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Assisted Living Facility Package
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If you have a facility to house your assisted living patients, this is the package for you.

This package is for those who own a facility or home where you will house patients who need assistance.  This is not for visiting a patient in their own homes.  If you are visiting patients in their homes, please click here.

The following forms are included in this package:

  1. Assisted Living Resident HIPAA Information & Admission Application
  2. Assisted Living Admission & Service Fee Agreement
  3. Assisted Living Admission Room Reservation Agreement
  4. Assisted Living Acknowledgements
  5. Assisted Living Activity Assessment
  6. Accident / Illness Report
  7. Medication Log
  8. Medication Waiver
  9. Invoice
  10. Bad Check Notice

Please click on the names of the forms above to see a sample of the form as well as a more detailed description.

All of these forms will be delivered in Word, Works and PDF format.  Each and every form is completely editable in Microsoft Word and will come with instructions on how to open each file as well as how to edit (including adding a logo) for your convenience.

You may also choose to have the forms arrive to you with your business information already on the forms.  If you would like us to customize the forms for you, we will add your business information and logo (if provided) and send the files out to you personally.  This way you are ready to print and go.  This is a perfect option for those who are not so computer savvy.

Forms are an immediate download unless you would like them customized with your business information.  If you selected to have them customized, they are sent via email within 5 business days or less.  We do not ship the forms.

Payments accepted are Discover, Visa and Mastercard.  You may also pay with a check, money order or PayPal (must contact us for these payment methods).  

Please send us an email, click the live chat button to the right or call 484-348-4233 with any questions.

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