Regina Brochures:
To download a Long Term Care brochure, click here.
To download a Short Term Rehab brochure, click here.
Admission Forms:
Click on the individual forms to download. Forms are listed below by number and also by form description.
(Please note: you will need Adobe Acrobat to view these documents)
Listed by Form Number:
1025_20090825 Advance Health Care Directive
1026_20090825 MA & Monthly Income
1027_20090825 Ancillary Services
1028_20090825 Health Information Disclosure
1029_20090825 Contract for Fees and Services
1030_20090825 Dental Exam Consent
1031_20090825 Health Insurance Information
1032_20090825 Hospital Preference
1033_20090825 Vaccine Flu and Pneumonia
1035_20090825 MA-51 Medical Evaluation and Instructions
1045_20090825 Electronic Resident Database
1046_20090825 MA Bulletin Self Directive
1047_20090825 Patient Rights Care and Treatment
1048_20090825 Living Will Declaration
1049_20090825 Self Directive Acknowledgement
1050_20090825 Medicare Second Payer Questionnaire
1060_20090825 Skilled Stay Requirement
1061_20090825 Privacy Practices Notice
1062_20090825 Medical Information Release
1063_20090825 Eye Care
1064_20090825 Shelly Medication Service
1065_20090825 Social Service History
1066_20090825 Resident Rights
1067_20090825 Safety Guide
1068_20090825 Cabinet Locks
1085_20090825 Admission Guidelines
Listed by Form Description:
Admission Guidelines
Advance Health Care Directive
Ancillary Services
Cabinet Locks
Contract for Fees and Services
Dental Exam Consent
Electronic Resident Database
Eye Care
Health Information Disclosure
Health Insurance Information
Hospital Preference
Living Will Declaration
MA Bulletin Self Directive
Medical Evaluation and Instructions
Medical Information Release
Medicare Second Payer Questionnaire
Monthly Income
Patient Rights Care and Treatment
Privacy Practices Notice
Resident Rights
Safety Guide
Self Directive Acknowledgement
Shelly Medication Service
Skilled Stay Requirement
Social Service History
Vaccine Flu and Pneumonia
In addition, Regina Nursing Center is connected to many resources in the greater Philadelphia area which may be of value. Call or e-mail us for a list of hospitals, physicians, medical, healthcare, and financial organizations and institutions that can provide valuable information to you and your loved ones.
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