C.C. Young Online Applications

Online Application for Admission to Lawther Point Health Center

Thank you for choosing C. C. Young and allowing us to be of service.
-Russell Crews, President & CEO

 

To apply for admissions, start here and complete all steps:

Admissions Agreement

 

If unable to complete all steps above, returning applicants may individually select the remaining document(s) needed to complete your applications paperwork:

Notice Regarding Advance Directive

Medicaid Conversion Statement

Consent to Use Biographical and Photographical Material

Acknowledgment of Receipt of Notice of Privacy Practices

Consent to use and disclosure of protected health information for treatment, payment or healthcare operations

Privacy Act Statement – Health Care Records

Restraint Practice Disclosure

Department of Age and Disability

Authorization to Obtain Medical Information

Authorization to Release Medical Information

Acknowledgment Form

Flu Vaccine Consent

Pneumonia Vaccine Consent

Payor Screening Form

Resident Funds

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