Common use of Amputation Clause in Contracts

Amputation. No  Yes (describe) PODIATRIC: Does the resident have podiatric concerns requiring treatment or which impair ability to ambulate or transfer?  No  Yes (describe) ‌‌‌ TASK LEVEL OF ASSISTANCE COMMENTS Toileting: (Getting to/from and on/off the toilet, cleansing self after elimination and adjusting clothing)  Independent: Able to toilet independently with or without assistive device.  Intermittent Assistance: Able to toilet with minimal intermittent assistance and/or supervision.  Continual Assistance: Able to toilet with constant assistance and/or supervision.  Total Assistance: Unable to toilet. Requires total assistance with toileting. Ostomy  Yes  No Comments: Bathing: (Getting in and out of tub or shower, washing and drying entire body)  Independent: Able to bathe or shower independently with or without assistive device.  Intermittent Assistance: Able to bathe or shower w/minimal intermittent assistance and/or supervision.  Continual Assistance: Able to bathe or shower with constant assistance and/or supervision.  Total Assistance: Unable to use shower or tub. Bathed in bed or at bedside. Comments: Dressing: (Getting clothes from closets and drawers, dressing and undressing upper/lower body including buttons, snaps, zippers, socks and shoes)  Independent: Able to dress and undress independently with or without assistive device.  Intermittent Assistance: Able to dress and undress with minimal, intermittent assistance and/or supervision.  Continual Assistance: Requires assistance throughout the dressing and undressing process.  Total Assistance: Requires another person to dress and undress upper and lower body. Comments: New York State Department of Health ASSISTED LIVING RESIDENCE Division of Assisted Living RESIDENT EVALUATION Resident’s Name: _ Facility Name: _ Date of Evaluation: _ SECTION 4: PHYSICAL FUNCTION Cont. TASK LEVEL OF ASSISTANCE COMMENTS Grooming: (Washing face, hair care, shaving, teeth/denture, fingernail care, eyeglasses care)  Independent: Able to groom self independently with or without assistive device.  Intermittent Assistance: Requires grooming utensils to be set up and placed within reach.  Continual Assistance: Requires assistance throughout the grooming process.  Total Assistance: Depends entirely upon someone else for grooming. Comments: Transportation: (Physical and mental ability to safely use a car, taxi, or public transportation [bus, train, subway)  Independent: Able to independently drive a regular or adapted car; OR uses a regular or handicap accessible public bus, train or subway.  Independent: But requests facility perform task.  Intermittent Assistance: Able to ride in a car only when driven by another person; AND/OR due to physical, cognitive or mental limitations occasionally requires another person to accompany him/her when using a bus, train or subway.  Continual Assistance: Able to ride in a car only when driven by another person; OR able to use a bus or handicap van, train or subway only when assisted or accompanied by another person.  Total Assistance: Unable to ride in a car, taxi, bus or van, and requires transportation by ambulance. Comments: