Elderly Care Home Resident Risk Assessment
Resident Details
Resident Name
Date of Birth
Room Number
Assessment Date
Assessor Name
Medical History
Mobility
Mobility Status
Independent
Requires Assistance
Wheelchair User
Bedbound
Falls History
No Falls
1-2 Falls in Past Year
3+ Falls in Past Year
Cognition
Cognitive Status
Alert & Oriented
Mild Impairment
Moderate Impairment
Severe Impairment
Nutrition & Hydration
Nutrition Risk
Low
Medium
High
Hydration Risk
Low
Medium
High
Skin Integrity
Pressure Ulcer Risk
Low
Medium
High
Medication
Current Medications
Allergies
Other Risks / Notes