RCFCI APPLICATION PROCESS
PLEASE DO NOT COMPLETE ANY FORMS WITHOUT FIRST SPEAKING TO PNH STAFF
Please call the Facility Manager/Assistant Manager at the location you would like to apply to discuss openings or be placed on the waitlist:
| Long Beach |
(562) 432-2000 |
Residential Care Facility for the Chronically Ill
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| Van Nuys |
(818)787-2403 |
Residential Care Facility for the Chronically Ill
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| West Hills |
(818)347-1777 |
Residential Care Facility for the Chronically Ill
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AFTER SPEAKING TO PNH STAFF, COMPLETE THE FOLLOWING FOUR FORMS WHICH ARE REQUIRED FOR A CLIENT INTERVIEW:
Diagnosis - pdf
Preplacement Appraisal - pdf
Physician Report - pdf
Verification of Homelessness - pdf
COMPLETE THE FOLLOWING FORM ONLY IF INSTRUCTED BY PNH STAFF:
TB Testing - pdf(must be within 90 days of placement)
You will need Acrobat Reader to view and print the application documents. If you do not have Acrobat Reader installed on your computer you can download a free copy of the latest version at www.adobe.com.
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