Get Nursing Admission Form

Filling out the nursing admission form online is a critical step in ensuring proper care for individuals entering a nursing facility. This guide provides detailed, step-by-step instructions to help users navigate the online form with ease.

Follow the steps to successfully complete the nursing admission form online.

1. Click ‘Get Form’ button to access the form and open it in your chosen document editor.
2. Begin by entering today's date. This is essential as it indicates when the admission notification is generated.
3. Fill in the member's name and date of birth. Accuracy is crucial; double-check the information for spelling and correct date format.
4. Provide the facility name where the individual will be admitted, followed by the facility contact name and their fax number.
5. Document any additional diagnoses as necessary. Ensure that this information is current and comprehensive.
6. Indicate the admission source. Specify whether the person is being admitted from the community, a nursing home, or a hospital.
7. If the admission is from a hospital, enter the hospital admission date.
8. Complete the discharge diagnosis field accurately to reflect the individual’s health status upon admission.
9. Select the reason for admission by checking the appropriate code. Options include initial admission, category change, readmission, and other relevant reasons.
10. Indicate the effective date of the admission or any change/update relevant to the patient's care.
11. Provide the name of the hospital from which the individual was discharged, along with the hospital discharge date if applicable.
12. Fill in relevant inquiries about bed hold days, both medical and therapeutic, if applicable.
13. When specifying the product type, ensure to circle the appropriate option based on the admission, change, update, or discharge status.
14. Document the date of admission to the nursing home and the UCare member ID number.
15. Complete additional fields as required, such as primary care clinic and facility provider ID.
16. Include supporting documentation such as therapy evaluations or nursing home admission orders to assist in determining coverage.
17. Before finalizing, review all provided information for accuracy and completion to avoid delays in processing.
18. Once confirmed, save the changes, and choose to download, print, or share the completed form as necessary.

Complete your nursing admission form online today to ensure timely and effective care.