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.
++ From the website, you can fill out the form + and submit an assessment request.
++ + Initial Commit for Adult Day Care Center.
++ Related Products
++ Our Services
+ +Odoo + Customization
+Odoo + Implementation
+Odoo + Support
+Hire + Odoo Developer
+Odoo + Integration
+Odoo + Migration
+Odoo + Consultancy
+Odoo + Implementation
+Odoo + Licensing Consultancy
++ Our Industries
+ +Trading
+Easily procure and sell your products
+POS
+Easy configuration and convivial experience
++ Education
+A platform for educational management
++ Manufacturing
+Plan, track and schedule your operations
+E-commerce & + Website
+Mobile friendly, awe-inspiring product pages
+Service + Management
+Keep track of services and invoice
++ Restaurant
+Run your bar or restaurant methodically
+Hotel + Management
+An all-inclusive hotel management application
++ Support
+Got + questions or need help? Get in touch.
+Say hi to + us on WhatsApp!
++ Create a new Activity! +
++ Create a Lead +
+ Leads are the qualification step before the creation of an opportunity. +
++ Create a new product +
++ 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! +
+