This assessment guide will help
you determine the type of products you should use. Please answer the
questions below as accurately as possible by typing the number value in
the box to the right of the question. Once all questions are answered,
press the RECOMMEND button. At any time feel free to call one
of our trained customer service representatives at 1-800-467-3224 option 7 and they
can assist you.
What is your Continence Level (Urinary)
0 = Continent; you do not have loss of bladder control
1 = Usually Continent; you are rarely incontinent; may
have one episode per week
2 = Occasionally Incontinent; my have a couple of episodes
per week
3 = Frequently incontinent; incontinent daily, but my
have periods of continence
4 = Incontinent; multiple episodes of incontinence throughout
the day.
Urinary Incontinence Amount
0 = Continent
1 = Light; less than 3.4 oz per episode
2 = Moderate; 3.4 to 10.1 oz per episode
4 = Heavy; 10.1 to 16.9 oz per episode
6 = SuperHeavy; greater than 18.6 oz per episode
(8 oz = 1 cup)
What is your Continence Level (Fecal)
0 = Continent; no fecal episodes
2 = Light; occasional fecal smears
4 = Moderate; occasional fecal episodes
6 = Incontinent; fecal incontinence
Toileting Ability / Mobility
0 = No assistance; ambulatory
1 = Minimal assistance; may need little help with sitting
up
2 = Moderate assistance; needs physical assistance from
at least one caregiver
4 = Unable/immobile; unable to ambulate to bathroom and/or
cannot use commode or bedpan
Mental/Physical Status/Level of Orientation
0 = Oriented; the ability to communicate
2 = Slightlyconfused; sometimes cannot communicate
4 = Confused; unable to communicate needs effectively
6 = Skin condition is fair to poor; inability to communicate
condition causing skin breakdown