The Breathing Association
Helping you breath easier

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Outreach
TBA has expanded its outreach services to include assistance at your neighborhood OhioHealth clinic locations as well as home visits for the medically homebound. If you or someone you know is in need of a home visit and they meet the criteria, an Outreach Case Manager will come to their home to assist them in receiving HEAP services. Call 566-0750 to speak to a representative of our HEAP outreach department or complete and e-mail the Home Visit Request Form

HEAP Record of Home Visit.

Today's Date
Client Name:
Client Address:
City:
Zip Code:

Reason for Home Visit (Type of Infirmity)



What are the special circumstances requiring the home visit?:



Household Size: Adults   Children

Household Income:  3 Month   12 Month

Main Streets:
Office Use Only:
Date the Home Visit was completed:

Signature of HEAP Case Manager: