INFO PAGE
Admission Forms
For instructions on completing and filing the forms below, contact the Laguna Honda Admission Office at 415-682-5683 or LHH.referral@sfdph.org.
Admission Application & House Rules
- LHH Admission Application (English)
- LHH Medicare Secondary Payer Form (English)
- LHH Dental Clinic Form (English)
- Laguna Honda Rules (English)
- Laguna Honda Rules (Chinese)
- Laguna Honda Rules (Spanish)
- Laguna Honda Rules (Tagalog)
- CDPH Standard Admission Agreement for Skilled Nursing Facilities and Intermediate Care Facilities (English)
- CDPH Standard Admission Agreement for Skilled Nursing Facilities and Intermediate Care Facilities (Chinese)
- CDPH Standard Admission Agreement for Skilled Nursing Facilities and Intermediate Care Facilities (Spanish)
Summary Notice of HIPAA Privacy Practices and Acknowledgement of Receipt
English | Chinese | Russian | Spanish | Tagalog | Vietnamese
Full Notice of HIPAA Privacy Rights
English | Chinese | Russian | Spanish | Tagalog | Vietnamese
Consent for Treatment
English | Chinese | Russian | Spanish | Tagalog | Vietnamese