Nursing Home Templates

This document is a progress note used in nursing homes at the University of Virginia Health System to track the medical progress of patients.

This document is used for admitting a resident into an assisted living facility.

This form is used for transferring a resident from a nursing home to a hospital emergency department.

This form is used for gathering information about the residents and their conditions in a healthcare facility. It helps in maintaining accurate records and ensuring the well-being of the residents.

This Form is used for requesting an evaluation of a resident's eligibility for certain long-term care services in Florida.

This document is for applying for a state grant program specifically for nursing homes and domiciliary spaces in the space program analysis.

This form is used for applying for a refund of sales tax paid on generators used in nursing homes or assisted living facilities in Florida.

This Form is used for institutional billing in nursing home facilities in Florida. It is also known as Form UB-04 or CMS-1450. The form is used to submit claims for reimbursement from Medicare, Medicaid, or other insurance providers for services provided to nursing home residents. The instructions provide guidance on how to complete the form accurately and submit it correctly.

This type of document is used for applying for certification as a nursing home training provider for Alzheimer's Disease or Related Disorders training in Florida.

This form is used for reporting compliance with the Civil Rights Act Title VI for skilled nursing, intermediate care, and other 24-hour facilities in Illinois.

This form is used for requesting a long-term care bed reserve or reporting a temporary absence for individuals in Illinois.

This document is used for obtaining consent from nursing home residents in Illinois to collect their fingerprints.

This document is a helpful checklist for selecting a nursing home for yourself or a loved one. It outlines key factors to consider, such as staff qualifications, facility cleanliness, and resident safety measures.

This Form is used for the Nursing Facility Utilization Fee in Montana.

This Form is used for facilitating the placement of individuals in out-of-state nursing facilities in Nevada.

This form is used for tracking nursing facility activities in the state of Nevada.

This Form is used to provide instructions for completing the HFEL-6 Resident Care Staffing Report in New Jersey. This document is used by residential care facilities to report staffing information.

This form is used for referring individuals in New Jersey to long-term services and supports. It helps assess their eligibility and needs for assistance with daily activities and healthcare services.

This form is used for the Money Follows the Person Eligibility Screening Tool in New Jersey. It helps determine eligibility for the program.

This form is used for the re-evaluation of long-term care needs in the state of New Jersey. It helps determine the eligibility and level of care needed for individuals receiving long-term care services.

This checklist is for adult hospital, hospice or nursing home patients in New York who do not have the capacity to make medical decisions and do not have a health care proxy. It outlines the steps for selecting a surrogate from the surrogate list, who will make decisions on behalf of the patient.

This form is used for applying to become a temporary manager and/or receiver for nursing homes and assisted living facilities in Washington state.

This form is used for reporting credit balances in nursing homes in Washington.

This document is for reporting credit balances in nursing homes in Washington state.

This Form is used for notifying the transfer or discharge of a resident from a nursing home in Washington state.

This form is used for pre-admission screening and resident review in Washington state. It is required for individuals seeking long-term care services to determine their eligibility and level of care needed.

This document provides information about the staffing requirements for nursing homes in Rhode Island. It outlines the guidelines and regulations for hiring and maintaining a skilled and sufficient staff to ensure quality care for residents.

This document is used to apply for registration for continuing care in the state of Rhode Island.

This form is used for assessing the level of care needed for nursing home facilities in Nevada.

This form is used for requesting skilled nursing services in a community setting in Washington. It is part of the pre-admission screening and resident review process.

This document is used for applying for long-term care or waiver in the state of Connecticut.