MEDICAL CARE FOR THE DEMENTIA PATIENT

Memory loss/dementia diagnosis yes no. Lyme Disease yes no. Use cane or walker yes no. Significant Health Events (past 3 months) Chest Pain, shortness or breath, palpitations during exertion yes no. Dizziness, falling, tripping (circle all that apply) yes no. Painful joints, muscle pain or back pain (circle what applies) yes no ................
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