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OCI SS Form HHI1SECTION I: STUDENT DATA State of HawaiiREQUEST FOR PREHOSPITAL INSTRUCTION SERVICESDEPARTMENT OF EDUCATIONOffice of Curriculum, Instruction and Student Support Student Services BranchINSTRUCTIONS: 1.

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How to fill out home-hospital instruction services form

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To fill out the home-hospital instruction services form, follow these steps:

02

Start by providing your personal information, including your name, address, and contact details.

03

Indicate the type of home-hospital instruction services you require. This could include medical assistance, nursing care, or any specific instructions for caregivers.

04

Specify the duration for which you need these services. You may opt for short-term assistance or long-term care.

05

Describe any specific medical conditions or requirements that the caregiver should be aware of. This could include medication dosages, dietary restrictions, or mobility needs.

06

If applicable, mention any medical equipment or devices that you rely on and require assistance with.

07

Provide emergency contact information in case of any unforeseen situations.

08

Review the form to ensure all information is accurate and complete.

09

Finally, sign and date the form to indicate your consent and understanding of the provided instructions.

Who needs home-hospital instruction services form?

01

The home-hospital instruction services form is needed by individuals who require medical assistance or nursing care in the comfort of their own homes. This includes patients who have been discharged from a hospital but still require ongoing medical attention, individuals with chronic illnesses or disabilities, and older adults who prefer to receive healthcare services at home.

02

This form ensures that caregivers and healthcare professionals have all the necessary information to provide the required services and adhere to any specific instructions or medical conditions.

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