Get Ots 2 Go Screening Form - Hamilton Health Sciences

Filling out the OTs 2 Go Screening Form is an important step in accessing necessary services. This guide provides you with a clear, step-by-step approach to ensure you complete the form accurately and efficiently.

Follow the steps to fill out the screening form successfully.

1. Press the ‘Get Form’ button to retrieve the OTs 2 Go Screening Form and open it for editing.
2. Begin by entering the client’s name in the designated field. Ensure full names are used for clarity.
3. Fill in the OHCN (Ontario Health Card Number) in the corresponding area to help identify the client.
4. Provide the client's phone number, ensuring it includes the area code for accurate contact.
5. Input the client's date of birth (DOB) in the specified format to maintain uniformity.
6. In the next section, complete the client's address, including street number, name, and postal code.
7. Enter the name of the family contact, which allows for communication if necessary.
8. Select the relationship to the client from the options provided, marking either home or work contact.
9. Indicate whether to contact the client or the caregiver by checking the appropriate box.
10. Identify the family physician's name, ensuring this is the primary healthcare provider.
11. Provide relevant phone numbers for the physician’s office, ensuring the contact details are complete.
12. Record any diagnosis associated with the client in this field for thorough understanding.
13. Specify the day program that the client is attending, if applicable.
14. List the attendance days for the program, allowing proper scheduling.
15. Detail the type of mobility device currently in use by the client.
16. Describe the condition of the device to understand its functionality and any needed repairs.
17. Note that the referral was made by Safety at Home, ensuring accurate processing.
18. If applicable, complete the mobility assessment field for necessary evaluations.
19. For Hamilton residents only, fill out the home safety section as indicated.
20. Provide a rationale for the referral, giving context for the request.
21. Enter the name of the person making the referral and their contact details.
22. Document the date of receipt for tracking purposes.
23. Finally, review all entries for accuracy before choosing to save changes, download, print, or share the completed form.

Complete the OTs 2 Go Screening Form online today for the necessary support you or your loved one may need.