Fall Risk Assessment (Morse Fall Scale)
Assessment

Fall Risk Assessment (Morse Fall Scale)

2 pages14 fieldsHIPAA-ready

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Fall Risk Assessment (Morse Fall Scale)
Patient Information
Assessment Date
History of Falling
Secondary Diagnoses
Ambulatory Aid Used
Select...
IV Access / Heparin Lock
Gait Assessment
Select...
Mental Status
Select...
Morse Fall Scale Score
Risk Level Classification
Fall-Risk Medications
Environmental Hazards
Interventions Implemented
Assessor Signature
Sign here
Submit

The Fall Risk Assessment Form implements the widely validated Morse Fall Scale (MFS) to systematically evaluate patients for fall risk upon admission and at regular intervals throughout their hospital stay or care episode. It captures six key predictive factors — history of falling, presence of secondary diagnoses, use of ambulatory aids, intravenous access or heparin lock status, gait characteristics, and mental status self-assessment — each scored according to the standardized MFS methodology. The resulting composite score categorizes patients into low, moderate, or high fall risk tiers, directly informing the level of preventive interventions required.

Beyond the core Morse scale items, this template includes supplementary documentation fields for recording environmental hazard observations, current medications that may increase fall risk (such as sedatives, antihypertensives, and diuretics), and a section for documenting the specific fall prevention interventions implemented based on the risk score. This comprehensive approach ensures that the assessment drives actionable care planning rather than serving as a standalone checklist.

Designed for acute care hospitals, skilled nursing facilities, rehabilitation centers, and home health agencies, this form supports Joint Commission National Patient Safety Goal compliance for fall reduction programs. It facilitates consistent documentation across nursing shifts, enables trending of fall risk scores over time, and provides the evidence-based framework that quality improvement teams need to measure the effectiveness of institutional fall prevention initiatives.

What's included

  • Complete Morse Fall Scale scoring with all six predictive factors
  • Automatic risk level classification based on composite score
  • Fall-risk medication inventory and environmental hazard checklist
  • Individualized fall prevention intervention documentation
  • Trending capability for serial assessments across care episodes
  • Assessor signature and date-stamped documentation
  • Structured medication list with dosage and frequency tracking

Who uses this template

  • Hospital admission and daily nursing fall risk screening using the Morse Fall Scale
  • Skilled nursing facility resident fall risk evaluation and care plan development
  • Rehabilitation center patient safety assessment and fall prevention documentation
  • Home health agency initial and periodic fall risk stratification visits

All form fields

14 fields across 2 pages. Customize any field after signing up.

Patient InformationText
Assessment DateDate
History of FallingMultiple Choice
Secondary DiagnosesMultiple Choice
Ambulatory Aid UsedDropdown
IV Access / Heparin LockMultiple Choice
Gait AssessmentDropdown
Mental StatusDropdown
Morse Fall Scale ScoreNumber
Risk Level ClassificationMultiple Choice
Fall-Risk MedicationsMedications
Environmental HazardsCheckbox
Interventions ImplementedCheckbox
Assessor SignatureE-Signature

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