Exit this survey Key Words Used in Functional Assessment Question Title 1. Occasional help to perform task. Patient provides most of effort. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 2. Patient performs the task independently without devices or medications yet there are safety concerns 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 3. Patient performs all effort while staff cues and coaxes completion. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 4. Requires more than occasional help with the caregiver providing hand over hand assistance for every portion of the performed activity. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 5. An assessment for this task was recorded earlier, I need to assist the patient quickly to perform this activity and do not have time to let them show me how much they can do for themselves at this moment. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 6. This is not a cognitive area; the patient cannot perform the task I am requesting as it is physically unsafe for the Admission Assessment Reference period timeline. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 7. It is within the discharge reference window, the activity has nothing to do with locomotion or tub transfers and the patient still is not able to perform the activity due to safety reasons. How is this scored? 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 8. This patient requires occasional contact for balance; the activity requires three areas for assessment and the patient only performs one of those items independently without significant help of the caregiver. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 9. The patient has an ostomy device; yesterday I read that the patient was independent after the staff set up the equipment. Today the patient sets up their own equipment and no cuing was provided during bowel management. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 10. The patient uses a wheelchair and is ready to transfer back to bed. They manage to lock their brakes, remove leg rests and arm rest independently. I place the transfer board under the patient by shifting their weight and holding them so they do not fall. For each scoot over the board I assist the patient to reduce friction because they cannot scoot unless I lift them. They cannot stand pivot yet. Once they are in the bed they can pull their legs up onto the bed. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 11. The patient is in a wheelchair that is considerably higher than the toilet. S/he approach safely, lock the brakes and remove the leg rests with minimal cuing. S/he transfer to the toilet with contact guard. They are unable to get up from the toilet despite the use of toilet grab bars requiring a full lift back to the wheelchair. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 12. It requires two persons to safely ambulate the patient for any amount of distance. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 13. The patient can propel their wheelchair without any help household distances of 55 feet. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 14. The patient ambulates up and down 10 steps and requires the help of two persons. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 15. It is not safe to take the patient on the stairs anytime within the first three days of their IRF stay. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 16. The patient ambulates up and down 12 steps with the help of one person. The patient requires contact guard and an occasional placement of the foot on the step if a scissoring is noticed when placing their foot on the next step. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 17. After the utensils are placed in the patients hand (toothbrush, hair brush, washcloth), the patient requires the caregiver to help hand over hand (to keep utensils in the hand) and then assists in the necessary movements to complete each of the tasks for grooming. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 18. The patient requires incidental physical help with only one area of grooming because they became too tired to complete all tasks independently. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 19. The patient approaches the sink independently at wheelchair level; as expected supplies were within reach on the sink and S/he performed the task independently and timely. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 20. The patient requires physical assistance for washing, rinsing and drying the body for more than two areas of the body, in fact, the caregiver must hold the washcloth or towel most of the time since grasp is weak. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 21. The patient is bathing and with just cues has performed all of the washing, rinsing and drying of all body parts. A few times, the patient required the caregiver to place the washcloth or towel back in their hand after dropping it out of their safe reach. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimal Independence; No more than touching; patient expends >75% or more of effort 3 = Moderate Independence: More help than touching; patient expends between 50 - 74% of effort 2 = Maximal Independence: Physically assist patient; patient expends between 25 - 49% of effort 1 = Total Independence; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 22. The patient is dressing their upper body and requires help to hold the clothing so they can place their head into the opening and maneuver their arms through the sleeves. The patient can button and snap their own fasteners on their shirt. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 23. With the placement of a tenodesis wrist splint, the patient can dress their upper body independently, including buttoning and fastening the clothing. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 24. The family has not brought in the patients clothing, I suggest to the patient that we try to take on and off scrub pants but the patient refuses. S/he prefer to use their own clothing when they get dressed. