I need help moving in bed  Sometimes I wake to be moved  Personal Care I like to have a bath in (circle) morning/night  I like to shower in the (circle) morning/night  I need special equipment……………………………..  I like to choose my own clothes  I need help with……………………………………………  (e.g. dressing, showering, cleaning teeth) I use dentures  Moving around and I am able to get around by myself  transferring I need help with…………………………….  I use a: (e.g. frame/wheelchair) ……………………………………..  I use a hoist to move from…..………….to …………………..  I need a 2 person lift for when…………………………………  Keeping me & others I need bed rails at night  safe I wear special seat in my wheelchair  I may run away if you are not watching  Other: ……………………………………………………………………………………………. ……………………………………………………………………………………………. Things that keep me safe, ……………………………………………………………………………………………. things I do that might harm myself or worry/harm others
 I need help moving in bed  Sometimes I wake to be moved Personal Care  I like to have a bath in (circle) morning/night  I like to shower in the (circle) morning/night  I need special equipment……………………………..  I like to choose my own clothes  I need help with…………………………………………… (e.g. dressing, showering, cleaning teeth)  I use dentures Moving around and transferring  I am able to get around by myself  I need help with…………………………….  I use a: …………………………………….. (e.g. frame/wheelchair)  I use a hoist to move from…..………….to …………………..  I need a 2 person lift for when………………………………… Keeping me & others safe Things that keep me safe, things I do that might harm myself or worry/harm others  I need bed rails at night  I wear special seat in my wheelchair  I may run away if you are not watching Other: ……………………………………………………………………………………………. ……………………………………………………………………………………………. …………………………………………………………………………………………….
All-about-me-health-profile-Word-version2.docx