Activities of Daily Living Chart

This chart relates to activities a patient might do during a typical day; for each activity, place a check in the most appropriate box.

 Patient can manage without help.Patient needs someone around to watch or guide them.Patient needs some help but can do most of it alone.Patient needs a lot of help.
Bathe or shower (includes getting in and out of the bath, cleaning and drying body)    
Dress themselves includes lower and upper body clothing, buttons, etc.    
Walk around their home (on the level)    
Get into bed from a chair and out of bed into a chair    

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