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If William likes to be referred to as Bill, please indicate
Please describe scars, marks, tattoos, and any other identifying information that would help us more easily identify the Special Needs Individual. Include any medical ID bracelets, worn identification, and tracking devices. Example: a scar on the right cheek, walks with a limp, wears a medical ID bracelet on left wrist.
Example: special needs individual hasn't been diagnosed yet but displays symptoms of Autism Spectrum disorder; unresponsive to directed questions, no eye contact, animated arm movement, pacing, walking in circles, jumping up and down, loud outbursts, etc.
Any other condition that you would like us to know about regarding the Special Needs Individual. Examples include; no sense of danger, blind or vision issues, deaf or hearing issues, nonverbal communicator, mental retardation, prone to seizures, other cognitive impairment
If the Special Needs Individual communicates other than verbally, please list those alternative methods.
List any personal tracking device carried by the Special Needs Individual.
Please list favorite places, activities, attractions. Think of places that offer the individual his/her favorite type of entertainment or stimuli. Does the individual like to walk to Publix on a daily basis? Would the individual get in the car and drive back to the home where he/she grew up? Additionally, list hobbies and favorite objects; toys, music, video games, likes or dislikes.
The physician will only be contacted in cases of emergency.
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