Also forwarded on behalf of Joy Graham. ---------- > Date: Sunday, May 04, 1997 21:51:46 > From: Bob & Joy Graham > To: Dennis Greene > Subject: Hospitalisation Form > > Please could you send this to the List too. Thanks > > Hospitalisation Form > > AS A PERSON WITH PARKINSON'S DISEASE I HAVE PROBLEMS > WITH THE ITEMS CHECKED BELOW > > Full > Name:....................................................................... > ............................................... > > Doctor:......................................................Neurologist:... > ............................................ > > MEDICATION > > o 1. I need my Parkinson's medication administered EXACTLY on schedule. > o 2. Without medication I will become rigid and disoriented. > o 3. Response to medication may affect physical therapy timing. > > AMBULATION > > o 4. I have difficulty with balance. > o 5. I may freeze and fall. > o 6. I require help getting motion started and walking. > > ELIMINATION (underline specifics) > > o 7. I have urinary problems: either hesitancy, frequency, inability > to wait, or incontinence. > o 8. I suffer from constipation, need special diet or other > treatment. Impaction is a significant danger. > > COORDINATION > > o 9. I cannot open food containers easily. > o 10. I cannot always repeat a former action. > o 11. I may not have the strength to push a call button. > o 12. I have slow responses. > o 13. I have trouble turning over in bed. > > COMMUNICATION > > o 14. I have low voice volume. > o 15. I have difficulty enunciating. > o 16. My face shows little or no emotion ("mask" of Parkinson's). > > EATING AND SWALLOWING > > o 17. I choke on food and require a special diet. > o 18. I am a very slow eater. > > SLEEPING > > o 19. I have trouble getting to sleep. > o 20. I sleep fitfully. > o 21. I have anxiety sweats > > Adapted from a list by Beverly Steward (Central Ohio Parkinson Society > Newsletter) which has been designed to make your stay in hospital as > satisfactory as possible. It is important to explain to the nurses some > significant facts about the way PD affects you. Ask to have this sheet put > in your file at the nurses' station. You might also consider having a > close family member get a limited power of attorney to represent you, and > if you have a Durable Power of Attorney, be sure the doctor and hospital > have copies. > > > > >