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Partners in Personal Assistance | Home Health Care Ann Arbor

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Personal Information






In Case of Emergency Notify:



Personal Requirements for PAs while in your home. (For example, your smoking policy, phone usage, visitor policy, music/noise level preference).



Personal References:


Days & Hours Assistance is needed:

Morning



Mid day



Evening



Night


We must have a copy of your job description (how/when you want the work done).



How do you pay for personal assistance?

What is your 3rd party payer?


Please type your full name below to acknowledge that all of the information provided is accurate.


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