| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | patient(+) | 0;1 | POINTER | 2 | B | The patient associated with this Outcomes record. |
| .02 | record type(+) | 0;2 | SET OF CODES | 1:Self Report of Function 2:FIM 3:ASIA 4:CHART 5:FAM 6:DIENER 7:DUSOI 8:Multiple Sclerosis | This field describes the record type: Self Report of Function, FIM, ASIA, CHART, FAM, DIENER, DUSOI, or Multiple Sclerosis. The user will not see Multiple Sclerosis listed as a possible Record Type unless the patient has an Etiology of Multiple Sclerosis. This field is used internally, the user is not allowed to edit it. | |
| .021 | score type | 2;17 | POINTER | 154.3 | Score Type is used to document the phase of rehabilitation at the time the Outcome measure is recorded. Score Types are applicable to either INPATIENT, OUTPATIENT, or CONTINUUM OF CARE care types. Important: a Score Type containing the phrase "FOLLOW-UP (END)" indicates the close, or end, of the episode of care, and will prompt the user to enter a Care End Date. | |
| .022 | associated admission date | 2;18 | DATE-TIME | |||
| .023 | division | 0;23 | FREE TEXT | |||
| .024 | disposition | 0;24 | FREE TEXT | |||
| .03 | respondent type | 0;3 | SET OF CODES | 1:PATIENT 2:CLINICIAN 3:PROXY | The respondent type field indicates the source of the data for this Outcomes record. | |
| .04 | date recorded(+) | 0;4 | DATE-TIME | C | This field is the date the Functional Status data was obtained from the patient. It may not be a future date. | |
| .05 | eating | 0;5 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .06 | grooming | 0;6 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .07 | bathing | 0;7 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .08 | dressing upper body | 0;8 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .09 | dressing lower body | 0;9 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .1 | toileting | 0;10 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .11 | bladder management | 0;11 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .12 | bowel management | 0;12 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .13 | xfer to bed/chair/wheelchair | 0;13 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .14 | xfer to toilet | 0;14 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .15 | xfer to tub/shower | 0;15 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .16 | walk/wheelchair | 0;16 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .161 | method of walk/wheelchair | 2;15 | SET OF CODES | W:WALK C:WHEELCHAIR B:BOTH | ||
| .17 | stairs | 0;17 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .18 | comprehension | 0;18 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .181 | method of comprehension | 2;13 | SET OF CODES | A:AUDITORY V:VISUAL B:BOTH | This field contain the method of comprehension of a patient. | |
| .19 | expression | 0;19 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .191 | method of expression | 2;14 | SET OF CODES | V:VOCAL N:NONVOCAL B:BOTH | This field will contain the method of expression of the patient. | |
| .2 | social interaction | 0;20 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .21 | problem solving | 0;21 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| .22 | memory | 0;22 | POINTER | 154.11 | How much help does the patient need with his day to day activities? The answer should be based on an average day and the patient's usual way of doing the activity. | |
| 1.01 | clinician | 1;0 | MULTIPLE | 154.101 | This field contains the names of the clinicians who see the patient. | |
| 2.01 | get to places outside of home | 2;1 | SET OF CODES | 1:WITHOUT HELP 2:WITH HELP 3:UNABLE | This question asks if the patient needs help from someone else to perform this activity. | |
| 2.02 | shopping | 2;2 | SET OF CODES | 1:WITHOUT HELP 2:WITH HELP 3:UNABLE | This question asks if the patient needs help from someone else to perform this activity. | |
| 2.03 | planning and cooking own meals | 2;3 | SET OF CODES | 1:WITHOUT HELP 2:WITH HELP 3:UNABLE | This question asks if the patient needs help from someone else to perform this activity. | |
