FIM Test

Question 1

Total Assistance (patient < 25%)

Answer 1

1

Question 2

Maximal Assistance (patient = 25% to 49%)

Answer 2

2

Question 3

Moderate Assistance (patient = 50% to 74%)

Answer 3

3

Question 4

Minimal Assistance (patient = 75% or more

Answer 4

4

Question 5

Supervision (cueing, setup, coaxing)

Answer 5

5

Question 6

Modified Independence (device, safety, extra time)

Answer 6

6

Question 7

Complete Independence (timely, safely)

Answer 7

7

Question 8

No helper • No setup • No device

Answer 8

Level 7, Complete Independence:

Question 9

No helper • Patient requires a device • Patient requires more than a reasonable amount
of time (three times expected)
• There are safety considerations for which the patient accepts responsibility

Answer 9

Level 6, Modified Independence:

Question 10

Patient requires verbal cueing, coaxing, encouragement, or instructions
• Setup includes assistance with preparation before the patient performs an activity, or removal and disposal of equipment or materials after an activity is performed

Answer 10

Level 5, Supervision:

Question 11

A helper provides touching assistance, contact guard assistance, or guiding assistance, or the patient performs 75% or more of the effort

Answer 11

Level 4, Minimal Assistance:

Question 12

A helper provides lifting assistance, or the patient performs 50% to 74% of the effort

Answer 12

Level 3, Moderate Assistance:

Question 13

A helper provides lifting assistance, or the patient performs 25% to 49% of the effort

Answer 13

Level 2, Maximal Assistance:

Question 14

The patient requires two helpers or performs less than 25% of the effort

Answer 14

Level 1, Total Assistance:

Question 15

indicates that the patient did not perform the activity and that a helper did not perform the activity for the patient during the entire assessment time frame

Answer 15

code 0

Question 16

No FIM® item can be coded ? on discharge

Answer 16

0

Question 17

If the patient does not perform the activity at the time of discharge, rate the patient level

Answer 17

1, Total Assistance

Question 18

Based on observations performed in the first ? days

Answer 18

3

Question 19

if the patient uses a wheelchair and a helper is required to:
• Lock and unlock brakes
• Lift and lower (or remove and replace) footrests
• Remove or replace armrests • Positions a sliding board • Apply an orthosis • Supervise or provide cues

Answer 19

Record level 5, Supervision/Setup

Question 20

The patient requires touching, steadying, or contact guard assistance, or the patient requires a helper to lift only one leg onto or off the bed

Answer 20

Level 4:

Question 21

The patient requires lifting for part of the transfer (either to bring the patient to a standing position or to help lower the patient), a helper must lift both legs onto or off the bed, or both

Answer 21

Level 3:

Question 22

The patient requires assistance both for lifting (to come to a standing position) and for lowering (to come to a sitting position)

Answer 22

Level 2:

Question 23

A helper performs all tasks, the patient utilizes a mechanical lift, or more than one helper is required

Answer 23

Level 1:

Question 24

If the patient requires two helpers because of functional limitations, rate the patient

Answer 24

level 1, Total Assistance

Question 25

If two helpers are present because of an organizational (hospital) policy, but the patient requires assistance from only one of them, base the patient’s rating on

Answer 25

the amount of assistance the one helper provides

Question 26

150 feet or greater

Answer 26

Level 3:

Question 27

50 to 149 feet

Answer 27

Level 2:

Question 28

Less than 50 feet

Answer 28

Level 1:

Question 29

The patient operates a wheelchair or walks a minimum of 50 feet/15 meters independently, with or without a device

Answer 29

Household Ambulation (exception):

Question 30

150 feet/50 meters (minimum distance) No Helper:

Answer 30

Level 7, Complete Independence:

Question 31

150 feet/50 meters (minimum distance) with a device or safety concerns No Helper:

Answer 31

Level 6, Modified Independence:

Question 32

50 feet/15 meters (independent) [EXCEPTION]

Answer 32

Level 5, Household Ambulation:

Question 33

A patient who walks less than 150 feet will never be rated higher than level 2 unless the patient is rated “Household Exception” (50 feet, independently)

Answer 33

A patient who walks less than 50 feet will never be rated higher than level 1

Question 34

The patient | goes up and down 4–6 steps without a helper, with or without a device

Answer 34

Household Ambulation (Exception):

Question 35

Stairs • No Helper: 12–14 stairs

Answer 35

• Level 7:

Question 36

Stairs • No Helper: 12–14 stairs with a device

Answer 36

Level 6:

Question 37

Stairs • No Helper: 4–6 stairs (independent) [exception]

Answer 37

Level 5

Question 38

Stairs Helper 12–14 stairs

Answer 38

Level 5:

Question 39

Stairs helper The patient goes up and down fewer than 4–6 stairs, requires assistance from two helpers, or uses a stair lift

Answer 39

Level 1:

Question 40

Stairs helper 4-6 stairs

Answer 40

level 2

Question 41

If the patient is able to transfer in/out of bed independently and safe what is their FIM score for TRANSFER BED?

