DISCHARGE/TRANSFER: CLIENT NOTIFICATION


Date
Client Name
To("Client/Client’s Representative")  
Address  ("Street & Number ") ("City") ("Zip/Postal Code")  


Please be advised that effective   ("Date") Compassionate Homecare of South Florida, LLC will cease delivering services to you for the following reason(s):

Transfer to ("Name of Receiving Service Provider")             
Location of Receiving Service Provider 
Other (Specify)

 

If applicable, you may request an informal meeting to discuss this plan with the Agency Management Team within 14 days of the date of this notification. You also have the right to seek legal counsel.

Telephoned client-   Time                                                     
Date
Email Date/Time
 Title of Agency Representative  





Signature of Agency Representative 

 

 

 

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Document name: DISCHARGE/TRANSFER: CLIENT NOTIFICATION
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December 18, 2023 4:18 pm GMTDISCHARGE/TRANSFER: CLIENT NOTIFICATION Uploaded by John Smith - smitch@chsfl.co IP 202.47.33.79
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