{"id":332,"date":"2022-11-10T01:38:33","date_gmt":"2022-11-10T01:38:33","guid":{"rendered":"http:\/\/choicehome.flywheelsites.com\/give-back\/"},"modified":"2024-10-16T21:15:43","modified_gmt":"2024-10-16T21:15:43","slug":"give-back","status":"publish","type":"page","link":"https:\/\/dmg.org.in\/choicehomecare\/give-back\/","title":{"rendered":"Give Back"},"content":{"rendered":"<p>[cs_content][cs_element_section _id=&#8221;1&#8243; ][cs_element_layout_row _id=&#8221;2&#8243; ][cs_element_layout_column _id=&#8221;3&#8243; ][x_custom_headline level=&#8221;h1&#8243; looks_like=&#8221;h1&#8243; accent=&#8221;false&#8221; class=&#8221;somerton-creative-avenir-white-title2&#8243; style=&#8221;font-size: 3rem; padding-top: 50px; padding-bottom: 50px;&#8221;]Give back[\/x_custom_headline][\/cs_element_layout_column][\/cs_element_layout_row][\/cs_element_section][cs_element_section _id=&#8221;5&#8243; ][cs_element_layout_row _id=&#8221;6&#8243; ][cs_element_layout_column _id=&#8221;7&#8243; ][x_custom_headline level=&#8221;h2&#8243; looks_like=&#8221;h3&#8243; accent=&#8221;false&#8221; class=&#8221;somerton-creative-avenir-green-title&#8221;]Give Back to the Community Program[\/x_custom_headline][cs_element_gap _id=&#8221;9&#8243; ][cs_text _bp_base=&#8221;4_4&#8243; class=&#8221;somerton-creative-avenir&#8221; style=&#8221;line-height: 1.5rem;&#8221;]<\/p>\n<p>Every month, Choice Homecare gives a package of 25 hours of free care to a client recommended by one of our business partners or qualified affiliates.<\/p>\n<p>This helps someone who can\u2019t afford homecare or attendant care services receive the extra care that they need, at a value of over $1,000.<\/p>\n<p>This is one way Choice Homecare invests in our community, making lives better.<\/p>\n<p>[\/cs_text][x_button size=&#8221;global&#8221; block=&#8221;false&#8221; circle=&#8221;false&#8221; icon_only=&#8221;false&#8221; href=&#8221;#form&#8221; title=&#8221;&#8221; target=&#8221;&#8221; info=&#8221;none&#8221; info_place=&#8221;top&#8221; info_trigger=&#8221;hover&#8221; info_content=&#8221;&#8221; class=&#8221;somerton-creative-blue-rounded-button&#8221;]Recommend someone[\/x_button][\/cs_element_layout_column][cs_element_layout_column _id=&#8221;12&#8243; ][x_image type=&#8221;none&#8221; src=&#8221;32608:full&#8221; alt=&#8221;People are happy to be well cared for&#8221; link=&#8221;false&#8221; href=&#8221;#&#8221; title=&#8221;&#8221; target=&#8221;&#8221; info=&#8221;none&#8221; info_place=&#8221;top&#8221; info_trigger=&#8221;hover&#8221; info_content=&#8221;&#8221; class=&#8221;service-image&#8221; style=&#8221;object-position: 70% 50%;&#8221;][\/cs_element_layout_column][\/cs_element_layout_row][\/cs_element_section][cs_element_section _id=&#8221;14&#8243; ][cs_element_layout_row _id=&#8221;15&#8243; ][cs_element_layout_column _id=&#8221;16&#8243; ][x_image type=&#8221;none&#8221; src=&#8221;32609:full&#8221; alt=&#8221;Professional worker in a healthcare&#8221; link=&#8221;false&#8221; href=&#8221;#&#8221; title=&#8221;&#8221; target=&#8221;&#8221; info=&#8221;none&#8221; info_place=&#8221;top&#8221; info_trigger=&#8221;hover&#8221; info_content=&#8221;&#8221; class=&#8221;service-image&#8221; style=&#8221;object-position: 78% 50%;&#8221;][\/cs_element_layout_column][cs_element_layout_column _id=&#8221;18&#8243; ][x_custom_headline level=&#8221;h2&#8243; looks_like=&#8221;h3&#8243; accent=&#8221;false&#8221; class=&#8221;somerton-creative-avenir-white-title2&#8243;]Who can make a recommendation?<br \/>\n[\/x_custom_headline][cs_element_gap _id=&#8221;20&#8243; ][cs_text _bp_base=&#8221;4_4&#8243; class=&#8221;text-white somerton-creative-avenir&#8221; style=&#8221;line-height: 1.5rem;&#8221;]<\/p>\n<p>Any professional working in a healthcare field may recommend someone for this bursary.<\/p>\n<p>Is someone in your care struggling? Would they benefit from 25 hours of care? Submit an application form on their behalf.<\/p>\n<p>Together, we can help people in our community.<\/p>\n<p>[\/cs_text][x_button size=&#8221;global&#8221; block=&#8221;false&#8221; circle=&#8221;false&#8221; icon_only=&#8221;false&#8221; href=&#8221;#form&#8221; title=&#8221;&#8221; target=&#8221;&#8221; info=&#8221;none&#8221; info_place=&#8221;top&#8221; info_trigger=&#8221;hover&#8221; info_content=&#8221;&#8221; class=&#8221;btn-white&#8221;]Recommend someone[\/x_button][\/cs_element_layout_column][\/cs_element_layout_row][\/cs_element_section][cs_element_section _id=&#8221;23&#8243; ][cs_element_layout_row _id=&#8221;24&#8243; ][cs_element_layout_column _id=&#8221;25&#8243; ][x_custom_headline level=&#8221;h2&#8243; looks_like=&#8221;h3&#8243; accent=&#8221;false&#8221; class=&#8221;somerton-creative-avenir-green-title&#8221;]Who is eligible?