Dear Colleague,

We know that all families and DSPs are doing everything they can to prevent individuals with intellectual and developmental disabilities (I/DD) from being diagnosed with COVID-19. However, despite everyone's best efforts, a small number of individuals have already received this dreaded diagnosis, and some will likely be hospitalized. In an effort to prevent further spread of the Coronavirus, most hospitals are not allowing visitors because the virus is so contagious. Because it is likely that visitors will not be permitted, this two-page form may be helpful for anyone with I/DD who might need to be hospitalized during the COVID-19 pandemic. Click here or the image below to view this form.
The health passport form provides a concise way to record all of the essential aspects of the individual's medical history including COVID-19 symptoms and risk factors; personal assistance needs; and the individual's self-expression, likes and dislikes. It is a fillable form, and the information can be entered online, or the form can be printed and filled in by hand. The health passport can be duplicated, with a request from the caregivers that it should be readily available to every health care professional who is caring for the individual at the hospital. 

This form was created by the Ohio Association of County Board of Developmental Disabilities with substantial input and guidance from Dr. Susan Abend of the Right Care Now Project. The Arc of New Jersey made a small change on the original form to better reflect the I/DD service system in New Jersey.
This is one of many emails that The Arc of New Jersey is distributing in an effort to help individuals with I/DD, their families, and staff to be safe and healthy throughout the COVID-19 pandemic. To see other emails that The Arc of New Jersey has distributed on this topic, please go to  
Thank you.

Beverly Roberts
Director, Mainstreaming Medical Care
The Arc of New Jersey
985 Livingston Avenue
North Brunswick, NJ 08902
Direct line and fax:  732.246.2567