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

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    Alvaro Bejarano Martin

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    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
    910 views2 pages

    Original Title

    WeeFim Score (1)

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    910 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
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 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: enquiries@lifetimecare.nsw.gov.au

    LTCS WeeFIM score sheet – Burns– JULY 2011

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