,,HDC
 ,H1L? & ,4ABIL;Y ,COMMIS.N]
     ,TE ,TOIHAU ,HAUORA1
         ,HAU_ATANGA

     ,MY ,H1L? ,PASSPORT

,PL1SE 5SURE ,I TAKE ,MY ,H1L?
  ,PASSPORT ) ME :5 ,I L1VE4

 ,REVIEW YR 9=MA;N :5 "DLI<T
SAV+ O3URS1 OR E>LI] IF *ANGE
            O3URS4

      ,ADAPT$ 9 A3ORD.E
       ) ,SEC;N #FI ( !
      ,COPY"R ,ACT #AIID
   BY ! ,ROYAL ,NEW ,Z1L&
       ,F.DA;N ( ! ,BL


      ,PRODUC$ #BJBD BY
  ,A3ESSIBLE ,=MATS ,S]VICE
 ,BL ,L[ ,VI.N ,,NZ1 ,AUCKL&1
          ,NEW ,Z1L&       P#A
        H1L? PASSPORT       #B

,DATE ( COMPLE;N3 ",-

,UPDAT$ 9=MA;N IS 9SIDE ! BACK
  COV] ( ? BOOKLET3 .7"<,TICK
  EI ,YES OR ,NO">.'
  ,,YES ",-
  ,,NO ",-

,F/ "N3 ",-
,LA/ "N3 ",-
,I L TO 2 "KN Z3 ",-

    ,NOTES = ! P]SON COMPLET+
    ,MY ,H1L? ,PASSPORT
  ,COMPLET+ YR ,H1L? ,PASSPORT
IS OP;NAL4 ,Y MAY DECIDE H[ M*
9=MA;N Y WANT TO GIVE "U EA*
SEC;N & MAY *OOSE N TO
COMPLETE "S SEC;NS ( YR ,H1L?
,PASSPORT4
  ,IF Y >E UNSURE :AT TO WRITE
9 A "PICUL> SEC;N1 PL1SE REF]
TO ! ,GUIDE = ,COMPLET+     #A
        H1L? PASSPORT      A#B
,MY ,H1L? ,PASSPORT4

    ,NOTES = M$ICAL & SUPPORT
    /AFF
_4 ,IF Y >E 9VOLV$ ) MY C>E &
  SUPPORT1 PL1SE R1D ? DOCU;T4
_4 ,? IS N MY ,M$ICAL ,RECORD4
  ,? DOCU;T GIVES 9=MA;N AB3
    ,-,?+S Y ,,M/ "K AB ME
    ,-,?+S T >E IMPORTANT TO
      ME
    ,-,O!R USE;L 9=MA;N
_4 ,? DOCU;T /AYS ) ME 9
  HOSPITAL4 ,PL1SE 5SURE ,I
  TAKE X ) ME :5 ,I L1VE4
----------------------------#C
    #A4 ,P]SONAL DETAILS
A4 ,NA;NAL ,H1L? ,9DEX
  "<,,NHI">3 ",-
;B4 ,E?NIC;Y3 ",-
;C4 ,ADDRESS3 ",-
;D4 ,TELEPH"O3 ",-
  ,MOBILE3 ",-
;E4 ,EMAIL3 ",-             #B
        H1L? PASSPORT      A#C
;F4 ,PREF]R$ ME?OD ( 3TACT3
  ",-
;G4 ,I H A 4ABIL;Y AL]T3
  ,,YES ",-
  ,,NO ",-
    ,A 4ABIL;Y AL]T IS A NOTE
      ON YR M$ICAL RECORD
;H4 ,MY ,G5]AL ,PRACTI;N]
  "<,,GP">3
  ,PRACTICE3 ",-
  ,TELEPH"O3 ",-
  ,MOBILE3 ",-
  ,EMAIL3 ",-

