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


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Price: $16.90
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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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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.

  • 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
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