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 25. The patient is lying in bed to perform the lower body dressing task because their balance is not yet safe to sit at the edge. The patient is able to hold their own pants but the caregiver must lift their legs to help thread them through the pant legs. The patient can roll from side to side and is able to pull the clothing over their own hips as well as fasten the closures. They can put on their own socks and shoes using assistive devices for reach. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 26. The patient uses a reacher and long handled shoe horn to dress the lower body. They are safe and perform the activity in a reasonable amount of time. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 27. The patient can hold their own clothing but lacks stabilization to thread their legs into their under pants and pants. The caregiver lifts the patients legs. The patient needs the same amount of help with their feet while the patient helps hold their socks open. The caregiver places the shoes in a location where the patient can slide their feet into the shoes and then the patient can tie them, needing help to sit back up in the chair. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 28. The facility leaves a bedside commode next to every patients bed for convenience at night. The patient controls bowels completely and intentionally without any noted accidents for more than 3 days, but since the bedside commode is present they use it at night even though they could go to the bathroom but staff like the convenience. 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 29. The patient has had a total of 3 bladder accidents in the past 7 days. (Soiling of linen or clothing requiring a change.) Considering only the number of accidents, what score is applied for accidents. (The PAI will eventually utilize the lowest score between management and accident to reflect burden). 7 = Complete Independence; reasonable time, no modifications, devices 6 = Modified Independence; > reasonable time, safety concern, > reasonable time, device 5 = Supervision, Set Up; Stand-by, cuing, coaxing, no physical assistance; may apply device 4 = Minimally Dependent; No more than touching; patient expends >75% or more of effort 3 = Moderately Dependent: More help than touching; patient expends between 50 - 74% of effort 2 = Maximally Dependent: Physically assist patient; patient expends between 25 - 49% of effort 1 = Totally Dependent; Patient expends less than 25% of effort; Caregiver performs tasks 0 = Does Not Occur Not Observed - no assessment rendered / cannot score Question Title 30. The patient requires continual prompting to communicate basic needs and does not seem to understand or responds inappropriately when asked questions about basic needs for comprehension. 7 = Complete Independence—The patient understands complex or abstract directions and conversation, and understands either spoken or written language (not necessarily English). 6 = Modified Independence—In most situations, the patient understands readily or with only mild difficulty complex or abstract directions and conversation. The patient does not require prompting, though (s)he may require a hearing or visual aid, other assistive device, or extra time to understand the information. 5 = Standby Prompting—The patient understands directions and conversation about basic daily needs more than 90% of the time. The patient requires prompting (slowed speech rate, use of repetition, stressing particular words or phrases, pauses, visual or gestural cues) less than 10% of the time. 4 = Minimal Prompting—The patient understands directions and conversation about basic daily needs 75 to 90% of the time. 3 = Moderate Prompting—The patient understands directions and conversation about basic daily needs 50 to 74% of the time. 2 = Maximal Prompting—The patient understands directions and conversation about basic daily needs 25 to 49% of the time. Understands only simple, commonly used spoken expressions (e.g., hello, how are you) or gestures (e.g., waving good-bye, thank you). Requires prompting more than half the time. 1 = Total Assistance—The patient understands directions and conversation about basic daily needs less than 25% of the time, or does not understand simple, commonly used spoken expressions (e.g., hello, how are you) or gestures (e.g., waving good-bye, thank you), or does not respond appropriately or consistently despite prompting Question Title 31. The patient needs help to understand directions and conversation about basic needs only occasionally. Very little prompting is necessary for comprehension. 7 = Complete Independence—The patient understands complex or abstract directions and conversation, and understands either spoken or written language (not necessarily English). 6 = Modified Independence—In most situations, the patient understands readily or with only mild difficulty complex or abstract directions and conversation. The patient does not require prompting, though (s)he may require a hearing or visual aid, other assistive device, or extra time to understand the information. 5 = Standby Prompting—The patient understands directions and conversation about basic daily needs more than 90% of the time. The patient requires prompting (slowed speech rate, use of repetition, stressing particular words or phrases, pauses, visual or gestural cues) less than 10% of the time. 4 = Minimal Prompting—The patient understands directions and conversation about basic daily needs 75 to 90% of the time. 3 = Moderate Prompting—The patient understands directions and conversation about basic daily needs 50 to 74% of the time. 2 = Maximal Prompting—The patient understands directions and conversation about basic daily needs 25 to 49% of the time. Understands only simple, commonly used spoken expressions (e.g., hello, how are you) or gestures (e.g., waving good-bye, thank you). Requires prompting more than half the time. 1 = Total Assistance—The patient understands directions and conversation about basic daily needs less than 25% of the time, or does not understand simple, commonly used spoken expressions (e.g., hello, how are you) or gestures (e.g., waving good-bye, thank you), or does not respond appropriately or consistently despite prompting Question Title 32. The patient needs help to express basic needs of hunger, thirst or discomfort only rarely. 