Get Aic Referral Form

Filling out the AIC Referral Form is an essential step in accessing home-based services for individuals in need. This guide will provide you with detailed, step-by-step instructions to ensure that you complete the form accurately and efficiently online.

Follow the steps to successfully complete the AIC referral form online.

1. Press the ‘Get Form’ button to obtain the form and open it for online completion.
2. Begin with the client’s particulars section. Enter the person's name, NRIC/Passport/FIN/UIN number, date of birth, and address. Ensure all details are correct, as this information is crucial for processing the referral.
3. In the services required section, select the types of home services needed. You may choose from home medical, nursing, therapy, or help services. Attach any required supporting documents as specified.
4. Complete Section A by detailing specific services needed, such as follow-up prescriptions or caregiver training, and provide any necessary attachments.
5. Proceed to Section B where you will indicate any procedures required, such as wound dressing or catheter changes. Fill in the specific details, including types of devices or supplies needed.
6. Fill out Section C with medical history, including primary diagnosis and any drug allergies. Make sure to note if there are any active infectious diseases.
7. In Section D, assess the current functional status of the client. Indicate any impairments or assistance levels needed for various activities.
8. Provide social information in Section E, including contact details of the next of kin and main caregiver.
9. Complete Section F by identifying the referring source. Provide necessary details including name, signature, contact number, and designation.
10. Review all entered information for accuracy, and ensure that all required documents are attached before clicking to save changes, download, print, or share the form.

Complete your documents online today for efficient processing of the AIC referral.