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).

Vocational Specialist (Bolingbrook, IL)


  • Location: Bolingbrook, IL
  • Schedule/Shift: Part-time/temporary (school year schedule); M-F 8:30 a.m.-5 p.m. with some evenings
  • Salary Range:$11/hour
  • Description: The vocational specialist provides individualized support for students at the host business worksite rotation or competitive job which includes: job coaching, building natural supports, identifying job accommodations, assistive technology, etc. The vocational specialist communicates effectively with the Project SEARCH instructor, coordinator, other job coaches, employers, co-workers, family members, and school and agency personnel as it relates to the student being trained. Through coordination with departments, the vocational specialist carries out steps of the job coaching plan with students and other parties as appropriate in addition to working with consumers, employers, families, job placement specialists, agency personnel, affiliate school personnel and other appropriate parties to problem solve issues related to training and employment.
  • Responsibilities: Adheres to and promotes standards of the host business and/or competitive work site in order to promote job productivity and efficiency. Submits and completes appropriate job coaching paperwork. Recognizes and acts on the legal responsibilities concerning the safety and welfare of the consumers. Demonstrates daily work assignment responsibilities: is accountable for all hours assigned, is punctual and regular in attendance, and attends appropriate training activities.
  • Minimum Qualifications: Paraprofessional license or bachelor’s degree preferred. Experience preferably in social service, psychology or a related field is a plus. Computer skills including Word, Excel, email and Internet. A valid driver’s license is required. Maintain a current CPR and First Aid card with training provided through Trinity. The physical activities for this position involve: balancing, pulling, pushing, standing, climbing, grasping, stooping, crouching, crawling, kneeling, reaching, repetitive motion, and lifting up to 25 pounds.
  • Contact Information: Jillian Fundarek, (815) 485-6197,