Get the free Project LifesaverWNY Intake Form - projectlifesaverwny

Print Form Project Lifesaver ANY Intake Form Information about Person with Special Needs Last Name Initial New Date: First Name Date of Birth: Height: Update Nickname (if any) Age: Weight: Hair Color:

How to fill out project lifesaverwny intake form

How to fill out the Project LifesaverWNY intake form?

1. Start by gathering all necessary information: Before filling out the intake form, make sure you have all the required information readily available. This may include the participant's personal details, emergency contacts, medical history, and any specific needs or requirements.
2. Begin with personal information: The intake form will typically ask for the participant's full name, date of birth, address, and contact details. Fill in these fields accurately to ensure proper identification and communication.
3. Provide emergency contact information: In case of an emergency or if the participant goes missing, it is crucial to have reliable contact information. Enter the names, phone numbers, and relationships of at least two emergency contacts who can be reached quickly.
4. Describe the participant's medical history: The intake form will inquire about the participant's medical conditions, allergies, medications, and any specific instructions for caretakers or first responders. Be thorough and detailed to ensure the participant's safety and well-being.
5. Mention any additional needs or requirements: If the participant has any unique needs or requirements, such as mobility issues or communication preferences, make sure to include these on the form. This information helps the Project LifesaverWNY team provide appropriate assistance.
6. Sign and date the form: Once you have completed all the necessary sections, carefully review the form for accuracy and completeness. Sign and date the form to acknowledge that the information provided is true and accurate to the best of your knowledge.

Who needs the Project LifesaverWNY intake form?

1. Individuals at risk: The Project LifesaverWNY intake form is designed for individuals who are at risk of wandering, such as those with cognitive impairments, Alzheimer's disease, autism, or other conditions that may make them prone to elopement or getting lost.
2. Families of at-risk individuals: Family members or guardians of at-risk individuals should complete the intake form. This ensures that the Project LifesaverWNY program has all the essential information needed to assist and locate the individual in case of an emergency.
3. Caregivers and professionals: Caregivers, healthcare providers, or professionals working with individuals who are at risk can also benefit from filling out the intake form. It allows them to provide accurate and vital information about the person they are caring for, enabling the Project LifesaverWNY program to better assist in locating them if needed.

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What is project lifesaverwny intake form?

The project lifesaverwny intake form is a document used to gather information about individuals who are potential beneficiaries of the Project Lifesaver program.

Who is required to file project lifesaverwny intake form?

Individuals who are interested in enrolling a loved one with cognitive conditions, such as autism or Alzheimer's disease, in the Project Lifesaver program are required to file the intake form.

How to fill out project lifesaverwny intake form?

The project lifesaverwny intake form can be filled out online or in person by providing relevant information about the individual with cognitive conditions, emergency contacts, and medical history.

What is the purpose of project lifesaverwny intake form?

The purpose of the project lifesaverwny intake form is to ensure that the Project Lifesaver program has accurate and up-to-date information about enrolled individuals in case of emergencies.

What information must be reported on project lifesaverwny intake form?

The project lifesaverwny intake form requires information such as the individual's name, address, medical conditions, medications, emergency contacts, and caregiver details.