Visit Appointment Request and Registration

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Aloha, Valued Visitors!

Kindly complete the whole digital form and wait for FaithCare Senior Hale to CONFIRM your planned visitation date and time. Thank you for your patience.

- FaithCare Senior Hale Admin

PLEASE READ CAREFULLY BEFORE PROCEEDING.

Visitors are welcome and are encouraged to visit residents. Visitors may visit a resident as long as they do not cause disruption for other residents and staff or jeopardize the safe operation of FaithCare Senior Hale.

Visiting hours are from 9:30 a.m. to 11:00 a.m. and 2:00 p.m. to 3:30 p.m., from Monday to Saturday. All visitors are required to,

(a) register within 24 hours of the planned date and time of visitation, and

(b) undergo COVID-19 screening to be administered by the Administrator or ARCH staff.

Only two (2) adult visitors for each resident are allowed per day. Two (2) under 18 year-old visitors are allowed and are equivalent to one (1) adult visitor (for example, 1 adult and 2 under 18 years old per day).

All visitors are required to wash or sanitize hands prior to entering the home and will be asked to wear face mask properly at all times while at the premises of FaithCare Senior Hale.

Visitation are only allowed in the common areas like living room and in the outside patio.

Visitors are NOT ALLOWED in the resident’s bedroom.

There are NO public restrooms available for visitors at the FaithCare Senior Hale.

Other hours may be arranged with prior notice and in a case-to-case basis.

All things or accessories to be used by the resident offered by visitors shall be checked-in with Administrator or staff to ensure it will be included into resident’s inventory of personal things.

All food or snacks offered to the resident by the visitors, should be checked-in with the Administrator to ensure that they are clinically appropriate for the resident. FaithCare Senior Hale encourages visitors to check-in with the Administrator prior to visiting if planning to bring foods or snacks.

I HAVE REVIEWED AND HAVE BECOME FULLY AWARE OF THE VISITATION POLICIES AND PROCEDURES OF FAITHCARE SENIOR HALE. *

Yes

Required

Enter a valid email

Today's date *

YYYY

Date you are planning to visit? *

YYYY

Time you are planning to visit?

Time

Enter your Full Name *

Enter the name of the Resident you are visiting *

Relationship to the Resident? *

Enter your phone number *

COVID-19 SCREENING SURVEY

Please read carefully and complete the form before proceeding.

Thank you!

Are you feeling sick? *

Yes

Maybe

Over the last 14 DAYS, have you had any of the following symptoms? Select all that apply. *

Fever and/or chills (Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher)

Dry cough or barking cough

Shortness of breath

Decreased or loss of smell or taste

Sore throat

Runny or stuffy/congested nose

Headache that is unusual or long lasting

Nausea, vomiting or stomach pain

Muscle ache or body pains that are unusual or long lasting

Extreme tiredness or fatigue

None of the above

In the last 14 DAYS, have you travelled outside the United States?
*

Yes

In the last 14 DAYS, has the health department notified you as a close contact of someone who currently has COVID-19? *

Yes

In the last 14 DAYS, has your doctor, health care provider or health department advised you that you should be staying at home or isolating? *

Yes

If you answered YES to any questions, you should stay home to self-isolate immediately and contact your health care provider to find out if you need a COVID-19 test.

I answered yes to those question & I will be staying or returning home to self-isolate

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