Scribd
Upload
1K views2 pages

Weefim Score Sheet: Burns: Area Score Age Norm Is Score Due To The Burns? Explain Reasons For Giving This Score

Uploaded by

Alvaro Bejarano Martin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
1K views2 pages

Weefim Score Sheet: Burns: Area Score Age Norm Is Score Due To The Burns? Explain Reasons For Giving This Score

Uploaded by

Alvaro Bejarano Martin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

WeeFIM® score sheet: Burns

Name: Date of birth: / / Age: months


Date of assessment: *Use norms overleaf for children 3 to 8 yrs.
Hospital/unit:
Date of motor accident:
Method of administration: Direct observation Interview with:

Area Score Age Is score Explain reasons for giving this score
norm due to
the
burns?
SELF CARE

1.Eating Yes
No

2.Grooming Yes
No

3.Bathing Yes
No

4.Dressing– Upper Yes


Body No

5.Dressing– Lower Yes


Body No

SPHINCTER CONTROL

6.Toileting Yes
No

7.Bladder Yes
management No

8.Bowel management Yes


No

Self care subtotal


TRANSFERS

9.Transfers: Yes Mode: W– Walk C- Wheelchair B- Both


Chair/Wheelchair No

10.Transfers: Yes
Toilet No

11.Transfers: Yes
Tub/Shower No

LOCOMOTION

12. Locomotion: Yes Mode: W – Walk C- Wheelchair


Walk/ No L- Crawl B- Both
Wheelchair/Crawl
13.Locomotion: Stairs Yes
No

Mobility subtotal

LTCS WeeFIM score sheet – Burns– JULY 2011


WeeFIM® score sheet: Burns

Area Score Age Is score Explain reasons for giving this score
norm due to
the
burns?
COMMUNICATION

14.Comprehension Yes Mode: A – Auditory V - Visual C - Both


No

15.Expression Yes Mode: V – Vocal N - Non-vocal B - Both


No

SOCIAL COGNITION

16.Social interaction Yes


No

17.Problem solving Yes


No

18.Memory Yes
No
Cognition subtotal
WeeFIM® TOTAL

Administered by: WeeFIM® credentialed: Yes No


Signature: Date of assessment:

WeeFIM® LEVELS

NO HELPER
7 Complete Independence (Timely, Safely)
6 Modified Independence (Device)

HELPER – Modified Dependence


5 Supervision
4 Minimal assistance (subject = 75% or more)
3 Moderate assistance (subject = 50% or more)

Helper – Complete Dependence


2 Maximal assistance (subject = 25% - 49%)
1 Total assistance (subject = 0% - 24%)

Contact details for queries about eligibility to the Lifetime Care and Support Scheme:
Lifetime Care and Support Authority: http://www.lifetimecare.nsw.gov.au
Phone: 1300 738 586
Fax: 1300 738 583 Email: [email protected]

LTCS WeeFIM score sheet – Burns– JULY 2011

You might also like