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<document id='1804644' localTitle='PM&amp;R FIM NOTE' nationalTitle='PHYSICAL MEDICINE REHAB DIAGNOSTIC STUDY REPORT' >
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 LOCAL TITLE: PM&amp;R FIM NOTE                                      
STANDARD TITLE: PHYSICAL MEDICINE REHAB DIAGNOSTIC STUDY REPORT 
DATE OF NOTE: JUN 17, 2015@14:54     ENTRY DATE: JUN 17, 2015@14:54:57      
      AUTHOR: FORREST,ZACHARY      EXP COSIGNER:                           
     URGENCY:                            STATUS: COMPLETED                     

Rehab Bed Unit Admission: 6/17/2015
Admission Class: 1-Initial Rehabilitation
Discharge Date:  6/17/2015

DIAGNOSIS
      Impairment Group: 2.1 Brain Dysfunction, Non-Traumatic         
                                             
         Date of Onset: 6/17/2015

FUNCTIONAL INDEPENDENCE MEASURE (FIM)
                                                             GOALS
 Self-Care                                                             
  Eating                                                           7 
  Grooming                                                         7   
  Bathing                                                          7  
  Dressing-Upper Body                                              7       
  Dressing-Lower Body                                              7       
  Toileting                                                        7    
 Sphincter Control                                                         
  Bladder Management                                               7       
  Bowel Management                                                 7       
 Mobility                                                             
  Bed, Chair, Wheelchair                                           7       
  Toilet                                                           7 
  Tub, Shower                                                      7      
 Locomotion                                                             
  Walk/Wheelchair                                             both 7       
  Stairs                                                           7 
Motor Subtotal Score:                                              91      
 Communication                                                             
  Comprehension                                               both 7       
  Expression                                                  both 7       
 Social Cognition                                                          
  Social Interaction                                               7       
  Problem Solving                                                  7       
  Memory                                                           7 
 Cognitive Subtotal Score:                                         35      
Total Motor and
      Cognitive Score:                                             126     
 
* 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% +)
 
ADDITIONAL INFORMATION:
  Testing CCDA
 
/es/ ZACHARY FORREST
physician tester
Signed: 06/17/2015 14:55
</content>
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