How much help does the person need for handeling finances ?
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How much assistance does the person need for handeling monery while shopping ?
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How much problem does the person have with past memory ?
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How much problem does the person have with recent memory ?
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How much help does the person need with feeding itself?
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How much help does the person need for upper body dressing ?
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How much help does the person need for lower body dressing ?
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How much help does the person need for choosing dressing ?
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How much help does the person need for toiletting ?
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How much trouble does the the person have with urine continence ?
0
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How often does the the person have bowel continence ?
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How much problem does the person have with judgement ?
0
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How much trouble does the person have with judgemental safety ?
0
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How much problem does the person have with time orientation ?
0
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How much problem does the person have with location orientation ?
0
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How much help does the person need with bathing ?
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How much problem does the person have with speech ?
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How much help does the person need with bed to chair transfer ?
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How much does the person suffer from anxiety ?
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How much trouble does the person have with mobility ?
0
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How much help does the person need with transport ?
0
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How much has the person have lost its appetite ?
0
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How much does the person suffer from depression ?
0
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How much trouble does the person have in remembering the objects location ?
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How much trouble does the person have with its job function ?
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How much trouble does the person have with concentration ?
0
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How much does the person suffer from agitation ?
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How much does the person suffer from delusion ?
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How much does the person suffer from obsession ?
0
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How much does the person show signs of lassitude ?
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How much does the person show signs of apathy ?
0
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How much does the person show signs of irritation ?
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How much does the person show signs of pessimism ?
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How much trouble does the person have with sleeping ?
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How much does the person show signs of violence towards itself or others like hitting ?
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How much does the person show signs of violence like kicking ?
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How much does the person show signs of violence like grabbing onto people ?
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How much does the person show signs of violence like pushing ?
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How much does the person show signs of violence like biting ?
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How much does the person show signs of violence like throwing things ?
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How much does the person show signs of violence towrds itself or others like hurting ?
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How much does the person show signs of violence like spitting ?
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How much help does the person need with grooming ?
0
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How much has the person lost interest in hobbies ?
0
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How much have the person lost weight ?
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How much trouble does the person have with swallowing ?
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How much trouble does the person have with conducting normal activity ?
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How much trouble does the person have with its ability to walk ?
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How much trouble does the person have with locating misplaced objects ?
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Does the person suffer from skin ulcer ? (answer not zero if true)
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How much does the person have gastric-peptic ulcer ? (answer not zero if true)
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How much trouble does the person have in locating misplaced objects ?
0
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How much trouble does the person have with recognizing faces of family or friends ?
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How much trouble does the person have with remembering names of family or friends ?
0
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How much trouble does the person have with remembering things about family or friends ?
0
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How much trouble does the person have with arithmetic ?
0
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How much trouble does the person have with learning of a new tool usage ?
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How much trouble does the person have with communication ?
0
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How much trouble does the person have with managing its medication ?
0
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6
7
How much trouble does the person have with recalling conversation ?
0
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4
5
6
7
Does the person suffer from cancer ? (answer not zero if true)
0
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6
7
Does the person suffer from Congestive Heart Failure ? (answer not zero if true)
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How often does the person scream ?
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1
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Most of the test results are available. You may choose to evaluate now or continue for complete results.
How much does the person complain of pain ?
0
1
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5
6
7
How much help does the person need with food preparation ?
0
1
2
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4
5
6
7
How much help does the person need with drink preparation ?
0
1
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6
7
How much trouble does the person have with drinking ?
0
1
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6
7
How much help does the person have with hygiene ?
0
1
2
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4
5
6
7
How much help does the person have with using the telephone ?
0
1
2
3
4
5
6
7
How much help does the person have with housework ?
0
1
2
3
4
5
6
7
How much has the person lost its ability to smile ?
0
1
2
3
4
5
6
7
How much trouble does the person have with breathing ?
0
1
2
3
4
5
6
7
How much does the person suffer from hypertension ?
0
1
2
3
4
5
6
7
How much does the person suffer from suicidal thoughts ?
0
1
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6
7
How much does the person show signs of self-depreciation ?
0
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6
7
How much does the person show signs of mood changes ?
0
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How much does the person show signs of hallucination ?
0
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How much does the person show signs of unnatural elation ?
0
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7
How much does the person show signs of disinhibition ?
0
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How often does the person is doubtful ?
0
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How often does the person show signs of discontent with life ?
0
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7
How often does the person feel Lonely ?
0
1
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5
6
7
How often does the person feel wishfull ?
0
1
2
3
4
5
6
7
How often does the person report of depression ?
0
1
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5
6
7
How often does the person behave Unfriendly ?
0
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2
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6
7
How often does the person receive proper affection ?
0
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5
6
7
How often does the person receive proper attention ?
0
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6
7
How often does the person have to clarify itself?
0
1
2
3
4
5
6
7
How often does the person feel helpless ?
0
1
2
3
4
5
6
7
How often does the person feel self discontent ?
