MADSA Member Agency Fact Sheet
Please take a few minutes to complete this fact sheet. This information will allow us to establish a demographic database on our membership that will be helpful in fielding inquiries about available adult day services in Michigan along with promoting our services with legislators and funding agencies. Thank you.
Agency Name
County
Number of Years in Operation
Ownership/Structure
Check All That Apply
If you are part of a Parent Organization, what is the organization's name?
If you are part of a Hospital System, what is the hospital's name?
Days of Operation
Check All That Apply
Hours of Operation
Number of Participants Served Annually
Average Number of Participants Serviced Daily
Type of Services Offered
Check All That Apply
Special Certifications
Check All That Apply
Staffing Composition
Under each title, type the number of staff in that position
Director
Manager
Medical Director
Nurse Practitioner
RN
LPN
Social Worker
Activity Coordinator
PT/OT
CNAs
Program Assistant
Beautician
Massage Therapy
Music Therapy
Art Therapy
Other
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