Forms

Health Care Center

Application for Admission to Christian Care Center – Mesquite
CPR is the Standard Order
Pre-Admission Questionnaire
Resident Interest Questionnaire
Spiritual Life Review & Assessment
Transfer to Hospital or Therapeutic Home Visit
Smoking Policy
Agreement of Benefits
Medicare Secondary Payer Manual
Responsible Party Appointment
Authorization and Releases
ProvideRX Pharmacy Network
Long-Term Care Ombudsman Program
Authorization for Release of Information to CCC
Statement of Resident Rights and Responsibilities
Human Resources Code
Texas Department of Human Services Information Regarding Authorized Electronic Monitoring
Electric Motorized Vehicle Operating Rules
Notice of Privacy Practices
Residency and Care Agreement
Mobile Vision Care
Dental Examination Authorization
Podiatry Request & Authorization Form
Policy and Procedures
Safe Resident Handling Program
Ancillary Services and Products Provided by CCC
Beauty Shop
SNF Determination on Admission
Living Wills / Durable Powers of Attorney
Texas Department of Aging and Disability Services / Advance Care Planning
Policy on Drug Testing and Criminal History Checks
Communiques Receipt Form

Greenway Village Forms

COST COMPARISON WORKSHEET
PREMIER CLUB APPLICATIONT

Hartin-McMillan

EMERGENCY CONTACT FORM
RETIREMENT Living Application for Hartin-McMillan

The Courtyard

Application Packet