Top Menu

Admission Forms

Dear Sir / Madam:

On behalf of Shady Lane Nursing Home, we would like to thank you for expressing an interest in our facility. Pursuant to your request, we have enclosed an application for admission.

In order to be considered for admission, we ask that you complete the enclosed application.

Please answer all of the questions truthfully and completely. It is your responsibility to have the application, medical history, and chest x-ray results delivered to Shady Lane Nursing Home.

When all of these materials are received, the complete file will be reviewed by our Admissions Committee in order to determine eligibility for admission and Shady Lane Home’s ability to provide the necessary level of care required. Based upon a preliminary review, you will be notified of our decision.

If you have any questions or need additional assistance, please feel free to contact us at (856) 224-6979.

Yours truly,

Charles Fentress
Chairman
NOTE: Medicaid eligibility may be determined by contacting the Board of Social Services located at 400 Hollydell Drive in Sewell, New Jersey 08080. Phone – (856) 582-9200.

Any questions regarding Medicare eligibility should be directed to the Social Security Administrative Offices located at 51 Charles III Drive, in Glassboro, New Jersey 08028. Phone – (856) 256-9700.

Admission Form & Questionaire (adobe )- to be completed online and printed to your printer. You can then mail the completed form.

Admission Form & Questionaire (print) – to be printed then completed by hand and mailed in.

HIPAA Release Authorization-Board of Social Services-(print)-to be printed then completed by hand and mailed in.

Medical History and Admission Examination – please print and fill out.
(To be sent by attending physician or done after arrival but before final acceptance of patient)

Information for Family – Welcome to view or print information.

Suggested Items for residents – A list of items that can be helpful. Please view or print information.