Answer 41

7

Question 42

If the patient is able to transfer in/out of bed with only using an assistive device or bars, what is their FIM score for TRANSFER BED?

Answer 42

6

Question 43

If the patient is able to transfer in/out of bed independently, but takes more time than usual, what is their FIM score for TRANSFER BED?

Answer 43

6

Question 44

If the patient must increase the HOB in order to transfer in/out of bed, what is their FIM score for TRANSFER BED?

Answer 44

6

Question 45

If the patient needs supervision, cueing,or coaxing when transfering in/out of the bed, what is their FIM score for TRANSFER BED?

Answer 45

5

Question 46

If the patient needs help with the wheelchair (i.e unlocking brakes or removing footrest) when transfering in/out of the bed, what is their FIM score for TRANSFER BED?

Answer 46

5

Question 47

If the patient needs CGA or steadying assist when transfering in/out of the bed what is their FIM score for TRANSFER BED?

Answer 47

4

Question 48

If the patient needs assistance lifting 1 limb in/out of the bed when transfering in/out of the bed, what is their FIM score for TRANSFER BED?

Answer 48

3

Question 49

If the patient performs 50-74% of the task of transferring in/out of the bed, what is their FIM score for TRANSFER BED?

Answer 49

3

Question 50

If the patient needs assistance lifting 2 limbs in/out of the bed when transfering in/out of the bed, what is their FIM score for TRANSFER BED?

Answer 50

3

Question 51

If the patient is performing 50-74% of the task and needs assistance such as lifting or lowering to move from supine to sit/sit to supine, what is their FIM score for TRANSFER BED.

Answer 51

3

Question 52

If the patient is performing 25-49% of the task and needs assistance for lifting and lowering themselves to transfer in/out of the bed, what is their FIM score for TRANSFER BED?

Answer 52

2

Question 53

If the patient needs total assistance by using a Hoyer or 2 or more people to transfer in/out of bed, what is their FIM score for TRANSFER BED?

Answer 53

1

Question 54

If in a wheelchair, patient approaches a bed or chair, locks brakes, lifts foot rests, removes arm rest if necessary, and performs either a standing pivot or sliding transfer and returns, and performs this activity safely. Whats their TRANSFERS FIM score?

Answer 54

7

Question 55

If the patient requires an adaptive or assistive device, or the transfer takes more than a reasonable amount of time, or there are safety considerations, what is their FIM score for TRANSFERS?

Answer 55

6

Question 56

If the patient requires supervision such as standing by, cueing, or coaxing, or requires setup such as positioning a sliding board or moving foot rests, what is their FIM score for TRANSFERS?

Answer 56

5

Question 57

If the patient requires no more help than touching and performs 75% or more of transferring tasks what is their FIM score for TRANSFERS?

Answer 57

4

Question 58

If the patient does not need help getting in or out of bed, but needs an assistive device such as a sliding board, grab bar or grace, or the transfer takes more than reasonable time, what is their FIM score for TRANSFERS?

Answer 58

6

Question 59

If the patient performs half or more of the effort and needs only supervision, cuing or coaxing for bed, chair, or wheelchair transfers, what is their FIM score for TRANSFERS?

Answer 59

5

Question 60

If the patient performs half or more of the effort and needs only incidental help such as CGA or steadying during bed, chair, or wheelchair transfers, what is their FIM score for TRANSFERS?

Answer 60

4

Question 61

If the patient needs assistance getting on and off the toilet, performs half or more of the transferring tasks, and needs only supervision, coaxing, or cueing what is their FIM score for TRANSFERS: TOILET?

Answer 61

5

Question 62

If the patient requires more help than touching or performs 50-74% of any task, what is their FIM score going to be?

Answer 62

3

Question 63

If the patient requires more help than touching or performs 25-49% of any task, what is their FIM score going to be?

Answer 63

2

Question 64

If the patient requires supervision or setup when performing any task, what is their FIM score going to be?

Answer 64

5

Question 65

If the patient requires no more help than touching and performs 75% or more of any task, what is their FIM score going to be?

Answer 65

4

Question 66

When looking at cognitive variables, if the patient requires assistance 30% of the time, he is doing 70% which makes his FIM score what?

Answer 66

3

Question 67

When looking at cognitive variables, if the patient requires assistance 51% of the time, he is doing 49% which makes his FIM score what?

Answer 67

2

Question 68

When looking at cognitive variables, if the patient requires assistance 49% of the time, he is doing 51% which makes his FIM score what?

Answer 68

3