105175-4
Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
Active
Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
| LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
|---|---|---|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] | |||
| Indent95032-9 | Functional Abilities and Goals | |||
| Indent Indent95020-4 | Self-Care | |||
| Indent Indent Indent94849-7 | Self-Care.Usual | |||
| Indent Indent Indent Indent95019-6 | Eating | |||
| Indent Indent Indent Indent95018-8 | Oral hygiene | |||
| Indent Indent Indent Indent95017-0 | Toileting hygiene | |||
| Indent Indent Indent Indent95016-2 | Wash upper body | |||
| Indent Indent Indent Indent95015-4 | Shower/bathe self | |||
| Indent Indent Indent Indent95014-7 | Upper body dressing | |||
| Indent Indent Indent Indent95013-9 | Lower body dressing | |||
| Indent Indent Indent Indent95012-1 | Putting on/taking off footwear | |||
| Indent Indent Indent94850-5 | Self-Care.Most Dependent | |||
| Indent Indent Indent Indent94933-9 | Eating | |||
| Indent Indent Indent Indent94934-7 | Oral hygiene | |||
| Indent Indent Indent Indent95043-6 | Toileting hygiene | |||
| Indent Indent Indent Indent94935-4 | Wash upper body | |||
| Indent Indent Indent Indent94936-2 | Shower/bathe self | |||
| Indent Indent Indent Indent94937-0 | Upper body dressing | |||
| Indent Indent Indent Indent94938-8 | Lower body dressing | |||
| Indent Indent Indent Indent94939-6 | Putting on/taking off footwear | |||
| Indent Indent Indent94876-0 | Self-Care Priorities | |||
| Indent Indent95023-8 | Mobility | |||
| Indent Indent Indent94851-3 | Mobility.Usual | |||
| Indent Indent Indent Indent95011-3 | Roll left and right | |||
| Indent Indent Indent Indent95010-5 | Sit to lying | |||
| Indent Indent Indent Indent95009-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent95008-9 | Sit to stand | |||
| Indent Indent Indent Indent95007-1 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent95006-3 | Toilet transfer | |||
| Indent Indent Indent Indent95005-5 | Car transfer | |||
| Indent Indent Indent Indent94932-1 | Does the patient walk? | |||
| Indent Indent Indent Indent95004-8 | Walks 10 feet | |||
| Indent Indent Indent Indent95003-0 | Walks 50 feet with two turns | |||
| Indent Indent Indent Indent95002-2 | Walks 150 feet | |||
| Indent Indent Indent Indent95001-4 | Walks 10 feet on uneven surfaces | |||
| Indent Indent Indent Indent95000-6 | 1 step (curb) | |||
| Indent Indent Indent Indent94999-0 | 4 steps | |||
| Indent Indent Indent Indent94998-2 | 12 steps | |||
| Indent Indent Indent Indent94997-4 | Picking up object | |||
| Indent Indent Indent Indent94996-6 | Walk indoors | |||
| Indent Indent Indent Indent94995-8 | Carries something in both hands | |||
| Indent Indent Indent Indent94994-1 | Walks for 15 minutes | |||
| Indent Indent Indent Indent94993-3 | Walks across a street | |||
| Indent Indent Indent94852-1 | Mobility.Most Dependent | |||
| Indent Indent Indent Indent94940-4 | Roll left and right | |||
| Indent Indent Indent Indent94941-2 | Sit to lying | |||
| Indent Indent Indent Indent94942-0 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent94943-8 | Sit to stand | |||
| Indent Indent Indent Indent94944-6 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent94945-3 | Toilet transfer | |||
| Indent Indent Indent Indent94946-1 | Car transfer | |||
| Indent Indent Indent Indent94947-9 | Walks 10 feet | |||
| Indent Indent Indent Indent94948-7 | Walks 50 feet with two turns | |||
| Indent Indent Indent Indent94949-5 | Walks 150 feet | |||
| Indent Indent Indent Indent94950-3 | Walks 10 feet on uneven surfaces | |||
| Indent Indent Indent Indent94951-1 | 1 step (curb) | |||
| Indent Indent Indent Indent94952-9 | 4 steps | |||
| Indent Indent Indent Indent94953-7 | 12 steps | |||
| Indent Indent Indent Indent94954-5 | Picking up object | |||
| Indent Indent Indent Indent94955-2 | Walks indoors | |||
| Indent Indent Indent Indent94956-0 | Carries something in both hands | |||
| Indent Indent Indent Indent94957-8 | Walks for 15 minutes | |||
