| 5 |
requires assistance in choosing proper clothing to wear for day/season/occasion |
| 6A |
improperly putting on clothes without assistance |
| 6B |
unable to bathe properly occasionally or more often over past weeks |
| 6C |
inability to handle mechanics of toileting occasionally or more often over past weeks |
| 6D |
urinary incontinence occasionally or more often |
| 6E |
fecal incontinence occasionally or more often over past week |
| 7A |
ability to speak limited to approximately 6 words or fewer in the course of a day |
| 7B |
speech ability limited to use of a single intelligible word in a day (may be repeated) |
| 7C |
ambulatory ability is lost; cannot walk without personal assistance |
| 7D |
cannot sit up without assistance; will fall without lateral support |
| 7E |
loss of ability to smile |
| 7F |
loss of ability to hold head up independently |
