A senior care intake form typically includes personal details, medical history, and social information like hobbies and living situation. You will need to gather information such as the senior’s name, date of birth, and contact information for their doctor and a close relative or friend. Depending on the service, other documents like a BC Services Card, medication list, and income information may also be required.
General information
Personal Details: Name, date of birth, age, gender, marital status.
Contact Information: Primary phone number, as well as names and phone numbers of a close relative, friend, and doctor or nurse practitioner.
Medical Information:
List of current medications, including prescriptions.
Information on allergies or other medical conditions.
Mobility status and use of glasses or hearing aids.
Social & Lifestyle Information:
Employment status and source of income.
Hobbies, dislikes, and general preferences.
Living situation (e.g., alone, with spouse, in an apartment).
Service-specific information
For home care services: You may need to provide information on daily routines, preferred start date, and frequency of service.
For assisted living facilities: The form may ask for details like your room number and any items to watch out for.
For financial/income-based services: Be prepared to provide income information, such as recent tax returns or pension cheque stubs.
Important documents
BC Services Card: This is essential for accessing publicly funded home and community care services.
Advance Care Plan: If you have a plan, bring it to the attention of healthcare providers and family members.