Flagstaff Care Homes Forms

Forms Needed For Resident Check-in

Please be aware that all of these forms need to be completed to comply with the Arizona Department of Health Services regulations for senior assisted living homes.

Your cooperation in making sure our homes are in compliance is greatly appreciated.

Each home has it's own set of forms, so please select accordingly.

The Pines	Pine Meadows Ranch	Eldercare Springs
Documents are in PDF format All Physician Documents (212 kb) All Resident Documents (369 kb) Individual Physician Documents: Consent For Medications Physician's Report Physician's Routine Orders Tuberculosis Test Results Individual Resident Documents: Acknowledgement Admission Agreement Evacuation Plan Food Preference Questionnaire Grievence Procedures Home Rules Important Phone Numbers Insurance Card Living Will Residency Agreement Resident Information Resident Inventory Resident Rights Resident Situation & Health Social & Recreational Activities Vacination Authorization Welcome Letter	Documents are in PDF format All Physician Documents (212 kb) All Resident Documents (369 kb) Individual Physician Documents: Consent For Medications Physician's Report Physician's Routine Orders Tuberculosis Test Results Individual Resident Documents: Acknowledgement Admission Agreement Evacuation Plan Food Preference Questionnaire Grievence Procedures Home Rules Important Phone Numbers Insurance Card Living Will Residency Agreement Resident Information Resident Inventory Resident Rights Resident Situation & Health Social & Recreational Activities Vacination Authorization Welcome Letter	Documents are in PDF format All Physician Documents (212 kb) All Resident Documents (369 kb) Individual Physician Documents: Consent For Medications Physician's Report Physician's Routine Orders Tuberculosis Test Results Individual Resident Documents: Acknowledgement Admission Agreement Evacuation Plan Food Preference Questionnaire Grievence Procedures Home Rules Important Phone Numbers Insurance Card Living Will Residency Agreement Resident Information Resident Inventory Resident Rights Resident Situation & Health Social & Recreational Activities Vacination Authorization Welcome Letter