touchline - broward 211211-broward.org/docs/211_touchline_brochure_final.pdf“it’s comforting to...
TRANSCRIPT
TOUCHLINE PROGRAM
• Broward County Residents• 60 Years of age and over
• Living alone
What is Touchline?• A FREE telephone reassurance call to
check on your safety and well being.How do I sign up for Touchline?• Fill out the attached application and
return it by mail to:
2-1-1 BrowardTouchline Program250 N.E. 33rd Street
Oakland Park, FL 33334
Broward
Broward
954-640-5800Who is Touchline for?
DO
CTO
R’S N
AM
E TE
LEP
HO
NE
: SPEC
IAL M
EDIC
AL A
ND
OTH
ER C
ON
DITIO
NS
-LIST A
NY
PR
OB
LEM
S, M
ED
ICA
L, EM
OTIO
NA
L OR
O
THE
R, W
HIC
H M
IGH
T AFFE
CT Y
OU
R A
BILITY
TO A
NS
WE
R Y
OU
R D
AILY
TOU
CH
LINE
TE
LEP
HO
NE
CA
LL. M
ED
ICA
L:
ME
DIC
ATIO
N:
HA
ND
ICA
P:
OTH
ER
: IN
THE
EV
EN
T OF A
HU
RR
ICA
NE
, (PLE
AS
E C
HE
CK
ON
E):
I HA
VE
NO
PLA
N TO
EV
AC
UA
TEA
ND
WO
ULD
LIKE
SO
ME
AD
VIC
E.
I PLA
N TO
RE
MA
IN A
T HO
ME
. I P
LAN
TO M
OV
E TE
MP
OR
AR
ILY TO
:
AD
DR
ES
S:
_____ _____________________________________________________________________________TE
LEP
HO
NE
:_______________________________________________________________________
PLE
AS
E N
OTE
: IF YO
UR
EM
ER
GE
NC
Y
CO
NTA
CTS
AR
E N
OT A
VA
ILAB
LE, TH
E P
OLIC
E
DE
PAR
TMEN
T WILL B
E C
ON
TAC
TED
TO
CH
EC
K O
N Y
OU
R S
AFETY. FIR
ST C
ALL FO
R
HELP W
ILL NO
T BE R
ESPON
SIBLE FO
R A
NY
AC
TION
S TAK
EN B
YEM
ERG
ENC
Y PER
SON
NEL.
IMPO
RTA
NT! IT IS
NEC
ES
SA
RY
FOR
YO
U TO
LE
T US
KN
OW
BE
FOR
EH
AN
D W
HE
N Y
OU
WILL
NO
T BE
HO
ME
FOR
OU
R C
ALL
EA
CH
DA
Y.
CA
LL US
AT TH
ES
E N
UM
BE
RS
24 HO
UR
S A
D
AY
: 2-1-1 OR
(954) 390 - 0485 OR
(954) 537- 0211
THIS
SP
AC
E FO
R O
FFICE
US
E O
NLY
CLIE
NT I.D
. NO
.___________________________
CO
DE
______________PR
IOR
ITY____________
BE
GIN
CA
LLS: D
ATE________TIM
E__________
EN
TER
ED
BY
: ____________________________
________________________________________C
LIEN
T SIG
NA
TUR
E
________________________________________D
ATE
DIS
AB
ILITY
:
DO
CTO
R’S N
AM
E TE
LEP
HO
NE
:
SPECIA
L MED
ICA
L AN
D O
THER
CO
ND
ITION
S-LIS
T AN
Y P
RO
BLE
MS
, ME
DIC
AL, E
MO
TION
AL O
R
OTH
ER
, WH
ICH
MIG
HT A
FFEC
T YO
UR
AB
ILITY TO
AN
SW
ER
YO
UR
DA
ILY TO
UC
HLIN
E
TELE
PH
ON
E C
ALL.
ME
DIC
AL:
ME
DIC
ATIO
N:
HA
ND
ICA
P:
OTH
ER
: IN
THE
EV
EN
T OF A
HU
RR
ICA
NE
, (PLE
AS
E C
HE
CK
ON
E):
I HA
VE
NO
PLA
N TO
EV
AC
UA
TEA
ND
WO
ULD
LIKE
SO
ME
AD
VIC
E.
