Appointments are 4-hour time slots. However, you are welcome to book as many appointments as you would like between the hours of 8am-6pm. Although a negative test result is not required for general visitors, regular testing prior to visiting is strongly encouraged to protect all residents and associates.

VENTANA BY BUCKNER

COVID-19 PANDEMIC

VISITOR ACKNOWLEDGEMENT OF RISK

UNDERSTANDING and ACKNOWLEDGEMENT OF RISKS. I understand and acknowledge the following:

1.   According to the Centers for Disease Control (the “CDC”), adults age 65 and older and those with underlying health conditions (especially if not well controlled) may be particularly susceptible or at higher risk for illness and death or complications from COVID-19. Such underlying conditions include, but are not limited to, chronic lung disease, heart conditions, suppressed immune system, obesity, diabetes, kidney disease, liver and other gastrointestinal diseases, cancer and post cancer recovery.

2.   Persons in congregate settings (multiple people living together such as at the Facility) may be at risk of contracting COVID-19 even when all appropriate interventions and preventative measures are in place.

3.   The CDC has noted that a congregate setting, with a medically frail and/or older resident population, are at high risk of being affected by respiratory pathogens like COVID-19.

4.   The CDC has stated that there is evidence that COVID-19 is spread by asymptomatic and pre-symptomatic infected individuals. This means that the silent spread of COVID-19 may go undetected in congregate living situations even with appropriate precautions and can be transmitted by infected persons who do not exhibit signs or symptoms of illness.

5.   I am requesting access to the premises of the Facility identified above during a COVID-19 pandemic and acknowledge and accept that such admission is contingent on my agreement to follow all Facility visitation rules and regulations, including all required and recommended COVID-19 precautions. These precautions include, but not limited to, wearing a mask, maintaining social distancing during my visitation and not visiting common areas of the community. I further agree that I am solely responsible for the expense, if any, of such test.

6.   I understand and acknowledge that my own activities when I am outside of the Facility during this COVID-19 pandemic could impact the health of Facility residents and staff and that therefore I am accountable for  wearing personal protective equipment such as a mask, observing social distancing and hand washing recommendations, when I am outside the Facility so I do not put residents and staff at potential risk when I enter the Facility as a visitor.

7.   Despite adhering to all requested precautions, there is still a potential I could be exposed to and contract COVID-19 while on Facility premises and that the Facility cannot guarantee a COVID-19 risk-free environment.

I HAVE READ, AGREE TO, AND VOLUNTARILY SIGN THIS VISITOR ACKNOWLEDGEMENT OF RISK EFFECTIVE AS OF THE DATE SET FORTH BELOW.

Appointments are 4-hour time slots. However, you are welcome to book as many appointments as you would like between the hours of 8am-6pm. Although a negative test result is not required for general visitors, regular testing prior to visiting is strongly encouraged to protect all residents and associates.

VENTANA BY BUCKNER

COVID-19 PANDEMIC

VISITOR ACKNOWLEDGEMENT OF RISK

UNDERSTANDING and ACKNOWLEDGEMENT OF RISKS. I understand and acknowledge the following:

1.   According to the Centers for Disease Control (the “CDC”), adults age 65 and older and those with underlying health conditions (especially if not well controlled) may be particularly susceptible or at higher risk for illness and death or complications from COVID-19. Such underlying conditions include, but are not limited to, chronic lung disease, heart conditions, suppressed immune system, obesity, diabetes, kidney disease, liver and other gastrointestinal diseases, cancer and post cancer recovery.

2.   Persons in congregate settings (multiple people living together such as at the Facility) may be at risk of contracting COVID-19 even when all appropriate interventions and preventative measures are in place.

3.   The CDC has noted that a congregate setting, with a medically frail and/or older resident population, are at high risk of being affected by respiratory pathogens like COVID-19.

4.   The CDC has stated that there is evidence that COVID-19 is spread by asymptomatic and pre-symptomatic infected individuals. This means that the silent spread of COVID-19 may go undetected in congregate living situations even with appropriate precautions and can be transmitted by infected persons who do not exhibit signs or symptoms of illness.

5.   I am requesting access to the premises of the Facility identified above during a COVID-19 pandemic and acknowledge and accept that such admission is contingent on my agreement to follow all Facility visitation rules and regulations, including all required and recommended COVID-19 precautions. These precautions include, but not limited to, wearing a mask, maintaining social distancing during my visitation and not visiting common areas of the community. I further agree that I am solely responsible for the expense, if any, of such test.

6.   I understand and acknowledge that my own activities when I am outside of the Facility during this COVID-19 pandemic could impact the health of Facility residents and staff and that therefore I am accountable for  wearing personal protective equipment such as a mask, observing social distancing and hand washing recommendations, when I am outside the Facility so I do not put residents and staff at potential risk when I enter the Facility as a visitor.

7.   Despite adhering to all requested precautions, there is still a potential I could be exposed to and contract COVID-19 while on Facility premises and that the Facility cannot guarantee a COVID-19 risk-free environment.

I HAVE READ, AGREE TO, AND VOLUNTARILY SIGN THIS VISITOR ACKNOWLEDGEMENT OF RISK EFFECTIVE AS OF THE DATE SET FORTH BELOW.

VENTANA BY BUCKNER

COVID-19 PANDEMIC

ESSENTIAL CAREGIVER ACKNOWLEDGEMENT OF RISK

 UNDERSTANDING and ACKNOWLEDGEMENT OF RISKS. I understand and acknowledge the following:

1.   According to the Centers for Disease Control (the “CDC”), adults age 65 and older and those with underlying health conditions (especially if not well controlled) may be particularly susceptible or at higher risk for illness and death or complications from COVID-19. Such underlying conditions include, but are not limited to, chronic lung disease, heart conditions, suppressed immune system, obesity, diabetes, kidney disease, liver and other gastrointestinal diseases, cancer and post cancer recovery.

