English: REQUIREMENTS PROBLEMS ASSESSMENT FACTORS NORMAL ______________________________________________________________________________________________ Bathing - hygiene ______________________________________________________________________________________________ Hair management ______________________________________________________________________________________________ Dresses self ______________________________________________________________________________________________ Skin integrity ______________________________________________________________________________________________ Foot care ______________________________________________________________________________________________ Hearing ______________________________________________________________________________________________ Verbal communication ______________________________________________________________________________________________ Vision ______________________________________________________________________________________________ Telephone access ______________________________________________________________________________________________ Bladder function ______________________________________________________________________________________________ Bowel functioning ______________________________________________________________________________________________ Toileting ability ______________________________________________________________________________________________ Feeding ability ______________________________________________________________________________________________ Meal preparation ______________________________________________________________________________________________ Grocery shopping ______________________________________________________________________________________________ Diet adequacy ______________________________________________________________________________________________ General mobility ______________________________________________________________________________________________ Able to transfer ______________________________________________________________________________________________ Able to travel ______________________________________________________________________________________________ Social outlets ______________________________________________________________________________________________ Leisure activities ______________________________________________________________________________________________ Sleep / rest adequate ______________________________________________________________________________________________ Exercise / fitness ______________________________________________________________________________________________
French: CRITÈRES D’ÉVALUATION RÉGULIER PROBLÈMES EXIGENCES ______________________________________________________________________________________________ Hygiène corporelle ______________________________________________________________________________________________ Soins des cheveux ______________________________________________________________________________________________ Habillage autonome ______________________________________________________________________________________________ Condition de la peau ______________________________________________________________________________________________ Soins des pieds ______________________________________________________________________________________________ Audition ______________________________________________________________________________________________ Communication orale ______________________________________________________________________________________________ Vision ______________________________________________________________________________________________ Accès à un téléphone ______________________________________________________________________________________________ Vessie ______________________________________________________________________________________________ Intestins ______________________________________________________________________________________________ Toilette ______________________________________________________________________________________________ Capacité de se nourrir ______________________________________________________________________________________________ Préparation des repas ______________________________________________________________________________________________ Emplettes à l’épicerie ______________________________________________________________________________________________ Qualité de la diète ______________________________________________________________________________________________ Mobilité générale ______________________________________________________________________________________________ Capacité de transfert ______________________________________________________________________________________________ Capacité de voyager ______________________________________________________________________________________________ Clubs sociaux ______________________________________________________________________________________________ Activités de loisir ______________________________________________________________________________________________ Sommeil et repos adéquats ______________________________________________________________________________________________ Exercice et forme physique ______________________________________________________________________________________________