| SPECIFICATION |
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ical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9559,"questionText":"Prior history of falls within 3 months|\r\nAny unintentional change in position resulting in coming to rest on the ground or at a lower level","requir
d Core Elements<br \/> Information may be gathered from medical record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"co
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quired\": true, \"inline\": false, \r\n \"text\": \"10. Cognitive impairment<br \/> Could include patients with dementia, Alzheimer's
\r\n or stroke patients or patients who are confused, use poor judgment, have\r\n decreased comprehension, impulsivity, memory deficits. Consider patients ability\r\n to adhere to the plan of care.\", \r\n \"intro\": \"Required Core Elem
ents<br \/> Information may be gathered from medical record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1,
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,"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42508,"choiceTypeId":15274,"designator":"4.","hint":null,"id":9625,"instrument":345,"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation ma
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stionText":"Incontinence|\r\nInability to make it to the bathroom or commode in timely manner|\r\nIncludes frequency, urgency, and\/or nocturia.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":40},{"choice":[{"ch
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15274,"designator":"5.","hint":null,"id":9626,"instrument":345,"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver
. |\r\nBeyond protocols listed below, scoring should be based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9561,
"questionText":"Visual Impairment|\r\nIncludes but not limited to, macular degeneration, diabetic retinopathies, visual field loss, age\r\nrelated changes, decline in visual acuity, accommodation, glare tolerance, depth perception, and\r\nn
ight vision or not wearing prescribed glasses or having the correct prescription.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":50},{"choice":[{"choiceId":6173,"choiceText":"No","ien":109856,"legacyValue":0,"se
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"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols listed below, scoring should be based
on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9562,"questionText":"Impaired functional mobility|\r\nMay include patients who need help with IADLS or ADLS or have gait or transfer problems,\r\narthritis, pa
in, fear of falling, foot problems, impaired sensation, impaired coordination or improper\r\nuse of assistive devices.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":60},{"choice":[{"choiceId":6173,"choiceText":
"No","ien":109856,"legacyValue":0,"sequence":1},{"choiceId":6174,"choiceText":"Yes","ien":109857,"legacyValue":1,"sequence":2}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42508,"choiceTypeId":15274,"designator":"7.","h
int":null,"id":9628,"instrument":345,"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols l
isted below, scoring should be based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9563,"questionText":"Environmental hazards|\r\nMay include but not limited to, poor illumination, equipment tubing, inappr
opriate footwear, pets,\r\nhard to reach items, floor surfaces that are uneven or cluttered, or outdoor entry and exits.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":70},{"choice":[{"choiceId":6173,"choiceText
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"hint":null,"id":9629,"instrument":345,"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols
f applicable, the patient\/caregiver. |\r\nBeyond protocols listed below, scoring should be based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9557,"questionText":"Age 65+","required":true,"responseTypeI
listed below, scoring should be based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9564,"questionText":"Poly Pharmacy (4 or more prescriptions - any type)|\r\nAll PRESCRIPTIONS including prescriptions fo
r OTC meds. Drugs highly associated with fall risk\r\ninclude but not limited to, sedatives, anti-depressants, tranquilizers, narcotics, antihypertensives,\r\ncardiac meds, corticosteroids, anti-anxiety drugs, anticholinergic drugs, and hyp
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lements|\r\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver. |
\r\nBeyond protocols listed below, scoring should be based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9565,"questionText":"Pain affecting level of function|\r\nPain often affects an individual's desire
