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NOTICE Of APPEAL
COMMONWIALTH O' 'INNSYLVANIA
COUI,-g"'-COMMON-'LIAf..' -
0' CIIMllULAND COUllTt
JUDICIAl. DIITlICl
FROM
DISTRICT JUSTICE JUDGMENT
NO. 09-3-03
COMMON'UASNo.
1(. - ///'1 6.;.J. T.u--
NOTICE Of APPEAL
Notic. is given that the appellant hen filed in the abo...e COUf' of Common Plem on oppeal from the judgment rendered by the Didrict Justice on tI,e
date and in the ellMt mentioned bel"",
"".tJ.D IRE JOB I.SOIl
A(lf)IW 01 AJIf'ILLANT ..-
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em !if AI!
z.c:oor-
NAMA 01 AIffUAN1'
~~~1lTII lIKST~5lOf"~_________-CAJ!.ISJ.,I.I-__-- PA "-...,,,
a...~96 L~1Ul ~JIIQ._R~-----[~~_'&'nl'!M'M!'ic!\\'
CV 19 9~111
LT 19 - :;." ." <'~.-
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1M block wiil be signed ONLY when this nolaHon i. requir.d under Po. R.CP.JP. No. /I appellant CLAIM- NT (see Pa, R,C'p,JP, No,
10088. .L
This Notic. 01 Appeal, when received by the Oi.lriel lu.He., w,1I operol. at a 1001(6) in action~! e Districl Justice, he MUST
SlJPERSfOEAS 10 the judgment Iaf po.....ion in lhi. ca... FILE A COMPLAINT within twenty (20) days alter
___ filing his NOTICE 01 APPEAL,
11013
$q1a/Uro 01 ProthonOtaly Of Deputy
PIAECI1'E TO ENTER RULE TO fiLE COMPLAINT AND RULE TO flU
(T/lis section 0/1oIm to be'usecJ ONLY when appellan/ WJS DEFENDANT Isee Pa. Fic.P.J.P. No. tOO/(7) /n action before DisIT/c/. Jus/ico.
IF NOT USED, detach from c~y 01 norlCo 0/ appeal to be served upon appellee). ' , , ,
PRAECIPE. To Prothonolary
Enter rul. upon
IF.ADER NURSTNr. DnMR
f\ano 01 <JWl]11W( 5 J
4~' 11/'1 ~'J1.f T" n
, oppeIIee(.), to file a eamplaint i~ this appeal
(Common Pleas Nn
) within lwenty (20) dayM. . 9lc. of rule or
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01 non pro~
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RULEI To tAD1!:1l NIIIISTNr. IIl1MR , appell..(.), '
Name 01 ,.._e/ll ',-' L
(1) You are noHIied thaI a rule i. hereby ""tered upon you 10 fil. a eomploinl in thll app.al within twenly (20) day. of lhe dale of
....ic. 01 !his rule upon you by per""",1 ",,,ic. Of by eerlified or regi'lered rol
(2)11 you do "';1 lite a eomploinl within Ihi. lime, a JUDGMENT OF NON PROS Will BE ENTERED AGAINST YOU,
(3) The date o' service of this rule if servKe was by moil is the date of moiling.
Date: Jet
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"MPS Screening Questionnaire", "Medicare Acceptance Policy". and "Authorization of Payment
of Medicare Benefits to Provider", true and correcl copies of which are appended hereto as
E,'thibit "B" and are incorporated by reference and which will hereafter be referred to as
"Admissions Agreements"
6. The" Admissions Agreements" were e~ecuted by the guardian pursuant to and
within the powers granted to her by the order appointing her as plenary guardian of Defendanl.
7 On April 24, 1995, the appointment of the guardian was e~tended by order of
court for an addilional period oflwenly (20) days. A lrue and correct copy of the order
extending the appoinlment is allached hereto and incorporated as Exhibit "C".
8 On April 25. 1995, the powers of the guardian were limiled by order of court, a
true and correcl copy of the order being allached herelo and incorporated as Exhibit "D", The
powers of the guardian were limited to paying medical e~penses and changing locks on the
residence of Defendant
9. By Ihe terms of orders of court, Ihe guardianship referenced above e~pired on or
about May 14. 1995.
