Activities of daily living 2
More assessment tools
Name: _____________________ Today’s Date: _________
Please check the box that most applies for each activity:
| Activity | Need No Help
(2 pts. each) |
Need Some Help
(1 pt. each) |
Unable to Do At All
(0 pts. each) |
| 1. Using the telephone | ___ | ___ | ___ |
| 2. Getting to places beyond walking distance | ___ | ___ | ___ |
| 3. Grocery shopping | ___ | ___ | ___ |
| 4. Preparing meals | ___ | ___ | ___ |
| 5. Doing housework or handyman work | ___ | ___ | ___ |
| 6. Doing laundry | ___ | ___ | ___ |
| 7. Taking medications | ___ | ___ | ___ |
| 8. Managing money | ___ | ___ | ___ |
| Total Score: ___ = | ( __ x 2 =) ___ + | ( __ x 1=) ___ + | 0 |