Long Term Care Facilities Templates

This is a document developed for nursing facilities which are supposed to be filed during standard or extended health surveys.

This form is used to document the disbursements for a conservatee's residential or long-term care facility living expenses in California. It is specifically for the standard account.

This document is used to notify the Florida Agency for Health Care Administration (AHCA) about a change in facility administrator. It is a required form for healthcare facilities in Florida.

This form is used for transmitting third-party liability payments for long-term care facilities in Illinois.

This Form is used for administrators of long-term care facilities in Illinois.

This document is for reporting serious injury incidents at long-term care facilities in Illinois.

This form is used for notifying the admission or termination of a Medicaid beneficiary in a long-term care facility in New Jersey.

This form is used for notifying the state of New Jersey about the admission or termination of a Medicaid beneficiary in a long-term care facility.

This form is used for long term care facilities in Illinois to notify the appropriate authorities of any changes or updates.

This Form is used for reporting information about residents in private long-term care facilities in Illinois.

This Form is used for reporting fires that occur in long-term care facilities in Texas.

This document is used for reporting incidents that occur in long-term care facilities in Kentucky.

This document is used for the identification and screening of individuals in New Mexico who may require Level I services under the PASRR program.

This Form is used for long-term care facilities in Ohio to enter into a Medicaid provider agreement with the state.

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 form is used for obtaining consent from a facility in Oklahoma for authorized electronic monitoring.

This form is used for maintaining a roster of feeding assistants in long-term care facilities in Wisconsin.

This document highlights the flexibilities provided by CMS (Centers for Medicare & Medicaid Services) to long-term care facilities, such as skilled nursing facilities and nursing facilities, in their fight against COVID-19. It includes various measures and guidelines to help these facilities manage and mitigate the impact of the pandemic.

This form is used for determining the private daily room rate at long-term care or chronic facilities in Maryland.

This Form is used for submitting survey responses for long term care facilities in Virginia.

This document is used for reporting serious injury incidents and communicable diseases in long-term care facilities in Illinois.

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

This document is a request for a criminal record check for individuals working in long-term care facilities in Arkansas. It is used to ensure the safety and security of residents in these facilities.

This form is used for preadmission screening and annual resident review in the state of Michigan. It is used to evaluate the eligibility and care needs of individuals seeking admission to long-term care facilities.