Notice of Denial of Readmission/Return
This notice is issued by {enter name of facility}
to {enter name of resident}
.
Copies of this notice have also been issued to the following people (include address and relationship to
resident) and agencies:
Date resident transferred from facility:
Location to which transferred:
This action is taken or proposed to be taken because: (Check appropriate box(es))
(*see below for link to Oregon Administrative Rules (OAR’s))
Denial of right to return from the hospital – OAR 411-088-0050
Denial of right to readmission – OAR 411-088-0060
Request not made within 180 days – OAR 411-088-0060(1)(a)
Not eligible by means of payment – OAR 411-088-0060(1)(b)
No bed available at present time (will be admitted as soon as bed is
available – OAR 411-088-0060(2))
Other [OAR reference required; include the specific subsection of the OAR which gives the facility
authority to issue the notice. Example of subsection in bold: OAR 411-088-0020(1)(f)(A)-(B)]
More specifically, this action is taken/proposed because (include the specific subsection of the OAR which
gives the facility the authority to issue the notice).
Your Hearing Rights:
What you can do when you do not agree with this notice:
If you disagree with this notice, you must notify the Office of Licensing and Regulatory Oversight within
10 days from the date you receive this Notice of Denial of Readmission/Return.
Please see instructions on page 2.
If you have questions about your right to disagree with this Notice of Denial of Readmission/Return
you may contact the Oregon Long-Term Care Ombudsman at 1-800-522-2602, 3855 Wolverine Street
NE, Suite 6, Salem OR 97305-1251, LTCO.contact@LTCO.state.or.us.
Signature and title of facility representative
Date
Page 1 of 2
SDS 0510 (04/15)
Instructions to Request a Hearing:
If you disagree with this denial notice, please contact the Office of Licensing and Regulatory Oversight at
503-373-2227 and ask to speak to the Nursing Facility Denial of Readmission/Return Representative. The
Representative will schedule an informal conference with you, anyone you wish to include and the Nursing
Facility. The purpose of the informal conference is to resolve the matter without a formal hearing. If
agreement is not reached at the informal conference, you may request a hearing. Hearings are held by the
Office of Administrative Hearings, which is independent from the Department of Human Services (DHS).
After the hearing the judge will issue a Final Order. If you are not satisfied with the Final Order you may
request reconsideration from the Office of Administrative Hearings or you may petition the Court of Appeals
(ORS 183.480-183.497). Note to military personnel: Active duty service members have a right to stay (delay)
these proceedings under the federal Servicemembers Civil Relief Act (SCRA).
For more information, you may contact the Oregon State Bar (1-800-452-8260), the Oregon Military
Department (1-800-452-7500).
Grounds for Contesting this Notice:
OAR 411-088-0080 (4)(f):
(A) In a hearing concerning right of readmission, the only questions raised shall be whether the application
was timely, whether the former resident is eligible by means of payment, and whether another person was or
is entitled to the bed.
(B) In a hearing concerning right of return, the only questions raised shall be whether full payment is or was
available for the period of hospital stay and whether there was authority under OAR 411-088-0050(2) for
another person to be given the bed.
Who can help with my hearing?
Anyone may represent you. You may call the Public Benefits Hotline (a program of Legal Aid Services of
Oregon and the Oregon Law Center) at 1-800-520-5292 for advice and possible representation.
What are my other hearing rights?
At the hearing, you can tell why you do not agree with the Notice. You can have people testify for you. The
laws about your hearing rights and the hearing process are at OAR 137-003-0501 to 0700, 411-088-0080,
ORS 183.411 to 183.470 and ORS 441.600, 441.605 and 441.615.
Can I have an expedited hearing?
You have the right to an “expedited hearing” if the Nursing Facility has given you a Notice of Denial because
the facility is closing.
This Notice of Denial of Readmission/Return must be accompanied by a copy of the DHS Office of Licensing
and Regulatory Oversight brochure, "Leaving the Nursing Facility" (DHS 9847). This brochure further
explains any rights you may have to a hearing. If you did not receive a copy of the brochure, you should
contact the DHS Office of Regulatory Oversight at 503-373-2227 immediately.
*Click on this link for access to OAR’s: http://www.dhs.state.or.us/policy/spd/rules/411_088.pdf
Page 2 of 2
SDS 0510 (04/15)