LTC Brochure Download
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PLEASE NOTE: All questions with an * are required.
For questions related to this form, e-mail
navello@jointcommission.org
*
1
. Please enter in the following data:
Please enter in the following data:
First Name
Last Name
Title
Company Name
Address
City
State
Zip Code
Phone
Fax
Email
*
2
. How would you describe your long term care facility?
How would you describe your long term care facility?
Hospital-based Skilled Nursing Facility
Free-standing Nursing Home/Skilled Nursing Facility
Corporately Owned Facility
Other (please specify)
*
3
. Is your long term care facility currently accredited by Joint Commission
Is your long term care facility currently accredited by Joint Commission
Yes
No
Don't Know
*
4
. When would you be interested in becoming Joint Commission Long Term Care accredited?
When would you be interested in becoming Joint Commission Long Term Care accredited?
Within 6 months
6-12 months
12-18 months
Not sure about timing
Not interested /already accredited
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