Facility Bed Reserve % Bed Reserve Policy Notification Provide One Copy to Resident/Authorized Representative Complete Form and Obtain Signatures Resident Fund Policy Notification and Provide One Copy to Resident/Authorized Representative Authorization Keep Original for Facility Records Complete Form Laundry Services Provide One Copy to Resident/Authorized Representative Keep Original for Facility Records Notification of Facility Policy Regarding Personal Provide One Copy to Resident/Authorized Representative Property Complete Form and Obtain Signatures Authorization to Inspect and Open Official Provide One Copy to Resident/Authorized Representative Correspondence Keep Original for Facility Records Special Notifications: Resident Council Provide One Copy to Resident/Authorized Representative Care Plan Conferences Participation in Resident Field Trips Special Notice to Families and Visitors Complete Form and Obtain Signatures Audio, Video and Photographic Release Form Provide One Copy to Resident/Authorized Representative Keep Original for Facility Records Financial Notifications and Information Assignment of Medicare Benefits and Authorization for Release of Information Obtain Information and Signatures Your Benefits Under Medicare Provide One Copy to Resident/Authorized Representative Choose the Appropriate Form, For Single Individuals or Your Benefit Rights and Eligibility Information Married Couples With One Person in the Community) Medicaid Provide One Copy to Resident/Authorized Representative Medicaid Services and Supplies Covered by the Illinois Medical Assistance Program Provide One Copy to Resident/Authorized Representative
Bed Reserve Policy Notification Facility Bed Reserve % Provide One Copy to Resident/Authorized Representative Resident Fund Policy Notification and Authorization Complete Form and Obtain Signatures Provide One Copy to Resident/Authorized Representative Keep Original for Facility Records Laundry Services Complete Form Provide One Copy to Resident/Authorized Representative Keep Original for Facility Records Notification of Facility Policy Regarding Personal Property Provide One Copy to Resident/Authorized Representative Authorization to Inspect and Open Official Correspondence Complete Form and Obtain Signatures Provide One Copy to Resident/Authorized Representative Keep Original for Facility Records Special Notifications: Resident Council Care Plan Conferences Participation in Resident Field Trips Special Notice to Families and Visitors Provide One Copy to Resident/Authorized Representative Audio, Video and Photographic Release Form Complete Form and Obtain Signatures Provide One Copy to Resident/Authorized Representative Keep Original for Facility Records Financial Notifications and Information Assignment of Medicare Benefits and Authorization for Release of Information Obtain Information and Signatures Your Benefits Under Medicare Provide One Copy to Resident/Authorized Representative Your Benefit Rights and Eligibility Information Medicaid Choose the Appropriate Form, For Single Individuals or Married Couples With One Person in the Community) Provide One Copy to Resident/Authorized Representative Medicaid Services and Supplies Covered by the Illinois Medical Assistance Program Provide One Copy to Resident/Authorized Representative
Resident%20and%20Facility%20Contract.docx