Get Nc Dma - Nursing Home Notice Of Transfer Or Discharge Dma-9050 07-2011.doc - Ncdhhs

Filling out the NC DMA - Nursing Home NOTICE OF TRANSFER OR DISCHARGE form is an important process that ensures proper communication and documentation regarding the transfer or discharge of a resident. This guide provides step-by-step instructions to help you complete the form accurately and effectively.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to access the NC DMA - Nursing Home NOTICE OF TRANSFER OR DISCHARGE form in your preferred document editor.
2. Enter the date of notice at the top of the form in the designated space. This should reflect the day you are issuing the notice.
3. Fill in the resident's name, the facility's name, and its address. Additionally, provide the administrator's name and phone number to ensure proper contact information is available.
4. Indicate the date of transfer or discharge next. This is the date when the action is set to take place.
5. Select and write down the reason for the transfer or discharge based on the federally mandated reasons. Ensure that it is clear and aligns with the options provided in the document.
6. Specify whether a family member or legal representative has been notified about the transfer/discharge. Fill in their name to underline the importance of communication.
7. Check either the 'Transfer' or 'Discharge' option and indicate the location where the resident will be transferred or discharged to, including the name, address, and phone number of the new facility.
8. Make sure to highlight the resident’s right to appeal this transfer or discharge within 11 days, as stated in the form.
9. Lastly, the administrator must sign and date the form to finalize the notice. Ensure that all information is accurate before completing this step.
10. Once all fields are filled correctly, save the changes. You can then download, print, or share the completed form as needed.

Begin filling out the necessary documents online now.