10. The Defendant continued 10 reside in the facilily operated by Leader continuously
from April 28. 1995 to July 31, 1995. alllhe while receivinglhe benefits oflhe care and services
provided by Plainliff
lIOn or about July 31, 1995, the Plaintitl'signed herself out of the facility against the
medical advice of her physician.
12 The services rendered by Plaintitl"to the Defendant during Defendant's stay at the
facility were ordinary and necessary and conferred a benefit upon the PlaintilT.
.
.
IJ As of July J I, 1995, unpaid charges for Defendant's care amounted to $8,01627.
14 The Plaintiff' provided Defendanl with an in'/oice for the services rendered. A true
and correcl copy of an invoice to Plaintitl'is attached hereto and incorporated as Exhibit "E".
15. Plainlitl'has repealedly made demand upon the Defendant for payment oflhe
amount due and owing. Attached hereto as Exhibit "F" and made a part hereof is correspondence
from PlaintitT to Defendant demanding payment of the account balance.
16. Defendant has failed and refused to tender Ihe amounl due and owing.
17. Plaintiff's demand does not exceed the limits established for compulsory
arbitral ion.
COUNT I
18. PlaintitTincorporates by reference thereto the allegations set forth in paragraphs
one ( I) through seventeen (17) as though set forth allength.
19, The PlainlitThas performed all conditions precedent to recover under the
Admissions Agreements for services rendered to the Defendant.
20. Despite demand therefore, the Defendant has wrongfully failed and refused to pay
the amount due and owing 10 PlaintitT
21. The PlaintitT has breached the agreement to pay for Ihe services rendered to her by
Plaintiff.
WHEREFORE, Plaintil1: Manor HealthCare Corporation, requests that this honorable
court make an award to PlainlitT and againsl Defendant as follows:
I. $8,016.27 for services rendered;
2. cosls and interesl; and
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EXHIBIT A
RESIDENTS RESPONSIBLE PARTY AUTHORIZATION AND AGREEMENT
The undersigned has been legally appointed as the guardian, conservator, and/or holder
of a power of altorne~ to act on behalf of the Resident and shall serve as Responsible Party
for the Resident The undersigned has delivered to the Facility copies of the legal documents
designating the undersigned as the guardian, conservator, and/or holder of a power of attorney
of the Resident. In consideration of the Facility's agreement to admit the Resident to the Facility,
the undersigned, individually and personally, hereby warrants, represents, covenants and agrees
as follows:
1. That the undersigned will utilize the assets of the Resident to pay, when due, all costs
incurred by the Resident at the Facility, at the rates set forth in Exhibit G (Fee Schedule), and
arrange for the provision of personal clothing and care supplies as needed or desired by the
Resident and as required by the Facility.
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2. That the undersigned will utilize the assets of the Resident to replace any and all
furniShings or other property of the Facility or other residents or employees of the Facility
damaged by the Resident.
3. That all of the Information, Including but not IImited~t the Financial Data section, which
Is contained in the Application for Residency, dated _ "~ ,199 !S ,
and which Is attached hereto and made part of this Exhibi and made part of the Admission
Agreement, Is true and accurate as of this date and all assets listed In Application for Residency
are in fact available to Resident for the Resident's care while at the Facility.
4. That the undersigned, in both his/her Individual capacity and as ~....._
"'f'4( ,,-. \ . - . , will take no action to dissipate or otherwise trdnsfer tHe assets
of t/1e.Resident and/or assets which are available for the Resident's care, and all of which are
listed In said Application for Residency, nor allow any other third party to take such action, so
as to prevent such assets from being used to pay for the care of the Resident while at the
Facility.
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5. That when the assets available to pay for the Resident's care at the Facility are not
sufficient to pay for four (4) months of such care, prospectively, the undersigned will so notify
the Facility and will file, on behalf of the Resident, all applications and other documents neces-
sary or advisable to qualify him/her for all third party payor programs for which hEI/she may
be eligible, including Medicaid.
