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| Unknown | 1993-04-25 | 94.5 KB |
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hex view+--------+-------------------------+-------------------------+--------+--------+
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|00000200| 02 00 00 00 00 00 00 00 | 00 00 00 00 00 02 00 00 |........|........|
|00000210| 00 4b 31 4e 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.K1N P|OTENTIAL|
|00000220| 20 46 4f 52 20 44 45 48 | 59 52 41 54 49 4f 4e 20 | FOR DEH|YRATION |
|00000230| 44 55 45 20 54 4f 20 56 | 4f 4d 49 54 49 4e 47 3a |DUE TO V|OMITING:|
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|00000260| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000270| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00000280| 48 41 56 45 20 47 4f 4f | 44 20 53 4b 49 4e 20 54 |HAVE GOO|D SKIN T|
|00000290| 55 52 47 4f 52 2e 20 20 | 20 20 20 20 20 20 20 20 |URGOR. | |
|000002a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 58 5f | | X_|
|000002b0| 5f 5f 5f 5f 44 41 59 53 | 2e 20 20 20 20 20 20 20 |____DAYS|. |
|000002c0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000002d0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 03 | | .|
|000002e0| 00 00 00 50 33 44 20 20 | 20 4e 45 45 44 53 5f 5f |...P3D | NEEDS__|
|000002f0| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 43 48 41 |________|_____CHA|
|00000300| 49 52 20 57 48 49 43 48 | 20 50 52 45 56 45 4e 54 |IR WHICH| PREVENT|
|00000310| 53 20 20 20 20 20 20 20 | 20 20 20 52 49 53 49 4e |S | RISIN|
|00000320| 47 20 54 4f 20 50 52 45 | 56 45 4e 54 20 49 4e 4a |G TO PRE|VENT INJ|
|00000330| 55 52 59 20 44 55 45 20 | 54 4f 3a 20 20 20 20 20 |URY DUE |TO: |
|00000340| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00000350| 49 4e 4a 55 52 49 45 53 | 20 44 41 49 4c 59 2e 20 |INJURIES| DAILY. |
|00000360| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000370| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4e | | N|
|00000380| 4f 20 42 45 48 41 56 49 | 4f 52 20 50 52 4f 42 4c |O BEHAVI|OR PROBL|
|00000390| 45 4d 53 20 44 55 45 20 | 54 4f 20 43 48 41 49 52 |EMS DUE |TO CHAIR|
|000003a0| 2e 20 20 20 58 33 4d 4f | 4e 54 48 53 20 20 20 20 |. X3MO|NTHS |
|000003b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000003c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000003d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
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|00000410| 00 49 35 20 20 20 20 50 | 52 45 46 45 52 53 20 4f |.I5 P|REFERS O|
|00000420| 54 48 45 52 20 41 43 54 | 49 56 49 54 49 45 53 3a |THER ACT|IVITIES:|
|00000430| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000440| 20 20 20 20 20 20 20 20 | 20 5f 5f 5f 5f 5f 5f 5f | | _______|
|00000450| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 20 20 20 5f 5f 5f |________|__ ___|
|00000460| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 20 20 5f 5f |________|____ __|
|00000470| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 57 49 4c 4c 20 |________|___WILL |
|00000480| 50 41 52 54 49 43 49 50 | 41 54 45 20 49 4e 20 5f |PARTICIP|ATE IN _|
|00000490| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 5f 5f 5f |________|________|
|000004a0| 5f 5f 41 43 54 49 56 49 | 54 49 45 53 20 4f 46 20 |__ACTIVI|TIES OF |
|000004b0| 50 52 45 46 45 52 45 4e | 43 45 20 50 45 52 20 57 |PREFEREN|CE PER W|
|000004c0| 45 45 4b 2e 20 20 20 20 | 20 20 20 20 20 20 20 20 |EEK. | |
|000004d0| 58 33 4d 4f 4e 54 48 53 | 20 20 20 20 20 20 20 05 |X3MONTHS| .|
|000004e0| 00 00 00 4b 31 4e 20 20 | 20 50 4f 54 45 4e 54 49 |...K1N | POTENTI|
|000004f0| 41 4c 20 46 4f 52 20 44 | 45 48 59 52 41 54 49 4f |AL FOR D|EHYRATIO|
|00000500| 4e 20 44 55 45 20 54 4f | 20 56 4f 4d 49 54 49 4e |N DUE TO| VOMITIN|
|00000510| 47 3a 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |G: | |
|00000520| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000530| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000540| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00000550| 4c 20 48 41 56 45 20 47 | 4f 4f 44 20 53 4b 49 4e |L HAVE G|OOD SKIN|
|00000560| 20 54 55 52 47 4f 52 2e | 20 20 20 20 20 20 20 20 | TURGOR.| |
|00000570| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000580| 58 5f 5f 5f 5f 5f 44 41 | 59 53 2e 20 20 20 20 20 |X_____DA|YS. |
|00000590| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000005a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000005b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000005c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000005d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000005e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000005f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000600| 01 00 00 00 00 02 00 00 | 00 01 00 00 00 06 00 00 |........|........|
|00000610| 00 50 33 44 20 20 20 4e | 45 45 44 53 5f 5f 5f 5f |.P3D N|EEDS____|
|00000620| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 43 48 41 49 52 |________|___CHAIR|
|00000630| 20 57 48 49 43 48 20 50 | 52 45 56 45 4e 54 53 20 | WHICH P|REVENTS |
|00000640| 20 20 20 20 20 20 20 20 | 20 52 49 53 49 4e 47 20 | | RISING |
|00000650| 54 4f 20 50 52 45 56 45 | 4e 54 20 49 4e 4a 55 52 |TO PREVE|NT INJUR|
|00000660| 59 20 44 55 45 20 54 4f | 3a 20 20 20 20 20 20 20 |Y DUE TO|: |
|00000670| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 49 4e | | NO IN|
|00000680| 4a 55 52 49 45 53 20 44 | 41 49 4c 59 2e 20 20 20 |JURIES D|AILY. |
|00000690| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000006a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|000006b0| 42 45 48 41 56 49 4f 52 | 20 50 52 4f 42 4c 45 4d |BEHAVIOR| PROBLEM|
|000006c0| 53 20 44 55 45 20 54 4f | 20 43 48 41 49 52 2e 20 |S DUE TO| CHAIR. |
|000006d0| 20 20 58 33 4d 4f 4e 54 | 48 53 20 20 20 20 20 00 | X3MONT|HS .|
|000006e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000006f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000700| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000710| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000720| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000730| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000740| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000750| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000760| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000770| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000780| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000790| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000007a0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000007b0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000007c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000007d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000007e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000007f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000800| 02 05 00 00 00 00 00 00 | 00 02 00 00 00 07 00 00 |........|........|
|00000810| 00 45 34 4a 20 20 20 55 | 4e 41 42 4c 45 20 54 4f |.E4J U|NABLE TO|
|00000820| 20 54 55 52 4e 20 41 4e | 44 20 52 45 50 4f 53 49 | TURN AN|D REPOSI|
|00000830| 54 49 4f 4e 20 53 45 4c | 46 3a 20 20 20 20 20 20 |TION SEL|F: |
|00000840| 20 20 20 20 20 20 20 20 | 20 50 4f 54 45 4e 54 49 | | POTENTI|
|00000850| 41 4c 20 46 4f 52 20 53 | 4b 49 4e 20 42 52 45 41 |AL FOR S|KIN BREA|
|00000860| 4b 44 4f 57 4e 2e 20 20 | 20 20 20 20 20 20 20 20 |KDOWN. | |
|00000870| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 44 45 | | NO DE|
|00000880| 43 55 42 49 54 55 53 20 | 46 4f 52 4d 41 54 49 4f |CUBITUS |FORMATIO|
|00000890| 4e 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |N | |
|000008a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|000008b0| 46 41 4c 4c 53 2e 20 20 | 20 20 20 20 20 20 20 20 |FALLS. | |
|000008c0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 58 33 | | X3|
|000008d0| 4d 4f 4e 54 48 53 20 20 | 20 20 20 20 20 20 20 08 |MONTHS | .|
|000008e0| 00 00 00 49 35 20 20 20 | 20 50 52 45 46 45 52 53 |...I5 | PREFERS|
|000008f0| 20 4f 54 48 45 52 20 41 | 43 54 49 56 49 54 49 45 | OTHER A|CTIVITIE|
|00000900| 53 3a 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |S: | |
|00000910| 20 20 20 20 20 20 20 20 | 20 20 20 5f 5f 5f 5f 5f | | _____|
|00000920| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 20 20 20 5f |________|____ _|
|00000930| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 5f 20 20 |________|______ |
|00000940| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 57 49 4c |________|_____WIL|
|00000950| 4c 20 50 41 52 54 49 43 | 49 50 41 54 45 20 49 4e |L PARTIC|IPATE IN|
|00000960| 20 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 5f 5f 5f | _______|________|
|00000970| 5f 5f 5f 5f 41 43 54 49 | 56 49 54 49 45 53 20 4f |____ACTI|VITIES O|
|00000980| 46 20 50 52 45 46 45 52 | 45 4e 43 45 20 50 45 52 |F PREFER|ENCE PER|
|00000990| 20 57 45 45 4b 2e 20 20 | 20 20 20 20 20 20 20 20 | WEEK. | |
|000009a0| 20 20 58 33 4d 4f 4e 54 | 48 53 20 20 20 20 20 20 | X3MONT|HS |
|000009b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000009c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000009d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000009e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000009f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000a00| 02 06 00 00 00 04 00 00 | 00 02 00 00 00 09 00 00 |........|........|
|00000a10| 00 4a 32 42 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.J2B P|OTENTIAL|
|00000a20| 20 46 4f 52 20 43 4f 4e | 53 54 49 50 41 54 49 4f | FOR CON|STIPATIO|
|00000a30| 4e 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |N | |
|00000a40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000a50| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000a60| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000a70| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00000a80| 48 41 56 45 20 42 4d 20 | 41 54 20 4c 45 41 53 54 |HAVE BM |AT LEAST|
|00000a90| 20 45 56 45 52 59 20 54 | 48 52 45 45 20 44 41 59 | EVERY T|HREE DAY|
|00000aa0| 53 2e 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |S. | |
|00000ab0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000ac0| 20 20 20 20 20 20 20 20 | 20 20 58 33 4d 4f 4e 54 | | X3MONT|
|00000ad0| 48 53 20 20 20 20 20 20 | 20 20 20 20 20 20 20 0a |HS | .|
|00000ae0| 00 00 00 4b 31 4e 20 20 | 20 50 4f 54 45 4e 54 49 |...K1N | POTENTI|
|00000af0| 41 4c 20 46 4f 52 20 44 | 45 48 59 52 41 54 49 4f |AL FOR D|EHYRATIO|
|00000b00| 4e 20 44 55 45 20 54 4f | 20 56 4f 4d 49 54 49 4e |N DUE TO| VOMITIN|
|00000b10| 47 3a 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |G: | |
|00000b20| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000b30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000b40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00000b50| 4c 20 48 41 56 45 20 47 | 4f 4f 44 20 53 4b 49 4e |L HAVE G|OOD SKIN|
|00000b60| 20 54 55 52 47 4f 52 2e | 20 20 20 20 20 20 20 20 | TURGOR.| |
|00000b70| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000b80| 58 5f 5f 5f 5f 5f 44 41 | 59 53 2e 20 20 20 20 20 |X_____DA|YS. |
|00000b90| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000ba0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000bb0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00000bc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000bd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000be0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000bf0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000c00| 02 00 00 00 00 05 00 00 | 00 03 00 00 00 0b 00 00 |........|........|
|00000c10| 00 4e 34 45 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.N4E P|OTENTIAL|
|00000c20| 20 46 4f 52 20 44 45 43 | 55 42 49 54 55 53 20 55 | FOR DEC|UBITUS U|
|00000c30| 4c 43 45 52 53 2e 20 20 | 20 20 20 20 20 20 20 20 |LCERS. | |
|00000c40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000c50| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000c60| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000c70| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 44 45 | | NO DE|
|00000c80| 43 55 42 49 54 55 53 20 | 55 4c 43 45 52 20 46 4f |CUBITUS |ULCER FO|
|00000c90| 52 4d 41 54 49 4f 4e 2e | 20 20 20 20 20 20 20 20 |RMATION.| |
|00000ca0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000cb0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000cc0| 20 20 20 20 20 20 20 20 | 20 20 58 20 33 4d 4f 4e | | X 3MON|
|00000cd0| 54 48 53 2e 20 20 20 20 | 20 20 20 20 20 20 20 0c |THS. | .|
|00000ce0| 00 00 00 50 33 44 20 20 | 20 4e 45 45 44 53 5f 5f |...P3D | NEEDS__|
|00000cf0| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 43 48 41 |________|_____CHA|
|00000d00| 49 52 20 57 48 49 43 48 | 20 50 52 45 56 45 4e 54 |IR WHICH| PREVENT|
|00000d10| 53 20 20 20 20 20 20 20 | 20 20 20 52 49 53 49 4e |S | RISIN|
|00000d20| 47 20 54 4f 20 50 52 45 | 56 45 4e 54 20 49 4e 4a |G TO PRE|VENT INJ|
|00000d30| 55 52 59 20 44 55 45 20 | 54 4f 3a 20 20 20 20 20 |URY DUE |TO: |
|00000d40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00000d50| 49 4e 4a 55 52 49 45 53 | 20 44 41 49 4c 59 2e 20 |INJURIES| DAILY. |
|00000d60| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000d70| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4e | | N|
|00000d80| 4f 20 42 45 48 41 56 49 | 4f 52 20 50 52 4f 42 4c |O BEHAVI|OR PROBL|
|00000d90| 45 4d 53 20 44 55 45 20 | 54 4f 20 43 48 41 49 52 |EMS DUE |TO CHAIR|
|00000da0| 2e 20 20 20 58 33 4d 4f | 4e 54 48 53 20 20 20 20 |. X3MO|NTHS |
|00000db0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00000dc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000dd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000de0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000df0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000e00| 02 08 00 00 00 00 00 00 | 00 04 00 00 00 0d 00 00 |........|........|
|00000e10| 00 45 31 42 20 20 20 44 | 45 50 45 4e 44 45 4e 54 |.E1B D|EPENDENT|
|00000e20| 2f 4e 45 45 44 53 20 41 | 53 53 49 53 54 41 4e 43 |/NEEDS A|SSISTANC|
