Activities of Daily Living (ADL) Assessment Form

The Activities of Daily Living (ADL) Assessment Form provides a standardized evaluation of a patient's ability to independently perform essential self-care tasks and instrumental activities required for community living. Based on the Katz Index of Independence in ADL and the Lawton IADL Scale, this form rates patient functional status across basic ADLs including bathing, dressing, toileting, transferring, continence, and feeding, as well as instrumental ADLs such as medication management, financial handling, transportation, housekeeping, and meal preparation.

Each activity is rated on a structured independence scale ranging from fully independent to fully dependent, with intermediate levels capturing the need for supervision, minimal assistance, or maximum assistance. The form documents current assistive devices in use, environmental modifications in the home, and the availability of caregiving support. This detailed functional profile enables care teams to identify specific areas where intervention, adaptive equipment, or additional support services may improve patient independence and safety.

Widely used in geriatric medicine, home health agencies, skilled nursing facilities, rehabilitation programs, and social work assessments, this form supports care planning, discharge readiness evaluation, level-of-care determinations, and caregiver education. Regular ADL reassessment tracks functional trajectory over time, helping providers detect early decline and implement preventive strategies.