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Get LA OAAS-PF-10-010 2018-2024

Day Tuesday Wednesday Thursday Date→ Tasks: Indicate Tasks Completed Each Day by Signing with Worker’s Initials. Eating Bathing Dressing Grooming Transferring Ambulation Toileting Light Housekeeping Food Preparation & Storage Shopping Laundry Medication Reminders Assist to Scheduled Medical Appointment Assist to Arrange Medical Transportation Accompany to Medical Appointments Friday Saturday PARTICIPANT/RESPONSIBLE REPRESENTATIVE/LEGAL REPRESENTATIVE’S SIGNATURE:________________________.

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