6. If the Resident Is a Medicaid Resident, that the undersigned will provide financial intor-
mation regarding monthly credits, increases and decreases in the Resident's bank account(s)
and other assets to the Facility to enable the Facility to provide requested financial data to
Medicaid representatives.
7. If the Resident is a Medicaid Resident or a Medicare Resident, that the undersigned will
utilize the assets of the Resident to pay charges not covered by the Medicaid or Medicare
program in a timely manner, and to notify the Administrator of the Facility of any problem
anticipated in paying such Charges.
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EXHIBIT "8"
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EXHIBIT Q
FEE SCHEDULE
The ~lIo~rg ra\84l., ,B~all apply to services and supplies
~'('~ %Q!1!.I1,~ft at the Facility.
provided to
1. Dailv Rate. The daily rate Is · . The monthly daily rate equals
the daily rate multiplied by the number of days In one month.
.See per diem rat$ schedule
2. Services and Supplies Included In Dailv Rate. The dally rate shall Include the following
(insert other included services and supplies):
· Routine Nursing Care
· Unens
· CJ Private Roo~Semi-Prlvate Room/D Triple Room (check one)
· Meals
· Activities
3. Supplemental Services ar.d Supplies, The daily rate does not include the following
services and supplies, which will be provided by the Facility upon the Resident's
request and attending physician order, at the rates set forth below:
o
Item
Rate
· Prescription Drugs
As determined by pharmacy.
· Non-Prescription Drugs
· Nursing Supplies
As determined by pharmacy.
Current price list available at Facility's
business office.
· Private Room
Determined by location and level of care
required.
· Physical Therapy
$
$
$
$
$
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· Occupational Therapy
· Speech Therapy
· Laundry (Personal Clothing)
· Nursing (Other than ordinary
nurslng caN)
· Personal Care/Comfort Items
(e,g, T.V., telephone, clothing etc.)
Determined by the Item requested.
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(Insert other services and supplies not Included in the daily rate, but available at the
Facility, with current rates.)
See attached fee schedule
Other charges available upon request in the business office
4. Additional Services and Supplies Paid Under Medicat9 PnxIram.
In addition to the services and supplies included in the daily rate, the following are
paid by Medicare:
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· Specialized Rehabilitative/Therapy services
· Approwd medications
· Nursing supplies
· Covered Special Equipment
5. Additional Services and Supplies Paid lJnder Medicaid Program,
In addition to the services and supplies included in the daily rate, the following are
paid by Medicaid:
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· Specialized Rehabilitative/Therapy services (to the extent cOllered and paid
uncler the stale plan.)
· Approved medications
· Nursing supplies
· Routine pesonal hygiene items and services (to the extent COllered and paid
fer under the state Medicaid plan.)
· All other services and ilems covered and paid for uncler the state Medicaid
plan.
· Special equipment (to the exlent covered and paid for under the state
Medicaid plan.)
· (Add any additlonaJ items)
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11. ~I...nt of Charges. The Facility may adJuet any and all rates at the lime upon
ltIirty (30) days r;lIlor written notice to the Resident, the Responalble Party and the Guarantor
(I' any) or, in the caae of an emergency or i' the level 0' care changes, with such prior
notice as is rusonably possible.
I/We acknowledge receipt 0' this Exhibit G and agree to comply with, and pay in accor-
dance with, this Exhibit a and with the Admla8ion Agreement.
RECEIVED BY FACIUTY:
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'1'1. Gera/d/yu ~fr8~91&411
_lor R_* PIlIly . PrInl8d Nome
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Service Dates:
MSP SCREENIN'G QUESTIONNAIRE
6er-ald/fU 7?ob/n Sd n Medicare No.: :(a t-J;-07'1&A
lj-.:JY- 95
Resident Name:
Ask all four questions ot each Medicare resident. It the resident responds "Ves" to any question,
continue to page two asking all applicable questions. The residant or representative should sign
the form whenever possible,
NOTE:
It is important tQ ask all questions and document all answers regarding MSP, A
provider may be held liable if an overpayment occurs and Medicare finds that the
provider furnished erroneous Information or failed to disclose facts it knew were
relevant to payment.
