Do you know the expected discharge date of the child? If so, when? Ideally, we like to give families/caregivers the basket within a few weeks of the child's discharge date.
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What is the address the basket will be sent to?
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If the address is a hospital, what is the name of the hospital? What unit should the basket be sent to?
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What is the contact name for the address?
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Do you want the family/caregiver to know you requested the basket?
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Is English the primary language spoken in the home? If not, what is the primary language?
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Anything else you want us to know?
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A copy of your responses will be emailed to the address you provided.