Bathe

1 Point: no assist No constant reminders needed
2 Points: Light assist, light reminders Rarely needs reminders
3 Points: Part assist, light reminders Sometimes needs reminders
4 Points: Part assist, part reminders Frequently needs reminders
5 Points:Full assist, full reminders, or bed bath required Often needs reminders (e.g., Alzheimer's)

Wash Hands/Face

1 Point: No constant reminders needed
2 Points: Rarely needs reminders
3 Points: Sometimes needs reminders
4 Points: Frequently needs reminders
5 Points: Often needs reminders (e.g., Alzheimer's)

Brush Teeth

1 Point: No constant reminders needed
2 Points: Rarely needs reminders
3 Points: Sometimes needs reminders
4 Points: Frequently needs reminders
5 Points: Often needs reminders (e.g., Alzheimer's)

Reminders

1 Point: No constant reminders needed
2 Points: Rarely needs reminders
3 Points: Sometimes needs reminders
4 Points: Frequently needs reminders
5 Points: Often needs reminders (e.g., Alzheimer's)

Orient Person, Place, Time

1 Point: No constant reminders needed
2 Points: Rarely needs reminders
3 Points: Sometimes needs reminders
4 Points: Frequently needs reminders
5 Points: Often needs reminders (e.g., Alzheimer's)

Eat

1 Point: No constant reminders needed
2 Points: Rarely needs reminders
3 Points: Sometimes needs reminders
4 Points: Frequently needs reminders
5 Points: Often needs reminders (e.g., Alzheimer's)

Ambulate

1 Point: No constant reminders needed
2 Points: Rarely needs reminders
3 Points: Sometimes needs reminders
4 Points: Frequently needs reminders
5 Points: Often needs reminders (e.g., Alzheimer's)

Toileting

1 Point: No constant reminders needed
2 Points: Rarely needs reminders
3 Points: Sometimes needs reminders
4 Points: Frequently needs reminders
5 Points: Often needs reminders (e.g., Alzheimer's)

Dressing (Morning and Evening)

1 Point: No constant reminders needed
2 Points: Rarely needs reminders
3 Points: Sometimes needs reminders
4 Points: Frequently needs reminders
5 Points: Often needs reminders (e.g., Alzheimer's)

Cook

1 Point: No constant reminders needed
2 Points: Rarely needs reminders
3 Points: Sometimes needs reminders
4 Points: Frequently needs reminders
5 Points: Often needs reminders (e.g., Alzheimer's)

Clean

1 Point: No constant reminders needed
2 Points: Rarely needs reminders
3 Points: Sometimes needs reminders
4 Points: Frequently needs reminders
5 Points: Often needs reminders (e.g., Alzheimer's)

Shop

1 Point: No constant reminders needed
2 Points: Rarely needs reminders
3 Points: Sometimes needs reminders
4 Points: Frequently needs reminders
5 Points: Often needs reminders (e.g., Alzheimer's)

Conversate

1 Point: No constant reminders needed
2 Points: Rarely needs reminders
3 Points: Sometimes needs reminders
4 Points: Frequently needs reminders
5 Points: Often needs reminders (e.g., Alzheimer's)

ADL Points Form

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