Australian Capital Territory
Lifetime Care and Support (Catastrophic Injuries) FIM Score Sheet: Brain Injury Form Approval 2014
approval statement for
Approved form AF2014–53
made under the  
Lifetime Care and Support (Catastrophic Injuries) Act 2014, s 98 (Approved forms)

1	Name of instrument
This instrument is the Lifetime Care and Support (Catastrophic Injuries) FIM Score Sheet: Brain Injury Form Approval 2014.
2	Commencement 
This instrument commences on the day after its notification and applies in respect to applications made on or after 1 July 2014. 
3	Approved form
The attached form is the FIM Score Sheet: Brain Injury for assessing brain injury in an adult or a child aged over 8 years under the Lifetime Care and Support (Catastrophic Injuries) Act 2014. It is to be used in conjunction with an application form when applying to be a participant in the Lifetime care and Support Scheme under section 16 or 21 of the Act. 

Karen Doran
Lifetime Care and Support Commissioner of the Australian Capital Territory
and delegate of the Director-General
15 July 2014