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Get AHCA Form 3110-1023 (AFCH-1110) 2008

Nitive or behavioral status: Nursing/treatment/therapy service requirements: Special precautions: A To what extent does the individual need supervision or assistance with the following? Please check appropriate areas below. ↓ AMBULATION: __Independent __Needs Supervision __Needs Assistance __Needs Total Help BATHING: __Independent __Needs Supervision __Needs Assistance __Needs Total Help DRESSING: __Independent __Needs Supervision __Needs Assistance __Needs Total Help EATING: __Indepen.

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