Personal Data

General Information

  • Last name and first name
  • Maiden name
  • ID card number
  • Place of issue
  • JMBG
  • Gender
  • Citizenship
  • Ethnic and religious affiliation
  • Father's name
  • Mother's name
  • Mother's maiden name
  • Date, month and year of birth
  • Place and address of residence before entering the institution
  • Marital status
  • Education
  • Occupation during active life
  • Regular personal income (type and monthly amount)
  • Is the user health insured and on what basis
  • Information about the property he owns
  • Information about the use of free time

Health and Functional Status

  • Is the user mobile
  • Does the user use orthopedic aids
  • Does the user have chronic illnesses
  • Type and severity of illness
  • Is the user mentally stable
  • Does the user use therapy
  • Type of therapy
  • Does the user require special care
  • Description of special care

Family Status

  • Number and age of children
  • Is the user divorced
  • Is the user a widow
  • Does the user have a spouse/sister
  • Number and age of spouse/sister

Accommodation Data

  • Number and age of children
  • Is the user divorced
  • Is the user a widow
  • Does the user have a spouse/sister
  • Number and age of spouse/sister
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