Ampac 6 Clicks Form PDF Details

Understanding the functionality and application of the AM-PAC™ "6 Clicks" Basic Mobility Inpatient Short Form is crucial for healthcare professionals managing patient care within various inpatient settings. Developed by Boston University, this form serves as an efficient tool to evaluate a patient's basic mobility and the level of assistance they require for fundamental movements. It systematically asks the patient or the assessor to gauge the difficulty encountered in six basic activities, such as turning over in bed, sitting to standing, moving from lying to sitting, transferring from bed to chair, walking in the room, and climbing stairs. This assessment is then quantified through a scoring system that ranges from "Unable" to "None," indicating the level of difficulty or the amount of assistance needed. Furthermore, scores are converted using a specific conversion table to translate raw scores into standardized values, making it easier to track progress or make necessary adjustments to the patient's care plan. Revised in February 2013, the AM-PAC "6 Clicks" has become an indispensable tool not only for physical therapists but also for the broader medical team, contributing to better-informed decisions regarding patient mobility and independence during their hospital stay.

QuestionAnswer
Form NameAmpac 6 Clicks Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesmobility am pac form, basic mobility ampac, am pac form print, basic am pac form

Form Preview Example

AM-PAC

Short Form 1

Date:Name:

Number:

Boston University AM-PAC™ “6 Clicks”

Basic Mobility Inpatient Short Form

Please check the box that reflects your (the patient’s) best answer to each question.

 

Unable

A Lot

A

None

 

How much difficulty does the patient currently have…

Little

 

 

 

1.Turning over in bed (including adjusting bedclothes, sheets and blankets)?

2.Sitting down on and standing up from a chair with arms (e.g., wheelchair, bedside commode, etc.)

3.Moving from lying on back to sitting on the side of the bed?

1

1

1

2

2

2

3

3

3

4

4

4

 

 

 

 

 

A

 

 

 

 

Total

 

A Lot

 

 

None

 

How much help from another person does the patient currently need…

 

 

Little

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.Moving to and from a bed to a chair (including a wheelchair)?

5.Need to walk in hospital room?

6.Climbing 3-5 steps with a railing?

1

1

1

2

2

2

3

3

3

4

4

4

Raw Score:

 

CMS 0-100% Score:

 

Standardized Score:

 

CMS Modifier:

 

Note: Use the AM-PAC Basic Mobility Inpatient Short Form Conversion Table to convert raw scores.

Revised: 2/1/2013

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am pac form pdf conclusion process clarified (part 1)

2. Once the last section is completed, proceed to enter the relevant information in all these - bedside commode etc, Moving from lying on back to, How much help from another person, Total A Lot, Little, None, Moving to and from a bed to a, Need to walk in hospital room, Climbing steps with a railing, Raw Score, Standardized Score, and CMS Score CMS Modifier.

am pac form pdf conclusion process outlined (part 2)

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