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Morse Fall Risk Assessment Form

Use this Morse Fall Risk Assessment Tool determined from the Morse Fall Scale (MFS) to help evaluate a patient’s probability of falling. Implement this Morse Fall Risk Assessment by answering 6 crucial questions. This template involves a risk rating table which will help you select a fall risk rating (High, Medium, Low) based on your responses to the 6 crucial questions.

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Morse Fall Risk Assessment Form

Audit

Item

Was there a record of falling? (critical or within the last 3 months)
Was there a secondary diagnosis?
What ambulatory aid was used?
How was the patient's motion or transferring method?
Was there an intravenous apparatus or a heparin device included?
What is the mental situation of the patient right now?

Completion

Risk rating reference: Look at the total score from before and choose the appropriate risk level.
Overall Risk:
Full name and signature of the attending nurse:
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