Documentation Needed
Serving Southern Orange County, NY
and Sussex & Passaic Counties, NJ.
Thank you for choosing Mount Alverno Center!!
In order for the Admission process to be completed, we will require the following documentation:
- Patient Review Instrument (PRI) completed within the last 90 days (Cost is $90.33 payable to the Home Health Care Agency used).- Mandatory for Assisted Living Program residents.
- A Joint Assessment screen must be performed by the Mt. Alverno Case Manager and Good Samaritan Hospital representative prior to admittance (screen is good for thirty days). Mandatory for Assisted Living Program residents.
- Adult Home residents are not require to have the PRI and Joint Assessment listed above completed, however, they must be interviewed prior to admission to review needs and ascertain correct placement .
- Completed Medical and Mental Evaluation signed by resident’s Physician within the last 30 days.
- Immunization Record with PPD test completed and read within the last 30 days. Either a Nurse or Physician must sign this.
- Mt. Alverno Center offers a Friday afternoon Happy Hour and the resident’s doctor would need to sign off on the Happy Hour form to inform the Activities and Nursing staff if any alcoholic beverages are allowed.
- Physician’s Prescriptions for ALL medications, including over-the-counter medicines. All medications require “scripts” in accordance with NYS Adult Care regulations Faxed copies will be accepted prior to admissions but ORIGINALS MUST BE PRESENTED AT TIME OF ADMISSION. All medication that the resident has upon arrival is to be given to Nurse’s station for medication monitoring/administration.
- Copy of Social Security card, Medicare card, Medicaid card, and any other insurance card.
A blank Inventory listing will be provided to each resident/resident family that wish have property held by the facility for safe keeping in accordance with NYS DOH Regulation 487 . 6 (e) .
In addition to the above noted documentation any advance directives that may currently be in place, such as DNR, Health Care Proxy, Living Will and/or Power of Attorney should be presented either before or at the time of Admission. A blank Health Care Proxy/Instructions and a DNR Order/Refusal of DNR Order will be provided to you for completion prior to admission.
Any equipment prescribed to resident (i.e.: walker, cane, shower chair) should be brought with the resident’s belongings. If any equipment is needed, it must be ordered for the resident prior to admission, so it is available immediately.
Mount Alverno Center provides a laundry service of washable clothing for all residents . Clothing must be labeled by our Laundry Department in order to prevent loss . Please leave clothing with our receptionist in the Lobby at the time of admission . Any clothing entering the Center after the Admission date, must be accompanied by an inventory listing of clothing and left with the front desk to be sent to the Laundry department for labeling . The receptionist has a supply of blank inventory forms . Please bring a clothes hamper for the new resident’s room .
Mount Alverno Center uses ELKA MPS Inc ., a Long Term Care Pharmacy for delivery of medicinals for many of the residents . You are not required to use ELKA MPS Inc . but if you are choosing another pharmacy please let us know so any medication ordered will be from the pharmacy of your choice . Pick up of prescriptions would be the family’s responsibility if ELKA is not used .
In accordance with New York State regulations, we will need the name of a Funeral Home to be used for our records. This choice may be changed at any time however a name must be provided prior to admission.
Please contact me with the pharmacy and funeral home information before the admission date.
I can be reached Monday through Friday at (845) 987-5640. If I am not available, please leave a voice mail message, and I will return your call. Thank you.
Sincerely,
Daria M. Gargan
Account/Admissions Director
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