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The form details how to complete it by hand or electronically, what help may be provided by a nominated person, and what information applicants must have available, including legal name, Eircode, and PPS number.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/home-support-service-application-form/638761/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/home-support-service-application-form/638761.png","ImageObject",300,407,{"name":42,"@type":43},"Stanford","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-09","2026-10-22",true,{"@type":52,"interactionType":53,"userInteractionCount":26},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What does the Home Support Service help with?","Question",{"text":62,"@type":63},"It helps older people stay in their own homes and supports everyday tasks such as getting in and out of bed, dressing, undressing, and personal care like showering and shaving.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"Who carries out the needs assessment after the application is submitted?",{"text":67,"@type":63},"A healthcare professional carries out a needs assessment to decide whether your needs can be met by the service and the level of support required.",{"name":69,"@type":60,"acceptedAnswer":70},"Can someone else complete the application on my behalf?",{"text":71,"@type":63},"Yes. You may nominate someone to complete the form with your knowledge and consent, such as a spouse or partner, a child over 18, a family member/carer, or a registered healthcare professional.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},638761,1792699350,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":26,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":79,"read_time":98,"preview_page_count":4},2336477552062,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Home Support Service  \nApplication form  \nBefore you apply for the Home Support Service visit [www.hse.ie/homesupportservice](www.hse.ie/homesupportservice).  \nFreephone HSE Live on 1800 700 700 or phone 00 353 1 240 8787 from outside the Republic of Ireland and we will post the information to you.  \nWhat is home support?  \nThe home support service helps older people stay in their own homes for as long as possible. The home support service can help with everyday tasks such as getting in and out of bed, dressing and undressing, personal care such as showering and shaving.  \nHome Support Service application form 1  \nHow do I apply for home support?  \nStep 1.  \nFill in this form. Complete the parts that apply to you and provide as much information as possible to help us process your application. If completing this form digitally, you can proceed to relevant Parts by clicking on the Part below.  \nPart 1: Applicant details ................................ 5  \nPart 2: Nominated contact person ........................... 7  \nPart 3: Decision support service arrangements .................... 9  \nPart 4: Household and caregiver details........................ 10  \nPart 5: Where you live ................................. 12  \nPart 6: GP details ................................... 14  \nPart 7: Other community supports........................... 16  \nPart 8: Healthcare professional details ........................ 18  \nPart 9: Additional information in support of your application ............. 20  \nPart 10: Consumer directed home support ...................... 21  \nPart 11: HSE’s data protection and privacy statement ................ 22  \nPart 12: Declaration .................................. 23  \nBy completing this application form, a healthcare professional will carry out a needs assessment to decide if your needs can be met by the home support service and the level of support you may need. A needs assessment is a comprehensive assessment of your health, physical, sensory, emotional and social care needs. It may be undertaken by a nurse , social worker or occupational therapist.  \nStep 2.  \nUse the checklist on page 24 to make sure you have completed all relevant sections and have included documentary evidence if you have Decision Support Service arrangements in place. Do not send original documents as we cannot return them.  \nStep 3.  \nSend your completed application form and any supporting documents to your local Home Support Office. Find [your Home Support Office on](your Home Support Office on www.hse.ie/homesupportservice)[ ](your Home Support Office on www.hse.ie/homesupportservice)[www.hse.ie/homesupportservice](your Home Support Office on www.hse.ie/homesupportservice).  \nHome Support Service application form 2  \nImportant information when completing your application  \nThe application form should be completed by you. If you need help, you can nominate someone to complete the application form on your behalf, with your knowledge and consent. A nominated person can be:  \n• Your spouse or partner  \n• Your child or stepchild over 18 years  \n• Your nominated family member/carer  \n• A registered medical practitioner for example, General Practitioner (GP)  \n• A registered healthcare professional, for example, nurse, a social worker, physiotherapist, occupational therapist, dietician.  \n• The committee of a ward of court *  \n• A person(s) appointed under a registered enduring power of attorney *  \n• A decision-making representative appointed by court order *(*Please enclose documentary evidence)  \nHow to complete this form  \nBy hand  \nComplete the form in block capitals with a black ballpoint pen.  \nElectronically  \nUse a recent version of Adobe Acrobat Reader if you want to:  \n• save any changes you make to this form  \n• use a screen reader to complete this form  \nHome Support Service application form 3  \nWhen completing this form  \n• Use your full legal name.  \n• Please ensure that you have your Eircode and Personal Public Service (PP","cbCaigYQEChfyJLm","https://ap.wps.com/l/cbCaigYQEChfyJLm","pdf",847179,24,"English","# What is home support?\n## How do I apply for home support?\n## Important information when completing your application\n## How to complete this form\n## When completing this form\n## More information\n# Part 1: Applicant details\n# Part 2: Nominated contact person\n# Part 3: Decision support service arrangements","[{\"question\":\"What does the Home Support Service help with?\",\"answer\":\"It helps older people stay in their own homes and supports everyday tasks such as getting in and out of bed, dressing, undressing, and personal care like showering and shaving.\"},{\"question\":\"Who carries out the needs assessment after the application is submitted?\",\"answer\":\"A healthcare professional carries out a needs assessment to decide whether your needs can be met by the service and the level of support required.\"},{\"question\":\"Can someone else complete the application on my behalf?\",\"answer\":\"Yes. You may nominate someone to complete the form with your knowledge and consent, such as a spouse or partner, a child over 18, a family member/carer, or a registered healthcare professional.\"}]","Home Support Service - Application Form | PDF"]