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Ma 51 Form Pennsylvania 2015
Should sign if able. If unable, legal guardian or responsible party may sign.
11. Essential Vital Signs. Self-explanatory.
12. Medical Summary. Include any medical information you feel is important for determination of level of care.
Please list patient’s known allergies in this section.
13. Vacating of building. How much assistance does the patient require to vacate the building?
14. Medication Administration. Is the patient capable of being trained to self-administer medications?
15....
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