Senior Care Facility Supply Request Form

Streamline Supply Management for Senior Care Facilities

Running a senior care facility means juggling dozens of daily operational needs—and nothing brings that into sharper focus than managing medical supplies, equipment and materials. Whether you're a facility administrator, nursing supervisor, or care coordinator, you need a reliable system to request supplies that keeps residents safe, staff informed, and costs under control.

This Senior Care Facility Supply Request Form gives you a professional, compliant way to document supply needs with all the detail required for Medicare reimbursement, infection control standards, and inventory management. Instead of chasing down paper forms or managing email chains, you can centralize every request in one organized system.

Built for the realities of senior care operations

Senior care facilities face unique compliance and documentation requirements. This template captures resident count context, medical necessity justification, Medicare reimbursement codes (HCPCS), urgency levels, and infection control classifications—all the information your procurement team and billing department need to process requests quickly and accurately.

Use this form for requesting:

• Medical supplies (wound care, incontinence products, diagnostic equipment)
• PPE and infection control materials
• Mobility and assistive devices
• Facility equipment and furnishings
• Dietary and nutritional supplies

Each request includes fields for quantity, unit specifications, delivery requirements, and budget approval routing, so nothing falls through the cracks.

Automate approvals and purchasing workflows with Stepper

Once a supply request is submitted, you can use Stepper to automatically route high-value requests to administrators for approval, send urgent orders straight to your preferred vendors, update your inventory management system, and notify nursing staff when supplies arrive. This keeps your facility running smoothly without manual handoffs or delays that could impact resident care.

Secure, compliant and easy to use

Paperform is SOC 2 Type II certified, giving you the security and data handling standards required in healthcare environments. The form can be embedded on your facility intranet, shared via secure links with department heads, or accessed on mobile devices during rounds.

Whether you manage a small assisted living community or a large skilled nursing facility, this template helps you maintain the supply chain efficiency and documentation standards that keep residents safe and operations compliant.