ASSISTANCE WITH MEALTIME MANAGEMENT PLAN (Form-0073)
In accordance with the NDIS Dysphagia, Safe Swallowing and Mealtime Management Provider Obligations Personal Care Services – Level 3 Approved Accreditation – Additional Fees and Charges Apply
Resident's Details
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By selecting one check box, and signing below, you acknowledge and request, or otherwise, to the following:
I DO NOT request management/staff of Skymac to assist me with my Mealtime Management Plan. I understand that Skymac will not prepare my meals and liquids in the suggested manner, and I will be consuming regular meals at my own risk. I understand and accept that this is unsafe. Ihave been made aware of the associated health complications of Risk Feeding by a medicalprofessional and have been provided a Risk Feeding Information Guide.
I DO request management/staff of Skymac to assist me with my Mealtime Management Plan as prescribed by my Speech Pathologist. I also understand that:
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I have provided Skymac with a copy of my Mealtime Management Plan.
Skymac is authorised to prepare my meals and liquids for consumption in the suggested size, texture and consistency as outlined in my Mealtime Management Plan.
Skymac will ensure that I am alert and positioned in the appropriate manner for all meals and drinks as outlined in my Plan, if applicable.
Skymac may encourage me to make food and drink choices in line with my Plan, including reminders on consuming food and fluid at the appropriate consistency/texture, if applicable.
Skymac may contact my Speech Pathologist with any continued problems and organise to have the plan reviewed and/or changed.
Should I choose not to consume my meals prepared as per my Mealtime Management Plan, I do so at my own risk and Skymac may contact my Speech Pathologist to discuss a plan review.
I have provided Skymac with a copy of my Mealtime Management Plan.
If I experience acute or persistent swallowing problems while Skymac is assisting me with strategies in my Mealtime Management Plan, Skymac may contact my GP or health professional for re-assessment.
Signature of Resident
*Or signature of person acting on authority under Guardianship Administration Act 2000 or Powers of Attorney Act 1998 for the person named above, OR an Informal Decision Maker (must have an Informal Decision Maker Details Form-0071 signed) for the person named above.
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In the presence of (Witness)
Name
First Name
Last Name
Signature
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