Form Coding Instructions

Instructions: Based on your assessment, please answer the following questions about the individual's spoken language comprehension skills in low and high demand situations. For all questions, consider chronological age expectations when rating the individual. • Low demand situations are defined as verbal interactive situations where communication demands are reduced (e.g., familiar setting, familiar conversation partner, known context). For children this may include language content and forms acquired at a younger age than the child's current age. • High demand situations are defined as verbal interactive situations that provide minimal support and have inherently more communication demands or rules to follow (e.g., unfamiliar conversational partner or setting, unknown contexts, group conversation). For children this may include language content and forms representing more recently acquired or expected structures for the child's current chronological age

Source: American Speech-Language-Hearing Association

99837-7 How often does the individual understand simple messages/conversations related to routine daily activities in LOW demand situations?

Observation ID in Form

1

Form Context

(e.g., following simple directions)

Source: American Speech-Language-Hearing Association

Fully-Specified Name

Component
Frequency of understanding simple messages in routine low demand situations
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Frequency of understanding simple messages in routine low demand situations

Basic Attributes

Class
SURVEY.SLP
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL6183-9

AnswerCodeScoreAnswer ID
0-25% of the time (rarely)LA33175-3
26-49% of the time (sometimes)LA33176-1
50-75% of the time (often)LA33177-9
76-90% of the time (most of the time)LA33178-7
91-100% of the time (always)LA33179-5

Member of these Panels

LOINCLong Common Name
99836-9Functional Communication Measure - Spoken Language Comprehension ages 6 or older panel [ASHA NOMS]

99838-5 How often does the individual understand complex messages, as expected for chronological age, in LOW demand situations?

Observation ID in Form

2

Form Context

(e.g., story/lecture, sequencing of events, drawing appropriate conclusions, inferences, humor, subtle references)

Source: American Speech-Language-Hearing Association

Fully-Specified Name

Component
Frequency of understanding complex messages in low demand situations
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Frequency of understanding complex messages in low demand situations

Basic Attributes

Class
SURVEY.SLP
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL6183-9

AnswerCodeScoreAnswer ID
0-25% of the time (rarely)LA33175-3
26-49% of the time (sometimes)LA33176-1
50-75% of the time (often)LA33177-9
76-90% of the time (most of the time)LA33178-7
91-100% of the time (always)LA33179-5

Member of these Panels

LOINCLong Common Name
99836-9Functional Communication Measure - Spoken Language Comprehension ages 6 or older panel [ASHA NOMS]

99839-3 How often does the individual understand simple messages/conversations related to routine daily activities in HIGH demand situations?

Observation ID in Form

3

Form Context

(e.g., following simple directions)

Source: American Speech-Language-Hearing Association

Fully-Specified Name

Component
Frequency of understanding simple messages in routine high demand situations
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Frequency of understanding simple messages in routine high demand situations

Basic Attributes

Class
SURVEY.SLP
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL6183-9

AnswerCodeScoreAnswer ID
0-25% of the time (rarely)LA33175-3
26-49% of the time (sometimes)LA33176-1
50-75% of the time (often)LA33177-9
76-90% of the time (most of the time)LA33178-7
91-100% of the time (always)LA33179-5

Member of these Panels

LOINCLong Common Name
99836-9Functional Communication Measure - Spoken Language Comprehension ages 6 or older panel [ASHA NOMS]

99840-1 How often does the individual understand complex messages, as expected for chronological age, in HIGH demand situations?

Observation ID in Form

4

Form Context

(e.g., story/lecture, sequencing of events, drawing appropriate conclusions, inferences, humor, subtle references)

Source: American Speech-Language-Hearing Association

Fully-Specified Name

Component
Frequency of understanding complex messages in high demand situations
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Frequency of understanding complex messages in high demand situations

Basic Attributes

Class
SURVEY.SLP
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL6183-9

AnswerCodeScoreAnswer ID
0-25% of the time (rarely)LA33175-3
26-49% of the time (sometimes)LA33176-1
50-75% of the time (often)LA33177-9
76-90% of the time (most of the time)LA33178-7
91-100% of the time (always)LA33179-5

Member of these Panels

LOINCLong Common Name
99836-9Functional Communication Measure - Spoken Language Comprehension ages 6 or older panel [ASHA NOMS]

99841-9 How often does the individual function safely WITHOUT additional supervision/assistance (in excess of chronological age expectations) due to comprehension deficits?

Observation ID in Form

5

Fully-Specified Name

Component
Frequency of functioning without assistance due to comprehension deficit
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Frequency of functioning without assistance due to comprehension deficit

Basic Attributes

Class
SURVEY.SLP
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL6183-9

AnswerCodeScoreAnswer ID
0-25% of the time (rarely)LA33175-3
26-49% of the time (sometimes)LA33176-1
50-75% of the time (often)LA33177-9
76-90% of the time (most of the time)LA33178-7
91-100% of the time (always)LA33179-5

Member of these Panels

LOINCLong Common Name
99836-9Functional Communication Measure - Spoken Language Comprehension ages 6 or older panel [ASHA NOMS]

99842-7 How often does the individual participate in communication exchanges WITHOUT additional assistance from communication partner?

Observation ID in Form

6

Form Context

(no more than would be expected for chronological age)

Source: American Speech-Language-Hearing Association

Fully-Specified Name

Component
Frequency of participating in spoken language comprehension communication without assistance
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Frequency of participating in spoken language comprehension communication without assistance

Basic Attributes

Class
SURVEY.SLP
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.73 (NAM)
Change Reason
Release 2.73: COMPONENT: ASHA's request aligned with submission 6383;
Order vs. Observation
Observation

Normative Answer List LL6183-9

AnswerCodeScoreAnswer ID
0-25% of the time (rarely)LA33175-3
26-49% of the time (sometimes)LA33176-1
50-75% of the time (often)LA33177-9
76-90% of the time (most of the time)LA33178-7
91-100% of the time (always)LA33179-5

Member of these Panels

LOINCLong Common Name
99836-9Functional Communication Measure - Spoken Language Comprehension ages 6 or older panel [ASHA NOMS]

99843-5 Functional Communication Measure - Spoken Language Comprehension ages 6 or older score [ASHA NOMS]

Fully-Specified Name

Component
Functional Communication Measure - Spoken Language Comprehension ages 6 or older score
Property
Score
Time
-
System
^Patient
Scale
Qn
Method
ASHA NOMS

Basic Attributes

Class
SURVEY.SLP
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
99836-9Functional Communication Measure - Spoken Language Comprehension ages 6 or older panel [ASHA NOMS]

Example Units

UnitSource
{score}Example UCUM Units