1, Is the resident covered by the Veterans Administration, the Black Lung Program or Workers
C;:oppensation?
LX..,) No: Proceed to question ,;;2
( ) Yes: Bill the other insurer prior to Medicare
G
2, Is the illness or injury due to any type ot accident?
(X,) No: Proceed to question 1;3 or ';;4
( ) Yes: Complete next page and continue with questions below
-31F 65 OR OVER
-41F UNDER 65
3. Is the resident 65 or over and employed, or is the spouse employed at time of service?
0<) No: Retirement Date: Resident J 'l.1.J
Spouse Al .I A
Continue: See Note Below
) Ves: Complete next page - Medicare may not be primary
4. Is the resident under 65 and covered under any Employer Group Health Plan (EGHP) or
L.afi8 Group Health Plan (LGHP)?
p<:) No: See note
( ) Yes: Complete next page - Medicare may not be primary
Note: If answer to all questions is "No", bill Medicare as primary,
If any response Is "Ves", continue to next page; Medicare may not be primary,
Resident/Representative Signature ':J/t;J/L~~ 1,dL
Date t/~~r- '15
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DEPAR11ENI' OF
'.' ; HEALTH AND HUMAN SERVICES
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Section I
H.I. CLAIM NUMBER
~/I?S(J. fltJ7-:l~ -tJ7 lj/J
APPOINTMENT OF REPRESENTATIVE
I appoint this Individual:
I""nl or type name and add_ oIlnd..oduaI you wonl to fWl)I'Oeenl yOU,)
to act as my representative In connection with my claim or asserted rlghl under Titles XI, or XVIII 01 the
Social Security Act I authorize this Individual to make or give any request or notice; to present or to elicit
evidence; to obtain inlormatlon; and to receive any notice In connection with my claim wholly In my stead.
ADDRESS :337 N. w~5f ":;'-f-"eel-
(!.nplis/e ,PJ) 1701 s..
tj-;;Y- 95
TELEPHONE NUMBER 4 -'10 '8.5
(A1e7tl., :li:/9 5'17:;'
DATE
Section \I
ACCEPTANCE OF APPOINTMENT
I, ' hereby accept the above appointment. I certifY' that I
have not been suspended or prohibited lrom practice belore the Social Security Administration or the
Heallh . Care, Fin1J1Clng Administration; that I am not, as ll' current. or. lormer olllcer or' employee. of the
United :States, dlsQualllled.lrom acting as the claimant's representative; and that I will not charge or
receive any lee lor the representation unless It has been authorized In accordance with the laws and
regulations referred to on the reverse side hereof, In the event that I decide not to charge or collect a
lee lor the representation I will notify the Social Security Administration and the Health Care Financing
Administration !comoletlon.Df Secllon III (ocllonal) satisfies .this reauirement),
I am alan L~censeC1 Nurs~nq Home Aa.ml-n...stra't.or
(Attorney, unm repreaentallYe. rela~I~I.W student, etc.)
SIGNATURE (Representative)
ADDRESS
940 Walnut Bottom Rd " ,,-',
'Carlisle, P1. 17013 '
TELEP~IONE NUMBER
(AreaCodeI (717) 249-0085
DATE
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Section III WAIVER OF FEE OR DIRECT PAYMENT
(Note to Representallve: You may use this portion of the lorm to waJve a fee or to waive direct payment
01 the fee from withheld past-due benellts,) , "<, . " ' ,'.' '.<,
I waive my right to charge and collect a fee for representi"g~'(:;-e:rald/tt.i .1?ob//l5~'1''':
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belOl8 the Social Security Admlnlatratlon or Health Care Financing Admlnlatrallon.
