Fall Risk Assessment Tool

Current risk of the subject: Unknown

Health profile of the subject:

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

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