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How do you determine a disability?
What are various types of disability?

Eye Disability
    When do you declare that a person has eye disability?
Simple Geriatric screen

Patient Name: _______
Date: _______
Source: Patient _______ Other_______
HISTORY ITEMS
Have you had any falls in the last year? Abnormal
Yes
ACTION
Gait assessment
Further exam, home evaluation and Physical therapy.
Osteoporosis and injury risk assessment
RESULT AND COMMENTS

Do you have trouble with stairs, lighting, bathroom hazards, or other home hazards?
Abnormal
Yes to any
ACTION
Home evaluation or Physical Therapy
RESULT AND COMMENTS

Do you have a problem with urine leaks or accidents?
ACTION
RESULT AND COMMENTS

Over the past month, have you often been bothered by feeling sad, depressed, or hopeless?
ACTION
RESULT AND COMMENTS

During the past month, have you often been bothered by little interest or pleasure in doing things?
ACTION
RESULT AND COMMENTS

Do you ever feel unsafe where you live?
Abnormal
Yes
ACTION
Explore further, social work, APS

RESULT AND COMMENTS

Does anyone threaten you or hurt you?
Abnormal
Yes
ACTION
Explore further, social work, APS

RESULT AND COMMENTS

_______________________

Is pain a problem for you?
ACTION
Evaluate _______
RESULT AND COMMENTS

_______________________

Do you have any problems with any of the following areas? Who assists? Do you use any device? (for "yes" answers, consider causes, social services, and home eval/Physical Therapy/Occupational Therapy)
Doing strenous activities like fast walking/bicycling?
__________________________________________
Cooking?
__________________________________________
Shooping?
__________________________________________
Doing heavy housework like washing windows?
__________________________________________
Doing laundry?
__________________________________________
Getting to a place beyond walking distance by driving or taking a bus?
__________________________________________
Managing finances?
__________________________________________
Getting out of bed/transfer?
__________________________________________
Dressing?
__________________________________________
Toilet?
__________________________________________
Eating?
__________________________________________
Walking?
__________________________________________
Bathing (sponge bath, tub or shower)?
__________________________________________
Review medications that the patient brought in
Also ask about herbs, vitamins, supplements, and nonprescription medications
PHYSICAL EXAM ITEMS (The next few items may be performed by nursing staff in some settings)