I4 ,ANY DEP5D5TS3
  ,,YES ",-
  ,,NO ",-
    EG1 PETS1 *N1 NEI<B\R1
      FAMILY MEMB]4
  ,DESCRIBE3 ",-



                            #C
        H1L? PASSPORT       #D

    #B4 ,? IS :AT ,I WANT TO
    TELL Y AB MYF
  ,Y MAY *OOSE TO WRITE AB YR
IMPAIR;T OR O!R H1L? 3DI;NS,-
EG1 ,I H C]EBRAL PALSY1 ,I H
EPILEPSY & MY SEIZURES V>Y F
MILD TO /R;G4

_4 ",-
_4 ",-
_4 ",-
_4 ",-
----------------------------#E
    #C4 ,COMMUNICA;N
A4 ,MY PREF]R$ LANGUAGE3 ",-
;B4 ,I C AL USE3 ",-
  LANGUAGE_/S4
;C4 ,I NE$ AN 9T]PRET]3
  ,,YES ",-
  ,,NO ",-
  ,LANGUAGE3 ",-
;D4 ,I COMMUNICATE ) P US+,-
  EG1 GE/URES1 FACIAL       #D
        H1L? PASSPORT      A#E
  EXPRES.NS1 PICTURES1
  TELEPH"O1 TEXT+1 O!R
  TE*NOLOGY4
;E4 ,:AT Y %D 2 AW>E ( :5
  COMMUNICAT+ ) ME,-EG1 FACE
  ME1 SP1K CLE>LY1 TAP
  FURNITURE TO GET MY ATT5;N1
  5SURE MY HE>+ AID IS ON1
  TELL ME :AT Y >E DO+1 &
  3FIRM ,I H "U/OOD4
----------------------------#F
    #D4 ,DECI.N-MAK+
  ,IF ,I D N H A LEGAL
REPRES5TATIVE OR ADV.E
DIRECTIVES1 ,I TRU/ T ANY
DECI.N 3C]N+ MY C>E & WELF>E W
2 MADE BY APPROPRIATE
PR(ES.NAL_/S 9 MY BE/ 9T]E/S4

A4 ,I C & WD L TO MAKE MY [N
  DECI.NS1 S PL1SE ASK ME F/4
  ,,YES ",-
  ,,NO ",-
                            #E
        H1L? PASSPORT      A#F
;B4 ,I MAY NE$ ASSI/.E TO MAKE
  AN 9=M$ DECI.N4
  ,,YES ",-
  ,,NO ",-

;C4 ,IF = "S R1SON ,I AM
  UNABLE TO MAKE A DECI.N AT A
  "T :5 A DECI.N NE$S TO 2
  MADE1 ! FOLL[+ W APPLY3
  I4 ,I H A LEGAL
    REPRES5TATIVE
    ,,YES ",-
    ,,NO ",-
  ,MY LEGAL REPRES5TATIVE IS3
  ,FULL "N3 ",-
    ,_! LEGAL RELA;N%IP,-EG1
  WELF>E GU>DIAN1 5DUR+ P[] (
  ATTORNEY = H1L? & WELF>E4
    ,TELEPH"O3 ",-
    ,MOBILE3 ",-
    ,EMAIL3 ",-


                            #F
        H1L? PASSPORT      B#F
  II4 ,I H A LI/ ( MY WI%ES =
    H1L? C>E 9 ! FUTURE3
    ,,YES ",-
    ,,NO ",-
    ,9=MA;N AB MY WI%ES C 2
  F.D,-EG1 ON MY M$ICAL
  RECORDS1 AT HOME1 ) MY ,,GP
  :O HOLDS MY ADV.E
  DIRECTIVES1 ,I H GIV5 V]BAL
  DIRECTIVES TO MY SON4
----------------------------#G
    #E4 ,IMPORTANT P 9 MY LIFE
A4 ,F/ 3TACT P]SON3
    ,3TACT P C 2 ANY"O Y
  *OOSE1 EG1 FAMILY1 :_ANAU1
  FR1 SUPPORT "W]4
    ,FULL "N3 ",-
    ,RELA;N%IP TO ME3 ",-
    ,TELEPH"O3 ",-
    ,MOBILE3 ",-
    ,EMAIL3 ",-