[\/x_custom_headline][cs_element_gap _id=&#8221;27&#8243; ][cs_element_accordion _modules=&#8221;29,30,31,32&#8243; _id=&#8221;28&#8243; ][\/cs_element_accordion][\/cs_element_layout_column][cs_element_layout_column _id=&#8221;33&#8243; ][x_image type=&#8221;none&#8221; src=&#8221;221:full&#8221; alt=&#8221;Older man&#8221; link=&#8221;false&#8221; href=&#8221;#&#8221; title=&#8221;&#8221; target=&#8221;&#8221; info=&#8221;none&#8221; info_place=&#8221;top&#8221; info_trigger=&#8221;hover&#8221; info_content=&#8221;&#8221; class=&#8221;service-image&#8221; style=&#8221;object-position: 20% 50%;&#8221;][\/cs_element_layout_column][\/cs_element_layout_row][\/cs_element_section][cs_element_section _id=&#8221;35&#8243; ][cs_element_layout_row _id=&#8221;36&#8243; ][cs_element_layout_column _id=&#8221;37&#8243; ][x_custom_headline level=&#8221;h2&#8243; looks_like=&#8221;h3&#8243; accent=&#8221;false&#8221; class=&#8221;somerton-creative-avenir-white-title&#8221; style=&#8221;letter-spacing: 5pt; font-weight: 400; text-transform: uppercase;&#8221;]How it works[\/x_custom_headline][cs_element_gap _id=&#8221;39&#8243; ][\/cs_element_layout_column][\/cs_element_layout_row][cs_element_layout_row _id=&#8221;40&#8243; ][cs_element_layout_column _id=&#8221;41&#8243; ][x_custom_headline level=&#8221;h2&#8243; looks_like=&#8221;h5&#8243; accent=&#8221;false&#8221; class=&#8221;why-us-title text-primary somerton-creative-avenir-blue-title&#8221;]1[\/x_custom_headline][x_custom_headline level=&#8221;h2&#8243; looks_like=&#8221;h5&#8243; accent=&#8221;false&#8221; class=&#8221;why-us-title somerton-creative-avenir-blue-title&#8221; style=&#8221;text-transform: uppercase;&#8221;]Fill out form[\/x_custom_headline][cs_text _bp_base=&#8221;4_4&#8243; class=&#8221;why-us-content&#8221;]Fill out the form on this page. The candidate\u2019s identity is not necessary unless he or she is selected; a pseudonym is sufficient.<br \/>\n[\/cs_text][\/cs_element_layout_column][cs_element_layout_column _id=&#8221;45&#8243; ][x_custom_headline level=&#8221;h2&#8243; looks_like=&#8221;h5&#8243; accent=&#8221;false&#8221; class=&#8221;why-us-title text-primary somerton-creative-avenir-blue-title&#8221;]2[\/x_custom_headline][x_custom_headline level=&#8221;h2&#8243; looks_like=&#8221;h5&#8243; accent=&#8221;false&#8221; class=&#8221;why-us-title somerton-creative-avenir-blue-title&#8221; style=&#8221;text-transform: uppercase;&#8221;]Finalists are selected[\/x_custom_headline][cs_text _bp_base=&#8221;4_4&#8243; class=&#8221;why-us-content&#8221;]Choice Homecare reviews submissions to ensure the candidates meet submission qualifications. Five submissions that best fit the qualifications become finalists.[\/cs_text][\/cs_element_layout_column][cs_element_layout_column _id=&#8221;49&#8243; ][x_custom_headline level=&#8221;h2&#8243; looks_like=&#8221;h5&#8243; accent=&#8221;false&#8221; class=&#8221;why-us-title text-primary somerton-creative-avenir-blue-title&#8221;]3[\/x_custom_headline][x_custom_headline level=&#8221;h2&#8243; looks_like=&#8221;h5&#8243; accent=&#8221;false&#8221; class=&#8221;why-us-title somerton-creative-avenir-blue-title&#8221; style=&#8221;text-transform: uppercase;&#8221;]Selection panel[\/x_custom_headline][cs_text _bp_base=&#8221;4_4&#8243; class=&#8221;why-us-content&#8221;]The Selection Panel, made up of members of the health care community, scores the finalists. The candidate with the highest combined score will receive the recommended care. Choice Homecare has no say in the panelists\u2019 scores.<br \/>\n[\/cs_text][\/cs_element_layout_column][cs_element_layout_column _id=&#8221;53&#8243; ][x_custom_headline level=&#8221;h2&#8243; looks_like=&#8221;h5&#8243; accent=&#8221;false&#8221; class=&#8221;why-us-title text-primary somerton-creative-avenir-blue-title&#8221;]4[\/x_custom_headline][x_custom_headline level=&#8221;h2&#8243; looks_like=&#8221;h5&#8243; accent=&#8221;false&#8221; class=&#8221;why-us-title somerton-creative-avenir-blue-title&#8221; style=&#8221;text-transform: uppercase;&#8221;]Set up care[\/x_custom_headline][cs_text _bp_base=&#8221;4_4&#8243; class=&#8221;why-us-content&#8221;]Choice Homecare\u2019s Care Manager works with the referring professional to develop a Care Plan and a Caregiver Task list for the successful candidate. The Care Manager then arranges for care at a mutually agreed time and schedule.