Before admission, the following information is required in accordance with state and federal guidelines:
- Complete history and physical, updated within the last 5 days
- Complete list of diagnoses, current medications, diet, treatments, allergies, immunizations and therapy treatment needed
- DCH 3877-3878 forms (screening for Alzheimer’s Disease or other dementia)
- Copies of all insurance cards (front and back)
- Copies of all legal papers such Power of Attorney, Court appointed Guardian or Conservator papers
If you have any questions regarding admission requirements, or would like to schedule a tour of our facility, please email: admissions@benziemaples.org or call 231-352-9674 ext 205.
Medicare & Medicaid Information
- Pre-Admission Questionnaire – pdf
- Pre-Admission Information Sheet for Family – pdf
- Application for Admission Waiting List – pdf
- Advance Directives – pdf