A new family needing our services usually has first contact with our Family Services Coordinator who then sets up an appointment for a visit. This "visit" serves two purposes. The first purpose is to allow the Family Services Coordinator to privately interview the caregiver, asking questions about the caregiver's and client's needs, and to complete the enrollment package. The second purpose is to allow the staff to get to know the client better and conduct an initial assessment of their cognitive and physical abilities.
An enrollment package can be obtained by calling 423-587-9149, or you may download the forms separately below or the entire package here.
The enrollment package includes:
Application for Sliding Scale Fee - used to determine eligibility for adjusted fees
Registration Form - gives the address of the client, caregiver's phone numbers, people allowed to pick up the client here at the facility, and the client's doctors names and phone numbers.
Medical History Form - is to be filled out by the client's physician. This form may be given to the family or faxed directly to the physician's office by the Family Services Coordinator
Medications Form - is to be completed even if medications will not be given during the day at ALPS
Photo-Voice Release - gives the center permission to take a client's pictures and use them in different promotions for ALPS, is discussed with the family. The family decides whether or not they do or do not want their loved one to be photographed.
Waiver of Liability Form - required to be signed
Policies and Admissions Agreement - describes the types of services that our facility will offer and the policies of the agency
Title VI - A federal law, which is part of the Civil Rights Act of 1964 that protects individuals from discrimination on the basis of race, color, or national origin.
The Right To Be Informed - A participants Bill of Rights.
Activities of Daily Living Check List - completed by the family to give us a basic idea of what the client can do for themselves or where they require assistance
Medical Release Form - allows permission from doctors to ALPS any and all medical or confidential information
Information Release Form - gives permission to use and disclose protected information for the purpose of treatment and/or financial assistance
Grievance Policy Agreement - to provide a mechanism for the resolution of complaints, grievances or problems raised by caregivers
Food Program Eligibility - required completion per USDA guidelines
Items to Bring - items to bring with the participant on the first day
© 2016 ALPS Adult Day Services. All rights reserved. • 600 N. Daisy St. Morristown, TN 37814 • 423-587-9149