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Adult Day Services FamilyIntake Assessment Last Name:___ First Name:___ Date: ___INSTRUMENTAL ACTIVITIES OF DAILY LIVING 1. Telephone : Ability to NSW her the phone, dial numbers, and effectively
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How to fill out adult day services family-intake

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How to fill out adult day services family-intake

01
Obtain the family-intake form from the adult day services provider.
02
Fill out the personal information section with details about the client and their family members.
03
Provide information about the client's medical history, medications, and any special needs or preferences.
04
Answer any additional questions on the form about the client's daily routines, interests, and goals.
05
Sign and date the form before submitting it to the adult day services provider.

Who needs adult day services family-intake?

01
Adults who require assistance with daily living activities or supervision due to physical or cognitive impairments.
02
Families seeking support for a loved one who may benefit from socialization, therapeutic activities, and professional care while they are at work or attending to other responsibilities.
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Adult day services family-intake is a form used to gather information about a family member who will be receiving adult day services.
The family member or caregiver responsible for coordinating the adult day services is required to file the family-intake form.
The form can be filled out by providing details about the family member, their medical history, preferences, and any specific needs or requirements.
The purpose of the adult day services family-intake is to ensure that the individual receiving services is given proper care and attention based on their unique needs and preferences.
Information such as medical history, allergies, dietary restrictions, emergency contacts, and preferences for activities should be reported on the family-intake form.
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