Falls Risk Screen (Mandarin)

This is the Mandarin page for Fall Risk Screening. Click below for other languages:

Spanish | Portuguese Arabic

Mandarin

      

What is your full name?

      

What is your date of birth?

 

      

Answer option for these questions: Yes or No

 

      

Right now, are you feeling weak, dizzy, or lightheaded?

      

Have you fallen in the past 3 months?

      

Do you need assistance to walk?

      

Do you need a cane?

      

Do you need crutches?

      

Do you need a walker?

      

Do you need a wheelchair?

      

Do you need a companion to help you?

      

Do you have a fear of falling?

      

Have you taken or will you take any medications for anxiety to help you with this exam today?