MED-PASS carries a variety of Assisted Living specific forms to cover all of your documentation needs.  Along with these, the majority of MED-PASS's Long Term Care Documents are useable in assisted and independent living settings.

AL2003 - Fall Risk Evaluation

Use this two-sided form to evaluate a resident's risk for falling when they move-in to your community or when there is a change in their condition.

The form includes narrative space for interventions and a documentation area for new and current residents.

AL2001 - Assisted Living Service Plan

This four-page, comprehensive, assisted living service plan can work in conjunction with AL Service/Functional Evaluation (AL2000). Once concerns or areas of support are identified on the AL2000, use this form to outline the delivery of care and/or services.


Form prompts for:

  • Function or Activity
  • Resident's Need Based on Current Evaluation
  • Services Provided
  • Schedule of Services
  • Person(s) Providing Service
  • Location of Services
  • Goals and Expected Outcomes

AL2021 - Resident Service Delivery Record

Document the delivery (or refusal of) care and services on the Resident Service Delivery Record. This form accommodates up to 31 days and multiple entries per day.

For a complete lisiting of all of our Assisted Living forms click here