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STATE OF MARYLAND DEPARTMENT OF HEALTH (MPH) OFFICE OF HEALTH CARE QUALITY (ONCE)Form Revised 06/2018 DHH Form AL.APP.1.1.IN.3ASSISTED LIVING APPLICATION INSTRUCTIONS FOR COMPLETION Incomplete applications

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How to fill out assisted living application

01

Step 1: Gather all necessary documents such as identification, medical records, and financial information.

02

Step 2: Contact the assisted living facility or visit their website to obtain an application form.

03

Step 3: Fill out the application form completely and accurately.

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Step 4: Attach any required documents along with the application.

05

Step 5: Review the completed application to ensure all information is correct.

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Step 6: Submit the application either by mail or in person.

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Step 7: Follow up with the assisted living facility to confirm receipt of the application.

08

Step 8: Wait for a response from the facility regarding the status of your application.

09

Step 9: If accepted, complete any additional steps or paperwork as instructed by the facility.

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Step 10: Prepare for your move to the assisted living facility as directed by the facility staff.

Who needs assisted living application?

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Assisted living applications are typically needed by individuals who require assistance with daily activities such as bathing, dressing, medication management, and meal preparation.

02

This may include elderly individuals who have difficulty living independently, individuals with disabilities, or those recovering from an illness or surgery.

03

Ultimately, anyone who can benefit from the services and support provided by an assisted living facility may need to fill out an application.

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What is assisted living application?

Assisted living application is a form used to apply for residency in assisted living facilities where seniors can receive assistance with activities of daily living.

Who is required to file assisted living application?

Seniors or their legal guardians are required to file assisted living application.

How to fill out assisted living application?

Assisted living application can be filled out either online or in person at the facility by providing personal and medical information.

What is the purpose of assisted living application?

The purpose of assisted living application is to apply for residency in assisted living facilities in order to receive necessary care and assistance.

What information must be reported on assisted living application?

Information related to personal details, medical history, care needs, financial status, and emergency contacts must be reported on assisted living application.

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