| RPT |
.|.|Barthel 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.>||Barthel Index: <-Index->|| Range 0 - 100. Higher index values indicate independent living, low values indicate dependence on
others.||Questions and Answers||1. Bowels (preceding week):| <*Answer_5673*>|2. Bladder (preceding week):| <*Answer_5674*>|3. Grooming (preceding 24 - 48 hours):| <*Answer_5675*>|4. Toilet
use:| <*Answer_5676*>|5. Feeding:| <*Answer_5677*>|6. Transfer:| <*Answer_5678*>|7. Mobility:| <*Answer_5679*>|8. Dressing:| <*Answer_5680*>|9. Stairs:| <*Answer_5681*>|10.
Bathing:| <*Answer_5682*>||Copyright (c) 1965 Maryland State Medical Journal||Information contained in this note is based on a self-report assessment and is not sufficient to use alone for
diagnostic purposes. Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities and procedures.| $~
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