Nursing Home Notice of Involuntary Transfer or Discharge 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the resident's name and Medicaid ID (if applicable) in the designated fields. This information is crucial for identifying the individual involved.
3. If applicable, fill out the resident representative's details, including their name, address, and phone number.
4. Specify the place where the resident is being transferred, including the name, address, and phone number of that location.
5. Complete the current nursing home’s information along with a contact person’s details. This ensures clear communication regarding the transfer.
6. Indicate the date when notice was provided and the proposed move date. Remember that a nursing home can move a resident 30 days after giving this notice unless an appeal is pending.
7. Select a reason for discharge or transfer from the provided options. If medical reasons are checked, ensure a doctor's agreement is documented.
8. Provide any additional comments or explanations regarding why the nursing home wants to move the resident in the space provided.
9. Finally, ensure all signatures are obtained from relevant parties before distributing copies as required.

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