Functional
Abilities Checklist
Date:
1999, Sep 19
From: Suzanne
Meeks smeeks
Directions: Check the level of function of each activity of
daily living listed below. This will give you direction for
determining how much assistance the individual needs in performing
activities of daily living.
|
Function
|
Independent
|
Needs Help
|
Dependent
|
Does Not Do
|
|
*ADL's
|
|
|
|
|
|
Bathing
|
|
|
|
|
|
Dressing
|
|
|
|
|
|
Grooming
|
|
|
|
|
|
Oral Care
|
|
|
|
|
|
Toileting
|
|
|
|
|
|
Transferring
|
|
|
|
|
|
Walking
|
|
|
|
|
|
Eating
|
|
|
|
|
| |
|
|
|
|
|
*IADL's
|
|
|
|
|
|
Managing Meds
|
|
|
|
|
|
Using The Phone
|
|
|
|
|
|
Managing Money
|
|
|
|
|
|
Housework
|
|
|
|
|
|
Doing Laundry
|
|
|
|
|
|
Driving
|
|
|
|
|
|
Shopping
|
|
|
|
|
|
Cooking
|
|
|
|
|
*ADL's = Activities of
Daily Living
*IADL's = Instrumental
Activities of Daily Living
|
