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Patient Information
Health Care Provider Information
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What are some of the recipient's health issues?
Heart Disease COPD
High Blood Pressure Cancer
Dialysis Oxygen
Stroke Hospice
Self-Ambulatory Ambulatory with Assistance
Non-Ambulatory Wheelchair
Fall Risk Bed Bound
Cane/Walker
Diabetic Oral Meds
Insulin Dependant Self Injects
Continent Incontinent
Bowel Bladder only Catheter
Colostomy Bag Full Briefs/Pull Ups Pads
Alert Confused Dementia
Alzheimer's Depression
Bi-Polar Combative
Wanders Off Awake PM
Physical Therapy Fractured Hip/Leg
Occupational Therapy Arthritis
Scoliosis Paralyzed