The Application - Page 6

FUNCTIONAL ASSESSMENT FOR PLACEMENT:

More that the doctor needs to fill out. Here there are several sections with check boxes to check off.

• Ambulation - whether they require aids like a wheelchair, walker, cane, etc. and any assistance required, if they fall, if they are bedridden, etc.
• Transfer - Do they need help moving from one place to another, from bed, to a chair, etc.
• Limbs - normal, amputation, prostesis, etc.
• Bowel - full control, incontinent, occasionally incontient, using an incontinent product, etc.
• bladder - much the same as the bowel one but also include more info required as well as includes a cathether, etc.
• Ostomy - their ability to care for it, if they have it, etc.
• Dialysis - yes or no and what kind and what facility
• Skin condition - this section also includes footcare
• Cognitive function - this section includes memory loss, impaired judgement, lacks attention, forgetful, and forgetful for what.. (personal hygeine, electrical devices, medication), etc.
• As well as memory loss it includes 'disoriented to'. Options here to check off include time, person, place, etc. and how severe are they effected.
• Behavioural - lots of options to check off here.