Were care is needed:
Information About Loved One:
Loved One's Name:
Capable of moving about independently. Able to seek and follow directions. Able to evacuate independently in case of emergency
Ambulatory with cane or walker. Independent with wheelchair but needs help in emergency.
Requires occasional assistance to move about, but usually independent.
Mobile, but may require assistance due to confusion, poor vision, weakness or poor motivation.
May require assistance when transferring from bed, chair or toilet.
Requires transfer and transport assistance. Requires turning in bed and in wheelchair.