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ADL Tracking Form - Myers and Stauffer

ADL Tracking Form - Myers and Stauffer 2025

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The document is a Case Mix ADL Tracking Tool designed for recording and assessing the self-performance and support provided to residents in activities of daily living (ADLs) such as bed mobility, transfers, eating, and toilet use. It includes a coding system for evaluating the level of independence or assistance required by residents, along with an observation period for tracking these activities over several days. The form must be authenticated with initials and signatures.

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Click ‘Get Form’ to open the ADL Tracking Form in our editor.
Begin by entering the observation period dates in the designated boxes for each day. Ensure accuracy as this is crucial for tracking.
For each activity section (Bed Mobility, Transfer, Eating, Toilet Use), input the initials of the observer in the 'Int' column.
Next, select the appropriate code from the Self-Performance Key for how the resident performed each activity. Enter this code in the 'Self Performance' column.
Then, choose a code from the Support Provided Key that reflects the level of assistance given. Fill this in under 'Support Provided'.
Repeat steps 3 to 5 for all days listed on the form to ensure comprehensive tracking.
Finally, remember to add your initials and full signature/title at the bottom of the form to authenticate it.

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Versions	Form popularity	Fillable & printable
2016	4.1 Satisfied (58 Votes)
2012	4.9 Satisfied (54 Votes)

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