|00000e30| 45 20 46 52 4f 4d 20 53 | 54 41 46 46 20 46 4f 52 |E FROM S|TAFF FOR|
|00000e40| 20 54 52 41 4e 53 46 45 | 52 50 4f 54 45 4e 54 49 | TRANSFE|RPOTENTI|
|00000e50| 41 4c 20 46 4f 52 20 46 | 41 4c 4c 53 2e 20 20 20 |AL FOR F|ALLS. |
|00000e60| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 33 58 | | 3X|
|00000e70| 4d 4f 4e 54 48 20 20 20 | 20 20 20 4e 4f 20 46 41 |MONTH | NO FA|
|00000e80| 4c 4c 53 2e 20 20 20 20 | 20 20 20 20 20 20 20 20 |LLS. | |
|00000e90| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000ea0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000eb0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000ec0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 58 | | X|
|00000ed0| 33 4d 4f 4e 54 48 53 20 | 20 20 20 20 20 20 20 0e |3MONTHS | .|
|00000ee0| 00 00 00 45 34 4a 20 20 | 20 55 4e 41 42 4c 45 20 |...E4J | UNABLE |
|00000ef0| 54 4f 20 54 55 52 4e 20 | 41 4e 44 20 52 45 50 4f |TO TURN |AND REPO|
|00000f00| 53 49 54 49 4f 4e 20 53 | 45 4c 46 3a 20 20 20 20 |SITION S|ELF: |
|00000f10| 20 20 20 20 20 20 20 20 | 20 20 20 50 4f 54 45 4e | | POTEN|
|00000f20| 54 49 41 4c 20 46 4f 52 | 20 53 4b 49 4e 20 42 52 |TIAL FOR| SKIN BR|
|00000f30| 45 41 4b 44 4f 57 4e 2e | 20 20 20 20 20 20 20 20 |EAKDOWN.| |
|00000f40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00000f50| 44 45 43 55 42 49 54 55 | 53 20 46 4f 52 4d 41 54 |DECUBITU|S FORMAT|
|00000f60| 49 4f 4e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |ION | |
|00000f70| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4e | | N|
|00000f80| 4f 20 46 41 4c 4c 53 2e | 20 20 20 20 20 20 20 20 |O FALLS.| |
|00000f90| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00000fa0| 58 33 4d 4f 4e 54 48 53 | 20 20 20 20 20 20 20 20 |X3MONTHS| |
|00000fb0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00000fc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000fd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000fe0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000ff0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001000| 02 09 00 00 00 07 00 00 | 00 04 00 00 00 0f 00 00 |........|........|
|00001010| 00 47 32 20 20 20 20 55 | 4e 53 45 54 54 4c 45 44 |.G2 U|NSETTLED|
|00001020| 20 52 45 4c 41 54 49 4f | 4e 53 48 49 50 20 57 49 | RELATIO|NSHIP WI|
|00001030| 54 48 3a 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |TH: | |
|00001040| 20 20 20 20 20 20 20 20 | 20 55 4e 48 41 50 50 49 | | UNHAPPI|
|00001050| 4e 45 53 53 20 57 49 54 | 48 3a 20 20 20 20 20 20 |NESS WIT|H: |
|00001060| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001070| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00001080| 42 45 20 52 45 53 4f 4c | 56 45 44 20 41 53 20 44 |BE RESOL|VED AS D|
|00001090| 45 4d 4f 4e 53 54 52 41 | 54 45 44 20 42 59 20 56 |EMONSTRA|TED BY V|
|000010a0| 45 52 42 41 4c 49 5a 41 | 54 49 4f 4e 20 4f 46 20 |ERBALIZA|TION OF |
|000010b0| 50 4f 53 49 54 49 56 45 | 20 46 45 45 4c 49 4e 47 |POSITIVE| FEELING|
|000010c0| 53 2e 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |S. | |
|000010d0| 20 20 20 58 33 4d 4f 4e | 54 48 53 20 20 20 20 10 | X3MON|THS .|
|000010e0| 00 00 00 49 35 20 20 20 | 20 50 52 45 46 45 52 53 |...I5 | PREFERS|
|000010f0| 20 4f 54 48 45 52 20 41 | 43 54 49 56 49 54 49 45 | OTHER A|CTIVITIE|
|00001100| 53 3a 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |S: | |
|00001110| 20 20 20 20 20 20 20 20 | 20 20 20 5f 5f 5f 5f 5f | | _____|
|00001120| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 20 20 20 5f |________|____ _|
|00001130| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 5f 20 20 |________|______ |
|00001140| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 57 49 4c |________|_____WIL|
|00001150| 4c 20 50 41 52 54 49 43 | 49 50 41 54 45 20 49 4e |L PARTIC|IPATE IN|
|00001160| 20 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 5f 5f 5f | _______|________|
|00001170| 5f 5f 5f 5f 41 43 54 49 | 56 49 54 49 45 53 20 4f |____ACTI|VITIES O|
|00001180| 46 20 50 52 45 46 45 52 | 45 4e 43 45 20 50 45 52 |F PREFER|ENCE PER|
|00001190| 20 57 45 45 4b 2e 20 20 | 20 20 20 20 20 20 20 20 | WEEK. | |
|000011a0| 20 20 58 33 4d 4f 4e 54 | 48 53 20 20 20 20 20 20 | X3MONT|HS |
|000011b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000011c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000011d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000011e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000011f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001200| 02 0a 00 00 00 08 00 00 | 00 05 00 00 00 11 00 00 |........|........|
|00001210| 00 4a 31 4b 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.J1K P|OTENTIAL|
|00001220| 20 46 4f 52 20 4c 4f 57 | 20 53 45 4c 46 20 45 53 | FOR LOW| SELF ES|
|00001230| 54 45 45 4d 20 53 45 43 | 4f 4e 44 41 52 59 20 54 |TEEM SEC|ONDARY T|
|00001240| 4f 20 43 56 41 20 20 20 | 20 4c 49 4d 49 54 45 44 |O CVA | LIMITED|
|00001250| 20 4d 4f 56 45 4d 45 4e | 54 20 4f 46 3a 20 20 20 | MOVEMEN|T OF: |
|00001260| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001270| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00001280| 53 4f 43 49 41 4c 49 5a | 45 20 44 41 49 4c 59 20 |SOCIALIZ|E DAILY |
|00001290| 57 49 54 48 20 50 45 45 | 52 53 2e 20 20 20 20 20 |WITH PEE|RS. |
|000012a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|000012b0| 43 4f 4e 54 52 41 43 54 | 55 52 45 53 2e 20 20 20 |CONTRACT|URES. |
|000012c0| 20 20 20 20 20 20 20 20 | 20 20 20 20 58 33 4d 4f | | X3MO|
|000012d0| 4e 54 48 53 20 20 20 20 | 20 20 20 20 20 20 20 12 |NTHS | .|
|000012e0| 00 00 00 4a 32 42 20 20 | 20 50 4f 54 45 4e 54 49 |...J2B | POTENTI|
|000012f0| 41 4c 20 46 4f 52 20 43 | 4f 4e 53 54 49 50 41 54 |AL FOR C|ONSTIPAT|
|00001300| 49 4f 4e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |ION | |
|00001310| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001320| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001330| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001340| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00001350| 4c 20 48 41 56 45 20 42 | 4d 20 41 54 20 4c 45 41 |L HAVE B|M AT LEA|
|00001360| 53 54 20 45 56 45 52 59 | 20 54 48 52 45 45 20 44 |ST EVERY| THREE D|
|00001370| 41 59 53 2e 20 20 20 20 | 20 20 20 20 20 20 20 20 |AYS. | |
|00001380| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001390| 20 20 20 20 20 20 20 20 | 20 20 20 20 58 33 4d 4f | | X3MO|
|000013a0| 4e 54 48 53 20 20 20 20 | 20 20 20 20 20 20 20 20 |NTHS | |
|000013b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000013c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000013d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000013e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000013f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001400| 02 0b 00 00 00 09 00 00 | 00 05 00 00 00 13 00 00 |........|........|
|00001410| 00 4a 32 52 20 20 20 48 | 41 53 20 41 20 4e 4f 20 |.J2R H|AS A NO |
|00001420| 43 50 52 20 52 45 51 55 | 45 53 54 2e 20 20 20 20 |CPR REQU|EST. |
|00001430| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001440| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001450| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001460| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001470| 20 20 20 20 20 20 20 20 | 20 20 20 52 45 53 49 44 | | RESID|
|00001480| 45 4e 54 20 57 49 4c 4c | 20 42 45 20 4b 45 50 54 |ENT WILL| BE KEPT|
|00001490| 20 43 4f 4d 46 4f 52 54 | 41 42 4c 45 3a 48 4f 4e | COMFORT|ABLE:HON|
|000014a0| 4f 52 20 52 45 51 55 45 | 53 54 2e 20 20 50 41 49 |OR REQUE|ST. PAI|
|000014b0| 4e 20 52 45 4c 49 45 56 | 45 44 20 57 49 54 48 49 |N RELIEV|ED WITHI|
|000014c0| 4e 20 4f 4e 45 20 48 4f | 55 52 20 49 4e 54 45 52 |N ONE HO|UR INTER|
|000014d0| 56 45 4e 54 49 4f 4e 2e | 33 4d 4f 4e 54 48 53 14 |VENTION.|3MONTHS.|
|000014e0| 00 00 00 4b 31 4e 20 20 | 20 50 4f 54 45 4e 54 49 |...K1N | POTENTI|
|000014f0| 41 4c 20 46 4f 52 20 44 | 45 48 59 52 41 54 49 4f |AL FOR D|EHYRATIO|
|00001500| 4e 20 44 55 45 20 54 4f | 20 56 4f 4d 49 54 49 4e |N DUE TO| VOMITIN|
|00001510| 47 3a 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |G: | |
|00001520| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001530| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001540| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00001550| 4c 20 48 41 56 45 20 47 | 4f 4f 44 20 53 4b 49 4e |L HAVE G|OOD SKIN|
|00001560| 20 54 55 52 47 4f 52 2e | 20 20 20 20 20 20 20 20 | TURGOR.| |
|00001570| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001580| 58 5f 5f 5f 5f 5f 44 41 | 59 53 2e 20 20 20 20 20 |X_____DA|YS. |
|00001590| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000015a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000015b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000015c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000015d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000015e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000015f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001600| 02 0c 00 00 00 0a 00 00 | 00 06 00 00 00 15 00 00 |........|........|
|00001610| 00 4c 34 44 20 20 20 4e | 45 45 44 53 20 54 4f 20 |.L4D N|EEDS TO |
|00001620| 42 45 20 46 45 44 20 42 | 59 20 53 59 52 49 4e 47 |BE FED B|Y SYRING|
|00001630| 45 20 44 55 45 20 54 4f | 3a 20 20 20 20 20 20 20 |E DUE TO|: |
|00001640| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001650| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001660| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001670| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00001680| 43 4f 4e 53 55 4d 45 20 | 38 30 2d 31 30 30 25 20 |CONSUME |80-100% |
|00001690| 4f 46 20 44 49 45 54 20 | 44 41 49 4c 59 2e 20 20 |OF DIET |DAILY. |
|000016a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000016b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000016c0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000016d0| 20 20 20 58 33 4d 4f 4e | 54 48 53 2e 20 20 20 16 | X3MON|THS. .|
|000016e0| 00 00 00 4e 34 45 20 20 | 20 50 4f 54 45 4e 54 49 |...N4E | POTENTI|
|000016f0| 41 4c 20 46 4f 52 20 44 | 45 43 55 42 49 54 55 53 |AL FOR D|ECUBITUS|
|00001700| 20 55 4c 43 45 52 53 2e | 20 20 20 20 20 20 20 20 | ULCERS.| |
|00001710| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001720| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001730| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001740| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00001750| 44 45 43 55 42 49 54 55 | 53 20 55 4c 43 45 52 20 |DECUBITU|S ULCER |
|00001760| 46 4f 52 4d 41 54 49 4f | 4e 2e 20 20 20 20 20 20 |FORMATIO|N. |
|00001770| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001780| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001790| 20 20 20 20 20 20 20 20 | 20 20 20 20 58 20 33 4d | | X 3M|
|000017a0| 4f 4e 54 48 53 2e 20 20 | 20 20 20 20 20 20 20 20 |ONTHS. | |
|000017b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000017c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000017d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000017e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000017f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001800| 02 00 00 00 00 0b 00 00 | 00 06 00 00 00 17 00 00 |........|........|
|00001810| 00 50 31 44 20 20 20 4d | 41 59 20 4e 45 45 44 20 |.P1D M|AY NEED |
|00001820| 53 55 43 54 49 4f 4e 49 | 4e 47 20 46 4f 52 3a 20 |SUCTIONI|NG FOR: |
|00001830| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001840| 20 20 20 20 20 20 20 20 | 20 53 45 43 52 45 54 49 | | SECRETI|
|00001850| 4f 4e 20 42 55 49 4c 44 | 20 55 50 3e 20 20 20 20 |ON BUILD| UP> |
|00001860| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001870| 20 20 20 20 20 20 20 20 | 20 20 20 43 4f 4e 47 45 | | CONGE|
|00001880| 53 54 49 4f 4e 20 57 49 | 4c 4c 20 42 45 20 52 45 |STION WI|LL BE RE|
|00001890| 4c 49 45 56 45 44 20 57 | 49 54 48 49 4e 20 35 20 |LIEVED W|ITHIN 5 |
|000018a0| 4d 49 4e 55 54 45 53 20 | 20 20 20 20 20 4f 46 20 |MINUTES | OF |
|000018b0| 49 4e 54 45 52 56 45 4e | 54 49 4f 4e 2e 20 20 20 |INTERVEN|TION. |
|000018c0| 20 20 20 20 20 20 20 20 | 20 20 20 20 58 33 4d 4f | | X3MO|
|000018d0| 4e 54 48 53 2e 20 20 20 | 20 20 20 20 20 20 20 18 |NTHS. | .|
|000018e0| 00 00 00 50 33 44 20 20 | 20 4e 45 45 44 53 5f 5f |...P3D | NEEDS__|
|000018f0| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 43 48 41 |________|_____CHA|
|00001900| 49 52 20 57 48 49 43 48 | 20 50 52 45 56 45 4e 54 |IR WHICH| PREVENT|
|00001910| 53 20 20 20 20 20 20 20 | 20 20 20 52 49 53 49 4e |S | RISIN|
|00001920| 47 20 54 4f 20 50 52 45 | 56 45 4e 54 20 49 4e 4a |G TO PRE|VENT INJ|
|00001930| 55 52 59 20 44 55 45 20 | 54 4f 3a 20 20 20 20 20 |URY DUE |TO: |
|00001940| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00001950| 49 4e 4a 55 52 49 45 53 | 20 44 41 49 4c 59 2e 20 |INJURIES| DAILY. |
|00001960| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001970| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4e | | N|
|00001980| 4f 20 42 45 48 41 56 49 | 4f 52 20 50 52 4f 42 4c |O BEHAVI|OR PROBL|
|00001990| 45 4d 53 20 44 55 45 20 | 54 4f 20 43 48 41 49 52 |EMS DUE |TO CHAIR|
|000019a0| 2e 20 20 20 58 33 4d 4f | 4e 54 48 53 20 20 20 20 |. X3MO|NTHS |
|000019b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000019c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000019d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000019e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000019f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001a00| 02 0e 00 00 00 00 00 00 | 00 07 00 00 00 19 00 00 |........|........|
|00001a10| 00 43 31 20 20 20 20 48 | 41 53 20 48 45 41 52 49 |.C1 H|AS HEARI|
|00001a20| 4e 47 20 44 45 46 49 43 | 49 54 3a 20 20 20 20 20 |NG DEFIC|IT: |
|00001a30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001a40| 20 20 20 20 20 20 20 20 | 20 4e 4f 20 48 45 41 52 | | NO HEAR|
|00001a50| 49 4e 47 20 41 49 44 45 | 20 44 55 45 20 54 4f 3a |ING AIDE| DUE TO:|
