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Admission Requirements

Assisted Living Care

  • The applicant must have a complete physical verifying that he has the mental and physical ability to perform the following:
  • Perform routine and daily personal functions - dress and feed himself, make his own bed and keep his room clean.
  • Make his way to and from the first floor dining area.
  • Control body eliminations (either naturally or by prosthesis).
  • Make rational and competent decisions as to the desire to remain or leave Charlotte Hall

Nursing Home Care

The applicant must have his physician verify that he does not require medical, surgical and nursing care beyond the capabilities of the facility. If the applicant is admitted directly from a long-term health care facility, please provide the following information:

  • Current medical findings
  • Diagnosis and prognosis
  • Medical rehabilitation goals
  • A summary of the course of treatment followed in the hospital or other health care facility
  • Physician orders for immediate care

If the applicant moves to Charlotte Hall directly from home, please supply the following medical information:

  • Current (within 30 days) medical findings
  • Diagnosis and Prognosis
  • Medical rehabilitation goals
  • Physician orders for immediate care

For Physician

  • "Physician Certification Related to Medical Condition" Form
  • Healthcare Practitioner's Physical Assessment (Assisted Living only) Form 4506
  • Maryland Medical Assistance Medical Eligibility Review Form (Long-term Care only) Form 3871
  • VA Form10-10SH
  • Department of Health and Mental Hygiene ID Screen (Long-term Care only) Form 4345
  • Physicians Orders for your immediate care (Long-term Care only)
  • Chest X-ray

*All medical forms must be dated within 30 days of admission date*

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