N.H. Admin. Code § Ve-H 306.04

Current through Register No. 50, December 12, 2024

Section Ve-H 306.04 - Effect of Witnessed signature on Page 4 of the Application

The witnessed signature on page 4 of the application shall have the effect of:

(a) Stating the applicant's understanding that the home is owned and operated by the state and subject to the rules of the state;

(b) Giving the applicant's permission for the home to provide needed information, including the applicant's spouse's income and social security number, to the department of veterans' affairs;

(c) Giving the applicant's promise to abide by the rules and regulations established by the commandant, the board of managers, and the state;

(d) Confirming that:

(1) The assets are accurately stated; and

(2) The applicant has not transferred any assets within the 12-month period prior to the application for the sole purpose of complying with eligibility requirements;

(e) Certifying that there are no willful misrepresentations and the applicant's understanding that, if an investigation discloses any such misrepresentations, the applicant's admission may be denied or, if the applicant is already a resident, the applicant may be discharged;

(f) Giving the applicant's promise that he or she will provide proof of assets and income during the admission process and thereafter when requested by the business office for the determination of monthly cost of care;

(g) Giving the applicant's promise to accept transfer to another facility if the home does not have the resources to care for the applicant and the transfer is recommended by the medical director of the home;

(h) Confirming that the applicant has read, or has had read to him or her, the information in the application form and application instructions;

(i) Giving the applicant's assurance that the information given on the application form is true and correct to the best of the applicant's knowledge and belief; and

(j) Acknowledging that the home reserves the right to request updated information regarding the applicant's application for residency.

N.H. Admin. Code § Ve-H 306.04

#8953, eff 7-21-07

Amended by Volume XXXIX Number 06, Filed February 7, 2019, Proposed by #12711, Effective 1/15/2019, Expires 1/15/2029.