| 2.04 | doing housework | 2;4 | SET OF CODES | 1:WITHOUT HELP 2:WITH HELP 3:UNABLE | This question asks if the patient needs help from someone else to perform this activity. | |
| 2.05 | handling money | 2;5 | SET OF CODES | 1:WITHOUT HELP 2:WITH HELP 3:UNABLE | This question asks if the patient needs help from someone else to perform this activity. | |
| 2.06 | method ambulation (walking) | 2;6 | SET OF CODES | 1:WITHOUT HELP 2:WITH DEVICE 3:CANNOT WALK 4:BEDRIDDEN | Does the patient walk with or without a special aide or device? If the patient cannot walk choose 'Cannot Walk' or 'Bedridden' as appropriate. The selection 'With Device' refers to canes, walkers, etc.; it does not refer to wheelchairs. For wheelchairs see the 'Method of Ambulation (Wheelchair)' field. | |
| 2.07 | method ambulation (wheelchair) | 2;7 | SET OF CODES | 1:MANUAL 2:MOTORIZED 3:DOES NOT USE W/CHR 4:BEDRIDDEN | Does the patient use a manual or motorized wheelchair? If the patient does not use a wheelchair enter 'Does Not Use W/Chr' or 'Bedridden' as appropriate. | |
| 2.08 | help during last 2 weeks | 2;8 | BOOLEAN | 1:YES 0:NO | In the last two weeks did the patient need help from another person for everyday activities. | |
| 2.09 | number of hours of help | 2;9 | NUMERIC | If the patient required help within the last two weeks from another person for everyday activities enter the number of hours of help he required. | ||
| 2.13 | hours of help within last day | 2;16 | NUMERIC | |||
| 3.1 | pyramidal | MS;1 | POINTER | 154.2 | ||
| 3.2 | brainstem | MS;2 | POINTER | 154.2 | ||
| 3.3 | sensory | MS;3 | POINTER | 154.2 | ||
| 3.4 | cerebral | MS;4 | POINTER | 154.2 | ||
| 3.5 | cerebellar | MS;5 | POINTER | 154.2 | ||
| 3.6 | bowel & bladder function | MS;6 | POINTER | 154.2 | ||
| 3.7 | visual | MS;7 | POINTER | 154.2 | ||
| 3.8 | other | MS;8 | POINTER | 154.2 | ||
| 3.9 | edss | MS;9 | POINTER | 154.2 | ||
| 4.1 | physical independence | CHART;1 | NUMERIC | CHART PHYSICAL INDEPENDENCE SCORE The CHART Physical Independence Score should be computed according to the instructions in Appendix B of the CHART Manual. Although negative values can occur, particularly for individuals with high level cervical injuries, all scores should be in the 0 to 100 range. If negative values occur, they should be recorded as zero (0). In the Physical Independence dimension, a score of 100 indicates no handicap in an individual's ability to sustain a customarily effective independent existence. The need for regular or periodic assistance for activities which used to be performed independently is indicative of some degree of handicap. | ||
| 4.2 | mobility | CHART;2 | NUMERIC | CHART MOBILITY SCORE The CHART Mobility Score should be computed according to the instructions in Appendix B of the CHART Manual yielding a score between 0 through 100. If this computed sum is greater than 100, enter 100. In the Mobility dimension, a score of 100 indicates no handicap in an individual's ability to move about effectively in his/her surroundings. | ||
| 4.3 | occupation | CHART;3 | NUMERIC | CHART OCCUPATION SCORE The CHART Occupation Score should be entered as a 100, if the sum of elements referred to in Appendix B of the CHART Manual is 100 or greater. The range of scores on this scales is from 0 through 100. In the Occupation Dimension, a score of 100 indicates no handicap in an individual's ability to occupy time in the manner customary to that person's sex, age, and culture. | ||
| 4.4 | social interaction | CHART;4 | NUMERIC | CHART SOCIAL INTEGRATION SCORE In the CHART Social Integration Dimension, a score of 100 indicates no handicap in an individual's ability to participate in and maintain customary social relationships. The CHART Social Integration Score should be computed according to the instructions in Appendix B of the CHART Manual. If the added sum is greater than 100, enter 100, but all scores should fall in the range between 0 through 100. | ||
