Get the free Nursing Facility Tracking Form - dhcfp state nv

This document provides instructions for the completion of the Nursing Facility Tracking Form, which is used to notify the Medicaid Central Office of any nursing facility admission, discharge, or death

How to fill out nursing facility tracking form

How to fill out Nursing Facility Tracking Form

1. Begin by entering the facility's name and address at the top of the form.
2. Fill in the date of the report.
3. Provide the names and contact information of the staff responsible for completing the form.
4. Record the number of residents currently in the facility.
5. List any residents who have experienced changes in their health status.
6. Document any admissions, discharges, or transfers that occurred during the reporting period.
7. Indicate the staffing levels and any significant changes in staff.
8. Note any incidents or events that may have impacted resident care.
9. Sign and date the form at the bottom.

Who needs Nursing Facility Tracking Form?

1. Nursing facilities are required to complete this form for regulatory compliance.
2. Healthcare providers involved in the care of residents.
3. Regulatory agencies for monitoring resident health and safety.
4. Families of residents may also benefit from understanding the care provided.

For pdfFiller’s FAQs

What is Nursing Facility Tracking Form?

The Nursing Facility Tracking Form is a document used to collect and report information regarding the admissions and discharges of residents in nursing facilities.

Who is required to file Nursing Facility Tracking Form?

Nursing facilities that receive reimbursement from state Medicaid programs are typically required to file the Nursing Facility Tracking Form.

How to fill out Nursing Facility Tracking Form?

To fill out the Nursing Facility Tracking Form, facilities must provide accurate resident data, including personal details, admission and discharge dates, and any relevant measurements or assessments requested in the form.

What is the purpose of Nursing Facility Tracking Form?

The purpose of the Nursing Facility Tracking Form is to ensure proper tracking of residents for care management, reimbursement purposes, and to comply with state and federal regulations.

What information must be reported on Nursing Facility Tracking Form?

The form must report information such as resident identification details, admission and discharge dates, the reason for admission or discharge, and any changes in the resident's health status.