Planning Ahead - Florida Developmental Disabilities Council

A DAY IN THE LIFE OF:(NAME)List morning medications:Arises at:AMNeeds assistance with: Hygiene Dressing GroomingPrefer: Shower Bath Taken: PM AMAids or appliances used to get around include:Braces Special shoes Walker Wheelchair Crutches Positioning aids OtherUses:EyeglassesContact lensOther Communication Devices (list):HearingaidsTelecommunication devices (TDD)CommunicationboardAble to eat without help: YES NO If No, needs help with:Uses: Special plate Special utensils Special cup StrawHas problems with choking: YES NOIs able to drink: Thin Liquids Thickened LiquidsUsually ready to start the day at: AM By going to:Transported by:List bedtime medications:BEDTIME PREPARATIONList any routine activities performed at bedtime.Usual bedtime: PMIs there a quiet time/meditation: YES NO If Yes, describe:Help needed getting to sleep: YES NODescribe sleep pattern (how well, how long usually sleeps)SAFETY PRECAUTIONSCan the person be left unsupervised: Yes NoFor how long? Minutes Hours Days60 Section 2, The Personal Information Section