Resident Name Wentification # Date Brief Interview for Mental Status (BIMS) Repeiltion of Three Words ‘Ask resident: am going (o say three words for you to remomber. Pleaso repeat the words after I have sald ail three, The words ere: sock, blue anc! bed. Now (ell me the threo words." Number of words repeated after first attempt: LJ o-none tone Alter the resident’ first attempt, repeal the words using cues (“sock, something (0 wear; blue, a color; bod, a ploce of furniture’). You may repeat the words up to two more times. ‘Temporal Orientation (orientation to month, year and day) ‘Ask resident: “Please loll mo wat yoar tis right now.” Two 3, Throo Able to report correct year 0, Missed by > 6 yoars, or no enewor ‘1. Missed by 2.6 years 2. Missed by 1 year 3. Correct ‘Ask resident: “Whaf month aro we in right now?" Able to report correct month 0. Missed by> 1 month, or no answer 1. Missed by 6 days to one month 2. Accurate within § days ‘Ask resident: “What day of tho wook is today?" Able to roport correct day of the week 0. incorrect, or no answver 4. Correct Recall ‘Ask resident: “Let's go back fo the oanler question. What we Ifunable to remember a word, give cue (‘somothing fo wear; the three words that | asked you to repost?" “a color,” “a piece of future’) for that word, 0. No - could 1. Yes, after cyging 2, Yes, no cue, ] 0, No - could 1, Yes, after cueing (2. Yes, no cue ‘Add scores for each question and fl in fotal score (00-15). Entor 99 if the resident was unable to complete the interview.