Catholic Social Services

Serving all faiths, all ages and all walks of life.

We seek justice, and change lives.

  • Facebook
  • Twitter
  • YouTube
Link to Amazon Smile website
  • Counseling
    • Alternatives to Domestic Aggression
    • Behavioral Health Counseling Services
    • Family Assessment Clinic (FAC)
    • Marriage Preparation
    • Pregnancy Counseling
    • Offender Success (previously Prisoner ReEntry)
    • RENEW for women
    • Substance Abuse Treatment Services
    • Washtenaw Child Advocacy Center
  • Food & Health
    • Emergency Food
    • HVA Patient Advocacy
    • Packard Health Clinic
  • Parenting & Families
    • Families First
    • Family Time (parenting support)
    • Foster Care
    • Grandparents as Parents
    • Washtenaw Child Advocacy Center
    • Nurturing Families Washtenaw
    • Pregnancy Counseling
    • Family Assessment Clinic (FAC)
  • Adoption & Foster Care
    • Newborn Adoption
    • Foster Care
    • Post-Adoption Services
    • Pregnancy Counseling
    • Waiting Child Adoption
  • Seniors
    • Adult Day Program – “The Oaks”
    • BLUePRiNT For AGING
    • Grandparents as Parents
    • Volunteer Caregiver Respite
    • Medicare/Medicaid Assistance
    • Neighborhood Senior Services
    • Resource Advocacy
    • RSVP (Senior Volunteer)
    • Tax Assistance
  • Collaborations
    • BLUePRiNT For AGING
    • Packard Health Clinic
    • Intentional Communities of Washtenaw
    • Literacy Coalition of Washtenaw County
    • Offender Success (previously Prisoner ReEntry)
    • WITH Housing
You are here: Home / Seniors / Adult Day Program – “The Oaks” / Biopsychosocial Assessment – Activities of Daily Living

Biopsychosocial Assessment – Activities of Daily Living

[contact-form to=’theoaks@csswashtenaw.org’ subject=’Biopsychosocial Assessment Activities of Daily Living’][contact-field label=’Name of Participant’ type=’name’ required=’1’/][contact-field label=’Primary Language’ type=’text’ required=’1’/][contact-field label=’Other Languages Spoken’ type=’url’/][contact-field label=’Is the participant able to read?’ type=’select’ required=’1′ options=’,Yes,No’/][contact-field label=’Does the participant understand what they read?’ type=’select’ required=’1′ options=’,Yes,No’/][contact-field label=’Can the participant write?’ type=’select’ required=’1′ options=’,Yes,No’/][contact-field label=’Does the participant follow directions?’ type=’select’ required=’1′ options=’,Yes,No’/][contact-field label=’Ability to Verbalize Needs’ type=’select’ required=’1′ options=’,Good,Fair,Poor’/][contact-field label=’Vision’ type=’select’ required=’1′ options=’,Good,Fair,Poor’/][contact-field label=’Hearing’ type=’select’ required=’1′ options=’,Good,Fair,Poor’/][contact-field label=’Oral’ type=’select’ required=’1′ options=’,Good,Fair,Poor’/][contact-field label=’Does the participant use a computer?’ type=’select’ required=’1′ options=’,Yes,No’/][contact-field label=’Use of Prostheses (i.e. hearing aid, dentures%26#x002c; glasses%26#x002c; etc.). If yes%26#x002c; what type?’ type=’textarea’/][contact-field label=’Additional Comments’ type=’textarea’/][contact-field label=’Religious/Spiritual Preference’ type=’text’/][contact-field label=’Does the participant currently attend?’ type=’text’/][contact-field label=’Name of Clergy’ type=’text’/][contact-field label=’Phone Number’ type=’text’/][contact-field label=’Comments’ type=’textarea’/][contact-field label=’Primary Physician’ type=’text’ required=’1’/][contact-field label=’Address’ type=’text’ required=’1’/][contact-field label=’City%26#x002c; State%26#x002c; Zip’ type=’text’ required=’1’/][contact-field label=’Phone Number’ type=’text’ required=’1’/][contact-field label=’Fax Number’ type=’text’/][contact-field label=’Hospital Preference’ type=’text’ required=’1’/][contact-field label=’Name of Pharmacy’ type=’text’ required=’1’/][contact-field label=’Address’ type=’text’ required=’1’/][contact-field label=’City%26#x002c; State%26#x002c; Zip’ type=’text’ required=’1’/][contact-field label=’Phone Number’ type=’text’ required=’1’/][contact-field label=’Please list any hospitalizations in the last 5 years including date and reason’ type=’textarea’/][contact-field label=’Form Completed By:’ type=’text’ required=’1’/][contact-field label=’Relationship’ type=’text’ required=’1’/][contact-field label=’Date’ type=’text’ required=’1’/][/contact-form]

Search this site

Get In Touch

Phone: 734.971.9781
Fax: 734.971.2730

Main Building:
4925 Packard Road
Ann Arbor, MI 48108

Senior Center
5361 McAuley Drive
Ypsilanti, MI 48197

Latest Tweets

Tweets by CSSWashtenaw

Connect with Us

Contact Us
Find Help
Hours, Phone & Locations
Email Updates
Facebook
Twitter

Visit Our Main Building

© Copyright Catholic Social Services of Washtenaw County · Powered by 501Websites · WEBSITE LOGIN
CSSW Employee Site (Secure Login)
Privacy Policy