<br \/>\n[\/cs_text][\/cs_element_layout_column][\/cs_element_layout_row][cs_element_layout_row _id=&#8221;57&#8243; ][cs_element_layout_column _id=&#8221;58&#8243; ][cs_element_gap _id=&#8221;59&#8243; ][x_button size=&#8221;global&#8221; block=&#8221;false&#8221; circle=&#8221;false&#8221; icon_only=&#8221;false&#8221; href=&#8221;#form&#8221; title=&#8221;&#8221; target=&#8221;&#8221; info=&#8221;none&#8221; info_place=&#8221;top&#8221; info_trigger=&#8221;hover&#8221; info_content=&#8221;&#8221; class=&#8221;btn-white&#8221;]Fill out form[\/x_button][\/cs_element_layout_column][\/cs_element_layout_row][\/cs_element_section][cs_element_section _id=&#8221;61&#8243; ][cs_element_layout_row _id=&#8221;62&#8243; ][cs_element_layout_column _id=&#8221;63&#8243; ][x_custom_headline level=&#8221;h3&#8243; looks_like=&#8221;h3&#8243; accent=&#8221;false&#8221; class=&#8221;cs-ta-center somerton-creative-avenir-green-title&#8221;]Choice Homecare GIVE-BACK Program[\/x_custom_headline][cs_element_gap _id=&#8221;65&#8243; ][x_raw_content class=&#8221;somerton-creative-avenir&#8221; style=&#8221;line-height: 1.5rem;&#8221;]<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_4_container\" data-token=\"e820ecfbb3b7519e20e5e315bcec7629\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_give-backprogram\" data-token=\"e820ecfbb3b7519e20e5e315bcec7629\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Give-Back Program<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"4\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_4\" id=\"frm_hide_fields_4\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"give-backprogram\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_4\" name=\"frm_submit_entry_4\" value=\"d35a4cbdc6\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/choicehomecare\/wp-json\/wp\/v2\/pages\/332\" \/><div id=\"frm_field_8_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_nnewx\" id=\"field_nnewx_label\" class=\"frm_primary_label\">Candidate\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_nnewx\" name=\"item_meta[8]\" value=\"\"  placeholder=\"Your name\" data-reqmsg=\"Candidate cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_nnewx\" \/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_nnewx\">(The name may be a pseudonym until the candidate has been selected)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_9_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_yw8q2\" id=\"field_yw8q2_label\" class=\"frm_primary_label\">Referred by\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_yw8q2\" name=\"item_meta[9]\" value=\"\"  placeholder=\"Referred by\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_yw8q2\" \/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_yw8q2\">(A healthcare-related organization, a professional designation, or a health care sector position)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_10_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_d2kad\" id=\"field_d2kad_label\" class=\"frm_primary_label\">Title \/ Organization\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_d2kad\" name=\"item_meta[10]\" value=\"\"  placeholder=\"Title \/ Organization\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_kpq2k\" id=\"field_kpq2k_label\" class=\"frm_primary_label\">Referrer email\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_kpq2k\" name=\"item_meta[11]\" value=\"\"  placeholder=\"Your email\" data-reqmsg=\"Referrer email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_12_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_qhmao\" id=\"field_qhmao_label\" class=\"frm_primary_label\">Referrer phone\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_qhmao\" name=\"item_meta[12]\" value=\"\"  placeholder=\"Your phone\" data-reqmsg=\"Referrer phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_14_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Screening requirements (Y\/N)<\/h3>\r\n\r\n\r\n<div id=\"frm_field_13_container\" class=\"frm_form_field form-field  frm_inline_container horizontal_radio\">\r\n    <div  id=\"field_tvsb8_label\" class=\"frm_primary_label\">Ottawa Region (Ottawa, Kanata, Barrhaven, Orleans)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_tvsb8_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_13-14-0\">\t\t\t<label  for=\"field_tvsb8-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[13]\" id=\"field_tvsb8-0\" value=\"Yes\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Ottawa Region (Ottawa, Kanata, Barrhaven, Orleans) is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_13-14-1\">\t\t\t<label  for=\"field_tvsb8-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[13]\" id=\"field_tvsb8-1\" value=\"No\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Ottawa Region (Ottawa, Kanata, Barrhaven, Orleans) is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_16_container\" class=\"frm_form_field form-field  frm_inline_container horizontal_radio\">\r\n    <div  id=\"field_r0mqr_label\" class=\"frm_primary_label\">PSW services only\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_r0mqr_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_16-14-0\">\t\t\t<label  for=\"field_r0mqr-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[16]\" id=\"field_r0mqr-0\" value=\"Yes\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"PSW services only is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_16-14-1\">\t\t\t<label  for=\"field_r0mqr-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[16]\" id=\"field_r0mqr-1\" value=\"No\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"PSW