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Skilled Nursing Facilities

This page is used by staff working at Skilled Nursing Facilities contracted Optum Public Sector San Diego. Skilled Nursing Facility staff can obtain forms, protocols, and other documents that support their work with the County of San Diego clients residing Skilled Nursing Facilities.

Application

Forms
Claims_UB04_Example_Form.pdf
Disbarment_and_Exclusion_Attestation_Form.docx
SF-LTC_Bed_Hold_Request_Form.pdf
SF-LTC_Concurrent_Review_Guide_for_County_Funded_SNF.pdf
SF-LTC_Concurrent_Review_Process_for_County_Funded_SNF.pdf
SF-LTC_Discharge_Process_For_County_Funded_SNF.pdf
SF-LTC_Documentation_Needed_for_Referral_For_County_Funded_SNF.pdf
SF-LTC_Mini-Cog_Exam.doc
SF-LTC_Recommendation_for_Case_Manager.pdf
2015-10-09
SF-LTC_Referral_Process_for_County_Funded_SNF.pdf
SF-LTC_Referral_Screening_Form.doc
2015-10-09
SF-LTC_Referral_Screening_Form_Tips.pdf
2018-05-25
SF-LTC_Tips_for_Completing_Referral_Screening_Form.doc
2018-05-25
SF-LTC_Verification_of_Admission_and_Request_for_Initial_Authorization_to_SNF.pdf
2018-05-25
SF-LTC_Notification_of_Return_to_County_Funded_SNF_From_Bed_Hold.pdf
2018-05-25
SF-LTC_Notification_to_Optum_of_Discharge_From_ County_Funded_SNF.doc
2018-05-25
Skilled Nurisng Facilities Discharge Form.docx
2023-05-30


2018-05-25
Serious Incident RCA Worksheet (doc)
2015-11-05
Skilled Nurisng Facilities Discharge Form - Form Fill (pdf)
Revised 05/26/2023 2023-05-30

Manuals
Skilled_Nursing_Facilities_Handbook_-_3rd Edition.pdf
2016-08-01