I DATE
SIGNATURE
(See ~l "*""..do' en_I
FORM HCFA-1898-U4 \10-84)
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CHARGING OF FEES FOR REPRESENTING BENEFICIARIES BEFORE THE SOCIAL SECURITY ADMINISTRATION
An attorney, or arher representative. who wishes to
charge a tee tor services renoered In connection
with a claim oetore the Social Security Administration
IS reQulled by law to oOtaon approval of the fee from
the Social Security Administration or the He 11th Care
FinanCing Administration (sections 2061a) and
1631(d)(2) of the Social Security Act; sections
404,1720 and 416.1520 of Social Security Admini-
stration Regulations Nos, 4 and 16, resoectively I. If
lhe representative Wishes to waive a fee or to waive
direct payment of the fee from past-due Social
Security benefits, he may do so. Section III on Ihe
front of this form can be used for that purpose,
The form SSA-1560-Y 4, 'Petltlon to Obtain Approval
of a Fee tor Representing a Beneficiary belore the
Social Security Administration, eliCits the Informa-
tion required to be submitted in support of fee
petitions, It should be completed by the represent-
ative after services are completed and the original
and third carbon copy of the SSA-1560-U4 flied
with the office of the SocIal Security Administration
or the Health Care Financing Administration which
took the lalest action on the claim, The represent-
ative is required to furnish the "Clalmant's/Beneficlary's
Copy" of the SSA-1560-U4 petition to the claimant
for whom the services were rendered,
Social Security Administration approval of a fee IS
not required where the fee is for services (11 rendered
in an ottlclal capaCity such as that of legal guardian,
committee, or Similar court-appoonted ottice and the
court has approved the fee in Question, 12) in rep-
resenting the beneficiary before a court of law, or
(3) in representing the benefiCiary in a claim for
reimbursement of medical expenses exclusively
handled by a private intermediary, Where a repre-
sentative has rendered services In a claim before the
Social Security Administration and a court of law, the
regulations require that the amount of the fee to be
charged, if any, for services performed before the
Social Security Administration be speCified, If any fee
Is to be charged for such services. a petition for
approval of that amount ",ust be submitted, In this
connection a claim which has been remanded by a
court to the Social Security for lurther administrative
proceedings Is considered to be before the Social
Ser.urity Administration after the remand by the court.
FORM HCFA-18e8-U4I to-e41
AUTHORIZATION OF FEE
The SOCial secunty regulations contemplate that J
representative Will receive fall 'Ialue tor the serVices
perf':lrmed before the SOCial Security Administration
on behalf of a claimant while at the same time gIVIng
J measure of secunty to the benefiCiaries, In appro'lIng
a requested fee, the SOCial Security Administration
or the Health Cdre FinanCing Administration conSiders
the nature and type of services performed, the
comple.,ty of the case, Ihe level of skill and
competence required In rendition of the services. the
amount of time spent on the case, the results
achieved, the level of administrative review to which
the reprasentative carned the claim and the amount
of the fee requested by the representative, When a
fee is authorized, both the representative and the
claimant are notified and allowed 30 days In which
to request an administrative review in case of
disagreement.
CONFLICT OF INTEREST
Sections 203, 205 and 207 of Tille XVIII of the
United States Code make it a criminal offense for
certain officers, employees and former ottlcers and
employees of the United Stales to render certaon
services In mailers atfecting the Government or to
aid or assist In the prosecution of claims against the
United States.
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RESIDENT JRESPONSIBLE PARTY AUTHORIZATION FORM
'1-;)<;-95 ',' ~'e.YaJd;JU 'Ko/;/115tJlL
Dal. R._r. Neme
(For the purposes of this document, the term I references the Resident/Responsible party or
Guarantor as noted on the signature line page 2.)
AMBULANCE I hereby give my permission to the Facility that, in the event I have to be trans-
ferred to a hospital and must go by ambulance, the Facility hss my permission to order !Sid
vehicle and I will assume responsibility for payment.
PODIATRIST:
I hereby authorize use of the services of Dr, , who will
examine the Resident and bill me directly. I assume full responsibility for payment
of aU charges,
I will arrange transportation for the Resident to the Podiatrist's Office.
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.
I prefer Dr, Ci"~Q'^.
provide podiatric care.
