Section He-M 701.04 - Application Procedures(a) Initial inquiries or referrals for admission to Glencliff home shall be directed to the admissions coordinator at Glencliff home.(b) An application for admission to Glencliff home shall: (2) Be made by: b. A person acting with the consent of the applicant; orc. A person legally authorized to act on behalf of the applicant;(3) Contain the following information regarding the applicant: a. Name, address, sex, and birth date;b. Birthplace and citizenship status;e. Name, address, and telephone number of physician(s);f. History of previous hospitalization(s) for psychiatric treatment;g. Description of self-care abilities and physical functioning;h. Adaptive equipment needed;i. Medical history, including history of TB testing;j. Medical status, including: 2. Medications currently prescribed; and3. Evaluation of current mental status;k. Therapeutic and rehabilitative services needed;m. Financial assets, including: n. Source of payment for care at Glencliff home;(4) Contain written authorization permitting medical and psychiatric facilities and personnel that are providing or have provided care and treatment to the applicant to release clinical and medical records concerning the applicant to Glencliff home; and(5) Be made only after the applicant has obtained a determination of eligibility for nursing facility level of care from the bureau of elderly and adult services of the department in accordance with He-E 802.05, if the applicant is a medical assistance recipient.(c) An applicant or applicant representative shall send an application and related material to the admissions coordinator at Glencliff home.(d) Within 15 days of receipt of an application, excluding weekends and state legal holidays, the administrator or his or her designee shall review the application and related material and shall take action as required by He-M 701.05.(e) If the administrator or his or her designee determines that application information is insufficient to establish eligibility for admission, the administrator or designee shall: (1) Notify the applicant of the name, address, official title, and telephone number of the Glencliff employee who may be contacted regarding the application;(2) Take steps necessary to obtain the needed information and make a determination of eligibility in accordance with He-M 701.03, if possible, including: a. Notifying the applicant of any apparent errors or omissions; andb. Requesting any additional information required by (b) above; and(3) Deny the application if necessary information is not provided pursuant to (2) above and inform the applicant in writing of the following: a. The fact that sufficient information to determine eligibility has not been provided or obtained;b. The specific, additional information which is needed; andc. The right of the applicant to resubmit the application at any time.(f) If the administrator or his or her designee finds that sufficient information is available to determine eligibility for admission, the administrator or designee shall either: (1) Approve eligibility for admission and inform the applicant in writing of the approval if the applicant meets all of the criteria for admission; or(2) Deny eligibility for admission if the applicant does not meet one or more of the eligibility criteria in He-M 701.03 and, within 10 days of the determination, issue written notification to the applicant and, if applicable, his or her guardian of the denial and the specific criteria not met.N.H. Admin. Code § He-M 701.04
#2817, eff 8-16-84; EXPIRED: 8-16-90
New. #5224, eff 9-12-91, EXPIRED: 9-12-97
New. #7165, eff 12-18-99, EXPIRED: 12-18-07
New. #9502, eff 7-3-09
Amended by Volume XXXVII Number 45, Filed November 09, 2017, Proposed by #12406, Effective 10/24/2017, Expires 4/22/2018.