|00001a60| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001a70| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00001a80| 48 41 56 45 20 4e 45 45 | 44 53 20 43 4f 4d 4d 55 |HAVE NEE|DS COMMU|
|00001a90| 4e 49 43 41 54 45 44 20 | 45 56 45 52 59 20 53 48 |NICATED |EVERY SH|
|00001aa0| 49 46 54 20 42 59 3a 20 | 20 20 20 20 20 20 20 20 |IFT BY: | |
|00001ab0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001ac0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 58 | | X|
|00001ad0| 33 4d 4f 4e 54 48 53 20 | 20 20 20 20 20 20 20 1a |3MONTHS | .|
|00001ae0| 00 00 00 45 31 42 20 20 | 20 44 45 50 45 4e 44 45 |...E1B | DEPENDE|
|00001af0| 4e 54 2f 4e 45 45 44 53 | 20 41 53 53 49 53 54 41 |NT/NEEDS| ASSISTA|
|00001b00| 4e 43 45 20 46 52 4f 4d | 20 53 54 41 46 46 20 46 |NCE FROM| STAFF F|
|00001b10| 4f 52 20 54 52 41 4e 53 | 46 45 52 50 4f 54 45 4e |OR TRANS|FERPOTEN|
|00001b20| 54 49 41 4c 20 46 4f 52 | 20 46 41 4c 4c 53 2e 20 |TIAL FOR| FALLS. |
|00001b30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001b40| 33 58 4d 4f 4e 54 48 20 | 20 20 20 20 20 4e 4f 20 |3XMONTH | NO |
|00001b50| 46 41 4c 4c 53 2e 20 20 | 20 20 20 20 20 20 20 20 |FALLS. | |
|00001b60| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001b70| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001b80| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001b90| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001ba0| 20 58 33 4d 4f 4e 54 48 | 53 20 20 20 20 20 20 20 | X3MONTH|S |
|00001bb0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00001bc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001bd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001be0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001bf0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001c00| 02 0f 00 00 00 0d 00 00 | 00 07 00 00 00 1b 00 00 |........|........|
|00001c10| 00 45 34 42 20 20 20 42 | 45 44 46 41 53 54 20 4d |.E4B B|EDFAST M|
|00001c20| 4f 53 54 20 4f 46 20 54 | 48 45 20 54 49 4d 45 20 |OST OF T|HE TIME |
|00001c30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001c40| 20 20 20 20 20 20 20 20 | 20 50 4f 54 45 4e 54 49 | | POTENTI|
|00001c50| 41 4c 20 46 4f 52 20 53 | 4b 49 4e 20 42 52 45 41 |AL FOR S|KIN BREA|
|00001c60| 4b 44 4f 57 4e 2c 46 41 | 4c 4c 53 20 20 20 20 20 |KDOWN,FA|LLS |
|00001c70| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 53 4b | | NO SK|
|00001c80| 49 4e 20 42 52 45 41 4b | 44 4f 57 4e 20 51 20 53 |IN BREAK|DOWN Q S|
|00001c90| 48 49 46 54 2e 20 20 20 | 20 20 20 20 20 20 20 20 |HIFT. | |
|00001ca0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00001cb0| 46 41 4c 4c 53 20 20 20 | 20 20 20 20 20 20 20 20 |FALLS | |
|00001cc0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001cd0| 20 58 33 4d 4f 4e 54 48 | 53 20 20 20 20 20 20 1c | X3MONTH|S .|
|00001ce0| 00 00 00 45 34 4a 20 20 | 20 55 4e 41 42 4c 45 20 |...E4J | UNABLE |
|00001cf0| 54 4f 20 54 55 52 4e 20 | 41 4e 44 20 52 45 50 4f |TO TURN |AND REPO|
|00001d00| 53 49 54 49 4f 4e 20 53 | 45 4c 46 3a 20 20 20 20 |SITION S|ELF: |
|00001d10| 20 20 20 20 20 20 20 20 | 20 20 20 50 4f 54 45 4e | | POTEN|
|00001d20| 54 49 41 4c 20 46 4f 52 | 20 53 4b 49 4e 20 42 52 |TIAL FOR| SKIN BR|
|00001d30| 45 41 4b 44 4f 57 4e 2e | 20 20 20 20 20 20 20 20 |EAKDOWN.| |
|00001d40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00001d50| 44 45 43 55 42 49 54 55 | 53 20 46 4f 52 4d 41 54 |DECUBITU|S FORMAT|
|00001d60| 49 4f 4e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |ION | |
|00001d70| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4e | | N|
|00001d80| 4f 20 46 41 4c 4c 53 2e | 20 20 20 20 20 20 20 20 |O FALLS.| |
|00001d90| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001da0| 58 33 4d 4f 4e 54 48 53 | 20 20 20 20 20 20 20 20 |X3MONTHS| |
|00001db0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00001dc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001dd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001de0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001df0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001e00| 02 10 00 00 00 0e 00 00 | 00 08 00 00 00 1d 00 00 |........|........|
|00001e10| 00 46 33 43 20 20 20 54 | 45 4e 44 45 4e 43 59 20 |.F3C T|ENDENCY |
|00001e20| 54 4f 20 55 54 49 20 44 | 55 45 20 54 4f 20 49 4e |TO UTI D|UE TO IN|
|00001e30| 44 57 45 4c 4c 49 4e 47 | 20 43 41 54 48 45 54 45 |DWELLING| CATHETE|
|00001e40| 52 2e 20 20 20 20 20 20 | 20 4d 55 53 54 20 48 41 |R. | MUST HA|
|00001e50| 56 45 20 43 41 54 48 45 | 54 45 52 20 44 55 45 20 |VE CATHE|TER DUE |
|00001e60| 54 4f 3a 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |TO: | |
|00001e70| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 53 49 | | NO SI|
|00001e80| 47 4e 53 20 4f 52 20 53 | 59 4d 50 54 4f 4d 53 20 |GNS OR S|YMPTOMS |
|00001e90| 4f 46 20 55 54 49 3a 20 | 20 20 20 20 20 20 20 20 |OF UTI: | |
|00001ea0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 46 45 56 | | FEV|
|00001eb0| 45 52 2c 43 4c 4f 55 44 | 59 20 55 52 49 4e 45 2c |ER,CLOUD|Y URINE,|
|00001ec0| 42 4c 4f 4f 44 59 20 55 | 52 49 4e 45 2c 44 49 53 |BLOODY U|RINE,DIS|
|00001ed0| 43 4f 4c 4f 52 45 44 20 | 55 52 49 4e 45 2e 20 1e |COLORED |URINE. .|
|00001ee0| 00 00 00 47 32 20 20 20 | 20 55 4e 53 45 54 54 4c |...G2 | UNSETTL|
|00001ef0| 45 44 20 52 45 4c 41 54 | 49 4f 4e 53 48 49 50 20 |ED RELAT|IONSHIP |
|00001f00| 57 49 54 48 3a 20 20 20 | 20 20 20 20 20 20 20 20 |WITH: | |
|00001f10| 20 20 20 20 20 20 20 20 | 20 20 20 55 4e 48 41 50 | | UNHAP|
|00001f20| 50 49 4e 45 53 53 20 57 | 49 54 48 3a 20 20 20 20 |PINESS W|ITH: |
|00001f30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00001f40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00001f50| 4c 20 42 45 20 52 45 53 | 4f 4c 56 45 44 20 41 53 |L BE RES|OLVED AS|
|00001f60| 20 44 45 4d 4f 4e 53 54 | 52 41 54 45 44 20 42 59 | DEMONST|RATED BY|
|00001f70| 20 56 45 52 42 41 4c 49 | 5a 41 54 49 4f 4e 20 4f | VERBALI|ZATION O|
|00001f80| 46 20 50 4f 53 49 54 49 | 56 45 20 46 45 45 4c 49 |F POSITI|VE FEELI|
|00001f90| 4e 47 53 2e 20 20 20 20 | 20 20 20 20 20 20 20 20 |NGS. | |
|00001fa0| 20 20 20 20 20 58 33 4d | 4f 4e 54 48 53 20 20 20 | X3M|ONTHS |
|00001fb0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00001fc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001fd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001fe0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001ff0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002000| 02 11 00 00 00 0f 00 00 | 00 08 00 00 00 1f 00 00 |........|........|
|00002010| 00 48 34 20 20 20 20 52 | 45 53 49 44 45 4e 54 20 |.H4 R|ESIDENT |
|00002020| 52 45 53 49 53 54 53 20 | 43 41 52 45 3a 20 20 20 |RESISTS |CARE: |
|00002030| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002040| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002050| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002060| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002070| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00002080| 48 41 56 45 20 41 44 4c | 20 4e 45 45 44 53 20 4d |HAVE ADL| NEEDS M|
|00002090| 45 54 20 51 20 53 48 49 | 46 54 53 20 20 20 20 20 |ET Q SHI|FTS |
|000020a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000020b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000020c0| 20 20 20 20 20 20 20 20 | 20 20 58 33 4d 4f 4e 54 | | X3MONT|
|000020d0| 48 53 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |HS | |
|000020e0| 00 00 00 49 35 20 20 20 | 20 50 52 45 46 45 52 53 |...I5 | PREFERS|
|000020f0| 20 4f 54 48 45 52 20 41 | 43 54 49 56 49 54 49 45 | OTHER A|CTIVITIE|
|00002100| 53 3a 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |S: | |
|00002110| 20 20 20 20 20 20 20 20 | 20 20 20 5f 5f 5f 5f 5f | | _____|
|00002120| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 20 20 20 5f |________|____ _|
|00002130| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 5f 20 20 |________|______ |
|00002140| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 57 49 4c |________|_____WIL|
|00002150| 4c 20 50 41 52 54 49 43 | 49 50 41 54 45 20 49 4e |L PARTIC|IPATE IN|
|00002160| 20 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 5f 5f 5f | _______|________|
|00002170| 5f 5f 5f 5f 41 43 54 49 | 56 49 54 49 45 53 20 4f |____ACTI|VITIES O|
|00002180| 46 20 50 52 45 46 45 52 | 45 4e 43 45 20 50 45 52 |F PREFER|ENCE PER|
|00002190| 20 57 45 45 4b 2e 20 20 | 20 20 20 20 20 20 20 20 | WEEK. | |
|000021a0| 20 20 58 33 4d 4f 4e 54 | 48 53 20 20 20 20 20 20 | X3MONT|HS |
|000021b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000021c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000021d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000021e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000021f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002200| 02 12 00 00 00 10 00 00 | 00 09 00 00 00 21 00 00 |........|.....!..|
|00002210| 00 4a 31 44 44 20 20 50 | 4f 54 45 4e 54 49 41 4c |.J1DD P|OTENTIAL|
|00002220| 20 46 4f 52 20 45 4c 45 | 56 41 54 45 44 20 54 45 | FOR ELE|VATED TE|
|00002230| 4d 50 45 52 41 54 55 52 | 45 2f 44 45 48 59 44 52 |MPERATUR|E/DEHYDR|
|00002240| 41 54 49 4f 4e 20 20 20 | 20 46 52 4f 4d 20 53 45 |ATION | FROM SE|
|00002250| 50 54 49 43 45 4d 49 41 | 20 20 20 20 20 20 20 20 |PTICEMIA| |
|00002260| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002270| 20 20 20 20 20 20 20 20 | 20 20 20 54 45 4d 50 45 | | TEMPE|
|00002280| 52 41 54 55 52 45 20 57 | 49 4c 4c 20 42 45 20 42 |RATURE W|ILL BE B|
|00002290| 45 4c 4f 57 20 31 30 30 | 20 44 45 47 52 45 45 53 |ELOW 100| DEGREES|
|000022a0| 20 46 4f 52 20 5f 5f 5f | 44 41 59 53 20 57 49 4c | FOR ___|DAYS WIL|
|000022b0| 4c 20 48 41 56 45 20 47 | 4f 4f 44 20 53 4b 49 4e |L HAVE G|OOD SKIN|
|000022c0| 20 54 55 52 47 4f 52 2e | 20 20 20 20 20 20 20 20 | TURGOR.| |
|000022d0| 20 58 33 4d 4f 4e 54 48 | 53 20 20 20 20 20 20 22 | X3MONTH|S "|
|000022e0| 00 00 00 4a 31 4b 20 20 | 20 50 4f 54 45 4e 54 49 |...J1K | POTENTI|
|000022f0| 41 4c 20 46 4f 52 20 4c | 4f 57 20 53 45 4c 46 20 |AL FOR L|OW SELF |
|00002300| 45 53 54 45 45 4d 20 53 | 45 43 4f 4e 44 41 52 59 |ESTEEM S|ECONDARY|
|00002310| 20 54 4f 20 43 56 41 20 | 20 20 20 4c 49 4d 49 54 | TO CVA | LIMIT|
|00002320| 45 44 20 4d 4f 56 45 4d | 45 4e 54 20 4f 46 3a 20 |ED MOVEM|ENT OF: |
|00002330| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002340| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00002350| 4c 20 53 4f 43 49 41 4c | 49 5a 45 20 44 41 49 4c |L SOCIAL|IZE DAIL|
|00002360| 59 20 57 49 54 48 20 50 | 45 45 52 53 2e 20 20 20 |Y WITH P|EERS. |
|00002370| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4e | | N|
|00002380| 4f 20 43 4f 4e 54 52 41 | 43 54 55 52 45 53 2e 20 |O CONTRA|CTURES. |
|00002390| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 58 33 | | X3|
|000023a0| 4d 4f 4e 54 48 53 20 20 | 20 20 20 20 20 20 20 20 |MONTHS | |
|000023b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000023c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000023d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000023e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000023f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002400| 02 13 00 00 00 11 00 00 | 00 09 00 00 00 23 00 00 |........|.....#..|
|00002410| 00 4a 31 53 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.J1S P|OTENTIAL|
|00002420| 20 46 4f 52 20 49 4d 50 | 41 49 52 45 44 20 56 49 | FOR IMP|AIRED VI|
|00002430| 53 55 41 4c 20 46 55 4e | 43 54 49 4f 4e 49 4e 47 |SUAL FUN|CTIONING|
|00002440| 20 44 55 45 20 54 4f 20 | 20 43 41 54 41 52 41 43 | DUE TO | CATARAC|
|00002450| 54 53 3a 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |TS: | |
|00002460| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002470| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00002480| 48 41 56 45 20 4e 4f 20 | 49 4e 4a 55 52 49 45 53 |HAVE NO |INJURIES|
|00002490| 20 44 41 49 4c 59 2e 20 | 20 20 20 20 20 20 20 20 | DAILY. | |
|000024a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000024b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000024c0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 58 33 4d | | X3M|
|000024d0| 4f 4e 54 48 53 20 20 20 | 20 20 20 20 20 20 20 24 |ONTHS | $|
|000024e0| 00 00 00 4a 32 42 20 20 | 20 50 4f 54 45 4e 54 49 |...J2B | POTENTI|
|000024f0| 41 4c 20 46 4f 52 20 43 | 4f 4e 53 54 49 50 41 54 |AL FOR C|ONSTIPAT|
|00002500| 49 4f 4e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |ION | |
|00002510| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002520| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002530| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002540| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00002550| 4c 20 48 41 56 45 20 42 | 4d 20 41 54 20 4c 45 41 |L HAVE B|M AT LEA|
|00002560| 53 54 20 45 56 45 52 59 | 20 54 48 52 45 45 20 44 |ST EVERY| THREE D|
|00002570| 41 59 53 2e 20 20 20 20 | 20 20 20 20 20 20 20 20 |AYS. | |
|00002580| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002590| 20 20 20 20 20 20 20 20 | 20 20 20 20 58 33 4d 4f | | X3MO|
|000025a0| 4e 54 48 53 20 20 20 20 | 20 20 20 20 20 20 20 20 |NTHS | |
|000025b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000025c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000025d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000025e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000025f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002600| 02 14 00 00 00 12 00 00 | 00 0a 00 00 00 25 00 00 |........|.....%..|
|00002610| 00 4a 32 4a 20 20 20 48 | 41 53 20 41 20 4e 4f 20 |.J2J H|AS A NO |
|00002620| 43 50 52 20 52 45 51 55 | 45 53 54 2e 20 20 20 20 |CPR REQU|EST. |
|00002630| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002640| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002650| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002660| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002670| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00002680| 42 45 20 4b 45 50 54 20 | 43 4f 4d 46 4f 52 54 41 |BE KEPT |COMFORTA|
|00002690| 42 4c 45 2d 50 41 49 4e | 20 57 49 4c 4c 20 42 45 |BLE-PAIN| WILL BE|
