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Geriatric Hx

Memory:   
Mood:   
Sleep:  
Appetite:   
Hearing impairment:  
Visual impairment:  
Driving: 
Input from family and caregiver: 
Home safety:   


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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