Section C - BIMS Interview for MDS 3.0 Data Collection Tool - 100/pad

CP3001-C

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This form is being replaced for MDS V 1.18.11. Item # CP3001-C can only be used until September 30, 2023. On October 1, 2023, the form is replaced with item # CP301C-18. Click here to see the new form.

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Description

Use this stand-alone form to capture resident responses to the MDS 3.0 Section C BIMS (Brief Interview for Mental Status.) This stand-alone form gives the responsible discipline the ability to maintain their own interview documents and manage their work flow.

Features

Includes scoring to determine resident's PDPM Cognitive Level
Language and format coincide with the MDS 3.0 data set
Includes prompts to confirm items A1100 (Language) and B0700 (Makes Self Understood) essential in the interview process
RAI Version 3.0 Manual chapters pertinent to the interview topic are listed at the bottom of the page for quick reference
Conducting the Interview tips and suggested language provided
To aid in the transfer of collected data this form’s two color design includes purple to match corresponding sections on the MED-PASS MDS 3.0 Item Sets also printed in PURPLE

Specifications

Size	8 1/2 x 11
Unit	Pad of 100
Number of Pages	1
Other Info	Handwritten
Hole Punch	5 holes left, 5 holes top

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