Healthcare
ADLs
(Simple v1)
ADLs
Green
normal,
purple
refused / not done.
bathing
—
0 Independent
1 Setup/Supervision
2 Partial
3 Max
4 Dependent
done
refused
dressing
—
0 Independent
1 Setup/Supervision
2 Partial
3 Max
4 Dependent
done
refused
grooming
—
0 Independent
1 Setup/Supervision
2 Partial
3 Max
4 Dependent
done
refused
oral care
—
0 Independent
1 Setup/Supervision
2 Partial
3 Max
4 Dependent
done
refused
Activities (last 24h)
Choose from list
Add
toileting
—
0 Independent
1 Setup/Supervision
2 Partial
3 Max
4 Dependent
done
bladder control
—
0 Independent
1 Setup/Supervision
2 Partial
3 Max
4 Dependent
done
catheter/foley care
performed
Assistive device
NONE
CANE
WALKER
WHEELCHAIR
BEDBOUND
Ambulation distance
Time up (min)
Sleep (hours)
Save ADLs
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