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* 1. Name and phone number

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* 2. What services are you looking for? (Companionship, lighthouse work etc)

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* 3. Do you have any medical conditions or needs require attention?

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* 4. What outcomes do you hope to achieve through home health Care?

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* 5. Do you have medical equipment needs?

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* 6. What medical conditions or needs required attention?

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* 7. What days and hours are you specifically looking for ?

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* 8. Do you have insurance coverage or medicaid- Medicare?

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* 9. What are your expectations for caregiving communication and updates

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* 10. Are there any additional services or support you'll find valuable

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