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Discover the easiest, fastest way to capture outcomes

AM-PAC™ short forms are preformatted sheets that only require a pencil or pen to complete. A simple look-up scoring guide converts the sum of the answers into an AM-PAC™ score that you can enter into your EHR or use in your outcomes reporting program.
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In October 2014, the Center for Medicare & Medicaid Innovation compiled a set of meaningful measures for monitoring and evaluating its models in the Priority Measures for Monitoring and Evaluation report. Page 13 lists the AM-PAC short forms as the only patient-reported functional and status change measure being tracked.

Licensing is as simple as 1-2-3!

  1. Click the button below to go to the order form
  2. Complete the form – Organization information, billing information, and facilities you wish to license
  3. Click the submit button -You’re done! We’ll email you the details, and send an invoice for payment

Excerpt of Priority Measures for Monitoring and Evaluation report

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What you get with your Short Form subscription

The AM-PAC™ was developed at Boston University under a grant from NIH/NICHD/NCMRR and NIDRR. Mediware has licensed this instrument from Boston University and offers licenses for the AM-PAC™ Short Form through the PAC-Metrix web application. Licensed users receive access to all three versions of the AM-PAC™ Short Forms as well as ongoing support services:

  1. Standard Outpatient Short Form:   [Sample] Basic Mobility, Daily Activity & Applied Cognitive Assessments Plus the related Scoring Guide
  2. DOTPA (Medicare) Outpatient Short Form: [Sample] Basic Mobility, Daily Activity, and Applied Cognitive Assessments plus the related Scoring Guide
  3. Inpatient “6-Clicks” Short Form:  [Sample] Basic Mobility, Daily Activity, and Applied Cognitive Assessments plus the related Scoring Guide
  4. Automated Online Conversion tool for all three assessment types
  5. Boston University AM-PAC™ User Guide and Manual
  6. PAC-Metrix User Guide
  7. Updates to all assessment instruments as they are published by Boston University
  8. Updates from Boston University regarding questions about the instruments and how they are best used

The AM-PAC™ Short Form license gives you access to PDF files containing the assessments.  You can re-create the assessment to use your logo or even build the assessment into your EHR provided you don’t change the questions or the scoring mechanism.  If you build in your EHR, don’t forget to convert the raw score into the AM-PAC™ scores.

Frequently asked questions

Q: If I license the short forms, can I build the assessments in my EHR?
A:  Yes.  There are two restrictions you need to consider first, however.

  1. You may not change the wording of the questions.  They must be presented exactly as they are on the PDF forms that you receive with your license.  Wording changes will invalidate your results.
  2. In your EHR, you must also convert the raw score (the sum of the answers selected on the assessment) into the AM-PAC™ Scale (t-score).  It is not a valid practice to reference the raw score as an AM-PAC™ Score.  Each short form instrument has a different scale and is provided with a conversion matrix.

Q:  How much does a license cost?
A:  The annual cost for the short forms is $400/facility.  However, we offer an e-ordering discounted price of $280/facility annually for a two-year license or $340/facility for a one-year license.  To take advantage of this discounted pricing, you need only complete the online order form here.

Q:  How do you determine the number of facilities?
A:  For the purposes of counting facilities, each physical address represents a facility to be licensed.


Simplify G-code modifiers for any therapy discipline

Similar to the full computer based AM-PAC™, the short forms cover all three functional domains. In general, these functional domains can be mapped to three therapy disciplines:

  • Basic mobility – often maps to physical therapy
  • Daily activity – often maps to occupational therapy
  • Applied cognitive – often maps to speech and language pathology

Upon completion of the AM-PAC™ Short Form, the raw assessment score must be converted to AM-PAC™ t-scores (the official AM-PAC™ scoring model). This process also yields a severity modifier that can be applied to a G-code. This severity modifier (and therapist selected G-code) satisfy CMS’s outcomes-based reporting requirements.

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