ER, Hospitalization and Urgent Care Entry Form

Please enter your full name.

For example, Adella House or New Lenox Woodworks

6. Individual's Level of Mobility
8. Gender
9. Type of Report
11. Day of the Week
12. Person Recommending the Visit
13. Was 911 used?
14. Was the physician notified prior to the visit?
15. When was the guardian notified?
16. Is there an Unusual Incident Report associated with this visit?
18. Is this the first visit for this problem?
22. Disposition from ER/Hospital
Please provide the following information in #25:

1. What led up to the event described above?

2. What was the exact issue that caused the event?

3. What was staff's immediate response to the event?

4a. What testing was done?

4b. What was the results of the testing?

5. What treatment was ordered as a result of the testing?

6. Is there any follow-up needed related to this event?

Please give a brief, specific description that includes all requested information (see instruction above).

Independent Living Coach/Direct Support Professional (DSP) (Des Plaines, IL)


Location: Des Plaines, IL


When you join the Trinity team, you become a member of a culture of kindness – a community that truly cares. Through your work helping people with disabilities and mental illness flourish and live full and abundant lives, you will meet lifelong friends and experience ample opportunities for growth.

At Trinity, staff members receive recognition for outstanding work and discretionary effort, reinforcing the value of positive relationships throughout the agency, and are given room to exercise their talents and use them for the benefit of helping others. With ample opportunities to grow and flourish, join our team today!

Come and be a part of an organization that cares! Make a difference in the lives of those with disabilities at Trinity Services, Inc. An Independent Living Coach (ILC) provides services and supports to individuals with disabilities served by Trinity Services in community residential settings.


-Providing individualized assistance and coaching with personal care, meal preparation, leisure activities

-Transportation to jobs and appointments

-Assistance with other daily activities as necessary in order to assist individuals in gaining independence and achieving personal outcomes.

Schedule/Shift: Full time (40+ hours per week) and Part time (at least 30 hours per week) LPT (Less than 20 hours per week)

Three different shifts have openings:

-First shift 7am-3pm

-Second Shift: 3pm-11pm

-Third Shift: 11pm-7am

Salary Range: $11/hr

Minimum Requirements: High School Diploma or GED, Clean background check and drug test, and pass physical exam and basic reading comprehension test.


-Helping people in significant ways every day

-Health and dental insurance

-Paid vacation, sick time, and personal time

-Unlimited referral bonuses

-Employee recognition program

-Advancement opportunities

-Overtime availability

*Benefits vary for full-time and part-time!

Contact Information: Jillian Newstat, (815) 485-6197,