It is appreciated if you would be as complete as possible when answering these questions. Answering all questions allows our Admissions Office to process your application as quickly as possible and to help serve you efficiently.
ADMISSIONS APPLICATION: Prior to admission you’ll be asked to provide copies of the following documents which may pertain to your loved one. Failure to provide copies of these documents may result in an admission delay.
Everyone is encouraged to call your insurance carrier directly to obtain details regarding your specific insurance coverage and benefit package. It is important to note that if you have benefits, you still must meet criteria / qualifications set forth by your insurance carrier. You should be aware, in advance, of placement of any potential deductibles and/or co-payment requirements. All long-term residents of Fairport Baptist Homes are required to appoint a Power of Attorney and have a Health Care Proxy.
Please be sure to give us the name and complete address of your current Physician (and other Specialists) so medical information may be obtained prior to admission. Your signature at the end of this form is necessary in order to obtain medical information from a phyisicain's office, hospital, and /or/clinic. Copies of this form may be included with letters requesting information on your medical condition.
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It is mandated that the Fairport Baptist Homes be notified three (3) months prior to the exhaustion of resources available for the applicants care so that hte Medicaid application can be initiated. The Fairport Baptist Homes reserves the right to request additional financial information including, but not limited to, copies of financial statements and/or the most recently completed 1089 form(s).
Please be advised that upon admission to the Fairport Baptist Homes skilled nursing that a security deposit equal to one months' (30 days) private room rate is required for all private pay Residents.
