Home Care Eligibility Quiz – Form2019-05-20T06:59:34+00:00

Home Care Eligibility Quiz

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YesNoDon't Know


Bathing or showeringGetting dressedPreparing foodSelf-feeding with utensils (not including cooking)Using the bathroomGrocery ShoppingDrivingGoing to doctor’s appointmentsGetting from Point A to Point B within their home (ex: getting out of bed)


Long Term Care InsurancePrivate Insurance/Life InsuranceVA BenefitsCredit card/Debit cardCheck/ACH transfer

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