or ability to move or pain can be a factor in depression or\r\ncompliance with safety recommendations.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":90},{"choice":[{"choiceId":6173,"choiceText":"No","ien":10985
6,"legacyValue":0,"sequence":1},{"choiceId":6174,"choiceText":"Yes","ien":109857,"legacyValue":1,"sequence":2}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42508,"choiceTypeId":15274,"designator":"10.","hint":null,"id":
9631,"instrument":345,"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols listed below, sc
oring should be based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9566,"questionText":"Cognitive impairment|\r\nCould include patients with dementia, Alzheimer's or stroke patients or patients who are\r\
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nconfused, use poor judgment, have decreased comprehension, impulsivity, memory deficits.\r\nConsider patients ability to adhere to the plan of care.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":100}],"display
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"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":8,"fontUnderlined":false,"id":81372,"left":2,"mask":null}],"info":{"author":"Missouri Alliance for HOME CARE","auxDate":null,"auxVersion":null,"copyrightTex
t":null,"copyrighted":false,"dllDate":null,"dllVersion":null,"enteredBy":null,"entryDate":"2025-02-28","fullText":true,"id":345,"interpretiveText":"A score of 4 or more is considered at risk for falling.","lastEditDate":3250228.1742,"lastEd
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eference":"Missouri Alliance for Home Care. (n.d.). Missouri Alliance for Home Care 10-Question Fall Risk Assessment Tool. Retrieved from https:\/\/www.homecaremissouri.org","requireSignature":true,"requiresLicense":"N","scoringRevision":1,
"scoringRoutine":null,"scoringTag":null,"staffOnly":"Y","submitNational":true,"suicideriskRoutine":null,"suicideriskTag":null,"targetPopulation":null,"version":null,"wasOperational":true},"report":{"id":349,"instrument":345,"template":"|Mis
souri Alliance for Home Care - 10 questions (MAHC-10)\r\n| \r\n| Date Given: <.Date_Given.>\r\n| Clinician: <.Staff_Ordered_By.>\r\n| Location: <.Location.>\r\n| \r\n| Veteran: <.Patient_Name_Last_First.>\r\n| SSN: <.Patient_S
SN.>\r\n| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>\r\n| \r\n| MAHC-10 Total = <-MAHC-10 Total->\r\n|\r\n| A score of 4 or more is considered at risk for falling. \r\n| \r\n|Questions and An
"choiceIdentifier":0,"choiceIdentifierIen":42508,"choiceTypeId":15274,"designator":"2.","hint":null,"id":9623,"instrument":345,"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medi
swers:\r\n| \r\n| 1. Age 65+\r\n| <*Answer_9557*>\r\n| 2. Diagnosis (3 or more co-existing)\r\n| Includes only documented medical diagnoses\r\n| <*Answer_9558*>\r\n| 3. Prior history of falls within 3 months\r\n|
Any unintentional change in position resulting in \r\n| coming to rest on the ground or at a lower level\r\n| <*Answer_9559*>
\r\n| 4. Incontinence\r\n| Inability to make it to the bathroom or commode \r\n| in timely manner. Includes frequency, urgency, and\/or \r\n| nocturia.\r\n| <*Answer_9560*>\r\n| 5. Visual Impairment\r\n|
Includes but not limited to, macular degeneration, \r\n| diabetic retinopathies, visual field loss, age related \r\n| changes, decline in visual acuity, accommodation, glare \r\n| tolerance, depth perception, and night vi
sion or not \r\n| wearing prescribed glasses or having the correct prescription.\r\n| <*Answer_9561*>\r\n| 6. Impaired functional mobility\r\n| May include patients who need help with IADLS or ADLS or \r\n| have g
ait or transfer problems, arthritis, pain, fear of \r\n| falling, foot problems, impaired sensation, impaired \r\n| coordination or improper use of assistive devices.\r\n| <*Answer_9562*>\r\n| 7. Environmental hazards\r
\n| May include but not limited to, poor illumination, \r\n| equipment tubing, inappropriate footwear, pets, hard to reach \r\n| items, floor surfaces that are uneven or cluttered, or \r\n| outdoor entry and exits.\r
\n| <*Answer_9563*>\r\n| 8. Poly Pharmacy (4 or more prescriptions - any type)\r\n| All PRESCRIPTIONS including prescriptions for OTC meds. Drugs \r\n| highly associated with fall risk include but not limited to, \r\n|
sedatives, anti-depressants, tranquilizers, narcotics, \r\n| antihypertensives, cardiac meds, corticosteroids, anti-anxiety \r\n| drugs, anticholinergic drugs, and hypoglycemic drugs. \r\n| <*Answer_9564*>\r\n| 9.
