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ALTCS Medical Assessment

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This Calculator Is Intended For Educational And Illustrative Purposes Only.

The results of this calculator should not be relied upon to determine ALTCS eligiblility. Only the ALTCS program can made that determination.

Mobility:

Transfering:

Bathing:

Dressing:

Gooming:

Eating:

Toileting:

Bowel Continence:

Bladder Continence:

Deterioration in Overall Function in last 90 days:

Orientation to Place:

Dressing:

Hearing:

Vision:

Dressing:

Wandering Frequency:

Wandering Intervention:

Self-Injurious Frequency:

Self-Injurious Intervention:

Aggression Frequency:

Aggression Intervention:

Resistiveness Frequency

Resistiveness Intervention:

Disruptiveness Frequency:

Disruptiveness Intervention:

Does the customer have paralysis?:

Does the customer have Alzheimer's, Dementia or OBS?

Does the customer require oxygen?: