Do you have diabetes, a vascular disease, a neuromuscular disease, or another condition that may prevent one or more areas of your body from receiving proper blood flow?

YES  NO

Are you confined to bed?

YES  NO

Are you in a wheelchair most of the time?

YES  NO

Do you have red areas on your skin that won’t go away?

YES  NO

Do you have tender “pressure points,” perhaps on your elbows, buttocks, hips, heels, or any other part of the body in prolonged contact with your bed or chair?

YES  NO

Is your skin cracked, blistered, scaly, or broken?

YES  NO

Do you have one or more open sores?

YES  NO

Do you see yellowish stains (possibly stained with blood) on your clothing, sheets, or chair?

YES  NO

Are most over-the-counter moisturizers ineffective in treating your skin conditions?

YES  NO

Do you have poor nutrition and hydration?

YES  NO

Do you have urinary and/or bowel incontinence?

YES  NO

Are you older, with thinning skin?

YES  NO

Do you have a family history of skin problems?

YES  NO

Do you have an active or outdoor lifestyle with exposure to sun and wind?

YES  NO

Do you take prednisone or other medications for a chronic condition?

YES  NO