Documents to be Completed by Family Caregiver/ Residents Prior to Admission
Please note that in order to meet regulatory requirements and to serve you better you are requested to complete/ help complete certain documents that are listed below (please click on the links) before admission to the facility.
Documents needed from the resident’s physician:
- Physician’s Visit Report and/or a detailed history and physical completed no more than 90-days prior to admission
- Admission Orders
Please review the Resident Handbook for the facility of your interest: (i) Columbus (ii) Toledo (iii) Ravenna (iv) Maple Heights (v) West Union
Please submit the following completed documents:
- Resident Agreement for the facility you selected: (i) Columbus (ii) Toledo (iii) Ravenna (iv) Maple Heights (v) West Union
- Submit the following forms, if applicable:
- Resident Acknowledgement/ Authorization Form
- Receipt of Privacy Practices
- Resident Profile (You may complete and submit this form online by clicking the “submit” button on the top right corner of the form. This document will help facility staff to know and serve the resident better. Please submit a recent picture at your earliest convenience.)
- If not already completed, Application Form and other remaining requirements stated in the list of documents required prior to admission date.
- Personal Items Inventory (List items that will be moved in along with an estimated price, whether new or old, and update list as needed) and CTS Form (if applicable).
Please schedule an appointment with an Alpine House nurse to complete
- Appraisal/ Health Assessment (within 90 days prior to admission)