Escolar Documentos
Profissional Documentos
Cultura Documentos
Yes or No
2. Overall Average Condition? -10 to +10
3. Worst Condition? Anything less than +10
4. Specified Areas of particular interest? -10 to +10
5. Progress toward Specified Goals? 0 to %100
This side is for Lower Function, This side is for Better Functioning
Sustaining and Sustaining and
Rebuilding Condition(s) Rebuilding Condition(s)
Non-Beneficial Beneficial
Negative Effects Reference Positive Effects
Person
1. May I, Can I, Should I? Yes or No (If yes proceed. If no, stop and ask questions.)
2. Overall Average Condition? -10 to +10 (Compared to a reference person.)
3. Worst Condition? Anything less than +10
4. Undesirable Conditions? Anything less than +10
5. Specified Areas of particular interest? -10 to +10
6. Progress Towards Specified Goals? 0 to 100%
7
This side is for Lower Function, This side is for Better Functioning
Sustaining and Sustaining and
Rebuilding Condition(s) Rebuilding Condition(s)
Non-Beneficial Beneficial
Negative Effects Reference Positive Effects
Person