Patient Fall Risk Assessment
Section 1 of 7 · 1 questionAge
Is the patient older than 60?
Section 2 of 7 · 2 questionsCompletion
Rate the fall risk probability
Do you have any further recommendations?
Section 3 of 7 · 2 questionsMedication
Is the patient currently on four or more pills/medication (excluding vitamins)?
Is the patient on any psychotropic medication?
Section 4 of 7 · 2 questionsPeripheral Sensation
Checked for diabetes?
Was a tactile sensitivity test (check if unable to feel 2 out of 3 trials) performed?
Section 5 of 7 · 1 questionPrevious Falls
Have there been one or more falls in the last few years?
Section 6 of 7 · 3 questionsStrength/Reaction
Sit to stand test (not able to complete in 12 seconds) performed?
Near tandem stand test (Not able to stand for more than 10 secs) performed?
Alternate step test (not able to finish in 10 seconds) performed?
Section 7 of 7 · 2 questionsVision
Has the patient been reviewed for glaucoma, cataracts, and appropriateness of spectacles?
Was a low contrast visual acuity test performed?
Checklist by GoAudits. This checklist is an example: we do not guarantee compliance with the laws applicable to your territory or industry. Seek professional advice to adapt it to your workplace or jurisdiction.
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