Forms and Handouts
Below you will find downloadable/printable pdf forms and handouts along with an explanation of each form.
To access the forms or handouts, simply click on the form or handout name (which will open a pdf), and then click “download” to save or locate then choose print option to print. If you don’t have a PDF reader, you can download a free program like Adobe Acrobat Reader, which is a widely used and reliable free option.
In the event that you do not have access to a printer at home, the library has computer and printers you can use or call Ellna’s Senior Home Care and schedule a time to fill out forms with the director, Paula Ogden at (573) 480-8025.
Client Care Agreement – This forms is an agreement between the client/guardian and Ellna’s Senior Home Care and expectations for the center and the client/guardian.
Legal Rights – This form list the rights of the client, and how to report failure by staff to meet the client’s right.
Caregiver Medical Consent – In the event a client is injured or has a medical emergency while in the care of Ellna’s this form details steps that will be taken and gives permission for the center to make medical decisions on your behalf should you not be reachable.
Activities of Daily Living (ADL) – This form will help determine how much much assistance a client needs and better inform the staff at Ellna’s how to meet the needs of clients. 1008
Financial Assistance – This form must be filled out to apply for financial assistance. Note financial assistance is granted based on needs of clients and if funds are available.