Get Application For Residency (please ... - Waunakee Manor

Filling out the APPLICATION FOR RESIDENCY for Waunakee Manor is a crucial step in your admission process. This guide will walk you through each section of the form, ensuring that you provide all necessary information accurately and efficiently.

Follow the steps to complete the residency application online.

1. Press the ‘Get Form’ button to access the residency application and open it in your document management tool.
2. Begin by entering your general information. Fill in the applicant's last name, first name, and middle name in the designated area. Complete the permanent address section with your street, city, county, state, and zip code.
3. Indicate your phone number and select your sex by marking the appropriate box. Then provide your birthdate and age.
4. Fill in your marital status and current/previous occupations for both yourself and your spouse, if applicable. Include the year of retirement, if retired.
5. Complete the section for health information. This includes your physician's name and contact information, as well as details about your diagnosis and any recent falls.
6. Answer whether you need assistance with dressing, feeding, bathing, or ambulation, marking 'yes' or 'no' for each.
7. Document any nursing home stays from the last five years and any hospital stays within the last twelve months, including dates.
8. In the emergency contact section, list names, addresses, phone numbers, and relationships for up to three individuals, in order of priority.
9. Provide additional information, including your dentist, religious affiliation, funeral home details, and whether you have executed any advance directives.
10. Answer financial questions regarding your housing situation and details of your income, including Social Security, private pensions, and other sources.
11. Fill in assets and liabilities to detail your financial situation accurately.
12. Indicate if the applicant has transferred any assets over $5,000 in the past two and a half years and any previous applications for Medicaid.
13. Finalize the application by signing and dating it. Ensure that the preparer and resident signatures are included.
14. Upon completion, save your changes, and you may choose to download, print, or share the application as necessary.

Complete your residency application online today for a smoother admission process.