Arletta's Adult Care Home, Inc.

 

 

 

 

 

INTEREST PROFILE

 

 Name________________________________Prefes to be called_________________________Admit date________

 Diagnosis/Medical History__________________________________________________________________________

 Age______Birth date______________Birthplace________________________________Heritage________________

 Education_______________________Occupation_________________________________Religion_______________

 Marital Status____________________ Contact person____________________________Telephone_____________

 ORDERS:  Activity level/Precautions_______________________________________________________________

 INTEREST AND HOBBIES           KEY:   C = current interest      P = past interest                0 = has not tried    

  - = not interested         E = enjoys activity       ? = possibly interested      X= dislikes                                 

CREATIVE READING INTELLECTUAL COMMUNITY
Crafts________________________ Books________________________ Discussions___________________ Voting_______________________
Knitting______________________ Large print___________________ Current Events________________ Politics_______________________
Crocheting____________________ Talking books_________________ Classes_______________________ Leadership____________________
Needlework___________________ Magazines____________________ Crosswords___________________ Club/lodge____________________
Sewing_______________________ Newspaper___________________ Word games___________________ Veterans______________________
Rugmaking___________________ _____________________________ Puzzles_______________________ Senior center_________________
Ceramics_____________________   Lectures______________________ Shopping_____________________
Painting______________________ PERFORMANCE Mathematics__________________ _____________________________
Drawing______________________ Drama_______________________ Science______________________  
Lettering_____________________ Speech_______________________ _____________________________ OUTDOORS
Models______________________ Storytelling___________________   Fishing_______________________
Leather______________________ Puppets______________________ CULTURAL Hunting______________________
Weaving_____________________ Band________________________ Museums_____________________ Birdwatching__________________
Photography__________________ Choir________________________ Theater_______________________ Nature study__________________
____________________________ Joke-telling___________________ Fine arts______________________ Car rides_____________________
____________________________ Reading aloud_________________ Ethnic activities________________ Sunning______________________
  _____________________________ Genealogy____________________ _____________________________
MANUAL ARTS   _____________________________  
Woodworking_________________ GAMES   PHYSICAL
Metal craft____________________ Cards________________________ RELIGIOUS Exercising____________________
Mechanical___________________ Chess/checkers________________ Bible study____________________ Swimming____________________
Refinishing___________________ Table games__________________ Worship______________________ Dancing______________________
Electronics____________________ Bingo________________________ Communion___________________ Walking______________________
_____________________________ Pool_________________________ Pastoral visits__________________ Bowling______________________
  Lawn games___________________ Fellowship____________________ Sports________________________
MUSICAL Floor games___________________ _____________________________ _____________________________
Singing______________________      
Instrument____________________ SOCIAL VOLUNTEER GARDENING
Concerts______________________ Small groups__________________ Visitation_____________________ Vegetables____________________
Radio________________________ Large groups__________________ Clerical______________________ Flowers______________________
Records______________________ Conversation__________________ Domestic_____________________ Houseplants___________________
Tapes________________________ Happy hour___________________ Grandparenting________________ Flower arranging______________
_____________________________ Smoking_____________________ Teaching_____________________ Yardwork_____________________
  Parties_______________________ Decorating____________________  
SPECTATOR Reminiscing___________________ Hosting______________________ OTHER
Sports________________________ Socials_______________________ Selling________________________ Pets_________________________
Movies_______________________ Telephoning___________________ Newsletter____________________ Collections____________________
TV__________________________ _____________________________ Planning activities_____________ Contests______________________
Travelogues___________________   _____________________________ Computers____________________
Circus_______________________ GROOMING   Scrapbooks___________________
_____________________________ Hair set______________________ FOOD Photo albums_________________
  Make up_____________________ Preparation___________________ _____________________________
EXPRESSIVE Barber_______________________ Eating_______________________ _____________________________
Writing______________________ Manicures____________________ Dining out____________________ _____________________________
Poetry_______________________ Fashions______________________ Learning diet__________________ _____________________________
Correspondence______________ _____________________________ _____________________________ _____________________________
Sign language_________________ _____________________________ _____________________________ _____________________________
Foreign language______________ _____________________________ _____________________________ _____________________________

Copyright 1995 Arletta's Adult Care Home, Inc.                                        
Last modified: August 06, 2016