Get Manitoba Home Care Program Care Assessment Form

Filling out the Manitoba Home Care Program Care Assessment Form online can be a straightforward process when you have clear guidance. This comprehensive guide will walk you through each section of the form to ensure a smooth and accurate submission.

Follow the steps to effectively complete the assessment form.

1. Click the ‘Get Form’ button to access the Manitoba Home Care Program Care Assessment Form and open it in your preferred online editor.
2. Begin by filling in the applicant's name, phone number, date, address, postal code, and personal health identification number (PHIN). Ensure all details are accurate and up to date.
3. Select the type of assessment required: admission or reassessment. Then, indicate the location where the assessment will be completed, whether at home, hospital, etc.
4. In the family information section, list who lives in the same household as the applicant. Include names, ages, and relationships. If there are no household members, write 'none' in the space provided.
5. Provide additional information about family members relevant to the assessment. Check the box next to 'next of kin' or local person responsible, and describe the level of support they provide.
6. Discuss any pertinent information about family functioning that may impact the delivery of home care services.
7. Move on to the household information section. Indicate the type of residence—house, apartment, senior citizen housing, or other—and provide remarks if necessary.
8. Document the available facilities within the household, such as heating, cooking, and bathing, and specify their adequacy. Note if these facilities affect the applicant's ability to function.
9. Assess household tasks and indicate who performs them (applicant or others). Include any limitations regarding the ability to complete these tasks.
10. In the health information section, list any major clinical findings and provide details on allergies, medications, and the applicant's ability to manage their treatment.
11. Complete the personal care information section, outlining the applicant’s abilities regarding sight, hearing, communication, toileting, ambulation, and other personal care needs.
12. Address psycho/social aspects by discussing the applicant's social interactions, community involvement, and mental status.
13. Finish by summarizing the assessment, identifying any unmet needs in health, personal care, or psycho/social areas that may affect the applicant's ability to remain in the community.
14. After completing the form, review all entries for accuracy. Save changes, and download or print the form as needed. Consider sharing the completed form with relevant healthcare providers.

Complete your Manitoba Home Care Program Care Assessment Form online today!