|000026a0| 20 52 45 4c 49 45 56 45 | 44 20 20 20 20 57 49 54 | RELIEVE|D WIT|
|000026b0| 48 49 4e 20 4f 4e 45 20 | 48 4f 55 52 20 4f 46 20 |HIN ONE |HOUR OF |
|000026c0| 49 4e 54 45 52 56 45 4e | 54 49 4f 4e 2e 20 20 20 |INTERVEN|TION. |
|000026d0| 58 33 4d 4f 4e 54 48 53 | 20 20 20 20 20 20 20 26 |X3MONTHS| &|
|000026e0| 00 00 00 4a 32 52 20 20 | 20 48 41 53 20 41 20 4e |...J2R | HAS A N|
|000026f0| 4f 20 43 50 52 20 52 45 | 51 55 45 53 54 2e 20 20 |O CPR RE|QUEST. |
|00002700| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002710| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002720| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002730| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002740| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 52 45 53 | | RES|
|00002750| 49 44 45 4e 54 20 57 49 | 4c 4c 20 42 45 20 4b 45 |IDENT WI|LL BE KE|
|00002760| 50 54 20 43 4f 4d 46 4f | 52 54 41 42 4c 45 3a 48 |PT COMFO|RTABLE:H|
|00002770| 4f 4e 4f 52 20 52 45 51 | 55 45 53 54 2e 20 20 50 |ONOR REQ|UEST. P|
|00002780| 41 49 4e 20 52 45 4c 49 | 45 56 45 44 20 57 49 54 |AIN RELI|EVED WIT|
|00002790| 48 49 4e 20 4f 4e 45 20 | 48 4f 55 52 20 49 4e 54 |HIN ONE |HOUR INT|
|000027a0| 45 52 56 45 4e 54 49 4f | 4e 2e 33 4d 4f 4e 54 48 |ERVENTIO|N.3MONTH|
|000027b0| 53 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |S.......|........|
|000027c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000027d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000027e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000027f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002800| 02 15 00 00 00 13 00 00 | 00 0a 00 00 00 27 00 00 |........|.....'..|
|00002810| 00 4b 31 46 20 20 20 45 | 4c 45 56 41 54 45 44 20 |.K1F E|LEVATED |
|00002820| 54 45 4d 50 45 52 41 54 | 55 52 45 20 46 52 4f 4d |TEMPERAT|URE FROM|
|00002830| 3a 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |: | |
|00002840| 20 20 20 20 20 20 20 20 | 20 50 4f 54 45 4e 54 49 | | POTENTI|
|00002850| 41 4c 20 46 4f 52 20 44 | 45 48 59 44 52 41 54 49 |AL FOR D|EHYDRATI|
|00002860| 4f 4e 3a 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |ON: | |
|00002870| 20 20 20 20 20 20 20 20 | 20 20 20 54 45 4d 50 45 | | TEMPE|
|00002880| 52 41 54 55 52 45 20 57 | 49 4c 4c 20 42 45 20 42 |RATURE W|ILL BE B|
|00002890| 45 4c 4f 57 20 31 30 30 | 20 44 45 47 52 45 45 53 |ELOW 100| DEGREES|
|000028a0| 20 46 4f 52 20 5f 5f 44 | 41 59 53 20 20 20 20 20 | FOR __D|AYS |
|000028b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000028c0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000028d0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 28 | | (|
|000028e0| 00 00 00 4b 31 4e 20 20 | 20 50 4f 54 45 4e 54 49 |...K1N | POTENTI|
|000028f0| 41 4c 20 46 4f 52 20 44 | 45 48 59 52 41 54 49 4f |AL FOR D|EHYRATIO|
|00002900| 4e 20 44 55 45 20 54 4f | 20 56 4f 4d 49 54 49 4e |N DUE TO| VOMITIN|
|00002910| 47 3a 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |G: | |
|00002920| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002930| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002940| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00002950| 4c 20 48 41 56 45 20 47 | 4f 4f 44 20 53 4b 49 4e |L HAVE G|OOD SKIN|
|00002960| 20 54 55 52 47 4f 52 2e | 20 20 20 20 20 20 20 20 | TURGOR.| |
|00002970| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002980| 58 5f 5f 5f 5f 5f 44 41 | 59 53 2e 20 20 20 20 20 |X_____DA|YS. |
|00002990| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000029a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000029b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000029c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000029d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000029e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000029f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002a00| 02 16 00 00 00 14 00 00 | 00 0b 00 00 00 29 00 00 |........|.....)..|
|00002a10| 00 4c 33 41 20 20 20 43 | 4f 4d 50 4c 41 49 4e 53 |.L3A C|OMPLAINS|
|00002a20| 20 41 42 4f 55 54 20 54 | 48 45 20 54 41 53 54 45 | ABOUT T|HE TASTE|
|00002a30| 20 4f 46 20 46 4f 4f 44 | 2e 20 20 20 20 20 20 20 | OF FOOD|. |
|00002a40| 20 20 20 20 20 20 20 20 | 20 50 4f 54 45 4e 54 49 | | POTENTI|
|00002a50| 41 4c 20 46 4f 52 20 57 | 45 49 47 48 54 20 4c 4f |AL FOR W|EIGHT LO|
|00002a60| 53 53 2e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |SS. | |
|00002a70| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00002a80| 45 41 54 20 38 30 2d 31 | 30 30 25 20 4f 46 20 44 |EAT 80-1|00% OF D|
|00002a90| 49 45 54 2e 20 20 20 20 | 20 20 20 20 20 20 20 20 |IET. | |
|00002aa0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002ab0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002ac0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002ad0| 58 33 4d 4f 4e 54 48 53 | 2e 20 20 20 20 20 20 2a |X3MONTHS|. *|
|00002ae0| 00 00 00 4c 34 44 20 20 | 20 4e 45 45 44 53 20 54 |...L4D | NEEDS T|
|00002af0| 4f 20 42 45 20 46 45 44 | 20 42 59 20 53 59 52 49 |O BE FED| BY SYRI|
|00002b00| 4e 47 45 20 44 55 45 20 | 54 4f 3a 20 20 20 20 20 |NGE DUE |TO: |
|00002b10| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002b20| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002b30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002b40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00002b50| 4c 20 43 4f 4e 53 55 4d | 45 20 38 30 2d 31 30 30 |L CONSUM|E 80-100|
|00002b60| 25 20 4f 46 20 44 49 45 | 54 20 44 41 49 4c 59 2e |% OF DIE|T DAILY.|
|00002b70| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002b80| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002b90| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002ba0| 20 20 20 20 20 58 33 4d | 4f 4e 54 48 53 2e 20 20 | X3M|ONTHS. |
|00002bb0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00002bc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002bd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002be0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002bf0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002c00| 02 17 00 00 00 15 00 00 | 00 0b 00 00 00 2b 00 00 |........|.....+..|
|00002c10| 00 4d 31 46 20 20 20 48 | 41 53 20 4e 4f 20 54 45 |.M1F H|AS NO TE|
|00002c20| 45 54 48 20 4f 52 20 44 | 45 4e 54 55 52 45 53 20 |ETH OR D|ENTURES |
|00002c30| 44 55 45 20 54 4f 3a 20 | 20 20 20 20 20 20 20 20 |DUE TO: | |
|00002c40| 20 20 20 20 20 20 20 20 | 20 50 4f 54 45 4e 54 49 | | POTENTI|
|00002c50| 41 4c 20 46 4f 52 20 57 | 45 49 47 48 54 20 4c 4f |AL FOR W|EIGHT LO|
|00002c60| 53 53 2e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |SS. | |
|00002c70| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00002c80| 53 54 41 59 20 57 49 54 | 48 49 4e 20 49 42 57 20 |STAY WIT|HIN IBW |
|00002c90| 4f 46 3a 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |OF: | |
|00002ca0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002cb0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002cc0| 20 20 20 20 20 20 20 58 | 33 4d 4f 4e 54 48 53 2e | X|3MONTHS.|
|00002cd0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 2c | | ,|
|00002ce0| 00 00 00 4e 34 45 20 20 | 20 50 4f 54 45 4e 54 49 |...N4E | POTENTI|
|00002cf0| 41 4c 20 46 4f 52 20 44 | 45 43 55 42 49 54 55 53 |AL FOR D|ECUBITUS|
|00002d00| 20 55 4c 43 45 52 53 2e | 20 20 20 20 20 20 20 20 | ULCERS.| |
|00002d10| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002d20| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002d30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002d40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00002d50| 44 45 43 55 42 49 54 55 | 53 20 55 4c 43 45 52 20 |DECUBITU|S ULCER |
|00002d60| 46 4f 52 4d 41 54 49 4f | 4e 2e 20 20 20 20 20 20 |FORMATIO|N. |
|00002d70| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002d80| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002d90| 20 20 20 20 20 20 20 20 | 20 20 20 20 58 20 33 4d | | X 3M|
|00002da0| 4f 4e 54 48 53 2e 20 20 | 20 20 20 20 20 20 20 20 |ONTHS. | |
|00002db0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00002dc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002dd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002de0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002df0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002e00| 02 18 00 00 00 16 00 00 | 00 0c 00 00 00 2d 00 00 |........|.....-..|
|00002e10| 00 4f 35 43 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.O5C P|OTENTIAL|
|00002e20| 20 46 4f 52 20 49 52 52 | 45 47 55 4c 41 52 20 50 | FOR IRR|EGULAR P|
|00002e30| 55 4c 53 45 20 41 4e 44 | 20 43 48 45 53 54 20 50 |ULSE AND| CHEST P|
|00002e40| 41 49 4e 53 3a 20 20 20 | 20 53 45 43 4f 4e 44 41 |AINS: | SECONDA|
|00002e50| 52 59 20 54 4f 20 48 49 | 53 54 4f 52 59 20 4f 46 |RY TO HI|STORY OF|
|00002e60| 20 48 45 41 52 54 20 44 | 49 53 45 41 53 45 2e 20 | HEART D|ISEASE. |
|00002e70| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00002e80| 4e 4f 54 20 48 41 56 45 | 20 43 48 45 53 54 20 50 |NOT HAVE| CHEST P|
|00002e90| 41 49 4e 53 2e 20 20 20 | 20 20 20 20 20 20 20 20 |AINS. | |
|00002ea0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 50 55 4c | | PUL|
|00002eb0| 53 45 20 57 49 4c 4c 20 | 42 45 20 36 30 2d 38 30 |SE WILL |BE 60-80|
|00002ec0| 2e 20 20 20 20 20 20 20 | 20 20 20 20 20 20 58 33 |. | X3|
|00002ed0| 4d 4f 4e 54 48 53 20 20 | 20 20 20 20 20 20 20 2e |MONTHS | .|
|00002ee0| 00 00 00 50 31 44 20 20 | 20 4d 41 59 20 4e 45 45 |...P1D | MAY NEE|
|00002ef0| 44 20 53 55 43 54 49 4f | 4e 49 4e 47 20 46 4f 52 |D SUCTIO|NING FOR|
|00002f00| 3a 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |: | |
|00002f10| 20 20 20 20 20 20 20 20 | 20 20 20 53 45 43 52 45 | | SECRE|
|00002f20| 54 49 4f 4e 20 42 55 49 | 4c 44 20 55 50 3e 20 20 |TION BUI|LD UP> |
|00002f30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00002f40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 43 4f 4e | | CON|
|00002f50| 47 45 53 54 49 4f 4e 20 | 57 49 4c 4c 20 42 45 20 |GESTION |WILL BE |
|00002f60| 52 45 4c 49 45 56 45 44 | 20 57 49 54 48 49 4e 20 |RELIEVED| WITHIN |
|00002f70| 35 20 4d 49 4e 55 54 45 | 53 20 20 20 20 20 20 4f |5 MINUTE|S O|
|00002f80| 46 20 49 4e 54 45 52 56 | 45 4e 54 49 4f 4e 2e 20 |F INTERV|ENTION. |
|00002f90| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 58 33 | | X3|
|00002fa0| 4d 4f 4e 54 48 53 2e 20 | 20 20 20 20 20 20 20 20 |MONTHS. | |
|00002fb0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00002fc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002fd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002fe0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002ff0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003000| 02 00 00 00 00 17 00 00 | 00 0c 00 00 00 2f 00 00 |........|...../..|
|00003010| 00 50 33 43 20 20 20 4e | 45 45 44 53 20 4d 49 54 |.P3C N|EEDS MIT|
|00003020| 54 45 4e 28 53 29 20 52 | 45 53 54 52 41 49 4e 28 |TEN(S) R|ESTRAIN(|
|00003030| 53 29 20 54 4f 3a 20 5f | 5f 5f 5f 5f 5f 48 41 4e |S) TO: _|_____HAN|
|00003040| 44 20 20 20 20 20 20 20 | 20 54 4f 20 50 52 45 56 |D | TO PREV|
|00003050| 45 4e 54 20 49 4e 4a 55 | 52 59 20 44 55 45 20 54 |ENT INJU|RY DUE T|
|00003060| 4f 3a 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |O: | |
|00003070| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00003080| 4e 4f 54 20 50 55 4c 4c | 20 54 55 42 45 20 4f 55 |NOT PULL| TUBE OU|
|00003090| 54 2e 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |T. | |
|000030a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|000030b0| 49 4e 4a 55 52 49 45 53 | 20 44 41 49 4c 59 2e 4e |INJURIES| DAILY.N|
|000030c0| 4f 20 42 45 48 41 56 49 | 4f 52 20 50 52 4f 42 4c |O BEHAVI|OR PROBL|
|000030d0| 45 4d 53 2e 58 33 4d 4f | 4e 54 48 53 2e 20 20 30 |EMS.X3MO|NTHS. 0|
|000030e0| 00 00 00 50 33 44 20 20 | 20 4e 45 45 44 53 5f 5f |...P3D | NEEDS__|
|000030f0| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 43 48 41 |________|_____CHA|
|00003100| 49 52 20 57 48 49 43 48 | 20 50 52 45 56 45 4e 54 |IR WHICH| PREVENT|
|00003110| 53 20 20 20 20 20 20 20 | 20 20 20 52 49 53 49 4e |S | RISIN|
|00003120| 47 20 54 4f 20 50 52 45 | 56 45 4e 54 20 49 4e 4a |G TO PRE|VENT INJ|
|00003130| 55 52 59 20 44 55 45 20 | 54 4f 3a 20 20 20 20 20 |URY DUE |TO: |
|00003140| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00003150| 49 4e 4a 55 52 49 45 53 | 20 44 41 49 4c 59 2e 20 |INJURIES| DAILY. |
|00003160| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003170| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4e | | N|
|00003180| 4f 20 42 45 48 41 56 49 | 4f 52 20 50 52 4f 42 4c |O BEHAVI|OR PROBL|
|00003190| 45 4d 53 20 44 55 45 20 | 54 4f 20 43 48 41 49 52 |EMS DUE |TO CHAIR|
|000031a0| 2e 20 20 20 58 33 4d 4f | 4e 54 48 53 20 20 20 20 |. X3MO|NTHS |
|000031b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000031c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000031d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000031e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000031f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003200| 02 1a 00 00 00 00 00 00 | 00 0d 00 00 00 31 00 00 |........|.....1..|
|00003210| 00 42 33 20 20 20 20 43 | 4f 4d 50 52 4f 4d 49 53 |.B3 C|OMPROMIS|
|00003220| 45 44 20 4d 45 4d 4f 52 | 59 20 52 45 43 41 4c 4c |ED MEMOR|Y RECALL|
|00003230| 20 41 42 49 4c 49 54 59 | 20 20 20 20 20 20 20 20 | ABILITY| |
|00003240| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003250| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003260| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003270| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00003280| 4b 4e 4f 57 3a 20 20 20 | 20 20 20 20 20 20 20 20 |KNOW: | |
|00003290| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000032a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|000032b0| 4c 20 41 54 54 45 4e 44 | 20 41 43 54 49 56 49 54 |L ATTEND| ACTIVIT|
|000032c0| 49 45 53 20 44 41 49 4c | 59 3a 20 20 20 20 20 20 |IES DAIL|Y: |
|000032d0| 20 20 20 20 20 20 20 58 | 33 4d 4f 4e 54 48 53 32 | X|3MONTHS2|
