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Katz Index of Independence in Activities of Daily Living (NM800078)

Katz Index of Independence in Activities of Daily Living (NM800078) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires



Patient Name

DOB:

MR #


NM800078 (Rev. 09/26/16) Worksheet Only – Not a Medical Record Document
UW Health uwhealth.org
(University of Wisconsin Hospitals and Clinics Authority)
KATZ INDEX OF INDEPENDENCE IN
ACTIVITIES OF DAILY LIVING






ACTIVITIES
POINTS (1 OR 0)
INDEPENDENCE:
(1 POINT)
NO supervision, direction or personal
assistance

DEPENDENCE:
(0 POINTS)
WITH supervision, direction, personal
assistance or total care
BATHING

POINTS: ________

(1 POINT) Bathes self completely or
needs help in bathing only a single part
of the body such as the back, genital
area or disabled extremity.

(0 POINTS) Needs help with bathing
more than one part of the body, getting
in or out of the tub or shower. Requires
total bathing.
DRESSING

POINTS: ________

(1 POINT) Gets clothes from closets
and drawers and puts on clothes and
outer garments complete with
fasteners. May have help tying shoes.

(0 POINTS) Needs help with dressing
self or needs to be completely dressed.
TOILETING

POINTS: ________

(1 POINT) Goes to toilet, gets on and
off, arranges clothes, cleans genital
area without help.
(0 POINTS) Needs help transferring to
the toilet, cleaning self or uses bedpan
or commode.
TRANSFERRING

POINTS: ________

(1 POINT) Moves in and out of bed or
chair unassisted. Mechanical
transferring aides are acceptable.
(0 POINTS) Needs help in moving from
bed to chair or requires a complete
transfer.
CONTINENCE

POINTS: ________

(1 POINT) Exercises complete self-
control over urination and defecation.
(0 POINTS) Is partially or totally
incontinent of bowel or bladder.
FEEDING

POINTS: ________

(1 POINT) Gets food from plate into
mouth without help. Preparation of
food may be done by another person.
(0 POINTS) Needs partial or total help
with feeding or requires parenteral
feeding.



TOTAL POINTS = ________ 6 = High (patient independent) 0 = Low (patient very dependent)


Slightly adapted from Katz, S., Down, T.D., Cash, H.R., & Gates, R.C. (1970) Progress in the development of the index of ADL. The
Gerontologist, 10(1), 20-30.