| 52552-7 | Falls in the past Y:Hx:1Y:^Patient:Ord: | |
| 97875-9 | Use AndOr advised cane or walker | |
| 97876-7 | Sometimes feel unsteady when walking | |
| 97877-5 | Use furniture to steady when walking | |
| 97878-3 | Worried about falling | |
| 97879-1 | Push with hands to stand up from chair | |
| 97880-9 | Trouble stepping up onto curb | |
| 97881-7 | Often rush to toilet | |
| 97882-5 | Loss of feeling in feet | |
| 97883-3 | Med causes light-headedness or fatigue | |
| 97884-1 | Taking medicine for sleep or mood | |
| 48527-6 | Often feel depressed | |
| 97885-8 | Stay Independent total score:Score:Pt:^Patient:Qn:Stay Independent | |
| 97874-2 | Stay Independent panel:-:Pt:^Patient:-:Stay Independent | |