Qualifying Scores from Supports Intensity Scale |
SIS Activity: | If your type of support is: | And your frequency of support score is: | And your daily support time score is: | Then your critical task hours = | Enter one time for each SIS activity |
A2: Bathing and taking care of personal hygiene and grooming needs | 1 or more | 0 | 0 or more | 0 | |
1 | 0 or more | 0 | |
2 | 0 or more | 0 | |
3 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
| 4 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
A3: Using the toilet | 1 or more | 0 | 0 or more | 0 | |
1 | 0 or more | 0 | |
| 2 | 0 or more | 0 | |
| 3 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
| 4 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
A4: Dressing | 1 or more | 0 | 0 or more | 0 | |
1 | 0 or more | 0 | |
| 2 | 0 or more | 0 | |
| 3 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
| 4 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
A6: Eating food | 1 or more | 0 | 0 or more | 0 | |
1 | 0 or more | 0 | |
2 | 0 or more | 0 | |
3 | 0 | 0 | |
1 | .25 | |
2 | 1 | |
3 | 3 | |
4 | 5 | |
4 | 0 | 0 | |
1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
A9: Using currently prescribed equipment or treatment | 1 or more | 0 | 0 or more | 0 | |
1 | 0 or more | 0 | |
2 | 0 or more | 0 | |
3 | 0 | 0 | |
1 | .25 | |
2 | 1 | |
3 | 3 | |
| 4 | 5 | |
| 4 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
E1: Taking medications | 1 or more | 0 | 0 or more | 0 | |
1 | 0 or more | 0 | |
2 | 0 or more | 0 | |
3 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
| 4 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
E2: Ambulating and moving about | 1 or more | 0 | 0 or more | 0 | |
1 | 0 or more | 0 | |
2 | 0 or more | 0 | |
3 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
| 4 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
E3: Avoiding health and safety hazards | 1 or more | 0 | 0 or more | 0 | |
1 | 0 or more | 0 | |
2 | 0 or more | 0 | |
3 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
| 4 | 0 | 0 | |
| 1 | .25 | |
| 2 | 1 | |
| 3 | 3 | |
| 4 | 5 | |
Daily critical support time score = | Sum of all times entered. |
[Statutory Authority: RCW
71A.12.030 and
71A.12.120. WSR 19-02-020, § 388-828-9660, filed 12/21/18, effective 2/1/19. WSR 08-15-091, recodified as § 388-828-9660, filed 7/17/08, effective 7/17/08. Statutory Authority: RCW 71A.12.30 [71A.12.030] and Title
71A RCW. WSR 08-12-037, § 388-828-10300, filed 5/30/08, effective 7/1/08.]