7 = Complete Independence. The patient expresses complex or abstract ideas clearly and fluently (not necessarily in English). 6 = Modified Independence. In most situations, the patient expresses complex or abstract ideas relatively clearly or with only mild difficulty. The patient does not need any prompting, but (s)he may require an augmentative communication device or system. 5 = Standby Prompting. The patient expresses basic daily needs and ideas more than 90% of the time. Requires prompting (e.g., frequent repetition) less than 10% of the time to be understood. 4 = Minimal Prompting. The patient expresses basic daily needs and ideas 75 to 90% of the time. 3 = Moderate Prompting. The patient expresses basic daily needs and ideas 50 to 74% of the time. 2 = Maximal Prompting. The patient expresses basic daily needs and ideas 25 to 49% of the time. The patient uses only single words or gestures, and (s)he needs prompting more than half the time. 1 = Total Assistance. The patient expresses basic daily needs and ideas less than 25% of the time, or does not express basic needs appropriately or consistently despite prompting. Question Title 33. The patient is unable to express discomfort, hunger, thirst or expresses these inappropriately or inconsistently when prompted most of the time. 7 = Complete Independence. The patient expresses complex or abstract ideas clearly and fluently (not necessarily in English). 6 = Modified Independence. In most situations, the patient expresses complex or abstract ideas relatively clearly or with only mild difficulty. The patient does not need any prompting, but (s)he may require an augmentative communication device or system. 5 = Standby Prompting. The patient expresses basic daily needs and ideas more than 90% of the time. Requires prompting (e.g., frequent repetition) less than 10% of the time to be understood. 4 = Minimal Prompting. The patient expresses basic daily needs and ideas 75 to 90% of the time. 3 = Moderate Prompting. The patient expresses basic daily needs and ideas 50 to 74% of the time. 2 = Maximal Prompting. The patient expresses basic daily needs and ideas 25 to 49% of the time. The patient uses only single words or gestures, and (s)he needs prompting more than half the time. 1 = Total Assistance. The patient expresses basic daily needs and ideas less than 25% of the time, or does not express basic needs appropriately or consistently despite prompting. Question Title 34. The patient needs extra time in social situations and to interact appropriately with staff. They do well in structured or modified environments and take medication for anxiety and depression. 7 = Complete Independence—The patient interacts appropriately with staff, other patients, and family members (e.g., controls temper, accepts criticism, is aware that words and actions have an impact on others), and does not require medication for control. 6 = Modified Independence—The patient interacts appropriately with staff, other patients, and family members in most situations, and only occasionally loses control. The patient does not require supervision, but may require more than a reasonable amount of time to adjust to social situations, or may require medication for control. 5 = Supervision—The patient requires supervision (e.g., monitoring, verbal control, cuing, or coaxing) only under stressful or unfamiliar conditions, but less than 10% of the time. The patient may require encouragement to initiate participation. 4 = Minimal Direction—The patient interacts appropriately 75 to 90% of the time. 3 = Moderate Direction—The patient interacts appropriately 50 to 74% of the time. 2 = Maximal Direction—The patient interacts appropriately 25 to 49% of the time, but may need restraint due to socially inappropriate behaviors. 1 = Total Assistance—The patient interacts appropriately less than 25% of the time, or not at all, and may need restraint due to socially inappropriate behaviors. Question Title 35. The patient needs help to interact appropriately with others only on occasion. 7 = Complete Independence—The patient interacts appropriately with staff, other patients, and family members (e.g., controls temper, accepts criticism, is aware that words and actions have an impact on others), and does not require medication for control. 6 = Modified Independence—The patient interacts appropriately with staff, other patients, and family members in most situations, and only occasionally loses control. The patient does not require supervision, but may require more than a reasonable amount of time to adjust to social situations, or may require medication for control. 5 = Supervision—The patient requires supervision (e.g., monitoring, verbal control, cuing, or coaxing) only under stressful or unfamiliar conditions, but less than 10% of the time. The patient may require encouragement to initiate participation. 4 = Minimal Direction—The patient interacts appropriately 75 to 90% of the time. 3 = Moderate Direction—The patient interacts appropriately 50 to 74% of the time. 2 = Maximal Direction—The patient interacts appropriately 25 to 49% of the time, but may need restraint due to socially inappropriate behaviors. 1 = Total Assistance—The patient interacts appropriately less than 25% of the time, or not at all, and may need restraint due to socially inappropriate behaviors. Question Title 36. The patient does not need any help or medications to interact with others in social and therapeutic situations. 7 = Complete Independence—The patient interacts appropriately with staff, other patients, and family members (e.g., controls temper, accepts criticism, is aware that words and actions have an impact on others), and does not require medication for control. 6 = Modified Independence—The patient interacts appropriately with staff, other patients, and family members in most situations, and only occasionally loses control. The patient does not require supervision, but may require more than a reasonable amount of time to adjust to social situations, or may require medication for control. 