| ENTRY SPECIFICATION |
{"name": "KATZ-ADL-18PT",
{"id": "q5132", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "1. Bathing: either sponge bath, tub bath or shower.",
"intro": "For each area of functioning listed below, check description that applies. (The
word \u0022assistance\u0022 means supervision, direction of personal
assistance.)",
"columns": 1,
"choices":[
{"id": "c2886", "text": "1. Receives no assistance (gets in and out of tub by self, if tub is usual means
of bathing).", "quickKey": 1},
{"id": "c2516", "text": "2. Receives assistance in bathing only one part of body (such as back or leg).", "quickKey": 2},
"restartDays": 2,
{"id": "c2517", "text": "3. Receives assistance in bathing more than one part of the body (or not bathed).", "quickKey": 3}
]},
{"id": "q5133", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "2. Dressing: gets clothes from closets and drawers, including under-clothes,
outer garments and using fasteners (including braces if worn).",
"intro": "For each area of functioning listed below, check description that applies. (The
word \u0022assistance\u0022 means supervision, direction of personal
assistance.)",
"columns": 1,
"choices":[
"printTitle": "Katz Index of Independence in Activities of Daily Living",
{"id": "c2518", "text": "1. Gets clothes and dresses self without assistance.", "quickKey": 1},
{"id": "c2519", "text": "2. Gets clothes and dresses self without assistance except for tying shoes.", "quickKey": 2},
{"id": "c2887", "text": "3. Receives assistance in getting clothes, or dressing, or stays partly or
completely undressed.", "quickKey": 3}
]},
{"id": "q5134", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "3. Toileting: going to the \u0022toilet room\u0022 for bowel and urine
elimination; cleaning self after elimination and arranging clothes. (May use
cane, walker, or wheelchair, and manage bedpan or commode, emptying same next
morning).",
"content":[
"intro": "For each area of functioning listed below, check description that applies. (The
word \u0022assistance\u0022 means supervision, direction of personal
assistance.)",
"columns": 1,
"choices":[
{"id": "c2900", "text": "1. No assistance needed.", "quickKey": 1},
{"id": "c2901", "text": "2. Receives assistance with at least one procedure above.", "quickKey": 2},
{"id": "c2890", "text": "3. Does not go to \u0022toilet room\u0022 for elimination procedure.", "quickKey": 3}
]},
{"id": "q5135", "type": "ChoiceQuestion", "required": false, "inline": false,
{"id": "i1040", "type": "IntroText",
"text": "4. Transfer:",
"intro": "For each area of functioning listed below, check description that applies. (The
word \u0022assistance\u0022 means supervision, direction of personal
assistance.)",
"columns": 1,
"choices":[
{"id": "c2891", "text": "1. Moves in and out of bed, or chair, without assistance (may use support object
like cane or walker).", "quickKey": 1},
{"id": "c2892", "text": "2. Moves in and out of bed with assistance.", "quickKey": 2},
{"id": "c2526", "text": "3. Does not get out of bed.", "quickKey": 3}
"text": "For each area of functioning listed below, check description that applies. (The
]},
{"id": "q5136", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "5. Continence:",
"intro": "For each area of functioning listed below, check description that applies. (The
word \u0022assistance\u0022 means supervision, direction of personal
assistance.)",
"columns": 1,
"choices":[
{"id": "c2527", "text": "1. Controls urination and bowel movement completely by self.", "quickKey": 1},
{"id": "c2893", "text": "2. Has occasional \u0022accidents\u0022 of urination or bowels.", "quickKey": 2},
word \u0022assistance\u0022 means supervision, direction of personal
{"id": "c2529", "text": "3. Supervision helps keep urine or bowel control: catheter is used or is
incontinent.", "quickKey": 3}
]},
{"id": "q5137", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "6. Feeding:",
"intro": "For each area of functioning listed below, check description that applies. (The
word \u0022assistance\u0022 means supervision, direction of personal
assistance.)",
"columns": 1,
"choices":[
assistance.)"
{"id": "c2530", "text": "1. Feeds self without assistance.", "quickKey": 1},
{"id": "c2894", "text": "2. Feed self except for geting assistance in cutting meat or buttering bread.", "quickKey": 2},
{"id": "c2895", "text": "3. Receives assistance in feeding, or, is fed partly or completely by tubes or
intravenous.", "quickKey": 3}
]}]
}
},
|
