VULNERABILITY ASSESSMENT and Contact Details Employee_NrPPLE Healthcare Nr Old Medx NrName First Last PhoneEmail Home Address Street Address Address Line 2 City State Zip/ Postal Code Any Comorbidity Asthma Cerebrovascular disease Lung Diseases Hypertension or high blood pressure Immunocompromised state Neurologic conditions Liver disease Pregnancy Pulmonary fibrosis Smoking Thalassemia Type 1 or Type 2 diabetes Unlisted ComorbidityExample: Child under the age of 3 with ComobiditiesNameNext of Kin First Last Next of Kin Relationship Partner Husband / Wife Parent Friend Family Any Comorbidity Asthma Cerebrovascular disease Lung Diseases Hypertension or high blood pressure Immunocompromised state Neurologic conditions Liver disease Pregnancy Pulmonary fibrosis Smoking Thalassemia Type 1 or Type 2 diabetes Unlisted ComorbidityExample: Child under the age of 3 with ComobiditiesPhone NrNext of Kin
