|
Personal Long-Term Care Assessment Form
|
|
|
Do you want your adult children to provide your care?
Do you want your adult children to provide your care?*
|
|
|
Will your children be willing and able to provide your care?
Will your children be willing and able to provide your care?*
|
|
|
Will you be able to qualify for Medicaid?
Will you be able to qualify for Medicaid?*
|
|
|
Do you have any serious health conditions?
Do you have any serious health conditions?*
|
|
|
Is your net worth less than $100,000
Is your net worth less than $100,000*
|
|
