Reporting Facility Name:
* must provide value
ABC Hospice Inc. Adams Nursing Home Advance Rehabilitation & Consulting Limited Partnership Affinity Hospice Ahava Healthcare of Alabaster "Special Focus Facility" AHC Millennium Alabama Clinical Schools Alabama Hospice Care of Birmingham Alabama Hospice Care of Jasper Alabama Hospice Care of Mobile Alabama Hospice Care of Oxford Alabama Hospice Care of Tuscaloosa Alabama Hospice of the Shoals Alabama Physical Rehabilitation Service Inc. Albertville Nursing Home Aletheia House Aliceville Manor Nursing Home Allen Health and Rehabilitation Altoona Health & Rehab Amedisys Hospice Care Amedisys Hospice Care of Sylacauga Amedisys Hospice of Birmingham Amedisys Hospice of Florence Amedisys Hospice of Gadsden Amedisys Hospice of Montgomery Amedisys Hospice of Tuscaloosa American Autism & Rehabilitation Center Inc. Andalusia Manor Andrews Institute Rehabilitation LLC Angels for the Elderly I Angels for the Elderly II Angels for the Elderly III Angels for the Elderly IV Anniston Health and Rehab Services LLC Arbor Springs Health and Rehab Center Ltd. Arbor Woods Health and Rehab Arbors Specialty Care at Somerby of West Mobile Arlington Outpatient Rehab Arlington Rehabilitation & HealthCare Center AseraCare Hospice AseraCare Hospice-Decatur AseraCare Hospice-Hamilton AseraCare Hospice-Jackson AseraCare Hospice-Mobile AseraCare Hospice-Monroeville Ashbury Manor Ashland Place Health and Rehabilitation LLC Aspire Physical Recovery Center at Cahaba River LLC Aspire Physical Recovery Center at Hoover LLC Aspire Physical Recovery Center of West Alabama LLC Assisted Living of Arab Athens Health and Rehabilitation LLC Atmore Nursing Center Atria Regency Atria Regency Specialty Care Attalla Health and Rehab Autumn Cove Autumn Cove Memory Care Autumn Place Autumn Woods Assisted Living Ava Hills Assisted Living Azalea Court Assisted Living Azalea Gardens of Mobile Azalea Manor of Haleyville Baldwin House Baptist Hospice Barfield Health Care Baron House of Hueytown BayPointe Hospital & Children's Residential Svcs & Adolescent Ind. Program Belmont Belmont II Bibb Medical Center Nursing Home Bill Nichols State Veterans Home Bill Nichols State Veterans Home Birmingham Nursing and Rehabilitation Center East LLC Birmingham Nursing and Rehabilitation Center LLC Blake at Malbis Blake Memory Care Community Branchwater Village Brennity at Daphne AL Brennity at Daphne MC Brennity at Fairhope Brentwood Retirement Community I Brentwood Retirement Community II Brewer-Porch Children's Center Briar Glen Alzheimer's Special Care Center Bridgewood Gardens Bridgewood Gardens Memory Care Brookdale Hampton Cove Brookdale Jones Farm Brookdale Shoals ALF (AL) Brookdale Shoals SCALF (AL) Brookdale University Park ALF (AL) Brookdale University Park SCALF (AL) Brookdale University Park SNF (AL) Brookshire Healthcare Center Brookside Assisted Living Community Brookside Memory and Specialty Care on Cody Brown Nursing Home Burns Nursing Home Inc. Camden Nursing Facility Inc. Canterbury Health Care Facility Capitol Hill Healthcare Center Caregivers of Pleasant Grove Inc. Carillon Oaks Heflin Carrington Place Cedar Hill Assisted Living Facility Cedar Hill Specialty Care Assisted Living Cedar View Assisted Living Centers for the Developmentally Disabled Champion Sports Medicine Champion Sports Medicine Champion Sports Medicine Champion Sports Medicine Champion Sports Medicine Champion Sports Medicine Champion Sports Medicine & Rehab Center - Gardendale Champion Sports Medicine & Rehab Center - St. Vincent's Champion Sports Medicine & Rehab Center - Tuscaloosa Champion Sports Medicine & Rehabilitation Center - Jasper Champion Sports Medicine & Rehabilitation Center - Livingston Chapman Healthcare Center Inc. Chapman Specialty Care Assisted Living Facility Charlton Place Rehabilitation & Health Care Center Chattahoochee Hospice Inc. Chelsea's Hidden Acres Cherokee County Health & Rehabilitation Center Cherokee Village Specialty Care Assisted Living Facility Cherry Hill Outpatient Rehabilitation Center Cherry Hill Rehabilitation & Healthcare Center Children's Hospital of Alabama Outpatient Rehabilitation Center Choctaw Health and Rehab Choice Therapy Services Civic Center Health and Rehabilitation LLC Clay County Nursing Home Cleburne County Nursing Home Cloverdale Rehabilitation and Nursing Center Col. Robert L. Howard State Veterans Home Freedom Court Collinsville Healthcare & Rehab Colonel Robert L. Howard State Veterans Home Colonial Haven Care & Rehabilitation Center Columbia Cottage - Hartselle Columbia Cottage-Florence Columbia Cottage-Mountain Brook Columbiana Health and Rehabilitation LLC Columbus Hospice of Alabama Comfort Care Coastal Hospice - Baldwin Comfort Care Coastal Hospice - Mobile Comfort Care Hospice LLC Comfort Care Hospice of Andalusia Comfort Care Hospice of Brewton Comfort Care Hospice of Cullman Comfort Care Hospice of Decatur Comfort Care Hospice of Gadsden Comfort Care Hospice of Gardendale Comfort Care Hospice of Greenville Comfort Care Hospice of Huntsville Comfort Care Hospice of Jasper Comfort Care Hospice of Monroeville Comfort Care Hospice of Montgomery Comfort Care Hospice of Pelham Comfort Care Hospice of Scottsboro Comfort Care Hospice of Sheffield Comfort Care Hospice of Talladega Comfort Care Hospice of Tuscaloosa Community Hospice Care Community Hospice of Baldwin County Community Hospice of Baldwin County in Bay Minette Community Hospice of Dale Medical Center Compassus - Auburn Compassus - Gadsden Compassus - Roanoke Compassus -Auburn Bethany House Compassus Hospice and Palliative Care - Birmingham Compassus Hospice Care Suite Compassus-Florence Compassus-Huntsville Compassus-Troy Coosa Valley Health and Rehab Coosa Valley Healthcare Center Coosa Valley Hospice Cordova Health and Rehabilitation LLC Cornerstone Fitness and Wellness LLC Cottage of the Shoals Country Cottage - Montgomery - Holly Country Cottage - Montgomery - Ivy Country Cottage - Montgomery - Oakleaf Country Cottage Magnolia Cottage Country Cottage Montgomery-Magnolia Country Cottage-Decatur Country Cottage-Decatur-Magnolia Country Cottage-Huntsville-Ivy Country Cottage-Huntsville-Magnolia Country Cottage-Huntsville-Oakleaf Country Cottage-Oakleaf Country Cottage-Russellville Country Gables Country Living Country Place Memory Care of Greenville Country Place Senior Living of Brewton Country Place Senior Living of Fairhope Country Place Senior Living of Foley Country Place Senior Living of Greenville Country Place Senior Living of Hamilton Country Place Senior Living of Winfield Covenant Hospice Inc. - Dothan Covenant Hospice Inc. Mobile Covenant Hospice Inc.-Daphne Covenant Hospice Inpatient Care Center at Providence Hospital Covenant Place of Gardendale Covenant Woods of Gardendale Crimson Health and Rehab LLC Crimson Village Crossville Health and Rehabilitation LLC Crowne Health Care of Citronelle Crowne Health Care of Eufaula Crowne Health Care of Fort Payne Crowne Health Care of Greenville Crowne Health Care of Mobile Crowne Health Care of Montgomery Crowne Health Care of Springhill Crowne Health Care of Thomasville Crowne Place Assisted Living Cullman Health Care Center Cullman Regional Hospice Cumberland Health and Rehab Cypress Cove Center Dadeville Healthcare Center Daffodil House Assisted Living Danberry at Inverness Dauphin Way Assisted Living Davis/Orman Intermediate Care Facility DaySpring Hospice Andalusia Dayspring Hospice Dothan Dayspring Hospice LLC Decatur Health and Rehab Center Decatur Morgan Hospital - Danville Road Campus Diversicare of Arab Diversicare of Bessemer Diversicare of Big Springs Diversicare of Boaz Diversicare of Foley Diversicare of Lanett Diversicare of Montgomery Diversicare of Oneonta Diversicare of Oxford Diversicare of Pell City Diversicare of Riverchase Diversicare of Winfield Dogwood Manor Assisted Living Dugger Mountain Specialty Care Assisted Living EAMC - Lanier Nursing Home East Alabama Medical Center Skilled Nursing Facility East Central Mental Health Center East Glen Eastchase Senior Living Easter Seals Central Alabama Rehabilitation and Career Center Eastern Shore Rehabilitation and Health Center Eastview Rehabilitation & Healthcare Center El Reposo Nursing Facility Elba Nursing and Rehabilitation Center LLC Elmcroft of Byrd Springs Elmcroft of Grayson Valley Elmcroft of Heritage Woods Elmcroft of Heritage Woods Specialty Care Assisted Living Facility Encompass Health Hospice Albertville Encompass Health Hospice Alexander City Encompass Health Hospice Anniston Encompass Health Hospice Birmingham Encompass Health Hospice Clanton Encompass Health Hospice Cullman Encompass Health Hospice Decatur Encompass Health Hospice -Dothan Encompass Health Hospice Gadsden Encompass Health Hospice Greenville Encompass Health Hospice Hamilton Encompass Health Hospice Houston County Encompass Health Hospice Jasper Encompass Health Hospice Madison County Encompass Health Hospice Mobile Encompass Health Hospice Montgomery Encompass Health Hospice Muscle Shoals Encompass Health Hospice Northport Encompass Health Hospice Oneonta Encompass Health Hospice Opelika Encompass Health Hospice Pell City Encompass health Hospice Rainsville Encompass Health Hospice Scottsboro Encompass Health Hospice Talladega Encompass Health Hospice-Huntsville Encompass Health Hospice-Prattville Encompass Health Hospice-Rainbow City EncompassHealth Hospice Troy Englewood Health Care Center Enterprise Health & Rehabilitation Center Evergreen Nursing Home Expect Care Hospice Extendicare Health Center Fair Haven Fair Haven - Assisted Living Fair Haven - Specialty Care Fairhope Health and Rehab Fairview at Redstone Village Falkville Health Care Center Father Purcell Memorial Exceptional Children's Center Fayette Medical Center