Forms Required For Admission
In addition to the following forms, we will need a recent
TB test with a negative status no older than 6 months.
The forms are in PDF format.
You can type into most of the forms and save them on your computer
for printing later.
|
Fairfield
CA Facility Forms |
|
| Mental and physical health needs of the potential resident. | Appraisal of Needs |
| Identification information and Emergency Contacts. | Emergency Contacts |
| Consent to give life sustaining care. | Consent For Emergency Help |
| Rental and services agreement. | Admission Agreement |
| A detailed report of the potential residents health and medical needs. | Physicians Report |
| Doctors permission to give Non Prescription Medications. | PRN Medications |
| Detailed inventory of personal property. (not required) | Personal Property |
| Know your personal rights | Personal Rights |
| Know your medical rights. | Your Medical Rights |
| California's Laws regarding health and safety in a care facility | Health and Safety Codes |
| Genesis Care Home House Rules. | House Rules |
| TB Test no older than 6 months. | This form comes from your doctor |
