WHAT IF I HAVE A CURRENT DIAGNOSIS, RECENT HISTORY OR SYMPTOMS OF MENTAL ILLNESS OR MENTAL RETARDATION?
If you have one of the specified conditions or symptoms, a physician must certify whether you qualify for an exception allowing admission to a nursing home. You qualify for an exception if: • You have a primary diagnosis of dementia, such as Alzheimers disease; or • You are being discharged from a hospital and need 30 days or less of convalescent • care for the condition treated by the hospital; or • You are in a coma. If you meet one of these conditions, it must be certified by a physician on another form (DSS-3878). After the form is completed, you may be admitted to a nursing home of your choice. A copy of the form will be included in your nursing home record and another copy will be sent to the local community mental agency. Request a copy of the completed form for your records. No further action is required. If you mental health status cannot be evaluated due to your medical condition (such as a severe stroke), the screening can be delayed. You may be admitted to a nursing home on
