Get Nursing Home Resident Applicant Fingerprint Consent Form ... - Forms Petersenhealthcare

Filling out the Nursing Home Resident Applicant Fingerprint Consent Form is a crucial step for individuals applying to nursing homes identified as offenders. This guide will provide you with clear, step-by-step instructions to complete the form correctly, ensuring compliance with the necessary regulations.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing method.
2. Begin by entering the facility information. Fill in the name of the nursing home and the facility ID. Ensure all details are accurate to avoid any delays.
3. Next, input the contact person's name along with their email address and phone number. This information is essential for any follow-up communication.
4. Move on to the applicant information section. Carefully fill in the applicant's sex, race, date of birth, full name, height, weight, eye color, hair color, and place of birth. Make sure these details match the identification documentation provided.
5. When prompted, enter the optional Social Security Number (SSN) if the applicant chooses to provide it.
6. Complete the livescan vendor and appointment information. Provide the fingerprint vendor's name, address, and phone number, along with the appointment date and time.
7. Fill in the requesting agency ORI identifier and purpose code. Ensure that the request type is marked appropriately to ensure compliance.
8. Read and understand the privacy statement. The applicant must sign and date this section to authorize the release of criminal history record information.
9. Finally, print the completed form. Ensure that the original signed copy is retained by the nursing home facility, one copy is provided to the livescan fingerprinting vendor, and one copy is given to the applicant.

Complete your documents online with confidence and ensure a smooth application process today.