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DPH 05-022 Standard Admission Agreement

Final Documentation

Updated Informative Digest

Final Statement of Reasons and Addendas I - VI (Lists of Commenters and Comments)

Approved Regulation Text

Required Statements

Standard Admission Agreement

Table of Contents

Attachment A, Facility Owner and License Identification

Attachment B-1, Supplies & Services Included in Basic Daily Rate for Private Pay & Privately Insured Residents

Attachment B-2, Optional Supplies & Services Not Included in Basic Daily Rate for Private Pay & Privately Insured Residents

Attachment C-1, Supplies & Services Included in the Basic Daily Rate for Medi-Cal Residents

Attachment C-2, Supplies & Services Not Included in the Medi-Cal Basic Daily Rate that Medi-Cal Will Pay the Dispensing Provider for Separately

Attachment C-3, Optional Supplies & Services Not Covered by Medi-Cal that May be Purchased by Medi-Cal Residents

Attachment D-1, Supplies & Services Covered by the Medicare program for Medicare Residents

Attachment D-2, Optional Supplies & Services Not Covered by Medicare that May be Purchasd by Medicare Residents

Attachment E, Authorization for Disclosure of Medical Information

Attachment F, Resident Bill of Rights

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Last modified on: 2/7/2012 11:13 AM