| Indent Indent Indent Indent94958-6 | Walks across a street | |||
| Indent Indent95131-9 | Mobility (Wheelchair) | |||
| Indent Indent Indent95021-2 | Does the person use a manual wheelchair? | |||
| Indent Indent Indent95024-6 | Manual Wheelchair.Usual | |||
| Indent Indent Indent Indent94992-5 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent94991-7 | Wheels 150 feet | |||
| Indent Indent Indent Indent94990-9 | Wheels for 15 minutes | |||
| Indent Indent Indent Indent94989-1 | Wheels across a street | |||
| Indent Indent Indent95025-3 | Manual Wheelchair.Most Dependent | |||
| Indent Indent Indent Indent94959-4 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent94960-2 | Wheels 150 feet | |||
| Indent Indent Indent Indent94961-0 | Wheels for 15M | |||
| Indent Indent Indent Indent94962-8 | Wheels across a street | |||
| Indent Indent Indent95022-0 | Does the person use a motorized wheelchair and/or scooter? | |||
| Indent Indent Indent95027-9 | Motorized Wheelchair/Scooter.Usual | |||
| Indent Indent Indent Indent94992-5 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent94991-7 | Wheels 150 feet | |||
| Indent Indent Indent Indent94990-9 | Wheels for 15 minutes | |||
| Indent Indent Indent Indent94989-1 | Wheels across a street | |||
| Indent Indent Indent95026-1 | Motorized Wheelchair/Scooter.Most Dependent | |||
| Indent Indent Indent Indent94959-4 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent94960-2 | Wheels 150 feet | |||
| Indent Indent Indent Indent94961-0 | Wheels for 15M | |||
| Indent Indent Indent Indent94962-8 | Wheels across a street | |||
| Indent Indent94877-8 | Mobility Priorities | |||
| Indent Indent95028-7 | Instrumental Activities of Daily Living (IADL) | |||
| Indent Indent Indent95029-5 | Instrumental Activities of Daily Living.Usual | |||
| Indent Indent Indent Indent94976-8 | Makes a light cold meal | |||
| Indent Indent Indent Indent94977-6 | Makes a light hot meal | |||
| Indent Indent Indent Indent94978-4 | Light daily housework | |||
| Indent Indent Indent Indent94979-2 | Heavier periodic housework | |||
| Indent Indent Indent Indent94980-0 | Light shopping | |||
| Indent Indent Indent Indent94981-8 | Telephone-answering call | |||
| Indent Indent Indent Indent94982-6 | Telephone-placing call | |||
| Indent Indent Indent Indent94983-4 | Medication management-oral medications | |||
| Indent Indent Indent Indent94984-2 | Medication management-inhalant/mist medications | |||
| Indent Indent Indent Indent94985-9 | Medication management-injectable medications | |||
| Indent Indent Indent Indent94986-7 | Simple financial management | |||
| Indent Indent Indent Indent94987-5 | Complex financial management | |||
| Indent Indent Indent95030-3 | Instrumental Activities of Daily Living.Most Dependent | |||
| Indent Indent Indent Indent94963-6 | Makes a light cold meal | |||
| Indent Indent Indent Indent94964-4 | Makes a light hot meal | |||
| Indent Indent Indent Indent94965-1 | Light daily housework | |||
| Indent Indent Indent Indent94966-9 | Heavier periodic housework | |||
| Indent Indent Indent Indent94967-7 | Light shopping | |||
| Indent Indent Indent Indent94968-5 | Telephone-answering call | |||
| Indent Indent Indent Indent94969-3 | Telephone-placing call | |||
| Indent Indent Indent Indent94970-1 | Medication management-oral medications | |||
| Indent Indent Indent Indent94971-9 | Medication management-inhalant/mist medications | |||
| Indent Indent Indent Indent94972-7 | Medication management-injectable medications | |||
| Indent Indent Indent Indent94973-5 | Simple financial management | |||
| Indent Indent Indent Indent94974-3 | Complex financial management | |||
| Indent Indent Indent94878-6 | IADL Priorities | |||
| Indent Indent95031-1 | Assistive Devices for Everyday Activities | |||
| Indent Indent Indent95042-8 | In the past month, has the person used, or expressed or demonstrated a need for an assistive device? | |||
| Indent Indent Indent94879-4 | Cane/crutch | |||
| Indent Indent Indent94880-2 | Walker | |||
| Indent Indent Indent94881-0 | Standard folding walker | |||
