Get Mn Ucare Skilled Nursing Home/swing Bed Admission Notification Form 2017

Filling out the MN UCare Skilled Nursing Home/Swing Bed Admission Notification Form online can be a straightforward process with the right guidance. This form is crucial for notifying UCare about the admission and discharge of members, as well as any significant updates.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Enter the date of admission to the nursing home in the provided field.
3. Fill in today’s date to indicate when the form is being completed.
4. Input the UCare member ID number in the designated area.
5. Provide the member's full name in the appropriate field.
6. Enter the primary care clinic’s name associated with the member.
7. Record the member’s date of birth in the specified section.
8. Input the facility provider ID number in the corresponding field.
9. Enter the name of the facility providing care.
10. Provide the facility's contact phone number for communication purposes.
11. Write down the name of the facility contact person for reference.
12. Fill in the admitting diagnosis using the ICD10 code in the designated space.
13. Enter the contact fax number of the facility for documentation purposes.
14. If applicable, input any additional diagnosis information as needed.
15. Indicate whether the admission is from the community or a nursing home resident.
16. If the admission is from a hospital, please provide the hospital's name and relevant admission and discharge dates.
17. Fill in the discharge diagnosis if applicable.
18. Select the reason for admission from the provided options, including options like initial admission or readmission.
19. Check the product type selected from the options provided.
20. Complete any additional fields required, such as the number of skilled days requested.
21. Review all entries to ensure accuracy and completeness.
22. Once finalized, save changes, download, print, or share the form according to your needs.

Take action today and complete your forms online for a smoother admission process.