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Question 1 of 13
1. Question
Does this person need support with hearing or vision?
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Question 2 of 13
2. Question
Does this person have a history of seizures?
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Question 3 of 13
3. Question
What kind of supports are needed while the person is eating?
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Question 4 of 13
4. Question
What allergies does the person have. (Select all that apply. If none, select no allergies)
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Question 5 of 13
5. Question
Does this person ambulate independently?
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Question 6 of 13
6. Question
Does this person need physical assistance with toileting?
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Question 7 of 13
7. Question
Does this person need physical assistance with bathing?
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Question 8 of 13
8. Question
Does this person need physical assistance with brushing their teeth?
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Question 9 of 13
9. Question
Does the person have any risks in regards to sexual abuse? (Select all that apply)
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Question 10 of 13
10. Question
Does the person have risks in regards to physical abuse? (select all that apply)
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Question 11 of 13
11. Question
Is this person susceptible to self-abuse? (Select all that apply)
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Question 12 of 13
12. Question
Is this person at risk of financial exploitation?
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Question 13 of 13
13. Question
Does this person have a history of inaccurate reporting?
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