Admissions
It is the policy of Hills & Dales that individuals desiring admission to receive services follow an approved admission process. All individuals are required to complete an application. Once Hills & Dales has a referral, a face-to-face visit is made to determine if the referral is appropriate for the requested service(s), and whether or not Hills & Dales can meet the individual’s service needs. It is strongly recommended that all referrals tour Hills & Dales. Once the application is received by Hills & Dales we will refer the applicant to the Department of Human Services and the Social Security office to assure that if/when admission does occur, the individual is eligible and that funding will be approved. The individual’s primary physician must complete a Level of Care Certification for Facility. This is a Level of Certification (LOC) verifying necessity of ICF/MR-ID (Intermediate Care Facility for the Mentally Retarded-Intellectually Disabled) level of care.
Next, the Admissions Committee reviews the referral report, case file information and then determines the status of the referral. A decision to provide services includes a review of the individual’s health, welfare and safety as well as the availability of the resources and supports necessary to meet the needs of the individuals. The final approval for admission is determined by the Admissions Committee.
Admission to Hills & Dales ICF/MR-ID (Intermediate Care Facility for the Mentally Retarded-Intellectually Disabled) services is limited to individuals who are 18 years old and younger.
Individuals desiring readmission to Hills & Dales programs/services will be determined on an individual basis by the Admissions Committee. The Admissions Committee will consider time lapsed since Hills & Dales last provided services, Hills & Dales’ ability to meet the needs of the individual and the age of the individual.
If individuals are searching for support through Hills & Dales’ Home and Community Based Services, individuals and families will receive assistance on how to locate, access and coordinate a network of supports and services that will allow them to live a full life in the community.
Thank you for inquiring about Hills & Dales services. To apply for services please complete the following application and releases.
(All applications require Adobe Reader)
AG115 Application for Services
AG519 Release of Information dhs
AG519 Release of Information school
AG519 Release of Information current provider
AG519 Release of Information primary physician
AG519 Release of Information – Specialty Physician
After we receive the completed application and release forms, we will send them out in order to obtain reports. These reports will be reviewed, along with the application for services, assisting our staff to identify our ability to provide appropriate services.
If you have any questions please contact Casey Leist, Referrals & Activities Coordinator at (563) 585-0560 ext. 206 or email at cleist@hillsdales.org.
(Please take time to print and review the Notice of Privacy Practices.)
For more information please call Casey Leist at 563-556-7878 ext. 206.