, who is willing to visit the Facility to
DENTIST:
x:
I hereby authorize the use of the services of Dr, , who
will examine the Resident and bill me directly for each visit. I assume full responsibility
for payment of all charges.
I will ar~ar.ge transportation for the Resident to the Dentist's oHice. f)c .tee\-",
Dr. 't . \\ f will visit the Resident In the Facility,
G
CUNIC APPOINTMENTS: The Responsible Party or Guarantor agrees to accompany the
Resident on regularly scheduled clinic or hospital appointments ordered by the Resident's
physician. The Responsible Party/Guarantor will be notified In advance In order to make the
necessary arrangements for the clinic or hospital appointments.
The Facility will, when medically necessary, accompany the Resident. A charge will be made
for the employee's time, based at their hourly wage for the number of hours reQUired for the
appointment.
RESIDENT OUTINGS:
I hereby desire/give my permission for the Resident to go on outings with Facility
supervision. I understand that the Facility would be
doing this service and I therefore will remain In full
NtANOR HEALTHCARE
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responeiblllty during this time, I also understand that participation Is subject to physician
permla8lcn, Some outings may require a small lee, which will be added to the regular
monthly statement.
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I do not desira/give permission for the Resident to go on C'Utings with Facility
supervision.
The Ambulance, Podiatrist, and/or Dentist listed above are Independent contractors and
providers and are not employees, agents or representatives of the Facility and thus they, and
not the Facility, are responsible for their own actions,
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08101 R8l1ldanr. S1Qnalure
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Oal. '. Signature
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ACCEPTED BY FACIUTY
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The underalgned ReaIdent andlor the undersigned Responsible Party acknowledges
receipt of the Resident Personal Fund Account Procedure and halle had explained, to their
satisfaction, all of their questions.
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Resident or Responsible Perty . PrInted Name
Oete
I/We authorize the Facility to establish a Resident Account for melthe Resident in
accordance with the Resident Personal Fund Account Procedure. In addition to the Resident,
the following persons are authorized to withdraw monies from the Resident Account (if none,
write in NONE): N 0 "'--l
"Name
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Resident or Responalble
"Witness. required In the State 01111111018
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Name
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"Name
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Oete
Name 01 Reaident
* Cannot be Employee of Facility or have any
financial interest in the Facility,
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ADMISSION AGREEMENT
CONTRACT BETWEEN RESIDENT AND FACILITY
pjTHI$.ADMISSIO~~GREEMENT (the "Agreement") is entered into this ~V_ day of
_!:.l.1 ,19 _ __ ,between Lea er - a 1 sle (the "Facility"),
rnklt'iu J::} ~.f(J}f (the "Resident"), and/or (the
"Responsible Party"). As used herein, the term "Resident" shall also mean the Responsible
Party, if any, The parties agree as follows:
1. Commencement. This Agreement shall begin on the date of admission of the Resident
to the Facility.
2. Termination of Agreement, Discharge and Transfer,
a Termination by Resident. The Resident may terminate this Agreement by giving
the Facility at least five (5) days advance written notice, The Resident is responsible for
payment of all Charges for five (5) days after notice is given, or until the Resident actually
leaves the Facility whichever is last. It the Resident leaves tl'.e Facility (i) before the attending
physician discharges the Resident, or (iI) against medical advice, the Resident and Respon-
sible Party agree to assume all responsibility for injury or harm to the Resident, and hereby
release the Facility, its employees and agents, from all liability connected with such
departure.
b. Termination by Facility. The Facility may terminate this Agreement and discharge
the Resident upon at least thirty (30) days prior written notice if (1) the Resident's needs
cannot be met; (2) the Resident presents a danger to the health or safety of other Indivi-
duals; (3) the Resident fails to pay Charges for supplies or services after notice; (4) the
Resident's health has improved sufficiently so that the Resident no longer needs the
services provided; or (5) the Facility ceases to operate. However, the Resident may be
transferred or discharged upon less than thirty (30) days notice if: ( 1) an immediate trans-
fer or discharge is required due to the Resident's medical needs; (2) the Resident presents
a threat to the health and safety of individuals in the Facility; or (3) the Resident has not
resided in the Facility tor thirty (30) days. Such notice shall be given as soon as practicable.
