|1. Please DOWNLOAD and print the attached form. This form must be completed in full before admission to the home may occur. This includes being signed and dated by the applicant or the applicant’s representative. You may return the form to the home by dropping it off or by mail to the attention of Jackie Pietron, Admissions Coordinator.|
2. If you have any questions regarding the admission form you may call the home at 814-467-5505 and someone will assist you.
3. When an opening is available Jackie will contact you. Prior to admission, medical records of the applicant must be reviewed. If the applicant is hospitalized the hospital will supply the necessary information. If the applicant is in the community then the primary care physician must provide medical records. This includes:
- History and Physical
- List of current medications
- Current chest x-ray (Within 60 days of admission)
- Lab work and results
- PPD with a 48 hour reading (If seeking placement in personal care)
If accepted for placement, Jackie will contact you to set up an appointment to complete a formal application. A tour of the home will be given and you will be shown the available room. You will meet with representatives from Social Services and Housekeeping. You will be asked to provide additional information and the following identification cards and documents:
- Social Security Card
- Medicare Card
- All additional medical cards such as BC/BS, Security Blue, UPMC for Life, UMWA, etc.
- All prescription cards such as PACE or Medicare Part D
- Power of Attorney Document (If applicable)
- Living Will/Advance Directive (If applicable)