Updated research request forms and data security approval requirement effective 4/24/23
Demographic information: conditions related to MR/DD status - MR/DD with organic condition - epilepsy.
Demographic information: conditions related to MR/DD status - MR/DD with organic condition - other organic condition related to MR/DD.
Demographic information: conditions related to MR/DD status - MR/DD with organic condition - MR/DD with no organic condition
Demographic information: date background information was completed.
Demographic information: admitted form (at entry).
Demographic information: lived alone (prior to entry)
Demographic information: residential history prior to entry - prior stay at this nursing home.
Demographic information: residential history prior to entry - prior stay in other nursing home.
Demographic information: residential history prior to entry - other residential facility.
Demographic information: residential history prior to entry - MH/psychiatric setting.
Demographic information: residential history prior to entry - MR/DD setting.
Demographic information: residential history prior to entry - none of above
Demographic information: lifetime occupation(s).
Demographic information: education (highest level completed).
Demographic information: primary language
Demographic information: if other (language), specify.
Demographic information: metal health history
Customary routine: cycle of daily events - stays up late at night
Customary routine: cycle of daily events - naps regularly during day
Customary routine: cycle of daily events - goes out one or more days a week.
Customary routine: cycle of daily events - stys busy with hobbies/fixed routine.
Customary routine: cycle of daily events - spends most time alone or watching TV
Customary routine: cycle of daily events - moves independently indoors.
Customary routine: cycle of daily events - use of tobacco daily.
Customary routine: cycle of daily events - none of above.
Customary routine: eating patterns - distinct food preferences.
Customary routine: eating patterns - eats between meals most days.
Customary routine: eating patterns - use of alcohol weekly.
Customary routine: eating patterns - none of above.
Customary routine: ADL patterns - in bedclothes much of day.
Customary routine: ADL patterns - wakens to toilet most nights.
Customary routine: ADL patterns - has irregular bowel movement pattern.
Customary routine: ADL patterns - showers for bathing.
Customary routine: ADL patterns - bathing in PM.
Customary routine: ADL patterns - none of above.
Customary routine: involvement patterns - daily contact with relatives/friends.
Customary routine: involvement patterns - usually attends church, temple, etc..
Customary routine: involvement patterns - finds strength in faith.
Customary routine: involvement patterns - daily animal companion.
Customary routine: involvement patterns - involved in group activities.
Customary routine: involvement patterns - none of above.
Customary routine: invovlement patterns - unknown customary routine.
Cognitive patterns: long-term memory OK
Cognitive patterns: memory/recall ability - current season.
Cognitive patterns: memory/recall ability - location of own room.
Cognitive patterns: memory/recall ability - staff names/faces.
Cognitive patterns: memory/recall ability - that he/she is in nursing home.
Cognitive patterns: memory/recall ability - none of above
Cognitive patterns: cognitive skills/daily decision making.
Cognitive patterns: indicators of delirium - easily distracted.