Long Term Care Unit First Choice Hospice First Choice Hospice Andalusia First Choice Hospice Ozark Inc. Five Points Hospice Fleming Farms Senior Living Florala Health and Rehabilitation LLC Florence Nursing and Rehabilitation Center LLC Floyd E. "Tut" Fann State Veterans Home Floyd E. "Tut" Fann State Veterans Home Folsom Center for Rehabilitation and Healthcare Forest Manor Health and Rehab Gables at Charlton Place Assisted Living Community Gadsden Health and Rehab Center Galleria Woods Assisted Living Facility Galleria Woods Skilled Nursing Facility Gardens of Clanton Gardens of Daphne Gardens of Eufaula Gardens of Madison Gardens of Pelham Gardens of Waterford Gardens of Wetumpka Gardens of Wetumpka II Gateway Generations of Red Bay LLC Generations of Vernon LLC Georgiana Health and Rehabilitation LLC Glen Haven Health and Rehabilitation LLC Glenwood Center Good Samaritan Hospice Good Samaritan Hospice of Madison Goodwater Healthcare Center Gordon Oaks Assisted Living Community Gordon Oaks Memory Care Community Grand Bay Convalescent Home Inc. Grand South Senior Living ALF Grand South Senior Living SCALF Grandview at Redstone Village Grandview Gardens at Redstone Village Green Oaks Inn - Creel House Green Oaks Inn - Pepper House Greenbriar at the Altamont Assisted Living Facility Greenbriar at the Altamont Skilled Nursing Facility Greene County Nursing Home Greensprings I Greensprings II Greenwood Place Gulf Coast Health and Rehabilitation LLC Haleyville Health Care Center Hallmark Manor Hamrick Highlands Assisted Living Hanceville Nursing & Rehab Center Inc. Harbor at Legacy Village of Jacksonville Harbor Chase of Huntsville Harbor Chase of Huntsville Specialty Care Harborchase of Jasper Assisted Living Facility Harborchase of Jasper Specialty Care Assisted Living Facility Hartford Health Care Hartford Retirement Village Hatley Health Care Inc. Haven at Eastchase Haven Memory Care Facility Health Care Inc. Heartlite Hospice Help at Home Hendrix Health and Rehabilitation Henry County Health & Rehabilitation Facility "Outpatient Therapy" Henry County Health and Rehabilitation Facility Heritage Assisted Living Heritage Health Care & Rehab Inc. Heritage Memory Care Heritage Residential Care Village Highlands Health and Rehab Hill Crest Behavioral Health Services Hilltop at Glenwood I (SCALF) Hilltop at Glenwood II Hillview Terrace Holly Cottage at Country Cottages Homeland Assisted Living Homestead Hospice of Cahaba Homestead Hospice of Cahaba LLC East Homestead Hospice of Cahaba LLC Southwest Homestead Hospice of Southern Alabama LLC Hope Hospice Inc. Hospice Family Care Hospice Family Care - Inpatient Hospice of Clay County Hospice of Limestone County Hospice of Monroe County Hospice of Montgomery Hospice of North Alabama LLC Hospice of North Alabama-Russellville Hospice of Northwest Alabama Hospice of the Valley Inc. Hospice of West Alabama Hospice of West Alabama Inc. - Homecare Hospice Services of Alabama LLC Hospice Services of Central Alabama Hospice Services of North Alabama Hunter Creek Health and Rehabilitation LLC Huntsville Health and Rehabilitation LLC Huntsville Hospital Therapy Services Impact Rehabilitation and Sports Medicine Inc. Inn Assisted Living at Somerby of West Mobile Innerfit Inc. Ivy Creek Hospice Ivy Gate J.R. Thomas Wellness Fitness & Physical Therapy Center Jackson Health Care Facility Jacksonville Health and Rehabilitation LLC JK@ Arrowhead Inc. John Knox Manor Inc. II Journey Hospice of Alabama Kare-In-Home Hospice of Mobile, LLC. Keestone of Florence Keller Landing Kelley Place Kemp Meadows Assisted Living Center Kemp Meadows Specialty Care Assisted Living Kensington Health and Rehabilitation Kindred Hospice - Anniston Kindred Hospice - Cullman Kindred Hospice - Daphne Kindred Hospice - Dothan Kindred Hospice - Enterprise Kindred Hospice - Florence Kindred Hospice - Hoover Kindred Hospice - Huntsville Kindred Hospice - Jasper Kindred Hospice - Mobile Kindred Hospice - Montgomery Kindred Hospice - Phenix City Kindred Hospice - Rainbow City Kirkwood by the River Kirkwood by the River Kirkwood by the River Specialty Care Knollwood Healthcare Knollwood Pointe Knollwood Pointe SCALF Lafayette Extended Care Lafayette Nursing Home Lake Haven Assisted Living Facility Lake Martin Hospice LLC dba Ivy Creek Hospice of Elmore Lakeside Hospice Inc. Lakeview Estates Lakewood Senior Living of Jasper I Lakewood Senior Living of Jasper II Lakewood Senior Living of Smith Lakewood Senior Living of Valley II Lakewood Specialty Care of Valley Lauderdale Christian Nursing Home Laurel Oaks Behavioral Health Center Lee County Youth Development Legacy Health and Rehabilitation of Pleasant Grove LLC Legacy Hospice of the East LLC Legacy Ridge Trussville Legacy Village of Jacksonville Legacy Woods I Legacy Woods II Legacy Woods III Lighthouse Rehabilitation & Healthcare Center Limestone Lodge II Limestone Lodge West Limestone Manor Lineville Health and Rehabilitation LLC Little Sisters of the Poor Sacred Heart Residence Little Sisters of the Poor Sacred Heart Residence Liveoak Village Longleaf at Liberty Park Longleaf at Liberty Park (SCALF) Longleaf Health & Rehab LLC Luverne Health and Rehabilitation LLC Lynwood Nursing Home Madison at The Range Madison at The Range Memory Care Madison Heights Madison Manor Nursing Home Madison Village Magnolia Gardens Assisted Living Magnolia Haven Health and Rehabilitation Center Magnolia House Magnolia Ridge Magnolia Trace Rehabilitation Suite Magnolia Wood Therapeutic- Prattville Maplewood Lane Assisted Living Marengo Nursing Home Marion Regional Nursing Home Marshall Manor Nursing Home Martinview Assisted Living-East Martinview Assisted Living-West Maxwell Alternative Residential Services McClellan Senior Living McGuffey Health and Rehabilitation Center Meadowood Retirement Village Meadowood Retirement Village SCALF Meadows Meadows of Brewton Meadows of Jackson Meadows of Monroeville Meadowview Nursing Center Memory Care at Somerby at St. Vincent's One Nineteen Merrill Gardens at Madison Merrill Gardens at Madison (SCALF) Merry Wood Lodge Mitchell-Hollingsworth Nursing & Rehabilitation Center LLC Mobile Nursing and Rehabilitation Center LLC Monarch Place Monroe Manor Health & Rehabilitation Center Montgomery Children's Specialty Center Montgomery Health and Rehab LLC Montrose Bay Health and Rehab Morning Glory Meadows Morning Pointe of Tuscaloosa Morning Pointe of Tuscaloosa Specialty Care Assisted Living Facility Morningside of Auburn Morningside of Cullman Morningside of Decatur Morningside of Madison Morningside of Riverchase Morningside of Sheffield Morningside of Vestavia Hills Morningside of Vestavia Hills - SCALF Morningview Estates Moundville Health and Rehabilitation LLC Mount Royal Towers Mountain Cove Mt. View Lake Retirement Village Murray House NHC Healthcare - Anniston NHC Healthcare - Moulton NHC Place-Anniston SCALF Noble Manor Noble Manor Noble Manor LLC #3 Memory Care North Hill Nursing and Rehabilitation Center LLC North Mobile Nursing and Rehabilitation Center North River Village Northside Health Care Northway Health and Rehabilitation LLC Northwest Alabama Easter Seal Children's Clinic Rehabilitation Center Oak Circle Assisted Living Oak Grove Inn Oak Knoll Health and Rehabilitation LLC Oak Landing Oak Landing Specialty Care Assisted Living Oak Park Oak Trace Care & Rehabilitation Center OakBridge Terrace Assisted Living Residence at Magnolia Trace Oakbridge Terrace Assisted Living Residence at Westminster Village Oakland Place Oaks on Parkwood Assisted Living Facility Oaks on Parkwood Skilled Nursing Facility Oaks on Parkwood Specialty Care Assisted Living Facility Oakview Manor Health Care Center Oakwood-North Baldwin's Center for Living Oasis Healthcare-Moody Oasis Healthcare-Tuscaloosa Old Town Home Olive Home Inc.-Oneonta #2 Opp Health and Rehabilitation LLC Orchard Rehabilitation & Healthcare Center Other Ozark Health and Rehabilitation LLC Paden Ridge Assisted Living Palm Gardens Health and Rehabilitation LLC Park Manor Health and Rehabilitation LLC Park Place Parkwood Health Care Facility Pathways Intentional Memory Care -Huntsville Peachtree Assisted Living Perry County Nursing Home Phenix City Health Care Inc. Piedmont Health Care Center Pine Needle Place Pine Place Pine Valley Retirement Community Plantation Manor Assisted Living I Plantation Manor Assisted Living II Plantation Manor Nursing Home Prattville Health and Rehabilitation LLC Premier Assisted Living Prince Place ProHealth Hospice ProHealth Hospice- Tuscaloosa ProHealth Hospice-Central Alabama Providence Home Rebound Rehab Reflections at Regency Birmingham Regal Place at Regency Pointe Regency Assisted Living Regency Health Care and Rehabilitation Center Regency Retirement Village Regency Retirement Village of Tuscaloosa Rehab Associates - Selma Rehab Associates of Jackson Hospital LLC Rehab Associates- Prattville Rehab Works Physical Rehabilitation East Alabama Medical Center RehabCare Remembrance Village Restore Huntsville Restore Outpatient of Florala Restore Outpatient of South Alabama Restore Therapy Services Ltd. Restore Therapy Services Outpatient Restore Therapy Services Outpatient Restore Vestavia Ridgeview Health Services Inc. Ridgewood Health Services Inc. River City Center River Highlands River Highlands LLC SCALF River Oaks Assisted Living Riverview Physical Medicine Roanoke Rehabilitation & Healthcare Center Robertsdale Outpatient Rehabilitation Center Robertsdale Rehabilitation & Healthcare Center Rose Manor of Haleyville Rosewood Manor Assisted Living Rosewood Manor Specialty Care Royal Haven at Regency Pointe Russellville Health Care Inc. Saad Hospice Inpatient Facility Saad Hospice Services SafetyNet Academy Savannah Terrace of Andalusia I Savannah Terrace of Andalusia