Section 2-B Managing Uncontrolled Symptoms (A SECTION ppendix) 2-B Should you develop uncontrolled symptoms that cannot be addressed in your current residence, your hospice benefit includes the General Inpatient Level of Care provided in a contracted MJHS Hospice Inpatient Unit (IPU) or skilled nursing facility. In order to continue receiving hospice services from MJHS-HPC, any hospitalization related to your hospice diagnosis must be provided at an MJHS-HPC contracted facility. You can decide to use services or be admitted to a hospital or facility not contracted with MJHS-HPC for symptoms related to your hospice diagnosis by revoking your hospice benefit or assuming responsibility for any fees or charges related to the service provided. If your symptoms become unmanageable, don t panic: STOP and call one of our 24/7 numbers: Manhattan and the Bronx: (212) 649-5555 Brooklyn: (718) 921-7900 Queens and Nassau: (516) 239-2400 A nurse or physician will immediately evaluate you and your symptoms to see if the General Inpatient Level of Care is best for you. Please speak to your RN Case Manager at the time of admission to predetermine where you would prefer to be transferred, should this level of care is needed. Locations for Inpatient Level of Care Bronx MJHS HOSPICE MurIEl and HarOld block residence 2550 Webb Avenue, 12th Floor Bronx, NY 10468 Phone: 1-800-Hospice (467-7423) MOntEfIOrE MEdICal (EInStEIn CaMPuS) 1825 Eastchester Road Bronx NY, 10461 Phone: (718) 904-2000 MOntEfIOrE MEdICal (MOSES CaMPuS) 111 East 210th Street Bronx NY, 10467 Phone: (718) 920-4321 MOntEfIOrE MEdICal (WakEfIEld CaMPuS) 600 East 233rd Street Bronx NY, 10466 Phone: (718) 920-9000 Contracted with MJHS to provide hospice and accept ventilator patients MUS.17.v2 1
Locations for Inpatient Level of Care continued Brooklyn MJHS HOSPICE InPatIEnt residence at MEnOraH 1516 Oriental Blvd. Brooklyn NY, 11235 Phone: (718) 368-7744 new york MEtHOdISt HOSPItal 506 Sixth Street Brooklyn NY, 11215 Phone: ( 718) 780-3000 manhattan MJHS HOSPICE InPatIEnt unit at MOunt SInaI beth ISraEl (9 Dazian - Pod D) 1st Avenue at 16th Street New York, NY 10003 Phone: (212) 844-1712 new JEWISH HOME 120 West 106th Street New York NY, 10025 Phone: (212) 870-5000 long island: nassau the amsterdam at HarbOrSIdE 300 East Overlook Port Washington NY, 11050 Phone: (516) 472-6610 SOutH nassau COMMunItIES HOSPItal One Healthy Way Oceanside NY, 11572 Phone: (516) 632-3000 MJHS InPatIEnt unit at boro Park for rehabilitation and HEaltHCarE 4915 10th Avenue- 3rd Floor Brooklyn, NY 11219 Phone: (718) 851-3700 MOunt SInaI St. luke S 1111 Amsterdam Avenue New York, NY 10025 Phone: (212) 523-4000 MEadOWbrOOk CarE 320 W. Merrick Road Freeport NY, 11520 Phone: (516) 377-8232 WIntHrOP university HOSPItal 259 First Street Mineola NY, 11501 Phone: (516) 663-0333 MOunt SInaI beth ISraEl - brooklyn division 3201 Kings Highway Brooklyn NY, 11234 Phone: (718) 252-3000 MOunt SInaI WESt (formerly roosevelt HOSPItal) 1000 Tenth Avenue New York, NY 10019 Phone: (212) 523-4000 MJHS HOSPICE InPatIEnt unit at beach terrace CarE 640 West Broadway Long Beach NY, 11561 Phone: (516) 431-4400 Contracted with MJHS to provide hospice and accept ventilator patients MUS.17.v2 2
