Get Aic Cel Referral Form

The AIC-CEL Referral Form is designed to facilitate the application for home medical, nursing, therapy, and support services. This guide will provide you with clear instructions on how to complete the form online effectively.

Follow the steps to fill out the AIC-CEL Referral Form online.

1. Press the ‘Get Form’ button to obtain the AIC-CEL Referral Form and open it in your preferred document editor.
2. Begin by entering the official registration number at the top of the form, which is for AIC/CEL input only.
3. Fill in the client’s particulars section by providing the patient’s name, identification number (NRIC/Passport/FIN/UIN), date of birth, address, postal code, telephone number, and age.
4. Indicate the accommodation type (private or various types of HDB rooms) and housing status (purchased or rental) along with the lift-landing availability.
5. Complete the demographic information including race, gender, citizenship/IC color, marital status, preferred language, and religion. Ensure all relevant fields are filled.
6. State the planned or actual date of discharge from the hospital and current location of the client.
7. In Section A, outline the services required: home medical, nursing, therapy, or help. Attach necessary documents such as the inpatient discharge summary where applicable.
8. For Section B, specify any procedures necessary, like wound dressing or urinary catheters, including details about the type and due dates for changes.
9. In Section C, summarize the client’s medical history and any primary diagnoses, including drug allergies and whether the patient has an active infectious disease.
10. Fill out Section D by providing the current functional status of the client, detailing any impairments, mobility status, and levels of assistance needed.
11. In Section E, provide social information such as next-of-kin details and main caregiver information, and indicate if the patient is known to other community services.
12. Complete Section F by noting the referring source’s information including name, signature, department, contact number, and email address.
13. After filling out all the sections, save your changes and review the form for accuracy. You can then download, print, or share the completed form as needed.

Start filling out the AIC-CEL Referral Form online today to ensure timely assistance.