INFO PAGE
Admission & Discharge Forms
For instructions on completing and filing the forms below, please contact the Laguna Honda Admission Office at (415) 682-5683 or fax (415) 682-5689.
Admission Application & House Rules
- LHH Admission Application (English)
- LHH Dental Clinic Form (English)
- LHH Medicare Secondary Payer Form (English)
- LHH House Rules (Chinese)
- LHH House Rules (English)
- LHH House Rules (Spanish)
- LHH House Rules (Tagalog)
- CDPH Standard Admission Agreement for Skilled Nursing Facilities and Intermediate Care Facilities (Chinese)
- CDPH Standard Admission Agreement for Skilled Nursing Facilities and Intermediate Care Facilities (English)
- CDPH Standard Admission Agreement for Skilled Nursing Facilities and Intermediate Care Facilities (Spanish)
REAL Posters
REAL Poster English | REAL Poster Chinese | REAL Poster Russian | REAL Poster Spanish |REAL Poster Tagalog | REAL Poster Vietnamese
Summary Notice of HIPAA Privacy Practices and Acknowledgement of Receipt
Chinese | English | Russian | Spanish | Tagalog | Vietnamese
Full Notice of HIPAA Privacy Rights
Chinese | English | Russian | Spanish | Tagalog | Vietnamese
Consent for Treatment
Chinese | English | Russian | Spanish | Tagalog | Vietnamese