I PLA
N TO
RE
MA
IN A
T HO
ME
. I P
LAN
TO M
OV
E TE
MP
OR
AR
ILY TO
:
AD
DR
ES
S:
_____ _____________________________________________________________________________TE
LEP
HO
NE
:_______________________________________________________________________
PLE
AS
E N
OTE
: IF YO
UR
EM
ER
GE
NC
Y
CO
NTA
CTS A
RE
NO
T AV
AILA
BLE
, THE
PO
LICE
D
EP
ARTM
ENT W
ILL BE
CO
NTA
CTE
D TO
C
HE
CK
ON
YO
UR
SAFE
TY. FIRS
T CA
LL FOR
H
ELP WILL N
OT B
E RESPO
NSIB
LE FOR
AN
Y A
CTIO
NS TA
KEN
BY EM
ERG
ENC
Y PER
SON
NEL.
IMPO
RTA
NT! IT IS
NEC
ES
SA
RY
FOR
YO
U TO
(954) 537- 0211
THIS
SP
AC
E FO
R O
FFICE
US
E O
NLY
CLIE
NT I.D
. NO
.___________________________
CO
DE
______________PR
IOR
ITY____________
BE
GIN
CA
LLS: D
ATE________TIM
E__________
EN
TER
ED
BY
: ____________________________
________________________________________ C
LIEN
T SIG
NA
TUR
E
________________________________________ D
ATE
NO
TE
S:
PL
EA
SE
NO
TE
: IF Y
OU
R E
ME
RG
EN
CY
CO
NTA
CT
S A
RE
NO
T A
VA
ILA
BL
E, T
HE
PO
LIC
ED
EP
AR
TM
EN
T W
ILL B
E C
ON
TAC
TE
D T
OC
HE
CK
ON
YO
UR
SA
FE
TY. 2
-1-1
BR
OW
AR
D
WIL
L N
OT
BE
RE
SP
ON
SIB
LE
FO
R A
NY
AC
TIO
NS
TAK
EN
BY
EM
ER
GE
NC
YP
ER
SO
NN
EL
.
RE
HA
ND
WH
EN
YO
U W
ILL LE
T US
KN
OW
BE
FON
OT B
E H
OM
E FO
R O
UR
CA
LL EA
CH
DA
Y.
CA
LL US
24 HO
UR
S A
DA
Y A
T 954-640-5800.
Broward
Broward
954-640-5800
“It’s comforting to know
someone is there for you and only
a phone call away.”
First Call For Help of Broward, Inc., d/b/a 211 Broward, is a 501(c)3 Non-Profit
Website: www.211-broward.org 2-1-
1 or
(95
4) 3
90-0
485
TOU
CH
LIN
E A
PPLI
CA
TIO
N
RET
UR
N C
OM
PLET
ED
APP
LIC
ATI
ON
TO
:
NA
ME
: TE
LEP
HO
NE
: A
DD
RE
SS
: C
ELL
ULA
R:
AP
T N
O:
DA
TE O
FB
IRTH
:
AG
E:
S
EX
: C
ITY
:
ZIP
CO
DE
: LI
VIN
G A
LON
E?
YES
OR
NO
A
PA
RTM
EN
T/C
ON
DO
NA
ME
:
AP
AR
TME
NT/
CO
ND
O M
AN
AG
EM
EN
T TE
LEP
HO
NE
: C
AN
WE
CO
NTA
CT
THE
M IN
CA
SE
OF
AN
EM
ER
GE
NC
Y?
YE
S
OR
NO
P
LEA
SE
GIV
E B
OTH
CR
OS
S-S
TRE
ETS
NE
AR
ES
T Y
OU
R H
OM
E IN
TH
E E
VE
NT
OF
AN
E
ME
RG
EN
CY
:
EMER
GEN
CY
CO
NTA
CT
PER
SON
S P
LEA
SE
LIS
T (A
T LE
AST
2)L
OC
AL
BR
OW
AR
D
CO
UN
TY R
ES
IDE
NTS
WH
O W
ILL
GO
TO
YO
UR
HO
ME
AN
D C
HEC
K O
NYO
UR
SA
FETY
AN
D
WEL
L B
EIN
GIN
TH
E E
VE
NT
THA
T Y
OU
DO
NO
T A
NS
WE
R Y
OU
R D
AIL
Y T
OU
CH
LIN
E C
ALL
. TH
ES
E R
ES
IDE
NTS
MU
ST
BE
WIT
HIN
WA
LKIN
G O
R S
HO
RT
DR
IVIN
G D
ISTA
NC
EFR
OM
YO
UR
H
OM
E.