The Resident acknowledges receipt from the Facility of materials as to the Resident's right
to appeal a discharge decision with State authorities and the appeals process. If this
Agreement is terminated and/or the Resident is discharged by the Facility, the Respon-
sible Party agrees to accept custody of the Resident upon discharge and cooperate with
the Facility to facilitate the Resident's discharge.
3, Responsible Party, The Resident's Responsible Party may be any person legally
responsible for the Resident, including a court-appointed guardian or conservator, or a
person holding a power of attorney, A Responsible Party who Is also a guardian, conser-
vator, or holder of a power of attorney must execute this Agreement and the Resident's
Responsible Party Authorization and Agreement attached as Exhibit A, and must provide
the Facility with a copy of legal documentation regarding his/her appointment.
MANOR HEALTHCARE
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b. Medicant Beneflciarfes. The services and supplies ir.eluded in the Facility's dally rate
will be provided to Medicare residents, as well as services and supplies noted on the Fee
Schedule sa being Included in the Medicare rate, The Resident is responsible for paying any
Medicare co-insurance amounts. The Resident understands that Medicare eligibility and
coverage is established by federal guidelines which currently limit payment to a fixed number
of days. If the Resident enters the Facility and the Medicare application is denied, the Resident
shall be liable for all charges as provided In the Fee Schedule, The Resident is responsible for
payment for items covered by Medicare supplemental insurance. and the Resident is respon-
sible for applying for reimbursement from his/her insurer,
(Choose one and cross out, date, and all parties Initial the inapplicable Section 7(c),)
c. Medicaid Benefi 'ries, The Facility does n rrently participate In the Medicaid
program. Accordingly, perso who are ad' as private pay residents will be unable to
COlllltlrt to Medicaid status. In 0 er to f ' ate proper discharge planning, the Resident and/or
ResponSible Party agree to provl e Facility with at least four (4) months prior written notice
ot the Resident's becoming 'Ible f coverage under the Medicai9 program or their not being
able to pay privately, itial Date ~ Ql y - '15
or
c. Medicaid Beneficiaries. If required by the Medicaid program, a Resident must have
pre-admission approval. If the Resident believes he/she qualifies as a Medicaid Resident,
he/she shall promptly complete and submit all documents necessary to apply for Medicaid
coverage. It Medicaid coverage is denied, the Resident will be liable for all Charges as provided
in the Fee Schedule, from the admission date, When Medicaid pays for only a portion of the
incurred charges, the Resident is responsible for paying his/her portion, as determined by state
Medicaid regulations. This charge will be billed to tr.e Resident by the Facility and shall be paid
in accordance with Section 7(a), The Resident shall also be responsible for payment of Facility's
current charges for any requested non-Medicaid covered services or supplies. The services
and supplies Included in the Facility's daily rate, and all other services and supplies noted on
the Fee Change Sheet as being included in the Medicaid rate, will be so provided. If the Resi-
dent is a Medicaid resident, he/she will provide financial information regarding monthly credits,
increases or decreases in the Resident's bank account(s), and other assets to the Facility to
enab"-lhe ~aciVt;f~to provide req~r~;nF~ data to Medicaid representatives.
InitiaIUl'~ ~ Date
d. Insurance Coverccge, The Resident is responsible for, and shall pay, the daily rate
and Charges for supplemental services and supplies not timely paid by any insurer, as well as
applicable co-insurance and deductible amounts.
e. Rate Adjustments. The Facility may adjust the daily rate or the Charges for supple-
mental services or supplies for any or all residents, with at least thirty (30) days' written
advance notice or, in the event of an emergency or in the event the level of care changes, with
as much notice as is reasonably possible. Ally such adjustment shall be deemed agreed to by
the Resident or Responsible Party unless the Facility is notified in writing to the contrary within
ten (10) days after mailing such a notice, If the Resident does not consent to the rate adjust-
ment, the Resident agrees to leave the Facility no later than the day before the rate increase is
effective,
3 of 7
Rev. t/94 A4. AS