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Long-Term Care Facility COVID-19 Response


  1. 1. Facility Identification
  2. 2. General Questions
  3. 3. Visitor Policies
  4. 4. Outside Consult
  5. 5. Staffing Screening & Support
  6. 6. Resident Care
  7. 7. Resident Admittance & Re-admittance
  8. 8. Needs
  • Facility Identification

    1. Notice
      Do not include any sensitive information on this form or (if applicable) files uploaded to this form. Sensitive information includes, but is not limited to, social security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, or passwords.