0
1
2
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4
5
6
7
How bad is the person's overall health quality ?
0
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6
7
How bad is the person's overall life quality ?
0
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7
How often is the person confused ?
0
1
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3
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6
7
How often does the person forget what it was going to say in the middle of a conversation ?
0
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How often does the person forget its address or phone number ?
0
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7
How much trouble does the person have with adapting to changes ?
0
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6
7
How much trouble does the person have with adapting to limitation ?
0
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7
How much trouble does the person have with learning ?
0
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7
How much trouble does the person have with the meaning of unusual words ?
0
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5
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7
How much trouble does the person have with understanding articles in magazines ?
0
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5
6
7
How much trouble does the person have with following stories ?
0
1
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4
5
6
7
How much help does the person need with composing a letter ?
0
1
2
3
4
5
6
7
How much trouble does the person have with social interaction ?
0
1
2
3
4
5
6
7
How much trouble does the person have with emotional adjustment ?
0
1
2
3
4
5
6
7
How often does the person wander ?
0
1
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3
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5
6
7
How often does the person dress inappropriately ?
0
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2
3
4
5
6
7
How often does the person show signs of verbal aggression ?
0
1
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3
4
5
6
7
How often does the person make strange noises ?
0
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7
How often is the person scratching ?
0
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6
7
How often does the person want to get to a different place ?
0
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3
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5
6
7
How often does the person intentionally fall ?
0
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7
How often does the person complain ?
0
1
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3
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5
6
7
How often does the person eat inappropriately ?
0
1
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3
4
5
6
7
How often does the person handle things inappropriately ?
0
1
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3
4
5
6
7
How often does the person hide things ?
0
1
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3
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5
6
7
How often does the person horde things ?
0
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5
6
7
How often does the person tear things ?
0
1
2
3
4
5
6
7
How often does the person make verbal sexual advances ?
0
1
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3
4
5
6
7
How often does the person make physical sexual advances ?
0
1
2
3
4
5
6
7
How often does the person make unwarranted requests for help or attention ?
0
1
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3
4
5
6
7
Is the person over 83 of age ? (answer not zero if true)
0
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3
4
5
6
7
Is the person male ? (answer not zero if true)
0
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3
4
5
6
7
Did the person recently need Oxygen therapy ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person suffer from malnutrition ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person have unstable medical condition ? (answer not zero if true)
0
1
2
3
4
5
6
7
Is the person bedfast ? (answer not zero if true)
0
1
2
3
4
5
6
7
Is the person not awake most of the time? (answer not zero if true)
0
1
2
3
4
5
6
7
How bad is patient's consciousness level ?
0
1
2
3
4
5
6
7
How often does the person miss giving eye contact ?
0
1
2
3
4
5
6
7
How often does the person miss having fluid intake ?
0
1
2
3
4
5
6
7
How bad is the person's muscle flexibility ?
0
1
2
3
4
5
6
7
How often does the person make multiple physical complaints ?
0
1
2
3
4
5
6
7
Has the person had mycordial infarction ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person suffer from the peripheral vascular disease ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person suffer from the cerebrovascular disease ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person suffer from Hemiplegia ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person suffer from the pulmonary disease ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person suffer from diabetes ? (answer not zero if true)
0
1
2
3
4
5
6
7
Has the person had diabetes organ damage ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person suffer from the renal disease ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person suffer from the mild liver disease ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person suffer from the severe liver disease ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person suffer from the metastatic cancer ? (answer not zero if true)
0
1
2
3
4
5
6
7
Is the person diagnosed with dementia ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person suffer from the rheumatic connective tissue disease ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person suffer from HIV ? (answer not zero if true)
0
1
2
3
4
5
6
7
Does the person consume Warfarin ? (answer not zero if true)
0
1
2
3
4
5
6
7
How much does the person suffer according to medical opinion ?
0
1
2
3
4
5
6
7
How much does the person suffer according to family opinion ?
0
1
2
3
4
5
6
7
How much trouble does the person have with comprehension ?
0
1
2
3
4
5
6
7
How much trouble does the person have with expression ?
0
1
2
3
4
5
6
7
How much trouble does the person have with reading ?
0
1
2
3
4
5
6
7
How much trouble does the person have with writing ?
0
1
2
3
4
5
6
7
How much help does the person need with shower transfer ?
0
1
2
3
4
5
6
7
How much help does the person need with car transfer ?
0
1
2
3
4
5
6
7
How much help does the person need with stairs ?
0
1
2
3
4
5
6
7
How much trouble does the person have with recalling history ?
0
1
2
3
4
5
6
7
How much trouble does the person have with remembering learned things ?
0
1
2
3
4
5
6
7
How bad is the person's situational awareness ability?
0
1
2
3
4
5
6
7
How much trouble does the person have working with tools ?
0
1
2
3
4
5
6
7
How much help does the person need with laundry ?
0
1
2
3
4
5
6
7
How much difficulty does the person have with sitting up ?
0
1
2
3
4
5
6
7
