31 Pa. Code § 151.9
(b) Readability. Documents given to residents and prospective residents, including disclosure statements and resident’s agreements, shall be drafted in accordance with the following standards:
(e) Rescission. A prospective resident shall have the right to rescind the resident’s agreement, without penalty or forfeiture, within 7 days after each of the following times:
(f) Form. The disclosure statement and resident’s agreement shall have attached a separate page notifying prospective residents of their right to rescind the resident’s agreement as follows:
NOTICE OF RIGHT TO RESCIND
date rescission period begins
You may rescind and terminate your resident’s agreement, without penalty or forfeiture, within 7 days of the above date. You are not required to move into the continuing care facility before the expiration of this 7 day period. No other agreement or statement you sign shall constitute a waiver of your right to rescind your agreement within the seven (7) day period.
To rescind your resident’s agreement, mail or deliver a signed and dated copy of this notice, or any other dated written notice, letter or telegram, stating your desire to rescind to (name of provider/facility) at (business address) not later than midnight of (last day for rescission).
Pursuant to this notice, I hereby cancel my resident’s agreement.
DATE PROSPECTIVE RESIDENT’S SIGNATURE