Nursing Home Templates

This document is used for notifying the conversion of beds in nursing homes to alternative bed banking in Washington.

This form is used for obtaining a Certificate of Need-Exemption for nursing homes in Washington to renovate or replace beds. It serves as an authorization notice for the bed replacement or renovation.

This Form is used for requesting nursing facility rates in the state of Alabama.

This form is used for nursing home discharge planning in Alabama. It is part of the MDS 3.0 Section Q, which focuses on the care transition process for residents.

This form is used for filing an exemption application for an incorporated nonprofit nursing home in Maine.

This form is used for the county review of nursing home, IMD or ICF/IID referrals in Wisconsin. It helps ensure that the appropriate care and services are provided to individuals in need of specialized care.

This document provides information on the number of nursing home and adult care facility (ACF) COVID-related deaths statewide in New York.

This document is used to apply for a nursing home in Ohio and indicates that the applicant is ready to proceed.

This document is used to notify the Ohio Residential Care Facility of readiness for a particular event or situation. It may pertain to staff training, inspections, or other necessary preparations.

This Form is used for the annual renewal of nursing home or residential care facilities in the state of Ohio.

This form is used for referring individuals to participate in the Peace Nursing Home Pilot Project in the City of Philadelphia, Pennsylvania.

This Form is used for requesting an exemption from licensure for a home for the aged in Michigan.

This form is used for notifying a nursing home resident in North Carolina about a transfer or discharge.

This Form is used for reporting immunization information for nursing home patients in Arkansas.

This document provides information about the status of nursing facility care in the state of Colorado. It includes details about the quality and availability of care for residents in nursing homes.

This type of document is used for applying for state licensure for long-term care facilities in Alaska. It is an application form that must be completed and submitted to the appropriate licensing agency.

This document is for applying or reapplying for a nursing home license in the state of Vermont.

This form is used for notifying the Wisconsin Nursing Home of a change in the administrator or director of nursing.

This form is used for the Masshealth Long-Term-Care Eligibility Review in Massachusetts. It is used to determine if individuals are eligible for long-term care services.

This document is a checklist for situations where adult hospital, hospice or nursing home patients in New York do not have the capacity to make medical decisions and do not have a health care proxy. It provides guidance on the use of a surrogate selected from the surrogate list according to New York's Public Health Law.

This document is a checklist for adult hospital, hospice, or nursing home patients in New York who lack medical decision-making capacity, do not have a health care proxy, and have no available surrogate from the surrogate list.

This Form is used for implementing enhanced barrier precautions in skilled nursing facilities and nursing homes. It helps to improve the safety measures against infections.

This document is an application for Long Term Care Mainecare in the state of Maine. It is used to apply for financial assistance for long-term care services for individuals who meet certain eligibility criteria.

This form is used for renewing or changing ownership of home health, home services, and home nursing agencies in Illinois.

This form is used for filing a complaint regarding the Long Term Care Ombudsman Program in North Dakota.

This form is used for applying for a tax exemption for nonprofit nursing homes in the state of Maine.

This form is used for nursing facilities in Texas to disclose information about their memory care services for residents. It provides details about the facility's specialized care programs and staff qualifications.

This form is used for disclosing important information about memory care services in Texas assisted living facilities.

This form is used for requesting action in long term care in the state of Alabama.