---
title: Nursing Home Admission Application Form Template | Paperform
description: Professional nursing home admission application template with medical history, insurance coverage, care level assessment, and document uploads. Secure, customizable, and ready to use.
url: "https://paperform.co/templates/nursing-home-admission-application"
type: static
generatedAt: "2026-03-28T00:44:39.545Z"
---

[← Back to free form templates](/templates/)    ![Nursing Home Admission Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/nursing-home-admission-application.png)
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### Streamline Your Nursing Home Admission Process with Paperform

Managing nursing home admissions requires collecting sensitive medical information, insurance details, and comprehensive care assessments—all while maintaining compliance and providing a compassionate experience for families during a challenging time. This **Nursing Home Admission Application template** helps assisted living facilities, nursing homes, and senior care providers create a professional, secure intake process that gathers everything needed for proper placement and care planning.

#### Why Senior Care Facilities Need Digital Admission Forms

Traditional paper-based admission processes create bottlenecks, increase errors, and delay placement decisions when families need answers quickly. With Paperform's nursing home admission template, you can:

 - **Collect complete medical histories** including current medications, allergies, diagnoses, and physician information in one organized submission
 - **Assess care level requirements** using conditional logic that shows relevant questions based on mobility, cognitive status, and daily living needs
 - **Gather insurance and financial information** securely, including Medicare, Medicaid, and supplemental coverage details
 - **Create a professional first impression** with an on-brand form that reflects the quality and compassion of your care facility
 - **Speed up the review process** by routing complete applications directly to your admissions team with all required documentation attached

#### Perfect for Assisted Living and Long-Term Care Providers

This template is designed specifically for:

 - **Nursing homes and skilled nursing facilities** managing complex medical needs and insurance requirements
 - **Assisted living communities** assessing independent living capabilities and support service needs
 - **Memory care units** evaluating cognitive status and specialized dementia care requirements
 - **Continuing care retirement communities (CCRCs)** processing admissions across multiple care levels
 - **Senior care administrators** streamlining intake processes and reducing administrative burden

#### Built for Healthcare Workflows

The nursing home admission form includes carefully structured sections for:

 - Prospective resident demographics and contact information
 - Responsible party and emergency contact details
 - Current living situation and reason for seeking placement
 - Comprehensive medical history including diagnoses, medications, and allergies
 - Physical and cognitive assessment questions
 - Activities of daily living (ADL) evaluation
 - Insurance coverage and financial responsibility information
 - Physician and hospital information
 - Special care needs and preferences
 - Document uploads for medical records, insurance cards, and legal documents

Conditional logic ensures families only see questions relevant to their situation, creating a streamlined experience that feels personal rather than overwhelming.

#### Automate Your Admissions Workflow with Stepper

Once an application is submitted, **Stepper** (stepper.io) can automate your entire admissions workflow:

 - Route applications to clinical reviewers based on care level requirements
 - Send automated confirmation emails to families with next steps and timelines
 - Create tasks for admissions coordinators to verify insurance coverage
 - Schedule intake assessments and facility tours automatically
 - Update your resident management system with new applicant information
 - Notify medical directors when high-acuity applications require review

This automation means faster placement decisions, better communication with families, and a smoother transition for new residents.

#### Security and Compliance Built In

Senior care facilities handle sensitive protected health information that requires robust security measures. Paperform is **SOC 2 Type II compliant** and includes features like:

 - Encrypted data transmission and storage
 - Secure file uploads for medical documents and insurance cards
 - Custom data retention policies
 - Access controls and audit trails
 - Integrations with HIPAA-compliant systems when paired with appropriate Business Associate Agreements

While Paperform is not itself HIPAA compliant, its security features combined with proper implementation can support your facility's compliance requirements for initial intake processes.

#### Seamless Integration with Your Care Management Tools

Connect your nursing home admission form to the tools your team already uses:

 - **CRM systems** like Salesforce or HubSpot to track prospective residents through the admissions pipeline
 - **Google Sheets or Airtable** for admissions team collaboration and application tracking
 - **Slack** for real-time notifications when priority applications arrive
 - **Electronic health record (EHR) systems** via webhook integrations to transfer admitted resident data
 - **Email platforms** to send personalized follow-up sequences to families

These integrations ensure no application falls through the cracks and every family receives timely communication about their loved one's placement.

#### Designed for Compassionate Care

The admission process sets the tone for a family's entire experience with your facility. This template balances the need for comprehensive information with a user-friendly experience that respects the emotional weight of nursing home placement decisions. Clear section headings, helpful field descriptions, and a professional design create confidence during a vulnerable time.

#### Get Started in Minutes

With Paperform's intuitive editor, you can customize this nursing home admission template to match your facility's specific requirements, brand guidelines, and state regulations. Add your logo, adjust questions to reflect your care specialties, set up conditional logic for different care levels, and launch your new digital admission process—no IT department required.

**Trusted by healthcare providers worldwide**, Paperform combines enterprise-grade security with an interface simple enough for any admissions coordinator to manage. Start improving your nursing home admission process today with Paperform's comprehensive, professional template designed specifically for senior care facilities.
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