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Hearing and ability to understand spoken language in patient's own language.
Speech and oral (verbal) expression of language in patient's own language.
Frequency of pain interfering with patient's activity or movement.
Intractable pain.
Does patient have skin lesion or open wound?
Does patient have pressure ulcer?
Number of pressure ulcers, stage 1.
Number of pressure ulcers, stage 2.
Number of pressure ulcers, stage 3.
Number of pressure ulcers, stage 4.
In addition to above, is there at least one pressure ulcer that cannot be observed due to eschar or nonremovable dressing, including casts?
Stage of most problematic pressure ulcer.
Status of most problematic pressure ulcer.
Does patient have stasis ulcer?
Current number of observable stasis ulcers.
Does patient have at least one stasis ulcer that cannot be observed due to nonremovable dressing?
Status of most problematic stasis ulcer.
Does patient have a surgical wound?
Current number of observable surgical wounds.
Does patient have at least one surgical wound that cannot be observed due to nonremovable dressing?
Status of most problematice (observable) surgical wound.
When patient is dyspneic or noticeable short of breath.
Respiratory treatments utilized at home: continuous positive airway pressure.
Respiratory treatments utilized at home: none of the above.
Respiratory treatments utilized at home: oxygen (intermittent or continuous).
Respiratory treatments utilized at home: ventilator (continually or at night).
Patient has been treated for urinary tract infection in past 14 days.
Urinary incontinence or urinary catheter presence.
When urinary incontinence occurs.
Bowel incontinence frequency.
Ostomy for bowel elimination.
Cognitive functioning.
When confused (reported or observed).
When anxious (reported or observed).
Depressive feelings: depressed mood.
Depressive feelings: hopelessness.
Depressive feelings: none of the above.
Depressive feelings: recurrent thoughts of death.
Depressive feelings: sense of failure or self reproach.
Depressive feelings: thoughts of suicide.
Patient's behaviors: a suicide attempt.
Patient's behaviors: agitation.
Patient's behaviors: diminished interest in most activities.
Patient's behaviors: indecisiveness, lack of concentration.
Patient's behaviors: none of the above.
Patient's behaviors: recent change in appetite or weight.
Patient's behaviors: sleep disturbances.
Behaviors demonstrated at least once a week: delusional, hallucinatory, paranoid behavior.
Behaviors demonstrated at least once a week: disruptive, infantile, or socially inappropriate behavior.
Behaviors demonstrated at least once a week: impaired decision making.