|
Getting Around Alone
• • •
|
Are you able to drive your car without problems?
|
|
Shop for groceries alone?
|
Are you bothered by your teeth or dentures?
|
|
Can you prepare you own meals?
|
Do you have information about household hazards that might hurt you?
|
|
Can you do housework without help?
|
Do you fasten your seatbelt when in a car?
|
|
Can you manage your money without help?
|
Are you sexually active in the last year?
|
|
Are you able to eat without assistance ?
|
How much physical pain do you have?
|
|
Are you able to Bath without Assistance ?
|
Can perform physical activity for 2 minutes.
|
|
Are you able to Dress without Assistance ?
|
Rate your general health.
|
|
Do you have trouble taking medication?
|
How is Life treating you?
|
|
Able to get around house by yourself ?
|
I am able to manage my health problems.
|
|
Someone can help or keep you company?
|
I do not smoke?
|
|
I have had trouble eating well.
|
Have not fallen 2 times in the past year?
|
|
How often do you have problems using your phone?
|
Have not been injured in a fall this year?
|
|
Do you have information to tract your medications?
|
|
