Checklist for skilled/care rehabilitation needs
Supine to sit:
[radio name="variable_1" value="Independent|Stand By Assist/Supervision|Assist Minimal (patient performs at least 75 percent of activity)|Assist Moderate (patient performs at least 50 percent of activity)|Assist Maximal (patient performs less than 25 percent of activity)|Dependent"]
Sit to stand:
[radio name="variable_2" value="Independent|Stand By Assist/Supervision|Assist Minimal (patient performs at least 75 percent of activity)|Assist Moderate (patient performs at least 50 percent of activity)|Assist Maximal (patient performs less than 25 percent of activity)|Dependent"]
Ambulation:
[radio name="variable_3" value="Independent|Stand By Assist/Supervision|Assist Minimal (patient performs at least 75 percent of activity)|Assist Moderate (patient performs at least 50 percent of activity)|Assist Maximal (patient performs less than 25 percent of activity)|Dependent"]
Feeding:
[radio name="variable_4" value="Independent|Stand By Assist/Supervision|Assist Minimal (patient performs at least 75 percent of activity)|Assist Moderate (patient performs at least 50 percent of activity)|Assist Maximal (patient performs less than 25 percent of activity)|Dependent"]
Toilet transfers:
[radio name="variable_5" value="Independent|Stand By Assist/Supervision|Assist Minimal (patient performs at least 75 percent of activity)|Assist Moderate (patient performs at least 50 percent of activity)|Assist Maximal (patient performs less than 25 percent of activity)|Dependent"]
Grooming:
[radio name="variable_6" value="Independent|Stand By Assist/Supervision|Assist Minimal (patient performs at least 75 percent of activity)|Assist Moderate (patient performs at least 50 percent of activity)|Assist Maximal (patient performs less than 25 percent of activity)|Dependent"]
Dysphagia:
[radio name="variable_7" value="absent|present"]
Tube feedings:
[radio name="variable_8" value="does not require|REQUIRES"]
IV antibiotics:
[radio name="variable_9" value="does not require|REQUIRES"]
Supine to sit:
[radio name="variable_1" value="Independent|Stand By Assist/Supervision|Assist Minimal (patient performs at least 75 percent of activity)|Assist Moderate (patient performs at least 50 percent of activity)|Assist Maximal (patient performs less than 25 percent of activity)|Dependent"]
Sit to stand:
[radio name="variable_2" value="Independent|Stand By Assist/Supervision|Assist Minimal (patient performs at least 75 percent of activity)|Assist Moderate (patient performs at least 50 percent of activity)|Assist Maximal (patient performs less than 25 percent of activity)|Dependent"]
Ambulation:
[radio name="variable_3" value="Independent|Stand By Assist/Supervision|Assist Minimal (patient performs at least 75 percent of activity)|Assist Moderate (patient performs at least 50 percent of activity)|Assist Maximal (patient performs less than 25 percent of activity)|Dependent"]
Feeding:
[radio name="variable_4" value="Independent|Stand By Assist/Supervision|Assist Minimal (patient performs at least 75 percent of activity)|Assist Moderate (patient performs at least 50 percent of activity)|Assist Maximal (patient performs less than 25 percent of activity)|Dependent"]
Toilet transfers:
[radio name="variable_5" value="Independent|Stand By Assist/Supervision|Assist Minimal (patient performs at least 75 percent of activity)|Assist Moderate (patient performs at least 50 percent of activity)|Assist Maximal (patient performs less than 25 percent of activity)|Dependent"]
Grooming:
[radio name="variable_6" value="Independent|Stand By Assist/Supervision|Assist Minimal (patient performs at least 75 percent of activity)|Assist Moderate (patient performs at least 50 percent of activity)|Assist Maximal (patient performs less than 25 percent of activity)|Dependent"]
Dysphagia:
[radio name="variable_7" value="absent|present"]
Tube feedings:
[radio name="variable_8" value="does not require|REQUIRES"]
IV antibiotics:
[radio name="variable_9" value="does not require|REQUIRES"]
Result - Copy and paste this output: