SELF CARE

1. Feeding     
    Independent
    Needs help cutting, spreading butter, etc, or requires modified diet
    Unable
2. Bathing     
    Independent (or in shower)
    Dependent
3. Grooming     
    Independant face/hair/teeth/shaving(implements provided)
    Needs help with personal care
4. Dressing     
    Independant (including buttons,zips, laces etc)
    Needs help but can do about half unaided
    Dependant

CONTINENCE

5. Bowels     
    Continent
    Occaisional accident (one per week)
    Incontinent (or needs to be given enemas)
6. Bladder     
    Continent
    Occaisional accident (one per week)
    Incontinent or catheterized and unable to manage alone

MOBILITY

7. Toilet use     
    Independant (getting on and off toilet,wiping and dressing)
    Needs some help but can do some things alone
    Dependant
8. Transfers (bed to chair and back)     
    Independent
    Minor help (verbal or physical)
    Major help (one or two people,physical help needed), can sit
    Unable, no sitting balance
9. Mobility (on level surfaces)     
    Independent (but may use any aid like a cane or walker) for > 50 yards
    Walks with help of one person (verbal or physical) for > 50 yards
    Wheelchair independent, including corners for > 50 yards
    Immobile or mobilises < 50 yards
10. Stairs     
    Independent
    Needs help (verbal,physical,carrying aid)
    Unable

Self care subtotal /30
Continence subtotal /20
Mobility subtotal /50

TOTAL    /100