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Admission Application – DOWNLOAD NOW

How to Apply for an Admission in Nursing or Personal Care

There is a two-step application process that will be needed in order for us to meet your needs.

Step #1- Medical and Financial Application

We will ask you to complete and return to us the Inquiry for Admission application. This application helps us to determine the level of care required for you. A financial disclosure is also attached to the inquiry. We ask that you complete this in its entirety as this will determine if you qualify for financial assistance. Once the whole form is completed, you may send it to the Admissions Coordinator.

Step #2- Medical Record Review
We will request that medical records of the applicant be sent to us for review. Please have those records faxed to the attention of Admission Coordinator at (814) 467-6437. If the applicant is hospitalized, please request records to be faxed or made available to the Church of the Brethren Home by the social worker at the hospital.

Records that must be provided are as follows:

  • 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)

The following identification cards and documents must also be provided:

  • 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/POLST/Advance Directive (If applicable)

Once all of the information is submitted to the Church of the Brethren Home, our Admissions Coordinator will follow up with you for further information. If accepted and an appropriate bed is available, an appointment will be scheduled to discuss the admission process.


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