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Continence Level - Urine

Day	Night
		Continent: not incontinent
		Usually continent: rarely incontinent, may have one per week
		Occasional incontinent: not daily, a couple times per week
		Frequently incontinent: incontinent daily, may be continent for hours at a time
		Incontinent: multiple episodes of incontinence

Urine Incontinence Output

Day	Night
		No incontinence
		Light: less than 100cc at a time
		Moderate: 100-300cc (1 cup) at a time
		Heavy: 300-500cc, (1-2 cups) at time
		Very Heavy: more than 550cc at a time

Bowel Incontinence

Day	Night
		Continent no bowel episodes
		Occasional fecal smears
		Occasional fecal episodes
		Fecal incontinent

Toileting Ability/ Mobility

Day	Night
		No assistance: ambulatory
		Minimal assistance: may need a little help
		Moderate assistance: need help of one or more person
		Immobile/unable to ambulate, Change positions. Can not use commode or toliet

Other Consideration

Day	Night
		Oriented: able to communicate
		Slightly confused: sometimes able to share needs
		Confused: unable to share needs
		Skin condition: fair and intact to poor and breakdown present

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