MEDICAL HISTORY
SYMPTOMS
Current symptoms( check if applicable)
Comments
Thinking / Memory
Impulsivity
Visual difficulty / Light sensitivity
Difficulty swallowing liquids and / or solids
Changes to speech / voice
Gait / Balance / Prone to falls
Note use of any ambulatory equipment and typical direction( s) of falls
Difficulty with coordination / motor skills
Hallucinations
CurePSP Prepare to Care 19