queens flushing HOSPItal MEdICal 4500 Parson Blvd. Flushing NY, 11355 Phone: (718) 670-5000 new york PrESbytErIan queens 56-45 Main Street Flushing NY, 11355 Phone: (718) 670-2000 SIlvErCrESt for nursing and rehab 144-45 87th Avenue Briarwood NY, 11435 Phone: (718) 480-4000 Skilled Nursing Facilities Bronx obainbridge nursing and rehabilitation 3518 Bainbridge Avenue Bronx NY, 10467 Phone: (718) 655-1991 ofordham nursing and rehabilitation 2678 Kingsbridge Terrace Bronx NY, 10463 Phone: (718) 796-5800 othe Plaza rehabilitation 100 West Kingsbridge Road Bronx NY, 10468 Phone: (718) 410-1500 osplit rock rehabilitation and HEaltH CarE 3525 Baychester Avenue Bronx NY, 10466 Phone: (718) 798-8900 oworkmen S CIrClE MultICarE 3155 Grace Avenue Bronx NY, 10469 Phone: (718) 379-8100 obeth abraham HEaltH SErvICES 612 Allerton Avenue Bronx NY, 10467 Phone: (718) 519-4000 ohudson POIntE at riverdale for nursing & rehab 3220 Henry Hudson Pkwy Bronx NY, 10463 Phone: (718) 514-2000 oriverdale nursing HOME 641 West 230th Street Bronx NY, 10463 Phone: (718) 796-4800 otriboro for rehabilitation and nursing CarE 1160 Teller Avenue Bronx NY, 10456 Phone: (718) 293-1500 oeastchester rehab and HEaltH CarE 2700 Eastchester Road Bronx NY, 10469 Phone: (718) 231-5550 omorningside HOuSE nursing HOME & rehabilitation SErvICE CarE 1000 Pelham Parkway S. Bronx NY, 10461 Phone: (718) 409-8200 oschervier nursing CarE 2975 Independence Avenue Bronx NY, 10463 Phone: (718) 548-1700 ouniversity nursing HOME 2505 Grand Avenue Bronx NY, 10468 Phone: (718) 295-1400 Contracted with MJHS to provide hospice and accept ventilator patients MUS.17.v2 3
Skilled Nursing Facilities continued Brooklyn oaugustana for EXtEndEd CarE and rehabilitation 5434 Second Avenue Brooklyn, NY 11220 Phone #: (718) 630-6000 obrooklyn GardEnS rehab & nursing 835 Herkimer Street Brooklyn, NY 11233 Phone: (718) 221-2600 oconcord nursing HOME InC. 300 Madison Street Brooklyn, NY 11216 Phone: (718) 636-7500 ohamilton Park nursing and rehab 691 92nd Street Brooklyn, NY 11228 Phone: (718) 567-1000 olinden for nursing and rehabilitation 2237 Linden Boulevard Brooklyn, NY 11207 Phone: (718) 649-7000 othe PHOEnIX rehabilitation and nursing 140 St. Edwards Street Brooklyn, NY 11201 Phone: (718) 858-6400 ospring CrEEk rehab and nursing CarE 660 Louisiana Avenue Brooklyn, NY 11239 Phone: (718) 669-7100 obedford for oboro Park nursing and rehabilitation 4915 Tenth Avenue 40 Heyward Street Brooklyn, NY 11219 Brooklyn, NY 11249 Phone #: (718) 851-3700 Phone: (718) 858-6200 obuena vida COntInuInG CarE & rehab 48 Cedar Street Brooklyn, NY 11221 Phone: (718) 455-6200 ocrown HEIGHtS for nursing and rehabilitation 810 St. Mark s Avenue Brooklyn, NY 11213 Phone: (718) 467-7300 othe HErItaGE rehab & HEaltH 5606 15th Avenue Brooklyn, NY 11219 Phone: (718) 851-1000 omenorah for rehab and nursing CarE 1516 Oriental Blvd. Brooklyn, NY 11235 Phone: (718) 646-4441 orutland