checked> 0 - Able to get clothes out of closets and drawers, put them on and remove them from the upper body without assistance checked> 1 - Able to dress upper body without assistance if clothing is laid out or handed to the patient checked> 2 - Someone must help the patient put on upper body clothing checked> 3 - Patient depends entirely upon another person to dress the upper body

checked> 0 - Able to obtain, put on, and remove clothing and shoes without assistance checked> 1 - Able to dress lower body without assistance if clothing and shoes are laid out or handed to the patient checked> 2 - Someone must help the patient put on undergarments, slacks, socks or nylons, and shoes checked> 3 - Patient depends entirely upon another person to dress lower body

checked> 0 - Able to bath self in shower or tub independently, including getting in and out of tub/shower checked> 1 - With the use of devices, is able to bath self in shower or tub independently, including getting in and out of the tub/shower checked> 2 - Able to bath in shower or tub with the intermittent assistance of another person: (a) for intermittent supervision or encouragement or reminders, OR (b) to get in and out of the shower or tub, OR (c) for washing difficult to reach areas checked> 3 - Able to participate in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision checked> 4 - Unable to use the shower or tub, but able to bathe self independently with or without the use of devices at the sink, in chair, or on commode checked> 5 - Unable to use the shower or tub, but able to participate in bathing self in bed, at the sink, in bedside chair, or on commode, with the assistance or supervision of another person throughout the bath checked> 6 - Unable to participate effectively in bathing and is bathed totally by another person

checked> 0 - Able to get to and from the toilet and transfer independently with or without a device checked> 1 - When reminded, assisted, or supervised by another person, able to get to and from the toilet and transfer checked> 2 - Unable to get to and from the toilet but is able to use a bedside commode (with or without assistance) checked> 3 - Unable to get to and from the toilet or bedside commode but is able to use a bedpan/urinal independently checked> 4 - Is totally dependent in toileting

checked> 0 - Able to independently transfer checked> 1 - Transfers with minimal human assistance or with use of an assistive device checked> 2 - Unable to transfer self but is able to bear weight and pivot during the transfer process checked> 3 - Unable to transfer self and is unable to bear weight or pivot when transferred by another person checked> 4 - Bedfast, unable to transfer but is able to turn and position self in bed checked> 5 - Bedfast, unable to transfer and is unable to turn and position self

checked> 0 - Able to independently walk on even and uneven surfaces and negotiate stairs with or without railings (i.e., needs no human assistance or assistive device) checked> 1 - With the use of a one-handed device (e.g. cane, single crutch, hemi-walker), able to independently walk on even and uneven surfaces and negotiate stairs with or without railings checked> 2 - Requires use of a two-handed device (e.g., walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces checked> 3 - Able to walk only with the supervision or assistance of another person at all times checked> 4 - Chairfast, unable to ambulate but is able to wheel self independently checked> 5 - Chairfast, unable to ambulate and is unable to wheel self checked> 6 - Bedfast, unable to ambulate or be up in a chair