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Clientsummaryreport 5254 3
Clientsummaryreport 5254 3
Patient Information:
Patient Name:
Palmer, Dodi
Address:
2840 S Mann St
Gender:
Tennant Type:
Owner
Is Veteran:
No
Housing Type:
Single Family
Has HOA:
No
No. Floors:
Lives With:
Self
Female
Special Considerations:
Inaccessible None
Areas:
Assistive None
Devices:
Result in Injury: No
What Room:
Result in Hospitalization: No
Result in Rehabilitation: No
Other Considerations:
Consideration Type
Other Concern
Therapist Note
Client wants to be safe living by herself.
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Pre-Assessment
Personal Safety
Rating %
Therapist
Accessibility
Rating %
100.00 %
91.67 %
100.00 %
87.50 %
100.00 %
90.00 %
100.00 %
75.00 %
100.00 %
83.33 %
100.00 %
83.33 %
Room Assessed
Post-Assessment
Therapist
Personal Safety
Accessibility
Rating %
Rating %
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Accessibility Rating
100.00 %
91.67 %
Recommended Modifications:
- Towel Bar Grab Bar
- Angled Grab Bar
- Grab Bar Left Side of Bathing Entry
- Horizontal Grab Bar
- 18" - Textured
- Hand Held Shower
Accessibility Rating
100.00 %
87.50 %
Recommended Modifications:
- Organize/Declutter Space
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Page: 3 of 8
Accessibility Rating
100.00 %
90.00 %
Recommended Modifications:
- Towel Bar Grab Bar
- Angled Grab Bar
- Grab Bar Left Side of Bathing Entry
- Horizontal Grab Bar
- 18" - Textured
http://www.homeforlifedesign.com
Page: 4 of 8
Accessibility Rating
100.00 %
75.00 %
Recommended Modifications:
- Add Visible Steps
- Add Hand Rails
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Page: 5 of 8
Accessibility Rating
100.00 %
83.33 %
Recommended Modifications:
- Organize/Declutter Space
http://www.homeforlifedesign.com
Page: 6 of 8
Accessibility Rating
100.00 %
83.33 %
Recommended Modifications:
- Add Visible Steps
http://www.homeforlifedesign.com
Page: 7 of 8
Submitted By:
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Page: 8 of 8