SeamlessDocs

Communication Needs -
Are you new to NSSRA
Walk Independently
Uses Wheelchair?
Transfers Independently
Transfers With Assistance
Uses Orthopedic Equipment
Requires a Vehicle with a lift?
Requires Staff Assistance - Transportation
Communication Needs -
checkbox_dp0
checkbox_MwK
checkbox_oH8
checkbox_agc
checkbox_kgM
checkbox_ih8
checkbox_yKN
checkbox_tBk
checkbox_o26
checkbox_D02
checkbox_Bmi
Requires Assistance in Bathroom
Requires Bathroom Schedule
Requires assistance Dressing
Can Participant Write
Can Participant Read
Behavior Plan
Able to say name
Able to Constantly Say Phone Number
Check Box 46
Does Participant Wander From the Group
Check Box 48
Is Participant responsible for own belongings?
Can Participant Recognize Danger
Does Participant swim
Requires 1:1 assistance in the water
Requires Assistance Eating
Check Box 58
checkbox_ajs
checkbox_nvt
checkbox_9e4
checkbox_qCJ
checkbox_qrI
Photo permission
Photo Permission
Signature HereClick to Sign
04/01/2026Click to Sign
x

Additional Signatures Required