The Barthel index scale

THE PATIENT NAME---Anniki M nisi-------------------------------------------
Index date-16/03/2010-----------------------------------------------------
Activity score for the last week
FEEDNG
0= Unable
5=Needs helpcutting, spreading butter,etc
10=Independent---------------5
GROOMING
0=Needs help with personal care
5=independent face/hair/teeth/shaving/implements provided-----------5
BATHING
0=Dependent
5=independent (or in shower)------------0
BOWELS
0=Incontinent
5=occasional accident
10=continent-----------10
BLADDER
0=incontinent
5=occasional accident
10=continent--------------10
TOILET USE
0=dependent
5=needs help but can do something alone
10=continent----------------5
TRANSFERS (BED TO CHAIR AND BACK)
0=Unable no sitting balance
5=major help (one or two people, physical)
10=major help (verbal or physical)
15=independent ------------------------5
MOBILITY
0=Immobile or<50 yards
5=wheelchair independent, including corners>50 yards
10=walks with the help of one person >50 yards
15=independent but may use the aid, for example stick >50 yards--------------10
STAIRS
0=Unable
5=needs help
10=independent-------------------5
TOTAL (0-100)----------------50
A total score of less 100 means that the patient needs some intervention ,but there is an improvevement

The Bathel index scale

THE PATIENT NAME---Anniki M nisi-------------------------------------------
Index date------------------------------------------------------
Activity score
FEEDNG
0= Unable
5=Needs helpcutting, spreading butter,etc
10=Independent----------------5
GROOMING
0=Needs help with personal care
5=independent face/hair/teeth/shaving/implements provided-----------5
BATHING
0=Dependent
5=independent (or in shower)------------0
BOWELS
0=Incontinent
5=occasional accident
10=continent-----------5
BLADDER
0=incontinent
5=occasional accident
10=continent---------------5
TOILET USE
0=dependent
5=needs help but can do something alone
10=continent----------------5
TRANSFERS (BED TO CHAIR AND BACK)
0=Unable no sitting balance
5=major help (one or two people, physical)
10=major help (verbal or physical)
15=independent ------------------------5
MOBILITY
0=Immobile or<50 yards
5=wheelchair independent, including corners>50 yards
10=walks with the help of one person >50 yards
15=independent but may use the aid, for example stick >50 yards--------------10
STAIRS
0=Unable
5=needs help
10=independent--------------------0
TOTAL (0-100)----------------40
A total score of less 100 means that the patient needs some intervention