Application and Residency Agreement

The Residential Health Care Facility (RHCF) offers 24-hour support for medical needs and assistance with daily tasks like bathing, dressing, and eating. These facilities also offer services such as rehabilitation therapy, medication management, meals, and social activities, all designed for individuals who need a high level of medical and personal care on an ongoing basis.

A physician must confirm that nursing home care is medically necessary, and the individual must meet the state’s eligibility criteria before admission can proceed. A Patient Review Instrument (PRI) must also be completed before admission.

If you are interested in residency at the RHCF, the first step is to contact the Lewis County Clinical Resource Management office by calling (315) 376-5205.  The course of the application process depends on whether the applicant is applying from the community (e.g., home or assisted living facility) or from a hospital.

The Application for Admission and our Residency Agreement are available for access or download below. If you are unable to download the Application or Residency Agreement, or if you need assistance completing the forms, please call the Clinical Resource office at (315) 376-5205. Applications may be returned in person, by mail, or faxed to (315) 376-5153.