Online Admissions Application

Required Paperwork 

(PRIOR TO ADMISSION) 

The Administration of this facility requests that copies of the following documents be submitted to admission personnel prior to the actual admission of a prospective resident. 

1. Copy of birth certificate and/or naturalization-citizenship papers. 

2. Copy of Social Security Card. 

3. Copy of all medical insurance cards such as Title XIX (Medicaid), Medicare and 

Blue Cross-Blue Shield etc. 

4. P.O.A. and/or Conservatorship papers. 

5. Proof of Identification. 

6. Proof of Income. 

7. QuantiFERON Gold test results. 

8. Physician Information (Name of Doctor, address, phone/fax). 

9. Bank Statements (2 years worth). 

1. Current Medication List. 

(UPON ADMISSION) 

  1. Current Medication List

  2. Physician Orders to administer medications.

  3. Scheduled appointment with the physician in the community.

We thank you in advance for your cooperation and understanding of the RCH admission requirements. Acknowledgment and acceptance of facility policy and procedures help to create a smoother transition period for prospective residents when admitted to the extended healthcare environment.