Fall Risk Assessment Tool

Current risk of the subject: Unknown

Health profile of the subject:

Does the subject suffer rheumatic disease?
Does the subject suffer Parkinson?
Does the subject use sedatives?
Does the subject live alone?
Does the subject suffer any pain?
Does the subject use a walking aid?
Dizziness or unsteadiness last year?
Urinary incontinence last year?
Does the subject use antiepileptics?
History of previous falls?
Fear of falling (Deshpande)?
History of previous strokes?
Is the subject female?
Does the subject use antihypertensives?
Diabetes blood glucose 126?
Visual acuity (3 meter):
Hearing impairment?:
Contrast sensitivity?:
Revised Walking Subscore:
Subject's number of IADL:
Number of drugs used by the subject:
How does the subject feel:
Number of ADL disabilities (0-6):
physical activity level:
MMSE score:
Visual stereognosis:

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