|000032e0| 00 00 00 43 31 20 20 20 | 20 48 41 53 20 48 45 41 |...C1 | HAS HEA|
|000032f0| 52 49 4e 47 20 44 45 46 | 49 43 49 54 3a 20 20 20 |RING DEF|ICIT: |
|00003300| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003310| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 48 45 | | NO HE|
|00003320| 41 52 49 4e 47 20 41 49 | 44 45 20 44 55 45 20 54 |ARING AI|DE DUE T|
|00003330| 4f 3a 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |O: | |
|00003340| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00003350| 4c 20 48 41 56 45 20 4e | 45 45 44 53 20 43 4f 4d |L HAVE N|EEDS COM|
|00003360| 4d 55 4e 49 43 41 54 45 | 44 20 45 56 45 52 59 20 |MUNICATE|D EVERY |
|00003370| 53 48 49 46 54 20 42 59 | 3a 20 20 20 20 20 20 20 |SHIFT BY|: |
|00003380| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003390| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000033a0| 20 58 33 4d 4f 4e 54 48 | 53 20 20 20 20 20 20 20 | X3MONTH|S |
|000033b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000033c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000033d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000033e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000033f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003400| 02 1b 00 00 00 19 00 00 | 00 0d 00 00 00 33 00 00 |........|.....3..|
|00003410| 00 44 31 20 20 20 20 49 | 4d 50 41 49 52 45 44 20 |.D1 I|MPAIRED |
|00003420| 56 49 53 55 41 4c 20 46 | 55 4e 43 54 49 4f 4e 49 |VISUAL F|UNCTIONI|
|00003430| 4e 47 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |NG | |
|00003440| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003450| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003460| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003470| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00003480| 48 41 56 45 20 4e 4f 20 | 49 4e 4a 55 52 49 45 53 |HAVE NO |INJURIES|
|00003490| 20 44 41 49 4c 59 20 20 | 20 20 20 20 20 20 20 20 | DAILY | |
|000034a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000034b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000034c0| 20 58 33 4d 4f 4e 54 48 | 53 20 20 20 20 20 20 20 | X3MONTH|S |
|000034d0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 34 | | 4|
|000034e0| 00 00 00 45 31 42 20 20 | 20 44 45 50 45 4e 44 45 |...E1B | DEPENDE|
|000034f0| 4e 54 2f 4e 45 45 44 53 | 20 41 53 53 49 53 54 41 |NT/NEEDS| ASSISTA|
|00003500| 4e 43 45 20 46 52 4f 4d | 20 53 54 41 46 46 20 46 |NCE FROM| STAFF F|
|00003510| 4f 52 20 54 52 41 4e 53 | 46 45 52 50 4f 54 45 4e |OR TRANS|FERPOTEN|
|00003520| 54 49 41 4c 20 46 4f 52 | 20 46 41 4c 4c 53 2e 20 |TIAL FOR| FALLS. |
|00003530| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003540| 33 58 4d 4f 4e 54 48 20 | 20 20 20 20 20 4e 4f 20 |3XMONTH | NO |
|00003550| 46 41 4c 4c 53 2e 20 20 | 20 20 20 20 20 20 20 20 |FALLS. | |
|00003560| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003570| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003580| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003590| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000035a0| 20 58 33 4d 4f 4e 54 48 | 53 20 20 20 20 20 20 20 | X3MONTH|S |
|000035b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000035c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000035d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000035e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000035f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003600| 02 1c 00 00 00 1a 00 00 | 00 0e 00 00 00 35 00 00 |........|.....5..|
|00003610| 00 45 31 46 20 20 20 44 | 45 50 45 4e 44 45 4e 54 |.E1F D|EPENDENT|
|00003620| 2f 4e 45 45 44 53 20 41 | 53 53 49 53 54 41 4e 43 |/NEEDS A|SSISTANC|
|00003630| 45 20 42 59 20 53 54 41 | 46 46 20 46 4f 52 20 54 |E BY STA|FF FOR T|
|00003640| 4f 49 4c 45 54 20 55 53 | 45 20 20 20 20 20 20 20 |OILET US|E |
|00003650| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003660| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003670| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00003680| 55 53 45 20 54 4f 49 4c | 45 54 2f 42 45 44 20 50 |USE TOIL|ET/BED P|
|00003690| 41 4e 20 51 20 53 48 49 | 46 54 20 20 2f 41 53 20 |AN Q SHI|FT /AS |
|000036a0| 4e 45 45 44 45 44 20 20 | 20 20 20 20 20 20 20 20 |NEEDED | |
|000036b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000036c0| 20 20 20 20 20 20 20 20 | 20 20 20 20 58 33 4d 4f | | X3MO|
|000036d0| 4e 54 48 53 20 20 20 20 | 20 20 20 20 20 20 20 36 |NTHS | 6|
|000036e0| 00 00 00 45 34 42 20 20 | 20 42 45 44 46 41 53 54 |...E4B | BEDFAST|
|000036f0| 20 4d 4f 53 54 20 4f 46 | 20 54 48 45 20 54 49 4d | MOST OF| THE TIM|
|00003700| 45 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |E | |
|00003710| 20 20 20 20 20 20 20 20 | 20 20 20 50 4f 54 45 4e | | POTEN|
|00003720| 54 49 41 4c 20 46 4f 52 | 20 53 4b 49 4e 20 42 52 |TIAL FOR| SKIN BR|
|00003730| 45 41 4b 44 4f 57 4e 2c | 46 41 4c 4c 53 20 20 20 |EAKDOWN,|FALLS |
|00003740| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00003750| 53 4b 49 4e 20 42 52 45 | 41 4b 44 4f 57 4e 20 51 |SKIN BRE|AKDOWN Q|
|00003760| 20 53 48 49 46 54 2e 20 | 20 20 20 20 20 20 20 20 | SHIFT. | |
|00003770| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4e | | N|
|00003780| 4f 20 46 41 4c 4c 53 20 | 20 20 20 20 20 20 20 20 |O FALLS | |
|00003790| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000037a0| 20 20 20 58 33 4d 4f 4e | 54 48 53 20 20 20 20 20 | X3MON|THS |
|000037b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000037c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000037d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000037e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000037f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003800| 02 1d 00 00 00 1b 00 00 | 00 0e 00 00 00 37 00 00 |........|.....7..|
|00003810| 00 45 34 46 20 20 20 4c | 4f 53 53 20 4f 46 20 56 |.E4F L|OSS OF V|
|00003820| 4f 4c 55 4e 54 41 52 59 | 20 4d 4f 56 45 4d 45 4e |OLUNTARY| MOVEMEN|
|00003830| 54 20 4f 46 3a 20 20 20 | 20 20 20 20 20 20 20 20 |T OF: | |
|00003840| 20 20 20 20 20 20 20 20 | 20 50 4f 54 45 4e 54 49 | | POTENTI|
|00003850| 41 4c 20 46 4f 52 20 43 | 4f 4e 54 52 41 43 54 55 |AL FOR C|ONTRACTU|
|00003860| 52 45 53 3a 20 20 20 20 | 20 20 20 20 20 20 20 20 |RES: | |
|00003870| 20 33 58 4d 4f 4e 54 48 | 53 20 20 4e 4f 20 43 4f | 3XMONTH|S NO CO|
|00003880| 4e 54 52 41 43 54 55 52 | 45 53 3a 20 20 20 20 20 |NTRACTUR|ES: |
|00003890| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000038a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000038b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000038c0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 58 33 | | X3|
|000038d0| 4d 4f 4e 54 48 53 20 20 | 20 20 20 20 20 20 20 38 |MONTHS | 8|
|000038e0| 00 00 00 45 34 4a 20 20 | 20 55 4e 41 42 4c 45 20 |...E4J | UNABLE |
|000038f0| 54 4f 20 54 55 52 4e 20 | 41 4e 44 20 52 45 50 4f |TO TURN |AND REPO|
|00003900| 53 49 54 49 4f 4e 20 53 | 45 4c 46 3a 20 20 20 20 |SITION S|ELF: |
|00003910| 20 20 20 20 20 20 20 20 | 20 20 20 50 4f 54 45 4e | | POTEN|
|00003920| 54 49 41 4c 20 46 4f 52 | 20 53 4b 49 4e 20 42 52 |TIAL FOR| SKIN BR|
|00003930| 45 41 4b 44 4f 57 4e 2e | 20 20 20 20 20 20 20 20 |EAKDOWN.| |
|00003940| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00003950| 44 45 43 55 42 49 54 55 | 53 20 46 4f 52 4d 41 54 |DECUBITU|S FORMAT|
|00003960| 49 4f 4e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |ION | |
|00003970| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4e | | N|
|00003980| 4f 20 46 41 4c 4c 53 2e | 20 20 20 20 20 20 20 20 |O FALLS.| |
|00003990| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000039a0| 58 33 4d 4f 4e 54 48 53 | 20 20 20 20 20 20 20 20 |X3MONTHS| |
|000039b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000039c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000039d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000039e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000039f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003a00| 02 1e 00 00 00 1c 00 00 | 00 0f 00 00 00 39 00 00 |........|.....9..|
|00003a10| 00 46 31 41 20 20 20 49 | 4e 43 4f 4e 54 49 4e 45 |.F1A I|NCONTINE|
|00003a20| 4e 54 20 4f 46 20 42 4f | 57 45 4c 2d 55 4e 41 42 |NT OF BO|WEL-UNAB|
|00003a30| 4c 45 20 54 4f 20 52 45 | 54 52 41 49 4e 20 44 55 |LE TO RE|TRAIN DU|
|00003a40| 45 20 54 4f 3a 20 20 20 | 20 50 4f 54 45 4e 54 49 |E TO: | POTENTI|
|00003a50| 41 4c 20 46 4f 52 20 53 | 4b 49 4e 20 42 52 45 41 |AL FOR S|KIN BREA|
|00003a60| 4b 44 4f 57 4e 3a 20 20 | 20 20 20 20 20 20 20 20 |KDOWN: | |
|00003a70| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00003a80| 42 45 20 43 4c 45 41 4e | 20 41 4e 44 20 44 52 59 |BE CLEAN| AND DRY|
|00003a90| 20 41 4e 44 20 46 52 45 | 45 20 4f 46 20 42 4f 44 | AND FRE|E OF BOD|
|00003aa0| 59 20 4f 44 4f 52 53 2e | 20 20 20 20 20 4e 4f 20 |Y ODORS.| NO |
|00003ab0| 44 45 43 55 42 49 54 55 | 53 20 46 4f 52 4d 41 54 |DECUBITU|S FORMAT|
|00003ac0| 49 4f 4e 2e 20 20 20 20 | 20 20 20 20 20 20 20 20 |ION. | |
|00003ad0| 20 20 20 58 33 4d 4f 4e | 54 48 53 20 20 20 20 3a | X3MON|THS :|
|00003ae0| 00 00 00 46 33 43 20 20 | 20 54 45 4e 44 45 4e 43 |...F3C | TENDENC|
|00003af0| 59 20 54 4f 20 55 54 49 | 20 44 55 45 20 54 4f 20 |Y TO UTI| DUE TO |
|00003b00| 49 4e 44 57 45 4c 4c 49 | 4e 47 20 43 41 54 48 45 |INDWELLI|NG CATHE|
|00003b10| 54 45 52 2e 20 20 20 20 | 20 20 20 4d 55 53 54 20 |TER. | MUST |
|00003b20| 48 41 56 45 20 43 41 54 | 48 45 54 45 52 20 44 55 |HAVE CAT|HETER DU|
|00003b30| 45 20 54 4f 3a 20 20 20 | 20 20 20 20 20 20 20 20 |E TO: | |
|00003b40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00003b50| 53 49 47 4e 53 20 4f 52 | 20 53 59 4d 50 54 4f 4d |SIGNS OR| SYMPTOM|
|00003b60| 53 20 4f 46 20 55 54 49 | 3a 20 20 20 20 20 20 20 |S OF UTI|: |
|00003b70| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 46 | | F|
|00003b80| 45 56 45 52 2c 43 4c 4f | 55 44 59 20 55 52 49 4e |EVER,CLO|UDY URIN|
|00003b90| 45 2c 42 4c 4f 4f 44 59 | 20 55 52 49 4e 45 2c 44 |E,BLOODY| URINE,D|
|00003ba0| 49 53 43 4f 4c 4f 52 45 | 44 20 55 52 49 4e 45 2e |ISCOLORE|D URINE.|
|00003bb0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00003bc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003bd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003be0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003bf0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003c00| 02 1f 00 00 00 1d 00 00 | 00 0f 00 00 00 3b 00 00 |........|.....;..|
|00003c10| 00 46 33 47 20 20 20 4e | 45 45 44 53 20 50 45 52 |.F3G N|EEDS PER|
|00003c20| 49 4f 44 49 43 3a 20 20 | 20 20 20 20 20 20 20 20 |IODIC: | |
|00003c30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003c40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003c50| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003c60| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003c70| 20 20 20 20 20 20 20 20 | 20 20 20 5f 5f 5f 5f 5f | | _____|
|00003c80| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 57 49 4c |________|_____WIL|
|00003c90| 4c 20 4b 45 45 50 3a 20 | 20 20 20 20 20 20 20 20 |L KEEP: | |
|00003ca0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 5f 5f 5f | | ___|
|00003cb0| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 46 55 4e 43 54 49 |________|__FUNCTI|
|00003cc0| 4f 4e 49 4e 47 20 41 53 | 20 4e 45 45 44 45 44 20 |ONING AS| NEEDED |
|00003cd0| 41 4e 44 20 4f 52 44 45 | 52 45 44 2e 20 20 20 3c |AND ORDE|RED. <|
|00003ce0| 00 00 00 47 32 20 20 20 | 20 55 4e 53 45 54 54 4c |...G2 | UNSETTL|
|00003cf0| 45 44 20 52 45 4c 41 54 | 49 4f 4e 53 48 49 50 20 |ED RELAT|IONSHIP |
|00003d00| 57 49 54 48 3a 20 20 20 | 20 20 20 20 20 20 20 20 |WITH: | |
|00003d10| 20 20 20 20 20 20 20 20 | 20 20 20 55 4e 48 41 50 | | UNHAP|
|00003d20| 50 49 4e 45 53 53 20 57 | 49 54 48 3a 20 20 20 20 |PINESS W|ITH: |
|00003d30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003d40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00003d50| 4c 20 42 45 20 52 45 53 | 4f 4c 56 45 44 20 41 53 |L BE RES|OLVED AS|
|00003d60| 20 44 45 4d 4f 4e 53 54 | 52 41 54 45 44 20 42 59 | DEMONST|RATED BY|
|00003d70| 20 56 45 52 42 41 4c 49 | 5a 41 54 49 4f 4e 20 4f | VERBALI|ZATION O|
|00003d80| 46 20 50 4f 53 49 54 49 | 56 45 20 46 45 45 4c 49 |F POSITI|VE FEELI|
|00003d90| 4e 47 53 2e 20 20 20 20 | 20 20 20 20 20 20 20 20 |NGS. | |
|00003da0| 20 20 20 20 20 58 33 4d | 4f 4e 54 48 53 20 20 20 | X3M|ONTHS |
|00003db0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00003dc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003dd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003de0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003df0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003e00| 02 20 00 00 00 1e 00 00 | 00 10 00 00 00 3d 00 00 |. ......|.....=..|
|00003e10| 00 48 33 41 20 20 20 57 | 41 4e 44 45 52 53 3a 20 |.H3A W|ANDERS: |
|00003e20| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003e30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003e40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003e50| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003e60| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003e70| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00003e80| 4e 4f 54 20 57 41 4e 44 | 45 52 20 4f 55 54 20 4f |NOT WAND|ER OUT O|
|00003e90| 46 20 46 41 43 49 4c 49 | 54 59 20 51 20 53 48 49 |F FACILI|TY Q SHI|
|00003ea0| 46 54 2e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |FT. | |
|00003eb0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003ec0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 58 | | X|
|00003ed0| 33 4d 4f 4e 54 48 53 20 | 20 20 20 20 20 20 20 3e |3MONTHS | >|
|00003ee0| 00 00 00 48 34 20 20 20 | 20 52 45 53 49 44 45 4e |...H4 | RESIDEN|
|00003ef0| 54 20 52 45 53 49 53 54 | 53 20 43 41 52 45 3a 20 |T RESIST|S CARE: |
|00003f00| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003f10| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003f20| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003f30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003f40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00003f50| 4c 20 48 41 56 45 20 41 | 44 4c 20 4e 45 45 44 53 |L HAVE A|DL NEEDS|
