Apply with an Ombudsman

Assisted Living Waiver > Ombudsman

Download, Print and Fax
Complete and Sign Online

Submit Forms

To Apply:

  1. Submit an active ombudsman referral on county letterhead

  2. Return the Ombudsman Intake Packet.(Current wait time 1 to 2 months)

  3. If currently in a Skilled Nursing Facility (SNF) or Hospital, profide the following:
    - Face Sheet
    - H&P
    - Medication List

  4. Submit if Applicable:

NOTE: You MUST send an active ombudsman referral to be placed on this waitlist.