services only is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_17_container\" class=\"frm_form_field form-field  frm_inline_container horizontal_radio\">\r\n    <div  id=\"field_jjaer_label\" class=\"frm_primary_label\">Lack budget to pay\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_jjaer_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_17-14-0\">\t\t\t<label  for=\"field_jjaer-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[17]\" id=\"field_jjaer-0\" value=\"Yes\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Lack budget to pay is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_17-14-1\">\t\t\t<label  for=\"field_jjaer-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[17]\" id=\"field_jjaer-1\" value=\"No\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Lack budget to pay is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_18_container\" class=\"frm_form_field form-field  frm_inline_container horizontal_radio\">\r\n    <div  id=\"field_w8opj_label\" class=\"frm_primary_label\">Agrees to sign non-chargeable Agreement of Service\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_w8opj_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_18-14-0\">\t\t\t<label  for=\"field_w8opj-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[18]\" id=\"field_w8opj-0\" value=\"Yes\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Agrees to sign non-chargeable Agreement of Service is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_18-14-1\">\t\t\t<label  for=\"field_w8opj-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[18]\" id=\"field_w8opj-1\" value=\"No\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Agrees to sign non-chargeable Agreement of Service is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_19_container\" class=\"frm_form_field form-field  frm_inline_container horizontal_radio\">\r\n    <div  id=\"field_w2tl9_label\" class=\"frm_primary_label\">Agrees to receive care\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_w2tl9_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_19-14-0\">\t\t\t<label  for=\"field_w2tl9-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[19]\" id=\"field_w2tl9-0\" value=\"Yes\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Agrees to receive care is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_19-14-1\">\t\t\t<label  for=\"field_w2tl9-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[19]\" id=\"field_w2tl9-1\" value=\"No\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Agrees to receive care is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_20_container\" class=\"frm_form_field form-field  frm_inline_container horizontal_radio\">\r\n    <div  id=\"field_b2jum_label\" class=\"frm_primary_label\">Home environment is safe\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_b2jum_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_20-14-0\">\t\t\t<label  for=\"field_b2jum-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[20]\" id=\"field_b2jum-0\" value=\"Yes\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Home environment is safe is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_20-14-1\">\t\t\t<label  for=\"field_b2jum-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[20]\" id=\"field_b2jum-1\" value=\"No\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Home environment is safe is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_21_container\" class=\"frm_form_field form-field  frm_inline_container horizontal_radio\">\r\n    <div  id=\"field_msqhf_label\" class=\"frm_primary_label\">Non-Aggressive behavior\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_msqhf_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_21-14-0\">\t\t\t<label  for=\"field_msqhf-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[21]\" id=\"field_msqhf-0\" value=\"Yes\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Non-Aggressive behavior is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_21-14-1\">\t\t\t<label  for=\"field_msqhf-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[21]\" id=\"field_msqhf-1\" value=\"No\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Non-Aggressive behavior is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_22_container\" class=\"frm_form_field form-field  frm_inline_container horizontal_radio\">\r\n    <div  id=\"field_qambl_label\" class=\"frm_primary_label\">Lack family support\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_qambl_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_22-14-0\">\t\t\t<label  for=\"field_qambl-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_qambl-0\" value=\"Yes\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Lack family support is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_22-14-1\">\t\t\t<label  for=\"field_qambl-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_qambl-1\" value=\"No\"\n\t\t