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Last updated: 9/13/2018
Worksheet For Determining Evacuation Capability ICF IID (Existing Facilities Only) {CMS-2786M}
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223224Evacuation Capability Determination for Board and Care Occupancies American LegalNet, Inc. www.FormsWorkFlow.com (Check only one)(Check only one)(Check only one)(Check only one)(Check only one)(Check only one) American LegalNet, Inc. www.FormsWorkFlow.com Determining the Resident222sOverall Need for Assistance American LegalNet, Inc. www.FormsWorkFlow.com Note: All answers must be 223Yes224 before proceeding. American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com
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