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AHCA Form 1823, March 2017. 58A-5.0181(2)(b), F.A.C.. Page 1 of 5 INSTRUCTIONS TO LICENSED HEALTH CARE PROVIDERS: After completion of all items inThe most cited 1823 issue is the form not being completely filled out. Here is an example of a correct form. Every field is filled out. Believe it or not the Please utilize the following instructions to complete the form in its entirety. By following these instructions, this will minimize any follow up phone calls or. INSTRUCTIONS TO LICENSED HEALTH CARE PROVIDERS: After completion of all items in Sections 1 and 2 (pages 1 - 3), return this form to the facility at the AHCA Recommended Form 1823. 9/2013. RESIDENT HEALTH ASSESSMENT for ASSISTED LIVING FACILITIES. ❖ This form must be completed annually for residents INSTRUCTIONS TO LICENSED HEATLH CARE PROVIDERS. After completion of all items in Sections 1 and 2, return this form to the facility at the address indicated