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Get WA DSHS 02-516 2013

The Provider/Resident Manager and the resident or the resident’s guardian or agent sign. File in the resident’s record. Records and information concerning each person in care shall be maintained in such a manner as to preserve confidentiality. RESIDENT’S NAME NAME OF RESIDENT’S GUARDIAN CONTACT LENSES DENTURES EYE GLASSES HEARING AID JEWELRY WATCH MONEY/CHECKBOOK/CREDIT CARDS DATE OF ADMISSION OTHER CLOTHING LIST NUMBER ITEM DESCRIPTION Bathrobe Belt Blouse Brassiere Coat .

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