Affordable Care Services and Enterprises

Local: External link opens in new tab or window404-405-4571

Or Local: External link opens in new tab or window404-478-9796

Toll-Free: External link opens in new tab or window800-299-5670

We offer Services in English, Spanish and ASL

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Quality Customized Care

We Proudly Offer These Services

We also offer customized services and program to meet your needs

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Private Home Care

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PRIVATE HOME CARE

Affordable Care Services is a top-rated, certified private home care provider who delivers quality customize care. We provide dedicated and committed care for a variety of different circumstances. With over 20 years of experience, Affordable Care Services has built an exceptional reputation among clients, caregivers, physicians, and professional agencies. At Affordable Care Services, we understand the everyday challenges you face with expecting dedicated and dependable services. At Affordable Care Services, we strive to promote and deliver quality, customized and reliable services. We understand that people want more than anything, to stay in their own homes if possible and that this is conceivable with the right assistance and supports. We recognize the importance and responsibilities of what it means to be a caregiver, expecting to keep a loved one at home where he or she can have the most excellent possible quality of life. Through our highly skilled, trained and dedicated team members, empathy and commitment to excellence, we make supports and care at home a certainty. We're currently providing Services for the S.O.U.R.C.E.; C.C.S.P.; I.C.W.P.; & SFC Programs.

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Private Home Care Intake Application Form

To Download the "Private Home Intake Application Form" follow these instructions:

External link opens in new tab or windowPrivate Home Intake Application Form


1. Download the form to your computer

2. Fill it all out

3. Go back to the website

4. Click on the upload/browse button and attach form

5. Then hit submit




OR


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Name:
Referral Date:
Contact #:
Email:

Which Service (s) are you requesting?
SOURCE:  CCSP:  GAPP:
PRIVATE PAY: 
OTHER:

What type of service will you be requesting?
Skilled Nursing  
Personal Care  
Companion Sitter

If with SOURCE; CCSP; ICWP; SFC Which Case Management Agency, are you with and your Care Coordinator’s Name?

If private paying has there been any hospitalizations in the past 12 months?
Yes or No
If yes, please explain:

If private paying, what is the potential client's current diagnosis?

How soon will you need services to start?
How Many days per week will you need services?
How many hours per day will you need services?

Do you have a friend or family member that you would like to provide this service to you?
Yes or No

What county are you located in?

Is there any additional information you would like our company to know?

Thank you for choosing Affordable Cares Service. At this time, we will review it and contact you back.


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The Concept Of a Safe House

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Independent Support ServiceS (HOUSING)

Our goal is to help people in need live independently through providing resources and services. We assist in various ways such as financial management, meal assistance, shopping, and other critical daily, activities.


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INDEPENDENT SUPPORT SERVICES REFERRAL FORM (ISS)

To Download the " Independent Support Services Referral Form" follow these instructions:

External link opens in new tab or windowIndependent Support Services Referral Form


1. Download the form to your computer
2. Fill it all out
3. Go back to the website
4. Click on the upload/browse button and attach form
5. Then hit submit



OR


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Name:

Referral Date:

Contact #:

Referred Person:
Email:

Diagnosis:


Have there been any hospitalizations in the last 12 months? If so, please explain.


Is the potential client on any Psychotropic Medications currently?

Yes  No  Unknown

If yes, explain:


Is the individual medication compliant?

Yes  No  Unknown

If no, explain:


Does the potential client require assistance with hygiene? (Bathing, dressing.)

Yes  No  Unknown

If no, explain:


What is the individual’s income source and amount?
SSI $  

SSDI $  

SSA $  

Private Pay $


Who is currently over potential client's funds?


Relationship to potential client


Does the Potential client receive Snap Benefits (food stamps)?

Yes  No  Unknown
If yes, what is the amount? Amount: $


Are there any specific living requests? (City, on the bus line, house/apartment, etc.)


Does the individual use any assistive medical device? (Cane, Walker, wheelchair)

if yes, explain


Is this individual vision or hearing impaired?

Yes or No


Has the Potential Client ever been convicted of any? Criminal offense.

If yes, please explain


Does this individual have a current or previous history of substance abuse?

Yes orNo


What are the potential clients' Preferred Pronouns? (She/Her/Him/He/They)


What is the potential client’s reason for housing, and how soon would services be needed?


Does the individual possess any state identification if not is there a birth certificate?

Yes  No  Unknown


Thank you for choosing Affordable Cares Service. At this time, we will review and reach back to you as expeditiously as we can.



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Social Engagement

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Community Integration

This service of ours is related towards individuals that experience lack of community activities and resources. We understand the role of having an active community life in their growth, and we seek to support their development through community integration. Whether it’s an opportunity for participation in schools, leisure activities, or a variety of interests, we can help.

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Affordable Care Services and Enterprises LLC

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925 Main St Suite 106

Stone Mountain GA 30083

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Local: External link opens in new tab or window404-405-4571

Or Local: External link opens in new tab or window404-478-9796

Toll-Free: External link opens in new tab or window800-299-5670

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info@affordablecse.com

 

We offer our services in English, Spanish and American Sign Language.

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