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Your Name: Date: Assisted Living Facility (ALF) Level II Online Dementia Care Training Program Module 3 Worksheet: MINIMIZING FALLS 1. Why is someone with dementia more at risk of falling? 2. What
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How to fill out your name date assisted?

01
Start by locating the designated field for your name. Usually, this field is labeled as "Name" or "Full Name." It is usually found at the top of the form or document.
02
Once you have located the field, carefully write your full name in the blank space provided. Make sure to use your legal name, as it appears on official documents like your ID or passport. Avoid using nicknames or abbreviations unless specifically instructed to do so.
03
After filling out your name, move on to the "Date" field. This field is typically labeled as "Date," "Date of Birth," or "DOB." It is usually located next to or below the name field.
04
Fill in the date by using the appropriate format. In most cases, the format is month/day/year (e.g., 01/25/1990). However, some forms or documents may require a different format, such as day/month/year or spelled out month names.
05
Double-check your entries for accuracy. Ensure that there are no spelling mistakes or errors in the name or date provided. Accuracy is crucial to avoid any legal or administrative complications later on.

Who needs your name date assisted?

01
Employment Applications: When applying for a job, employers commonly ask for your name and date of birth as part of the application process. This information helps them verify your identity and conduct background checks.
02
Government Forms: Various government forms, such as passport applications, tax forms, and social security applications, require your name and date of birth to establish your identity and ensure proper processing.
03
School or College Applications: Educational institutions often request your name and date of birth as part of their application process. This helps them identify you as a unique applicant and verify your age for enrollment purposes.
04
Legal Documents: When signing legal documents, such as contracts, leases, or affidavits, your name and date of birth may be required to establish your identity and ensure the legality of the document.
05
Medical Records: Healthcare providers typically require your name and date of birth to accurately identify and maintain your medical records. This information helps them provide appropriate and personalized care.
Remember, it is essential to provide your name and date accurately and honestly across different platforms and applications. Safeguard your personal information and use discretion when sharing this data.
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