Head Office: Level 1/254 Brighton Road, Somerton Park SA 5044

Participant Acceptance Checklist

PARTICIPANT ACCEPTANCE CHECKLIST

Participants Name:
Has the participant previously received services from Creativ Minds
DD slash MM slash YYYY

Have the following T&C’s, forms and documents been completed and submitted by the participant / carer / doctor:

Form 1 – Service Support Agreement & T&C’s
Form 2 – Individual Support Plan
Form 3 – Hospital Discharge Referral
Form 4 – Epilepsy Management Plan
Form 5 – Diabetes Management Plan
Form 6 – Asthma Management Plan
Form 7 – Medication Form
Form 8 – Non Prescription Medication Form
Form 21 - Individual Participant Risk Assessment Form
Form 49 – Mealtime Management Plan
MM slash DD slash YYYY

General Managers Approval:

Participant Approved
MM slash DD slash YYYY

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