5 = Supervision—The patient requires supervision (e.g., monitoring, verbal control, cuing, or coaxing) only under stressful or unfamiliar conditions, but less than 10% of the time. The patient may require encouragement to initiate participation. 4 = Minimal Direction—The patient interacts appropriately 75 to 90% of the time. 3 = Moderate Direction—The patient interacts appropriately 50 to 74% of the time. 2 = Maximal Direction—The patient interacts appropriately 25 to 49% of the time, but may need restraint due to socially inappropriate behaviors. 1 = Total Assistance—The patient interacts appropriately less than 25% of the time, or not at all, and may need restraint due to socially inappropriate behaviors. Question Title 37. The patient does not need extra time to make decision or solve problems, they can self correct and make decisions in familiar and unfamiliar situations. 7 = Complete Independence—The patient consistently recognizes problems when present, makes appropriate decisions, initiates and carries out a sequence of steps to solve complex problems until the task is completed, and self-corrects if errors are made. 6 = Modified Independence—In most situations, the patient recognizes a present problem, and with only mild difficulty makes appropriate decisions, initiates and carries out a sequence of steps to solve complex problems, or requires more than a reasonable time to make appropriate decisions or solve complex problems. 5 = Supervision—The patient requires supervision (e.g., cuing or coaxing) to solve routine problems only under stressful or unfamiliar conditions, but no more than 10% of the time. 4 = Minimal Direction—The patient solves routine problems 75 to 90% of the time. 3 = Moderate Direction—The patient solves routine problems 50 to 74% of the time. 2 = Maximal Direction—The patient solves routine problems 25 to 49% of the time. The patient needs direction more than half the time to initiate, plan, or complete simple daily activities, and may need restraint for safety. 1 = Total Assistance—The patient solves routine problems less than 25% of the time. The patient needs direction nearly all the time, or does not effectively solve problems, and may require constant one-to-one direction to complete simple daily activities. The patient may need a restraint for safety. Question Title 38. The patient needs help to solve problems most of the time as they are unable to solve problems or are very inconsistent. Generally, to be safe they require supervision. 7 = Complete Independence—The patient consistently recognizes problems when present, makes appropriate decisions, initiates and carries out a sequence of steps to solve complex problems until the task is completed, and self-corrects if errors are made. 6 = Modified Independence—In most situations, the patient recognizes a present problem, and with only mild difficulty makes appropriate decisions, initiates and carries out a sequence of steps to solve complex problems, or requires more than a reasonable time to make appropriate decisions or solve complex problems. 5 = Supervision—The patient requires supervision (e.g., cuing or coaxing) to solve routine problems only under stressful or unfamiliar conditions, but no more than 10% of the time. 4 = Minimal Direction—The patient solves routine problems 75 to 90% of the time. 3 = Moderate Direction—The patient solves routine problems 50 to 74% of the time. 2 = Maximal Direction—The patient solves routine problems 25 to 49% of the time. The patient needs direction more than half the time to initiate, plan, or complete simple daily activities, and may need restraint for safety. 1 = Total Assistance—The patient solves routine problems less than 25% of the time. The patient needs direction nearly all the time, or does not effectively solve problems, and may require constant one-to-one direction to complete simple daily activities. The patient may need a restraint for safety. Question Title 39. The patient requires minimal prompting to recognize people or daily routines. Generally you do not have to repeat request and the patient self initiates or uses environmental cues to recall day to day activities. 7 = Complete Independence. The patient recognizes people frequently encountered, remembers daily routines, and executes requests of others without need for repetition. 6 = Modified Independence. The patient appears to have only mild difficulty recognizing people frequently encountered, remembering daily routines, and responding to requests of others. The patient may use self-initiated or environmental cues, prompts, or aids. 5 = Supervision. The patient requires prompting (e.g., cuing, repetition, reminders) only under stressful or unfamiliar conditions, but no more than 10% of the time. 4 = Minimal Prompting. The patient recognizes and remembers 75 to 90% of the time. 3 = Moderate Prompting. The patient recognizes and remembers 50 to 74% of the time. 2 = Maximal Prompting. The patient recognizes and remembers 25 to 49% of the time, and needs prompting more than half the time. 1 = Total Assistance. The patient recognizes and remembers less than 25% of the time, or does not effectively recognize and remember. Question Title 40. The patient needs help to recognize and remember only rarely or under stressful conditions. 7 = Complete Independence. The patient recognizes people frequently encountered, remembers daily routines, and executes requests of others without need for repetition. 6 = Modified Independence. The patient appears to have only mild difficulty recognizing people frequently encountered, remembering daily routines, and responding to requests of others. The patient may use self-initiated or environmental cues, prompts, or aids. 5 = Supervision. The patient requires prompting (e.g., cuing, repetition, reminders) only under stressful or unfamiliar conditions, but no more than 10% of the time. 4 = Minimal Prompting. The patient recognizes and remembers 75 to 90% of the time. 3 = Moderate Prompting. The patient recognizes and remembers 50 to 74% of the time. 2 = Maximal Prompting. The patient recognizes and remembers 25 to 49% of the time, and needs prompting more than half the time. 1 = Total Assistance. The patient recognizes and remembers less than 25% of the time, or does not effectively recognize and remember. Done