Get Elcor Application

This guide provides a comprehensive approach to completing the Elcor Application online. By following these detailed steps, users can ensure that they fill out the form accurately and efficiently.

Follow the steps to complete the Elcor Application online.

1. Click ‘Get Form’ button to obtain the application form and open it in your preferred editor.
2. Fill in the date at the top of the application. This is essential for record-keeping.
3. Input your full name, including any maiden name, if applicable. Ensure correct spelling to avoid issues.
4. Provide your current location and usual residential address. This information is crucial for communication and care arrangements.
5. Specify your marital status and ensure to enter a valid phone number for contact purposes.
6. Indicate your sex, date of birth, present age, and place of birth accurately.
7. Confirm your U.S. citizenship status and provide your current county of residence.
8. List the names of close living relatives or friends, circling or marking two to be notified in case of an emergency.
9. Detail your previous occupation or profession and any current hobbies, interests, or activities.
10. Provide health-related information, including current physician, hospital preference, and any known diagnosis.
11. Answer questions regarding services in the U.S. Armed Forces and educational background.
12. Fill out the section on financial information, including social security number, Medicare, and Medicaid information.
13. Indicate the details of burial arrangements, funeral home preferences, and if there is someone responsible for these arrangements.
14. In case power of attorney or conservatorship is applicable, provide details and ensure documentation is ready for submission.
15. Complete the financial disclosure report, which is necessary for placement on the admission waiting list.
16. Review all provided information to ensure accuracy. Make any necessary corrections.
17. Once complete, you can save changes, download, print, or share the form as needed.

Start completing your application online today for a smoother admission process.