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

Name Description Date
* Optum1 UnitedHealthcare Facility Application.doc
2016-08-26

Forms

Name Description Date
* Admin-Day-Request-Form.doc
All 2016-11-30
* Bed-Hold-Initial-Request.doc
All 2016-11-30
* Bed Hold Return.doc
All 2016-11-10
* Case Manager Recommendation for County Funded SNF Concurrent Review (pdf)
County Funded SNF 2016-08-15
* Case Manager Recommendation for Initial Referral to LTC
All 2017-12-22
* Concurrent Review Guide for County Funded SNF (doc)
County Funded SNF 2017-08-24
* County Funded SNF Admit Verification
County Funded SNF 2016-08-26
* County Funded SNF Referral Process
County Funded SNF 2016-08-15
* Discharge Notification
All 2016-08-26
* Documentation Needed for County Funded SNF
County Funded SNF 2016-08-15
* LTC Levels of Care Summary (doc)
All 2017-08-24
* Microsoft Word - Documents needed for State Hospital
State Hospital 2017-12-22
* Mini-Cog Exam
All 2016-08-15
* Referral Screening Form
All 2016-08-15
* Referral Screening Form--Tips for Completing
All 2016-08-26
* Representative Payee Form.doc
IMD 2016-11-10
* SNFs Contracted with Optum
County Funded SNF 2016-08-26
* Transfer Notification Form (doc)
All 2018-03-07
* Verification-of-Admit-to-LTC-Facility.doc
All 2016-11-30

Manuals

Name Description Date
* Skilled Nursing Facilities Handbook - 3rd Edition.pdf
2016-08-26