Client Information

  • Client Intake Status and Form Navigation

  • Please see below the status of the Client Intake for: {fullClients}

    The person completing these forms is: {whoIs}

    Representative or Referrers Name (if applicable): {fullName34}

  • Client Information

  •   Not Started  

  •   Complete Caring Lotus Details  

  • Onboarding Pack

  •   Not Started  

  •   In Progress  

  •   Sent for Signature  

  • Risk Plan

  •   Not Started  

  •   In Progress  

  • Client Support Plan

  •   Not Started  

  •   In Progress  

  •   Sent for Signature  

  • Client Information Form

    This form was designed to get some basic details from you, a representative or a referral.

    Once you have submitted this form, a representative from Caring Lotus will be in contact with you to discuss your needs in a little more detail and walk you through the rest of our intake process.

    If you have any issues completing this form, please do not hesitate to get in contact with one of our friendly representatives by calling (03) 7036 1516 so that they can complete it for you over the phone with you.

  • CLIENT INFORMATION FORM - Staff Information

    Office Use Only
  • Date Caring Lotus Completed
     - -
    • Temporary Health Details 
    • High Intensity / Special Needs*
    • Have you been assessed and have a care plan?
    • Special Needs
    • What Special needs are you funded for?
    • Does the client currently take medications*
    • Who will be responsible
    • CL Support Workers are required to
    • Have they signed a medication consent form?

    • MEDICATION FORMS AND DATA

      Client Medication Plan & Consent Form

      Data - Client Medication Plan and Consent Form DATA

       

      Self-administration of Medication Assessment

      Data - Self-administation of Medication Assessment Data

    • Audit Participation
    • Audit Email to go to
    • Client Updates Events/Engagement Intro
    • Skip to last page?*

  • Caring Lotus

    Initial Client Information Form

  • Basic Demographic Information

  • Who is completing this form?*

  • Client's Details

  • Date of Birth*
     - -
  • Interpreter Required
  • Preferred communication?

  • Representative or Guardianship

  • Is a Public Advocate order in place?

  • For participants under the age of 18 years of age, under guardianship or in the care of family or caregivers we ask that their details be completed below

  • Representative 1

  • Representative 1 Contact Type

  • Representative 2

  • Representative 2 Contact Type

  • A little more personal details

    Please including any disabilities, diagnosis or medical conditions that will help us understand your care needs.

  • Does the Client take any Medications
  • Who will be responsible:
  • Caring Lotus Support Workers are required to

  • Use of other Services

    This helps us understand how we fit in with your complete care package. If you give us consent we are happy to work with other services to help deliver a complete support plan with you.

  • Other Services
  • Do you have a Behaviour Support Plan?
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  • Funding details

  • Type of Funding
  • NDIS Plan start date
     - -
  • NDIS Plan end date
     / /

  • Services Required

  • Your Goals and Aspirations

    We thrive on working with you on your Goals and Aspirations. Please let us know what you would like us to focus on with you in order of importance. You can also give us a timeframe in which you are hoping to achieve this. When working together, so many things are possible.

  • ACKNOWLEDGEMENT PAGE

  • Do you have any documents that you would like to upload?

    If available, please upload any supporting documentation like NDIS Plans, Dr. or other service provider supporting documents etc.

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  • Clear
  • Date Initial Information Signed/Completed
     - -

  • Thank You for completing the Client Information Form.  Please click Submit to continue.

  • Thank You for updating / editing the Client Information Form.  Please click Submit to commit your changes and return to the Checklist Page.

  • Click Submit to take me to the {takeMe}

  • EMERGENCY PLAN

    Contacts and Details for the Clients Emergency Plan, this will be sent to client.

  • Participant Emergency Contact Details

  • Location / Vehicle

  • Assembly Point

  • Admin Page

  • Webhook for child forms to share the status and other identified information with the main form.  This is used to control the forms talking to each other. The below webhook needs to be added to the child forms.

    https://flow.zoho.com.au/7000395343/flow/webhook/incoming?zapikey=1001.f6048e99b26d2f90dc470bcae5f97c79.bb75cfae477b17e96da6b6b5a8f80ad1&isdebug=false

  • DateTimeStamp
     - -
    • Onboarding Information 
    • Risk Plan Information 
    • Client Support Information 
    • Should be Empty: