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Assisted Living Move In Check List

Thank you for choosing assisted living at Arleigh Burke Pavilion. We are committed to making sure that your family member’s transition to our residence is as easy as possible. If you have any questions, please do not hesitate to call the Move-In Coordinator at 703-538-2974.

  1. Application: Once a decision is made to select Arleigh Burke Pavilion, an application must be completed in its entirety. Applications can be obtained by contacting Arleigh Burke Pavilion’s Move-In Coordinator. Click here for an application.
  2. UAI: Arrangements must be made with Arleigh Burke Pavilion’s Move-In Coordinator to complete a Uniform Assessment Instrument (UAI) for the prospective resident. This evaluation is required by the Virginia Department of Social Services to ensure our assisted living services are appropriate to meet each new resident’s needs. Our nurse manager meets & reviews with you your functional and psychosocial status which includes a mini-mental examination.
  3. H&P: Virginia Department of Social Services also requires a complete history and physical exam (H&P) completed by an independent physician within 30 days prior to the move-in date. This report will also contain Tuberculosis screening which must be filled out by an independent physician (either a PPD test result or chest X-ray report) TB Form. Please have a physician complete both forms. H&P Form
  4. Personal & Social History: Virginia Department of Social Services requires that a personal and social history be completed on all residents admitted to assisted living. This form can be obtained by contacting Arleigh Burke Pavilion’s Move-In Coordinator. P&S History
  5. Physician: Choosing a physician; it is the resident or family’s responsibility to choose a physician that will serve as the resident’s primary care physician. If you choose your current provider he/she needs to be available to accept phone calls from our nursing staff about changes in your health condition. Should you need a new physician, the Move-In Coordinator, for your convenience, can provide you with a list of physicians who are familiar with the Pavilion.
  6. Move-in Date: Once all necessary paperwork has been completed, a mutually agreed upon move-in date will be arranged.


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