II Seagrass Village of Gulf Shores Seasons of Talladega #1 Seasons of Talladega #2 Select Physical Therapy Self Health Care & Rehab Center Inc. Selma Health and Rehab LLC Senior Rehab & Recovery at Limestone Health Facility Serenity Place I Serenity Place II Shadescrest Health Care Center Shelby Ridge Nursing Home Shepherd's Cove Hospice Shepherd's Cove IPU Shoals Hospice LLC Signature Healthcare of Whitesburg Gardens Sole Purpose Sober Living, Inc. Somerby at St. Vincent's One Nineteen Somerset Assisted Living Facility/East Somerset Assisted Living Facility/West Sonrise Assisted Living Sonrise Specialty Care Assisted Living South Hampton Nursing & Rehabilitation Center South Haven Health and Rehabilitation LLC South Health and Rehabilitation LLC Southeast Hospice Network LLC - Montgomery Southeast Hospice Network LLC (Shelby) Southeast Hospice Network LLC (Walker) Southeastern Rehab Southern Estates Assisted Living Community Southern Springs Healthcare Facility SouthernCare Atmore SouthernCare Daphne SouthernCare Dothan SouthernCare Enterprise SouthernCare Evergreen SouthernCare Greenville SouthernCare Grove Hill SouthernCare Mobile SouthernCare New Beacon - Alabaster SouthernCare New Beacon - Anniston SouthernCare New Beacon - Jasper SouthernCare New Beacon - Scottsboro SouthernCare New Beacon - Sylacauga SouthernCare New Beacon Alexander City SouthernCare New Beacon Clanton SouthernCare New Beacon Cullman SouthernCare New Beacon Decatur SouthernCare New Beacon Demopolis SouthernCare New Beacon Gadsden SouthernCare New Beacon Huntsville SouthernCare New Beacon Montgomery SouthernCare New Beacon -N. Birmingham SouthernCare New Beacon Quad Cities SouthernCare New Beacon S. Birmingham SouthernCare New Beacon Selma SouthernCare New Beacon Tuscaloosa Southland Nursing Home Specialty Care at Danberry at Inverness Spring Hill Manor Nursing Home Spring Terrace Assisted Living Facility Springhill Home Health and Hospice Springhill Hospice - Baldwin County Springhill Senior Residence St. Joseph Hospice of South Alabama LLC St. Martins in the Pines St. Martins in the Pines Assisted Living Facility St. Martin's-In-The-Pines Specialty Care Assisted Living Facility St. Vincent's Hospice Stepping Stone Pediatric Therapy Inc. Strickland/Stringfellow ICF/IID Sturgis Hall/John Knox Manor III Summer Village Azalea Place Summer Village Camellia Place Summer Village Magnolia Place Summerford Nursing Home Inc. Summit Summit Health & Rehab Services Inc. Sumter Assisted Living Facility Sumter Health and Rehabilitation LLC Sunrise Manor II Sunset Manor Sylacauga Health and Rehab Services Talladega Healthcare Center Inc. Tallassee Health and Rehabilitation LLC Taylor Mill Oaks Terrace at Grove Park Terrace at Grove Park Specialty Care Assisted Living Facility Terrace at Priceville Terrace at Priceville Specialty Care Assisted Living Facility Terrace Lake Assisted Living Terrace Manor Nursing & Rehabilitation Center Terrace Oaks Care & Rehabilitation Center The Children's Hospital of Alabama Rehabilitation Center at Lakeshore Foundation dba Children's at Lakeshore The Harbor at Hickory Hill The Harbor at Opelika The Huntingdon The Landings of Montgomery The Landings of Northport - SCALF The Landings of Northport -ALF The Learning Tree - Wellington The Learning Tree - Pup The Renaissance Assisted Living The Sanctuary at the Woodlands The Summit Assisted Living Facility Therapy Achievements Clinic Therapy Achievements Rehab Center Thomas Hospital Outpatient Center Physical Therapy Clinic Three Springs Courtland CRF Three Springs-Courtland Three Springs-New Beginnings Thrive at Jones Farm Thrive at Jones Farm SCALF Tides at Crimson Village TLC Nursing Center Traditions of Athens Traditions Way Traylor Retirement Community Troy Health & Rehabilitation Center Trussville Health & Rehabilitation Center Tuscaloosa Rehabilitation and Hand Center Inc. Tuskegee Rehabilitation Clinic Twin Magnolias Assisted Living Twin Oaks Rehabilitation & HealthCare Center USA Healthcare - Decatur Health and Rehab Valley Park Manor Valley Park Manor SCALF Valley View Health and Rehabilitation LLC Veranda Suites Village at Cook Springs Assisted Living Facility Village at Cook Springs Rehabilitation Center Village at Cook Springs Skilled Nursing Facility Village at Cook Springs Specialty Care Assisted Living Facility Village East Vitality Living Upland Park Walker Rehabilitation Center Inc. Washington County Nursing Home Wesley Gardens Retirement Community Wesley Gardens Retirement Community-Specialty Care Wesley Place on Honeysuckle Wesley Place on Honeysuckle - Assisted Living Wesley Place on Honeysuckle - Specialty Care West Gate Village West Hill Health and Rehab Westbrook Assisted Living Westminster Assisted Living of Cullman Westminster Assisted Living of Decatur Westminster Memory Care of Cullman Westminster Memory Care of Decatur Westside Terrace Health and Rehabilitation Center Wetumpka Health and Rehabilitation LLC Whitehall Assisted Living Community Whitehall West Assisted Living William F. Green State Veterans Home William F. Green State Veterans Home Williamsburg Manor II WillowBrooke Court Skilled Care Center at Magnolia Trace WillowBrooke Court Skilled Care Center at Westminster Village Willows Assisted Living Wills Creek Village Windsor House Wiregrass Rehabilitation Center & Nursing Home Woodhaven Manor Nursing Home Woodland Haus (SCALF) Woodland Village Rehabilitation and Healthcare Center Woodlands at Tannehill Woodmoore Woodstock Hospice Care Facility Wynnwood Oaks I Wynnwood Oaks II
Other (specify):
* must provide value
Facility Address:
* must provide value
City:
* must provide value
State:
* must provide value
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Johnston Atoll Marshall Islands Northern Mariana Islands Palau Midway Islands Puerto Rico U.S. Minor Outlying Islands Navassa Island Virgin Islands of the U.S. Wake Island Baker Island Howland Island Jarvis Island Kingman Reef Palmyra Atoll
County:
* must provide value
Autauga County Baldwin County Barbour County Bibb County Blount County Bullock County Butler County Calhoun County Chambers County Cherokee County Chilton County Choctaw County Clarke County Clay County Cleburne County Coffee County Colbert County Conecuh County Coosa County Covington County Crenshaw County Cullman County Dale County Dallas County DeKalb County Elmore County Escambia County Etowah County Fayette County Franklin County Geneva County Greene County Hale County Henry County Houston County Jackson County Jefferson County Lamar County Lauderdale County Lawrence County Lee County Limestone County Lowndes County Macon County Madison County Marengo County Marion County Marshall County Mobile County Monroe County Montgomery County Morgan County Perry County Pickens County Pike County Randolph County Russell County Saint Clair County Shelby County Sumter County Talladega County Tallapoosa County Tuscaloosa County Walker County Washington County Wilcox County Winston County
Zip Code:
* must provide value
Facility Phone Number:
* must provide value
Interview Proxy Name and Title:
* must provide value
Email address:
* must provide value
Date of Report:
* must provide value
Today M-D-Y
Case's First Name:
* must provide value
Case's Last Name:
* must provide value
______ 's DOB:
* must provide value
Today M-D-Y
______ 's Sex:
* must provide value
Female Male
______ 's Ethnicity:
* must provide value
Hispanic or Latino
Not Hispanic or Latino
Unknown
______ 's Race:
* must provide value
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
Unknown
Does ______ have any tribal affiliation?
* must provide value
Yes No Unknown
If yes, which tribe(s)?
* must provide value
If yes, enrolled member?
* must provide value
Yes No Unknown
Please select the case's affiliation with your facility:
* must provide value
Employee
Resident
Vendor/Contractor
Visitor
Other
Other (specify):
* must provide value
Date of most recent admission:
* must provide value
Today M-D-Y
______ 's Home Address:
* must provide value
______ 's City:
* must provide value
______ 's State:
* must provide value
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Johnston Atoll Marshall Islands Northern Mariana Islands Palau Midway Islands Puerto Rico U.S. Minor Outlying Islands Navassa Island Virgin Islands of the U.S. Wake Island Baker Island Howland Island Jarvis Island Kingman Reef Palmyra Atoll
______ 's County:
* must provide value
Autauga County Baldwin County Barbour County Bibb County Blount County Bullock County Butler County Calhoun County Chambers County Cherokee County Chilton County Choctaw County Clarke County Clay County Cleburne County Coffee County Colbert County Conecuh County Coosa County Covington County Crenshaw County Cullman County Dale County Dallas County DeKalb County Elmore County Escambia County Etowah County Fayette County Franklin County Geneva County Greene County Hale County Henry County Houston County Jackson County Jefferson County Lamar County Lauderdale County Lawrence County Lee County Limestone County Lowndes County Macon County Madison County Marengo County Marion County Marshall County Mobile County Monroe County Montgomery County Morgan County Perry County Pickens County Pike County Randolph County Russell County Saint Clair County Shelby County Sumter County Talladega County Tallapoosa County Tuscaloosa County Walker County Washington County Wilcox County Winston County
______ 's Zip Code:
* must provide value
______ 's Phone Number:
* must provide value
Did ______ experience any symptoms during his/her illness?
* must provide value
Yes No Unknown
When did ______ first feel ill (onset date)?
* must provide value
Today M-D-Y
Is ______ still feeling ill?
* must provide value
Yes No Unknown
If no , when did ______ feel better?
