Spinal Cord Independence Measure (SCIM) Documentation

Clinical form to document SCIM scores for spinal cord injury patients across self-care, respiration/sphincter management, and mobility, and to track functional change over rehabilitation.

Assessment Context

• Assessment date
• Assessment type
• Patient identifier
  Use the facility's internal identifier or medical record number. Do not enter a full SSN.
• Clinician name
• Care setting

SCIM Scoring Summary

• SCIM version used
• Total SCIM score
  Enter the summed SCIM score from the item-level assessment.
• Change from last SCIM score
  Enter the difference from the previous documented SCIM score, if available.
• Overall interpretation
  Briefly summarize the patient's functional independence level and notable changes since the prior assessment.

Self-Care

• Feeding score
• Grooming score
• Bathing score
• Upper body dressing score
• Lower body dressing score

Respiration and Sphincter Management

• Respiration score
• Bladder management score
• Bowel management score
• Sphincter management aids or assistance used

Mobility

• Bed mobility score
• Transfer score
• Indoor wheelchair mobility score
• Outdoor mobility score
  Complete if applicable to the patient's mobility status.
• Stairs score
  Complete if the patient is expected to negotiate stairs.

Clinical Notes and Follow-Up

• Functional change summary
  Summarize meaningful changes in self-care, respiration, or mobility since the last assessment.
• Barriers to independence
• Follow-up plan
• Consent for clinical documentation and trend tracking
  By submitting, you confirm this information is being recorded for treatment, care coordination, and outcome tracking in accordance with applicable privacy rules.