                            #G
        H1L? PASSPORT      A#G
;B4 ,SECOND 3TACT P]SON3
  ,FULL "N3 ",-
  ,RELA;N%IP TO ME3 ",-
  ,TELEPH"O3 ",-
  ,MOBILE3 ",-
  ,EMAIL3 ",-
;C4 ,ANY O!R P]SON OR AG5CY &
    _! 3TACT DETAILS3 ",-
----------------------------#H
    #F4 ,?+S TO "K :5 PROVID+
    H1L? S]VICES
A4 ,I AM 9 PA9 :5,-EG1 ,I TELL
  Y1 ,I MAKE A "PICUL> S.D1 ,I
  COV] OR HOLD AN >EA ( MY
  BODY4
;B4 ,I AM ALL]GIC TO,-EG1
  C]TA9 M$ICA;NS1 P]FUME1
  NUTS4
;C4 ,:5 GIV+ ME M$ICA;N1
  PL1SE,-EG1 PUT PILLS ON A
  SPOON1 TELL ME :AT ,I W
  EXP]I;E4
    ,AN UP-TO-DATE M$ICA;N LI/
  IS 9 ! BACK COV] ( ?      #H
        H1L? PASSPORT      A#H
  BOOKLET4
  ,,YES ",-
  ,,NO ",-
;D4 ,SUPPLE;TS & H]BAL
  REM$IES,-EG1 ,I TAKE VITAM9
  ;,C TABLETS DAILY4
;E4 ,:5 EXAM9+ ME1 PL1SE,-EG1
  TELL ME :AT Y >E DO+1 2 AW>E
  ( MY CA!T] BAG1 LIE ME ON MY
  LEFT SIDE4
;F4 ,O!R ?+S Y NE$ TO "K AB ME
  :5 PROVID+ A H1L? S]VICE4
----------------------------#I
    #G4 ,SAFETY & COM=T
,I NE$ ASSI/.E = MY SAFETY &
  COM=T
  ,,YES ",-
  ,,NO ",- "<,IF NO1 MOVE TO
    PR9T PAGE #AA4">

A4 ,?+S IMPORTANT = MY
  PHYSICAL SAFETY,-EG1 RAIS$
  B$ RAILS1 MY S1T BELT1 %>P
  OBJECTS REMOV$ F ROOM1    #I
        H1L? PASSPORT      A#I
  SU/A9$ OBS]VA;N4
;B4 ,?+S T MAY UPSET ME OR
  MAKE ME 2COME ANXI\S >E,-EG1
  B"R LI<TS1 L\D NOISE1 LACK (
  9=MA;N4
;C4 ,Y WD "K T ,I AM ANXI\S OR
  /RESS$ :5,-EG1 ,I AVOID EYE
  3TACT1 ,I BITE MYF1 ,I CRY1
  ,I BANG OBJECTS4
;D4 ,?+S Y CD D TO MAKE ME
  FEEL M 9 3TROL & COM=TABLE,-
  EG1 PLAY S(T MUSIC1 TAKE ME
  \ = A WALK1 GIVE ME A TASK4
---------------------------#AJ
    #H4 ,MOV+ >.D
,I NE$ ASSI/.E TO MOVE >.D
  ,,YES ",-
  ,,NO ",-

A4 ,I MOVE >.D US+,-EG1 A
  MOBIL;Y AID1 ,I NE$ A HOI/ =
  TRANSF]S1 ,I H A GUIDE DOG4
;B4 ,IF Y >E ASSI/+ ME Y NE$
  TO "K,-EG1 ROLL ME ON    #AJ
        H1L? PASSPORT     A#AJ
  "O SIDE :5 ASSI/+ ME TO MOVE
  9 B$1 LET ME HOLD YR LEFT >M
  :5 Y >E GUID+ ME1 PL1SE PUT
  MY P[] :EEL*AIR ON *>GE AT
  NI<T4
---------------------------#AA
    #I4 ,DAILY ACTIVITIES
,I MAY NE$ ASSI/.E ) "S DAILY
  ACTIVITIES
  ,,YES ",-
  ,,NO ",-

