Functional Risk Assessment—Part 1 Activities of Daily Independence: Dependence: Living (1 point each) (0 point each) No supervision, direction, or Supervision, direction, personal personal assistance needed assistance, or total care needed Bathing Bathes self completely or needs Needs help with bathing more than one help in bathing a single body part part of body, getting in or out of tub or Score: _____ shower, or total bathing Dressing Gets clothes from closets and Needs help with dressing self or needs drawers and puts on clothes and to be completely dressed Score: _____ outer garments complete with fasteners; may have help tying shoes Toileting Goes to toilet, gets on and off, Needs help transferring to toilet, clothes, cleans without cleaning, or uses bedpan or commode Score: _____ help Transferring Moves in and out of chair Needs help in moving from bed to chair unassisted; mechnical transferring or requires a complete transfer Score: _____ aides are acceptable Continence Exercises complete self control Is partially or totally incontinent Score: _____ Feeding Gets food from plate into mouth Needs partial or total help with feeding or without help; preparation of food requires parenteral feeding Score: _____ may be done by another person Total Interpretation: 6 = patient independent, 0 = patient very dependent Score: _____ Functional Risk Assessment—Part 1 1. Activities of Daily Living (ADL) are those basic elements of self-care that indicate a need for supportive services, such as home health care. Scoring 1 point = No supervision, direction, or personal assistance needed 0 points = Supervision, direction, personal assistance, or total care needed
Functional Risk Assessment—Part 1 Activities of Daily Living Independence: (1 point each) No supervision, direction, or personal assistance needed Dependence: (0 point each) Supervision, direction, personal assistance, or total care needed Bathing Score: _____ Bathes self completely or needs help in bathing a single body part Needs help with bathing more than one part of body, getting in or out of tub or shower, or total bathing Dressing Score: _____ Gets clothes from closets and drawers and puts on clothes and outer garments complete with fasteners; may have help tying shoes Needs help with dressing self or needs to be completely dressed Toileting Score: _____ Goes to toilet, gets on and off, clothes, cleans without help Needs help transferring to toilet, cleaning, or uses bedpan or commode Transferring Score: _____ Moves in and out of chair unassisted; mechnical transferring aides are acceptable Needs help in moving from bed to chair or requires a complete transfer Continence Score: _____ Exercises complete self control Is partially or totally incontinent Feeding Score: _____ Gets food from plate into mouth without help; preparation of food may be done by another person Needs partial or total help with feeding or requires parenteral feeding Total Score: _____ Interpretation: 6 = patient independent, 0 = patient very dependent Functional Risk Assessment—Part 1 1. Activities of Daily Living (ADL) are those basic elements of self-care that indicate a need for supportive services, such as home health care. Scoring 1 point = No supervision, direction, or personal assistance needed 0 points = Supervision, direction, personal assistance, or total care needed