Free Trial Visit - The Ruby Pardue Blackburn Adult Day Health Care Center

free trial visit 2019 The best way to see if The Ruby Pardue Blackburn Adult Day Health Care Center program is right for you and your loved one is to come by for a day FREE of charge. You can then determine if adult day health care is right for you.

During the free trial visit, our Health Care Coordinator, along with other members of our care team staff, assess needs to determine what our team will focus on during future stays with us.

Participant Enrollment Packet will be given and worked through with you by a staff member.

Helpful Links Prior to Enrollment:

Veterans Services

Medicaid CAP Services

Transportation Services

Trial Visit Information Form

Participant Information

Participant Name *

Participant Age *

Participant Date of Birth *

Diagnosis *

My loved one can do the following

Dress themselves

Feed themselves (food will be sat in front of them)

Walk to the bathroom independently

Engage in activities with prompts

Check all that apply

How would you describe your loved one? *

Is your loved one continent? *

If no, please tell us how they need help in the bathroom

(simple guidance, help dressing and undressing, assistance with cleaning, if in a wheelchair please describe their transfer).

Spiritual, religious, or cultural needs?

Dietary Needs *

(Regular, Chopped, Pureed, Describe Other)

Likes *

Dislikes *

Allergies *

(Write "None" if there are none)

What activities does your loved one enjoy? *

Will they be taking medication at the center? *

We encourage morning and evening meds to be taken at home. If there is a lunchtime med, we will be happy to help with it. You will have to bring it in a prescription bottle to be kept at the center.

Family/Caregiver information

Your Name *

Email address *

Relationship to Loved One *

How Did You Hear About Us?