data-sectionid=\"14\"  data-invmsg=\"Lack family support is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_24_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_z7fr6\" id=\"field_z7fr6_label\" class=\"frm_primary_label\">Comments and Diagnosis (Details are helpful in the Selection Process)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[24]\" id=\"field_z7fr6\" rows=\"5\"  data-sectionid=\"14\"  data-invmsg=\"Comments and Diagnosis (Details are helpful in the Selection Process) is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_25_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">If screening requirements are met, please provide information in the relevant sections below<\/h3>\r\n\r\n\r\n<div id=\"frm_field_27_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_mymd1_label\" class=\"frm_primary_label\">Fall Risk \/ Mobility\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_mymd1_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_27-25-0\">\t\t\t<label  for=\"field_mymd1-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[27]\" id=\"field_mymd1-0\" value=\"1\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Fall Risk \/ Mobility is invalid\"   \/> 1<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_27-25-1\">\t\t\t<label  for=\"field_mymd1-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[27]\" id=\"field_mymd1-1\" value=\"2\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Fall Risk \/ Mobility is invalid\"   \/> 2<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_27-25-2\">\t\t\t<label  for=\"field_mymd1-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[27]\" id=\"field_mymd1-2\" value=\"3\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Fall Risk \/ Mobility is invalid\"   \/> 3<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_27-25-3\">\t\t\t<label  for=\"field_mymd1-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[27]\" id=\"field_mymd1-3\" value=\"4\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Fall Risk \/ Mobility is invalid\"   \/> 4<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_mymd1\">(Levels: 1 - Minor. 2 - Moderate. 3 - Significant. 4 - Serious)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_28_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ibgqh\" id=\"field_ibgqh_label\" class=\"frm_primary_label\">Comments\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[28]\" id=\"field_ibgqh\" rows=\"5\"  data-sectionid=\"25\"  data-invmsg=\"Comments is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_29_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_e32jk_label\" class=\"frm_primary_label\">Need help for personal hygiene and\/or housekeeping\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_e32jk_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_29-25-0\">\t\t\t<label  for=\"field_e32jk-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[29]\" id=\"field_e32jk-0\" value=\"1\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Need help for personal hygiene and\/or housekeeping is invalid\"   \/> 1<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_29-25-1\">\t\t\t<label  for=\"field_e32jk-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[29]\" id=\"field_e32jk-1\" value=\"2\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Need help for personal hygiene and\/or housekeeping is invalid\"   \/> 2<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_29-25-2\">\t\t\t<label  for=\"field_e32jk-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[29]\" id=\"field_e32jk-2\" value=\"3\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Need help for personal hygiene and\/or housekeeping is invalid\"   \/> 3<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_29-25-3\">\t\t\t<label  for=\"field_e32jk-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[29]\" id=\"field_e32jk-3\" value=\"4\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Need help for personal hygiene and\/or housekeeping is invalid\"   \/> 4<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_e32jk\">(Levels: 1 - Minor. 2 - Moderate. 3 - Significant. 4 - Serious)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_30_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_u57t8\" id=\"field_u57t8_label\" class=\"frm_primary_label\">Comments\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[30]\" id=\"field_u57t8\" rows=\"5\"  data-sectionid=\"25\"  data-invmsg=\"Comments is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_31_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_8vyax_label\" class=\"frm_primary_label\">Post-Op \/ Recent Surgery or Hospitalization\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_8vyax_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_31-25-0\">\t\t\t<label  for=\"field_8vyax-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[31]\" id=\"field_8vyax-0\" value=\"1\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Post-Op \/ Recent Surgery or Hospitalization is invalid\"   \/> 1<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_31-25-1\">\t\t\t<label  for=\"field_8vyax-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[31]\" id=\"field_8vyax-1\" value=\"2\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Post-Op \/ Recent Surgery or Hospitalization is invalid\"   \/> 2<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_31-25-2\">\t\t\t<label  for=\"field_8vyax-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[31]\" id=\"field_8vyax-2\" value=\"3\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Post-Op \/ Recent Surgery or Hospitalization is invalid\"   \/> 3<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_31-25-3\">\t\t\t<label  for=\"field_8vyax-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[31]\" id=\"field_8vyax-3\" value=\"4\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Post-Op \/ Recent Surgery or Hospitalization is invalid\"   \/> 4<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_8vyax\">(Levels: 1 - Minor. 2 - Moderate. 3 - Significant. 4 - Serious)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_32_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_7coll\" id=\"field_7coll_label\" class=\"frm_primary_label\">Comments\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[32]\" id=\"field_7coll\" rows=\"5\"  data-sectionid=\"25\"  data-invmsg=\"Comments is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_33_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_39sn3_label\" class=\"frm_primary_label\">Dementia\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_39sn3_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_33-25-0\">\t\t\t<label  for=\"field_39sn3-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[33]\" id=\"field_39sn3-0\" value=\"1\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Dementia is invalid\"   \/> 1<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_33-25-1\">\t\t\t<label  for=\"field_39sn3-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[33]\" id=\"field_39sn3-1\" value=\"2\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Dementia is invalid\"   \/> 2<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_33-25-2\">\t\t\t<label  for=\"field_39sn3-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[33]\" id=\"field_39sn3-2\" value=\"3\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Dementia is invalid\"   \/> 3<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_33-25-3\">\t\t\t<label  for=\"field_39sn3-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[33]\" id=\"field_39sn3-3\" value=\"4\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Dementia is invalid\"   \/> 4<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_39sn3\">(Levels: 1 - Minor. 2 - Moderate. 3 - Significant. 4 - Serious)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_34_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_b6wjp\" id=\"field_b6wjp_label\" class=\"frm_primary_label\">Comments\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[34]\" id=\"field_b6wjp\" rows=\"5\"  data-sectionid=\"25\"  data-invmsg=\"Comments is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_35_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_efy0y_label\" class=\"frm_primary_label\">Disabilities (please specify)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_efy0y_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_35-25-0\">\t\t\t<label  for=\"field_efy0y-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[35]\" id=\"field_efy0y-0\" value=\"1\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Disabilities (please specify) is invalid\"   \/> 1<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_35-25-1\">\t\t\t<label  for=\"field_efy0y-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[35]\" id=\"field_efy0y-1\" value=\"2\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Disabilities (please specify) is invalid\"   \/> 2<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_35-25-2\">\t\t\t<label  for=\"field_efy0y-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[35]\" id=\"field_efy0y-2\" value=\"3\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Disabilities (please specify) is invalid\"   \/> 3<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_35-25-3\">\t\t\t<label  for=\"field_efy0y-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[35]\" id=\"field_efy0y-3\" value=\"4\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Disabilities (please specify) is invalid\"   \/> 4<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_efy0y\">(Levels: 1 - Minor. 2 - Moderate. 3 - Significant. 