Senior Citizen's Guide to Metro Detroit Spring/Summer Edition 2017 - page 37

SeniorCitizensGuide.com/detroit
35
Step 4. Take Action
Questions:
1.
_______________________________________________________
________________________________________________________
2.
_______________________________________________________
________________________________________________________
3.
_______________________________________________________
________________________________________________________
4.
_______________________________________________________
________________________________________________________
Bring to your next visit:
q
This Worksheet after you
fill it out
q
The Caregiver Self-
Assessment Worksheet
q
A list of your questions
q
Someone who can
support you
Care Team or Social Worker
contact:
Date:_ ___________________
Name:_ __________________
Phone:___________________
q
Talk with my care team about my health needs
q
Talk with my mental health provider about my care needs
q
Talk with my social worker about getting long term care
services
q
Get support from my family and friends
q
Write down my questions and bring them with me to my
next visit
q
Other:_______________________________________________
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