Admission Paperwork Completion Checklist

Checklist to confirm completion of a nursing home admission packet, including required consents, financial agreement, resident rights acknowledgment, photo authorization, and physician notification.

Resident Admission Details

• Resident Name
• Admission Date
• Room Number
• Admission Type

Admission Packet Checklist

• Consent to Treat completed and signed
• Financial Responsibility Agreement completed and signed
• Resident Rights acknowledgment completed and signed
• Photo authorization completed and signed
• Notice of Privacy Practices provided
• Advance directive information reviewed, if applicable

Physician Notification

• Attending physician notified
• Date physician was notified
• Notification method
• Notification notes

Missing Items and Follow-Up

• Items still needed
• Follow-up owner
• Follow-up due date
• Follow-up notes