Item | Score | ||
1. History of falling | No | 0 | |
Yes | 25 | ||
2. Secondary diagnosis | No | 0 | |
Yes | 15 | ||
3. Ambulatory aid | |||
None/bed rest/nurse assist | 0 | ||
Crutches/cane/walker | 15 | ||
Furniture | 30 | ||
4. Intravenous therapy/saline lock | No | 0 | |
Yes | 20 | ||
5. Gait | |||
Normal/bed rest/wheelchair | 0 | ||
Weak | 10 | ||
Impaired | 20 | ||
6. Mental status | |||
Oriented to own ability | 0 | ||
Overestimates/forgets limitations | 15 | ||
Total |
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