HAVE YOU OR A LOVED ONE....

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

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

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* 3. Had frequent or recurring infections?

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

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

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* 6. Started feeling weaker or more tired?

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

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

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* 9. Started needing help from others with bathing?

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* 10. Started needing help from others with dressing?

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* 11. Started needing help from others with eating?

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

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* 13. Started needing help from others with walking?

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