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JEWEL HUMAN SERVICES INC MAIN OFFICE 12110 153RD STREET JAMAICA, NY. 11434DAY REHABILITATION PROGRAM 548 LINDEN BLVD. BROOKLYN, N.Y. 11203DAY REHABILITATION INTAKE FORM LAST NAME: FIRST NAME: INTAKE
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How to fill out day habilitation intake form

01
Obtain a copy of the day habilitation intake form from the appropriate source
02
Start by filling out the basic personal information section, such as name, date of birth, and contact information
03
Provide any relevant medical history or diagnoses that may be important for the day habilitation program to be aware of
04
Fill out the section regarding current medications, including dosage and any special instructions
05
Describe any specific goals or objectives you or the individual needing day habilitation hope to achieve through the program
06
Specify any preferences or accommodations that may be necessary for the individual's participation in the program
07
If applicable, provide information about any support services or therapies that the individual is currently receiving
08
Sign and date the form to indicate that the information provided is accurate and complete

Who needs day habilitation intake form?

01
Individuals who require day habilitation services or support
02
Individuals with cognitive or developmental disabilities
03
Individuals transitioning from a different program or setting
04
Family members or legal guardians of individuals who are unable to fill out the form themselves
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The day habilitation intake form is a document used to gather information about individuals seeking day habilitation services.
Individuals interested in receiving day habilitation services are required to file the intake form.
To fill out the day habilitation intake form, individuals need to provide personal information, medical history, and reasons for seeking day habilitation services.
The purpose of the day habilitation intake form is to assess the individual's needs and determine their eligibility for day habilitation services.
Information such as personal details, medical history, goals for day habilitation services, and any support needed should be reported on the intake form.
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