*1.Name of facility(Required.)

AmesAureliaCarrollCascadeCherokeeCrescoKnoxvilleLe MarsManningMarshalltownMilfordNewton EastNewton WestOgdenPleasantvillePomeroyShell RockSioux CitySpirit LakeStantonShenandoah

*2.What is your facility's current ICF and SNF census?
Example: You have 49 total residents today and of those 49, 3 are skilled. You would respond 49/3 in the answer box.(Required.)

*3.Do you have any current residents in the hospital? If so, what is the name of the resident in the hospital? What hospital is this person at? Does this person have an expected readmit date yet?(Required.)

*4.Please tell us how many beds in isolation you have available for admissions today.(Required.)

*5.Please tell us how many beds outside of isolation you have available for admissions today.(Required.)

6.Please tell us how many CCDI beds you have available for admission today.
*** Only for buildings with a CCDI Unit