Resident Intake & Assessment
Before a resident joins our home, we complete a thorough intake and assessment to ensure we are fully prepared to meet their physical, emotional, and social needs. This form is completed by a caseworker, family representative, or referring professional and takes approximately 15–20 minutes to complete.
Step 1
Complete the form
Fill out all sections as accurately as possible. Required fields are marked.
Step 2
We review & follow up
Our care team reviews the submission and contacts you within 1–2 business days.
Step 3
Admission planning
We work with you to confirm placement, care plan, and move-in date.
What's covered in this assessment
1. Client Information
Basic personal details including name, date of birth, gender, and identification.
2. Referral Information
Details about the referring source, caseworker name, phone, and email.
3. Presenting Needs
Reason for placement, immediate care needs, and preferred admission date.
4. Mental & Emotional Status
Current mental health status, diagnosis history, and active treatment details.
5. Physical Health Status
Overall health condition, mobility, diagnoses, medications, and primary physician.
6. Daily Living Skills (ADLs)
Ability to perform daily tasks and specific areas where support is needed.
7. Behavioral Assessment
History of aggression, behavioral concerns, and additional notes.
8. Housing History
Previous living situation, prior placements, and history of homelessness.
9. Risk Assessment
Risk level, safety concerns, and advance directive documentation.
10. Support System
Family, community, and case management support along with emergency contacts.
11. Financial & Insurance
Payment method, insurance provider, policy, and member ID details.
12. Recommendation
Recommended level of support and assessor's notes and signature.
All information submitted is kept strictly confidential and used solely for the purpose of care planning and placement at T.N.T Adult Family Care Home. For questions, call us at 219-292-4478 or email tntafl2255@gmail.com.
Ready to begin? Click below to open the secure intake and assessment form.
Contact
Reach out to us for any inquiries. We are dedicated to providing care with compassion and dignity for every resident, every day.
