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Evaluation

Are you evaluating a male in the hospital?

Age of the patient

years

Number of prescription drugs being taken

Does the patient have?

• socioeconomic problems?

• weight loss?

• loss of appetite?

• impaired vision?

• impaired hearing?

• confusion or forgetfulness?

• dementia?

• depression?

• incontinence of urine and/or stool?

• falls within the past 3 months?

• prolonged bedrest?

Results

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