4 - Serious)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_36_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_9hec8\" id=\"field_9hec8_label\" class=\"frm_primary_label\">Comments\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[36]\" id=\"field_9hec8\" rows=\"5\"  data-sectionid=\"25\"  data-invmsg=\"Comments is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_37_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_8ivzz_label\" class=\"frm_primary_label\">Other (please specify)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_8ivzz_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_37-25-0\">\t\t\t<label  for=\"field_8ivzz-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_8ivzz-0\" value=\"1\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Other (please specify) is invalid\"   \/> 1<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-25-1\">\t\t\t<label  for=\"field_8ivzz-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_8ivzz-1\" value=\"2\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Other (please specify) is invalid\"   \/> 2<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-25-2\">\t\t\t<label  for=\"field_8ivzz-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_8ivzz-2\" value=\"3\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Other (please specify) is invalid\"   \/> 3<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-25-3\">\t\t\t<label  for=\"field_8ivzz-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_8ivzz-3\" value=\"4\"\n\t\t data-sectionid=\"25\"  data-invmsg=\"Other (please specify) is invalid\"   \/> 4<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_8ivzz\">(Levels: 1 - Minor. 2 - Moderate. 3 - Significant. 4 - Serious)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_38_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_sgkz7\" id=\"field_sgkz7_label\" class=\"frm_primary_label\">Comments\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[38]\" id=\"field_sgkz7\" rows=\"5\"  data-sectionid=\"25\"  data-invmsg=\"Comments is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_39_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_mrlqf\" id=\"field_mrlqf_label\" class=\"frm_primary_label\">Additional comments for this section\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[39]\" id=\"field_mrlqf\" rows=\"5\"  data-sectionid=\"25\"  data-invmsg=\"Additional comments for this section is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_40_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Other situations<\/h3>\r\n\r\n\r\n<div id=\"frm_field_42_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_2b1sb_label\" class=\"frm_primary_label\">Lives alone?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_2b1sb_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_42-40-0\">\t\t\t<label  for=\"field_2b1sb-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[42]\" id=\"field_2b1sb-0\" value=\"Yes\"\n\t\t data-sectionid=\"40\"  data-invmsg=\"Lives alone? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_42-40-1\">\t\t\t<label  for=\"field_2b1sb-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[42]\" id=\"field_2b1sb-1\" value=\"No\"\n\t\t data-sectionid=\"40\"  data-invmsg=\"Lives alone? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_43_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_78z09\" id=\"field_78z09_label\" class=\"frm_primary_label\">Comments (optional)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[43]\" id=\"field_78z09\" rows=\"5\"  data-sectionid=\"40\"  data-invmsg=\"Comments (optional) is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_44_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_btphp_label\" class=\"frm_primary_label\">Family support nearby?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_btphp_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_44-40-0\">\t\t\t<label  for=\"field_btphp-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[44]\" id=\"field_btphp-0\" value=\"Yes\"\n\t\t data-sectionid=\"40\"  data-invmsg=\"Family support nearby? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_44-40-1\">\t\t\t<label  for=\"field_btphp-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[44]\" id=\"field_btphp-1\" value=\"No\"\n\t\t data-sectionid=\"40\"  data-invmsg=\"Family support nearby? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_45_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_anbjq\" id=\"field_anbjq_label\" class=\"frm_primary_label\">Comments (optional)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[45]\" id=\"field_anbjq\" rows=\"5\"  data-sectionid=\"40\"  data-invmsg=\"Comments (optional) is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_46_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_a8p9n_label\" class=\"frm_primary_label\">PSW Scheduling Requirements?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_a8p9n_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_46-40-0\">\t\t\t<label  for=\"field_a8p9n-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[46]\" id=\"field_a8p9n-0\" value=\"Yes\"\n\t\t data-sectionid=\"40\"  data-invmsg=\"PSW Scheduling Requirements? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_46-40-1\">\t\t\t<label  for=\"field_a8p9n-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[46]\" id=\"field_a8p9n-1\" value=\"No\"\n\t\t data-sectionid=\"40\"  data-invmsg=\"PSW Scheduling Requirements? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_47_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_be39x\" id=\"field_be39x_label\" class=\"frm_primary_label\">Comments (optional)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[47]\" id=\"field_be39x\" rows=\"5\"  data-sectionid=\"40\"  data-invmsg=\"Comments (optional) is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_48_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_p62g8\" id=\"field_p62g8_label\" class=\"frm_primary_label\">Others (describe)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[48]\" id=\"field_p62g8\" rows=\"5\"  data-sectionid=\"40\"  data-invmsg=\"Others (describe) is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_51_container\">\n\t\t\t<label for=\"field_3f5qs\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_3f5qs\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[51]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"uMUct\/wiT+X0+EsR2ANFKIjlwkK4kZ74dR1nkv5qFG\/eVCMgeORfLRHDaFahNHhv\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n[\/x_raw_content][\/cs_element_layout_column][\/cs_element_layout_row][\/cs_element_section][cs_element_section _id=&#8221;67&#8243; ][cs_element_layout_row _id=&#8221;68&#8243; ][cs_element_layout_column _id=&#8221;69&#8243; ][x_custom_headline level=&#8221;h3&#8243; looks_like=&#8221;h3&#8243; accent=&#8221;false&#8221; class=&#8221;cs-ta-center somerton-creative-avenir-green-title&#8221;]Other details and fine print[\/x_custom_headline][cs_element_gap _id=&#8221;71&#8243; ][cs_text _bp_base=&#8221;4_4&#8243; class=&#8221;p-mb-0 somerton-creative-avenir&#8221; style=&#8221;line-height: 1.5rem;&#8221;]<\/p>\n<ul>\n<li>Submission deadline: 15th of the month.<\/li>\n<li>Submissions after the 15th of the month will be considered for the following month.<\/li>\n<li>Final Candidate Selection will be chosen at the end of each month and the Referral Sources will be informed by return email without candidate name disclosure.<\/li>\n<li>Service delivery is contingent upon scheduling and caregiver availability.<\/li>\n<li>We respect privacy. The information supplied is confidential to Choice Homecare and the Selection Panel.<\/li>\n<li>Choice Homecare reserves the right to publish selection results (except for information that affects personal privacy).<\/li>\n<li>Selection results are available to all participants upon request (except for information that affects personal privacy).<\/li>\n<\/ul>\n<p>Please <a href=\"https:\/\/dmg.org.in\/choicehomecare\/contact-us\/\">contact us<\/a> or call us if you have any questions.<\/p>\n<p>[\/cs_text][\/cs_element_layout_column][\/cs_element_layout_row][\/cs_element_section][cs_element_section _id=&#8221;73&#8243; ][cs_element_layout_row _id=&#8221;74&#8243; ][cs_element_layout_column _id=&#8221;75&#8243; ][cs_element_global_block _id=&#8221;76&#8243; ][\/cs_element_layout_column][\/cs_element_layout_row][\/cs_element_section][\/cs_content]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[cs_content][cs_element_section _id=&#8221;1&#8243; ][cs_element_layout_row _id=&#8221;2&#8243; ][cs_element_layout_column _id=&#8221;3&#8243; ][x_custom_headline level=&#8221;h1&#8243; looks_like=&#8221;h1&#8243; accent=&#8221;false&#8221; class=&#8221;somerton-creative-avenir-white-title2&#8243; style=&#8221;font-size: 3rem; padding-top: 50px; padding-bottom: 50px;&#8221;]Give back[\/x_custom_headline][\/cs_element_layout_column][\/cs_element_layout_row][\/cs_element_section][cs_element_section _id=&#8221;5&#8243; ][cs_element_layout_row [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-blank-4.php","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-332","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/dmg.org.in\/choicehomecare\/wp-json\/wp\/v2\/pages\/332","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dmg.org.in\/choicehomecare\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dmg.org.in\/choicehomecare\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dmg.org.in\/choicehomecare\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dmg.org.in\/choicehomecare\/wp-json\/wp\/v2\/comments?post=332"}],"version-history":[{"count":10,"href":"https:\/\/dmg.org.in\/choicehomecare\/wp-json\/wp\/v2\/pages\/332\/revisions"}],"predecessor-version":[{"id":34641,"href":"https:\/\/dmg.org.in\/choicehomecare\/wp-json\/wp\/v2\/pages\/332\/revisions\/34641"}],"wp:attachment":[{"href":"https:\/\/dmg.org.in\/choicehomecare\/wp-json\/wp\/v2\/media?parent=332"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}