* must provide value
Today M-D-Y
Fever (>=100.4):
* must provide value
Yes No Unknown
Subjective fever:
* must provide value
Yes No Unknown
New uncontrolled cough that causes difficulty breathing:
* must provide value
Yes No Unknown
Shortness of breath:
* must provide value
Yes No Unknown
Chest pain:
* must provide value
Yes No Unknown
Muscle Aches:
* must provide value
Yes No Unknown
Fatigue:
* must provide value
Yes No Unknown
Chills/Rigors:
* must provide value
Yes No Unknown
Congestion/Runny nose:
* must provide value
Yes No Unknown
Sore throat:
* must provide value
Yes No Unknown
New loss of smell of taste:
* must provide value
Yes No Unknown
Vomiting:
* must provide value
Yes No Unknown
Headache:
* must provide value
Yes No Unknown
Abdominal pain or tenderness:
* must provide value
Yes No Unknown
Diarrhea:
* must provide value
Yes No Unknown
Which would best describe where the patient was staying at the time of illness onset?
* must provide value
House/single family home Apartment Hotel/motel Long term care facility Acute care inpatient facility Rehabilitation facility Correctional facility Mobile home Group home Homeless shelter Outside, in a car, or other location not meant for human habitation Other, specify Unknown
If other, specify housing:
* must provide value
Pneumonia (clinical or X-ray diagnosed):
* must provide value
Yes No Unknown
Acute respiratory distress syndrome:
* must provide value
Yes No Unknown
Abnormal chest x-ray:
* must provide value
Yes No Unknown
Did ______ have an alternative more likely diagnosis/etiology for their illness?
* must provide value
Yes No Unknown
Other Etiology (specify):
* must provide value
Current Smoker:
* must provide value
Yes No Unknown
Former Smoker:
* must provide value
Yes No Unknown
Diabetes Mellitus:
* must provide value
Yes No Unknown
Chronic Lung Disease (asthma/emphysema/COPD):
* must provide value
Yes No Unknown
Cardiovascular Disease:
* must provide value
Yes No Unknown
Chronic Renal Disease:
* must provide value
Yes No Unknown
Chronic Liver Disease:
* must provide value
Yes No Unknown
Autoimmune condition:
* must provide value
Yes No Unknown
Which autoimmune condition does ______ have?
* must provide value
Hypertension:
* must provide value
Yes No Unknown
Severe obesity (BMI >= 30):
* must provide value
Yes No Unknown
Substance abuse or misuse:
* must provide value
Yes No Unknown
Disability (neurologic, neurodevelopmental, intellectual, physical, vision or hearing impairment):
* must provide value
Yes No Unknown
If yes, specify:
* must provide value
Psychological/psychiatric condition:
* must provide value
Yes No Unknown
If yes, specify:
* must provide value
Is ______ immunocompromised?
* must provide value
Yes No Unknown
Specify the immunosuppressive condition(s):
* must provide value
Did ______ have an abnormal EKG?
* must provide value
Yes No Unknown
Was ______ hospitalized at the time of illness onset?
* must provide value
Yes No Unknown
Is ______ pregnant?
* must provide value
Yes No Unknown
Other underlying condition or risk behavior:
* must provide value
Yes No Unknown
If yes, specify:
* must provide value
Has ______ been tested for COVID-19?
* must provide value
Yes No Unknown
Was the POSITIVE clinical specimen tested on-site or sent to a reference lab?
* must provide value
On-site
Reference laboratory
Please provide the laboratory name:
* must provide value
Please provide the test type performed at the reference lab:
*A PCR test detects the viral RNA of SARS-CoV-2.
*An antigen test detects specific proteins on the surface of SARS-CoV-2.
* must provide value
PCR/NAAT
Antigen
Unsure
Please select the testing platform used:
* must provide value
Quidel Sofia 2 SARS Antigen FIA
Abbott BinaxNOW
LumiraDX SARS-CoV-2 Ag
LumiraDx SARS-CoV-2 Ag
BD Veritor™ Plus System for rapid COVID-19 (SARS-CoV-2) testing
JOYSBIO COVID-19 Antigen Rapid Test Kit [Colloidal Gold] (Antigen)
INDICAID COVID-19 Rapid Antigen Test (Antigen)
Celltrion DiaTrust COVID-19 Ag Rapid Test (Antigen)
iHealth COVID-19 Antigen Rapid Test (Antigen)
Date of Specimen collection
* must provide value
Today M-D-Y
Specimen Source
* must provide value
Nasal swab
Nasopharyngeal swab
Is this the first time ______ was tested?
* must provide value
Yes No Unknown
Was the patient fully vaccinated against COVID-19?
A breakthrough case is defined as a U.S. resident who has SARS-CoV-2 RNA or antigen detected on a respiratory specimen ≥ 14 days after completing the primary series of an FDA-authorized COVID-19 vaccine (e.g., two does of the Moderna or Pfizer vaccine, or a single dose of the Janssen vaccine).
* must provide value
Yes
No
Unknown
Is the patient you are reporting a U.S. resident?
* must provide value
Yes
No
Unknown
Was the primary FDA-authorized COVID-19 vaccine series completed? (e.g., the patient received two doses of the Moderna or Pfizer vaccine, or a single dose of the Janssen vaccine).
* must provide value
Yes
No
Did the patient have a positive SARS-CoV-2 test at least 14 days after completion of the vaccine series?
* must provide value
Yes
No
Did the patient have a history of a positive SARS-CoV-2 test less than 45 days prior to current positive test?
* must provide value
Yes
No
Unknown
Date of last COVID-19 vaccination:
* must provide value
Today M-D-Y
✅ This patient meets the criteria for a COVID-19 vaccine breakthrough case. ADPH will follow up with the reference lab regarding specimen submission to the Bureau of Clinical Laboratories.
❌ This patient does not meet the criteria for a COVID-19 vaccine breakthrough case or further testing.
Reviewed by Central Office Staff:
* must provide value
Yes
No
You may upload up to three laboratory reports and/or supporting documents for this patient. Please provide the following information found in the patient's medical record:
✅ Positive COVID-19 laboratory report
If the requested documents are not uploaded with this submission, someone from ADPH will be in touch with the reporter shortly to collect the additional information.
How many would you like to upload?
* must provide value
0 1 2 3
Is ______ deceased?
* must provide value
Yes No Unknown
Date of death:
* must provide value
Today M-D-Y
Was ______ hospitalized for this illness?
* must provide value
Yes No Unknown
Hospital Name:
* must provide value
Andalusia Health Athens Limestone Hospital Atmore Community Hospital Baptist Medical Center East Baptist Medical Center South BayPointe Behavioral Health Beacons Children's Hospital Bibb Medical Center Birmingham VA Medical Center Brookwood Baptist Medical Center Bryce Hospital Bullock County Hospital Central Alabama Veterans Health Care System East Campus Central Alabama Veterans Health Care System West Campus Children's Hospital of Alabama Choctaw General Hospital Citizens Baptist Medical Center Clay County Hospital Community Hospital Inc. Coosa Valley Medical Center Crenshaw Community Hospital Crestwood Medical Center Crossbridge Behavioral Health A Baptist South Facility Cullman Regional Medical Center D. W. McMillan Memorial Hospital Dale Medical Center DCH Regional Medical Center Decatur Morgan Hospital - Decatur Campus Decatur Morgan Hospital - Parkway Campus Decatur Morgan West Dekalb Regional Medical Center EAMC - Lanier East Alabama Medical Center EastPointe Hospital Elmore Community Hospital Encompass Health Lakeshore Rehabilitation Hospital Encompass Health Rehabilitation Hospital of Dothan Encompass Health Rehabilitation Hospital of Gadsden Encompass Health Rehabilitation Hospital of Montgomery Encompass Health Rehabilitation Hospital of North Alabama Encompass Health Rehabilitation Hospital of Shelby County Evergreen Medical Center Fayette Medical Center Flowers Hospital Floyd Cherokee Medical Center Gadsden Regional Medical Center Grandview Medical Center Greene County Health System Grove Hill Memorial Hospital Hale County Hospital Helen Keller Memorial Hospital Highlands Medical Center Hill Crest Behavioral Health Services Hill Hospital of Sumter County Huntsville Hospital Infirmary LTAC Hospital J. Paul Jones Hospital Jack Hughston Memorial Hospital Jackson Hospital and Clinic Inc. Jackson Medical Center Lake Martin Community Hospital Lakeland Community Hospital Laurel Oaks Behavioral Health Center Lawrence Medical Center Madison Hospital Marshall Medical Centers North Campus Marshall Medical Centers South Campus Mary S. Harper Geriatric Psychiatry Center Medical Center Barbour Medical Center Enterprise Medical West Hospital Mizell Memorial Hospital Mobile Infirmary Medical Center Monroe County Hospital Mountain View Hospital Noland Hospital Anniston II LLC Noland Hospital Birmingham II LLC Noland Hospital Dothan II LLC Noland Hospital Montgomery II LLC Noland Hospital Tuscaloosa II LLC North Alabama Medical Center North Alabama Specialty Hospital North Baldwin Infirmary North Mississippi Medical Center - Hamilton Northeast Alabama Regional Medical Center Northport Medical Center Northwest Medical Center Other Pickens County Medical Center Prattville Baptist Hospital Princeton Baptist Medical Center Providence Hospital Red Bay Hospital Regional Medical Center of Central Alabama Regional Rehabilitation Hospital Riverview Regional Medical Center Russell Medical Center Russellville Hospital Sanctuary At The Woodlands Select Specialty Hospital-Birmingham Shelby Baptist Medical Center Shoals Hospital South Baldwin Regional Medical Center Southeast Health Medical Center Springhill Memorial Hospital St. Vincent's Birmingham St. Vincent's Blount St. Vincent's Chilton St. Vincent's East St. Vincent's St.Clair Stringfellow Memorial Hospital Tanner Medical Center -East Alabama Thomas Hospital Thomasville Regional Medical Center Troy Regional Medical Center Tuscaloosa VA Medical Center UAB Callahan Eye Hospital Authority Unity Psychiatric Care- Huntsville University of Alabama Hospital USA Health Children's & Women's Hospital USA Health University Hospital Vaughan Regional Medical Center-Parkway Campus Walker Baptist Medical Center Washington County Hospital Whitfield Regional Hospital Wiregrass Medical Center
Other (specify):
* must provide value
City:
* must provide value
State:
* must provide value
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Johnston Atoll Marshall Islands Northern Mariana Islands Palau Midway Islands Puerto Rico U.S. Minor Outlying Islands Navassa Island Virgin Islands of the U.S. Wake Island Baker Island Howland Island Jarvis Island Kingman Reef Palmyra Atoll
County:
* must provide value
Autauga County Baldwin County Barbour County Bibb County Blount County Bullock County Butler County Calhoun County Chambers County Cherokee County Chilton County Choctaw County Clarke County Clay County Cleburne County Coffee County Colbert County Conecuh County Coosa County Covington County Crenshaw County Cullman County Dale County Dallas County DeKalb County Elmore County Escambia County Etowah County Fayette County Franklin County Geneva County Greene County Hale County Henry County Houston County Jackson County Jefferson County Lamar County Lauderdale County Lawrence County Lee County Limestone County Lowndes County Macon County Madison County Marengo County Marion County Marshall County Mobile County Monroe County Montgomery County Morgan County Other Perry County Pickens County Pike County Randolph County Russell County Saint Clair County Shelby County Sumter County Talladega County Tallapoosa County Tuscaloosa County Walker County Washington County Wilcox County Winston County
Other County:
* must provide value
Admission Date:
* must provide value
Today M-D-Y
Today M-D-Y
Was ______ admitted to an intensive care unit?
