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PRINTED: 04/30/2019 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION A.
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Obtain the rocky pass family care form from the designated website or office.
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Fill out all the required personal information such as name, address, contact details, and relationship to the patient.
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Who needs rocky pass family care?

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Individuals who have a family member in need of long-term care and assistance.
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Individuals who are looking to ensure that their family member’s medical history and information are readily available in case of emergencies.
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Rocky Pass Family Care is a program designed to provide assistance and support to families in need of caregiving services for their loved ones.
Family members who are responsible for providing care for their loved ones are required to file for Rocky Pass Family Care.
To fill out Rocky Pass Family Care, individuals need to provide information about the care recipient, the type of care needed, and the caregiver's contact information.
The purpose of Rocky Pass Family Care is to ensure that families have access to the necessary resources and support needed to provide quality care for their loved ones.
Information such as the care recipient's medical history, care needs, and any medications they are taking must be reported on Rocky Pass Family Care.
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