Get Va Assisted Living Facility Disclosure Statement 2019-2026

Completing the VA Assisted Living Facility Disclosure Statement is essential for providing prospective residents with vital information about the facility. This guide offers a clear, step-by-step approach to assist users in filling out the disclosure statement accurately and professionally.

Follow the steps to complete the disclosure statement effectively.

1. Click ‘Get Form’ button to access the disclosure statement form and open it in an editable format.
2. Start with the general information about the facility. Fill in the name of the facility and the licensee, and specify the ownership structure such as individual, partnership, or corporation.
3. Proceed to the accommodations, services, and fees section. Clearly list all accommodations, services, and care included in the base fee, detailing any additional charges for services not included.
4. Document the admission, transfer, and discharge criteria. Clearly outline the criteria for admitting residents, transferring them within the facility, and discharging them.
5. Indicate the categories of activities provided for residents. State the frequency of activities and average types available each week, noting any participation limitations.
6. Provide information about staff including their number, types, and qualifications on each shift. Ensure that the data accurately reflects the staffing levels and qualifications.
7. Complete the liability insurance disclosure section, indicating whether the facility maintains the necessary insurance coverage.
8. Fill out the on-site emergency electrical power source disclosure, specifying whether the facility has such a source and the details of its operation and maintenance.
9. Review all entered information for accuracy and ensure that it is clearly disclosed in plain language.
10. Obtain initials from the prospective resident or their legal representative at the bottom of each page and at the bottom of Section VII regarding emergency power source.
11. Finally, save your changes, download, print, or share the completed form as necessary.

Begin completing your disclosure statement online today for a thorough and compliant representation of your facility.