Forms

Click on the appropriate link to download the printable version of the blank paper form for the Adult Long Term Care, Children's Long Term Supports, or Mental Health / AODA  functional screen or Personal Care Screening Tool.

The paper forms are in Adobe PDF format and require Adobe Acrobat reader software. If you are unable to open the paper forms, click on the link below and follow the download instructions to install Acrobat Reader on your computer:

www.adobe.com/products/acrobat/readstep2.html.

For Children's forms, since ADL and IADL questions are age-specific, the Children's LTS Functional Screen Paper Form does not include all of the possible questions for the different age ranges. Click on the "Children's Long Term Supports Age-Specific ADL and IADL Questions" link and enter the child's birth date and screen begin date to pull up the age-specific ADL/IADL questions."