Checklist: List of Basic Functions
My loved one might benefit from help with:
(Please check the responses that apply.)

The second list describes common tasks, to refine your picture of your loved one's needs.

Checklist: List of Common Tasks
My loved one might benefit from help with:
(Please click on the responses that apply.)

The next list consists of your own thoughts on your loved one's activities, behavior, and health, which may have a bearing on his or her need for help. Simply write your responses in the indicated locations.

Viewer's Notes:

The last list identifies people in a position to care for your loved one on a personal or professional basis, and ranks their likely effectiveness in doing so:

Checklist: Current Resources
(Please rank each item.)