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Information About Your Business

For Community Providers

Total Capacity
Number of Single Rooms
Number of Shared Rooms
Minimum cost for shared and private rooms.

Additional Information

Do you have awake staff members available 24/7?
What is the staff per resident ratio?
Do you provide or assist with transportation to appointments?
What is the cost per ride?
Can you accommodate languages other than English?
List all other languages your facility can accommodate.
Do you assist with diabetes management and injections?
Please explain how you are able to assist diabetes patients.
Do you accept hospice residents?
How many hospice beds are you licensed for?
Do you provide memory care?
How many beds do you have in memory care?
What types of programs do you offer in memory care?

Are you (or any of your staff) an RN or LVN?
Do you manage residents who need total care?
Do you have hospital beds if needed?
Does your facility allow pets?

Anything else you'd like to share with us?