Admittance Forms – Tiffany’s Adult Day Care Center

	Admission Guidelines In order to guarantee the best care for our guests we have guidelines to verify that we are adequately suited to be the best care giver. This document lists all of our guidelines that must be met before any guest can be admitted as participant in our program.
	Physician Assessment One of the most important things is to properly understand the medical needs of our guests. This form will help us understand the participant’s medical needs. The form must be filled out and signed by the participant’s primary physician.
	Daily Living Assistance Aside from the medical needs there are many little day to day things that participants may require assistance with. This form will give us a better understanding of the participant’s abilities and needs. Having a good understanding is crucial for tailoring activates and accommodating needs to ensure that time spent with us is as comfortable as possible.
	Cognitive Impariment Participants and there ability levels are know best by the loved ones, it is important that we grasp this valuable knowledge so that we can truly know and understand the needs of our guests. This form must be filled out for any participants with cognitive impairments.
	Tell us About Yourself Outside of the physical and mental aspects there are many other parts to person including there likes, dislikes, interests, Favorite TV show or book. This form will help us get to know our guest on a more personal level so that we can help tailor there days and make there time with us as enjoyable as possible.
	Emergency Care Authorization We do everything posible to make sure our guests are taken care of and needs are meet. However, in the unfortunate event of an emergence it is imparative for the saftey of our guests that we have emergency infomation and authorization on file. This form gives us the necesary information and authorization to get the proper help for our guest in the event of an emergency
	All forms are in PDF format and require Adobe Reader to open. If any of the forms do not open properly you can download the latest version of Adobe Reader from adobe.com.

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