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.
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.
