--0000000000005dbe9e05d6805719 Content-Type: text/plain; charset="UTF-8" ---------- Forwarded message --------- From: Mariana Juarez Date: Tue, Jan 25, 2022 at 1:02 PM Subject: Frax | New Intake | Warm Transferred to Paul To: wellesley-intake@homecareassistance.com 01-25-2022 Paul McCampbell HCA MA WLL | Home Care Assistance | Wellesley, MA I spoke with the following Guest. I completed an Intake. Our Guest is expecting the following: *Intake Result* Guest transferred to Care Manager. Frax | New Intake | Warm Transferred to Paul Please Email or Phone the Guest at: 978-458-1411 Please review this information. If you have any questions, please contact Leader@FraxOutsourcing.com. Thank you, Mariana Juarez Guest Information ------------------------------ *Overview* Tracy Christ called to inquire about services for herself. She was looking to get care 24/7 care with 12-hour shifts and would like 2 Female CG's at a time. She is bedridden and does not get out of bed much. She would like for the CG to do light housekeeping, personal care, sort her billing out, and some incontinence care. Tracy would like female CG's and for them to be white. Tracy does have a slurred speech and tremble. Tracy was wanting to get care started by Today or Tomorrow. I reached out to the office number and was able to speak to Paul who took the call. Tracy has presidential insurance and was wanting to know if we accept it. She also wanted to know if we require a down payment. *Type of care* Personal *Guest Name* Tracy Christ *Guest Primary Phone or Caller ID* 978-458-1411 *Guest Location* Declined / Not Provided *Guest Secondary Phone* Declined / Not Provided *Zip Code of Client* 02030 *How did the Guest hear about us?* Declined *Guest Email (leave "Declined / Not Provided" if no email is gathered)* Declined / Not Provided *Is the Guest the decision maker?* Yes *How does the Guest know the client?* Self Potential Client Information ------------------------------ *Client Name* Tracy Christ *Client Phone* Declined / Not Provided *Client has dementia?* *Potential Client Email* Declined / Not Provided *Is client agreeable to receiving services?* Yes *Service Address* 206 Clay Brooke RD , Dover , MA 02030 *Is this address a facility* No Health Information ------------------------------ *Health Notes* -Slurred speech -Tremble *Age* 64 *Does the client have any cognitive impairments?* Slurred Speech and tremble *Does Client live alone?* Yes *Allergies* no ibuprofen , Aspirin, no carrots, ketamine *Incontinence care?* Yes *Assistive Devices* Wheel chair Household Information ------------------------------ *Pets? (Include type)* No *Are there smokers in the home?* No *Are there any other caregivers?* Pt Schedule Information ------------------------------ *Days requested* 24/7 *Hours Requested* 24/7 *Start Date Requested* 1/25/2022 Payment Information ------------------------------ *Payment source* Declined / Not Provided *Rates Quoted:* RATE RANGE: -------------------- $35.00 - $39.00 p