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REFERRAL FORM Respite Service Coordination All referrals must meet the program eligibility criteria as follows: o Must have a diagnosed disability as per the Disability Act 2006 o Must be aged between
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How to fill out breakaway flexible respite program

01
To fill out the breakaway flexible respite program, follow these steps:
02
Begin by providing your personal information, such as your name, contact details, and address.
03
Indicate the reason for needing respite care and include any relevant medical or support needs.
04
Specify the duration and frequency of respite care required.
05
Include any preferences or special instructions for the care provider.
06
Provide information about the individual receiving care, such as their age, medical conditions, and any specific care requirements.
07
If applicable, include any emergency contact information.
08
Review the form for accuracy and completeness before submitting it.
09
Submit the completed form to the designated authority or organization offering the breakaway flexible respite program.

Who needs breakaway flexible respite program?

01
The breakaway flexible respite program is designed for individuals who require temporary relief from caregiving responsibilities.
02
This program is suitable for caregivers who need a short-term break to attend to personal matters, rest, or recharge.
03
It may also benefit individuals caring for someone with a disability, chronic illness, or age-related needs.
04
Caregivers who feel overwhelmed or experiencing caregiver burnout can also benefit from the breakaway flexible respite program.
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The program allows caregivers to ensure the well-being of their loved ones while taking care of their own physical and mental health.
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It is important to consult with the specific organization or authority offering the program to determine eligibility criteria and available services.
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Breakaway flexible respite program is a service designed to provide temporary relief for caregivers of individuals with disabilities or special needs.
Caregivers or service providers who are seeking respite services for individuals with disabilities or special needs are required to file breakaway flexible respite program.
To fill out breakaway flexible respite program, caregivers or service providers need to provide information about the individual needing respite care, the desired respite services, and any specific needs or preferences.
The purpose of breakaway flexible respite program is to support caregivers by offering temporary respite care for individuals with disabilities or special needs, allowing caregivers to take a break and recharge.
Information that must be reported on breakaway flexible respite program includes the individual's name, age, medical history, any allergies or special requirements, preferred activities, and emergency contact information.
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