ShirleyBOARD | Background/Fact Sheet

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Patient's First Name:	Lilac
Patient's Last Name:	Pederson
Address Line 1:	PO Box 22BB
Address Line 2:
City	Bernardsville
State	NJ
Zip	07924
Relationship to you:	Mother
Phone number :	111-111-1111
What best describes the condition or need of the person you're caring for:	Physical Impairment, Cognitive Impairment
Hospital name:	NA
Hospital phone number:	NA
Other facility name:	NA
Other facility phone:	NA
Other facility description:	NA
Background: Enter a brief summary about the individual and why they need care? Think of this as a “how did we get here” type summary (limit 1,000 characters).	Lillac was diagnosed with Alzheimer's in the Fall of 2005 during her 75th year of life. With the help of in-home caregivers, Lillac continues to live in her own home - something very important to her.