* must provide value
Yes No Unknown
Did ______ receive ECMO?
* must provide value
Yes No Unknown
Did ______ receive mechanical ventilation/intubation?
* must provide value
Yes No Unknown
Number of days with mechanical ventilation:
* must provide value
Was there a second hospitalization?
* must provide value
Yes No Unknown
Hospital Name:
* must provide value
Andalusia Health Athens Limestone Hospital Atmore Community Hospital Baptist Medical Center East Baptist Medical Center South BayPointe Behavioral Health Beacons Children's Hospital Bibb Medical Center Birmingham VA Medical Center Brookwood Baptist Medical Center Bryce Hospital Bullock County Hospital Central Alabama Veterans Health Care System East Campus Central Alabama Veterans Health Care System West Campus Children's Hospital of Alabama Choctaw General Hospital Citizens Baptist Medical Center Clay County Hospital Community Hospital Inc. Coosa Valley Medical Center Crenshaw Community Hospital Crestwood Medical Center Crossbridge Behavioral Health A Baptist South Facility Cullman Regional Medical Center D. W. McMillan Memorial Hospital Dale Medical Center DCH Regional Medical Center Decatur Morgan Hospital - Decatur Campus Decatur Morgan Hospital - Parkway Campus Decatur Morgan West Dekalb Regional Medical Center EAMC - Lanier East Alabama Medical Center EastPointe Hospital Elmore Community Hospital Encompass Health Lakeshore Rehabilitation Hospital Encompass Health Rehabilitation Hospital of Dothan Encompass Health Rehabilitation Hospital of Gadsden Encompass Health Rehabilitation Hospital of Montgomery Encompass Health Rehabilitation Hospital of North Alabama Encompass Health Rehabilitation Hospital of Shelby County Evergreen Medical Center Fayette Medical Center Flowers Hospital Floyd Cherokee Medical Center Gadsden Regional Medical Center Grandview Medical Center Greene County Health System Grove Hill Memorial Hospital Hale County Hospital Helen Keller Memorial Hospital Highlands Medical Center Hill Crest Behavioral Health Services Hill Hospital of Sumter County Huntsville Hospital Infirmary LTAC Hospital J. Paul Jones Hospital Jack Hughston Memorial Hospital Jackson Hospital and Clinic Inc. Jackson Medical Center Lake Martin Community Hospital Lakeland Community Hospital Laurel Oaks Behavioral Health Center Lawrence Medical Center Madison Hospital Marshall Medical Centers North Campus Marshall Medical Centers South Campus Mary S. Harper Geriatric Psychiatry Center Medical Center Barbour Medical Center Enterprise Medical West Hospital Mizell Memorial Hospital Mobile Infirmary Medical Center Monroe County Hospital Mountain View Hospital Noland Hospital Anniston II LLC Noland Hospital Birmingham II LLC Noland Hospital Dothan II LLC Noland Hospital Montgomery II LLC Noland Hospital Tuscaloosa II LLC North Alabama Medical Center North Alabama Specialty Hospital North Baldwin Infirmary North Mississippi Medical Center - Hamilton Northeast Alabama Regional Medical Center Northport Medical Center Northwest Medical Center Other Pickens County Medical Center Prattville Baptist Hospital Princeton Baptist Medical Center Providence Hospital Red Bay Hospital Regional Medical Center of Central Alabama Regional Rehabilitation Hospital Riverview Regional Medical Center Russell Medical Center Russellville Hospital Sanctuary At The Woodlands Select Specialty Hospital-Birmingham Shelby Baptist Medical Center Shoals Hospital South Baldwin Regional Medical Center Southeast Health Medical Center Springhill Memorial Hospital St. Vincent's Birmingham St. Vincent's Blount St. Vincent's Chilton St. Vincent's East St. Vincent's St.Clair Stringfellow Memorial Hospital Tanner Medical Center -East Alabama Thomas Hospital Thomasville Regional Medical Center Troy Regional Medical Center Tuscaloosa VA Medical Center UAB Callahan Eye Hospital Authority Unity Psychiatric Care- Huntsville University of Alabama Hospital USA Health Children's & Women's Hospital USA Health University Hospital Vaughan Regional Medical Center-Parkway Campus Walker Baptist Medical Center Washington County Hospital Whitfield Regional Hospital Wiregrass Medical Center
Other (specify):
* must provide value
Admission Date:
* must provide value
Today M-D-Y
During the 14 days before illness onset or positive specimen collection date (for asymptomatic residents), did ______ reside in a LTCF?
* must provide value
Employee None Resident Unknown Vendor/Contractor Visitor
Is this facility the same as the reporting facility?
* must provide value
Yes No Unknown
Please select the name of the other LTCF the patient resided in:
* must provide value
ABC Hospice Inc. Adams Nursing Home Advance Rehabilitation & Consulting Limited Partnership Affinity Hospice Ahava Healthcare of Alabaster "Special Focus Facility" AHC Millennium Alabama Clinical Schools Alabama Hospice Care of Birmingham Alabama Hospice Care of Jasper Alabama Hospice Care of Mobile Alabama Hospice Care of Oxford Alabama Hospice Care of Tuscaloosa Alabama Hospice of the Shoals Alabama Physical Rehabilitation Service Inc. Albertville Nursing Home Aliceville Manor Nursing Home Allen Health and Rehabilitation Altoona Health & Rehab Amedisys Hospice Care Amedisys Hospice Care of Sylacauga Amedisys Hospice of Birmingham Amedisys Hospice of Florence Amedisys Hospice of Gadsden Amedisys Hospice of Montgomery Amedisys Hospice of Tuscaloosa American Autism & Rehabilitation Center Inc. Andalusia Manor Andrews Institute Rehabilitation LLC Angels for the Elderly I Angels for the Elderly II Angels for the Elderly III Angels for the Elderly IV Anniston Health and Rehab Services LLC Arbor Springs Health and Rehab Center Ltd. Arbor Woods Health and Rehab Arbors Specialty Care at Somerby of West Mobile Arlington Outpatient Rehab Arlington Rehabilitation & HealthCare Center AseraCare Hospice AseraCare Hospice-Decatur AseraCare Hospice-Hamilton AseraCare Hospice-Jackson AseraCare Hospice-Mobile AseraCare Hospice-Monroeville Ashbury Manor Ashland Place Health and Rehabilitation LLC Aspire Physical Recovery Center at Cahaba River LLC Aspire Physical Recovery Center at Hoover LLC Aspire Physical Recovery Center of West Alabama LLC Assisted Living of Arab Athens Health and Rehabilitation LLC Atmore Nursing Center Atria Regency Atria Regency Specialty Care Attalla Health and Rehab Autumn Cove Autumn Cove Memory Care Autumn Place Autumn Woods Assisted Living Ava Hills Assisted Living Azalea Court Assisted Living Azalea Gardens of Mobile Azalea Manor of Haleyville Baldwin House Baptist Hospice Barfield Health Care Baron House of Hueytown BayPointe Hospital & Children's Residential Svcs & Adolescent Ind. Program Belmont Belmont II Bibb Medical Center Nursing Home Bill Nichols State Veterans Home Bill Nichols State Veterans Home Birmingham Nursing and Rehabilitation Center East LLC Birmingham Nursing and Rehabilitation Center LLC Blake at Malbis Blake Memory Care Community Branchwater Village Brennity at Daphne AL Brennity at Daphne MC Brennity at Fairhope Brentwood Retirement Community I Brentwood Retirement Community II Brewer-Porch Children's Center Briar Glen Alzheimer's Special Care Center Bridgewood Gardens Bridgewood Gardens Memory Care Brookdale Hampton Cove Brookdale Jones Farm Brookdale Shoals ALF (AL) Brookdale Shoals SCALF (AL) Brookdale University Park ALF (AL) Brookdale University Park SCALF (AL) Brookdale University Park SNF (AL) Brookshire Healthcare Center Brookside Assisted Living Community Brookside Memory and Specialty Care on Cody Brown Nursing Home Burns Nursing Home Inc. Camden Nursing Facility Inc. Canterbury Health Care Facility Capitol Hill Healthcare Center Caregivers of Pleasant Grove Inc. Carrington Place Cedar Hill Assisted Living Facility Cedar Hill Specialty Care Assisted Living Cedar View Assisted Living Champion Sports Medicine Champion Sports Medicine Champion Sports Medicine Champion Sports Medicine Champion Sports Medicine Champion Sports Medicine Champion Sports Medicine & Rehab Center - Gardendale Champion Sports Medicine & Rehab Center - St. Vincent's Champion Sports Medicine & Rehab Center - Tuscaloosa Champion Sports Medicine & Rehabilitation Center - Jasper Champion Sports Medicine & Rehabilitation Center - Livingston Chapman Healthcare Center Inc. Chapman Specialty Care Assisted Living Facility Charlton Place Rehabilitation & Health Care Center Chattahoochee Hospice Inc. Chelsea's Hidden Acres Cherokee County Health & Rehabilitation Center Cherokee Village Specialty Care Assisted Living Facility Cherry Hill Outpatient Rehabilitation Center Cherry Hill Rehabilitation & Healthcare Center Children's Hospital of Alabama Outpatient Rehabilitation Center Choctaw Health and Rehab Choice Therapy Services Civic Center Health and Rehabilitation LLC Clay County Nursing Home Cleburne County Nursing Home Cloverdale Rehabilitation and Nursing Center Col. Robert L. Howard State Veterans Home Freedom Court Collinsville Healthcare & Rehab Colonel Robert L. Howard State Veterans Home Colonial Haven Care & Rehabilitation Center Columbia Cottage - Hartselle Columbia Cottage-Florence Columbia Cottage-Mountain Brook Columbiana Health and Rehabilitation LLC Columbus Hospice of Alabama Comfort Care Coastal Hospice - Baldwin Comfort Care Coastal Hospice - Mobile Comfort Care Hospice LLC Comfort Care Hospice of Andalusia Comfort Care Hospice of Brewton Comfort Care Hospice of Cullman Comfort Care Hospice of Decatur Comfort Care Hospice of Gadsden Comfort Care Hospice of Gardendale Comfort Care Hospice of Greenville Comfort Care Hospice of Huntsville Comfort Care Hospice of Jasper Comfort Care Hospice of Monroeville Comfort Care Hospice of Montgomery Comfort Care Hospice of Pelham Comfort Care Hospice of Scottsboro Comfort Care Hospice of Sheffield Comfort Care Hospice of Talladega Comfort Care Hospice of Tuscaloosa Community Hospice Care Community Hospice of Baldwin County Community Hospice of Baldwin County in Bay Minette Community Hospice of Dale Medical Center Compassus - Auburn Compassus - Gadsden Compassus - Roanoke Compassus -Auburn Bethany House Compassus Hospice and Palliative Care - Birmingham Compassus Hospice Care Suite Compassus-Florence Compassus-Huntsville Compassus-Troy Coosa Valley Health and Rehab Coosa Valley Healthcare Center Coosa Valley Hospice Cordova Health and Rehabilitation LLC Cornerstone Fitness and Wellness LLC Cottage of the Shoals Country Cottage - Montgomery - Holly Country Cottage - Montgomery - Ivy Country Cottage - Montgomery - Oakleaf Country Cottage Magnolia Cottage Country Cottage Montgomery-Magnolia Country Cottage-Decatur Country Cottage-Decatur-Magnolia Country Cottage-Huntsville-Ivy Country Cottage-Huntsville-Magnolia Country Cottage-Huntsville-Oakleaf Country Cottage-Oakleaf Country Cottage-Russellville Country Gables Country Living Country Place Memory Care of Greenville Country Place Senior Living of Brewton Country Place Senior Living of Fairhope Country Place Senior Living of Foley Country Place Senior Living of Greenville Country Place Senior Living of Hamilton Country Place Senior Living of Winfield Covenant Hospice Inc. - Dothan Covenant Hospice Inc. Mobile Covenant Hospice Inc.-Daphne Covenant Hospice Inpatient Care Center at Providence Hospital Covenant Place of Gardendale Covenant Woods of Gardendale Crimson Health and Rehab LLC Crimson Village Crossville Health and Rehabilitation LLC Crowne Health Care of Citronelle Crowne Health Care of Eufaula Crowne Health Care of Fort Payne Crowne Health Care of Greenville Crowne Health Care of Mobile Crowne Health Care of Montgomery Crowne Health Care of Springhill Crowne Health Care of Thomasville Crowne Place Assisted Living Cullman Health Care Center Cullman Regional Hospice Cumberland Health and Rehab Cypress Cove Center Dadeville Healthcare Center Daffodil House Assisted Living Danberry at Inverness Dauphin Way Assisted Living Davis/Orman Intermediate Care Facility DaySpring Hospice Andalusia Dayspring Hospice Dothan Dayspring Hospice LLC Decatur Health and Rehab Center Decatur Morgan Hospital - Danville Road Campus Diversicare of Arab Diversicare of Bessemer Diversicare of Big Springs Diversicare of Boaz Diversicare of Foley Diversicare of Lanett Diversicare of Montgomery Diversicare of Oneonta Diversicare of Oxford Diversicare of Pell City Diversicare of Riverchase Diversicare of Winfield Dogwood Manor Assisted Living Dugger Mountain Specialty Care Assisted Living EAMC - Lanier Nursing Home East Alabama Medical Center Skilled Nursing Facility East Glen Eastchase Senior Living Easter Seals Central Alabama Rehabilitation and Career Center Eastern Shore Rehabilitation and Health Center Eastview Rehabilitation & Healthcare Center El Reposo Nursing Facility Elba Nursing and Rehabilitation Center LLC Elmcroft of Byrd Springs Elmcroft of Grayson Valley Elmcroft of Heritage Woods Elmcroft of Heritage Woods Specialty Care Assisted Living Facility Encompass Health Hospice Albertville Encompass Health Hospice Alexander City Encompass Health Hospice Anniston Encompass Health Hospice Birmingham Encompass Health Hospice Clanton Encompass Health Hospice Cullman Encompass Health Hospice Decatur Encompass Health Hospice -Dothan Encompass Health Hospice Gadsden Encompass Health Hospice Greenville Encompass Health Hospice Hamilton Encompass Health Hospice Houston County Encompass Health Hospice Jasper Encompass Health Hospice Madison County Encompass Health Hospice Mobile Encompass Health Hospice Montgomery Encompass Health Hospice Muscle Shoals Encompass Health Hospice Northport Encompass Health Hospice Oneonta Encompass Health Hospice Opelika Encompass Health Hospice Pell City Encompass health Hospice Rainsville Encompass Health Hospice Scottsboro Encompass Health Hospice Talladega Encompass Health Hospice-Huntsville Encompass Health Hospice-Prattville Encompass Health Hospice-Rainbow City EncompassHealth Hospice Troy Englewood Health Care Center Enterprise Health & Rehabilitation Center Evergreen Nursing Home Expect Care Hospice Extendicare Health Center Fair Haven Fair Haven - Assisted Living Fair Haven - Specialty Care Fairhope Health and Rehab Fairview at Redstone Village Falkville Health Care Center Father Purcell Memorial Exceptional Children's Center Fayette Medical Center Long Term Care Unit First Choice Hospice First Choice Hospice Andalusia First Choice Hospice Ozark Inc. Five Points Hospice Florala Health and Rehabilitation LLC Florence Nursing and Rehabilitation Center LLC Floyd E. "Tut" Fann State Veterans Home Floyd E. "Tut" Fann State Veterans Home Folsom Center for Rehabilitation and Healthcare Forest Manor Health and Rehab Gables at Charlton Place Assisted Living Community Gadsden Health and Rehab Center Galleria Woods Assisted Living Facility Galleria Woods Skilled Nursing Facility Gardens of Clanton Gardens of Daphne Gardens of Eufaula Gardens of Madison Gardens of Pelham Gardens of Waterford Gardens of Wetumpka Gardens of Wetumpka II Gateway Generations of Red Bay LLC Generations of Vernon LLC Georgiana Health and Rehabilitation LLC Glen Haven Health and Rehabilitation LLC Glenwood Center Good Samaritan Hospice Good Samaritan Hospice of Madison Goodwater Healthcare Center Gordon Oaks Assisted Living Community Gordon Oaks Memory Care Community Grand Bay Convalescent Home Inc. Grandview at Redstone Village Grandview Gardens at Redstone Village Green Oaks Inn - Creel House Green Oaks Inn - Pepper House Greenbriar at the Altamont Assisted Living Facility Greenbriar at the Altamont Skilled Nursing Facility Greene County Nursing Home Greensprings I Greensprings II Greenwood Place Gulf Coast Health and Rehabilitation LLC Haleyville Health Care Center Hallmark Manor Hamrick Highlands Assisted Living Hanceville Nursing & Rehab Center Inc. Harbor at Legacy Village of Jacksonville Harbor Chase of Huntsville Harbor Chase of Huntsville Specialty Care Harborchase of Jasper Assisted Living Facility Harborchase of Jasper Specialty Care Assisted Living Facility Hartford Health Care Hartford Retirement Village Hatley Health Care Inc. Haven at Eastchase Haven Memory Care Facility Health Care Inc. Heartlite Hospice Hendrix Health and Rehabilitation Henry County Health & Rehabilitation Facility "Outpatient Therapy" Henry County Health and Rehabilitation Facility Heritage Assisted Living Heritage Health Care & Rehab Inc. Heritage Memory Care Heritage Residential Care Village Highlands Health and Rehab Hill Crest Behavioral Health Services Hilltop at Glenwood I (SCALF) Hilltop at Glenwood II Hillview Terrace Holly Cottage at Country Cottages Homeland Assisted Living Homestead Hospice of Cahaba Homestead Hospice of Cahaba LLC East Homestead Hospice of Cahaba LLC Southwest Homestead Hospice of Southern Alabama LLC Hometown Hospice Inc. Hope Hospice Inc. Hospice Family Care Hospice Family Care - Inpatient Hospice of Clay County Hospice of Limestone County Hospice of Monroe County Hospice of Montgomery Hospice of North Alabama LLC Hospice of North Alabama-Russellville Hospice of Northwest Alabama Hospice of the Valley Inc. Hospice of West Alabama Hospice of West Alabama Inc. - Homecare Hospice Services of Alabama LLC Hospice Services of Central Alabama Hospice Services of North Alabama Hunter Creek Health and Rehabilitation LLC Huntsville Health and Rehabilitation LLC Huntsville Hospital Therapy Services Impact Rehabilitation and Sports Medicine Inc. Inn Assisted Living at Somerby of West Mobile Innerfit Inc. Ivy Creek Hospice Ivy Gate J.R. Thomas Wellness Fitness & Physical Therapy Center Jackson Health Care Facility Jacksonville Health and Rehabilitation LLC JK@ Arrowhead Inc. John Knox Manor Inc. II Journey Hospice of Alabama Keestone of Florence Keller Landing Kelley Place Kemp Meadows Assisted Living Center Kemp Meadows Specialty Care Assisted Living Kensington Health and Rehabilitation Kindred Hospice - Anniston Kindred Hospice - Cullman Kindred Hospice - Daphne Kindred Hospice - Dothan Kindred Hospice - Enterprise Kindred Hospice - Florence Kindred Hospice - Hoover Kindred Hospice - Huntsville Kindred Hospice - Jasper Kindred Hospice - Mobile Kindred Hospice - Montgomery Kindred Hospice - Phenix City Kindred Hospice - Rainbow City Kirkwood by the River Kirkwood by the River Kirkwood by the River Specialty Care Knollwood Healthcare Knollwood Pointe Knollwood Pointe SCALF Lafayette Extended Care Lafayette Nursing Home Lake Haven Assisted Living Facility Lake Martin Hospice LLC dba Ivy Creek Hospice of Elmore Lakeside Hospice Inc. Lakeview Estates Lakewood Senior Living of Jasper I Lakewood Senior Living of Jasper II Lakewood Senior Living of Smith Lakewood Senior Living of Valley II Lakewood Specialty Care of Valley Lauderdale Christian Nursing Home Laurel Oaks Behavioral Health Center Lee County Youth Development Legacy Health and Rehabilitation of Pleasant Grove LLC Legacy Hospice of the East LLC Legacy Ridge Trussville Legacy Village of Jacksonville Legacy Woods I Legacy Woods II Legacy Woods III Lighthouse Rehabilitation & Healthcare Center Limestone Lodge II Limestone Lodge West Limestone Manor Lineville Health and Rehabilitation LLC Little Sisters of the Poor Sacred Heart Residence Little Sisters of the Poor Sacred Heart Residence Liveoak Village Longleaf at Liberty Park Longleaf at Liberty Park (SCALF) Longleaf Health & Rehab LLC Luverne Health and Rehabilitation LLC Lynwood Nursing Home Madison at The Range Madison at The Range Memory Care Madison Heights Madison Manor Nursing Home Madison Village Magnolia Gardens Assisted Living Magnolia Haven Health and Rehabilitation Center Magnolia House Magnolia Ridge Magnolia Trace Rehabilitation Suite