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Get OR OHA 8099 2014-2022

Ssing agency name: Assessment date: Domain 1: Level of assistance to complete ADL tasks 1 Personal hygiene 2 Meal planning and preparation 3 Clean and maintain residence 4 Manage / dispense medication 5 Use and maintain adaptive or medical devices 6 Assist with catheter (cleaning, changing, emptying) 7 Delegated nursing tasks (see OAR 411-034-0010) 8 Feeding 9 Mobility, transfers, or repositioning 10 Toileting, bowel, or bladder care Subtotal Domain 1 Total Full 4 4 4 4 4 5 5 5 5 5 Partial 3.

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