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Title

Pëgėgnenimshkëkiwgëmëk
Pokagon Health Services
Recording: 
bégednëgét
authorized by [the one who allows things]
Recording: 
ga wawabdêk
witness [the one who watched]
Recording: 
maktthéwit wdazhdéyakwpi’gën
signature of PHS staff [signature of worker]
Recording: 
nipithë ėthë dayen
address [where do you live at?]
Recording: 
nipithë ėthë dbéndagwzëyen
Tribal affiliation [where are you enrolled at?]
Recording: 
nipithë ėthë miktthéwiyen
employer [where do you work at?]
Recording: 
nipithë ėthë miktthéwiyen
employment [where do you work at?]
Recording: 
nithë ngom ė yawêk
date [what is it today?]
Recording: 
nithë ė zhnëkazyen
patient name [what are you called?]
Recording: 
nithë ėnwémet
relationship to patient [how are you related to h/s?]
Recording: 
nithëwpi ga ndadzëyen
Date of birth [when were you born?]
Recording: 
penothé
child
Recording: 
wgetsimen
h/s parent(s)
Recording: 
wgetthda nė gdaw
are you a veteran?
Recording: 
wzhebyé’en gbiwapkogdaswen
phone number [write your phone number]
Recording: 
wénithë da shëgnongot
emergency contact [who should be called?]
Recording: 
wénithë wa wabthegazet
patient [who will be seen?]
Recording: 
yazhdéyakwpi’gén
signature of patient [make your mark]
Recording: