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    ADL Checklist

    Uploaded by

    Alexandra Antipa
    The document is a physical therapy daily living checklist in both English and Spanish. It lists common daily tasks and asks the patient to indicate if each task is easy, mildly difficult, moderately difficult, severely difficult, unable to complete, or not applicable to rate their level of independence with daily activities. The checklist is scored out of a maximum of 100 points to assess the patient's functional abilities.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    ADL Checklist

    Uploaded by

    Alexandra Antipa
    587 views2 pages
    The document is a physical therapy daily living checklist in both English and Spanish. It lists common daily tasks and asks the patient to indicate if each task is easy, mildly difficult, moderately difficult, severely difficult, unable to complete, or not applicable to rate their level of independence with daily activities. The checklist is scored out of a maximum of 100 points to assess the patient's functional abilities.

    Original Description:

    A checklist containing activities of daily living

    Copyright

    © Attribution Non-Commercial (BY-NC)

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    The document is a physical therapy daily living checklist in both English and Spanish. It lists common daily tasks and asks the patient to indicate if each task is easy, mildly difficult, moderately difficult, severely difficult, unable to complete, or not applicable to rate their level of independence with daily activities. The checklist is scored out of a maximum of 100 points to assess the patient's functional abilities.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    587 views2 pages

    ADL Checklist

    Uploaded by

    Alexandra Antipa
    The document is a physical therapy daily living checklist in both English and Spanish. It lists common daily tasks and asks the patient to indicate if each task is easy, mildly difficult, moderately difficult, severely difficult, unable to complete, or not applicable to rate their level of independence with daily activities. The checklist is scored out of a maximum of 100 points to assess the patient's functional abilities.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    DATE:

    Physical Therapy: of Daily Living Checklist


    Please check if the task is easy or difficult to complete. If it is an activity you do not do or have never done check not applicable
    TASK Shoes Socks Bathing: Bath / Shower / Sponge Bathng Brush teeth Wash/Fix Hair Reach overhead Where do you sleep? Bed / Recliner / Other Sleeping Ironing Vacuum Mop/Sweep Wash Dishes Laundry Make bed Cook How much weight can you lift off the floor to waist level? Lifting Housework Yardwork Kneeling Squatting Driving Grocery shopping Stairs How long can you do the following task's before you have to sit and rest? Walking : Walking Standing Sitting Standing : Sitting :
    Easy to complete Mild Difficulty
    Moderate Difficulty Severe Difficulty Unable to Complete

    Not Applicable

    Maximum score is 100 points

    Patient Score:

    Therapist Signature

    Instructions: To score the ADL's points are awarded as follows:


    Easy to complete Mild Difficulty Moderate Difficulty Severe Difficulty Unable to Complete Not Applicable

    -4

    FECHA:

    Terapia Fisico:Lista de Actividades de Vivindo Cada Dia Por favor marque si hacendo cada tarea es facil or dificil para completar. Si usted no tiene tiene o nunca a hecho el actividad marque no aplica. TAREA Zapatos Calcetines Banarse: Bano / Derramar / Esponja Banarse Limpiar los dientes Lavar/arreglar pelo Alcanzar de arriba Donde duermes? Cama / Mueble de Reclinar / Otro Dormendo Planchar Aspirar Estropajo/Barrer Lavar Platos Lavar ropia Hacer la cama Cocinar Que tanto peso puedes levantar des del pieso hasta el cintura? Levantar Trabajo de la casa Trabajo de la jardin Arrodillarse Cuclillarse Manehando Comprar el mandado Escaleras Que tanto puedes a durar haciendo cada tarea antes de descansar? Caminando : Caminando Ponerse de pie Sentarse Ponserse de pie : Sentarse :
    Facil para completar

    Dificil Suave

    Dificil Moderado

    Dificil Severo Incapaz de Completar

    No Aplica

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