Are you evaluating an adult in the hospital?

Age of the patient


Number of chronic impairments in activities of daily living

Number of falls in the past 3 months

Does/Has/Was/Is the patient?

• have a history of a recent stroke or residual defect from a previous one?

• had a recent fracture?

• admitted from a nursing home?

• had an unplanned readmission within 3 months of a previous hospitalization?

• require assistance for mobilility?

• malnourished?

• have urinary and/or fecal incontinence?

• confused or demented?

• been bedridden for the past 2 weeks?

• have depression or bipolar disorder?


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