Heritage Mills - Senior Health Care Solutions

Heritage Mills
Personal Care & Memory Assistance Center
Shared Apartment Layout
NO COMMUNITY FEE!!!
Personal
Care
• 24-hour around-the-clock care
• Managed daily by experienced and professional nurses
• Quality individualized care delivered by trained Personal
Care Attendants
• Therapy Services
• Medication Administration
• Tasty and varied menu including snacks
• Recreational Activities by qualified professional(s)
• Monthly outings and entertainment
• Housekeeping and Laundry Services
• Transportation to medical appointments
• Spacious private living areas
• Our modernized center is equipped with many safety
features including; sprinkler, fire suppression, and nurse call
button system(s)
• Beauty Salon
• Free WiFi
• Many other amenities
For additional information, schedule a home consultation or arrange a personalized tour
Please Contact:
HERITAGE MILLS PERSONAL CARE & MEMORY ASSISTANCE CENTER
846 EAST WICONISCO AVE., TOWER CITY, PA 17980
(P) 717. 523.1257 (F) 717.523.1255
Heritage Mills
Personal Care & Memory Assistance Center
We Have Immediate Openings
in our Secure Memory Center
NO WAIT-LIST!
NO COMMUNITY FEE!
What We Offer:
• Onsite Therapy
• Transportation to & from medical appointments
• Home-like setting
• Newly remodeled rooms & common areas
Additional Features:
• All-inclusive rates
• We accept long term care insurance & VA benefits
• Personal care plans
• Medication management
For additional information, schedule a home consultation or arrange a personalized tour
Please Contact:
HERITAGE MILLS PERSONAL CARE & MEMORY ASSISTANCE CENTER
846 EAST WICONISCO AVE., TOWER CITY, PA 17980
(P) 717. 523.1257 (F) 717.523.1255
Heritage Mills
Personal
Care & Memory
Heritage
MillsAssistance Center
846 East Wiconisco Ave., Tower City, PA 17980
All community features are offered to both
Personal Care & Memory Care Residents:
• Unparalleled and compassionate care
• Supervised daily exercise classes
• Beauty Salon
• Free WIFI
• Resident common areas
• Trained Staff on campus and 24 hour emergency services
• Laundry rooms
• Call button system in every apartment
• Transportation to and from medical appointments
• Weekly housekeeping
• 3 home cooked meals prepared on site
• Personalized care plans
• Assistance with activities of daily living
• Medication management
• Daily social activities and weekly outings
For additional information, schedule a home consultation or arrange a personalized tour
Please Contact:
HERITAGE MILLS PERSONAL CARE & MEMORY ASSISTANCE CENTER
846 EAST WICONISCO AVE., TOWER CITY, PA 17980
(P) 717. 523.1257 (F) 717.523.1255
Date:
Name of Person Taking Info:
Name of person calling:
Relationship to prospect:
Best number to be reached at:
Email:
Address:
How did you hear about us?
What is your family members name?
Current Residence?
Home
Age:
Nursing Home
Assisted/Personal Care home
Hospital
Rehab Center
Is your Family member aware that you are looking to place them in a personal care home?
Yes
No
Are you interested in a Personal Care apartment or Memory Assist Apartment?
PC
MA
Are you interested in a Private or Shared room?
Private
Are you touring other facilities ?
Which one(s)?
Yes
No
Shared
When are you looking to move into the facility?
Monthly Income:
ADDITIONAL INFORMATION:
Dementia Diagnosis?
Yes
No
Wander Risk:
PCP:
City:
DOB:
Insurance:
Yes
No
Additional Diagnosis:
Special Diet:
Mobility Issues:
Walker
Cane
Incontinent?
Yes
No
Eval Scheduled:
Yes
No
VA Eligible?
Yes
No
Wheelchair
Where?
Long Term Care Policy:
Yes
* After filling out please scan and email to : [email protected]. THANK YOU!
No
Your Name:
Current Address:
Phone Number:
SSN#
Medcare #:
Medicare Supplement:
Sex:
M/F
Race:
Religion:
DOB:
Marital Status:
Language:
Church:
City:
Preferred Hospital:
Veteran:
Monthly Income:
Spouse of Vet:
EMERGENCY CONTACTS:
1. Name:
Relationship:
Address:
Phone:
2. Name:
Relationship:
Address:
Phone:
3. Name:
Relationship:
Address:
Phone:
POA:
Name:
Relationship:
Address:
Phone:
Send Monthly Bill To:
Name:
Relationship:
Address:
Phone:
Y/N
Y/N
PHYSICIANS:
Primary:
Address:
Phone:
Fax:
Podiatrist:
Address:
Phone:
Fax:
Opthalmologist:
Address:
Phone:
Fax:
Specialist:
Address:
Phone:
Fax:
Specialist:
Address:
Phone:
Fax:
ALLERGIES:
Funeral Home:
Name:
Address:
Phone:
Fax:
This Section to be completed by Director of Marketing
How did you hear about Heritage Mills?
Resident Move-in Date:
Care Level : PC
MA
Privacy Level:
Private or Shared
Moved in from?
Aid & Attendance Eligible:
Type of residency:
Permanent
Respite
A & A Application Date:
Y/N
Referral Source?
Trial
Other