{"content":[{"text":"TELL BRIEFLY ABOUT YOUR PARENTS, BROTHERS & SISTERS;_____________________________","bbox":{"left":0.058824,"top":0.093822,"width":0.8500400000000001,"height":0.015516000000000002}},{"text":"________________________________________________________________________________","bbox":{"left":0.113788,"top":0.125763,"width":0.79948,"height":0.015516000000000002}},{"text":"WHAT DOES HOSPICE/COMFORT CARE MEAN TO YOU:_____________________________________","bbox":{"left":0.058824,"top":0.157705,"width":0.855073,"height":0.015516000000000002}},{"text":"________________________________________________________________________________","bbox":{"left":0.117647,"top":0.189647,"width":0.79948,"height":0.015516000000000002}},{"text":"HAS SOMEONE CLOSE TO YOU DIED RECENTLY? WHAT OTHER SIGNIFICANT LOSSES HAVE \n AFFECTED YOUR LIFE. PLEASE EXPLAIN:_________________________________________________","bbox":{"left":0.058824,"top":0.221588,"width":0.86219,"height":0.03148699999999999}},{"text":"_________________________________________________________________________________","bbox":{"left":0.117647,"top":0.269501,"width":0.8096919999999999,"height":0.015515999999999974}},{"text":"WHY DO YOU WANT TO VOLUNTEER WITH THE DYING:_______________________________________","bbox":{"left":0.058824,"top":0.301443,"width":0.871034,"height":0.015515999999999974}},{"text":"__________________________________________________________________________________","bbox":{"left":0.117647,"top":0.333385,"width":0.819467,"height":0.015515999999999974}},{"text":"DO YOU HAVE EXPERIENCE WORKING WITH FAMILIES (THROUGH EMPLOYMENT, VOLUNTEERING, \n OR PERSONAL LIFE):_____________________________________________________________________","bbox":{"left":0.058824,"top":0.365326,"width":0.876288,"height":0.03148699999999999}},{"text":"__________________________________________________________________________________","bbox":{"left":0.117647,"top":0.413239,"width":0.819467,"height":0.015515999999999974}},{"text":"HOW DID YOU LEARN ABOUT HOUSE OF JOHN:______________________________________________","bbox":{"left":0.058824,"top":0.445181,"width":0.878106,"height":0.015515999999999974}},{"text":"DO YOU HAVE SPECIFIC CONCERNS OR APPREHENSIONS REGARDING PALLIATIVE CARE, OR \n CARING FOR THE DYING:__________________________________________________________________","bbox":{"left":0.058824,"top":0.477122,"width":0.8802719999999999,"height":0.03148699999999999}},{"text":"__________________________________________________________________________________","bbox":{"left":0.117647,"top":0.525035,"width":0.819467,"height":0.015515999999999974}},{"text":"REFERENCES: Please list three people who can be contacted as references (not relatives). \n please supply references from your volunteering or employment experiences:","bbox":{"left":0.058824,"top":0.588918,"width":0.737239,"height":0.03148699999999993}},{"text":"If possible,","bbox":{"left":0.806059,"top":0.588918,"width":0.0859120000000001,"height":0.015515999999999974}},{"text":"1.","bbox":{"left":0.088235,"top":0.636831,"width":0.014987,"height":0.015515999999999974}},{"text":"Name: _______________________ Relationship: ___________________________________","bbox":{"left":0.117647,"top":0.636831,"width":0.7564329999999999,"height":0.015515999999999974}},{"text":"Address: ______________________","bbox":{"left":0.117647,"top":0.668773,"width":0.295781,"height":0.015515999999999974}},{"text":"Phone: _______________________________________","bbox":{"left":0.423418,"top":0.668773,"width":0.45170399999999994,"height":0.015515999999999974}},{"text":"2.","bbox":{"left":0.088235,"top":0.700714,"width":0.014987,"height":0.015515999999999974}},{"text":"Name: _______________________ Relationship: ___________________________________","bbox":{"left":0.117647,"top":0.700714,"width":0.7564329999999999,"height":0.015515999999999974}},{"text":"Address: ______________________","bbox":{"left":0.117647,"top":0.732656,"width":0.295781,"height":0.015515999999999974}},{"text":"Phone: _______________________________________","bbox":{"left":0.423418,"top":0.732656,"width":0.45170399999999994,"height":0.015515999999999974}},{"text":"3.","bbox":{"left":0.088235,"top":0.764598,"width":0.014987,"height":0.015515999999999974}},{"text":"Name: _______________________ Relationship: ___________________________________","bbox":{"left":0.117647,"top":0.764598,"width":0.7564329999999999,"height":0.015515999999999974}},{"text":"Address: ______________________","bbox":{"left":0.117647,"top":0.79654,"width":0.295781,"height":0.015515999999999974}},{"text":"Phone: _______________________________________","bbox":{"left":0.423418,"top":0.79654,"width":0.45170399999999994,"height":0.015515999999999974}}],"images_bbox":[],"images_bbox_not_text_overlap":[]}