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Therapeutic Leave Pass and Bed Hold Form - MagellanofAZ

Therapeutic Leave Pass and Bed Hold Form - MagellanofAZ 2026

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The document is a Therapeutic Leave Pass and Bed Hold Form used by a facility to request a therapeutic leave for a recipient, outlining the dates, goals, and objectives related to their treatment plan. It also includes a bed hold request ensuring the recipient can return to the same bed after hospitalization for short-term stabilization.

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Click ‘Get Form’ to open the Therapeutic Leave Pass and Bed Hold Form in the editor.
Begin by entering the Facility Name and Recipient Name at the top of the form. This identifies where the request is coming from and who it pertains to.
Fill in the Date of Birth (DOB) of the recipient to ensure accurate identification.
In the 'Therapeutic Leave Pass Request' section, specify the Dates Requested by entering both Start Date and End Date for the leave.
Clearly outline the Goal and Objective of the Pass, ensuring it aligns with treatment needs.
Identify a Specific Goal in the Treatment Plan that relates to your stated Goal and Objective, providing context for your request.
For Bed Hold Request, ensure that you understand that hospitalization is a short-term intervention. Fill in the name of your facility where indicated.
Finally, have a Facility Representative print their name, title, and provide their signature to validate the form before submission.

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What is a bed hold in medical terms?

Bed hold means the right of an individual to resume nursing facility residency after he or she has been away from the facility due to hospitalization or therapeutic leave.

What are the rights of residents in assisted living in Georgia?

Each resident must have the right to participate in social, religious, and community activities that do not interfere with the rights of other residents. (i) Each resident must have the right to be free from mental, verbal, sexual and physical abuse, neglect and exploitation.

What is the bed hold benefit?

Bed-hold policies pay nursing homes to reserve the bed of acutely hospitalized Medicaid residents, and they vary across states in the proportion of the average daily rate paid for bed-hold and the number of days covered. Some states also require a minimum facility occupancy rate to allow bed-hold payments.

What does hold for bed mean?

Bed hold means the facilitys policy for retaining a bed or room for a resident during the time that the resident is temporarily absent from the facility; the policy shall include time frames for the bed hold, acceptable conditions for the bed hold and any associated charges.

Can families stay overnight in a nursing home?

Generally speaking -- Yes! If a patient requests for companionship overnight most skilled nursing facilities will encourage the support.

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What is the bed hold policy in Georgia?

Bed-Hold Policies In Georgia, Medicaid will pay for a hold on a residents bed during the residents absence for up to seven days. Family members or others may arrange for the nursing home to hold the bed for a longer period of time.

Therapeutic Leave Pass and Bed Hold Form - MagellanofAZ 2026

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