ADMISSIONS POLICY and PROCEDURE..............………………………………......05-02-001

APPLICATION FOR ADMISSION……………………………………………………..05-02-002

 

Instructions for Completing Application

Application for Admission – Personal Information - Part 1

Military Service Information – Part 2

Eligibility Requirements – Part 3

Health Care Information – Part 4

Insurance Information – Part 5

Advance Directive Information – Part 6

Emergency Contact Information – Part 7

Burial Arrangements – Part 8

Authorization for Disclosure of Protected Health Information – Part 9

Medical Information – Part 10

Patient Information – Part 11

Financial Information – Part 12

Affidavit Regarding Income Tax Return – Part 13

Financial Release Request – Part 14

Durable Power of Attorney (Medical/Financial) – Part 15

Certification – Part 16

Required Copies of Documents Checklist / Work-Sheet

Appendix A – New Jersey Administrative Code (N.J.A.C.) 5A: 5 – Chapter 5

Appendix B – Notice of Information Practices-Resident’s Privacy Rights-HIPAA

Appendix C – Calculating Financial Costs – An Overview

 

NOTICE OF INFORMATION PRACTICES……………………………………………05-02-003

ACKNOWLEDGEMENT OF RESIDENTS’ PRIVACY RIGHTS…………………….05-02-004

VETERAN HOME RESIDENT HANDBOOK OF RULES & REGULATIONS……...05-02-005

RESPONSE CARD TO APPLICATION FOR ADMISSION….……………………….05-02-006

ADMISSION AGREEMENT PROCEDURE……………………………………….…..05-02-007

ADMISSION AGREEMENT…………………………………………………..……05-02-007A