Get Inglis House Date - Inglis

Filling out the INGLIS HOUSE Date - Inglis application online can be a straightforward process when you have the right guidance. This form is essential for admission and requires specific information about the applicant's background, medical status, and financial situation.

Follow the steps to effectively complete the application form.

1. Click the ‘Get Form’ button to retrieve the application form and open it in your preferred digital editor.
2. Begin by filling in the applicant’s name and contact information, including home phone and address. Ensure that the ‘Date’ field at the top is correctly completed.
3. Continue by specifying the applicant’s date of birth, sex, religion, and marital status. If the applicant is divorced, attach a copy of the divorce decree as instructed.
4. Enter the Social Security Number of the applicant and make sure to prepare copies of identification documents such as a state driver license, Social Security card, and birth certificate, as well as insurance cards including Medicare.
5. Fill out the Medicare information, indicating the Medicare number along with other relevant coverage details such as additional insurance and any prior nursing center stays.
6. Provide primary contact information for the person responsible for the applicant’s care, including their relationship to the applicant, and include backup emergency contacts.
7. Complete the medical and personal data section, detailing the primary and secondary diagnoses, the primary physician’s contact details, and confirming the applicant’s awareness regarding the placement decision.
8. Document all hospitalizations within the last two years and any special needs the applicant may have, alongside their smoking status.
9. In the financial information section, disclose the names of individuals responsible for payments and provide thorough income and assets details, including necessary documentation.
10. Lastly, ensure all sections are accurate and complete, particularly the certification statement, where the applicant or responsible party must provide their signature and date.

Start filling out the INGLIS HOUSE Date - Inglis application online to ensure a smooth admission process.