|00003f60| 20 4d 45 54 20 51 20 53 | 48 49 46 54 53 20 20 20 | MET Q S|HIFTS |
|00003f70| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003f80| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00003f90| 20 20 20 20 20 20 20 20 | 20 20 20 20 58 33 4d 4f | | X3MO|
|00003fa0| 4e 54 48 53 20 20 20 20 | 20 20 20 20 20 20 20 20 |NTHS | |
|00003fb0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00003fc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003fd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003fe0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003ff0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004000| 02 21 00 00 00 1f 00 00 | 00 10 00 00 00 3f 00 00 |.!......|.....?..|
|00004010| 00 49 32 31 20 20 20 53 | 50 45 4e 44 53 20 4c 49 |.I21 S|PENDS LI|
|00004020| 54 54 4c 45 20 54 49 4d | 45 20 49 4e 20 41 43 54 |TTLE TIM|E IN ACT|
|00004030| 49 56 49 54 49 45 53 20 | 44 55 45 20 54 4f 3a 20 |IVITIES |DUE TO: |
|00004040| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004050| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004060| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004070| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00004080| 41 54 54 45 4e 44 20 41 | 54 20 4c 45 41 53 54 20 |ATTEND A|T LEAST |
|00004090| 33 20 41 43 54 49 56 49 | 54 49 45 53 20 50 45 52 |3 ACTIVI|TIES PER|
|000040a0| 20 57 45 45 4b 20 20 20 | 20 20 20 20 20 20 20 20 | WEEK | |
|000040b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000040c0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 58 | | X|
|000040d0| 33 4d 4f 4e 54 48 53 20 | 20 20 20 20 20 20 20 40 |3MONTHS | @|
|000040e0| 00 00 00 49 35 20 20 20 | 20 50 52 45 46 45 52 53 |...I5 | PREFERS|
|000040f0| 20 4f 54 48 45 52 20 41 | 43 54 49 56 49 54 49 45 | OTHER A|CTIVITIE|
|00004100| 53 3a 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |S: | |
|00004110| 20 20 20 20 20 20 20 20 | 20 20 20 5f 5f 5f 5f 5f | | _____|
|00004120| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 20 20 20 5f |________|____ _|
|00004130| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 5f 20 20 |________|______ |
|00004140| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 57 49 4c |________|_____WIL|
|00004150| 4c 20 50 41 52 54 49 43 | 49 50 41 54 45 20 49 4e |L PARTIC|IPATE IN|
|00004160| 20 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 5f 5f 5f 5f 5f | _______|________|
|00004170| 5f 5f 5f 5f 41 43 54 49 | 56 49 54 49 45 53 20 4f |____ACTI|VITIES O|
|00004180| 46 20 50 52 45 46 45 52 | 45 4e 43 45 20 50 45 52 |F PREFER|ENCE PER|
|00004190| 20 57 45 45 4b 2e 20 20 | 20 20 20 20 20 20 20 20 | WEEK. | |
|000041a0| 20 20 58 33 4d 4f 4e 54 | 48 53 20 20 20 20 20 20 | X3MONT|HS |
|000041b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000041c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000041d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000041e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000041f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004200| 02 22 00 00 00 20 00 00 | 00 11 00 00 00 41 00 00 |."... ..|.....A..|
|00004210| 00 4a 31 42 42 20 20 50 | 4f 54 45 4e 54 41 49 4c |.J1BB P|OTENTAIL|
|00004220| 20 46 4f 52 20 53 50 4f | 4e 54 41 4e 45 4f 55 53 | FOR SPO|NTANEOUS|
|00004230| 20 46 52 41 43 54 55 52 | 45 53 20 44 55 45 20 54 | FRACTUR|ES DUE T|
|00004240| 4f 20 20 20 20 20 20 20 | 20 4f 53 54 45 4f 50 4f |O | OSTEOPO|
|00004250| 52 53 49 53 20 20 20 20 | 20 20 20 20 20 20 20 20 |RSIS | |
|00004260| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004270| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 46 52 | | NO FR|
|00004280| 41 43 54 55 52 45 53 20 | 20 20 20 20 20 20 20 20 |ACTURES | |
|00004290| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000042a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000042b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000042c0| 20 20 20 20 20 58 33 4d | 4f 4e 54 48 53 20 20 20 | X3M|ONTHS |
|000042d0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 42 | | B|
|000042e0| 00 00 00 4a 31 44 44 20 | 20 50 4f 54 45 4e 54 49 |...J1DD | POTENTI|
|000042f0| 41 4c 20 46 4f 52 20 45 | 4c 45 56 41 54 45 44 20 |AL FOR E|LEVATED |
|00004300| 54 45 4d 50 45 52 41 54 | 55 52 45 2f 44 45 48 59 |TEMPERAT|URE/DEHY|
|00004310| 44 52 41 54 49 4f 4e 20 | 20 20 20 46 52 4f 4d 20 |DRATION | FROM |
|00004320| 53 45 50 54 49 43 45 4d | 49 41 20 20 20 20 20 20 |SEPTICEM|IA |
|00004330| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004340| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 54 45 4d | | TEM|
|00004350| 50 45 52 41 54 55 52 45 | 20 57 49 4c 4c 20 42 45 |PERATURE| WILL BE|
|00004360| 20 42 45 4c 4f 57 20 31 | 30 30 20 44 45 47 52 45 | BELOW 1|00 DEGRE|
|00004370| 45 53 20 46 4f 52 20 5f | 5f 5f 44 41 59 53 20 57 |ES FOR _|__DAYS W|
|00004380| 49 4c 4c 20 48 41 56 45 | 20 47 4f 4f 44 20 53 4b |ILL HAVE| GOOD SK|
|00004390| 49 4e 20 54 55 52 47 4f | 52 2e 20 20 20 20 20 20 |IN TURGO|R. |
|000043a0| 20 20 20 58 33 4d 4f 4e | 54 48 53 20 20 20 20 20 | X3MON|THS |
|000043b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000043c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000043d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000043e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000043f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004400| 02 23 00 00 00 21 00 00 | 00 11 00 00 00 43 00 00 |.#...!..|.....C..|
|00004410| 00 4a 31 47 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.J1G P|OTENTIAL|
|00004420| 20 46 4f 52 20 49 52 52 | 45 47 55 4c 41 52 20 50 | FOR IRR|EGULAR P|
|00004430| 55 4c 53 45 20 41 4e 44 | 20 43 48 45 53 54 20 50 |ULSE AND| CHEST P|
|00004440| 41 49 4e 53 20 20 20 20 | 20 53 45 43 4f 4e 44 41 |AINS | SECONDA|
|00004450| 52 59 20 54 4f 20 48 49 | 53 54 4f 52 59 20 4f 46 |RY TO HI|STORY OF|
|00004460| 20 48 45 41 52 54 20 44 | 49 53 45 41 53 45 2e 20 | HEART D|ISEASE. |
|00004470| 20 20 20 20 20 20 20 20 | 20 20 20 31 2e 57 49 4c | | 1.WIL|
|00004480| 4c 20 4e 4f 54 20 48 41 | 56 45 20 43 48 45 53 54 |L NOT HA|VE CHEST|
|00004490| 20 50 41 49 4e 53 2e 20 | 20 20 20 20 20 20 20 20 | PAINS. | |
|000044a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 32 2e 50 | | 2.P|
|000044b0| 55 4c 53 45 20 57 49 4c | 4c 20 42 45 20 36 30 2d |ULSE WIL|L BE 60-|
|000044c0| 38 30 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |80 | |
|000044d0| 20 20 58 33 4d 4f 4e 54 | 48 53 2e 20 20 20 20 44 | X3MONT|HS. D|
|000044e0| 00 00 00 4a 31 4b 20 20 | 20 50 4f 54 45 4e 54 49 |...J1K | POTENTI|
|000044f0| 41 4c 20 46 4f 52 20 4c | 4f 57 20 53 45 4c 46 20 |AL FOR L|OW SELF |
|00004500| 45 53 54 45 45 4d 20 53 | 45 43 4f 4e 44 41 52 59 |ESTEEM S|ECONDARY|
|00004510| 20 54 4f 20 43 56 41 20 | 20 20 20 4c 49 4d 49 54 | TO CVA | LIMIT|
|00004520| 45 44 20 4d 4f 56 45 4d | 45 4e 54 20 4f 46 3a 20 |ED MOVEM|ENT OF: |
|00004530| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004540| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00004550| 4c 20 53 4f 43 49 41 4c | 49 5a 45 20 44 41 49 4c |L SOCIAL|IZE DAIL|
|00004560| 59 20 57 49 54 48 20 50 | 45 45 52 53 2e 20 20 20 |Y WITH P|EERS. |
|00004570| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4e | | N|
|00004580| 4f 20 43 4f 4e 54 52 41 | 43 54 55 52 45 53 2e 20 |O CONTRA|CTURES. |
|00004590| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 58 33 | | X3|
|000045a0| 4d 4f 4e 54 48 53 20 20 | 20 20 20 20 20 20 20 20 |MONTHS | |
|000045b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000045c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000045d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000045e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000045f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004600| 02 24 00 00 00 22 00 00 | 00 12 00 00 00 45 00 00 |.$..."..|.....E..|
|00004610| 00 4a 31 4f 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.J1O P|OTENTIAL|
|00004620| 20 46 4f 52 20 53 48 4f | 52 54 4e 45 53 53 20 4f | FOR SHO|RTNESS O|
|00004630| 46 20 42 52 45 41 54 48 | 20 20 20 20 20 20 20 20 |F BREATH| |
|00004640| 20 20 20 20 20 20 20 20 | 20 44 55 45 20 54 4f 20 | | DUE TO |
|00004650| 50 4e 45 55 4d 4f 4e 49 | 41 20 20 20 20 20 20 20 |PNEUMONI|A |
|00004660| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004670| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 53 48 | | NO SH|
|00004680| 4f 52 54 4e 45 53 53 20 | 4f 46 20 42 52 45 41 54 |ORTNESS |OF BREAT|
|00004690| 48 2e 20 20 20 20 20 20 | 20 20 58 5f 5f 5f 5f 5f |H. | X_____|
|000046a0| 5f 5f 5f 44 41 59 53 2e | 20 20 20 20 20 20 20 20 |___DAYS.| |
|000046b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000046c0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000046d0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 46 | | F|
|000046e0| 00 00 00 4a 31 53 20 20 | 20 50 4f 54 45 4e 54 49 |...J1S | POTENTI|
|000046f0| 41 4c 20 46 4f 52 20 49 | 4d 50 41 49 52 45 44 20 |AL FOR I|MPAIRED |
|00004700| 56 49 53 55 41 4c 20 46 | 55 4e 43 54 49 4f 4e 49 |VISUAL F|UNCTIONI|
|00004710| 4e 47 20 44 55 45 20 54 | 4f 20 20 43 41 54 41 52 |NG DUE T|O CATAR|
|00004720| 41 43 54 53 3a 20 20 20 | 20 20 20 20 20 20 20 20 |ACTS: | |
|00004730| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004740| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00004750| 4c 20 48 41 56 45 20 4e | 4f 20 49 4e 4a 55 52 49 |L HAVE N|O INJURI|
|00004760| 45 53 20 44 41 49 4c 59 | 2e 20 20 20 20 20 20 20 |ES DAILY|. |
|00004770| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004780| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004790| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 58 | | X|
|000047a0| 33 4d 4f 4e 54 48 53 20 | 20 20 20 20 20 20 20 20 |3MONTHS | |
|000047b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000047c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000047d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000047e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000047f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004800| 02 25 00 00 00 23 00 00 | 00 12 00 00 00 47 00 00 |.%...#..|.....G..|
|00004810| 00 4a 31 58 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.J1X P|OTENTIAL|
|00004820| 20 46 4f 52 20 45 58 43 | 45 53 53 49 56 45 20 57 | FOR EXC|ESSIVE W|
|00004830| 45 41 4b 4e 45 53 53 20 | 41 4e 44 20 54 49 52 45 |EAKNESS |AND TIRE|
|00004840| 44 4e 45 53 53 2c 20 20 | 20 57 45 49 47 48 54 20 |DNESS, | WEIGHT |
|00004850| 4c 4f 53 53 2c 50 41 49 | 4e 2c 44 45 50 52 45 53 |LOSS,PAI|N,DEPRES|
|00004860| 53 49 4f 4e 20 46 52 4f | 4d 20 43 41 4e 43 45 52 |SION FRO|M CANCER|
|00004870| 20 50 52 4f 43 45 53 53 | 2e 20 20 57 49 4c 4c 20 | PROCESS|. WILL |
|00004880| 42 45 20 41 42 4c 45 20 | 54 4f 20 41 54 54 45 4e |BE ABLE |TO ATTEN|
|00004890| 44 20 41 43 54 49 56 49 | 54 49 45 53 20 44 41 49 |D ACTIVI|TIES DAI|
|000048a0| 4c 59 2e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |LY. | |
|000048b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000048c0| 20 20 20 20 20 20 58 33 | 4d 4f 4e 54 48 53 20 20 | X3|MONTHS |
|000048d0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 48 | | H|
|000048e0| 00 00 00 4a 32 42 20 20 | 20 50 4f 54 45 4e 54 49 |...J2B | POTENTI|
|000048f0| 41 4c 20 46 4f 52 20 43 | 4f 4e 53 54 49 50 41 54 |AL FOR C|ONSTIPAT|
|00004900| 49 4f 4e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |ION | |
|00004910| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004920| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004930| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004940| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00004950| 4c 20 48 41 56 45 20 42 | 4d 20 41 54 20 4c 45 41 |L HAVE B|M AT LEA|
|00004960| 53 54 20 45 56 45 52 59 | 20 54 48 52 45 45 20 44 |ST EVERY| THREE D|
|00004970| 41 59 53 2e 20 20 20 20 | 20 20 20 20 20 20 20 20 |AYS. | |
|00004980| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004990| 20 20 20 20 20 20 20 20 | 20 20 20 20 58 33 4d 4f | | X3MO|
|000049a0| 4e 54 48 53 20 20 20 20 | 20 20 20 20 20 20 20 20 |NTHS | |
|000049b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000049c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000049d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000049e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000049f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004a00| 02 26 00 00 00 24 00 00 | 00 13 00 00 00 49 00 00 |.&...$..|.....I..|
|00004a10| 00 4a 32 46 20 20 20 45 | 50 49 53 4f 44 45 53 20 |.J2F E|PISODES |
|00004a20| 4f 46 20 49 4e 53 4f 4d | 4e 49 41 20 20 20 20 20 |OF INSOM|NIA |
|00004a30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004a40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004a50| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004a60| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004a70| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00004a80| 53 4c 45 45 50 20 36 2d | 38 20 48 4f 55 52 53 20 |SLEEP 6-|8 HOURS |
|00004a90| 50 45 52 20 4e 49 47 48 | 54 2e 20 20 20 20 20 20 |PER NIGH|T. |
|00004aa0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004ab0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004ac0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004ad0| 58 33 4d 4f 4e 54 48 53 | 20 20 20 20 20 20 20 4a |X3MONTHS| J|
|00004ae0| 00 00 00 4a 32 4a 20 20 | 20 48 41 53 20 41 20 4e |...J2J | HAS A N|
|00004af0| 4f 20 43 50 52 20 52 45 | 51 55 45 53 54 2e 20 20 |O CPR RE|QUEST. |
|00004b00| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004b10| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004b20| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004b30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004b40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00004b50| 4c 20 42 45 20 4b 45 50 | 54 20 43 4f 4d 46 4f 52 |L BE KEP|T COMFOR|
|00004b60| 54 41 42 4c 45 2d 50 41 | 49 4e 20 57 49 4c 4c 20 |TABLE-PA|IN WILL |
