52731-7 Repetition of three words # [BIMS]

Observation ID in Form

B3a

Form Coding Instructions

After the patient's first attempt say: "I will repeat each of the three words with a cue and ask you about them later: sock, something to wear; blue, a color; bed, a piece of furniture." You may repeat the words up to two more times

Fully-Specified Name

Component

Repetition of three words

Property

Num

Time

Pt

System

^Patient

Scale

Ord

Method

BIMS

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.27

Last Updated

Version 2.63

Change Reason

Removed "Observed." from method to make consistent with other survey methods; Changed property to Num to match answer list

Order vs. Observation

Observation

Normative Answer List LL687-5

Member of these Panels

Related Names

• 3
• Brief Interview for Mental Status
• Cnt
• Count
• Number
• Ordinal
• Point in time
• QL
• Qual
• Qualitative
• Random
• Screen
• Survey

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52492-6 Year, Month, Day

Observation ID in Form

B3b

Fully-Specified Name

Component

Year, Month, Day

Property

-

Time

Pt

System

^Patient

Scale

-

Method

Basic Attributes

Class

PANEL.SURVEY.BIMS

Type

Surveys

First Released

Version 2.24

Last Updated

Version 2.64

Panel Type

Panel

Member of these Panels

Related Names

• Brief Interview for Mental Status (BIMS) Pnl
• Pan
• Panel
• Panl
• Pnl
• Point in time
• Random
• Survey

52732-5 Temporal orientation - current year [BIMS]

Observation ID in Form

B3b.1

Skip Logic

If answered 1. Missed by 2 to 5 years, or 0. Missed by more than 5 years or no answer, complete D. Confusion Assessment Method.

Fully-Specified Name

Component

Temporal orientation - current year

Property

Find

Time

Pt

System

^Patient

Scale

Ord

Method

BIMS

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.27

Last Updated

Version 2.63

Order vs. Observation

Observation

Normative Answer List LL643-8

Member of these Panels

Related Names

• Brief Interview for Mental Status
• Finding
• Findings
• Ordinal
• Point in time
• QL
• Qual
• Qualitative
• Random
• Screen
• Survey

52733-3 Temporal orientation - current month [BIMS]

Observation ID in Form

B3b.2

Skip Logic

If answered 1. Missed by 6 days to 1 month, or 0. Missed by more than 1 month or no answer, complete D. Confusion Assessment Method.

Fully-Specified Name

Component

Temporal orientation - current month

Property

Find

Time

Pt

System

^Patient

Scale

Ord

Method

BIMS

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.27

Last Updated

Version 2.63

Change Reason

Removed "Observed." from method to follow convention of other survey terms

Order vs. Observation

Observation

Normative Answer List LL644-6

Member of these Panels

Related Names

• Brief Interview for Mental Status
• Finding
• Findings
• Ordinal
• Point in time
• QL
• Qual
• Qualitative
• Random
• Screen
• Survey

54609-3 Temporal orientation - current day of the week [BIMS]

Observation ID in Form

B3b.3

Skip Logic

If answered 1. Incorrect or no answer, complete D. Confusion Assessment Method.

Fully-Specified Name

Component

Temporal orientation - current day of the week

Property

Find

Time

Pt

System

^Patient

Scale

Ord

Method

BIMS

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.27

Last Updated

Version 2.63

Change Reason

Removed "Observed." and ".MDS" from method to follow convention of other survey terms and to include term across CMS assessments

Order vs. Observation

Observation

Normative Answer List LL645-3

Member of these Panels

Related Names

• Brief Interview for Mental Status
• Finding
• Findings
• Ordinal
• Point in time
• QL
• Qual
• Qualitative
• Random
• Screen
• Survey

52493-4 Recall [BIMS]

Observation ID in Form

B3c

Form Coding Instructions

Ask patient: "Let's go back to the first question. What were those three words that I asked you to repeat?" If unable to remember a word, give cue (i.e. something to wear; a color; a piece of furniture) for that word

Fully-Specified Name

Component

Recall

Property

-

Time

Pt

System

^Patient

Scale

-

Method

BIMS

Basic Attributes

Class

PANEL.SURVEY.BIMS

Type

Surveys

First Released

Version 2.24

Last Updated

Version 2.67

Change Reason

Added method of BIMS

Order vs. Observation

Subset

Panel Type

Organizer

Member of these Panels

Related Names

• Brief Interview for Mental Status
• Brief Interview for Mental Status (BIMS) Pnl
• Pan
• Panel
• Panl
• Pnl
• Point in time
• Random
• Survey

52735-8 Able to recall "sock"

Observation ID in Form

B3c.1

Fully-Specified Name

Component

Recall - sock

Property

Find

Time

Pt

System

^Patient

Scale

Ord

Method

BIMS

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.27

Last Updated

Version 2.63

Change Reason

Removed "Observed." from method to follow survey convention

Order vs. Observation

Observation

Normative Answer List LL646-1

Member of these Panels

Related Names

• Brief Interview for Mental Status
• Finding
• Findings
• Ordinal
• Point in time
• QL
• Qual
• Qualitative
• Random
• Screen
• Survey

52736-6 Able to recall "blue"

Observation ID in Form

B3c.2

Fully-Specified Name

Component

Recall - blue

Property

Find

Time

Pt

System

^Patient

Scale

Ord

Method

BIMS

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.27

Last Updated

Version 2.63

Change Reason

Removed "Observed." from method to follow survey convention

Order vs. Observation

Observation

Normative Answer List LL647-9

Member of these Panels

Related Names

• Brief Interview for Mental Status
• Finding
• Findings
• Ordinal
• Point in time
• QL
• Qual
• Qualitative
• Random
• Screen
• Survey

52737-4 Able to recall "bed"

Observation ID in Form

B3c.3

Fully-Specified Name

Component

Recall - bed

Property

Find

Time

Pt

System

^Patient

Scale

Ord

Method

BIMS

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.27

Last Updated

Version 2.63

Change Reason

Removed "Observed." from method to follow survey convention

Order vs. Observation

Observation

Normative Answer List LL648-7

Member of these Panels

Related Names

• Brief Interview for Mental Status
• Finding
• Findings
• Ordinal
• Point in time
• QL
• Qual
• Qualitative
• Random
• Screen
• Survey