Maplewood Lane Assisted Living Marengo Nursing Home Marion Regional Nursing Home Marshall Manor Nursing Home Martinview Assisted Living-East Martinview Assisted Living-West McClellan Senior Living McGuffey Health and Rehabilitation Center Meadowood Retirement Village Meadowood Retirement Village SCALF Meadows Meadows of Brewton Meadows of Jackson Meadows of Monroeville Meadowview Nursing Center Memory Care at Somerby at St. Vincent's One Nineteen Merrill Gardens at Madison Merrill Gardens at Madison (SCALF) Merry Wood Lodge Mitchell-Hollingsworth Nursing & Rehabilitation Center LLC Mobile Nursing and Rehabilitation Center LLC Monarch Place Monroe Manor Health & Rehabilitation Center Montgomery Children's Specialty Center Montgomery Health and Rehab LLC Montrose Bay Health and Rehab Morning Glory Meadows Morning Pointe of Tuscaloosa Morning Pointe of Tuscaloosa Specialty Care Assisted Living Facility Morningside of Auburn Morningside of Cullman Morningside of Decatur Morningside of Madison Morningside of Riverchase Morningside of Sheffield Morningside of Vestavia Hills Morningside of Vestavia Hills - SCALF Morningview Estates Moundville Health and Rehabilitation LLC Mount Royal Towers Mountain Cove Mt. View Lake Retirement Village Murray House NHC Healthcare - Anniston NHC Healthcare - Moulton NHC Place-Anniston SCALF Noble Manor Noble Manor Noble Manor LLC #3 Memory Care North Hill Nursing and Rehabilitation Center LLC North Mobile Nursing and Rehabilitation Center North River Village Northside Health Care Northway Health and Rehabilitation LLC Northwest Alabama Easter Seal Children's Clinic Rehabilitation Center Oak Circle Assisted Living Oak Grove Inn Oak Knoll Health and Rehabilitation LLC Oak Landing Oak Landing Specialty Care Assisted Living Oak Park Oak Trace Care & Rehabilitation Center OakBridge Terrace Assisted Living Residence at Magnolia Trace Oakbridge Terrace Assisted Living Residence at Westminster Village Oakland Place Oaks on Parkwood Assisted Living Facility Oaks on Parkwood Skilled Nursing Facility Oaks on Parkwood Specialty Care Assisted Living Facility Oakview Manor Health Care Center Oakwood-North Baldwin's Center for Living Oasis Healthcare-Moody Oasis Healthcare-Tuscaloosa Old Town Home Olive Home Inc.-Oneonta #2 Opp Health and Rehabilitation LLC Orchard Rehabilitation & Healthcare Center Other Ozark Health and Rehabilitation LLC Paden Ridge Assisted Living Palm Gardens Health and Rehabilitation LLC Park Manor Health and Rehabilitation LLC Park Place Parkwood Health Care Facility Pathways Intentional Memory Care -Huntsville Peachtree Assisted Living Perry County Nursing Home Phenix City Health Care Inc. Piedmont Health Care Center Pine Needle Place Pine Place Pine Valley Retirement Community Plantation Manor Assisted Living I Plantation Manor Assisted Living II Plantation Manor Nursing Home Prattville Health and Rehabilitation LLC Premier Assisted Living Prince Place ProHealth Hospice ProHealth Hospice- Tuscaloosa ProHealth Hospice-Central Alabama Providence Home Rebound Rehab Reflections at Regency Birmingham Regal Place at Regency Pointe Regency Assisted Living Regency Health Care and Rehabilitation Center Regency Retirement Village Regency Retirement Village of Tuscaloosa Rehab Associates - Selma Rehab Associates of Jackson Hospital LLC Rehab Associates- Prattville Rehab Works Physical Rehabilitation East Alabama Medical Center RehabCare Remembrance Village Restore Huntsville Restore Outpatient of Florala Restore Outpatient of South Alabama Restore Therapy Services Ltd. Restore Therapy Services Outpatient Restore Therapy Services Outpatient Restore Vestavia Ridgeview Health Services Inc. Ridgewood Health Services Inc. River City Center River Highlands River Highlands LLC SCALF River Oaks Assisted Living Riverview Physical Medicine Roanoke Rehabilitation & Healthcare Center Robertsdale Outpatient Rehabilitation Center Robertsdale Rehabilitation & Healthcare Center Rose Manor of Haleyville Rosewood Manor Assisted Living Rosewood Manor Specialty Care Royal Haven at Regency Pointe Russellville Health Care Inc. Saad Hospice Inpatient Facility Saad Hospice Services SafetyNet Academy Savannah Terrace of Andalusia I Savannah Terrace of Andalusia II Seasons of Talladega #1 Seasons of Talladega #2 Select Physical Therapy Self Health Care & Rehab Center Inc. Selma Health and Rehab LLC Senior Rehab & Recovery at Limestone Health Facility Serenity Place I Serenity Place II Shadescrest Health Care Center Shelby Ridge Nursing Home Shepherd's Cove Hospice Shepherd's Cove IPU Shoals Hospice LLC Signature Healthcare of Whitesburg Gardens Somerby at St. Vincent's One Nineteen Somerset Assisted Living Facility/East Somerset Assisted Living Facility/West Sonrise Assisted Living Sonrise Specialty Care Assisted Living South Hampton Nursing & Rehabilitation Center South Haven Health and Rehabilitation LLC South Health and Rehabilitation LLC Southeast Hospice Network LLC - Montgomery Southeast Hospice Network LLC (Shelby) Southeast Hospice Network LLC (Walker) Southeastern Rehab Southern Estates Assisted Living Community Southern Springs Healthcare Facility SouthernCare Atmore SouthernCare Daphne SouthernCare Dothan SouthernCare Enterprise SouthernCare Evergreen SouthernCare Greenville SouthernCare Grove Hill SouthernCare Mobile SouthernCare New Beacon - Alabaster SouthernCare New Beacon - Anniston SouthernCare New Beacon - Jasper SouthernCare New Beacon - Scottsboro SouthernCare New Beacon - Sylacauga SouthernCare New Beacon Alexander City SouthernCare New Beacon Clanton SouthernCare New Beacon Cullman SouthernCare New Beacon Decatur SouthernCare New Beacon Demopolis SouthernCare New Beacon Gadsden SouthernCare New Beacon Huntsville SouthernCare New Beacon Montgomery SouthernCare New Beacon -N. Birmingham SouthernCare New Beacon Quad Cities SouthernCare New Beacon S. Birmingham SouthernCare New Beacon Selma SouthernCare New Beacon Tuscaloosa Southland Nursing Home Specialty Care at Danberry at Inverness Spring Hill Manor Nursing Home Spring Terrace Assisted Living Facility Springhill Home Health and Hospice Springhill Hospice - Baldwin County Springhill Senior Residence St. Joseph Hospice of South Alabama LLC St. Martins in the Pines St. Martins in the Pines Assisted Living Facility St. Martin's-In-The-Pines Specialty Care Assisted Living Facility St. Vincent's Hospice Stepping Stone Pediatric Therapy Inc. Strickland/Stringfellow ICF/IID Sturgis Hall/John Knox Manor III Summer Village Azalea Place Summer Village Camellia Place Summer Village Magnolia Place Summerford Nursing Home Inc. Summit Summit Health & Rehab Services Inc. Sumter Assisted Living Facility Sumter Health and Rehabilitation LLC Sunrise Manor II Sunset Manor Sylacauga Health and Rehab Services Talladega Healthcare Center Inc. Tallassee Health and Rehabilitation LLC Taylor Mill Oaks Terrace at Grove Park Terrace at Grove Park Specialty Care Assisted Living Facility Terrace at Priceville Terrace at Priceville Specialty Care Assisted Living Facility Terrace Lake Assisted Living Terrace Manor Nursing & Rehabilitation Center Terrace Oaks Care & Rehabilitation Center The Children's Hospital of Alabama Rehabilitation Center at Lakeshore Foundation dba Children's at Lakeshore The Harbor at Hickory Hill The Harbor at Opelika The Huntingdon The Landings of Montgomery The Landings of Northport - SCALF The Landings of Northport -ALF The Renaissance Assisted Living Therapy Achievements Clinic Therapy Achievements Rehab Center Thomas Hospital Outpatient Center Physical Therapy Clinic Three Springs Courtland CRF Three Springs-Courtland Three Springs-New Beginnings Thrive at Jones Farm Thrive at Jones Farm SCALF Tides at Crimson Village TLC Nursing Center Traditions of Athens Traditions Way Traylor Retirement Community Troy Health & Rehabilitation Center Trussville Health & Rehabilitation Center Tuscaloosa Rehabilitation and Hand Center Inc. Tuskegee Rehabilitation Clinic Twin Magnolias Assisted Living Twin Oaks Rehabilitation & HealthCare Center USA Healthcare - Decatur Health and Rehab Valley Park Manor Valley Park Manor SCALF Valley View Health and Rehabilitation LLC Veranda Suites Village at Cook Springs Assisted Living Facility Village at Cook Springs Rehabilitation Center Village at Cook Springs Skilled Nursing Facility Village at Cook Springs Specialty Care Assisted Living Facility Village East Walker Rehabilitation Center Inc. Washington County Nursing Home Wesley Gardens Retirement Community Wesley Gardens Retirement Community-Specialty Care Wesley Place on Honeysuckle Wesley Place on Honeysuckle - Assisted Living Wesley Place on Honeysuckle - Specialty Care West Gate Village West Hill Health and Rehab Westbrook Assisted Living Westminster Assisted Living of Cullman Westminster Assisted Living of Decatur Westminster Memory Care of Cullman Westminster Memory Care of Decatur Westside Terrace Health and Rehabilitation Center Wetumpka Health and Rehabilitation LLC Whitehall Assisted Living Community Whitehall West Assisted Living William F. Green State Veterans Home William F. Green State Veterans Home Williamsburg Manor II WillowBrooke Court Skilled Care Center at Magnolia Trace WillowBrooke Court Skilled Care Center at Westminster Village Willows Assisted Living Wills Creek Village Windsor House Wiregrass Rehabilitation Center & Nursing Home Woodhaven Manor Nursing Home Woodland Haus (SCALF) Woodland Village Rehabilitation and Healthcare Center Woodlands at Tannehill Woodmoore Woodstock Hospice Care Facility Wynnwood Oaks I Wynnwood Oaks II
Date of Admission:
* must provide value
Today M-D-Y
Date of Discharge:
* must provide value
Today M-D-Y
During the 14 days before illness onset or positive specimen collection date (for asymptomatic residents), did ______ stay in a hospital?
