All intake forms, assessments, and documents for new clients
First form in intake — sent after initial call, before home visit (can be filled out by staff or client)
Completed after home visit when moving forward — client can fill out and send in, or we complete with them
Done at home visit — can be done by phone if needed
Done at home visit — evaluates home safety, layout, hazards, and equipment
Authorization for PHI storage and electronic signatures
Fill out PHI Authorization on Jotform
How personal health information is collected, used, and protected
Fill out Privacy Practices on Jotform
Your rights as a client and agency responsibilities
Fill out Client Rights on Jotform
Consumer notice of direct care worker status
Fill out DCW Notification on Jotform
Pennsylvania State Regulations Compliance
Fill out Regulatory Addendum on Jotform
How to report complaints, investigation process, external resources
Fill out Complaints on Jotform
Authorized tasks, schedule, goals, and special instructions
Policies, procedures, and important information for clients
What we look for during home visits and recommendations
Welcome message for new clients
Generate structured risk analysis and care plan recommendations