Form online 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting the type of admission: either 'Skilled Nursing Home Admission' or 'Swing Bed Admission'. Enter today's date and the date of admission.
3. Fill in the patient information section, including the patient's name, member ID, date of birth, and PMI.
4. Select the appropriate UCare plan from the provided options. If applicable, note that a different form is required for certain plans.
5. Complete the admitting location details by indicating whether the admission is from a community or hospital. Include relevant dates and diagnosis codes.
6. Provide facility information such as facility name and NPI number, along with contact details for any questions.
7. Indicate if this is an initial admission or a discharge by selecting from the options provided. Include any necessary reason codes for changes or updates.

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