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Assessment Questionaire

Who Needs Help
Parkinson's Care
Post Rehab Care
Hospice Care
Respite Care
Physical Assistance with ADL's (Activities of Daily Living) 0-25%
Client requires medication reminders
Client is continent
Client self-manages incontinence
Client is incontinent and requires constant changing
Client is ambulatory
Client requires ambulation and transfer assistance
Client requires mobility assistance with device (Hoyer, etc.)
Client requires light housekeeping and laundry assistance
Client requires meal preparation daily
Client requires outside transportation services for shopping, etc.
Client sleeps through the night
Client requires assistance 1-3 times a night
Client requires assistance more than 3 times at night

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