Intake Forms- AGREEMENT FOR SHORT-TERM SKILLED NURSING AND/OR SKILLED PHYSICAL REHABILITATION July 18, 2011 By Maunalani Staff Maunalani Nursing and Rehabilitation Center AGREEMENT FOR SHORT-TERM SKILLED NURSING AND/OR SKILLED PHYSICAL REHABILITATION The undersigned hereby acknowledges that [Name of Resident, below] (hereafter referred to as "Resident"), is being admitted to Maunalani Nursing and Rehabilitation Center, (hereafter referred to as "Maunalani"), for the purposes of participating in a short-term program of skilled nursing and/or skilled physical rehabilitation. A limited number of beds are available at Maunalani for the provision of skilled nursing and skilled rehabilitative care. Therefore, cooperation on the part of Resident and Family is vitally important in order that you, as well as to others in the community, may benefit from this limited service. During this stay at Maunalani, the undersigned agrees to make preparations for the return of the Resident to home or community at the conclusion of the "skilled" program, as determined by Maunalani's interdisciplinary team, including the attending physician. Undersigned understands and agrees to abide by this short-term skilled nursing and/or skilled physical rehabilitation agreement.Name of Resident or Representative* First Last Relationship to Resident* Signature* Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY Share this:FacebookTwitterLinkedIn
