Admitting a Loved One to Fountainview
We will help you navigate the right place, the right time, the right care
Admitting a loved one to the Fountainview Center
Admitting a loved one to Fountainvview or any skilled facility is a serious decision that can be made easier is by the effective flow of information between involved parties. It’s important that you have information about Fountainview and the services we provide. It’s equally important we have details about your loved one to determine if his or her needs can be properly served by our facility.
To facilitate this exchange, please complete the following forms:
- Inquiry Record. This form starts the admissions process. It requests preliminary information about your loved one.
- Medical History. We require a history of your loved one’s medical health.
- Level of Function. We need to understand your loved one’s ability to perform routine functions, such as eating and bathing.
- Information Authorization. This form gives us permission to obtain medical information from current and past providers, such as physicians, medical facilities and other skilled nursing facilities.
Download forms (Adobe Reader® is required)
- Inquiry Record
- Medical History
- Level of Function
- Information Authorization
- DMA 6*
- PASRR Level 1 Form DMA 613*
*Ask your physician to complete these forms. They must be dated within 30 days of admission (not application).
Please note: You must complete and submit these forms prior to initiating the admission process. Email them to Heather@fountainview.net.
If you have any questions, please contact Heather@fountainview.net.
"You are a very special breed of caretakers who open their hearts to each of your residents. Not only did you embrace our mother and her needs, but you took each of us into your hearts. The love we felt and were shown was so tremendous."
Cathy Brown and family
“It was a surprise to us how quickly Mila adjusted to her new home and this was due in large part to all the wonderful people involved in her care. We couldn’t be more grateful to each and every one of you.”
George and Elizabeth Petkovich
“Although Dad was only there for two months, you provided excellent care and were there for us when we needed you.”
Mickey Wener, Jenny Michaels & Susan Hatfield
“Thank you so very much for the wonderful care you gave to my precious Mama. As I left there each day, I knew that she was in caring and competent hands. I didn’t worry about her for I knew that all of you are dedicated to good care for the residents.”
“Thank you for your loving care of my dad. Your efforts to truly see him as a person and an individual was a comfort to us as we watched the husband, father and grandfather we loved decline.”
“You are special people doing a difficult job. Never doubt the importance of all those ‘little’ things you do every day. In the end, they are the big things.”
Want to be sure Fountainview is the right place for
your loved one?
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The search for the right place to ensure the care of a loved one may be difficult. We can answer all of your questions to help you understand if Fountainview is right for you.