| Birthdate | +Gender | +||
| Address | +Medicaid | +||
| Medicare | +Marital Status | +||
| Supplemental Income | +Interest in Program | +||
| Previous Experience | +Where and When | +
| Present Living Arrangement | +Emergency Name | +||
| Living with whom | +Applicant Relationship | +||
| Living with Relationship | +Address Emergency | +||
| Responsible Relative | +Phone Emergency | +||
| Nearest Relative | +Emergency Name | +||
| Relationship with Relative | +Applicant Relationship #1 | +
| Physician Name | +Transportation | +||
| Physician Address | +Arrival Time | +||
| Phone | +Departure Time | +||
| Physician Last Vist | +Special Diet | +||
| Dentist Name | +Transportation | +||
| Dentist Address | +Responsible | +||
| Dentist Phone | +Phone Pay | +||
| Date of Dentist | +Your Email | +||
| Hospital Name | +Today date | +
| Diet Detail | +|||
| List of Allergies | +|||
| Time Request | +
| Social Security Number | +Referred By | +||
| Medicare Number | +Marital Status | +||
| Medicaid Number | +Place of Birth | +||
| Birth Date | +Age | +||
| Responsible Party/Guardian | +Primary Care | +||
| Responsible Address | +Primary Care Address | +||
| Responsible Telephone | +Primary Care Telephone | +||
| Present Living Arrangements | +Living with whom | +||
| Relationship with whom their living | +Nearest Responsible Relative | +||
| If Employed, where | +Business Phone | +||
| Why interested in joining the program? | +|||
| Have you had previous experience in an Adult Daycare Program? | +|||
| If yes, Where and When? | +|||
| Physician | +Travel By | +||
| Address | +Is Need Travel Assistance | +||
| Phone | ++ | + | |
| Present Diagnoses/Medical Problems | +Other Disability | +||
| Weight | +Height | +||
| Dentist | +Address | +||
| Phone Number | +Date of Last Visit | +
| Name | +Product | +Notes | +Time In | +Time Out | +Responsible By | +
| Full Name | +Relationship To Applicant | +||
| Address | +Phone | +
| Full Name | +Relationship To Applicant | +||
| Address | +Phone | +
| Transportation Provided By | +Arrive Time | +||
| Departure Time | +Special Diet? | +||
| If yes, Give Details | +|||
| List of Allergies | +|||
| I acknowledge that the participation in this program will be paid by | +|||
| Name of person/party responsible for mentioned above | +|||
| Phone number of person to pay bill | +|||
| Your email | +|||
| Hospital Choice | +|||
| Digital Signature | +
+ + Manage Adult Day Care Center and Activities. +
+
+ + Key Highlights +
++ Management of Adult dare care request.
++ Quote/Sales order can be created from Day Care + Registration.
++ Communication in open chatter for more details + gathering.
++ Printing Adult Dare Care registration pdf + report.
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+ + From the website, you can fill out the form + and submit an assessment request.
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+ + + Initial Commit for Adult Day Care Center.
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++ Create a Lead +
+ Leads are the qualification step before the creation of an opportunity. +
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++ You must define a product for everything you sell or purchase, + whether it's a storable product, a consumable or a service. +
++ Create a Customer! +
++ Create an Adult Member! +
+