TO:
FROM:
DATE:
RE:
All Adult Day Service Providers for NMT
Michael Null, Assistant Director, Service & Support Administrator
Heather Ryan, Service & Support Administrator
Day Program in Euclid and needs NMT (non-medical transportation) to and from her day program. She needs physical assistance from staff during transfers and to and from her wheelchair and is unable to bear weight through her lower extremities.
DEADLINE
TO RESPOND: Per HCBS waiver - Free Choice of Provider Rule 5123:2-9-11, verbal or written response required within two (2) working days following initial contact by SSA or receipt of this RFP (Responses due by 6/25/2013).
Verbal response at 440-350-5098 to be followed by written response to the attention of Heather Ryan, SSA at 9350 Progress Parkway, Unit A,
Mentor, Ohio 44060; or by fax 440-350-5125.
FUNDING
SOURCE: IO Waiver
SERVICE
HOURS NEEDED: Services to be provided 5 days/week
TRANSPORTATION:
This individual would need to access Non medical Transportation through an IO Waiver provider.
RESIDENTIAL
PROGRAM:
DIAGNOSES:
June 20, 2013
Client: # 76
This person is a fifty year old verbal female whose means of mobility is in her wheelchair. She is interested in attending the Help Foundation
Residential services are with Help Foundation.
Mild MR, Diabetes, HTN, High Cholesterol, Spina Bifida, Shunt,
Paraplegia, Acid Reflux, Seasonal Allergies, Depression, Hypoxia,
Diastolic Heart Failure and Venus Insufficiency .

CURRENT MEDICATION: Miralax Powder- 8.5 g every other day, One A Day,
Woman’s Multivitamin – 1 tablet, 1x/daily, Vitamin D3
2,000 IU- 1 tax 1x/daily, Cranberry 4200 mg- 1 tab
1x/daily, Citalopram HBR 20mg- 1 tab daily,
2
Pravastatin Sodium 40 mg, 1 tab, 1x/daily, Isosorbide
30mg- 1 tab 1x/daily, Nateglinide 120 mg- 1 tab 3x daily,
Actos 15 mg- 1 tab 1x/daily, Loratadine 10mg- 1 tab
1x/daily, Metoprolol Tartrate 25 mg- ½ 2x/daily,
Metformin HCL ER 500 mg0- 2 tabs 2x/daily, Diabetic
Blood Sugar check- 2x daily
GUARDIANSHIP: She is her own guardian.
PROVIDER
REQUIREMENT: A provider would need to be able to provide her NMT to and from their day program, located in Euclid.
SERVICE AREAS: Non medical transportation.
CHOICE &
OPTIONS: This individual enjoys interacting with her peers, going out to eat and watching TV.
PERSONAL
INCOME:
HOUSING:
Her residential provider physically assists her with her finances.
Individual lies in a group home with two (2) other individuals
COMMUNITY
MEMBERSHIP: Residential staff arranges for this individuals community outings/activities.
SAFETY: Routine home and community safety training. Requires verbal & physical assistance to maintain safety.
HEALTH: Individuals residential provider assists in scheduling all medical appointments and taking the individual to the appointments.