ATTACHMENT M SAMPLE SADS DAILY PARTICIPANT RECORD Participant_________________________________________________ Month__________________________ Year_________ FUNCTIONAL ASSESSMENT/STAFF INTERVENTION ADLs Level of Care Mobility Transfers Toileting Continence Eating Self-administration of medication Supervision and Monitoring Days of the Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 A. Physical Activities KEY Active: A, Passive: P Exercise/Tai Chi/Yoga Walking/ Sports/Wii Dance/Movement Painting/Arts and Crafts Cooking/Baking Gardening Other: July 2015
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aging.ny.gov Web viewParticipant_________________________________________________ Month __________________________ Year _________ ATTACHMENT M SAMPLE SADS DAILY PARTICIPANT . RECORD
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