Now Submit Your Monthly Reports Electronically
To help CareTeams submit their Monthly Service Report, RAIN is instituting
electronic reporting. You can either fill out the form provided below or
download the Report as either a Word document or an Adobe PDF. If you
elect to download the form, you can then mail, fax, or e-mail the form
to the RAIN office.
 
Downloadable Forms
Right-click on PC to save to disc.     Click and hold on Mac to save to disc.

Online Form

* Required Field

CareTeam Name *
Month
Year
Coordinator *
E-Mail *
No. of Members *
Service Provided
No. of Times
Total
Telephone
Visits
Transportation
Food/Meals
Social Outings
Housekeeping
Laundry
Shopping
Reading
Writing/Cards
Spiritual Conversation
Home Nursing
Emergency Assistance
Legal Assistance
Baby Sitting
Other-Specify in Comments
Other-Specify in Comments
     
 
Total
*
     
Comments:
 
 

 

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