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Client Intake Form
Initial information gathering for new clients.
Print-ready forms for clients, families, and caregivers across the Comox Valley and Campbell River. Tap View to preview a PDF in place, or Download to print and complete by hand.
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Forms shared at intake and during onboarding.
Initial information gathering for new clients.
Terms of service between client and Ubuntu Haven Living.
Client consent for personal and companion care services.
Consent to collect, use, and share personal information (PIPA).
Critical contacts and medical alerts at a glance.
Comprehensive list of current medications and allergies.
Clinical tools used by our caregivers during care delivery. A staff-only portal is on the roadmap; for now these are available for transparency and reference.
Identify risk factors and plan preventive interventions.
Room-by-room safety review and action plan.
Goal-driven plan covering routine, mobility, and support.
Shift documentation for ongoing care.
Document and follow up on incidents and near-misses.
Detailed documentation following a client fall.
Weekly log of medication reminders and self-administration.