General Patient Fall Risk Assessment Template

This fall risk assessment template is used to evaluate a patient's probability of falling. It includes fields to record a patient's fall history, current medication, and medical test results (vision, peripheral sensation, and mobility). Record the patient's fall risk rating depending on the number of accumulated risk factors. If a patient gets 1-2 risk factors patient has a Low risk probability of falling, a Medium risk for 3-5 risk factors and High risk for 6 risk factors and above.This fall risk assessment template is used to evaluate a patient's probability of falling. It includes fields to record a patient's fall history, current medication, and medical test results (vision, peripheral sensation, and mobility). Record the patient's fall risk rating depending on the number of accumulated risk factors. If a patient gets 1-2 risk factors patient has a Low risk probability of falling, a Medium risk for 3-5 risk factors and High risk for 6 risk factors and above.