| Answer | Independent - Person completes the activity by themself with no assistance from a helper. | LA30909-8 |
| Answer | Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | LA30910-6 |
| Answer | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | LA30911-4 |
| Answer | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | LA10055-4 |
| Answer | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | LA11759-0 |
| Answer | Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | LA30914-8 |
| Answer | Person refused. | LA30915-5 |
| Answer | Not applicable - Person does not usually do this activity. | LA30916-3 |
| Answer | Not attempted due to short-term medical condition or safety concerns. | LA30917-1 |
| answers-for | Eating - most dependent performance during the past month [CMS Assessment] | 94933-9 |
| answers-for | Oral hygiene - most dependent performance during the past month [CMS Assessment] | 94934-7 |
| answers-for | Wash upper body - most dependent performance during the past month [CMS Assessment] | 94935-4 |
| answers-for | Shower/bathe self - most dependent performance during the past month [CMS Assessment] | 94936-2 |
| answers-for | Upper body dressing - most dependent performance during the past month [CMS Assessment] | 94937-0 |
| answers-for | Lower body dressing - most dependent performance during the past month [CMS Assessment] | 94938-8 |
| answers-for | Putting on and taking off footwear - most dependent performance during the past month [CMS Assessment] | 94939-6 |
| answers-for | Roll left and right - most dependent performance during the past month [CMS Assessment] | 94940-4 |
| answers-for | Sit to lying - most dependent performance during the past month [CMS Assessment] | 94941-2 |
| answers-for | Lying to sitting on side of bed - most dependent performance during the past month [CMS Assessment] | 94942-0 |
| answers-for | Sit to stand - most dependent performance during the past month [CMS Assessment] | 94943-8 |
| answers-for | Chair/bed-to-chair transfer - most dependent performance during the past month [CMS Assessment] | 94944-6 |
| answers-for | Toilet transfer - most dependent performance during the past month [CMS Assessment] | 94945-3 |
| answers-for | Car transfer - most dependent performance during the past month [CMS Assessment] | 94946-1 |
| answers-for | Walk 10 feet - most dependent performance during the past month [CMS Assessment] | 94947-9 |
| answers-for | Walk 50 feet with two turns - most dependent performance during the past month [CMS Assessment] | 94948-7 |
| answers-for | Walk 150 feet - most dependent performance during the past month [CMS Assessment] | 94949-5 |
| answers-for | Walking 10 feet on uneven surfaces - most dependent performance during the past month [CMS Assessment] | 94950-3 |
| answers-for | Go up and down a curb/step - most dependent performance during the past month [CMS Assessment] | 94951-1 |
| answers-for | Go up and down 4 steps - most dependent performance during the past month [CMS Assessment] | 94952-9 |
| answers-for | Go up and down 12 steps - most dependent performance during the past month [CMS Assessment] | 94953-7 |
| answers-for | Picking up object - most dependent performance during the past month [CMS Assessment] | 94954-5 |
| answers-for | Walks indoors - most dependent performance during the past month [CMS Assessment] | 94955-2 |
| answers-for | Carries something in both hands - most dependent performance during the past month [CMS Assessment] | 94956-0 |
| answers-for | Walks for 15 minutes - most dependent performance during the past month [CMS Assessment] | 94957-8 |
| answers-for | Walks across a street - most dependent performance during the past month [CMS Assessment] | 94958-6 |
| answers-for | Wheel 50 feet with two turns - most dependent performance during the past month [CMS Assessment] | 94959-4 |
| answers-for | Wheel 150 feet - most dependent performance during the past month [CMS Assessment] | 94960-2 |
| answers-for | Wheels for 15 minutes - most dependent performance during the past month [CMS Assessment] | 94961-0 |
| answers-for | Wheels across a street - most dependent performance during the past month [CMS Assessment] | 94962-8 |
| answers-for | Makes a light cold meal - most dependent performance during the past month [CMS Assessment] | 94963-6 |
| answers-for | Makes a light hot meal - most dependent performance during the past month [CMS Assessment] | 94964-4 |
| answers-for | Light daily housework - most dependent performance during the past month [CMS Assessment] | 94965-1 |
| answers-for | Heavier periodic housework - most dependent performance during the past month [CMS Assessment] | 94966-9 |
| answers-for | Light shopping- most dependent performance during the past month [CMS Assessment] | 94967-7 |
| answers-for | Answering telephone call - most dependent performance during the past month [CMS Assessment] | 94968-5 |
| answers-for | Placing telephone call - most dependent performance during the past month [CMS Assessment] | 94969-3 |
| answers-for | Medication management.oral medications - most dependent performance during the past month [CMS Assessment] | 94970-1 |
| answers-for | Medication management.inhalant/mist medications - most dependent performance during the past month [CMS Assessment] | 94971-9 |
| answers-for | Medication management.injectable medications - most dependent performance during the past month [CMS Assessment] | 94972-7 |
| answers-for | Simple financial management - most dependent performance during the past month [CMS Assessment] | 94973-5 |
