TMPPM 2008 > Texas Medicaid Services > Hospital (Medical/Surgical Acute Care Facility) > General Information

25.1.5 Nursing Facility Admission

The revised Client Assessment, Review, and Evaluation (CARE) Form 3652-A must be used for admissions to a nursing facility. There are instances in which hospital social workers and/or discharge nurses complete the CARE forms 3652-A, such as:

•If the client is in a long-term care acute center (LTAC).

•If the potential receiving nursing facility (NF) desires a better clinical picture of the client, a paper copy of the CARE form 3652-A is completed by the hospital staff before the client is accepted for admission into the nursing facility.

To order new forms, specify that the order is for the CARE Form 3652-A and mail the request to the following address:

Texas Department of Aging and Disability Services
PO Box 149030 (MC E-205, Provider Forms)
Austin, TX 78714-9030
Fax: 1-512-490-4666
www.dads.state.tx.us/handbooks
/mpm-ltcf/5000/5720.htm