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Get Seating/Mobility Evaluation

Ating Describe oral motor skills Grooming/Hygiene Meal Prep IADLS Bowel Mngmnt: Bladder Mngmt: Continent Incontinent Accidents Continent Incontinent Catheter Equipment eval/justification form Comments: Comments: 2/12 Name: MR#: Insurance/Recipient# CURRENT SEATING / MOBILITY: Current Mobility Base: Manufacturer: Size: None Dependent Dependent with Tilt Manual Scooter Power Model: Color: Type of Control: Serial #: Age: Current Condition of Mobil.

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