SNF Admissions Referral Intake Checklist: Printable Worksheet & Follow-Up Tracker for Skilled Nursing Admissions

Keep every referral's source, documents, Medicare questions and follow-ups on one organized page. This printable intake worksheet helps a skilled nursing admissions coordinator or liaison capture the facts, route records for qualified review, and track what's still missing. Built only from public Medicare.gov, CMS and federal regulation sources, with links. Created by Chris Groves.

WHAT'S INSIDE (11-page PDF)

• Scope and source map that separates workflow prompts from federal requirements

• Referral capture worksheet

• Original Medicare SNF coverage prompts, including inpatient-versus-observation questions

• Resident-rights and admission-paperwork routing prompts

• Records-to-route worksheet for qualified review

• Missing-items and follow-up tracker

• Federal citations to 42 CFR Part 483 and Medicare.gov (sources checked October 2, 2026)

WHO IT'S FOR

SNF admissions coordinators, liaisons and administrators who want a generic, printable organizer.

GOOD TO KNOW

• Instant digital download (PDF). Nothing is shipped. US Letter size, 11 pages.

• Because this is a digital file, all sales are final. If a file won't open or is damaged, message me and I'll fix it or refund you.

• License: for your own organizational use. Please don't resell, share or post the file.

• Questions? Message me through this shop.

A generic organizer, not an admission standard, acceptance rule, clinical assessment, coverage determination, legal review or substitute for current facility policy, state requirements or qualified professional judgment. Keep protected health information in your approved secure system. No facility names, employer material or patient data are included. Not affiliated with or endorsed by CMS or Medicare.