| LP418274-9 | Chair/bed-to-chair transfer - most dependent performance during the past month | COMPONENT | 1 |
| LP418275-6 | Toilet transfer - most dependent performance during the past month | COMPONENT | 1 |
| LP418276-4 | Car transfer - most dependent performance during the past month | COMPONENT | 1 |
| LP418277-2 | Walk 10 feet - most dependent performance during the past month | COMPONENT | 1 |
| LP418278-0 | Walk 50 feet with two turns - most dependent performance during the past month | COMPONENT | 1 |
| LP418279-8 | Walk 150 feet - most dependent performance during the past month | COMPONENT | 1 |
| LP418280-6 | Walking 10 feet on uneven surfaces - most dependent performance during the past month | COMPONENT | 1 |
| LP418281-4 | Go up and down a curb/step - most dependent performance during the past month | COMPONENT | 1 |
| LP418282-2 | Go up and down 4 steps - most dependent performance during the past month | COMPONENT | 1 |
| LP418283-0 | Go up and down 12 steps - most dependent performance during the past month | COMPONENT | 1 |
| LP418284-8 | Picking up object - most dependent performance during the past month | COMPONENT | 1 |
| LP418285-5 | Walks indoors - most dependent performance during the past month | COMPONENT | 1 |
| LP418286-3 | Carries something in both hands - most dependent performance during the past month | COMPONENT | 1 |
| LP418287-1 | Walks for 15 minutes - most dependent performance during the past month | COMPONENT | 1 |
| LP418288-9 | Walks across a street - most dependent performance during the past month | COMPONENT | 1 |
| LP418289-7 | Wheel 50 feet with two turns - most dependent performance during the past month | COMPONENT | 1 |
| LP418290-5 | Wheel 150 feet - most dependent performance during the past month | COMPONENT | 1 |
| LP418291-3 | Wheels for 15 minutes - most dependent performance during the past month | COMPONENT | 1 |
| LP418292-1 | Wheels across a street - most dependent performance during the past month | COMPONENT | 1 |
| LP418293-9 | Mobility priorities for the next 6 months | COMPONENT | 1 |
| LP418294-7 | Makes a light cold meal - most dependent performance during the past month | COMPONENT | 1 |
| LP418295-4 | Makes a light hot meal - most dependent performance during the past month | COMPONENT | 1 |
| LP418296-2 | Light daily housework - most dependent performance during the past month | COMPONENT | 1 |
| LP418297-0 | Heavier periodic housework - most dependent performance during the past month | COMPONENT | 1 |
| LP418298-8 | Light shopping- most dependent performance during the past month | COMPONENT | 1 |
| LP418299-6 | Answering telephone call - most dependent performance during the past month | COMPONENT | 1 |
| LP418300-2 | Placing telephone call - most dependent performance during the past month | COMPONENT | 1 |
| LP418301-0 | Medication management.oral medications - most dependent performance during the past month | COMPONENT | 1 |
| LP418302-8 | Medication management.inhalant/mist medications - most dependent performance during the past month | COMPONENT | 1 |
| LP418303-6 | Medication management.injectable medications - most dependent performance during the past month | COMPONENT | 1 |
| LP418304-4 | Simple financial management - most dependent performance during the past month | COMPONENT | 1 |
| LP418305-1 | Complex financial management - most dependent performance during the past month | COMPONENT | 1 |
| LP418306-9 | Instrumental activities of daily living priorities for the next 6 months | COMPONENT | 1 |
| LP418307-7 | Need for and availability of a cane/crutch | COMPONENT | 1 |
| LP418308-5 | Need for and availability of a walker | COMPONENT | 1 |
| LP418309-3 | Need for and availability of a standard folding walker | COMPONENT | 1 |
| LP418310-1 | Need for and availability of a walker with seat | COMPONENT | 1 |
| LP418311-9 | Need for and availability of a walker with wheels | COMPONENT | 1 |
| LP418312-7 | Need for and availability of a wheelchair | COMPONENT | 1 |
| LP418313-5 | Need for and availability of a manual wheelchair | COMPONENT | 1 |
| LP418314-3 | Need for and availability of a motorized wheelchair/scooter | COMPONENT | 1 |
| LP418315-0 | Need for and availability of a limb prosthesis | COMPONENT | 1 |
| LP418316-8 | Need for and availability of a specialized seating pad | COMPONENT | 1 |
| LP418317-6 | Need for and availability of a mechanical lift | COMPONENT | 1 |
| LP418318-4 | Need for and availability of a reacher/grabber | COMPONENT | 1 |
| LP418319-2 | Need for and availability of a sock aid | COMPONENT | 1 |
| LP418320-0 | Need for and availability of an orthotic/brace | COMPONENT | 1 |
| LP418321-8 | Need for and availability of a bed rail | COMPONENT | 1 |
| LP418322-6 | Need for and availability of an electronic bed | COMPONENT | 1 |
| LP418323-4 | Need for and availability of grab bars | COMPONENT | 1 |