Resident Biography

In order to assist our staff in providing individualized, meaningful care to the residents who have made Northwood their home, we request that you, as a key member of the care team, provide us with a brief historical profile of the resident you represent. This biography as well as the "Life Story Book" we hope you will be interested in (please see last page), will provide us with important information to incorporate into their life with us. This will enable us to provide care that is geared to their particular needs, interests and enjoyments in life.

Note to friends and family members filling out the biography on behalf of a resident, please read the "you" in all questions as meaning the resident, as if they were filling out the form for themselves.

Name of Resident: Room No:

Name by which (you/they) prefer to be called:

DAILY ROUTINE

1.

a. What time do(es) (you /the resident) like to get up in the morning?

b. Do (you) prefer to stay in bed for awhile or get up immediately upon waking?

2. Briefly outline what (your) waking routine is like (wash, brush hair, brush

teeth etc.).

3. Do (you) eat breakfast in the morning? If so what are (your) preferred

breakfast foods?

4. What kind of clothes do (you) prefer to wear during the day?

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5. Do (you) like to take naps during the day? If so when, where and for how

long do (you) usually rest?

6. What kind of night time attire do (you/they) prefer?

7. What time do (you) like to go to bed for the night? Do (you) enjoy a snack

or a drink before bed?

8. What kind of assistance do (you) require? (Support when walking, help

with dressing, toileting, bathing, foot care etc.).

PERSONAL PREFERENCES

Please list a few of (you/the residents) favourite things and least favourite things under the following categories and perhaps note if they hold any special meaning for (you/them) and why.

1. Food and Beverages

2. Television Shows and Movies

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3. Books

4. Favourite things brought from home

5. Favourite time of year (ie. Fall or the Christmas Season)

6. Special Holidays or Anniversaries

7. Music

BACKGROUND

Please tell us a bit about (yourself) and (your) family.

1.

a. What is (your) marital status? (Married, Widowed, Divorced, Never Married

etc.).

b. Would (you) like to tell us a bit about (your) spouse or significant other?

(Their name, number of years together etc.).

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2.

a. Do (you) have children? If so tell us a bit about them (how many do you have, names occupations, where they live, anything (you) feel comfortable sharing).

b. Do (you) have grandchildren or great-grandchildren? What would (you) like

to tell us about them?

c. At this point in (your) life do (you) enjoy interacting with children and

would (you) enjoy having children around.

3. Where did (you) live: As a child? What was (your) favourite place?

4. Have (you) travelled? If so to where? What was (your) favourite place?

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5. What was (your) occupation? What did (you) enjoy most about (your) work?

What did (you) enjoy the least?

6. What are some of the volunteer organizations or service clubs (you) may have worked with or continue to work with?

7. Is religion and spirituality important to (you/them)?