Get Nursing Facility Change Of Statustransferdischarge Form
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How to fill out the Nursing Facility Change of Status/Transfer/Discharge Form online
This guide provides a clear and supportive overview of how to fill out the Nursing Facility Change of Status/Transfer/Discharge Form online. By following these steps, you can ensure that all relevant information is accurately submitted for change of status, transfer, or discharge.
Follow the steps to successfully complete the form online.
- Click ‘Get Form’ button to obtain the form and open it for editing.
- Enter the resident's name in the respective fields. Make sure to include both the last name and first name.
- Provide the Medicaid ID number to identify the resident's eligibility and benefits.
- Fill in the name of the facility where the resident is currently residing. This includes the full facility name.
- Enter the facility's contact phone number and fax number for further communication.
- Indicate the resident's middle initial to ensure proper identification.
- For current ICF Medicaid clients, notify the status of change by filling out the Medicare start and stop dates.
- Specify the resumed Medicaid status date if applicable, alongside the date of death if relevant.
- If a transfer is occurring, fill out the name of the nursing facility or CFI being transferred from and to, including the dates.
- Complete all necessary fields regarding original and actual Medicaid start and discharge dates.
- If discharging to community under the CFI program, provide the date entered into the nursing facility and the anticipated or actual date of discharge.
- Fill in the community address and a phone number if known for the next destination.
- Obtain signatures from both the facility representative and BEAS representative where indicated.
- Finally, make sure to review all entries for accuracy, then save changes, and download or print the completed form.
Complete your Nursing Facility Change of Status/Transfer/Discharge Form online today!
A red flag in a nursing home usually indicates a potential issue that needs immediate attention. This could relate to unsafe conditions, neglect, or violations of patient care standards. Being aware of these red flags is vital for ensuring the safety and well-being of residents. If you encounter any concerns, using the Nursing Facility Change Of Statustransferdischarge Form can assist in addressing these issues effectively.
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