Religious Affiliation Due Diligence: Note: Evidence (e.g., written admission policy, patient/resident application form, written hiring policies, codes of conduct, website information, statistical information, etc.) of each stated fact should be included in this tab. ANSWER (Yes or No) QUESTIONS Please provide explanations as requested – Attach additional pages as needed Admission Policies Yes No (please explain) Does the facility admit patients or residents of all religions and faiths? Yes (please explain) No Are patients/residents ever turned away because of their religious affiliation? Yes (please explain) No Does the facility grant any preference, priority or special treatment with respect to admission, treatment, payment, etc., based on religion or faith? Yes (please explain) No Does the facility focus on the needs of, market to, or target, a particular religious population? Yes (please explain) No Does the facility discourage individuals from seeking admission to the facility on the basis of religion? Yes (please explain) No Is it the to serve facility’s mission patients/residents of a particular religion? What percentage of the patients/residents admitted and treated at the facility are of the same religious denomination as the religious affiliation? facility’s Hiring and Employment Practices Yes No (please explain) Does the facility hire employees and medical staff that are of all religions and faiths? Yes (please explain) No In hiring employees and medical staff, does the facility give preference to Applicants of a particular religion?
Religious Affiliation Due Diligence: Note: Evidence (e.g., written admission policy, patient/resident application form, written hiring policies, codes of conduct, website information, statistical information, etc.) of each stated fact should be included in this tab. QUESTIONS ANSWER (Yes or No) Please provide explanations as requested – Attach additional pages as needed Admission Policies Does the facility admit patients or residents of all religions and faiths? Yes No (please explain) Are patients/residents ever turned away because of their religious affiliation? Yes (please explain) No Does the facility grant any preference, priority or special treatment with respect to admission, treatment, payment, etc., based on religion or faith? Yes (please explain) No Does the facility focus on the needs of, market to, or target, a particular religious population? Yes (please explain) No Does the facility discourage individuals from seeking admission to the facility on the basis of religion? Yes (please explain) No Is it the facility’s mission to serve patients/residents of a particular religion? Yes (please explain) No What percentage of the patients/residents admitted and treated at the facility are of the same religious denomination as the facility’s religious affiliation? Hiring and Employment Practices Does the facility hire employees and medical staff that are of all religions and faiths? Yes No (please explain) In hiring employees and medical staff, does the facility give preference to Applicants of a particular religion? Yes (please explain) No
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