Fill Out Form AHCA 1823 in 2026

AHCA Form 1823 is Florida’s official Resident Health Assessment for Assisted Living Facilities. You may also see it called the AHCA Florida 1823 Form. It records a resident’s physical and mental health, functional limits, need for help or supervision, and required nursing or therapy services.

Each assisted living resident must receive a face-to-face medical exam within 60 days before admission or 30 days after admission. A licensed physician, physician assistant, or advanced practice registered nurse performs the exam and completes the assessment. The information helps the facility decide if it can meet the resident’s care needs. It also supports safe placement and proper care planning.

Form AHCA 1823 is used during the assisted living admission process to decide if a person is eligible for assisted living services. A health care provider records exam findings, including medical history, mental or behavioral status, physical limits, and nursing or treatment needs.

The findings also help identify conditions that may prevent admission, such as a communicable disease, pressure sores, aggressive behavior, or a need for 24-hour nursing or psychiatric care. The assisted living facility uses this information to plan the resident’s care and meet Florida requirements under Chapter 429 and Rule 58A-5.

You can get a blank Form AHCA 1823 directly through PDFLeader. The form is issued by the Florida Agency for Health Care Administration, and a blank copy is preloaded in our browser-based editor. You do not need to find or download a template from another source.

PDFLeader lets you fill out the blank form and download it for future use. PDFLeader does not file or submit Form AHCA 1823 to the agency or any other institution.

The completed Form AHCA 1823 is not filed with AHCA or another state agency. The licensed health care provider who completes the health assessment sections returns it directly to the resident’s assisted living facility at the address supplied by that facility.

The provider and facility arrange the delivery method. The form may be hand-delivered, mailed, faxed, or sent through an electronic method provided by the facility. It is not sent through a state portal or mailed to a government office. The facility keeps the completed original in the resident’s file.

For the AHCA Florida 1823 Form, a licensed physician, licensed physician assistant, or licensed advanced practice registered nurse completes Section 1 after a face-to-face exam. The assisted living facility completes Section 2 to document the services it offers or arranges.

Facility administrators and staff then use the completed form to check admission eligibility and plan care based on the resident’s needs. Staff may cross-reference its information with the medication observation record and use it to help identify a resident in distress. The facility must keep the form in the resident’s record on the premises so state surveyors can review it for compliance.

Before you sign Form AHCA 1823, check the latest updates from Florida AHCA and ask the facility if it requires an electronic or wet-ink signature. You can sign the form electronically on PDFLeader with a simple electronic signature, not a digital signature. Then download the completed form and submit it outside PDFLeader using the method the facility requests.

Have the Resident Name, DOB, Authorized Representative, and facility details ready, including Facility Name, Telephone Number, Street Address, Fax Number, City, County, ZIP, and Contact Person. The provider will also need current health records showing Known Allergies, Height, Weight, Medical History and Diagnoses, Physical or Sensory Limitations, Cognitive or Behavioral Status, and Nursing/Treatment/Therapy Services. Enter “NONE” if there are no known allergies.

The AHCA Form 1823 instructions also require an assessment of activities of daily living, Special Diet Instructions, and explanations for listed conditions or requirements. The provider must assess self-care tasks and general oversight, then add comments for responses that show supervision, assistance, total care, or other needs. Have records that support these findings available for reference. The form does not name a separate supporting document that must be attached.

Form AHCA 1823 has no single fixed due date. The face-to-face medical exam must take place within 60 days before admission to an assisted living facility or within 30 days after admission. If a state- or DCF-contracted agency completes the assessment, the exam must occur within 30 days before placement.

Any missing items must be added within 30 days after admission. After the initial assessment, the resident must receive another face-to-face medical exam at least every three years or after a significant change, whichever comes first.

You do not need Form AHCA 1823 if an equivalent hospital or nursing home discharge summary documents every required examination item. Another medical examination record accepted by AHCA may also meet this requirement.

A new form is not required when a resident transfers from another facility with a current Form AHCA 1823, completed within the past three years, and has had no significant health change. A hospice patient may also be exempt under separate hospice rules. Check Florida Rules 59A-36.006 and 58A-5.0181 for the conditions that apply.