| answers-for | Complex financial management - most dependent performance during the past month [CMS Assessment] | 94974-3 |
| answers-for | Makes a light cold meal - usual functional ability during assessment period [CMS Assessment] | 94976-8 |
| answers-for | Makes a light hot meal - usual functional ability during assessment period [CMS Assessment] | 94977-6 |
| answers-for | Light daily housework - usual functional ability during assessment period [CMS Assessment] | 94978-4 |
| answers-for | Heavier periodic housework - usual functional ability during assessment period [CMS Assessment] | 94979-2 |
| answers-for | Light shopping - usual functional ability during assessment period [CMS Assessment] | 94980-0 |
| answers-for | Answering telephone call - usual functional ability during assessment period [CMS Assessment] | 94981-8 |
| answers-for | Placing telephone call - usual functional ability during assessment period [CMS Assessment] | 94982-6 |
| answers-for | Medication management.oral medications - usual functional ability during assessment period [CMS Assessment] | 94983-4 |
| answers-for | Medication management.inhalant/mist medications - usual functional ability during assessment period [CMS Assessment] | 94984-2 |
| answers-for | Medication management.injectable medications - usual functional ability during assessment period [CMS Assessment] | 94985-9 |
| answers-for | Simple financial management - usual functional ability during assessment period [CMS Assessment] | 94986-7 |
| answers-for | Complex financial management - usual functional ability during assessment period [CMS Assessment] | 94987-5 |
| answers-for | Wheels across a street - usual functional ability during assessment period [CMS Assessment] | 94989-1 |
| answers-for | Wheels for 15 minutes - usual functional ability during assessment period [CMS Assessment] | 94990-9 |
| answers-for | Wheel 150 feet - usual functional ability during assessment period [CMS Assessment] | 94991-7 |
| answers-for | Wheel 50 feet with two turns - usual functional ability during assessment period [CMS Assessment] | 94992-5 |
| answers-for | Walks across a street - usual functional ability during assessment period [CMS Assessment] | 94993-3 |
| answers-for | Walks for 15 minutes - usual functional ability during assessment period [CMS Assessment] | 94994-1 |
| answers-for | Carries something in both hands - usual functional ability during assessment period [CMS Assessment] | 94995-8 |
| answers-for | Walks indoors - usual functional ability during assessment period [CMS Assessment] | 94996-6 |
| answers-for | Picking up object - usual functional ability during assessment period [CMS Assessment] | 94997-4 |
| answers-for | Go up and down 12 steps - usual functional ability during assessment period [CMS Assessment] | 94998-2 |
| answers-for | Go up and down 4 steps - usual functional ability during assessment period [CMS Assessment] | 94999-0 |
| answers-for | Go up and down a curb/step - usual functional ability during assessment period [CMS Assessment] | 95000-6 |
| answers-for | Walking 10 feet on uneven surfaces - usual functional ability during assessment period [CMS Assessment] | 95001-4 |
| answers-for | Walk 150 feet - usual functional ability during assessment period [CMS Assessment] | 95002-2 |
| answers-for | Walk 50 feet with two turns - usual functional ability during assessment period [CMS Assessment] | 95003-0 |
| answers-for | Walk 10 feet - usual functional ability during assessment period [CMS Assessment] | 95004-8 |
| answers-for | Car transfer - usual functional ability during assessment period [CMS Assessment] | 95005-5 |
| answers-for | Toilet transfer - usual functional ability during assessment period [CMS Assessment] | 95006-3 |
| answers-for | Chair/bed-to-chair transfer - usual functional ability during assessment period [CMS Assessment] | 95007-1 |
| answers-for | Sit to stand - usual functional ability during assessment period [CMS Assessment] | 95008-9 |
| answers-for | Lying to sitting on side of bed - usual functional ability during assessment period [CMS Assessment] | 95009-7 |
| answers-for | Sit to lying - usual functional ability during assessment period [CMS Assessment] | 95010-5 |
| answers-for | Roll left and right - usual functional ability during assessment period [CMS Assessment] | 95011-3 |
| answers-for | Putting on/taking off footwear - usual functional ability during assessment period [CMS Assessment] | 95012-1 |
| answers-for | Lower body dressing - usual functional ability during assessment period [CMS Assessment] | 95013-9 |
| answers-for | Upper body dressing - usual functional ability during assessment period [CMS Assessment] | 95014-7 |
| answers-for | Shower/bathe self - usual functional ability during assessment period [CMS Assessment] | 95015-4 |
| answers-for | Wash upper body - usual functional ability during assessment period [CMS Assessment] | 95016-2 |
| answers-for | Toileting hygiene - usual functional ability during assessment period [CMS Assessment] | 95017-0 |
| answers-for | Oral hygiene - usual functional ability during assessment period [CMS Assessment] | 95018-8 |
| answers-for | Eating - usual functional ability during assessment period [CMS Assessment] | 95019-6 |
| answers-for | Toileting hygiene - most dependent performance during the past month [CMS Assessment] | 95043-6 |
| LONG_COMMON_NAME | en-US | CMS FASI Self-care and Mobility |
LOINC Version: 2.77
FHIR