1. Appendix B
   1. DATA COLLECTION TOOL

Appendix B

DATA COLLECTION TOOL

Records review will be completed by appropriate staff of Heritage Pointe of Fort Wayne.

Participant # ____

Demographic info:

Age ____

Sex ____

Ethnicity ______

Primary Diagnosis _________

Secondary Diagnoses_________

Data Collection Dates

Pre: ____

Post: _______

6 Month Follow-up: _______

Table of Contents

• Introduction
• Literature Review
• Methods
• Results
• Discussion
• Conclusion
• References
• Appendix A
• Appendix B
• Appendix C