Home / Physicians Resource

Physicians Resource

Documents Needed for Admission

Below are documents required for admission to a skilled nursing facility. Patient admission would be pending facility review of the patient’s clinical needs and financial resource approval.


Documents Needed for Admission


Level 1 - Click here for fillable form



DMA-6 - Click here for fillable form



Facesheet


History and Physical




Physician Orders



Medication Orders

Requirement and Details


State Required Document, click for external link to document


State Required Document, click for external link to document


Patient information and Financial Information


Must be a current history and physical completed by a physician within the last 30 days


Orders to include services needed i.e. Therapy (OT,PT, ST), long term care placement


Listing of all current medications, dosages and times including any specific instructions


Silver Quality Assurance Award Logo for 2019












*Please alert facility staff if resident has been in the hospital within the last 30 days.

**All documents noted above should be faxed to facility representative at 706.864.8506
View / Download / Print this page

© 2020 Chelsey Park Health . All Rights Reserved.

Privacy Policy | Non-Discrimination Policy