This fall risk assessment template is used to assess a patient’s likelihood of falling. It covers fields to register a patient’s fall history, current medication, and medical test results. Document the patient’s fall risk rating depending on the number of collected risk factors. If a patient gets 1 to 2 risk factors patient has a low risk likelihood of falling, a medium risk for 3 to 5 risk factors and a high risk for 6 risk factors and above.
Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.