Qualifying Scores from Supports Intensity Scale (per WAC 388-828-4200 through 388-828-4320) | ||||
SIS Activity | If your type of support score is: | And your frequency of support score is: | And your daily support time score is: | Score if you meet or exceed criteria |
A2: Bathing and taking care of personal hygiene and grooming needs | 1 or more | 2 or more | 1 or more | |
A3: Using the toilet | 1 or more | 2 or more | 1 or more | |
A4: Dressing | 1 or more | 2 or more | 1 or more | |
A5: Preparing food | 1 or more | 2 or more | 1 or more | |
A6: Eating food | 1 or more | 2 or more | 1 or more | |
A8: Housekeeping and cleaning | 1 or more | 2 or more | 1 or more | |
A9: Using currently prescribed equipment and medications | 1 or more | 2 or more | 1 or more | |
B2: Participating in recreational/leisure activities in community settings | 1 or more | 2 or more | 1 or more | |
B7: Interacting with community members | 1 or more | 2 or more | 1 or more | |
E1: Taking medications | 1 or more | 2 or more | 1 or more | |
E2: Ambulating and moving about | 1 or more | 2 or more | 1 or more | |
E3: Avoiding health and safety hazards | 1 or more | 2 or more | 1 or more | |
G3: Protecting self from exploitation | 1 or more | 2 or more | 1 or more | |
Total of all questions where criteria is met or exceed = | Sum of scores entered |
Qualifying Scores from Supports Intensity Scale (per WAC 388-828-4200 through 388-828-4320) | |||||
SIS Activity | If your type of support score is: | And your frequency of support score is: | And your daily support time score is: | Your weekly critical support time is: | Enter one time for each qualifying SIS activity |
A7: Taking care of clothes, including laundering | 1 or more | 2 or more | 0 | 0 | |
1 | .25 | ||||
2 | 1 | ||||
3 | 3 | ||||
4 | 5 | ||||
B5: Using public services in the community | 1 or more | 2 or more | 0 | 0 | |
1 | .25 | ||||
2 | 1 | ||||
3 | 3 | ||||
4 | 5 | ||||
B6: Shopping and purchasing goods and services | 1 or more | 2 or more | 0 | 0 | |
1 | .25 | ||||
2 | 1 | ||||
3 | 3 | ||||
4 | 5 | ||||
F2: Participating in recreation/leisure activities with others | 1 or more | 2 or more | 0 | 0 | |
1 | .25 | ||||
2 | 1 | ||||
3 | 3 | ||||
4 | 5 | ||||
F8: Engaging in volunteer work | 1 or more | 2 or more | 0 | 0 | |
1 | .25 | ||||
2 | 1 | ||||
3 | 3 | ||||
4 | 5 | ||||
G7: Managing money and personal finances | 1 or more | 2 or more | 0 | 0 | |
1 | .25 | ||||
2 | 1 | ||||
3 | 3 | ||||
4 | 5 | ||||
Mid-frequency support needs weekly critical support time total = | Sum of times entered |