Please bring the following information and items at the time of Admission.

· Resident Social Security Number

· Resident Insurance Card

· Resident Medications + Current List

· Resident List of Allergies or Special Health Alerts

· Church Contact - Person and Phone Number

· Name, Address, Phone Number of Physician to Follow (and sign death certificate)

· Date Last Seen by above Physician (required to be within 180
  days)

· Mortuary Name & Phone Number

· DNR/DNI signed order form

· Medical POA name and information

· Healthcare Directive

· Payment $2,800/week = ($400/day - check, VISA or MC)

· Names, Addresses, Phone Numbers of all Immediate Family &
  Friends for Contact and Bereavement Follow Up Lists

· Personal clothing items (including disposable briefs as
  necessary)

· Personal hygiene/grooming items (i.e. razor, makeup, lotion 
  etc.)