Assisted Living Services Assisted Living Services Application Step 1 of 10 10% FacilityAddress Phone NumberFaxTINEmailCountyAtlantic CountyBergen CountyBurlington CountyCamden CountyCape May CountyCumberland CountyEssex CountyGloucester CountyHudson CountyHunterdon CountyMercer CountyMiddlesex CountyMonmouth CountyMorris CountyOcean CountyPassaic CountySalem CountySomerset CountySussex CountyUnion CountyWarren CountyTotal number of bedsMemory unit bedsHospice bedsOther Admission InformationDirect Admission from Physician's OfficeYesNoDirect Admission from HomeYesNoAdmission 7 Days/WeekYesNoAdmission on HolidayYesNoOther Diagnostic TestingStat lab test with ≤ 8 hoursYesNoStat x-rays with ≤ 8 hoursYesNoEKGYesNoUltrasoundYesNoDoplerYesNoSwallow StudiesYesNoOther Nursing ServicesVital signs every 4 hoursYesNoIntake and Output monitoringYesNoAccuchecks at least every shiftYesNoPulse OxYesNoNebulizer treatmentsYesNoIncentive SpirometryYesNoCpapYesNoOxygenYesNoFoley Catheter CareYesNoOstomy CareYesNoRestorative NursingYesNoOther On-Site TherapiesPhysicalYesNoOccupationalYesNoSpeechYesNo Social ServicesLicensed Social WorkerYesNoDischarge PlannerYesNo Primary Care OversightRN on site 24 hours/dayYesNoNurse on site 24 hours/dayYesNoAt least one physician, NP or PA in the facility weeklyYesNoOther On-Site ConsultationsPsychiatryYesNoInternal MedicineYesNoGeriatricianYesNoPsychologistYesNoWound CareYesNoDentistYesNoHospice/Palliative CareYesNoHome HealthYesNoDietitionYesNoPodiatryYesNoOther InterventionsIV FluidsYesNoIV antibioticsYesNoIsolationYesNoSurgical drain managementYesNoAnalgesic PumpsYesNoAutomatic DefibrillatorYesNoOthers Pharmacy ServicesNew medications filled within 8 hoursYesNoPharmacist medication utilization auditYesNoOtherAdditional Information/Comments Captcha