A4 ,US+ ! TOILET,-EG1 ,I NE$
  ASSI/.E ) BUTTONS & ZIPS4
;B4 ,WA%+_/TAK+ A %[],-EG1 ,I
  NE$ ASSI/.E TO DRY MYF1 WA%
  MY HAIR4
;C4 ,GROOM+ @& P]SONAL
  HYGI5E,-EG1 ,I NE$ ASSI/.E
  TO BRU% MY HAIR1 TO USE A
  TOO?BRU%4
;D4 ,DRESS+ & UNDRESS+,-EG1 ,I
  NE$ ASSI/.E ) BUTTONS1 ,I
  C'T PUT ON %OES4         #AA
        H1L? PASSPORT     A#AA
;E4 ,EAT+ & DR9K+,-EG1 TELL ME
  :AT IS 9 ! FOOD1 ,I NE$ A
  /RAW = ALL FLUID1 ,I NE$
  FOOD 9 BITE-SIZ$ PIECES1
  FOOD M/ 2 S(T & MOI/4
;F4 ,SLEEP+,-EG1 ,I H SLEEP
  AID M$ICA;N1 ,I NE$ WAT] 2F
  ,I SLEEP1 ,I NE$ ! LI<T ON4
---------------------------#AB
    #AJ4 ,O!R HELP;L 9=MA;N
A4 ,I L,-EG1 MUSIC1 R\T9ES4
;B4 ,I D N L,-EG1 C]TA9 FOOD1
  D>K ROOMS4
;C4 ,MY RELIGI\S_/_SUAL NE$S,-
  EG1 KARAKIA_/PRAY]S1 ,HALAL
  FOOD4
;D4 ,MY CULTURAL NE$S,-EG1 ,I
  REQUIRE A WOMAN DOCTOR1 ":
  POSSIBLE ,I NE$ A FAMILY
  MEMB] ) ME AT ALL "TS4
;E4 ,O!R 9=MA;N,-EG1 TELL ME
  :5 Y BR+ ME FOOD1 & :AT IS 9
  X4
                           #AB
        H1L? PASSPORT      #AC

        ,AC"KL$GE;TS3

  ,? DOCU;T IS BAS$ ON ORIG9AL
"W CALL$ 8,? IS MY ,HOSPITAL
,PASSPORT0 BY ! ,W&SWOR?
,COMMUN;Y ,4ABIL;Y ,T1M1
,UNIT$ ,K+DOM4
  ,?ANK Y TO "EY"O :O HAS BE5
9VOLV$ 9 DEVELOP+
,NEW ,Z1L&'S ,MY ,H1L?
,PASSPORT4

          ,4CLAIM]3

  ,! ,H1L? & ,4ABIL;Y
,COMMIS.N] MAKES ! ,MY ,H1L?
,PASSPORT TEMPLATE AVAILABLE Z
A GUIDE ONLY & A3EPTS NO
RESPONSIBIL;Y = ! A3URACY ( !
COMPLET$ 9=MA;N4


                           #AC
        H1L? PASSPORT  #AD-#AF
  ^7,? ,PASSPORT /AYS ) ME 9
HOSPITAL4 ,PL1SE 5SURE ,I TAKE
X ) ME :5 ,I L1VE4^'

  ,TO PROVIDE FE$BACK ON ?
GUIDE1 PL1SE 3TACT3

,H1L? @& ,4ABIL;Y ,COMMIS.N]
  ,,PO ,BOX #AGIA
  ,AUCKL& #AADJ4
,FREE ,PH"O3 #JHJJ"AA"BB"CC
,EMAIL3
  H1L?PASSPORT@AHDC4ORG4NZ

            ,! ,5D








                           #AD