{"product_id":"adult-day-services-participant-admission-packet-editable-word-intake-forms-adult-day-care-customizable-admission-forms","title":"Adult Day Services Participant Admission Packet | Editable Word Intake Forms | Adult Day Care | Customizable Admission Forms","description":"\u003ch1\u003e⭐ Build a Complete Adult Day Services Intake Packet — Instantly ⭐  \u003c\/h1\u003e\u003cdiv\u003e\u003c\/div\u003e\u003ch2\u003eGive your program a professional, organized, and customizable enrollment package without starting from scratch.  \u003c\/h2\u003e\u003cdiv\u003e\u003c\/div\u003e\u003ch3\u003eThe basics to build a new adult day services participant enrollment package, from first contact to a complete record, in one editable Word file.\u003c\/h3\u003e\u003cdiv\u003e\u003c\/div\u003e\u003ch4\u003eThis Participant Admission Packet gives you five ready-to-edit forms built specifically for adult day services \/ adult day care centers.\u003c\/h4\u003e\u003ch4\u003e Replace the bracketed placeholders with your program's name, logo, and details, then add or remove fields so the packet fits your model of care and payer mix.\u003c\/h4\u003e\u003cdiv\u003e\u003c\/div\u003e\u003cdiv\u003e \u003cstrong\u003e📂 Inside the Packet  \u003c\/strong\u003e\n\u003c\/div\u003e\u003cdiv\u003eEach form is thoughtfully structured for real-world adult day operations, helping you streamline intake, support compliance, and maintain clean participant records.\u003c\/div\u003e\u003cdiv\u003e\u003c\/div\u003e\u003cdiv\u003e\u003cstrong\u003e- Admission Packet Contents Intake Checklist.\u003c\/strong\u003e\u003c\/div\u003e\u003cdiv\u003e  A staff checklist to track every required item as it is completed and filed in the participant record.\u003c\/div\u003e\u003cdiv\u003e\u003c\/div\u003e\u003cdiv\u003e\u003cstrong\u003e- Admission Application and Participant Information.\u003c\/strong\u003e\u003c\/div\u003e\u003cdiv\u003e  Demographics, services and days requested, transportation and meals, payment and funding source (private pay, Medicaid or waiver, LTC insurance, VA), billing contact, primary caregiver and responsible party, POA, physician, health summary at intake, and referral source.\u003c\/div\u003e\u003cdiv\u003e\u003c\/div\u003e\u003cdiv\u003e\u003cstrong\u003e- Participant Emergency and Contact Notification face sheet. \u003c\/strong\u003e\u003c\/div\u003e\u003cdiv\u003e  A first-responder ready page with code status, diagnoses, critical medications, physician and pharmacy, prioritized emergency contacts with pick-up and information-release flags, an authorized and not-authorized pick-up list for legal restrictions, and evacuation needs.\u003c\/div\u003e\u003cdiv\u003e\u003c\/div\u003e\u003cdiv\u003e\u003cstrong\u003e- Activity and Leisure Interest Assessment.\u003c\/strong\u003e\u003c\/div\u003e\u003cdiv\u003e  Life history and background, social style and communication, a past-and-present leisure interest inventory, and preferences and routines including triggers to avoid and what calms or re-engages the participant.\u003c\/div\u003e\u003cdiv\u003e\u003c\/div\u003e\u003cdiv\u003e\u003cstrong\u003e- ADL and Functional Assessment. \u003c\/strong\u003e\u003c\/div\u003e\u003cdiv\u003e  A 13-item ADL rating grid, mobility and safety, fall and elopement risk, cognition and communication, behavior and sensory, plus a summary and care considerations section with a reassessment date.\u003c\/div\u003e\u003cdiv\u003e\u003c\/div\u003e\u003cdiv\u003e\u003cstrong\u003e 👥 Who It’s For  \u003c\/strong\u003e\u003c\/div\u003e\u003cdiv\u003eAdult day services and adult day care directors, program coordinators, social workers, and case managers who need a clean, professional intake packet without building one from scratch.\u003c\/div\u003e\u003cdiv\u003e\u003c\/div\u003e\u003cdiv\u003e\u003cstrong\u003e💻 Format \u0026amp; Use  \u003c\/strong\u003e\u003c\/div\u003e\u003cdiv\u003eInstant digital download.  \u003c\/div\u003e\u003cdiv\u003eOne editable Word document you can fill on screen and customize to your setting.  \u003c\/div\u003e\u003cdiv\u003eNo physical item will be shipped.\u003c\/div\u003e\u003cdiv\u003e\u003c\/div\u003e\u003cdiv\u003e\u003cstrong\u003e ⚠️ Please Note  \u003c\/strong\u003e\u003c\/div\u003e\u003cdiv\u003eHealth requirements such as how often a physical exam, TB test, or TB screening is required vary by state and by program type and they change. The health fields are left open rather than assuming a schedule. Confirm the required items and their frequency against your state licensing regulations and your state or local TB control program before putting this packet into use.\u003c\/div\u003e\u003cdiv\u003e\u003c\/div\u003e\u003cdiv\u003eBecause this is an instant download, all sales are final. If anything is unclear, message me before purchasing and I am glad to help.\u003c\/div\u003e\u003cdiv\u003e\u003c\/div\u003e\u003cdiv\u003e\u003cspan style=\"font-size: 12pt;\"\u003e\u003cstrong\u003e 🎁 Bonus Included  \u003c\/strong\u003e\u003c\/span\u003e\u003c\/div\u003e\u003cdiv\u003eClient Rights (Edit it to align with federal, county or your state’s regulations), Photo \/ media consent \u0026amp; Grievance and Complaint Procedure\u003c\/div\u003e\u003cdiv\u003e\u003c\/div\u003e\u003cdiv\u003eIt is your responsibility to make sure these forms align with your regs as each state has different requirements. The good thing is, you can change anything in these forms!\u003c\/div\u003e","brand":"Senior Space","offers":[{"title":"Default Title","offer_id":54353884479763,"sku":null,"price":7.99,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0978\/8732\/2387\/files\/chRxyXMgpU.png?v=1782774875","url":"https:\/\/www.activitydirectorspayactivitydirectors.com\/products\/adult-day-services-participant-admission-packet-editable-word-intake-forms-adult-day-care-customizable-admission-forms","provider":"Activity Directors Pay Activity Directors","version":"1.0","type":"link"}