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| ADMISSION | DISCHARGE | FOLLW-UP |
| Self-Care |
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| A. Eating |
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| B. Grooming |
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| C. Bathing |
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| D. Dressing-Upper Body |
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| F. Toileting |
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| Sphincter Control |
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| G. Blandder Management |
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| H. Bwel Management |
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| Transfers |
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| I. Bed, Chair, Wheelchair |
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| J. Toilet |
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| K. Tub, Shower |
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| Locomotion |
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| L. Walk/wheelchair |
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| M. Stairs |
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| Motor Subtotal Score |
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| Communication |
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| N. Comprehension |
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| O. Expression |
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| Social Cognition |
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| P. Social Interaction |
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| Q. Problem Solving |
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| R. Memory |
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| Cognitive Subtotal Score |
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| TOTAL FIM Score |
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