NUTRITION Food lost in event (D-SNAP, Food Banks) Reason: Electrical loss Flooding Damage to home Food a daily struggle even outside of the event (SNAP, WIC, TEFAP, Meals on Wheels, NSLP, SFSP, Food Banks, Nutrition Programs for Seniors) Situation: Pregnant Child Under 5 Low Income Over 60 HEALTH/MEDICAL Unable to afford health insurance/care (FAMIS, FAMIS Plus, LIFC, Medicaid, BCCPTA) Unable to meet co-payments/deductibles for health care (MSP, Medicare) Unable to afford prescription medications (SSA Extra Help, SPAP, ADAP, PSI) Family Information (circle all that apply): Low Income Children under 19 Pregnant Receives SSI (Supplemental Security Income) Receives Medicare Blind Disabled Institutionalized Receives Medicaid LTC (Long Term Care) services 65+ OTHER Unemployed Reason: Event Related NOT Event Related Other:
NUTRITION Food lost in event (D-SNAP, Food Banks) Reason: Electrical loss Flooding Damage to home Food a daily struggle even outside of the event (SNAP, WIC, TEFAP, Meals on Wheels, NSLP, SFSP, Food Banks, Nutrition Programs for Seniors) Situation: Pregnant Child Under 5 Low Income Over 60 HEALTH/MEDICAL Unable to afford health insurance/care (FAMIS, FAMIS Plus, LIFC, Medicaid, BCCPTA) Unable to meet co-payments/deductibles for health care (MSP, Medicare) Unable to afford prescription medications (SSA Extra Help, SPAP, ADAP, PSI) Family Information (circle all that apply): Low Income Children under 19 Pregnant Receives SSI (Supplemental Security Income) Receives Medicare Blind Disabled Institutionalized Receives Medicaid LTC (Long Term Care) services 65+ OTHER Unemployed Reason: Event Related NOT Event Related Other:
Human_Shelter_Services_SOP.docx