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<assessment type='admission' cognitiveScore='5' motorScore='13' totalScore='18'>
<values eat='1' groom='1' bath='1' dressUp='1' dressLo='1' toilet='1' bladder='1' bowel='1' transChair='1' transToilet='1' transTub='1' locomWalk='1' locomStair='1' comprehend='1' express='1' interact='1' problem='1' memory='1' walkMode='W' comprehendMode='B' expressMode='B' />
</assessment>
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<care value='CONTINUUM OF CARE' />
<case value='18' />
<facility code='442' name='CHEYENNE VAMC' />
<id value='18' />
<impairmentGroup value='1.1' />
<name value='Functional Independence Measurement' />
<onset value='3150818' />
</fim>
<fim>
<admitClass value='2' />
<admitted value='3150705' />
<assessments>
<assessment type='discharge' cognitiveScore='25' motorScore='65' totalScore='90' >
<values eat='5' groom='5' bath='5' dressUp='5' dressLo='5' toilet='5' bladder='5' bowel='5' transChair='5' transToilet='5' transTub='5' locomWalk='5' locomStair='5' comprehend='5' express='5' interact='5' problem='5' memory='5' walkMode='5' comprehendMode='5' expressMode='5' />
</assessment>
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<case value='20' />
<discharged value='3150710' />
<facility code='442' name='CHEYENNE VAMC' />
<id value='20' />
<impairmentGroup value='1.9' />
<name value='Functional Independence Measurement' />
<onset value='3150704' />
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<fim>
<admitted value='3150621' />
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<assessment type='interim' cognitiveScore='30' motorScore='78' totalScore='108'>
<values eat='6' groom='6' bath='6' dressUp='6' dressLo='6' toilet='6' bladder='6' bowel='6' transChair='6' transToilet='6' transTub='6' locomWalk='6' locomStair='6' comprehend='6' express='6' interact='6' problem='6' memory='6' walkMode='H' comprehendMode='V' expressMode='V' />
</assessment>
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<case value='21' />
<facility code='442' name='CHEYENNE VAMC' />
<id value='21' />
<impairmentGroup value='1.8' />
<name value='Functional Independence Measurement' />
<onset value='3150620' />
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<fim>
<admitted value='3150802' />
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<assessment type='follow up' cognitiveScore='10' motorScore='26' totalScore='36' >
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<case value='22' />
<discharged value='3150805' />
<facility code='442' name='CHEYENNE VAMC' />
<id value='22' />
<impairmentGroup value='1.7' />
<name value='Functional Independence Measurement' />
<onset value='3150801' />
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<fim>
<admitted value='3150806' />
<assessments>
<assessment type='goals' cognitiveScore='35' motorScore='91' totalScore='126' >
<values eat='7' groom='7' bath='7' dressUp='7' dressLo='7' toilet='7' bladder='7' bowel='7' transChair='7' transToilet='7' transTub='7' locomWalk='7' locomStair='7' comprehend='7' express='7' interact='7' problem='7' memory='7' walkMode='W' comprehendMode='B' expressMode='B' />
</assessment>
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<care value='CONTINUUM OF CARE' />
<case value='23' />
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<facility code='442' name='CHEYENNE VAMC' />
<id value='23' />
<impairmentGroup value='1.8' />
<name value='Functional Independence Measurement' />
<onset value='3150807' />
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<fim>
<admitted value='3150403' />
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<assessment type='admission' cognitiveScore='5' motorScore='13' totalScore='18'>
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</assessment>
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<care value='CONTINUUM OF CARE' />
<case value='24' />
<facility code='442' name='CHEYENNE VAMC' />
<id value='24' />
<impairmentGroup value='1.9' />
<name value='Functional Independence Measurement' />
<onset value='3150401' />
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<fim>
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<admitted value='3150820' />
<assessments>
<assessment type='admission' cognitiveScore='30' motorScore='78' totalScore='108' >
<values eat='6' groom='6' bath='6' dressUp='6' dressLo='6' toilet='6' bladder='6' bowel='6' transChair='6' transToilet='6' transTub='6' locomWalk='6' locomStair='6' comprehend='6' express='6' interact='6' problem='6' memory='6' walkMode='C' comprehendMode='V' expressMode='N' />
</assessment>
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<care value='CONTINUUM OF CARE' />
<case value='25' />
<discharged value='3150820' />
<document id='1804699' localTitle='PM&amp;R FIM FSOD NOTE' nationalTitle='PHYSICAL MEDICINE REHAB DIAGNOSTIC STUDY REPORT' >
<content xml:space='preserve'>
 LOCAL TITLE: PM&amp;R FIM FSOD NOTE
STANDARD TITLE: PHYSICAL MEDICINE REHAB DIAGNOSTIC STUDY REPORT
DATE OF NOTE: AUG 20, 2015@11:40     ENTRY DATE: AUG 20, 2015@11:40:30
      AUTHOR: SWALL,MARIE          EXP COSIGNER:
     URGENCY:                            STATUS: COMPLETED

Therapy Start Date: 8/20/2015
Admission Class: 1-Initial Rehabilitation
Discharge Date:  8/20/2015

DIAGNOSIS
      Impairment Group: 1.1 Stroke, Left Body  Involvement (Right
                            Brain)
         Date of Onset: 8/20/2015

FUNCTIONAL INDEPENDENCE MEASURE (FIM)
                       ADMISSION
 Self-Care
  Eating                   6
  Grooming                 6
  Bathing                  6
  Dressing-Upper Body      6
  Dressing-Lower Body      6
  Toileting                6
 Sphincter Control
  Bladder Management       6
  Bowel Management         6
 Mobility
  Bed, Chair, Wheelchair   6
  Toilet                   6
  Tub, Shower              6
 Locomotion
  Walk/Wheelchair      w/c 6
  Stairs                   6
Motor Subtotal Score:      78
 Communication
  Comprehension        vis 6
  Expression        nonvoc 6
 Social Cognition
  Social Interaction       6
  Problem Solving          6
  Memory                   6
 Cognitive Subtotal Score: 30
Total Motor and
      Cognitive Score:     108

* FIM MEASUREMENT DEFINITIONS
     NO HELPER
       7.  Complete Independence (Timely, Safely)
       6.  Modified Independence (Device)
     HELPER (Modified Dependence)
       5.  Supervision
       4.  Minimal Assistance (Subject = 75% +)
       3.  Moderate Assistance (Subject = 50% +)
     HELPER (Complete Dependence)
       2.  Maximal Assistance (Subject = 25% +)
       1.  Total Assistance (Subject = 0% +)

/es/ MARIE SWALL
NWHIN PHYSICIAN
Signed: 08/20/2015 11:40
</content>
</document>
<facility code='442' name='CHEYENNE VAMC' />
<id value='25' />
<impairmentGroup value='1.1' />
<interruptionCode value='2' />
<name value='Functional Independence Measurement' />
<onset value='3150820' />
</fim>
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