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Douglas Murray Apply for Residence

Please note: at the end of this form you will need to download and print a Medical Assessment to be completed by a Medical Officer. This must be brought along to your first meeting at Douglas Murray Home. Please also note: the applicant's contribution towards costs is determined by their income.

Step 1 of 6

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Application Criteria for Admission(Required)
Please check the options that apply to this applicant. If for any reason you or the person you are applying for does not meet any of the criteria below, please get in touch

Please read the "Code of Conduct for Residents" and confirm that you have read the rules

All residents must abide by the rules of the institution
  • Strictly no smoking in the home (smoking is only allowed in designated outside areas)
  • No alcohol or drugs are allowed on the premises
  • No dangerous weapons or guns are allowed on the premises
  • No resident is allowed to leave the premises without permission from the Sister-in-Charge
  • Strict adherence to meal times is requested
  • Residents must be quiet and respectful during meal times
  • All residents' clothing must be marked, and be machine and tumble drier friendly
  • Valuables must be handed in at the office for safe-keeping (management is not responsible for losses if residents do not abide by rules)
  • All mobile phones, TVs and radios must be declared
  • Residents' TVs, radios, clothing, etc will be checked for cockroaches on an ongoing basis
  • TVs and radios in bedrooms must be switched off at 10pm
  • Strict adherence to visiting times is requested (permission will be granted in special cases)
  • No visitor is allowed in the rooms or wards without permission from staff
  • All grievances to be channeled via correct procedure, i.e. Sister-in Charge, CEO, Board
  • Medication will only be administered by trained staff
  • Residents are no allowed in the kitchen or laundry areas
  • Only Doctor prescribed food, special diets and allergies will be considered and catered for
  • No food is allowed in rooms, unless stored in sealed containers
  • Food requirements must be declared on admission
  • Respectful behaviour is required at all times to staff and other residents
  • All clothing brought in after admission must first be recorded in the Kit Book by the Sister-in-Charge

Disciplinary Measures

  • Serious misconduct will be referred to the Board and a final written notice will be given
  • All other rules broken will be dealt with by the CEO
Please tick to confirm you have read the above "Code of Conduct for Residents"
Name(Required)
Please select the relevant option

Insurance

Is your policy paid up?(Required)

Will

Have you made a will?(Required)
In the event of death, who will take responsibility for funeral expenses, as well as the outstanding debt owed to the Douglas Murray Home?

Important:

  1. Your application will only be finalised after this person has signed with a witness to take responsibility.
  2. For health reasons, the body of the deceased must be removed from the premises by the designated undertakers within 2 hours of death. Should this not occur, the Douglas Murray Home reserves the right to appoint an undertaker for this purpose, the costs of which will be passed on to the person listed above.

Pension

Retirement Annuity

Other investments

Property: Do you...

Person Responsible for Payment of Account

Important:

  1. Please note that the family contribution portion of the monthly board and lodging fee must be paid no later than the 7th day of each month
  2. Also note, in the case of death of the resident, the family of the said resident will be held liable for any debt owing to the home for outstanding board and lodging fees. All debt with the home must be settled within two months of the passing of the resident.
  3. Failure to comply with the above will result in the debtor being handed over to the Douglas Murray Home attorneys for collection.
Please options that apply to you...
Do you require any medical treatment at present?
Have you suffered from any serious illness?
Do you have any physical difficulties?
Please download and print the Douglas Murray Home medical certificate - this needs to be completed and signed by a qualified Medical Practitioner

Undertaking and Agreement by Resident Applicant

If I am admitted to the Douglas Murray home for the Aged, I hereby acknowledge and agree to the following:
  1. To abide by the organisation's household rules and any amendments thereto
  2. to pay my monthly board and lodging fees in advance by the 7th day of each month, the amount of which is calculated in accodance with the Douglas Murray Home tariff structure
  3. Any funds belonging to me and given by myself or on my authoriy to the Executor of my estate, may in the event of my death be used towards settling any debt that I may have incurred with the Douglas Murray Home
  4. The Douglas Murray Home does not accept reposnsibilty for any personal possessions, jewlery, documents, etc brought into the Home by me
  5. Should I decide to leave the Home, I will give one calendar's month notice in writing, or pay the Home one month's board and lodging in lieu of a notice
  6. Should I pass while being a resident at the Home, an administration fee equivalent to one month's full board and lodging becomes payable from my estate
  7. The Home reserves the right and has the sole discretion to transfer me from one room to ward to another. I accept that the Home has the right to implement such transfer if in its sole opinion my health status indicates that it is necessary or desirable
  8. Shoudl the need arise for any emergency medical treatment to me, and my next of kin is not available, the Sister-in-Charge may provide consent to such treatment by a medical professional or hospital
  9. The Home reserves the right to give notice to or even discharge any resident who exhibits violent tendencies or anti-social behaviour, into the care of the designated family member or guardian.
Please download and print the Douglas Murray Boarding and Lodging Agreement - this needs to be brought along to your first meeting
Max. file size: 64 MB.
Max. file size: 64 MB.
Please check the following to confirm

Wishlist

We always in need of the following:

  • Groceries (tea/coffee, dried goods, and perishables like fruit and vegetables)
  • Clothing
  • Bedding and Curtains
  • Ornaments
  • Bric-a-brac
  • Furniture
  • Artwork
  • Electric appliances

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