|
Admission Requirements
Assisted Living Care
- The applicant must have a complete physical verifying that he or she has the mental and physical ability to perform the following:
- Perform routine and daily personal functions - dress and feed themselves, make his/her own bed and keep his room clean.
- Make their 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/her physician verify that he/she 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*
Back to Admissions
|
