Service Information

Caregiver ReCharge: Central Registry Intake
Organization: Central Registry > Nucleus Independent Living
Description: Provides assistance in connecting clients with a variety of services from local community agencies. Services include in-home caregiver respite services.
What type of Caregiving Activities are required during in-home respite service?
What type of Caregiving Activities are currently provided by the caregiver?
If more than 1, please specify caregiver's relationship to others:

Are these eligibility requirements met?

The Primary caregiver is experiencing high levels of stress.
The Primary caregiver has a valid Health Card.
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Care Recipient Information

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What is the preferred Language?

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Is an interpreter required?

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Primary Caregiver
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Email (Confirmation and reminder emails will be sent here)

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Lives with Care Recipient?

What is the preferred Language?

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Is an interpreter required?

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Referral Source
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Email

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Secondary Informal Caregiver
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Health Information
Share additional, relevant client and caregiver health information.
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Additional Information

e.g., 1234 5678 99:

Indicate both the approximate number of hours on a daily and weekly basis:

(i.e. making calls, driving etc.):

Attach RAI and other applicable documents here.

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Send confirmation, change & reminder messages to < name > at < email >

Submission complete

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Summary

Reference #: -
  • Registrant:
  • Organization:
    Central Registry > Nucleus Independent Living
    Service:
    Caregiver ReCharge: Central Registry Intake
    Inquiry Phone:
    1 (905) 281-4443

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