How to Complete AHCA Form 1823: Timing, Signers, and Admission Blocks

AHCA Form 1823 is the Resident Health Assessment that Florida requires before someone moves into an assisted living facility. A licensed physician (MD or DO), physician assistant, or advanced practice registered nurse fills it out after a face-to-face exam, and the facility administrator uses it to decide whether the facility’s license lets them safely care for the resident.¹ The current version, dated April 2021, runs three pages and is split into a health assessment and a medication and self-care evaluation.

When the Exam Has to Happen

The face-to-face examination must take place within 60 days before admission.¹ If circumstances make that impossible, such as a fast hospital discharge, the exam can instead be completed within 30 days after admission.² Most facilities want the completed form before move-in day, though, because the administrator needs it to confirm the placement is appropriate.

If the exam happened more than 60 days before the resident actually moves in, it has expired and must be redone. After admission, a new face-to-face exam is required at least every three years, or sooner if the resident has a significant change in condition, such as a major surgery, a new chronic diagnosis, or a noticeable cognitive decline.²

Where to Get the Form

The blank form is a downloadable Word document on the Agency for Health Care Administration’s website; search for “AHCA Form 1823” or ask the facility’s admissions coordinator to send you a copy.³ Faxed and electronic copies of the completed form are both acceptable under Florida’s administrative code.²

Facilities can also accept the practitioner’s own health assessment form in place of Form 1823, as long as it covers every item the state form requires. If something is missing, the administrator has 30 days after admission to get the information from the practitioner in writing or by phone and document it in the resident’s record.²

Who Can Sign It

Only three types of practitioners may perform the exam and sign the medical certification: a licensed physician (MD or DO), a licensed physician assistant, or a licensed advanced practice registered nurse.¹ A registered nurse, LPN, social worker, or therapist cannot complete the form. The certification block on page three needs the examiner’s printed name, license number, title, address, phone number, signature, and the date of the exam; if any field is blank, the form is incomplete.

If the practitioner is employed by the facility to do the initial exam, that practitioner cannot have any financial interest in the facility.¹ Before you schedule, you can confirm the provider holds an active Florida license through the Department of Health’s MQA license verification portal.⁴

What the Practitioner Fills In

The top of the form collects the resident’s name, date of birth, any authorized representative, and the facility’s contact information. Everything below that is the clinical work.

Section 1: Health Assessment

The exam has to address the resident’s medical history and diagnoses, allergies, height and weight, physical or sensory limitations, cognitive and behavioral status (including a dedicated yes/no checkbox for elopement risk), any nursing or therapy needs, communicable disease screening for conditions like tuberculosis, MRSA, and scabies, and special diet instructions.²

A large part of Section 1 is the Activities of Daily Living grid. The practitioner rates seven categories, ambulation, bathing, dressing, eating, self-care, toileting, and transferring, on a four-level scale:

I (Independent): staff does not assist.
S (Needs Supervision): staff cues or prompts, resident completes the action.
A (Needs Assistance): staff provides physical help, resident participates.
T (Total Care): staff completes the action for the resident.

These ratings drive the care plan and shape which facilities are appropriate. Understating a resident’s needs can lead to a placement the facility isn’t equipped to handle, so accuracy here matters more than almost anything else on the form.

Near the end of Section 1, the practitioner answers a direct question: in their professional opinion, can this individual’s needs be met in an assisted living facility, which is not a medical, nursing, or psychiatric facility? A “no” means the resident is not appropriate for ALF placement.

Section 2: Medications and Self-Care

Section 2 requires an attached list of every currently prescribed medication with dosage, directions, and route of administration. It then asks whether the resident:

Is able to self-administer medications independently.
Needs assistance with self-administration, meaning unlicensed staff may help with nasal, eye, oral, ear, and topical medications.
Needs medication administration, which must be performed by a licensed nurse.

Not every assisted living facility has a licensed nurse on staff, so the difference between “assistance with self-administration” and “medication administration” can decide whether a given facility is even an option. An inaccurate box here can produce a placement that violates state rules.

Conditions That Can Block Admission

Form 1823 includes yes/no questions tied to the admission criteria in Rule 59A-36.006. A facility holding a standard, limited nursing services, or limited mental health license generally cannot admit someone who:²

Is bedridden, unless receiving licensed hospice services.
Requires 24-hour nursing supervision.
Requires 24-hour licensed professional mental health treatment.
Has stage 3 or 4 pressure sores. Stage 2 may be permitted under specific conditions with a licensed home health agency or nurse providing care.
Poses a danger to themselves or others, as determined by a health care or mental health practitioner.
Has a communicable disease likely to spread to other residents or staff.
Needs certain nursing services such as tube feeding, blood gas monitoring, artificial airway management, or administration of blood products.

If any of these apply to your family member, talk with the facility about whether a specialty license changes the answer before you schedule the exam.

How the Facility’s License Changes What’s Possible

Florida assisted living facilities operate under different license types, and Form 1823 findings feed directly into whether a specific facility can accept the resident.

A Limited Nursing Services (LNS) license allows a facility to provide certain nursing procedures beyond what a standard license covers, such as replacing an established catheter, caring for stage 2 pressure sores, applying and changing routine dressings, performing ear and eye irrigations, and providing nursing services within a nurse’s scope for hospice patients.⁵ Monthly nursing assessments are required for each resident receiving LNS care.

An Extended Congregate Care (ECC) license authorizes a higher level of support: total help with bathing, dressing, grooming, and toileting; more frequent nursing assessments; vital-sign monitoring; dietary management and intake tracking; medication administration; supervision of residents with dementia; and rehabilitative services.⁶ If Form 1823 shows a resident who needs total care across most ADL categories or ongoing nursing assessments, an ECC-licensed facility may be the right fit when a standard facility would not.

Match the needs the form documents to the facility’s specific license. A facility holding only a standard license cannot provide LNS or ECC services regardless of how willing the staff are. The license controls what is legally permitted.

Common Mistakes to Avoid

The most frequent problems with Form 1823 are simple to prevent:

Incomplete medical certification. A missing license number, unsigned form, or blank exam date invalidates the entire assessment. Check page three before you leave the practitioner’s office.
Stale exam dates. If the exam happened more than 60 days before move-in and the resident hasn’t been admitted yet, it has expired.
Vague ADL ratings. Every category marked “Independent” when the resident clearly needs help can produce an inadequate care plan and draws attention during inspections.
Missing medication list. Section 2 needs an attached list with dosages, directions, and routes; without it, the form is incomplete.
Wrong practitioner type. Only an MD, DO, PA, or APRN can sign, and a facility cannot accept one signed by anyone else.

If you notice a gap after submission, the administrator can contact the practitioner within 30 days of admission to get the missing information in writing or by phone and document it in the record.² Getting it right at the appointment is easier than fixing it later, so bring a checklist if it helps.

1
Florida Legislature. Florida Code 429 – Appropriateness of Placements; Examinations of Residents
2
Legal Information Institute. Florida Administrative Code Ann. R. 59A-36.006 – Admission Procedures, Appropriateness of Placement and Continued Residency Criteria
3
Florida Agency for Health Care Administration. Assisted Living Facility
4
Florida Department of Health. FL DOH MQA Search Portal – License Verification
5
Legal Information Institute. Florida Administrative Code Ann. R. 59A-36.022 – Limited Nursing Services
6
Legal Information Institute. Florida Administrative Code Ann. R. 59A-36.021 – Extended Congregate Care