| 4.5 | economic self sufficiency | CHART;5 | NUMERIC | CHART ECONOMIC SELF-SUFFICIENCY SCORE The CHART Economic Self-Sufficiency Score should be computed according to the instructions in Appendix B of the CHART Manual. Since poverty levels change every year, be sure to update your poverty levels annually, by referring to "Statistical Abstracts of the U.S.," "Weighted Average Poverty Levels" table, or by calling your local Census Bureau. Make sure to make the necessary point conversions in Item # E after deriving the "D" sum. The CHART Economic Self-Sufficiency Score should be a value of either 0, 25, 50, 75, or 100. | ||
| 4.6 | cognitive independence | CHART;6 | NUMERIC | |||
| 5.01 | swallowing | FAM;1 | POINTER | 154.11 | FAM SWALLOWING (1 to 7) Swallowing includes the ability to safely eat a regular diet by mouth. At level 7, the participant is able to eat a regular diet of choice in a reasonable amount of time. Please rate on the scale noted on the FAM Module Screen from 1 to 7 | |
| 5.02 | car transfers | FAM;2 | POINTER | 154.11 | FAM CAR TRANSFERS (1 to 7) This activity includes approaching the car, managing the car door and lock, getting on or off the car seat, and managing the seat belt. If a wheelchair is used for mobility, the activity includes loading and unloading the wheelchair. At level 7, the participant should be able to complete a car transfer without aids or assistive devices, in a reasonable amount of time. Please rate on the scale noted on the FAM Module Screen from 1 to 7. | |
| 5.03 | community access | FAM;3 | POINTER | 154.11 | FAM COMMUNITY ACCESS (1 to 7) Community Access includes the ability to manage transportation, including planning a route, time management, paying fares and anticipating access barriers (excluding car transfers). At level 7, the participant is able to independently use public transportation (bus, van, or taxi) or is able to drive a car with no safety considerations. Please rate on the scale noted on the FAM Module Screen from 1 to 7. | |
| 5.04 | reading | FAM;4 | POINTER | 154.11 | FAM READING (1 to 7) Reading includes the ability to understand non-vocal written material. At level 7, the participant is able to read and completely understand and retain complex lengthy paragraphs (newspapers, books, etc.) in a reasonable amount of times. Please rate this item on the scale noted on the FAM Module Screen from 1 to 7. | |
| 5.05 | writing | FAM;5 | POINTER | 154.11 | FAM WRITING (1 to 7) Writing includes the spelling, grammar, and completeness of written communication. At level 7, the participant is able to write short paragraphs with "average" accuracy in spelling, grammar, and completeness in a reasonable amount of time. Please rate on the scale noted on the FAM Module Screen from 1 to 7. | |
| 5.06 | speech intelligibility | FAM;6 | POINTER | 154.11 | FAM SPEECH INTELLIGIBILITY (1 TO 7) Speech Intelligibility includes articulation, rate, volume, and quality of vocal communication. At level 7, the participant should be able to converse with a well modulated, well articulated voice. Please rate this item on the scale noted on the FAM Module Screen from 1 to 7. | |
| 5.07 | emotional status | FAM;7 | POINTER | 154.11 | FAM EMOTIONAL STATUS (1 to 7) Emotional Status includes the frequency and severity of depression, anxiety, frustration, unresponsiveness, agitation, interference with general life functioning, and ability to cope with and take responsibility for emotional behavior. At level 7, the participant rarely exhibits emotional problems, and is fully able to control and cope with these problems in a way in which they do not interfere with general life functioning. Please rate this item on the seven-point scale noted on the FAME Module Screen. | |
| 5.08 | adjustment to limitations | FAM;8 | POINTER | 154.11 | FAM ADJUSTMENT TO LIMITATIONS (1 to 7) Adjustment to Limitations includes denial/awareness, acceptance of limitations, willingness to learn new ways of functioning, compensating, taking appropriate safety precautions and realistic expectations of recovery. At level 7, the participant should demonstrate the ability to compensate for limitations, exercise safe judgment in Activities of Daily Living, and have realistic expectations for long-term recovery. Please rate on the scale noted on the FAM Module Screen from 1 to 7. | |
