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Assessment
Task 115: Meal Preparation
115
๐ฝ๏ธ Functional Assessment Task
Meal Preparation
"Do you need help planning meals, cooking, or preparing food?"
Task Progress:
Follow-up Questions to Explore
What parts are hardest? (e.g., lifting, standing, safety, memory)
Do you prepare anything yourself? (describe what you can do)
Do you skip meals? (if yes, why)
Home-delivered meals?
Has them
Wants them
Not interested
Breakfast time
Lunch time
Dinner time
Snacks needed?
Dietary or fluid restrictions
Special diet or consistency needs
Cultural or religious food preferences
Do you have food allergies?
No
Yes
Food Allergies
Clear/None
Allergy #1
What are they allergic to?
What happens when exposed?
Last reaction date
Type of reaction
Has EpiPen?
No
Yes
Add Another Allergy
Notes / Responses
"What happens if no one is there to help?"
Level of Care Required
0
No Help
1
Reminders
2
Supervision
3
Standby
4
Hands-On
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