1) N
AM
E:
A
DD
RE
SS
:A
PT
____
___
CIT
Y A
ND
ZIP
CO
DE
:
TELE
PH
ON
E (H
)
(W
)
RE
LATI
ON
SH
IP:
HA
SA
KE
YTO
MY
HO
ME
: ___
____
_YE
S _
____
__N
O
2) N
AM
E
A
DD
RE
SS
AP
T __
____
_
CIT
Y A
ND
ZIP
CO
DE
TELE
PH
ON
E (H
)
(W
)
RE
LATI
ON
SH
IP:
H
AS
A K
EY
TO
MY
HO
ME
: ___
____
YE
S
____
___N
O
PLE
ASE
SEE
OT
HER
SID
E
Brow
ard
Brow
ard
Mai
l co
mp
lete
d
app
licat
ion
to
:
2-1-
1 B
row
ard
250
N.E
. 33r
d S
tree
tO
akla
nd
Par
k, F
L 3
3334
TO
uc
hL
iNE
A
PP
Lic
AT
iON
954-64
0-58
00
Important Numbers For Broward Seniors
Broward
Broward
1-800-963-5337
1-800-633-4227
954-731-8770
1-800-772-1213
Aging & Disability Resource Center
Medicare Hotline
Meals on Wheels (Home-delivered meals)
Social Security
Special Medical Needs ShelterRegistration and Transportation
TOPS (Transportation Options)
954-831-3902
866-682-2258
2-1-1’s Senior Helpline: 954-390-0485
2-1-
1 or
(95
4) 3
90-0
485
TOU
CH
LIN
E A
PPLI
CA
TIO
N
RET
UR
N C
OM
PLET
ED
APP
LIC
ATI
ON
TO
:
NA
ME
:TE
LEP
HO
NE
:
AD
DR
ES
S:
CE
LLU
LAR
:
AP
T N
O:
DA
TE O
FB
IRTH
:
AG
E:
SE
X:
CIT
Y:
Z
IP C
OD
E:
LIV
ING
ALO
NE
?
Y
ES
O
R
NO
AP
AR
TME
NT/
CO
ND
O N
AM
E:
AP
AR
TME
NT/
CO
ND
O M
AN
AG
EM
EN
T TE
LEP
HO
NE
: C
AN
WE
CO
NTA
CT
THE
M IN
CA
SE
OF
AN
EM
ER
GE
NC
Y?
YES
O
R
NO
PLE
AS
E G
IVE
BO
TH C
RO
SS
-STR
EE
TS N
EA
RE
ST
YO
UR
HO
ME
IN T
HE
EV
EN
T O
F A
N
EM
ER
GE
NC
Y:
EMER
GEN
CY
CO
NTA
CT
PER
SON
S P
LEA
SE
LIS
T (A
T LE
AST
2) L
OC
AL
BR
OW
AR
D
CO
UN
TY R
ES
IDE
NTS
WH
O W
ILL
GO
TO
YO
UR
HO
ME
AN
D C
HEC
K O
N Y
OU
R S
AFE
TY A
ND
W
ELL
BEI
NG
IN T
HE
EV
EN
T TH
AT
YO
U D
O N
OT
AN
SW
ER
YO
UR
DA
ILY
TO
UC
HLI
NE
CA
LL.
THE
SE
RE
SID
EN
TS M
US
T B
E W
ITH
IN W
ALK
ING
OR
SH
OR
T D
RIV
ING
DIS
TAN
CE
FR
OM
YO
UR
HO
ME
. 1)
NA
ME
:
A
DD
RE
SS
:A
PT
____
___
CIT
Y A
ND
ZIP
CO
DE
:
TELE
PH
ON
E (H
)
(W
)
RE
LATI
ON
SH
IP:
HA
SA
KE
YTO
MY
HO
ME
: ___
____
_YE
S _
____
__N
O
2) N
AM
E
A
DD
RE
SS
AP
T __
____
_
CIT
Y A
ND
ZIP
CO
DE
TELE
PH
ON
E (H
)
(W
)
RE
LATI
ON
SH
IP:
H
AS
A K
EY
TO
MY
HO
ME
: ___
____
YE
S
____
___N
O
PLE
ASE
SEE
OT
HER
SID
E
1)
NA
ME
:
AD
DR
ES
S:
AP
T
CIT
Y A
ND
ZIP
CO
DE
:
TE
LEP
HO
NE
(H
)(W
)
RE
LAT
ION
SH
IP:
HA
S A
KE
Y T
O M
Y H
OM
E:
YE
S
NO
2)N
AM
E:
A
DD
RE
SS
: A
PT
CIT
Y A
ND
ZIP
CO
DE
:
TE
LEP
HO
NE
(H
)
(W
)
RE
LAT
ION
SH
IP:
HA
S A
KE
Y T
O M
Y H
OM
E:
YE
S
NO
3)N
AM
E:
AD
DR
ES
S:
AP
T
CIT
Y A
ND
ZIP
CO
DE
:
TE
LEP
HO
NE
(H
)(W
)
RE
LAT
ION
SH
IP:
HA
S A
KE
Y T
O M
Y H
OM
E:
YE
S
NO
ZIP
CO
DE