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 Lic 603 1999-2023

Lic 603 1999-2023

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Health condition including any dietary limitations PHYSICAL DISABILITIES Describe any physical limitations including vision hearing or speech MENTAL CONDITION Specify extent of any symptoms of confusion forgetfulness participation in social activities i*e* active or withdrawn HEALTH HISTORY List currently prescribed medications and major illnesses surgery accidents specify whether hospitalized and length of hospitalization in last 5 years SOCIAL FACTORS Describe likes and dislikes interests and...
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