nursing HOME 585 Schenectady Avenue Brooklyn, NY 11203 Phone: (718) 604-5000 ost. JOaCHIM & anne nursing & rehab 2720 Surf Avenue Brooklyn, NY 11224 Phone: (718) 714-4800 o for nursing rehabilitation 520 Prospect Place Brooklyn, NY 11238 Phone: (718) 636-1000 ofour SEaSOnS nursing & rehab 1555 Rockaway Parkway Brooklyn, NY 11236 Phone: (718) 927-6300 oking david rehab (F/K/A Sephardic) 2266 Cropsey Avenue Brooklyn, NY 11214 Phone: (718) 266-2418 onew CarltOn rehab and nursing 405 Carlton Avenue Brooklyn, NY 11238 Phone: (718) 789-6262 oseagate rehab & nursing 3015 West 29th Street Brooklyn, NY 11224 Phone: (718) 266-5700 Contracted with MJHS to provide hospice and accept ventilator patients MUS.17.v2 4
manhattan oamsterdam nursing HOME 1060 Amsterdam Avenue New York, NY 10025 Phone: (212) 316-7700 ofort tryon rehab & HEaltH CarE 801 West 190th Street New York, NY 10040 Phone: (212) 543-6400 ogouverneur nursing facility (lower E. Side) 227 Madison Street New York, NY 10002 Phone: (212) 238-7897 oharlem for nursing and rehab 30 West 138th Street New York, NY 10037 Phone: (212) 690-7400 oisabella GErIatrIC 515 Audubon Avenue New York, NY 10040 Phone: (212) 342-9200 onew JEWISH HOME ManHattan division 120 West 106th Street New York, NY 10025 Phone: (212) 870-5000 onew EaStSIdE nursing HOME 25 Willett Street New York, NY 10002 Phone: (212) 673-8500 onorthern ManHattan rehabilitation and nursing 116 East 125th Street New York, NY 10035 Phone: (212) 426-1284 oupper EaSt SIdE rehab (f/k/a dewitt) 211 East 79th Street New York, NY 10075 Phone: (212) 879-1600 ost. Mary S, InC. 516 West 126th Street New York, NY 10027 Phone: (212) 662-1826 long island: nassau oamsterdam at HarbOrSIdE 300 East Overlook Port Washington, NY 11050 Phone: (516) 472-6610 obeach terrace CarE 640 West Broadway Long Beach, New York 11561 Phone: (516) 431-4400 ofulton COMMOnS CarE nursing and rehabilitation 60 Merrick Avenue East Meadow, NY 11554 Phone: (516) 222-9300 ograndell rehabilitation and nursing 645 West Broadway Long Beach, NY 11561 Phone: (516) 889-1100 olong beach nursing and rehabilitation 375 East Bay Drive Long Beach, NY 11561 Phone: (516) 897-1000 omeadowbrook CarE 320 W. Merrick Road Freeport, NY 11520 Phone: (516) 377-8200 ooceanside CarE 2914 Lincoln Avenue Oceanside, NY 11572 Phone: (516) 536-2300 orockville SkIllEd nursing and rehabilitation 50 Maine Avenue Rockville Centre, NY 11570 Phone: (516) 536-8000 opark avenue EXtEndEd CarE 425 National Boulevard Long Beach, NY 11561 Phone: (516) 431-2600 ext. 3004 Contracted with MJHS to provide hospice and accept ventilator patients MUS.17.v2 5
Skilled Nursing Facilities continued long island: nassau continued osunharbor ManOr 255 Warner Avenue Roslyn Heights, NY 11577 Phone: (516) 621-5400 queens ocliffside rehab & residential HEaltH CarE 144-45 87th Avenue Briarwood, NY 11435 Phone: (718) 886-0700 ofranklin for rehabilation and nursing 142-27 Franklin Avenue Flushing, NY 11355 Phone: (718) 670-3400 oholliswood for rehab and HEaltHCarE 195-44 Woodhull Avenue Jamaica, NY 11423 Phone: (718) 740-3500 onew SurfSIdE