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Lancaster County Office of Aging Referral Form

  1. Lancaster county office of aging

  2. Lancaster County Office of Aging Referral Form

  3. Please check one box below and provide all information requested

  4. Please do not report concerns about abuse, neglect , or exploitation using this form. Please note that if you need to report concerns about abuse, neglect, or exploitation, please do so by phone at 717-299-7979, 24 hours a day.

  5. Please Note: The following are required for placement in a facility.

    Please download forms and send by e mail attachment to . Please do not fax. As of 3/23/2020 we are not able to accept faxes.

  6. Financial information if known

  7. Please note that services from Office of Aging are not always free and you may be asked to contribute to the cost of your services depending on your income

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  9. This field is not part of the form submission.