--000000000000fe74dd05e81bb460 Content-Type: multipart/alternative; boundary="000000000000fe74dc05e81bb45f" --000000000000fe74dc05e81bb45f Content-Type: text/plain; charset="UTF-8" I can certainly out it into a Google doc. Just give me a bit and I will send it back out. On Wed., Sep. 7, 2022, 4:50 p.m. Angie Kunnath, wrote: > This is great. I would suggest creating a google form for this preliminary > assessment. This way the data can also be easily accessed by other team > members. > > Regards, > > Angie Kunnath > > *Home Care Assistance - **Serving Oakville, Mississauga, Burlington, > Waterloo & Wellington region* > > 375 University Ave E, Waterloo, ON, N2K3M7 Tel: 519-954-2111 > 2525 Old Bronte Rd, Suite 212, Oakville, ON, L6M 4J2 Tel: 905-337-1200 > > > > *Champions of Aging Well* > > *www.**H**o * > > *me Care > Assistance > Waterloo > .ca > www.HomeCareAssistanceGuelph.ca* > *www.HomeCareAssistanceOakville.ca**www.HomeCareAssistanceMississauga.ca* > > > Visit our Website > Read our Mission > Balanced Care Method > Hospital to Home Care > Review our Book Series > > Cognitive Therapeutics > Our Recent Press > Connect on LinkedIn > Read our Reviews > Watch our Videos > Subscribe to our Blog > > > On Wed, Sep 7, 2022 at 3:36 PM Cheryl Cartwright > wrote: > >> Okay, so once the intake is wrapping up and we are quite sure we are >> moving forward, we inform the client we will be sending a "preliminary >> assessment questionnaire" to help us create a shortlist of caregivers who >> have the right skill set. We also at this time send over our contracts and >> let the client know if they wish to proceed, please just send all this back >> and we will set up a more formal assessment with our nurse/case manager. We >> let the client know this last step will help us select a caregiver from our >> shortlist who will have the right chemistry and personality for the client. >> We offer that assessment over zoom or phone. If they want in person we tell >> them we can but it may slow the process just a little if they are okay with >> that. We also offer the phone or zoom assessment to be with several family >> members. >> >> Here is the mini assessment we send and simply ask that they provide as >> much detail as they can but that nuance and personality pieces will be >> discussed in the next stage. >> >> *Date of Birth:* >> *Address:* >> *Home phone number:* >> *Condition of the following areas:* >> - Hearing >> - Vision >> - Speech >> - Swallowing >> - Mobility >> >> *Mobility devices *(walker, wheelchair, stair lift, hoyer lift) >> *Safety devices *(grab bars, shower bench, non-slip mat, raised toilet >> seat) >> *Medical Conditions *(heart attack, stroke, hypertension, diabetes, etc.) >> *Behavioural and Cognitive conditions *(dementia, anxiety, combative) >> *Medications:* >> *Incontinence* (briefs, pullups, accident-protection or full >> incontinence) >> *Bathing & grooming *(how much assistance needed) >> *Allergies:* >> *Food/meal preferences:* >> >>