| Activities | Points |
| Laundry |
| 1. Does personal laundry completely | 1 |
| 2. Launders small items, rinses socks, stockings, etc | 1 |
| 3. All laundry must be done by others | 0 |
| Mode of transportation |
| 1. Travels independently on public transportation or drives own car | 1 |
| 2. Arranges own travel via taxi but does not otherwise use public transportation | 1 |
| 3. Travels on public transportation when assisted or accompanied by another | 1 |
| 4. Travel limited to taxi or automobile with assistance of another | 0 |
| 5. Does not travel at all | 0 |
| Responsibility for own medications |
| 1. Is responsible for taking medication in correct doses at correct time | 1 |
| 2. Takes responsibility if medication is prepared in advance in separate doses | 0 |
| 3. Is not capable of dispensing own medication | 0 |
| Ability to handle finances |
| 1. Manages financial matters independently (budgets, writes checks, pays rent and bills, goes to bank); collects and keeps track of income | 1 |
| 2. Manages day-to-day purchases but needs help with banking, major purchases, etc | 1 |
| 3. Incapable of handling money | 0 |
