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Evaluation

Are you evaluating a patient with advanced dementia?

Age of the patient

years

Gender of the patient

Is the patient bedfast?

Is the patient incontinent for feces?

Percent of most meals eaten (enter from 0 to 100)

Has oxygen therapy been required in the last 14 days?

Is the patient asleep most of the day (as well as at night)?

Is the patient totally dependent in all 7 activities of daily living (dressing, eating, toileting, grooming, bed mobility, transfer, and locomotion?

Does the patient have?

• cancer?

• congestive heart failure?

• dyspnea?

• an unstable medical condition?

Results

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