Forms

The Admissions Contract and Supplemental Documentation for new Admissions:

• • • Admissions Packet
    • Application for LTC MaineCare
    • Employee New Hire Packet
    • Guardian Pharmacy Resident Enrollment Form
    • MAXIMUS Referral Form

Required Walgreen Vaccination and Informed Consent Form:

• • • Resident Authorization and Informed Consent for Vaccination

Additional Vaccination Forms:

• • • Resident Handout – What to Expect
    • Facility Tip Sheet

Forms to Access Resident MaineCare Information:

• • • Appointment of Authorized Representative
    • Authorization To Release Information

The following are forms used within the Golden Acres organization:

• • • Walkthrough Checklist
    • Vista Sign In Sheets
    • Vista Sign-In-Sheets – Monday Entry
    • Temperatures
    • Task Reviews
    • Nurses Notes