Get Neshaminy Manor Application

Filling out the Neshaminy Manor Application online is a straightforward process that ensures your application for long-term admission is complete and accurate. This guide provides step-by-step instructions to help you successfully navigate each section of the application.

Follow the steps to complete your application effectively.

1. Press the ‘Get Form’ button to obtain the application form and open it for editing.
2. Begin by entering the applicant's name in the designated fields: last name, first name, middle name, and maiden name.
3. Provide the applicant's Social Security number in the specified field.
4. Indicate the reason for the application based on the options available in the form.
5. Record the applicant's current and past residences, starting with the present location. Fill in the street address, town, county, and zip code, along with the duration of residency.
6. Select the applicant’s current living arrangement from the options provided: private home, assisted living, nursing home, acute hospital, psychiatric hospital, or rehabilitation hospital. Indicate whether the applicant lives alone by checking 'yes' or 'no'.
7. If applicable, answer whether the applicant has received services from the AAA Waiver Program by selecting 'yes' or 'no'.
8. Address any history of mental retardation, mental illness, or developmental disability by selecting 'yes' or 'no'.
9. Enter the applicant's date of birth, place of birth, age, sex, marital status, and citizenship status. Provide the primary and any additional languages spoken.
10. Select the applicant's race/ethnicity from the options provided. Completing the religion/church affiliation is optional.
11. Indicate the highest completed education level by selecting from the provided choices.
12. If applicable, select whether the applicant has military service and provide relevant details.
13. Complete the section regarding the applicant's lifetime occupation and, if applicable, provide the name and Social Security number of the spouse along with the date of death if deceased.
14. Detail the applicant's insurance information including Medicare, HMO, medical assistance, and any long-term care insurance information.
15. Record income sources and amounts, along with banking information for any checking or savings accounts, including CDs or stocks.
16. Identify responsible parties for burial arrangements, and document emergency contacts with their details.
17. Certify that the information provided is true and accurate by signing the form and dating it.
18. Ensure that you attach copies of all required documents including health insurance cards, Medicare details, Social Security card, and advance directives.
19. Once all fields are completed, save your changes, and finalize by downloading, printing, or sharing the application.

Complete your documents online today for a smooth admission process!