CDEs
Forms
Are you able to run errands and shop?
Are you able to button your shirt?
Are you able to wash and dry your body?
Are you able to get in and out of a car?
Are you able to carry two bags filled with groceries 100 yards (100 m)?
Are you able to jump up and down?
Are you able to climb up five steps?
Are you able to wash dishes, pots, and utensils by hand while standing at a sink?
Are you able to make a bed, including spreading and tucking in bed sheets?
Are you able to carry a shopping bag or briefcase?
Are you able to take a tub bath?
Are you able to change the bulb in a table lamp?
Are you able to press with your index finger (for example ringing a doorbell)?
Are you able to put on and take off your socks?
Are you able to shave your face or apply makeup?
Are you able to squeeze a new tube of toothpaste?
Are you able to cut a piece of paper with scissors?
Are you able to pick up coins from a table top?
Are you able to hold a plate full of food?
Are you able to pour liquid from a bottle into a glass?
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