Below are documents required for admission to a skilled nursing facility. Patient admission would be pending facility review of the patient’s clinical needs and financial resource approval.
Level 1 – Click here for fillable form
DMA-6 – Click here for fillable form
Facesheet
History and Physical
Physician Orders
Medication Orders
State Required Document, click for external link to document
State Required Document, click for external link to document
Patient information and Financial Information
Must be a current history and physical completed by a physician within the last 30 days
Orders to include services needed i.e. Therapy (OT,PT, ST), long term care placement
Listing of all current medications, dosages and times including any specific instructions
*Please alert facility staff if resident has been in the hospital within the last 30 days.
**All documents noted above should be faxed to facility representative at 706.554.6163
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