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This document is for Massachusetts Nursing Facilities to provide and update demographic information to the Division of Health Care Finance and Policy. It details requirements for filing, including

How to fill out nursing facility demographic information

How to fill out NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM

1. Begin by entering the facility name at the top of the form.
2. Fill in the address of the nursing facility including street, city, state, and zip code.
3. Provide the phone number and fax number of the facility.
4. Enter the date of admission for the patient.
5. Complete the section for the patient's personal information, including full name, date of birth, gender, and social security number.
6. Fill out the insurance information, including provider name and policy number.
7. Specify the emergency contact details, including their relationship to the patient and contact information.
8. Review all entries for accuracy before submitting the form.

Who needs NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM?

1. The NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM is needed by healthcare providers, nursing facilities, and associated staff to collect essential demographic data for patients being admitted to the facility.

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What is NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM?

The NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM is a document used to collect demographic data about residents in a nursing facility, including their personal and medical information.

Who is required to file NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM?

Nursing facilities that receive federal or state funding are required to file the NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM for each resident to ensure compliance with regulations.

How to fill out NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM?

To fill out the NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM, staff should accurately enter each resident's personal information, health status, and relevant demographic details as instructed on the form.

What is the purpose of NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM?

The purpose of the NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM is to gather essential demographic and health data about residents to support facility operations and regulatory compliance.

What information must be reported on NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM?

The information that must be reported on the NURSING FACILITY: DEMOGRAPHIC INFORMATION FORM includes resident's name, date of birth, gender, medical history, admission dates, and other relevant demographic details.