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MED-PASS - Forms
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| HC1040H | | | Fall Risk Assessment | | This one-page form provides a “multi-factorial“ fall risk assessment for use in home care. Can be used for variety of situations including:- Change in condition
- When a fall has occurred
- Provides the multi-factorial risk assessment component as well as prompts to document one of four standardized and validated fall risk assessments required in the CMS OASIS-C Guidance.
Click here for the TUG standardized and validated fall risk assessment | | | Features: | - Documents up to 4 “multi-factorial” fall risk assessments
- Utilizes scoring based on the number of positive responses to 9 core elements or fall risk conditions listed
- Includes prompts to indicate and document that one of four standardized and validated fall risk assessments has also been performed
- Based on and used with the permission of the Missouri Alliance for Home Care
- Provides for narrative documentation of up to 4 interventions on back
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| Specifications: | | 8-1/2 x 11, 1 part, 5 holes top and left, 100 per pad | | | Related Products: | | |
| Click for information about our custom forms service | |
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