Adult Day Care of Calvert County
An Independent Nonprofit Organization Dedicated to the Care of Elderly & Disabled Adults



Click highlighted print to download the following:
1.  Referral Form:

2.  Physician's Assessment:
(1)  The ENROLLMENT/REFERRAL FORM should be completed and sent back to us at your convenience.  Choose the link above under "referral form". Please follow directions on the form and include your loved one’s documented income, if applicable.  Include a copy of the front page of the latest tax return showing the adjusted gross income or other acceptable official documentation, and an estimated itemized list of significant medical expenses.  If you have any questions regarding this, please let us know. 


(2)  The PHYSICIANS ASSESSMENT FORM may be printed using the above link.  The physician’s assessment form is good for 30 days.  Services for your loved one must begin within 30 days of the date the form is signed by the examining doctor. 


(3)  Finally, a TB test or chest x-ray is needed for your loved one as well.  We need documentation that he/she is free from tuberculosis before he/she can begin receiving services at the Center.  This section is on page 4 of the physician’s assessment form.  Please return these forms to us as well. 


(4)  Please call to schedule your INTAKE MEETING after the physical form is completed by your loved one’s primary care physician. Please bring all forms with you to this meeting if you have not already given them to us. This meeting should take about 30-45 min.

There is also a Meal Benefit Application (instructions and Benefit form) that we can provide at a later date.


If you have any questions, feel free to contact us.  We look forward to serving you.





Sign Up Today!

Email & Social Media Marketing by VerticalResponse

Providing quality care to your loved ones since 1986!
Days and Hours of Operation
Monday - Friday (except seclect Federal Holidays) 
Center Hours 7:30 a.m. - 4:00 p.m. 
Adult Medical Day Care Program Hours 10:00 a.m. - 2:00 p.m.
Adult Day Care of Calvert County
   PO Box 1659, 975 Solomons Island Rd, Prince Frederick, MD 20678 
PHONE 410-535-0133; FAX 410-535-4094
Adult Day Care of Calvert County can be found on the first floor of the Calvert County Health Department building at the corner of the Calvert Memorial Hospital campus.