Care On-Demand
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Date of Visit
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Time of Visit
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Care On-Demand
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Services Need During This Visit (Check All that Apply)
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Companionship
Meal Preparation
Light Housekeeping
Exercise: Walking to Wellness
Dressing
Respite Care
Toileting and Incontinence Care
Laundry / Stripping Bed
Bathing / Grooming
Medication Reminders
Transportation to Appointments
Running Errands
Alzheimer's and Dementia Care
Fall Prevention
Transportation: Social Outing
Supervision
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