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NURSING HOME ADMINISTRATOR /"A" - ,,- ^ , -,t ^ : ■ /
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LOS AKOEXES COUNTY /uEF/«* Vi EN? OF PUBLIC SOCIAL SERVICES
' Medical Services Division
- • 555? East Ferguson Irive
Ceaitnorcs, California 90022
FROM; Mra. Ollie Brora, L ^
Coordinator oJ Discharge Planning
724-3420, extension 461
TO; S.W. •.??.: ,S.W. Case No, HTOH, Soon
District Offii . .. ,
1,02.6 ! - at* fcoica Blvd. .. Ca!'Tl1 wfespro* M"D'>
—"•f&rr" " A--.'v A""' -• ''Ab.A: ?0C29 "' ..... ' :
£7 Thefedapfe Ccf A :...-:-a " r'Mi :"- "-VAre-naned patient's physician agree that
** nursing home care is no longer re;-.-.red and that a more independent living
arrange-.:..ont is fern ble,
£j We have been informed that this patient no longer appears to require cars in a
nursing home and th I a more Independent living arrangement ia feasible. •-. :
Q CONTINUED HORSING HOME CARE is APPROVED AS FOLLOWS:
■ .ra^-^—^te _' *>. ^fe^—^X . U
This should eneblo you to initiate and complete a discharge plan, If additional'"^ \
information is drstfrcdj fce^/rnhono our Coordinator of Discharge Planning at the above |
number* . '!
O REMARKS;
When plana have been completed, please return one copy of this form ^dth completed
information to the Medical Services Division.
Patient Discharged to: Address
Check appropriately;
£7 Board ervl Carr- £7 <Vn JV-o £7 With Relatives
£7 Other (Please cpt * _ _ _
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