Freedom Home Health Care - Service Request

Click here for Residents of Hillsborough/Manatee/Polk

Personal Information

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Check the box of the service that you may need

HomeMaker/Companion:

Help pay bills
Cooking & serving nutritious meals
Vaccuming & dusting
Laundry
Helping in writing letters
Grocery shopping
Companionship for day or night

Skilled Nursing:

Registered Nurse

Skilled nursing

RN's/LPN's

Injections

Catheter care

Wound care/dressings

Observation & assessment

Infusion therapy-RN's only

Tube feedings/care

Ostomy care & teaching

Diabetic care & teaching

Free skilled nursing evaluations

Instruction of disease processes, etc

Physical Therapy:

Weight training & exercises
Rehabilitation techniques
Home exercise program
Strength & endurance training

Occupational Therapy:

Activities of daily living training
Perceptual & fine motor training
Strength & endurance training
Splinting
Adaptive equipment

Certified Nursing Assistant:

Bathing & dressing
Assistance with getting in & out of bed
Home Maker/Companion to keep company
Daily Chores
Personal hygiene
Assistance with exercise
Shaving & hair care

Speech Therapy:

Shaving & hair care
Speech articulation
Dysphagia/swallowing treatments
Language disorders

Medical Social Workers:

Problem identification & make referrals to appropriate resources: community resource
referrals
Referral to community support group for family/caregiver
Entitlement, food assistance and financial counseling obtained
Spiritual support and professional counseling
referrals
Educational level maintained
Home assessment
Identify problems impeding plan of care

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Please download Patient Consent Form in PDF format here, fill it in and fax to: (727) 216-8812 or mail to our administrative office. (Adobe Reader required to view form. Click here to download.)


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