Check for highest consecutive level of disability:
- No difficulty either subjectively or objectively.
- Complains of forgetting of location of objects. Subjective work difficulties.
- Decreased job functioning evident to co-workers. Difficulty in travelling to new locations. Decreased organizational capacity.*
- Decreased ability to perform complex tasks, (e.g. planning for dinner for guests, handling personal finances, such as, forgetting to pay bills) difficulty marketing, etc.*
- Requires assistance in choosing proper clothing to wear for the day, season, or occasion (e.g. Patient may wear the same clothing repeatedly unless supervised).
- Improperly putting on clothes without assistance or cueing (e.g. may put street clothes over night clothes, put shoes on the wrong feet, or have difficulty buttoning clothing) occasionally or more frequently over the past weeks.*
- Unable to bathe properly (e.g. difficulty adjusting the bath water temperature) occasionally or more frequently over the past weeks.*
- Inability to handle mechanisms of toileting (e.g. forgets to flush the toilet, does not wipe properly, or properly dispose of toilet tissue) occasionally or more frequently over the past weeks.*
- Urinary incontinence (occasionally or more frequently over the past weeks).*
- Fecal incontinence (occasionally or more frequently over the past weeks).*
- Advanced Decline
- Ability to speak limited to approximately half a dozen intelligible different words or fewer, in the course of an average day or in the course of an extensive interview.
- Speech ability is limited to the use of a single intelligible word in an average day or in the course of an extensive interview (the person may repeat the word over and over).
- Ambulatory ability is lost (cannot walk without personal assistance).
- Cannot sit up without assistance (e.g. the individual will fall over if there are not lateral rests [arms] on the chair).
- Loss of the ability to smile.
- Loss of the ability to hold head up independently.
*Scored primarily on the basis of information obtained from a knowledgeable informant and/or caregiver. Reisberg, B. Functional Assessment Staging (FAST). Psychopharmacology Bulletin. 1988:24: 653-659
ALS (Amyotrophic Lateral Sclerosis)
MS (Multiple Sclerosis)
Renal Failure, Chronic or Acute
Frequent Co-Morbidity documentation requirements
Cachexia or Protein Calorie Malnutrition