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Application Process

 
When you contact the admissions office you will be embraced by our staff.  Your application and medical information will be reviewed to determine if we can meet your needs at Providence Extended Care Center and we will strive to provide you with a timely and respectful admission.
 
To apply for admission there are several forms that need to be completed. Some are completed by you and some need to go to your doctor for completion.

 

Please complete the following forms:
Admission Application.pdfAdmission Application
Admission Requirements.pdfAdmission Requirements
Medicaid Guidelines.pdfMedicaid Guidelines
Medicare Coverage.pdfMedicare Coverage
Schedule of Charges.pdfSchedule of Charges
Take the following forms to your doctor for completion:
Admission Orders.pdfAdmission Orders
Long Term Care Authorization - LTC1.pdfLong Term Care Authorization - LTC1
Long Term Care Authorization - LTC2.pdfLong Term Care Authorization - LTC2
MI MR Supplemental Assessment.pdfMI MR Supplemental Assessment
Nursing Home Needs Assessment.pdfNursing Home Needs Assessment
TB Screening Form.pdfTB Screening Form

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For more information
To learn more about Providence Extended Care Center, please contact our admissions office at (907) 562-2281, Monday through Friday, 8 a.m. to 5 p.m. To find general information and specific health topics, visit our online health library.