Alternate Level of Care (ALC) Designation

Overview and clinical staff and physician tools, supporting ALC designation across Nova Scotia Health.

Form Overview

The ALC Status Form is the official record documenting ALC status. It takes precedence over any previously existing ALC designation form.

The form provides one location within a patient’s chart to document all ALC status information (i.e., initial ALC designation, redesignation to acute if applicable, redesignation to ALC and changes in Support Required).

The form contains a section to document the ALC Support Required. The ALC Support Required is used to describe what is preventing you from discharging the ALC patient. Only one Support Required should be selected for an ALC patient, and it should be discussed and decided upon collaboratively by the interdisciplinary team.

The data collected from Support Required documentation will be used to help identify patient flow barriers and to advocate for additional community resources to support the ALC patient population effectively. A table containing detailed information about the Support Required options is provided on Page two of the form.

Where to Find the ALC Status Form

Central Zone (CZ)

The ALC Status Form is double-sided so it must be ordered from NS Health Printing & Digital Copying Services (currently Dal Print) to avoid printing errors. 

For more information on the printing request process: Central Zone Health Records Forms and Order Sets

To view a copy of the form (with a “For Reference Only” watermark):

  • Visit the Health Records Forms and Order Sets home page
  • Scroll to the bottom of the screen and enter NS_ALCSF or Alternate Level of Care (ALC) Status Form in the search box.


Eastern Zone (EZ), Northern Zone (NZ), and Western Zone (WZ)

Forms can be printed on demand/as needed.

  • Visit the Access Passport (EFR).
  • Search NS_ALCSF or Alternate Level of Care (ALC) Status Form to locate the form.  

For more information on the Access Passport (EFR): Access EFR eforms Quick Reference Guide 

Completing the Form

When a patient is designated as ALC, ANY Regulated Health Care Provider (RHCP), as appropriate, and in collaboration with the Most Responsible Health Care Provider (MRHCP), must document the following:

Click through the tabs for more information.

Select ONE option from the Support Required list by placing a checkmark next to it. If more than one support is applicable, please select the main/most significant option to help facilitate the patient's discharge. 

The Support Required can be updated at a later date if more information becomes available or if circumstances change.

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This is the date the original ALC designation is made.


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The ALC Status Form must be signed by the MRHCP in order to make the designation official.


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  • All subsequent changes to the patient’s ALC status/ALC Support Required must be documented on the ALC Status Form within 24 hours of the decision. 
  • Enter each status change on a new row of the ALC Status Changes table and include the following:
    • When entering a removal of ALC status/re-designation to acute, include MRHCP Signature and Date.
    • When entering an ALC re-designation, include MRHCP SignatureDate and ALC Support Required..
    • When entering a Change in ALC Support Required, include Date and ALC Support Required (updated selection from form list). Although the MRHCP signature is not required for this change, the signature of an interdisciplinary team member is required and must be added to the MRHCP Signature column.


Click through the tabs for more information.

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Nova Scotia Health, 2024.