CT ACHCA


	*Providing Excellence in Long-term Care Leadership!*

Occupancy Study Input Form

for the quarter ending 12/31/2011

Facility Name

Licensed capacity (total CCNH and RNHS beds; if unsure, check your actual license)

Number of beds currently set up to receive patients (usually your licensed capacity, but could be less than your licensed capacity for a number of reasons, e.g., renovations, staffing difficulties, etc; call Rick at 860-290-9424; RBrown@cahcf.com if you have any questions)

Number of residents on 12/31/2011 (include ALL bed holds, paid or otherwise)

This is a joint effort of CAHCF, CANPFA and the Connecticut Chapter of ACHCA. Please give us the information we need to make our case with legislators and regulators. It's important for us all. Thanks.

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If all else fails, print out this completed form and fax it to 860-290-9478. Thanks.

Occupancy Study Input Form for the quarter ending 12/31/2011

Occupancy Study Input Form

for the quarter ending 12/31/2011