|00004b70| 42 45 20 52 45 4c 49 45 | 56 45 44 20 20 20 20 57 |BE RELIE|VED W|
|00004b80| 49 54 48 49 4e 20 4f 4e | 45 20 48 4f 55 52 20 4f |ITHIN ON|E HOUR O|
|00004b90| 46 20 49 4e 54 45 52 56 | 45 4e 54 49 4f 4e 2e 20 |F INTERV|ENTION. |
|00004ba0| 20 20 58 33 4d 4f 4e 54 | 48 53 20 20 20 20 20 20 | X3MONT|HS |
|00004bb0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00004bc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004bd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004be0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004bf0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004c00| 02 27 00 00 00 25 00 00 | 00 13 00 00 00 4b 00 00 |.'...%..|.....K..|
|00004c10| 00 4a 32 4e 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.J2N P|OTENTIAL|
|00004c20| 20 46 4f 52 20 46 41 4c | 4c 53 20 44 55 45 20 54 | FOR FAL|LS DUE T|
|00004c30| 4f 20 45 50 49 53 4f 44 | 45 53 20 4f 46 20 56 45 |O EPISOD|ES OF VE|
|00004c40| 52 54 49 47 4f 20 20 20 | 20 4f 52 20 44 49 5a 5a |RTIGO | OR DIZZ|
|00004c50| 49 4e 45 53 53 2e 20 20 | 20 20 20 20 20 20 20 20 |INESS. | |
|00004c60| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004c70| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 49 4e | | NO IN|
|00004c80| 4a 55 52 49 45 53 20 46 | 52 4f 4d 20 46 41 4c 4c |JURIES F|ROM FALL|
|00004c90| 53 2e 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |S. | |
|00004ca0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004cb0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004cc0| 20 20 20 20 20 20 20 20 | 20 58 33 4d 4f 4e 54 48 | | X3MONTH|
|00004cd0| 53 2e 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4c |S. | L|
|00004ce0| 00 00 00 4a 32 52 20 20 | 20 48 41 53 20 41 20 4e |...J2R | HAS A N|
|00004cf0| 4f 20 43 50 52 20 52 45 | 51 55 45 53 54 2e 20 20 |O CPR RE|QUEST. |
|00004d00| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004d10| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004d20| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004d30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004d40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 52 45 53 | | RES|
|00004d50| 49 44 45 4e 54 20 57 49 | 4c 4c 20 42 45 20 4b 45 |IDENT WI|LL BE KE|
|00004d60| 50 54 20 43 4f 4d 46 4f | 52 54 41 42 4c 45 3a 48 |PT COMFO|RTABLE:H|
|00004d70| 4f 4e 4f 52 20 52 45 51 | 55 45 53 54 2e 20 20 50 |ONOR REQ|UEST. P|
|00004d80| 41 49 4e 20 52 45 4c 49 | 45 56 45 44 20 57 49 54 |AIN RELI|EVED WIT|
|00004d90| 48 49 4e 20 4f 4e 45 20 | 48 4f 55 52 20 49 4e 54 |HIN ONE |HOUR INT|
|00004da0| 45 52 56 45 4e 54 49 4f | 4e 2e 33 4d 4f 4e 54 48 |ERVENTIO|N.3MONTH|
|00004db0| 53 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |S.......|........|
|00004dc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004dd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004de0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004df0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004e00| 02 28 00 00 00 26 00 00 | 00 14 00 00 00 4d 00 00 |.(...&..|.....M..|
|00004e10| 00 4b 31 42 20 20 20 45 | 50 49 53 4f 44 45 53 20 |.K1B E|PISODES |
|00004e20| 4f 46 20 44 49 41 52 52 | 48 45 41 3a 20 20 20 20 |OF DIARR|HEA: |
|00004e30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004e40| 20 20 20 20 20 20 20 20 | 20 50 4f 54 45 4e 54 49 | | POTENTI|
|00004e50| 41 4c 20 46 4f 52 20 44 | 45 48 59 44 52 41 54 49 |AL FOR D|EHYDRATI|
|00004e60| 4f 4e 2e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |ON. | |
|00004e70| 20 20 20 20 20 20 20 20 | 20 20 20 52 45 53 49 44 | | RESID|
|00004e80| 45 4e 54 20 57 49 4c 4c | 20 48 41 56 45 20 4e 4f |ENT WILL| HAVE NO|
|00004e90| 20 4d 4f 52 45 20 54 48 | 45 4e 20 32 20 45 50 49 | MORE TH|EN 2 EPI|
|00004ea0| 53 4f 44 45 53 20 4f 46 | 20 20 20 20 20 44 49 41 |SODES OF| DIA|
|00004eb0| 52 52 48 45 41 20 49 4e | 20 45 49 47 48 54 20 48 |RRHEA IN| EIGHT H|
|00004ec0| 4f 55 52 53 2e 20 58 33 | 4d 4f 4e 54 48 53 20 20 |OURS. X3|MONTHS |
|00004ed0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4e | | N|
|00004ee0| 00 00 00 4b 31 46 20 20 | 20 45 4c 45 56 41 54 45 |...K1F | ELEVATE|
|00004ef0| 44 20 54 45 4d 50 45 52 | 41 54 55 52 45 20 46 52 |D TEMPER|ATURE FR|
|00004f00| 4f 4d 3a 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |OM: | |
|00004f10| 20 20 20 20 20 20 20 20 | 20 20 20 50 4f 54 45 4e | | POTEN|
|00004f20| 54 49 41 4c 20 46 4f 52 | 20 44 45 48 59 44 52 41 |TIAL FOR| DEHYDRA|
|00004f30| 54 49 4f 4e 3a 20 20 20 | 20 20 20 20 20 20 20 20 |TION: | |
|00004f40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 54 45 4d | | TEM|
|00004f50| 50 45 52 41 54 55 52 45 | 20 57 49 4c 4c 20 42 45 |PERATURE| WILL BE|
|00004f60| 20 42 45 4c 4f 57 20 31 | 30 30 20 44 45 47 52 45 | BELOW 1|00 DEGRE|
|00004f70| 45 53 20 46 4f 52 20 5f | 5f 44 41 59 53 20 20 20 |ES FOR _|_DAYS |
|00004f80| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004f90| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004fa0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00004fb0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00004fc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004fd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004fe0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00004ff0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005000| 02 29 00 00 00 27 00 00 | 00 14 00 00 00 4f 00 00 |.)...'..|.....O..|
|00005010| 00 4b 31 4a 20 20 20 48 | 41 53 20 45 50 49 53 4f |.K1J H|AS EPISO|
|00005020| 44 45 53 20 4f 46 20 50 | 41 49 4e 20 44 55 45 20 |DES OF P|AIN DUE |
|00005030| 54 4f 3a 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |TO: | |
|00005040| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005050| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005060| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005070| 20 20 20 20 20 20 20 20 | 20 20 20 45 50 49 53 4f | | EPISO|
|00005080| 44 45 53 20 4f 46 20 50 | 41 49 4e 20 57 49 4c 4c |DES OF P|AIN WILL|
|00005090| 20 42 4e 45 20 52 45 53 | 4f 4c 56 45 44 20 57 49 | BNE RES|OLVED WI|
|000050a0| 54 48 49 4e 20 20 20 20 | 20 20 20 20 20 4f 4e 45 |THIN | ONE|
|000050b0| 20 48 4f 55 52 20 4f 46 | 20 49 4e 54 45 52 56 45 | HOUR OF| INTERVE|
|000050c0| 4e 54 49 4f 4e 2e 20 20 | 20 20 20 20 20 20 20 20 |NTION. | |
|000050d0| 20 20 58 33 4d 4f 4e 54 | 48 53 2e 20 20 20 20 50 | X3MONT|HS. P|
|000050e0| 00 00 00 4b 31 4e 20 20 | 20 50 4f 54 45 4e 54 49 |...K1N | POTENTI|
|000050f0| 41 4c 20 46 4f 52 20 44 | 45 48 59 52 41 54 49 4f |AL FOR D|EHYRATIO|
|00005100| 4e 20 44 55 45 20 54 4f | 20 56 4f 4d 49 54 49 4e |N DUE TO| VOMITIN|
|00005110| 47 3a 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |G: | |
|00005120| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005130| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005140| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00005150| 4c 20 48 41 56 45 20 47 | 4f 4f 44 20 53 4b 49 4e |L HAVE G|OOD SKIN|
|00005160| 20 54 55 52 47 4f 52 2e | 20 20 20 20 20 20 20 20 | TURGOR.| |
|00005170| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005180| 58 5f 5f 5f 5f 5f 44 41 | 59 53 2e 20 20 20 20 20 |X_____DA|YS. |
|00005190| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000051a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000051b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000051c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000051d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000051e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000051f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005200| 02 2a 00 00 00 28 00 00 | 00 15 00 00 00 51 00 00 |.*...(..|.....Q..|
|00005210| 00 4c 31 43 20 20 20 4d | 4f 55 54 48 20 50 41 49 |.L1C M|OUTH PAI|
|00005220| 4e 20 53 45 43 4f 4e 44 | 41 52 59 20 54 4f 3a 20 |N SECOND|ARY TO: |
|00005230| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005240| 20 20 20 20 20 20 20 20 | 20 4e 45 45 44 53 20 53 | | NEEDS S|
|00005250| 50 45 43 49 41 4c 20 44 | 45 4e 54 41 4c 20 43 41 |PECIAL D|ENTAL CA|
|00005260| 52 45 2e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |RE. | |
|00005270| 20 20 20 20 20 20 20 20 | 20 20 20 50 41 49 4e 20 | | PAIN |
|00005280| 57 49 4c 4c 20 42 45 20 | 52 45 53 4f 4c 56 45 44 |WILL BE |RESOLVED|
|00005290| 20 49 4e 20 5f 5f 5f 57 | 45 45 4b 2e 20 20 20 20 | IN ___W|EEK. |
|000052a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000052b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000052c0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000052d0| 20 20 58 33 4d 4f 4e 54 | 48 53 2e 20 20 20 20 52 | X3MONT|HS. R|
|000052e0| 00 00 00 4c 33 41 20 20 | 20 43 4f 4d 50 4c 41 49 |...L3A | COMPLAI|
|000052f0| 4e 53 20 41 42 4f 55 54 | 20 54 48 45 20 54 41 53 |NS ABOUT| THE TAS|
|00005300| 54 45 20 4f 46 20 46 4f | 4f 44 2e 20 20 20 20 20 |TE OF FO|OD. |
|00005310| 20 20 20 20 20 20 20 20 | 20 20 20 50 4f 54 45 4e | | POTEN|
|00005320| 54 49 41 4c 20 46 4f 52 | 20 57 45 49 47 48 54 20 |TIAL FOR| WEIGHT |
|00005330| 4c 4f 53 53 2e 20 20 20 | 20 20 20 20 20 20 20 20 |LOSS. | |
|00005340| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00005350| 4c 20 45 41 54 20 38 30 | 2d 31 30 30 25 20 4f 46 |L EAT 80|-100% OF|
|00005360| 20 44 49 45 54 2e 20 20 | 20 20 20 20 20 20 20 20 | DIET. | |
|00005370| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005380| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005390| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000053a0| 20 20 58 33 4d 4f 4e 54 | 48 53 2e 20 20 20 20 20 | X3MONT|HS. |
|000053b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000053c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000053d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000053e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000053f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005400| 02 2b 00 00 00 29 00 00 | 00 15 00 00 00 53 00 00 |.+...)..|.....S..|
|00005410| 00 4c 33 45 20 20 20 4c | 45 41 56 45 53 20 32 35 |.L3E L|EAVES 25|
|00005420| 25 20 2b 20 46 4f 4f 44 | 20 55 4e 45 41 54 45 4e |% + FOOD| UNEATEN|
|00005430| 20 4f 4e 20 54 52 41 59 | 2e 20 20 20 20 20 20 20 | ON TRAY|. |
|00005440| 20 20 20 20 20 20 20 20 | 20 50 4f 54 45 4e 54 49 | | POTENTI|
|00005450| 41 4c 20 46 4f 52 20 57 | 45 49 47 48 54 20 4c 4f |AL FOR W|EIGHT LO|
|00005460| 53 53 2e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |SS. | |
|00005470| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00005480| 43 4f 4e 53 55 4d 45 20 | 38 30 2d 31 30 30 25 20 |CONSUME |80-100% |
|00005490| 4f 46 20 45 41 43 48 20 | 4d 45 41 4c 2e 20 20 20 |OF EACH |MEAL. |
|000054a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|000054b0| 4c 20 53 54 41 59 20 57 | 49 54 48 49 4e 20 49 42 |L STAY W|ITHIN IB|
|000054c0| 57 20 4f 46 3a 5f 5f 5f | 5f 5f 5f 5f 5f 5f 5f 5f |W OF:___|________|
|000054d0| 5f 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 54 |_ | T|
|000054e0| 00 00 00 4c 34 44 20 20 | 20 4e 45 45 44 53 20 54 |...L4D | NEEDS T|
|000054f0| 4f 20 42 45 20 46 45 44 | 20 42 59 20 53 59 52 49 |O BE FED| BY SYRI|
|00005500| 4e 47 45 20 44 55 45 20 | 54 4f 3a 20 20 20 20 20 |NGE DUE |TO: |
|00005510| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005520| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005530| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005540| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00005550| 4c 20 43 4f 4e 53 55 4d | 45 20 38 30 2d 31 30 30 |L CONSUM|E 80-100|
|00005560| 25 20 4f 46 20 44 49 45 | 54 20 44 41 49 4c 59 2e |% OF DIE|T DAILY.|
|00005570| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005580| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005590| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000055a0| 20 20 20 20 20 58 33 4d | 4f 4e 54 48 53 2e 20 20 | X3M|ONTHS. |
|000055b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000055c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000055d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000055e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000055f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005600| 02 2c 00 00 00 2a 00 00 | 00 16 00 00 00 55 00 00 |.,...*..|.....U..|
|00005610| 00 4d 31 41 20 20 20 4e | 45 45 44 53 20 4f 52 41 |.M1A N|EEDS ORA|
|00005620| 4c 20 48 59 47 49 45 4e | 45 20 42 45 46 4f 52 45 |L HYGIEN|E BEFORE|
|00005630| 20 42 45 44 2e 20 20 20 | 20 20 20 20 20 20 20 20 | BED. | |
|00005640| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005650| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005660| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005670| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00005680| 48 41 56 45 20 4f 52 41 | 4c 20 48 59 47 49 45 4e |HAVE ORA|L HYGIEN|
|00005690| 45 20 42 45 46 4f 52 45 | 20 47 4f 49 4e 47 20 54 |E BEFORE| GOING T|
|000056a0| 4f 20 53 4c 45 45 50 2e | 20 20 20 20 20 20 20 20 |O SLEEP.| |
|000056b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000056c0| 20 20 20 20 20 20 20 20 | 20 20 20 58 20 33 4d 4f | | X 3MO|
|000056d0| 4e 54 48 53 2e 20 20 20 | 20 20 20 20 20 20 20 56 |NTHS. | V|
|000056e0| 00 00 00 4d 31 46 20 20 | 20 48 41 53 20 4e 4f 20 |...M1F | HAS NO |
|000056f0| 54 45 45 54 48 20 4f 52 | 20 44 45 4e 54 55 52 45 |TEETH OR| DENTURE|
|00005700| 53 20 44 55 45 20 54 4f | 3a 20 20 20 20 20 20 20 |S DUE TO|: |
|00005710| 20 20 20 20 20 20 20 20 | 20 20 20 50 4f 54 45 4e | | POTEN|
|00005720| 54 49 41 4c 20 46 4f 52 | 20 57 45 49 47 48 54 20 |TIAL FOR| WEIGHT |
|00005730| 4c 4f 53 53 2e 20 20 20 | 20 20 20 20 20 20 20 20 |LOSS. | |
|00005740| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00005750| 4c 20 53 54 41 59 20 57 | 49 54 48 49 4e 20 49 42 |L STAY W|ITHIN IB|
|00005760| 57 20 4f 46 3a 20 20 20 | 20 20 20 20 20 20 20 20 |W OF: | |
|00005770| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005780| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005790| 20 20 20 20 20 20 20 20 | 20 58 33 4d 4f 4e 54 48 | | X3MONTH|
|000057a0| 53 2e 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |S. | |