| 5.09 | employability | FAM;9 | POINTER | 154.11 | FAM EMPLOYABILITY (1 to 7) Employment includes involvement in one or more of the following categories: in the workforce, as a student, or as a homemaker. At level 7, a participant can compete in the open market for a wide range of jobs, plan, execute, and assume responsibility for homemaking, or understand and carry out school assignments and maintain a passing average. Please rate this item on the seven-point scale on the FAM Module Screen from 1 to 7. | |
| 5.1 | orientation | FAM;10 | POINTER | 154.11 | FAM ORIENTATION (1 to 7) This item includes consistent orientation to person, place, time, and situation. At level 7, a participant should be completely oriented to person, place, time, and situation without any cues. Please rate on the scale noted on the FAM Module Screen from 1 to 7. | |
| 5.11 | attention | FAM;11 | POINTER | 154.11 | FAM ATTENTION (1 to 7) Attention includes the length of time the participant is able to concentrate on tasks, taking into consideration distractibility, level of responsiveness, and the difficulty of the task. At level 7, a participant should be able to attend to a task for sixty minutes without assistance in maintaining the task, taking into consideration distractions and self-directed return to tasks. Please rate this seven- point scale on the FAM Module Screen from 1 to 7. | |
| 5.12 | safety judgement | FAM;12 | POINTER | 154.11 | FAM SAFETY JUDGEMENT (1 to 7) Safety Judgment includes orientation to situation, awareness of deficits and their implications, ability to plan ahead, ability to understand the nature of situations involving potential danger and to identify risks involved, freedom from impulsivity, ability to remember safety related information, and ability to respond appropriately if danger arises. At level 7, a participant should be able to pursue all activities independently using proper safety awareness skills. Please rate on the scale noted on the FAM Module Screen from 1 to 7. | |
| 6.01 | diener composite score | SCORE;1 | NUMERIC | |||
| 6.02 | dusoi composite score | SCORE;2 | NUMERIC | |||
| 7.01 | asia impairment scale(+) | ASIA;1 | SET OF CODES | A:A B:B C:C D:D E:E | A = COMPLETE: No motor or sensory function is preserved in the sacral segments S04-S05. B = INCOMPLETE: Sensory but not motor function is preserved below the neurological level and extends through the sacral segments S04-S05. C = INCOMPLETE: Motor function is preserved below the neurological level, and the majority of key muscles below the neurological level have a muscle grade less than 3. D = INCOMPLETE: Motor function is preserved below the neurological level, and the majority of key muscles below the neurological level have a muscle grade greater than or equal to 3. E = NORMAL: Motor and sensory function is normal. | |
| 7.02 | total motor score | ASIA;2 | NUMERIC | |||
| 7.03 | total pin prick score | ASIA;3 | NUMERIC | This field contains the ASIA total pin prick score. | ||
| 7.04 | total light touch score | ASIA;4 | NUMERIC | This field contains the ASIA total light touch score. | ||
| 7.05 | neurolevel-sensory right | ASIA;5 | POINTER | 154.01 | This field contains the patient's right sensory neurological level. | |
| 7.06 | neurolevel-sensory left | ASIA;6 | POINTER | 154.01 | This field contains the patient's left sensory neurological level. | |
| 7.07 | neurolevel-motor right | ASIA;7 | POINTER | 154.01 | This field contains the patient's right motor neurological level. | |
| 7.08 | neurolevel-motor left | ASIA;8 | POINTER | 154.01 | This field contains the patient's left motor neurological level. | |
| 7.09 | asia complete/incomplete | ASIA;9 | SET OF CODES | C:COMPLETE I:INCOMPLETE | C (complete) means that the neurological level of injury is complete. I (incomplete) means that the neurological level of injury is not complete. | |
