Assured & Associates: In-home personal care services in Atlanta, Georgia

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Personal Care of Georgia, Inc.
8336 Office Park Drive,Suite
Douglasville, GA 30134
Phone: 678-391-0140
Fax: 678-391-0970

Assured & Associates offices are located at:

8336 Office Park Drive
Douglasville, GA 30134

Directions to our offices:

You can contact us at:

Phone 678-391-0140
Fax 678-391-0970

or complete our email form below.

---Your Contact Info
* First Name
Last Name
* Email
City
State
Zip code
---Patient Data
Patient First Name
Patient Last Name
Patient Address
Patient City
Patient State
Patient Zip code
Patient Date of Birth
Patient Sex		Male Female
Patient
Patient SSN
Race
Patient Diagnosis		Alzheimer's(331) Fracture Care(829.9) Wound Care(879.8) Stroke Care(434.91) Brain Injury(310.9) Quadriplegia(344.00) Other
---Emergency Info
Emergency Contact Name
Emergency Contact Phone
Comments
---Primary Insurance
Type
Member ID #
Group #
Phone #
Spoke with…
---Seconday Insurance
Type
Member ID #
Group #
Phone #
Spoke with…
---Requirments
Services		RN Sitter Mobility Assistance 24 hr Companion LPN Homemaker Transportation Erands C.N.A.
Hours		24 Hours 18 Hours 12 Hours 8 Hours 6 Hours
Durable Medical Equipment / Products and Services		Height Weight Semi Electric Bed Light Weight Wheelchair Walker Walker with Wheels Bedside Commode Helios Liquid Oxygen Oxygen Concntrators Lightweight Conserving Devices Nebulizer Compressor Portable Oxygen
Other Needs
---Physician Information
Name
Address
UPIN #
State License #
Phone Number

Assured & Associates Personal Care of Georgia, Inc.

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