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Manazel for Home Health Care in Egypt
Manazel Home Healthcare Services is planning to offer a unique combination of premier home health care in Egypt by providing highly trained and qualified nurses for our patients. Our care services fall into several categories of in-home care for seniors, including services for those with special care situations caused by numerous medical conditions. Our mission is to improve the quality of life for those we serve.
The answers to the questions below will help us better understand the needs of the person considering care and will assist us in suggesting a level of home health care that is appropriate. Please provide as much information as possible. Questions marked with a * are required.
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* Indicates required question
The person considering Home Health Care Services is:
*
You
Partner/Spouse
Parent
Sister/Brother
Grandparent
Aunt/Uncle
Friend
Other:
Patient's age
*
Your answer
Patient Sex
*
Male
Female
Required
Location
*
Your answer
How soon are services needed ?
*
Immediately
2 - 3 weeks
4 - 6 weeks
within one year
Other:
How would you describe the support system? (Select all that apply)
*
Living Alone
Living with Partner/Spouse
Living with Friend (s)
Friends/Partner/Relatives lives close by and checks in
Friends/Partner/relatives live out of town but visit
No relatives or friends
Other:
Required
How long will services be required?
*
One time
Short Term
Ongoing
Not certain
Other:
Required
What are the personal care needs?
*
Do not have any personal care needs at this time
Need assistance getting dressed and undressed
Need assistance with bathing, washing hair, brushing hair, cleaning teeth, shaving, etc.
Need assistance using toilet, commode, or with incontinence management
Not certain
How would you describe the mobillity of this person? (Select all that apply)
*
No problems with mobility
Stumble from time to time
Fallen recently
Difficulty with stairs
Use cane or walker for security
Need help to get out of chair / bed
Can't move by his own
Required
Health concerns/conditions:
*
None
Cancer
Stroke
Heart disease
Arthritis
Alzheimer's or dementia
Pain
Parkinson's disease
Diabetes
Brain injury
Lung problem
Recovering from surgery
Open wounds
Required
Does this person take prescription medications?
*
Yes
No
Not Certain
Cognitive Ability:
*
Is aware of surroundings (time, place and person)
Needs occassional reminders of surroundings
Needs frequent reminders of surroundings
Is unaware of surroundings
Not certain
Other:
Psychological and mental well-being:
*
Psychologically stable, well adjusted and conducts self appropriately
Exhibits signs of depression, confusion or anxiety
Exhibits signs of inappropriate behaviour such as verbal abuse, agitation, or physical aggression towards others
Not certain
Required
Name:
*
Your answer
Address:
Your answer
Contact phone# #
*
Your answer
Email:
manazelhealthcare@gmail.com
Phone: 01279559588
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