MEDICAL HISTORY:
Illnesses: ***
Hospitalizations: ***
Surgeries: ***
Injuries: ***
Patient is able to perform all activities of daily living with the EXCEPTION of: ***none/eating/feeding/bathing/dressing/toileting/transferring/maintaining continence***.
Falls in the last year: ***No/Yes ---details---***
SOCIAL HISTORY:
Alcohol use: ***none/drinks --- every ---***
Tobacco use: ***none/smokes --- every ---***
Illicit drug use: ***none/uses ---***
Diet includes: ***vegetables/fruits/dairy/meat***
Physical activity includes: ***
FAMILY HISTORY:
Hereditary diseases: ***
Conditions that place the patient at increased risk for disease: ***
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Result - Copy and paste this output: