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1K views1 page

Fim Form

Uploaded by

voscc7170
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

FUNCTIONAL INDEPENDENCE MEASURE

Occupational Therapy Department

FIM

7 Complete Independence (Timely, Safety) NO


L 6 Modified Independence (Device) HELPER
E Modified Dependence
V 5 Supervision
E 4 Minimal Assist (Subject = 75%+)
L 3 Moderate Assist (Subject = 50%+) HELPER
S Complete Dependence
2 Maximal Assist (Subject = 25%+)
1 Total Assist (Subject = 0%+)
Self Care ADMIT DISCHG FOL-UP
A. Feeding
7
B. Grooming
7
C. Bathing 2
D. Dressing-Upper Body 7
E. Dressing-Lower Body 5
F. Toileting 4

Note: If item is not testable, enter level1.


Sphincter Control
G. Bladder Management
H. Bowel Management
under 5 cuz she is occasional accident
Mobility
Transfer:
I. Bed, Chair, W/Chair 4
J. Toilet 4
2
K. Tub, Shower
whole process is long so she cannot sit long
Locomotion
L. Walk / Wheel Chair w 4
w w
c c c
M. Stairs 1

Communication
N. Comprehension a a a
v v v
O. Expression v v v
n 7 n n
7
Social Cognition 7
7
P. Social Interaction 7
Q. Problem Solving
R. Memory
Total 92

Copyright 1987 Research Foundation – State University of New York

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