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Admission Documentation Requirements​​

The State of Michigan requires the following medical documentation when a person is to be admitted to the Cass County Medical Care Facility. This same documentation is required whether the individual comes from home or from a hospital stay.

Documents Required:

A Medical History and Physical Examination Report

Must be submitted by the admitting physician. It must be current (prepared less than 60 days from the date of admission.

A Chest X-Ray

Must have been taken and submitted within a 60-day period prior to admission.

Admission or Transfer Orders​

Signed by the individual’s own physician and include current medication orders as well and any other special order for care.

Other Documents required when an individual transfers to our medical care facility includes:

  • History & Physical 
  • Face Sheet/Demographics pages-this is a page that has all your loved one’s information such as address,contact numbers, all insurance information, emergency contacts, social security number,birth date, etc.
  • PAS/ARR Level 1-this is form 3877*
  • PAS/ARR Level 2-this is form 3878*
  • Photo copies of the front and back of all insurance cards
  • Pharmacy coverage information

If your loved one is coming from a hospital or transferring from another facility that establishment will handle all the necessary paper work.

If your loved one is coming from home however, everything listed here can be done by your loved one’s Patient Care Provider (PCP). Once all the required information is gathered it can be faxed to the facility, with Attention Admissions.

Both PCP forms can be found by going to google and putting the name and form number in the search bar. 

The Cass County Medical Care Facility admits, provides nursing care to, and accommodates all residents without regard to race, age, sex, color, creed, religion, national origin, or physical or mental handicap, pursuant to the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973.