| **Be careful of the point system as you may accumulate additional fees each month. |
Does the extended Care Facility you chose use the "point system" for billing charges?
Or is it a flat monthly fee? |
____________ |
What is the base rent for the room desired? |
____________ |
Is there an initial deposit or assessment fee? If so, how much |
____________ |
Is there a fee for...
Assistance with personal care (bathing, dressing, etc.) |
____________ |
Laundry service fee |
____________ |
Housekeeping |
____________ |
Meals |
____________ |
Medication Management |
____________ |
Telephone Service |
____________ |
Television |
____________ |
Transportation Recreation and Outings |
____________ |
Grooming needs/supplies (pull ups, toothpaste, shampoo, etc.) |
____________ |
Assistance with ambulation |
____________ |
Misc. |
____________ |
Misc. |
____________ |
Misc. |
____________ |
Hair care (Beauty shop) |
____________ |
Total charges for the month |
____________ |
