Older Adult Community Assesment Table

Sheet1

Service Distance Answers to questions Notes
Pharmacy
Grocery Store
Bank
Primary Care Physician
Hospital
Dentist
Place of Worship
Resources if unable to drive
Senior Center
Meal delivery service
Sidewalks
Parks
Veterinarian
Pet supply store
Neighborhood crime rate
Emergency Services, fire, police, EMTs
Lawn service
House cleaning

&”Times New Roman,Regular”&16Community Assessment Required Template

pap 12/2020

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