| RPT |
.|.|Index of Activities of Daily Living||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.>|||Date of Evaluation:| <*Answer_5406*>|1. Bathing: either sponge bath, tub bath or shower.| <*Answer_5407*>|2. Dressing:
gets clothes from closets and drawers, including under-clothes, outer garmets and using fasteners (including braces if worn).| <*Answer_5408*>|3. Toileting: going to the "toilet room" for bowel
and urine elimination; cleaning self after elimination and arranging clothes.| <*Answer_5409*>|4. Transfer:| <*Answer_5410*>|5. Continence:| <*Answer_5411*>|6. Feeding:| <*Answer_5412*>|
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