HAVE YOU OR A LOVED ONE....

* 1. Been hospitalized or gone to the emergency room several times in the past six months?

* 2. Been making more frequent phone calls to your physicians?

* 3. Had frequent or recurring infections?

* 4. Started spending most of the day in a chair or bed?

* 5. Fallen several times over the past 6 months?

* 6. Started feeling weaker or more tired?

* 7. Experienced unexplained weight loss making clothes noticeably looser?

* 8. Noticed an increase in shortness of breath, even while resting?

* 9. Started needing help from others with bathing?

* 10. Started needing help from others with dressing?

* 11. Started needing help from others with eating?

* 12. Started needing help from others with getting out of bed?

* 13. Started needing help from others with walking?

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