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Oregon move out notice

Page 1 of 124 DEPARTMENT OF HUMAN SERVICES AGING 2025

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The document is a Notice of 30-Day Involuntary Move-Out for residents of a Residential Care/Assisted Living Facility in Oregon. It outlines the reasons for the move-out, which may include exceeding personal care needs, unsafe behavior, medical conditions, or non-payment. The notice informs the resident of their rights to request an administrative hearing if they disagree with the decision and provides contact information for assistance.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the last name and first name of the individual receiving the notice in the designated fields.
Fill in the date issued, ensuring it reflects the correct day of issuance.
Specify the facility type by selecting from options such as ALF, MCC, RCF, or SNC.
Complete the address section with accurate details including city, state, and ZIP code.
Provide a telephone number and email address for further communication.
Review the reasons for move-out listed on the form and ensure they are clearly stated. You may need to add specific reasons if applicable.
Sign and date where indicated for both the facility representative and yourself if necessary.

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