nursing HOME 22-41 New Haven Avenue Far Rockaway, NY 11691 Phone: (718) 471-3400 otownhouse for rehabilitation and nursing 755 Hempstead Turnpike Uniondale, NY 11553 Phone: (516) 565-1900 ocypress GardEn for nursing 139-66 35th Avenue Phone: (718) 961-5300 oforest view for rehab and nursing 71-20 110th Street Forest Hills, NY 11375 Phone: (718) 793-3200 omargaret tietz nursing and rehabilitation 164-11 Chapin Parkway Jamaica Hills, NY 11432 Phone: (718) 298-7800 owoodmere rehab & HEaltH CarE 121 Franklin Place Woodmere, NY 11598 Phone: (516) 374-9300 ofairview nursing CarE InC. 69-70 Grand Central Parkway Forest Hills, NY 11375 Phone: (718) 263-4600 ohillside ManOr rehab & EXtEndEd CarE 182-15 Hillside Avenue Jamaica Estates, NY 11432 Phone: (718) 291-8200 omeadow Park rehabilitation and HEaltH CarE 78-10 164th Street Fresh Meadows, NY 11366 Phone: (718) 591-8300 Contracted with MJHS to provide hospice and accept ventilator patients MUS.17.v2 6
queens continued othe PavIlIOn at queens 36-17 Parsons Boulevard Phone: (718) 961-4300 opark nursing HOME 128 Beach 115th Street Rockaway Park, NY 11694 Phone: (718) 474-6400 openinsula for EXtEndEd CarE and rehabilitation 50-15 Beach Channel Drive Far Rockaway, NY 11691 Phone: (718) 734-2000 opromenade rehabilitation and HEaltH CarE 140 Beach 114th Street Rockaway Park, NY 11694 Phone: (718) 945-4600 oregal HEIGHtS rehabiltation and HEaltHCarE 70-05 35th Avenue Jackson Heights, NY 11372 (718) 662-5100 oqueens boulevard EXtEndEd CarE facility 61-11 Queens Boulevard Woodside, NY 11377 Phone: (718) 205-0287 orockaway CarE 353 Beach 48th Street Far Rockaway, NY 11691 Phone: (718) 471-5000 oqueens nassau rehabilitation and nursing 520 Beach 19th Street Far Rockaway, NY 11691 Phone: (718) 471-7400 osapphire for rehabilitation and nursing (Formerly known as Flushng Manor Nursing And Rehabilitation Center) 35-15 Parsons Boulevard Phone: (718) 961-3500 osilvercrest for nursing and rehab 144-45 87th Avenue Briarwood, NY 11435 Phone: (718) 480-4000 ounion Plaza CarE 33-23 Union Street Phone: (718) 670-0700 owest lawrence CarE 1410 Seagirt Boulevard Far Rockaway, NY 11691 Phone: (718) 471-7000 owoodcrest rehab & residential HEaltH CarE 119-09 26th Avenue Phone: (718) 762-6100 Contracted with MJHS to provide hospice and accept ventilator patients MUS.17.v2 7
Inpatient/Skilled Nursing Preference Patient Name: Chart #: DOB: / / In the event of an emergency, and the need to provide a General Inpatient Level of Care, my preference is to be transferred to the following inpatient units: Inpatient Units (please list in order of preference): 1. 2. 3. 4. 5. Should long-term care be required during the course of my treatment, my preference is to be transferred to the following skilled nursing facilities: Skilled Nursing Facility (please list in order of preference): 1. 2. 3. 4. 5. Although it may not always be possible, MJHS Hospice will do their best to transfer you to the unit or skilled facility of your choice. 39 Broadway, 2 nd Floor, New York, NY 10006 Phone: (212)-649-5555 Fax: (212) 844-7605 Web: mjhs.org