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Geriatric Hx

Memory:

Mood:

Sleep:

Appetite:

Hearing impairment:

Visual impairment:

Driving: ο»Ώ

Input from family and caregiver:

Home safety:

ο»Ώ

ο»Ώ

Personal hygiene:

Continence management:

Dressing:

Feeding:

Ambulating:

Companionship:

Transportation and shopping:

Preparing meals:

Household management:

Medications management:

Communicating with others:

Finance management:

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