3 point performance rating scale

    • [PDF File]International Prostate Symptom Score (I-PSS)

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      About the I-PSS The International Prostate Symptom Score (I-PSS) is based on the answers to seven questions concerning urinary symptoms and one question concerning quality of life.


    • [PDF File]TINETTI BALANCE ASSESSMENT TOOL

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      TINETTI BALANCE ASSESSMENT TOOL GAIT SECTION Patient stands with therapist, walks across room (+/- aids), first at usual pace, then at rapid pace. Risk Indicators: Tinetti Tool Score Risk of Falls ≤18 High 19-23 Moderate ≥24 Low Date Indication of gait (Immediately after told to ‘go’.) Any hesitancy or multiple attempts = 0 No hesitancy = 1


    • [DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy

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      2. Print or type the appropriate date in block 1 and 3 through 21. Leave block 2 blank. 3. When completing blocks 14 and 15, follow these rules: a. Block 14 - The hour for starting leave may not be prior to the end of your normal workaday if leave starts on a workday. Of leave


    • [PDF File]Dynamic Gait Index - Dartmouth-Hitchcock

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      Scoring: A four-point ordinal scale, ranging from 0-3. “0” indicates the lowest level of function and “3” the highest level of function. Total Score = 24 Interpretation: < 19/24 = predictive of falls in the elderly > 22/24 = safe ambulators 1. Gait level surface _____ Instructions: Walk at your normal speed from here to the next mark ...


    • [PDF File]Clinical Opiate Withdrawl Scale

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      Clinical Opiate Withdrawal Scale Introduction The Clinical Opiate Withdrawal Scale (COWS) is an 11-item scale designed to be administered by a clinician. This tool can be used in both inpatient and outpatient settings to reproducibly rate common signs and symptoms of opiate withdrawal and monitor these symptoms over time. The summed


    • [PDF File]Berg Balance Scale - Brandeis University

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      Berg Balance Scale 1. SITTING TO STANDING INSTRUCTIONS: Please stand up. Try not to use your hand for support. ( ) 4 able to stand without using hands and stabilize independently ( ) 3 able to stand independently using hands ( ) 2 able to stand using hands after several tries ( ) 1 needs minimal aid to stand or stabilize


    • [PDF File]ASSESSMENT Timed Up & Go (TUG)

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      ASSESSMENT Purpose: To assess mobility Equipment: A stopwatch Directions: Patients wear their regular footwear and can use a walking aid, if needed. Begin by having the patient sit back in a standard arm chair and identify a line 3 meters, or 10 feet away, on the floor. 2 On the word “Go,” begin timing. 3 Stop timing after patient sits back ...


    • [PDF File]Generalized Anxiety Disorder 7-item (GAD-7) scale

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      Generalized Anxiety Disorder 7-item (GAD-7) scale Over the last 2 weeks, how often have you been bothered by the following problems? Not at all sure


    • [PDF File]VAMC SLUMS Examination - Saint Louis University

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      5. You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20. How much did you spend? How much do you have left? 6. Please name as many animals as you can in one minute. 0-4 animals 5-9 animals 10-14 animals 15+ animals 7. What were the five objects I asked you to remember? 1 point for each one correct. 8.


    • [PDF File]Performance Appraisal Plan Examples - USDA

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      performance plan that focus on results achieved, contain at least one element that is aligned with organizational goals, and are in place within 30 calendar days of the beginning of the appraisal period.


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