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CFSC Meal Time Me Time
老友記飯堂 X 護老者CAFE
簡易問答
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護老者姓名:
*
Your answer
護老者年齡:
*
Your answer
護老者性別:
*
男
女
被照顧者姓名:
*
Your answer
被照顧者年齡:
*
Your answer
被照顧者性別:
*
男
女
護老者與被照顧者關係:
*
Your answer
聯絡地址:
*
Your answer
聯絡電話:
*
Your answer
有照顧者接送
*
是
否
吞嚥正常
*
是
否
自行如廁
*
是
否
室內獨立行走 (拐杖)
*
是
否
最近曾經跌倒
*
是
否
失禁
*
是
否
滋擾行為
*
是
否
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