FLPD Cares

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flpdCares

FLPD CARES: An Autism Outreach Program

The FLPD Cares Program is an Autism Outreach Program that will allow our officers to better serve those in our community living with Autism. Through this program we hope to maintain a database of Autistic individuals we may interact with in hopes of improving our response. The form below is to be filled out with information about the person with Autism. By clicking “submit”, this form will be sent directly to the FLPD Desk Sergeant who will input the information into our database. The information will be kept confidential and made available only to our patrol officers. This process will allow officers who are responding to an incident involving a person with Autism to appropriately prepare for and handle the situation. Ultimately, through the FLPD Cares Program, we will be improving these interactions for all parties involved.

Please correct the field(s) marked in red below:

1
Individual's Name
 *
2
Preferred Name
3
Date of Birth
4
Age
5
Does the individual live alone?
 *
6
Address
 *
7
Business/Complex
8
Building
9
Apartment
10
City
 *

Individual’s Physical Description

11
Individual's Gender
12
Height
13
Weight
14
Race
15
Hair Color
16
Eye Color
17
Scars/Marks/Tattoos

18
Other Relevant Medical Conditions in addition to Autism
Other Relevant Medical Conditions in addition to Autism
19
If Other, Please Explain
20
Prescription Medications Needed
21
Sensory or Dietary Issues, If Any
22
Additional Information First Responders May Need

EMERGENCY CONTACT INFORMATION


23
Name of Emergency Contact (Parents/Guardians, Head of Household/Residence, or Care Providers)
24
Emergency Contact's Address
25
Emergency Contact's Phone Numbers
Emergency Contact's Phone Numbers
26
Name of Alternative Emergency Contact
27
Alternative Emergency Contact's Phone Numbers
Alternative Emergency Contact's Phone Numbers

INFORMATION SPECIFIC TO THE INDIVIDUAL

28
Favorite attractions or locations where the individual may be found
29
Atypical behaviors or characteristics of the Individual that may attract the attention of Responders
30
Individual’s favorite toys, objects, music, discussion topics, likes, or dislikes
31
Method of Preferred Communication.
(If nonverbal: Sign language, picture boards, written words, etc.)
32
Method of Preferred Communication II.
(If verbal: preferred words, sounds, songs, phrases they may respond to):
33
Identification Information.
(i.e. Does the individual carry or wear jewelry, tags, ID card, medical alert bracelets, etc.?):
34
Tracking Information.
(Does the individual have a Project Lifesaver or LoJack SafetyNet Transmitter Number?):
35
Please upload a photo of the individual (if possible)
36
Additional Notes or Information
  1. To receive a copy of your submission, please fill out your email address below and submit.
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