Admissions Checklist


Following is a list of necessary activities that we will need to complete with you, as well as documentation we kindly ask you to bring:

  1. Photo ID - including:  Driver’s License, Non-Driver’s ID or Passport

  2. Birth Certificate and Social Security Card   

  3. Copy of Insurance Cards

  4. Proof of application for Temporary Assistance with caseworkers contact information.  (All must be faxed to NHM prior to a bed date being scheduled.)  --Please see DSS LETTER for client to take to her home county DSS to apply for Temporary Assistance.


  6. New Hope Manor Application

  7. Phone Screening

  8. Referral Letter

  9. Mandate Letter (if applicable)

  10. NYSID Consent Form (if applicable)

  11. Psychosocial/Comprehensive Psychiatric Evaluation

  12. Medical History & Physical

                -CBC with Differential

                -CMPComplete Metabolic Panel

                -UA with Microscopic

                -Drug Screen

                -Intradermal PPD

  1. List of Current Medications

If Pregant...

  1. Sonogram (proof of live fetus)

  2. Prenatal Records

  3. Due Date

If Bringing Infant...

  1. Medical Records (History & Physical)

  2. Proof of Shots & Immunizations

  3. Medicaid Card

  4. Birth Certificate

  5. Social Security Card

  6. WIC Information


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