Wisconsin Long Term Care Functional Screen Instructions

The Adult Long-Term Care Functional Screen instructions are available both by individual module and as a complete document. Please note that the complete document is a large file and may take awhile to download, especially if you are using a modem. 

View/print complete set of LTC FS Instructions: 

Wisconsin Long Term Care Functional Screen Instructions (PDF, 996 KB) Revised 3/14/13, unmarked copy, 148 pages 

Marked copy (PDF, 632 KB) of the LTC FS Instructions with recent changes highlighted so that screeners are able to note new areas.

View/print by module:

• Module 1: Overview of the LTC FS  
• Module 2: LTC FS Target Groups 
• Module 3: LTC FS Basic Information (Screen Information, Demographics)
• Module 4: ADLs and IADLs 
• Module 5: Diagnosis 
• Module 6: Health-Related Services (HRS) Table  
• Module 7: Communication and Cognition 
• Module 8: Behaviors/Mental Health  
• Module 9: Risk
• Module 10: Completion of the Screen and Notes

Back to: Wisconsin's Functional Screen Home Page

PDF: The free Acrobat Reader^® software is needed to view and print portable document format (PDF) files. Learn more.

Last Revised:  May 31, 2013