| RPT |
.|.|Morse Fall Scale||Date Given: <.Date_Given.>|Clinician: <.Staff_Ordered_By.>|Location: <.Location.>||Veteran: <.Patient_Name_Last_First.>|SSN: <.Patient_SSN.>|DOB: <.Patient_Date_Of_Birth.>
(<.Patient_Age.>)|Gender: <.Patient_Gender.>|| Morse Fall Scale Score: <-Morse Score->||No risk: 0-24|Low risk: 25-44|High risk: 45 and higher||Questions and Answers|History of falling: immediate or
within 3 months?| <*Answer_3910*>|Secondary diagnosis:| <*Answer_3911*>|Ambulatory aid:| <*Answer_3912*>|Intravenous therapy/Heparin lock:| <*Answer_3913*>|Gait/Transferring:|
<*Answer_3914*>|Mental Status:| <*Answer_3915*>| |Copyright Janice M. Morse, 1996 $~
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