Assessment Tool: Functional Oral Intake Scale (FOIS)

Select the level that best describes the patient's current functional oral intake. The FOIS is used to track change in swallowing function over time and to guide diet texture and liquid consistency decisions in collaboration with the Speech-Language Pathologist.

Functional Oral Intake Scale (FOIS)

A 7-level ordinal scale for rating the functional oral intake of food and liquid in patients with dysphagia. Developed by Crary, Mann, and Groher (2005). Clinicians select the level that best describes the patient's current functional oral intake. Used to track change over time.

Scale overview

Level 1

Level 2

Level 3

Level 4

Level 5

Level 6

Level 7

← NPO No restrictions →

Level 1: Nothing by mouth (NPO)

Patient is unable to swallow safely. Receiving nutrition via tube feeding only.

Level 2: Tube dependent with minimal/inconsistent oral intake

Primary nutrition is via tube feeding. Patient attempts oral intake only for comfort or pleasure, but this does not provide meaningful nutrition or hydration.

Level 3: Tube dependent with consistent oral intake

Primary nutrition is via tube feeding, but patient has consistent oral intake of a single texture/consistency that provides supplemental nutrition.

Level 4: Total oral diet of a single consistency

Patient is taking total nutrition by mouth but is limited to a single texture or consistency (e.g., pureed only or thin liquids only). No tube feeding.

Level 5: Total oral diet with multiple consistencies, requiring special preparation

Patient eats a variety of food textures and liquid consistencies without tube feeding, but requires special preparation or compensatory strategies (e.g., chin tuck, positioning, modified utensils).

Level 6: Total oral diet with multiple consistencies, without special preparation, with specific food limitations

Patient eats independently across multiple textures without special preparation or compensatory strategies, but certain specific foods must be avoided (e.g., hard, crunchy, or mixed-consistency foods).

Level 7: Total oral diet with no restrictions

Patient eats a total oral diet with no restrictions on texture, consistency, or food type. No compensatory strategies required.