* must provide value
Yes No Unknown
Hospital Name:
* must provide value
Andalusia Health Athens Limestone Hospital Atmore Community Hospital Baptist Medical Center East Baptist Medical Center South BayPointe Behavioral Health Beacons Children's Hospital Bibb Medical Center Birmingham VA Medical Center Brookwood Baptist Medical Center Bryce Hospital Bullock County Hospital Central Alabama Veterans Health Care System East Campus Central Alabama Veterans Health Care System West Campus Children's Hospital of Alabama Choctaw General Hospital Citizens Baptist Medical Center Clay County Hospital Community Hospital Inc. Coosa Valley Medical Center Crenshaw Community Hospital Crestwood Medical Center Crossbridge Behavioral Health A Baptist South Facility Cullman Regional Medical Center D. W. McMillan Memorial Hospital Dale Medical Center DCH Regional Medical Center Decatur Morgan Hospital - Decatur Campus Decatur Morgan Hospital - Parkway Campus Decatur Morgan West Dekalb Regional Medical Center EAMC - Lanier East Alabama Medical Center EastPointe Hospital Elmore Community Hospital Encompass Health Lakeshore Rehabilitation Hospital Encompass Health Rehabilitation Hospital of Dothan Encompass Health Rehabilitation Hospital of Gadsden Encompass Health Rehabilitation Hospital of Montgomery Encompass Health Rehabilitation Hospital of North Alabama Encompass Health Rehabilitation Hospital of Shelby County Evergreen Medical Center Fayette Medical Center Flowers Hospital Floyd Cherokee Medical Center Gadsden Regional Medical Center Grandview Medical Center Greene County Health System Grove Hill Memorial Hospital Hale County Hospital Helen Keller Memorial Hospital Highlands Medical Center Hill Crest Behavioral Health Services Hill Hospital of Sumter County Huntsville Hospital Infirmary LTAC Hospital J. Paul Jones Hospital Jack Hughston Memorial Hospital Jackson Hospital and Clinic Inc. Jackson Medical Center Lake Martin Community Hospital Lakeland Community Hospital Laurel Oaks Behavioral Health Center Lawrence Medical Center Madison Hospital Marshall Medical Centers North Campus Marshall Medical Centers South Campus Mary S. Harper Geriatric Psychiatry Center Medical Center Barbour Medical Center Enterprise Medical West Hospital Mizell Memorial Hospital Mobile Infirmary Medical Center Monroe County Hospital Mountain View Hospital Noland Hospital Anniston II LLC Noland Hospital Birmingham II LLC Noland Hospital Dothan II LLC Noland Hospital Montgomery II LLC Noland Hospital Tuscaloosa II LLC North Alabama Medical Center North Alabama Specialty Hospital North Baldwin Infirmary North Mississippi Medical Center - Hamilton Northeast Alabama Regional Medical Center Northport Medical Center Northwest Medical Center Other Pickens County Medical Center Prattville Baptist Hospital Princeton Baptist Medical Center Providence Hospital Red Bay Hospital Regional Medical Center of Central Alabama Regional Rehabilitation Hospital Riverview Regional Medical Center Russell Medical Center Russellville Hospital Sanctuary At The Woodlands Select Specialty Hospital-Birmingham Shelby Baptist Medical Center Shoals Hospital South Baldwin Regional Medical Center Southeast Health Medical Center Springhill Memorial Hospital St. Vincent's Birmingham St. Vincent's Blount St. Vincent's Chilton St. Vincent's East St. Vincent's St.Clair Stringfellow Memorial Hospital Tanner Medical Center -East Alabama Thomas Hospital Thomasville Regional Medical Center Troy Regional Medical Center Tuscaloosa VA Medical Center UAB Callahan Eye Hospital Authority Unity Psychiatric Care- Huntsville University of Alabama Hospital USA Health Children's & Women's Hospital USA Health University Hospital Vaughan Regional Medical Center-Parkway Campus Walker Baptist Medical Center Washington County Hospital Whitfield Regional Hospital Wiregrass Medical Center
Other (specify):
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City:
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State:
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Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Johnston Atoll Marshall Islands Northern Mariana Islands Palau Midway Islands Puerto Rico U.S. Minor Outlying Islands Navassa Island Virgin Islands of the U.S. Wake Island Baker Island Howland Island Jarvis Island Kingman Reef Palmyra Atoll
County:
* must provide value
Autauga County Baldwin County Barbour County Bibb County Blount County Bullock County Butler County Calhoun County Chambers County Cherokee County Chilton County Choctaw County Clarke County Clay County Cleburne County Coffee County Colbert County Conecuh County Coosa County Covington County Crenshaw County Cullman County Dale County Dallas County DeKalb County Elmore County Escambia County Etowah County Fayette County Franklin County Geneva County Greene County Hale County Henry County Houston County Jackson County Jefferson County Lamar County Lauderdale County Lawrence County Lee County Limestone County Lowndes County Macon County Madison County Marengo County Marion County Marshall County Mobile County Monroe County Montgomery County Morgan County Other Perry County Pickens County Pike County Randolph County Russell County Saint Clair County Shelby County Sumter County Talladega County Tallapoosa County Tuscaloosa County Walker County Washington County Wilcox County Winston County
Other, specify:
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Admission Date:
* must provide value
Today M-D-Y
Discharge Date:
* must provide value
Today M-D-Y
During the 14 days before illness onset or positive specimen collection date (for asymptomatic residents), did ______ visit a healthcare clinic?
* must provide value
Yes No Unknown
Date of Visit:
* must provide value
Today M-D-Y
Healthcare Clinic Name:
* must provide value
City:
* must provide value
State:
* must provide value
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Johnston Atoll Marshall Islands Northern Mariana Islands Palau Midway Islands Puerto Rico U.S. Minor Outlying Islands Navassa Island Virgin Islands of the U.S. Wake Island Baker Island Howland Island Jarvis Island Kingman Reef Palmyra Atoll
County:
* must provide value
Autauga County Baldwin County Barbour County Bibb County Blount County Bullock County Butler County Calhoun County Chambers County Cherokee County Chilton County Choctaw County Clarke County Clay County Cleburne County Coffee County Colbert County Conecuh County Coosa County Covington County Crenshaw County Cullman County Dale County Dallas County DeKalb County Elmore County Escambia County Etowah County Fayette County Franklin County Geneva County Greene County Hale County Henry County Houston County Jackson County Jefferson County Lamar County Lauderdale County Lawrence County Lee County Limestone County Lowndes County Macon County Madison County Marengo County Marion County Marshall County Mobile County Monroe County Montgomery County Morgan County Other Perry County Pickens County Pike County Randolph County Russell County Saint Clair County Shelby County Sumter County Talladega County Tallapoosa County Tuscaloosa County Walker County Washington County Wilcox County Winston County
Other, specify:
* must provide value
Is ______ a close contact to a COVID-19 case?
* must provide value
Yes No Unknown
Is ______ epi-linked to a person suspected of having COVID-19?
* must provide value
Yes No Unknown
Is ______ epi-linked to a geographical area with at least one case of COVID-19?
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Yes No Unknown
Did ______ attend a gathering of more than 10 people?
* must provide value
Yes No Unknown
Details of conference or gathering:
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Did ______ have an exposure to an animal with confirmed or suspected COVID-19?
* must provide value
Yes No Unknown
If yes, specify the type of animal:
* must provide value
Use the time frame below to answer the following questions.
Infectious Period From : Illness onset date minus 2 days. (For asymptomatic residents, 2 days prior to positive specimen collection)
Infectious Period To : 10 days after illness onset, or specimen collection date if the person never experienced any symptoms. If the person is severely immunocompromised or severely ill, then isolation may continue up to 20 days.
While infectious, did ______ encounter any first responders, like ambulance, paramedics, police?
* must provide value
Yes No Unknown
Date of Exposure:
* must provide value
Today M-D-Y
Ambulance Service, Hospital, or Department Name
* must provide value
County:
* must provide value
Autauga County Baldwin County Barbour County Bibb County Blount County Bullock County Butler County Calhoun County Chambers County Cherokee County Chilton County Choctaw County Clarke County Clay County Cleburne County Coffee County Colbert County Conecuh County Coosa County Covington County Crenshaw County Cullman County Dale County Dallas County DeKalb County Elmore County Escambia County Etowah County Fayette County Franklin County Geneva County Greene County Hale County Henry County Houston County Jackson County Jefferson County Lamar County Lauderdale County Lawrence County Lee County Limestone County Lowndes County Macon County Madison County Marengo County Marion County Marshall County Mobile County Monroe County Montgomery County Morgan County Perry County Pickens County Pike County Randolph County Russell County Saint Clair County Shelby County Sumter County Talladega County Tallapoosa County Tuscaloosa County Walker County Washington County Wilcox County Winston County
Before submitting the COVID-19 LTC Investigation Form, please review the summary below and verify it is accurate. If everything is correct, click the submit button below and continue to enter the rest of the POSITIVE cases associated with your facility.
Date of Submission ______ Reporter and Facility Information ______ , ______ , ______ Case Information ______ ______ (DOB: ______ )