Long Term Care

This page is used by Acute Care and Long Term Care facilities to obtain forms, protocols, and other documentation that support their work with the County of San Diego clients needing referral or continued stay authorization in Long Term Care Facilities funded by the County of San Diego.

County LTC Admission and Concurrent Review Criteria

Applications

Facility Credentialing Application Instructions (doc)
2016-08-26

Forms

SF-LTC Documentation Needed for Referral For County Funded SNF.pdf
County Funded SNF 2016-08-15
SF-LTC Mini-Cog Exam.doc
All 2016-08-15
SF-LTC Referral Process for County Funded SNF.pdf
County Funded SNF 2016-08-15
SF-LTC Referral Screening Form.doc
All 2016-08-15
SF-LTC Referral Screening Form Tips.pdf
2016-08-26
SF-LTC Verification of Admission and Request for Initial Authorization to SNF.pdf
2016-08-26
Discharge Notification.doc
All 2016-08-26
Case Manager Recommendation for Initial Referral to LTC.doc
All 2017-12-22
SNFs Contracted with Optum.docx
County Funded SNF 2018-09-05
Bed Hold Request (doc)
2019-08-19
Bed Hold Return (doc)
2019-08-16
Case Management Concurrent Recommendation Long-Term Care County Funded SNF (pdf)
2016-08-15
Concurrent Review Guide for County Funded SNF (doc)
County Funded SNF 2017-08-24
Documentation Needed for State Hospital Referral (pdf)
State Hospital 2017-12-22
Documentation needed for IMD (doc)
2019-08-06
Documentation needed for SNF or NBU Patch (doc)
SNF Patch 2019-06-26
LTC Levels of Care Summary (doc)
Updated 08/15/2019 2019-08-15
Representative Payee Form (doc)
2019-08-19
Secure Facility/Long-Term Care Administrative Days Request Form (doc)
All 2016-11-30
Secure Facility/Long-Term Care Notice To Client/Representative Payee (doc)
All 2019-08-06
Transfer Notification Form (doc)
All 2018-03-07
Verification-of-Admit-to-LTC-Facility.doc
All 2016-11-30

Manuals

Skilled Nursing Facilities Handbook - 3rd Edition.pdf
2016-08-26