Activities	Independence (1 point)*	Dependence (0 points)†	Score
Bathing	Bathes self completely or needs help in bathing only a single part of the body, such as the back, genital area, or disabled extremity	Needs help with bathing more than one part of the body, getting in or out of the bathtub or shower; requires total bathing assistance	_________
Dressing	Gets clothes from closets and drawers, and puts on clothes and outer garments complete with fasteners; may need help tying shoes	Needs help with dressing self or needs to be completely dressed	_________
Toileting	Goes to toilet, gets on and off, arranges clothes, cleans genital area without help	Needs help transferring to the toilet and cleaning self, or uses bedpan or commode	_________
Transferring	Moves in and out of bed or chair unassisted; mechanical transfer aids are acceptable	Needs help in moving from bed to chair or requires a complete transfer	_________
Fecal and urinary continence	Exercises complete self-control over urination and defecation	Is partially or totally incontinent of bowel or bladder	_________
Feeding	Gets food from plate into mouth without help; preparation of food may be done by another person	Needs partial or total help with feeding or requires parenteral feeding	_________
		Total points‡:	_________