CNA ADL Documentation Sheet

Shift-based CNA flowsheet for documenting activities of daily living (ADLs), transfers, toileting, intake, and behaviors with a clear audit trail for MDS Section G and GG support.

Shift and Resident Identification

• Shift Date
• Shift Time
• Resident Identifier
  Use the facility-approved resident identifier or chart number. Do not enter unnecessary PII.
• Unit or Room

ADL Assistance Provided

• Bathing Assistance
• Dressing Assistance
• Grooming Assistance
• Feeding Assistance
• ADL Notes
  Document only observable, relevant details that support the selected assistance levels.

Transfers, Toileting, Intake, and Behaviors

• Transfer Status
• Toileting Assistance
• Intake Amount (mL)
  Enter measured intake only when applicable.
• Behavior Observed
• Behavior Notes
  Provide brief objective details only when a behavior was observed.

Review and Attestation

• I confirm this documentation is accurate and complete to the best of my knowledge.
• CNA Signature
• Submission Notes
  Use this field for any clarification needed by nursing or MDS review.