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If you decide to make Eastgate Manor your home, here are some necessary requirements. These screenings and documents will allow us to become the supportive environment you need.

You can access some of the required forms here.

Screenings

    • Determination of Need – three documents: 2536, OBRA I, and DON.
    • Our move-in coordinator will assist in determining the appropriate agency to complete the necessary assessments.
    • If you are currently hospitalized or in a Skilled Nursing facility, you can arrange for these documents to be forwarded to Eastgate Manor. Please discuss this with our Move-in Coordinator.
    • Eastgate Manor Assessment. We will schedule an appointment with our nursing staff.

 


 

Documentation

    • Medical Survey. This includes the results of a two-step TB test and a list of your current medications. Note: If you are currently in a Skilled Nursing Facility, you will be required to sign a release before that information can be forwarded to Eastgate Manor.
    • Health History Questionnaire. This can be completed by you or a family member.
    • Confidential Application. This can be completed by you or your designated representative.
    • Authorization of Release of Medical Information. This allows us to receive information from your doctor, or alternate healthcare provider, that will make us aware of your medical needs.
    • Responsible Party Designation. This allows you to identify a family member or other representative to whom Eastgate Manor is authorized to release information about your care or other concerns.

 


 

Miscellaneous Materials

    • Identification. Please include copies of the following cards (front and back)
      • Medicare Card or Primary Insurance Card
      • Primary Insurance
      • Social Security Card
      • Any supplemental insurance, including Medicare D
      • Federal or State-Issued Photo Identification
    • Advance Directives, any of the following that you have in place:
      • Living Will
      • Power of Attorney for Healthcare of Property
      • Do Not Resuscitate Order
      • Declaration for Mental Health Treatment

Note: As your directives can change, we request new copies of the most current documents in order to meet emergencies that may occur.

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