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Elopement Risk Assessment

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Instructions: Upon admission and quarterly (at a minimum) thereafter, assess the resident status in seven clinical areas listed below (1–7) by assigning the corresponding score which best describes the resident in the appropriate assessment column.

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Add the column of numbers to obtain the total score. If the total score is 10 or greater, the resident should be considered to be at risk for elopement. Prevention protocols should be followed and documents on the care plan.

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