IF YOU ARE IN A RE-HABILITATION HOSPITAL, NURSING HOME,
OR AT HOME RECOVERING FROM AN ILLNESS

When you are sick, visits especially from your priest or someone from your
parish of Christ the King cane be very meaningful and supportive. We at Christ
the King want to be able to visit you, but for your protection and privacy, the
Health Insurance Portability and Accountability Act (HIPAA) prohibits hospitals
from letting us know where you go after you leave a hospital.
If you or a loved one are admitted to a re-habilitation hospital, a nursing home,
or cannot leave your home for an extended period of time and you would like to
have a visit from a member of the staff at Christ the King, please let us know.
We are here to help you with your spiritual needs.
   1.  You can call us at the rectory at (508) 754-5361. If we do not answer,
please leave your name and a telephone number where we can reach you.  
We will get back to you as soon as we can.
   2.  Or, fill out the information sheet at the bottom. Detach it and send it to:

                Christ the King Church
                1052 Pleasant St.
                Worcester, MA. 01602

_______________________________________________________________

NAME:__________________________________

TELEPHONE # (where you can be reached)___________________________

I am currently at (check one)  (   ) Rehabilitation hospital  (   ) Nursing Home
(   ) Own home,   (   ) other

Address (include name of institution):
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I would like to be visited by a member of the staff of Christ the King Parish.
I would also like to receive the following Sacraments:  (    ) Holy Eucharist,
(    ) Reconciliation,  (    ) Sacrament of the Sick.