2.   Persons in congregate settings (multiple people living together such as at the Facility) may be at risk of contracting COVID-19 even when all appropriate interventions and preventative measures are in place.

3.   The CDC has noted that a congregate setting, with a medically frail and/or older resident population, are at high risk of being affected by respiratory pathogens like COVID-19.

4.   The CDC has stated that there is evidence that COVID-19 is spread by asymptomatic and pre-symptomatic infected individuals. This means that the silent spread of COVID-19 may go undetected in congregate living situations even with appropriate precautions and can be transmitted by infected persons who do not exhibit signs or symptoms of illness.

5.   I am requesting access to the premises of the Facility identified above during a COVID-19 pandemic and acknowledge and accept that such admission is contingent on my agreement to follow all Facility visitation rules and regulations, including all required and recommended COVID-19 precautions. These precautions include, but not limited to, wearing a mask, maintaining social distancing during my visitation and not visiting common areas of the community. I further agree that I am solely responsible for the expense, if any, of such test.

6.   I understand and acknowledge that my own activities when I am outside of the Facility during this COVID-19 pandemic could impact the health of Facility residents and staff and that therefore I am accountable for  wearing personal protective equipment such as a mask, observing social distancing and hand washing recommendations, when I am outside the Facility so I do not put residents and staff at potential risk when I enter the Facility as a visitor.

7.   Despite adhering to all requested precautions, there is still a potential I could be exposed to and contract COVID-19 while on Facility premises and that the Facility cannot guarantee a COVID-19 risk-free environment.

8.   As a “ESSENTIAL CAREGIVER” visitor, I acknowledge:
- The facility has trained me in the use of PPE and other infection control measures.
- I will use proper community approved PPE at all times during my scheduled visit.
-   I must identify myself as well as wear a community provided ID during each visit.

-   I must stay in the resident room, maintain caution, social distance where possible and will not be near other residents or staff.

-   I must follow the community protocols in making an appointment for the visits as well as follow all COVID-19 risk mitigation restrictions.

Essential caregivers no longer are required to present a negative test result prior to their visit with residents in Nursing areas. Testing is still strongly encouraged to protect all residents and associates.

I HAVE READ, AGREE TO, AND VOLUNTARILY SIGN THIS VISITOR ACKNOWLEDGEMENT OF RISK EFFECTIVE AS OF THE DATE SET FORTH BELOW.

VENTANA BY BUCKNER

COVID-19 PANDEMIC

ESSENTIAL CAREGIVER ACKNOWLEDGEMENT OF RISK

 UNDERSTANDING and ACKNOWLEDGEMENT OF RISKS. I understand and acknowledge the following:

1.   According to the Centers for Disease Control (the “CDC”), adults age 65 and older and those with underlying health conditions (especially if not well controlled) may be particularly susceptible or at higher risk for illness and death or complications from COVID-19. Such underlying conditions include, but are not limited to, chronic lung disease, heart conditions, suppressed immune system, obesity, diabetes, kidney disease, liver and other gastrointestinal diseases, cancer and post cancer recovery.

2.   Persons in congregate settings (multiple people living together such as at the Facility) may be at risk of contracting COVID-19 even when all appropriate interventions and preventative measures are in place.

3.   The CDC has noted that a congregate setting, with a medically frail and/or older resident population, are at high risk of being affected by respiratory pathogens like COVID-19.

4.   The CDC has stated that there is evidence that COVID-19 is spread by asymptomatic and pre-symptomatic infected individuals. This means that the silent spread of COVID-19 may go undetected in congregate living situations even with appropriate precautions and can be transmitted by infected persons who do not exhibit signs or symptoms of illness.

5.   I am requesting access to the premises of the Facility identified above during a COVID-19 pandemic and acknowledge and accept that such admission is contingent on my agreement to follow all Facility visitation rules and regulations, including all required and recommended COVID-19 precautions. These precautions include, but not limited to, wearing a mask, maintaining social distancing during my visitation and not visiting common areas of the community. I further agree that I am solely responsible for the expense, if any, of such test.

6.   I understand and acknowledge that my own activities when I am outside of the Facility during this COVID-19 pandemic could impact the health of Facility residents and staff and that therefore I am accountable for  wearing personal protective equipment such as a mask, observing social distancing and hand washing recommendations, when I am outside the Facility so I do not put residents and staff at potential risk when I enter the Facility as a visitor.

7.   Despite adhering to all requested precautions, there is still a potential I could be exposed to and contract COVID-19 while on Facility premises and that the Facility cannot guarantee a COVID-19 risk-free environment.

8.   As a “ESSENTIAL CAREGIVER” visitor, I acknowledge:
- The facility has trained me in the use of PPE and other infection control measures.
- I will use proper community approved PPE at all times during my scheduled visit.
-   I must identify myself as well as wear a community provided ID during each visit.

-   I must stay in the resident room, maintain caution, social distance where possible and will not be near other residents or staff.

-   I must follow the community protocols in making an appointment for the visits as well as follow all COVID-19 risk mitigation restrictions.

I HAVE READ, AGREE TO, AND VOLUNTARILY SIGN THIS VISITOR ACKNOWLEDGEMENT OF RISK EFFECTIVE AS OF THE DATE SET FORTH BELOW.