|000057b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000057c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000057d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000057e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000057f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005800| 02 2d 00 00 00 2b 00 00 | 00 16 00 00 00 57 00 00 |.-...+..|.....W..|
|00005810| 00 4e 34 41 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.N4A P|OTENTIAL|
|00005820| 20 46 4f 52 20 49 4e 46 | 45 43 54 49 4f 4e 20 4f | FOR INF|ECTION O|
|00005830| 46 3a 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |F: | |
|00005840| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005850| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005860| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005870| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 49 4e | | NO IN|
|00005880| 4a 55 52 49 45 53 2e 20 | 20 20 20 20 20 20 20 20 |JURIES. | |
|00005890| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000058a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000058b0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000058c0| 20 20 20 20 20 58 33 4d | 4f 4e 54 48 53 2e 20 20 | X3M|ONTHS. |
|000058d0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 58 | | X|
|000058e0| 00 00 00 4e 34 45 20 20 | 20 50 4f 54 45 4e 54 49 |...N4E | POTENTI|
|000058f0| 41 4c 20 46 4f 52 20 44 | 45 43 55 42 49 54 55 53 |AL FOR D|ECUBITUS|
|00005900| 20 55 4c 43 45 52 53 2e | 20 20 20 20 20 20 20 20 | ULCERS.| |
|00005910| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005920| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005930| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005940| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|00005950| 44 45 43 55 42 49 54 55 | 53 20 55 4c 43 45 52 20 |DECUBITU|S ULCER |
|00005960| 46 4f 52 4d 41 54 49 4f | 4e 2e 20 20 20 20 20 20 |FORMATIO|N. |
|00005970| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005980| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005990| 20 20 20 20 20 20 20 20 | 20 20 20 20 58 20 33 4d | | X 3M|
|000059a0| 4f 4e 54 48 53 2e 20 20 | 20 20 20 20 20 20 20 20 |ONTHS. | |
|000059b0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|000059c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000059d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000059e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000059f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005a00| 02 2e 00 00 00 2c 00 00 | 00 17 00 00 00 59 00 00 |.....,..|.....Y..|
|00005a10| 00 4f 34 42 20 20 20 4e | 45 45 44 53 20 41 4e 54 |.O4B N|EEDS ANT|
|00005a20| 49 41 4e 58 49 45 54 59 | 20 4d 45 44 49 43 41 54 |IANXIETY| MEDICAT|
|00005a30| 49 4f 4e 53 20 46 4f 52 | 3a 20 20 20 20 20 20 20 |IONS FOR|: |
|00005a40| 20 20 20 20 20 20 20 20 | 20 50 4f 54 45 4e 54 49 | | POTENTI|
|00005a50| 41 4c 20 46 4f 52 20 46 | 41 4c 4c 53 2e 20 20 20 |AL FOR F|ALLS. |
|00005a60| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005a70| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00005a80| 48 41 56 45 20 4c 45 53 | 53 20 54 48 41 4e 20 5f |HAVE LES|S THAN _|
|00005a90| 5f 5f 45 50 49 53 4f 44 | 45 53 20 4f 46 3a 20 20 |__EPISOD|ES OF: |
|00005aa0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 50 45 52 | | PER|
|00005ab0| 20 57 45 45 4b 2e 57 49 | 4c 4c 20 4e 4f 54 20 48 | WEEK.WI|LL NOT H|
|00005ac0| 41 56 45 20 41 4e 59 20 | 53 49 44 45 20 45 46 46 |AVE ANY |SIDE EFF|
|00005ad0| 45 43 54 53 20 46 52 4f | 4d 20 4d 45 44 53 20 5a |ECTS FRO|M MEDS Z|
|00005ae0| 00 00 00 4f 35 43 20 20 | 20 50 4f 54 45 4e 54 49 |...O5C | POTENTI|
|00005af0| 41 4c 20 46 4f 52 20 49 | 52 52 45 47 55 4c 41 52 |AL FOR I|RREGULAR|
|00005b00| 20 50 55 4c 53 45 20 41 | 4e 44 20 43 48 45 53 54 | PULSE A|ND CHEST|
|00005b10| 20 50 41 49 4e 53 3a 20 | 20 20 20 53 45 43 4f 4e | PAINS: | SECON|
|00005b20| 44 41 52 59 20 54 4f 20 | 48 49 53 54 4f 52 59 20 |DARY TO |HISTORY |
|00005b30| 4f 46 20 48 45 41 52 54 | 20 44 49 53 45 41 53 45 |OF HEART| DISEASE|
|00005b40| 2e 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c |. | WIL|
|00005b50| 4c 20 4e 4f 54 20 48 41 | 56 45 20 43 48 45 53 54 |L NOT HA|VE CHEST|
|00005b60| 20 50 41 49 4e 53 2e 20 | 20 20 20 20 20 20 20 20 | PAINS. | |
|00005b70| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 50 | | P|
|00005b80| 55 4c 53 45 20 57 49 4c | 4c 20 42 45 20 36 30 2d |ULSE WIL|L BE 60-|
|00005b90| 38 30 2e 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |80. | |
|00005ba0| 58 33 4d 4f 4e 54 48 53 | 20 20 20 20 20 20 20 20 |X3MONTHS| |
|00005bb0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00005bc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005bd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005be0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005bf0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005c00| 02 2f 00 00 00 2d 00 00 | 00 17 00 00 00 5b 00 00 |./...-..|.....[..|
|00005c10| 00 4f 35 47 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.O5G P|OTENTIAL|
|00005c20| 20 46 4f 52 20 4d 4f 4f | 44 20 53 57 49 4e 47 53 | FOR MOO|D SWINGS|
|00005c30| 20 41 4e 44 20 49 4e 46 | 45 43 54 49 4f 4e 53 3a | AND INF|ECTIONS:|
|00005c40| 20 20 20 20 20 20 20 20 | 20 53 45 43 4f 4e 44 41 | | SECONDA|
|00005c50| 52 59 20 54 4f 20 53 54 | 45 52 4f 49 44 20 54 48 |RY TO ST|EROID TH|
|00005c60| 45 52 41 50 48 59 2e 20 | 20 20 20 20 20 20 20 20 |ERAPHY. | |
|00005c70| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 49 4e | | NO IN|
|00005c80| 46 45 43 54 49 4f 4e 53 | 2e 20 20 20 20 20 20 20 |FECTIONS|. |
|00005c90| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005ca0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005cb0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005cc0| 20 20 20 20 58 33 4d 4f | 4e 54 48 53 2e 20 20 20 | X3MO|NTHS. |
|00005cd0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 5c | | \|
|00005ce0| 00 00 00 50 31 44 20 20 | 20 4d 41 59 20 4e 45 45 |...P1D | MAY NEE|
|00005cf0| 44 20 53 55 43 54 49 4f | 4e 49 4e 47 20 46 4f 52 |D SUCTIO|NING FOR|
|00005d00| 3a 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |: | |
|00005d10| 20 20 20 20 20 20 20 20 | 20 20 20 53 45 43 52 45 | | SECRE|
|00005d20| 54 49 4f 4e 20 42 55 49 | 4c 44 20 55 50 3e 20 20 |TION BUI|LD UP> |
|00005d30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005d40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 43 4f 4e | | CON|
|00005d50| 47 45 53 54 49 4f 4e 20 | 57 49 4c 4c 20 42 45 20 |GESTION |WILL BE |
|00005d60| 52 45 4c 49 45 56 45 44 | 20 57 49 54 48 49 4e 20 |RELIEVED| WITHIN |
|00005d70| 35 20 4d 49 4e 55 54 45 | 53 20 20 20 20 20 20 4f |5 MINUTE|S O|
|00005d80| 46 20 49 4e 54 45 52 56 | 45 4e 54 49 4f 4e 2e 20 |F INTERV|ENTION. |
|00005d90| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 58 33 | | X3|
|00005da0| 4d 4f 4e 54 48 53 2e 20 | 20 20 20 20 20 20 20 20 |MONTHS. | |
|00005db0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00005dc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005dd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005de0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005df0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005e00| 02 30 00 00 00 2e 00 00 | 00 18 00 00 00 5d 00 00 |.0......|.....]..|
|00005e10| 00 50 31 48 20 20 20 50 | 4f 54 45 4e 54 49 41 4c |.P1H P|OTENTIAL|
|00005e20| 20 46 4f 52 20 53 48 4f | 52 54 4e 45 53 53 20 4f | FOR SHO|RTNESS O|
|00005e30| 46 20 42 52 45 41 54 48 | 20 44 55 45 20 54 4f 3a |F BREATH| DUE TO:|
|00005e40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005e50| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005e60| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005e70| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 53 48 | | NO SH|
|00005e80| 4f 52 54 4e 45 53 53 20 | 4f 46 20 42 52 45 41 54 |ORTNESS |OF BREAT|
|00005e90| 48 2e 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |H. | |
|00005ea0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005eb0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00005ec0| 20 20 20 20 20 20 20 20 | 20 20 20 20 58 33 4d 4f | | X3MO|
|00005ed0| 4e 54 48 53 2e 20 20 20 | 20 20 20 20 20 20 20 5e |NTHS. | ^|
|00005ee0| 00 00 00 50 33 43 20 20 | 20 4e 45 45 44 53 20 4d |...P3C | NEEDS M|
|00005ef0| 49 54 54 45 4e 28 53 29 | 20 52 45 53 54 52 41 49 |ITTEN(S)| RESTRAI|
|00005f00| 4e 28 53 29 20 54 4f 3a | 20 5f 5f 5f 5f 5f 5f 48 |N(S) TO:| ______H|
|00005f10| 41 4e 44 20 20 20 20 20 | 20 20 20 54 4f 20 50 52 |AND | TO PR|
|00005f20| 45 56 45 4e 54 20 49 4e | 4a 55 52 59 20 44 55 45 |EVENT IN|JURY DUE|
|00005f30| 20 54 4f 3a 20 20 20 20 | 20 20 20 20 20 20 20 20 | TO: | |
|00005f40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00005f50| 4c 20 4e 4f 54 20 50 55 | 4c 4c 20 54 55 42 45 20 |L NOT PU|LL TUBE |
|00005f60| 4f 55 54 2e 20 20 20 20 | 20 20 20 20 20 20 20 20 |OUT. | |
|00005f70| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 4e | | N|
|00005f80| 4f 20 49 4e 4a 55 52 49 | 45 53 20 44 41 49 4c 59 |O INJURI|ES DAILY|
|00005f90| 2e 4e 4f 20 42 45 48 41 | 56 49 4f 52 20 50 52 4f |.NO BEHA|VIOR PRO|
|00005fa0| 42 4c 45 4d 53 2e 58 33 | 4d 4f 4e 54 48 53 2e 20 |BLEMS.X3|MONTHS. |
|00005fb0| 20 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 | .......|........|
|00005fc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005fd0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005fe0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00005ff0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00006000| 01 00 00 00 00 2f 00 00 | 00 18 00 00 00 5f 00 00 |...../..|....._..|
|00006010| 00 50 33 44 20 20 20 4e | 45 45 44 53 5f 5f 5f 5f |.P3D N|EEDS____|
|00006020| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 5f 5f 43 48 41 49 52 |________|___CHAIR|
|00006030| 20 57 48 49 43 48 20 50 | 52 45 56 45 4e 54 53 20 | WHICH P|REVENTS |
|00006040| 20 20 20 20 20 20 20 20 | 20 52 49 53 49 4e 47 20 | | RISING |
|00006050| 54 4f 20 50 52 45 56 45 | 4e 54 20 49 4e 4a 55 52 |TO PREVE|NT INJUR|
|00006060| 59 20 44 55 45 20 54 4f | 3a 20 20 20 20 20 20 20 |Y DUE TO|: |
|00006070| 20 20 20 20 20 20 20 20 | 20 20 20 4e 4f 20 49 4e | | NO IN|
|00006080| 4a 55 52 49 45 53 20 44 | 41 49 4c 59 2e 20 20 20 |JURIES D|AILY. |
|00006090| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000060a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 4e 4f 20 | | NO |
|000060b0| 42 45 48 41 56 49 4f 52 | 20 50 52 4f 42 4c 45 4d |BEHAVIOR| PROBLEM|
|000060c0| 53 20 44 55 45 20 54 4f | 20 43 48 41 49 52 2e 20 |S DUE TO| CHAIR. |
|000060d0| 20 20 58 33 4d 4f 4e 54 | 48 53 20 20 20 20 20 00 | X3MONT|HS .|
|000060e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000060f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00006100| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00006110| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00006120| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00006130| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00006140| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00006150| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00006160| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00006170| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00006180| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00006190| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000061a0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000061b0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000061c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000061d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000061e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000061f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00006200| 02 32 00 00 00 00 00 00 | 00 19 00 00 00 60 00 00 |.2......|.....`..|
|00006210| 00 42 32 41 20 20 20 43 | 4f 4d 50 52 4f 4d 49 53 |.B2A C|OMPROMIS|
|00006220| 45 44 20 53 48 4f 52 54 | 20 54 45 52 4d 20 4d 45 |ED SHORT| TERM ME|
|00006230| 4d 4f 52 59 20 20 20 20 | 20 20 20 20 20 20 20 20 |MORY | |
|00006240| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00006250| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00006260| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00006270| 20 20 20 20 20 20 20 20 | 20 20 20 57 49 4c 4c 20 | | WILL |
|00006280| 4b 4e 4f 57 3a 20 20 20 | 20 20 20 20 20 20 20 20 |KNOW: | |
|00006290| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|000062a0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|000062b0| 4c 20 41 54 54 45 4e 44 | 20 41 43 54 49 56 49 54 |L ATTEND| ACTIVIT|
|000062c0| 49 45 53 20 44 41 49 4c | 59 3a 20 20 20 20 20 20 |IES DAIL|Y: |
|000062d0| 20 20 20 20 20 20 58 33 | 4d 4f 4e 54 48 53 20 61 | X3|MONTHS a|
|000062e0| 00 00 00 42 33 20 20 20 | 20 43 4f 4d 50 52 4f 4d |...B3 | COMPROM|
|000062f0| 49 53 45 44 20 4d 45 4d | 4f 52 59 20 52 45 43 41 |ISED MEM|ORY RECA|
|00006300| 4c 4c 20 41 42 49 4c 49 | 54 59 20 20 20 20 20 20 |LL ABILI|TY |
|00006310| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00006320| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00006330| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00006340| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 57 49 4c | | WIL|
|00006350| 4c 20 4b 4e 4f 57 3a 20 | 20 20 20 20 20 20 20 20 |L KNOW: | |
|00006360| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 | | |
|00006370| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 57 | | W|
|00006380| 49 4c 4c 20 41 54 54 45 | 4e 44 20 41 43 54 49 56 |ILL ATTE|ND ACTIV|
|00006390| 49 54 49 45 53 20 44 41 | 49 4c 59 3a 20 20 20 20 |ITIES DA|ILY: |
|000063a0| 20 20 20 20 20 20 20 20 | 20 58 33 4d 4f 4e 54 48 | | X3MONTH|
|000063b0| 53 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |S.......|........|
|000063c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000063d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000063e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000063f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
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