MAUNALANI NURSING AND REHABILITATION CENTER REQUIREMENTS FOR ADMISSION
(From Nursing Facility, Care Home, Foster Home, Home)
Maunalani Nursing & Rehabilitation Center requires the following documents must be received prior to or at the time of admission.Forms may be faxed and acknowledged by facility on the same day as transfer.
State & Federal Requirements:
LONG TERM CARE FACILITY TRANSFER FORM:
- (1st) First page to be completed by nurse, (2nd) Second page to be completed by physician, level of care checked SNF/ICF, signed and dated by physician, date must be the same day as admission into the nursing facility.
PRE-ADMISSION SCREENING RESIDENT REVIEW FORM
- Original Level I screening (PASRR) must be completed and cleared for mental ilness/developmental disabilities prior to admission. If Level II screening is completed, accompanying documents are required.
OTHER FORMS AND INFORMATION
- If Medicaid is primary, a completed 1147 certifying the level of care must be received prior to admission.
- A transfer/discharge summary describing the resident’s condition signed by the physician must be received prior to admission.
- A list of resident’s current medications must be received prior to admission.
- Insurance information, identification, social security card, and proof of citizenship must be received prior to admission.
- Emergency, healthcare, and financial contact information must be received prior to admission.
- Admission packet must be completed prior to admission.
- Chest X-ray results, PPD (TB test results), Current Lab results within the last 7 days prior to admission
For further information, contact Social Services Department at 732-0771 ext. 214 or fax 737-8939.