Functional Assessment Staging (FAST)

Abstract

Yes Months1 No. ____ ________ ____ 1. No difficulties, either subjectively or objectively. ____ ________ ____ 2. Complains of forgetting location of objects; subjective work difficulties. ____ ________ ____ 3. Decrease job functioning evident to coworkers; difficulty in traveling to new locations. ____ ________ ____ 4. Decreased ability to perform complex tasks (e.g., planning dinner for guests; handling finances; marketing) ____ ________ ____ 5. Requires assistance in choosing proper clothing. ____ ________ ____ 6a. Difficulty putting clothing on properly. ____ ________ ____ 6b. Unable to bathe properly; may develop fear of bathing. ____ ________ ____ 6c. Inability to handle mechanics of toileting (i.e., forgets to flush, doesn’t wipe properly). ____ ________ ____ 6d. Urinary incontinence. ____ ________ ____ 6e. Fecal incontinence. ____ ________ ____ 7a. Ability to speak limited (1 to 5 words a day). ____ ________ ____ 7b. All intelligible vocabulary lost. ____ ________ ____ 7c. Nonambulatory. ____ ________ ____ 7d. Unable to sit up independently. ____ ________ ____ 7e. Unable to smile. ____ ________ ____ 7f. Unable to hold head up.