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DAY BREAK AT THE MILLER CENTER
REFERRAL FORM
ADULT DAY HEALTH CARE
2010 Crosby Way
Winter Park, Florida 32792
(407) 6294565
Fax (407) 6447373
Email: JSantana@fl.easterseals.com
DATE:___CLIENT INFO:
Client
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What is easterseals day break at?
Easterseals Day Break can be filled out online at the official website of Easterseals or at a local Easterseals Day Break center.
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Families or individuals who are in need of respite care services for individuals with disabilities are required to file Easterseals Day Break.
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To fill out Easterseals Day Break, individuals need to provide information about the individual with disabilities, the type of respite care needed, and any specific requirements or preferences.
What is the purpose of easterseals day break at?
The purpose of Easterseals Day Break is to provide respite care services for individuals with disabilities, allowing their families or caregivers to take a break and attend to other responsibilities.
What information must be reported on easterseals day break at?
Information such as the individual's medical history, special needs, dietary requirements, and any specific care instructions must be reported on Easterseals Day Break.
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