Common use of Facility Certification Clause in Contracts

Facility Certification. This Admission Agreement was signed only after an in-person or telephone interview with , during which the terms of this Agreement were reviewed and I answered any questions concerning Facility policies asked of me. (Name/Signature of Facility’s Representative) ATTACHMENT A PERSONAL AGREEMENT This Agreement is effective the day of , between Palatine Nursing Home (the “Facility”) and , residing at (hereinafter “Signator”). Signator hereby stipulates that valuable and sufficient consideration exists for Signator’s obligations under this Agreement, including but not limited to, the Facility’s agreement to admit (“Resident”) to the Facility and to provide any and all services and other things of value to Resident as specified in the Resident’s Admission Agreement with Facility (the “Admission Agreement”) since Resident’s admission to the Facility. Therefore, in consideration of the Facility’s agreement to admit Resident and to provide the services specified in the Admission Agreement,

Facility Certification. This Admission Agreement was signed only after an in-person or telephone interview with , during which the terms of this Agreement were reviewed and I answered any questions concerning Facility policies asked of me. (Name/Signature of Facility’s Representative) ATTACHMENT SCHEDULE A PERSONAL AGREEMENT This Agreement is effective the day of , between Palatine Kirkhaven Nursing Home (the “Facility”) and , residing at (hereinafter “Signator”). Signator hereby stipulates that valuable and sufficient consideration exists for Signator’s obligations under this Agreement, including but not limited to, the Facility’s agreement to admit (“Resident”) to the Facility and to provide any and all services and other things of value to Resident as specified in the Resident’s Admission Agreement with Facility (the “Admission Agreement”) since Resident’s admission to the Facility. Therefore, in consideration of the Facility’s agreement to admit Resident and to provide the services specified in the Admission Agreement,

Facility Certification. This Admission Agreement was signed only after an in-person or telephone interview with , during which the terms of this Agreement were reviewed and I answered any questions concerning Facility policies asked of me. _ (Name/Signature of Facility’s Representative) ATTACHMENT SCHEDULE A PERSONAL AGREEMENT This Agreement is effective the day of , between Palatine Kirkhaven Nursing Home (the “Facility”) and , residing at _ (hereinafter “Signator”). Signator hereby stipulates that valuable and sufficient consideration exists for Signator’s obligations under this Agreement, including but not limited to, the Facility’s agreement to admit (“Resident”) to the Facility and to provide any and all services and other things of value to Resident as specified in the Resident’s Admission Agreement with Facility (the “Admission Agreement”) since Resident’s admission to the Facility. Therefore, in consideration of the Facility’s agreement to admit Resident and to provide the services specified in the Admission Agreement,