Long Term Care Templates

This form is used for pre-admission screening and resident review in the state of Alaska. It helps determine if a person is eligible for long-term care services and assesses their needs before admission to a care facility.

This form is used by Iowa to assess members in home- and community-based services (HCBS) residential settings.

This type of document is an application form for individuals who want to become Certified Volunteer Long Term Care Ombudsmen in the state of Iowa.

This type of document is used to authorize the photographing or recording of a resident in a nursing or assisted living facility. It is specific to the State Long-Term Care Ombudsman Program in Texas.

This document is for the Program of All-inclusive Care of the Elderly (PACE) in New Mexico. It is a long-term care medical assessment.

This document is used for the Long Term Care Medical Assessment Abstract for individuals with ICF/IID and developmental disabilities who are seeking home and community-based services waiver in New Mexico.

This form is used for applying for Medical Assistance (Medicaid) in Pennsylvania for long term care, supports, and services.

This document is used for referring individuals to Rhode Island's Nursing Home Transition Program, which helps individuals transition from nursing homes back to their homes or community-based settings.

This document is an application form for individuals seeking to become an administrator-in-training for a Community Residential Care Facility in South Carolina.

This document is used for requesting sentinel surveillance for long-term care facilities in South Dakota.

This Form is used for filing complaints against facility administrators in South Dakota's Board of Nursing.

This form is used for long-term care aides in Oklahoma to affirm their completion of training.

This Form is used for designating a Long-Term Care Ombudsman as a representative and requesting to appeal a nursing facility discharge in Texas.

This form is used for requesting authorization for a long-term care facility in Alaska.

This form is used for determining the level of care in Colorado.

This form is used for requesting long-term care days at a hospital in Illinois.

This Form is used for exchanging information between long-term care facilities and the regional Medicaid office in Mississippi. The form helps facilitate communication and coordination of benefits for Medicaid recipients receiving long-term care services.

This document is used for estimating the cost of closing and managing a phosphogypsum stack system in Florida. It includes the cost of water management and long-term care.

This Form is used for the Phosphogypsum Stack System Trust Fund Agreement in Florida to demonstrate closure, water management, and/or long-term care financial assurance.

This form is used for obtaining an insurance certificate in Florida to demonstrate closure, water management, and/or long-term care financial assurance for a phosphogypsum stack system.

This form is used for a financial guarantee bond related to the closure, water management, and long-term care of a phosphogypsum stack system in Florida.

This document is for applying to the Lifespan Respite Voucher Program in Arkansas. It provides an application form needed to access respite services for caregivers of individuals with disabilities or special needs.

This form is used for the Phosphogypsum Stack System Standby Trust Fund Agreement in Florida. It demonstrates closure, water management, and long-term care financial assurance for the system.

This form is used for applying for a performance bond in Florida to demonstrate closure, water management, and/or long-term care financial assurance for the Phosphogypsum Stack System.

This document is used to demonstrate closure, water management, and/or long-term care financial assurance for a phosphogypsum stack system in Florida.

This form is used for assessing eligibility for a Medicaid waiver program in Kentucky.

This form is used for reporting critical incidents related to Home and Community Based Services (Waiver Services) in Louisiana.

This document is used for obtaining issuer certification for the Long-Term Care Insurance Partnership Program in Idaho. It ensures that insurance issuers meet the necessary requirements to participate in the program.

This document is for those seeking a referral for home care services in Prince Edward Island, Canada. It provides information and assistance in finding reliable and professional home care providers in the area.

This document provides information about the different types of living arrangements available in Manitoba, Canada. It includes details on options such as apartments, houses, and communal living spaces.

This form is used for the Long-Term Care Ombudsman Program in Oklahoma to provide program assurance for designated entities.

This form is used for filling out the Title XIX Work Sheet in the state of Oklahoma.