How to Admit to Care-Age

I.  Pre-Admission Application: If you are interested in admitting to Care-Age of Brookfield, please submit a Pre-Admission Admission Application. You may print the Application & fax, email or drop off. You may also submit the Application on-line.

II.  Pre-Admission Medical Assessment: Care-Age will need to do a Pre-Admission Medical Assessment. The Assessment is primarily based on specific medical records. Care-Age can obtain these medical records electronically (ProHealth providers) or via fax or mail. If the patient is currently in a hospital, please request the hospital to make a referral to Care-Age.

III.  Advance Directives: Care-Age will need copies of your applicable advance directives:

-Power of Attorney for Healthcare
–Activation of Power of Attorney for Healthcare (Mental Incapacitation Form signed by 2 physicians) if applicable
-Living Will
-Power of Attorney for Finances (Durable Power of Attorney)
-Guardianship of Person if applicable
-Guardianship of Estate if applicable
-Protective Placement Court Order if applicable

IV.  Insurance Cards: Care-Age will need copies of your applicable insurance cards:

-Medicare Advantage
-Primary (Employer / Commercial)
-Secondary / Supplemental
-Prescription Drug
-Social Security Card

Please Note: If a patient has been accepted into Care-Age for admission and patient will be admitting to Care-Age from somewhere other than a hospital, the following records are required from patient’s physician upon admission:

1)  Updated History & Physical within 5 days prior to Care-Age admission
2)  Current List of Medications & Treatments
3)  Negative Chest X-Ray within 90 days prior to Care-Age admission
OR Physician’s Free From Communicable Disease Statement within 5 days prior to Care-Age admission.
4)  CDC Screening: Physician’s Statement that patient has not traveled out of the country in the last 21 days prior to Care-Age admission
5)  Original Hard Copy Prescriptions for any Controlled Substances (Level II – V)
6)  Physician’s Order to Admit to Skilled Nursing Facility