waivers
The assurance that a person likely to need institutional care is told of the feasible alternatives under the waiver and given the choice.
Where to look: Paragraph (d), Alternatives.
Open section 441.302 on eCFR42 CFR 441.301, contents of request for a waiver
The person-centered planning process, the setting chosen by the person, and setting options that include non-disability settings and a private unit.
Where to look: Paragraphs (c)(1), (c)(2)(i) and (c)(4)(ii).
Open section 441.301 on eCFR42 CFR 431.51, free choice of providers
A Medicaid member may get services from any qualified provider willing to serve them.
Where to look: Paragraph (b)(1).
Open section 431.51 on eCFR45 CFR 164.501, HIPAA Privacy Rule definitions
The definition of treatment, which includes the referral of a patient from one health care provider to another.
Where to look: The definition of "Treatment".
Open section 164.501 on eCFR45 CFR 164.502, uses and disclosures of protected health information: general rules
The minimum-necessary standard and the disclosures it does not apply to, including disclosures to a health care provider for treatment.
Where to look: Paragraph (b)(1) and (b)(2).
Open section 164.502 on eCFR45 CFR 164.506, uses and disclosures for treatment, payment and health care operations
A covered organization may disclose health information for the treatment activities of a health care provider.
Where to look: Paragraph (c)(2), and (b) on consent.
Open section 164.506 on eCFR45 CFR 164.510, uses and disclosures requiring an opportunity to agree or object
Sharing with family and friends involved in the person's care, with the person present or absent.
Where to look: Paragraph (b)(1) to (b)(3).
Open section 164.510 on eCFR45 CFR 164.514, other requirements for uses and disclosures of protected health information
How the minimum-necessary standard is carried out: relying on another covered organization's request, and the bar on sending an entire record unless justified.
Where to look: Paragraph (d)(3)(iii) and (d)(5).
Open section 164.514 on eCFR22 CCR 87456, evaluation of suitability for admission (RCFE)
The four steps an RCFE completes before accepting a resident.
Where to look: Subdivision (a)(1) to (4).
Open section 87456 on Cornell LIITitle 22, section 87457: Pre-admission appraisal
The interview before admission, admission only with consent, and use of a needs assessment already completed by a placement agency or consultant.
Where to look: Subdivisions (a), (b) and (c)(4).
Open section 87457 on Cornell LIITitle 22, section 87458: Medical assessment
The medical assessment a home obtains before accepting a resident: who signs it, the one-year window, and what it includes (TB, medications, mobility, cognition).
Where to look: Subdivisions (a), (b) and (c)(1) to (8).
Open section 87458 on Cornell LIICommunity Care Licensing forms
The CDSS forms list, including LIC 602A (4/26), Medical Assessment for Residential Care Facilities for the Elderly, and LIC 605A (7/22), Release of Client/Resident Medical Information.
Where to look: The I to L list: LIC 602A and LIC 605A and their revision dates; the LIC 605A expiration line and notes 1 and 2.
Open the CDSS forms libraryLIC 602A, Medical Assessment for Residential Care Facilities for the Elderly (4/26)
The state's medical assessment form for RCFEs: diagnoses, self-management, physical and mental health, medication management, ambulatory status and hospice care.
Where to look: The note to the medical professional (page 1), the diagnosis blocks (pages 2 and 3), medication management and ambulatory status (page 8), and hospice care (page 9).
Open LIC 602A (PDF)TeamSTEPPS Tool: Check-Back (or Repeat-Back)
The check-back as closed-loop communication, and the risk that email and text messages are not read promptly.
Where to look: The tool description and its examples.
Open the AHRQ check-back toolTeamSTEPPS Tool: Handoff
Transfer of responsibility in a handoff, clarity about who is responsible, and acknowledgment by the receiver.
Where to look: "How To Use a Handoff Effectively".
Open the AHRQ handoff tool