| Indent Indent Indent94882-8 | Walker with seat | |||
| Indent Indent Indent94883-6 | Walker with wheels | |||
| Indent Indent Indent94884-4 | Wheelchair | |||
| Indent Indent Indent94885-1 | Manual wheelchair | |||
| Indent Indent Indent94886-9 | Motorized wheelchair and/or scooter | |||
| Indent Indent Indent94887-7 | Limb prosthesis | |||
| Indent Indent Indent94888-5 | Specialized seating pad (e.g. air-filled, gel, shaped foam) | |||
| Indent Indent Indent94889-3 | Mechanical lift | |||
| Indent Indent Indent94890-1 | Reacher/Grabber | |||
| Indent Indent Indent94891-9 | Sock aid | |||
| Indent Indent Indent94892-7 | Orthotics/Brace | |||
| Indent Indent Indent94893-5 | Bed rail | |||
| Indent Indent Indent94894-3 | Electronic bed | |||
| Indent Indent Indent94895-0 | Grab bars | |||
| Indent Indent Indent94896-8 | Transfer board | |||
| Indent Indent Indent94897-6 | Shower/commode chair | |||
| Indent Indent Indent94898-4 | Walk/wheel-in shower | |||
| Indent Indent Indent94899-2 | Glasses or contact lenses | |||
| Indent Indent Indent94900-8 | Hearing aid | |||
| Indent Indent Indent94901-6 | Communication device | |||
| Indent Indent Indent94902-4 | Stair rails | |||
| Indent Indent Indent94903-2 | Lift chair | |||
| Indent Indent Indent94904-0 | Ramps | |||
| Indent Indent Indent94905-7 | Raised toilet seat | |||
| Indent Indent Indent94906-5 | Glucometer | |||
| Indent Indent Indent94907-3 | CPAP | |||
| Indent Indent Indent94908-1 | Oxygen concentrator | |||
| Indent Indent Indent94910-7 | Other (specify): | |||
| Indent95033-7 | Preferences for Customary Routine and Activities | |||
| Indent Indent94911-5 | Living Arrangement Priorities | |||
| Indent Indent Indent95034-5 | Availability of Assistance | |||
| Indent Indent Indent Indent94912-3 | Does the person have assistance in their home? | |||
| Indent Indent Indent Indent95414-9 | Code the level of assistance in the person's home (both Paid and Unpaid) during the past month. | |||
| Indent Indent Indent Indent Indent94913-1 | Code the level of assistance in the person's home during the past month - paid assistance | |||
| Indent Indent Indent Indent Indent94914-9 | Code the level of assistance in the person's home during the past month - unpaid assistance | |||
| Indent Indent Indent95035-2 | Availability of Paid and Unpaid Assistance | |||
| Indent Indent Indent Indent95036-0 | Availability of Paid Assistance | |||
| Indent Indent Indent Indent Indent94915-6 | Self-care assistance | |||
| Indent Indent Indent Indent Indent94917-2 | Mobility assistance | |||
| Indent Indent Indent Indent Indent94919-8 | IADL assistance | |||
| Indent Indent Indent Indent Indent94921-4 | Medication administration | |||
| Indent Indent Indent Indent Indent94923-0 | Medical procedures/treatments | |||
| Indent Indent Indent Indent Indent94925-5 | Management of equipment | |||
| Indent Indent Indent Indent Indent94927-1 | Supervision | |||
| Indent Indent Indent Indent Indent94929-7 | Advocacy or facilitation of person's participation in appropriate medical care | |||
| Indent Indent Indent Indent95037-8 | Availability of Unpaid Assistance | |||
| Indent Indent Indent Indent Indent94916-4 | Self-care assistance | |||
| Indent Indent Indent Indent Indent94918-0 | Mobility assistance | |||
| Indent Indent Indent Indent Indent94920-6 | IADL assistance | |||
| Indent Indent Indent Indent Indent94922-2 | Medication administration | |||
| Indent Indent Indent Indent Indent94924-8 | Medical procedures/treatments | |||
| Indent Indent Indent Indent Indent94926-3 | Management of equipment | |||
| Indent Indent Indent Indent Indent94928-9 | Supervision | |||
| Indent Indent Indent Indent Indent94930-5 | Advocacy or facilitation of person's participation in appropriate medical care | |||
| Indent Indent94931-3 | Caregiving Priorities |
Fully-Specified Name
- Component
- Functional assessment standardized items (FASI) - v1.1
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.78
- Last Updated
- Version 2.78 (ADD)
- Order vs. Observation
- Order
- Panel Type
- Panel
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