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Application Process

When you contact the admissions office you will be embraced by our staff.  Your application and medical information will be reviewed to determine if we can meet your needs at Providence Extended Care and we will strive to provide you with a timely and respectful admission.
To apply for admission there are several forms that need to be completed. Some are completed by you and some need to go to your doctor for completion.

​More Information
General Facility Information:  (907) 212-9200
Questions Regarding Admissions:  (907) 212-9259​

Please complete the following forms:
admission agreement.pdfadmission agreement
Admission Requirements.pdfAdmission Requirements
Medicaid Guidelines.pdfMedicaid Guidelines
Medical Orders for Scope of Treatment (MOST).pdfMedical Orders for Scope of Treatment (MOST)
Medicare Coverage.pdfMedicare Coverage
Paltcs Admission Demographic Information.pdfPaltcs Admission Demographic Information
Schedule of Charges.pdfSchedule of Charges
Take the following forms to your doctor for completion:
Long Term Care Authorization - LTC1.pdfLong Term Care Authorization - LTC1
Nursing Home Needs Assessment.pdfNursing Home Needs Assessment
SNF Transfer Orders.pdfSNF Transfer Orders
TB Screening Form.pdfTB Screening Form
For more information
To learn more about Providence Extended Care, please contact our admissions office at (907) 212-9259, Monday through Friday, 8 a.m. to 5 p.m. To find general information and specific health topics, visit our online health library.

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