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


Skilled Nursing Facility Credentialing Application (pdf)	04/29/2021	2021-05-03

Forms


SF-LTC_Referral_Process_for_County_Funded_SNF.pdf	County Funded SNF	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
Admin Day Request Form for LTC (doc)	ALL	2019-08-23
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
Case Manager Recommendation for Initial Referral to LTC (doc)	Updated .0/13/2023	2023-03-13
Concurrent Review Guide for County Funded SNF (doc)	County Funded SNF	2017-08-24
Discharge Notification (doc)	ALL	2019-08-26
Documentation Needed for State Hospital Referral (pdf)	State Hospital	2017-12-22
Documentation for Concurrent Review (doc)	ALL	2019-08-26
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
LTC Referral Screening Form (doc)	ALL	2019-08-26
Representative Payee Form (doc)		2019-08-19
SF-LTC Mini-Cog Exam (pdf)		2022-04-07
SNFs Contracted with Optum (pdf)	County Funded SNF – Updated 11/07/2022	2022-11-08
Skilled Nursing Facilities Concurrent Review Template (docx)		2023-05-09
Skilled Nursing Facilities Concurrent Review Template - Form Fill (pdf)	Revised 05/01/2023	2023-05-09
Skilled Nursing Facilities Discharge Form (docx)	Revised 05/26/2023	2023-05-30
Skilled Nursing Facilities Discharge Form - Form Fill (pdf)	Revised 05/26/2023	2023-05-30
Transfer Notification Form (doc)	All	2018-03-07
Verification of Admit to LTC Facility (pdf)		2022-04-07

Manuals


Skilled_Nursing_Facilities_Handbook_-_3rd Edition.pdf		2016-08-26