| 7.1 | partial preservation-sensory r | ASIA;10 | POINTER | 154.01 | This field contains the patient's right sensory zone of partial preservation. | |
| 7.11 | partial preservation-sensory l | ASIA;11 | POINTER | 154.01 | This field contains the patient's left sensory zone of partial preservation. | |
| 7.12 | partial preservation-motor r | ASIA;12 | POINTER | 154.01 | This field contains the patient's right motor zone of partial preservation. | |
| 7.13 | partial preservation-motor l | ASIA;13 | POINTER | 154.01 | This field contains the patient's left motor zone of partial preservation. | |
| 7.14 | asia highest neuro level(+) | ASIA;14 | POINTER | 154.01 | ||
| 999.01 | ssn | COMPUTED | This is the patient's SSN from the Patient file (#2). | |||
| 999.02 | dob | COMPUTED | This is the patient's date of birth from the Patient file (#2). | |||
| 999.025 | age | COMPUTED | ||||
| 999.03 | motor score | COMPUTED | The Functional Status motor score is computed from the scores of the fields listed below. If one or more of the fields is blank, an averaging procedure is used to compute the score and the score will have a '*' appended to it. If all the fields are blank, this field returns the string 'ERROR'. EATING GROOMING BATHING DRESSING UPPER BODY DRESSING LOWER BODY FROM BATH TOILETING BLADDER MANAGEMENT BOWEL MANAGEMENT XFER TO BED/CHAIR/WHEELCHAIR XFER TO TOILET XFER TO TUB/SHOWER MOVE AROUND INSIDE YOUR HOUSE STAIRS | |||
| 999.04 | cognitive score | COMPUTED | The Functional Status cognitive score is computed from the scores of the fields listed below. The cognitive score is only returned for Clinician Reported FIMs, for Four Level Functional Measures this field returns the string 'N/A'. If one or more of the fields is blank, an averaging procedure is used to compute the score and the score will have a '*' appended to it. If all the fields are blank, this field returns the string 'ERROR'. COMPREHENSION EXPRESSION SOCIAL INTERACTION PROBLEM SOLVING MEMORY | |||
| 999.05 | total score | COMPUTED | The Functional Status total score is computed from the scores of the fields listed below. If one or more of the fields is blank, an averaging procedure is used to compute the score and the score will have a '*' appended to it. If all the fields are blank, this field returns the string 'ERROR'. Four Level Functional Measure Clinician Reported FIM ============================= ====================== EATING EATING GROOMING GROOMING BATHING BATHING DRESSING UPPER BODY DRESSING UPPER BODY DRESSING LOWER BODY FROM BATH DRESSING LOWER BODY FROM BATH TOILETING TOILETING BLADDER MANAGEMENT BLADDER MANAGEMENT BOWEL MANAGEMENT BOWEL MANAGEMENT XFER TO BED/CHAIR/WHEELCHAIR XFER TO BED/CHAIR/WHEELCHAIR XFER TO TOILET XFER TO TOILET XFER TO TUB/SHOWER XFER TO TUB/SHOWER MOVE AROUND INSIDE YOUR HOUSE MOVE AROUND INSIDE YOUR HOUSE STAIRS STAIRS COMPREHENSION EXPRESSION SOCIAL INTERACTION PROBLEM SOLVING MEMORY | |||
| 999.06 | chart total score | COMPUTED | CHART TOTAL SCORE The Total Score for the CHART should be the sum of the Physical Independence Score, Mobility Score, Occupation Score, Social Integration Score, and Economic Self-Sufficiency Score. The CHART TOTAL SCORE can range in values from 0 through 500 since it is the sum of the five previous scales that have been listed on CHART Module Screens. | |||
| 999.08 | length of rehab in days | COMPUTED | This computed field expresses the "net" number of days of inpatient rehabilitation, after subtracting the 3 longest interruptions in care. | |||
| 999.09 | date of death | COMPUTED | ||||
| 1000 | admission | 2;19 | POINTER | 154.991 | ||
| 1001 | care start date | 8;1 | DATE-TIME | |||
| 1002 | care end date | 8;2 | DATE-TIME | |||
| 1003 | care type | 8;3 | SET OF CODES | 1:INPATIENT 2:OUTPATIENT 3:ANNUAL EVALUATION 4:CONTINUUM OF CARE | ||
| 1004 | days of interrupted care | 8;4 | NUMERIC | This field stores the TOTAL (in days) of the three longest interruptions in care. "Care" refers to the period of inpatient rehabilitation from the Care Start Date to the INPT REHAB FINISH record date within a given episode of care. |