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Name: ___ Date: ___ Date of Birth: ___Activities of Daily Living Checklist1Name:Date:Over the last 2 weeks, how often have you been bothered by any of the following problems?Not Several More than at all days half the daysNearly every day1. Little interest or pleasure in doing things01232. Feeling down, depressed, or hopeless01233. Trouble falling or staying asleep, or sleeping too much01234. Feeling tired or having little energy01235. Poor appetite or overeating01236
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01
Start with personal hygiene: Ensure that the individual can wash their face, brush their teeth, and bathe.
02
Assess grooming activities: Check if they can comb their hair, shave, and dress themselves.
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Evaluate toileting: Confirm that they can use the toilet independently or with assistance if needed.
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Check mobility: Determine if they can move around safely, including walking and transferring from one place to another.
05
Observe feeding abilities: See if they can prepare and eat their meals, or if they require help.
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Review communication skills: Assess whether they can express their needs effectively, using verbal or non-verbal methods.
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Monitor managing medications: Ensure they can take their medications as prescribed, or identify if assistance is necessary.
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Consider safety awareness: Evaluate their ability to recognize and respond to safety hazards in their environment.

Who needs activities of daily living?

01
Individuals with physical disabilities or limitations.
02
Elderly people who require assistance with daily tasks.
03
Patients recovering from surgery or illness.
04
People with chronic illnesses that affect mobility or cognition.
05
Individuals with mental health conditions that impair daily functioning.
06
Caregivers and health professionals assessing patient care needs.
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Activities of daily living (ADLs) refer to the basic tasks that are essential for self-care and independent living. These include activities such as bathing, dressing, eating, toileting, transferring (moving from one place to another), and maintaining continence.
Typically, activities of daily living need to be assessed and filed by healthcare professionals, caretakers, or individuals seeking assistance or benefits related to caregiving, such as long-term care insurance or disability claims.
Filling out activities of daily living typically involves completing a standardized form that evaluates the individual's ability to perform each activity independently. This may include rating the individual's performance level, or indicating the amount of assistance needed for each activity.
The purpose of assessing activities of daily living is to determine a person's level of independence, identify areas of need for assistance, evaluate the qualifications for healthcare services, and create care plans tailored to individual needs.
The information required typically includes the individual's capabilities in each ADL category, the level of assistance needed (if any), and any relevant medical or social history that may impact the individual's ability to perform these activities.
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