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Mobility: How would you describe their mobility?

Fully mobile and independent
Needs occasional assistance (e.g., using a cane or walker)
Requires frequent assistance (e.g., help with transfers)
Primarily uses a wheelchair
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Memory: How would you describe their memory?

Sharp and independent
Occasionally forgetful (e.g., forgets names or appointments)
Frequently forgetful (e.g., forgets recent events, difficulty with routines)
Requires supervision for safety (e.g., wanders, forgets to turn off appliances)
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Self-Care Abilities: How well can they perform daily activities (bathing, dressing, eating)?

Fully independent
Needs occasional assistance
Needs regular assistance
Requires full assistance
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Medical Needs: Do they have any medical conditions that require regular monitoring or assistance?

No medical needs
Minor medical needs (e.g., medication management)
Moderate medical needs (e.g., diabetes management)
Extensive medical needs (e.g., frequent medical appointments, complex care)
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Social Engagement: How socially active are they?

Very socially active (e.g., regular social events, clubs)
Somewhat socially active (e.g., occasional events or visits)
Prefers solitude, occasional visits
Limited social interaction, requires encouragement to engage
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