Pain affecting level of function\r\n| Pain often affects an individual's desire or ability to move \r\n| or pain can be a factor in depression or compliance with safety | recommendations.\r\n| <*Answer_9565*>\r\n|
cal record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols listed below, scoring should be based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9558,"questionText":"Diagnosis (
10. Cognitive impairment\r\n| Could include patients with dementia, Alzheimer's or stroke \r\n| patients or patients who are confused, use poor judgment, \r\n| have decreased comprehension, impulsivity, memory deficits.\r
\n| Consider patients ability to adhere to the plan of care.\r\n| <*Answer_9566*>\r\n| \r\n|Information contained in this note is based on a self-report assessment \r\n|and is not sufficient to use alone for diagnostic purposes
. Assessment \r\n|results should be verified for accuracy and used in conjunction with \r\n|other diagnostic activities."},"scaleGroup":[{"grid1":0,"grid2":0,"grid3":0,"id":418,"instrument":345,"name":"MAHC-10 Total","ordInc":1,"ordMax":10,
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,{"id":16329,"questionId":9559,"scaleId":1606,"targetText":"Yes","value":1},{"id":16330,"questionId":9560,"scaleId":1606,"targetText":"No","value":0},{"id":16331,"questionId":9560,"scaleId":1606,"targetText":"Yes","value":1},{"id":16332,"qu
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caleId":1606,"targetText":"Yes","value":1},{"id":16336,"questionId":9563,"scaleId":1606,"targetText":"No","value":0},{"id":16337,"questionId":9563,"scaleId":1606,"targetText":"Yes","value":1},{"id":16338,"questionId":9564,"scaleId":1606,"ta
rgetText":"No","value":0},{"id":16339,"questionId":9564,"scaleId":1606,"targetText":"Yes","value":1},{"id":16340,"questionId":9565,"scaleId":1606,"targetText":
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\r\n listed below, scoring should be based on your clinical judgment.\"\r\n }, \r\n {\"id\": \"q9557\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"1. Age 65+\", \r\n \"intro\": \"Require
d Core Elements<br \/> Information may be gathered from medical record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"co
lumns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6173\", \"text\": \"0. No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9558\", \"type\": \"ChoiceQuestion\", \"re
quired\": true, \"inline\": false, \r\n \"text\": \"2. Diagnosis (3 or more co-existing)<br \/> Includes only documented medical\r\n diagnoses\", \r\n \"intro\": \"Required Core Elements<br \/> Information may be gathered from medical
record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6173\", \
"text\": \"0. No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9559\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"3. Prior
history of falls within 3 months<br \/> Any unintentional change in\r\n position resulting in coming to rest on the ground or at a lower level\", \r\n \"intro\": \"Required Core Elements<br \/> Information may be gathered from medical r
ecord,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6173\", \"t
"choiceId":6174,"choiceText":"Yes","ien":109857,"legacyValue":1,"sequence":2}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42508,"choiceTypeId":15274,"designator":"3.","hint":null,"id":9624,"instrument":345,"introDispla
ext\": \"0. No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9560\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"4. Inconti
nence<br \/> Inability to make it to the bathroom or commode in timely\r\n manner<br \/> Includes frequency, urgency, and\/or nocturia.\", \r\n \"intro\": \"Required Core Elements<br \/> Information may be gathered from medical record,\r
\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6173\", \"text\": \
"0. No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9561\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"5. Visual Impairme
nt<br \/> Includes but not limited to, macular degeneration,\r\n diabetic retinopathies, visual field loss, age related changes, decline in\r\n visual acuity, accommodation, glare tolerance, depth perception, and night\r\n vision or not wea
ring prescribed glasses or having the correct prescription.\",
\r\n \"intro\": \"Required Core Elements<br \/> Information may be gathered from medical record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinic
al judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6173\", \"text\": \"0. No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9562\", \"type
\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"6. Impaired functional mobility<br \/> May include patients who need help with\r\n IADLS or ADLS or have gait or transfer problems, arthritis, pain, fear of\
r\n falling, foot problems, impaired sensation, impaired coordination or improper\r\n use of assistive devices.\", \r\n \"intro\": \"Required Core Elements<br \/> Information may be gathered from medical record,\r\n assessment and if app
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licable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6173\", \"text\": \"0. No\", \"quickKey\":
0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9563\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"7. Environmental hazards<br \/> May includ
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\/> Information may be gathered from medical record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n
\"choices\":[\r\n {\"id\": \"c6173\", \"text\": \"0. No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9564\", \"type\": \"ChoiceQuestion\", \"required\": true, \"
inline\": false, \r\n \"text\": \"8. Poly Pharmacy (4 or more prescriptions - any type)<br \/> All PRESCRIPTIONS\r\n including prescriptions for OTC meds. Drugs highly associated with fall risk\r\n include but not limited to, sedatives,
anti-depressants, tranquilizers,\r\n narcotics, antihypertensives, cardiac meds, corticosteroids, anti-anxiety drugs,\r\n anticholinergic drugs, and hypoglycemic drugs. \", \r\n \"intro\": \"Required Core Elements<br \/> Information may
be gathered from medical record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n
{\"id\": \"c6173\", \"text\": \"0. No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9565\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n
\"text\": \"9. Pain affecting level of function<br \/> Pain often affects an individual's\r\n desire or ability to move or pain can be a factor in depression or compliance\r\n with safety recommendations.\", \r\n \"intro\": \"Require
|
