101109-7
MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
Active
Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
| LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
|---|---|---|---|---|
| 101109-7 | MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] | |||
| Indent101258-2 | Identification Information | |||
| Indent Indent58198-3 | Type of Record | |||
| Indent Indent54581-4 | Facility Provider Numbers | |||
| Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
| Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
| Indent Indent Indent45398-5 | State Provider Number | |||
| Indent Indent85632-8 | Type of Provider | |||
| Indent Indent90489-6 | Type of Assessment | |||
| Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent54587-1 | Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | |||
| Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent71440-2 | Type of discharge | |||
| Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent86526-1 | Unit Certification or Licensure Designation | |||
| Indent Indent54503-8 | Legal Name of Resident | |||
| Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent45394-4 | Last name | |||
| Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent45966-9 | Social Security and Medicare Numbers | |||
| Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent45397-7 | Medicare number | |||
| Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent46098-0 | Gender | |||
| Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent69854-8 | Ethnicity. Are you of Hispanic, Latino/a, or Spanish origin? | 1..4 | ||
| Indent Indent103708-4 | Race. What is your race? | 1..14 | ||
| Indent Indent45404-1 | Marital Status | |||
| Indent Indent101351-5 | Transportation (from NACHC©) | |||
| Indent Indent54506-1 | Optional Resident Items | |||
| Indent Indent Indent46106-1 | Medical record number | |||
| Indent Indent Indent45403-3 | Room number | |||
| Indent Indent Indent52462-9 | Name by which resident prefers to be addressed | |||
| Indent Indent Indent21843-8 | Lifetime occupation(s) | |||
| Indent Indent86528-7 | Most Recent Admission/Entry or Reentry into this Facility | |||
| Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent54590-5 | Type of Entry | |||
| Indent Indent Indent85398-6 | Entered From | |||
| Indent Indent52455-3 | Admission Date | {mm/dd/yyyy} | ||
| Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent93182-4 | Provision of Current Reconciled Medication List to Subsequent Provider at Discharge | |||
| Indent Indent93184-0 | Route of Current Reconciled Medication List Transmission to Subsequent Provider | 1..5 | ||
| Indent Indent54593-9 | Assessment Reference Date. Observation end date | {mm/dd/yyyy} | ||
| Indent Indent54507-9 | Medicare Stay | |||
| Indent Indent Indent54594-7 | Has the resident had a Medicare-covered stay since the most recent entry? | |||
| Indent Indent Indent54595-4 | Start date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent Indent54596-2 | End date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent101259-0 | Hearing, Speech, and Vision | |||
| Indent Indent103709-2 | Health Literacy | |||
| Indent101260-8 | Cognitive Patterns | |||
| Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
| Indent Indent103694-6 | Brief Interview for Mental Status (BIMS) | |||
| Indent Indent Indent103696-1 | Repetition of Three Words | |||
| Indent Indent Indent103702-7 | Temporal Orientation | |||
| Indent Indent Indent Indent103697-9 | Able to report correct year | |||
| Indent Indent Indent Indent103698-7 | Able to report correct month | |||
| Indent Indent Indent Indent103703-5 | Able to report correct day of the week | |||
| Indent Indent Indent103695-3 | Recall | |||
| Indent Indent Indent Indent103699-5 | Able to recall "sock" | |||
| Indent Indent Indent Indent103700-1 | Able to recall "blue" | |||
| Indent Indent Indent Indent103701-9 | Able to recall "bed" | |||
| Indent Indent Indent103704-3 | BIMS Summary Score | {score} | ||
| Indent Indent96901-4 | Delirium | |||
| Indent Indent Indent95816-5 | Signs and Symptoms of Delirium (from CAM©) | |||
| Indent Indent Indent Indent95813-2 | Acute Onset Mental Change | |||
| Indent Indent Indent Indent95812-4 | Inattention | |||
| Indent Indent Indent Indent95814-0 | Disorganized Thinking | |||
| Indent Indent Indent Indent95815-7 | Altered Level of Consciousness | |||
| Indent101261-6 | Mood | |||
| Indent Indent54634-1 | Should Resident Mood Interview be Conducted? | |||
| Indent Indent54635-8 | Resident Mood Interview (PHQ-2 to 9) | |||
| Indent Indent Indent86843-0 | Symptom Presence | |||
| Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
| Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent86844-8 | Symptom Frequency | |||
| Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
| Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent103705-0 | Total Severity Score | {score} | ||
| Indent Indent93159-2 | Social Isolation | |||
| Indent101264-0 | Functional Abilities and Goals | |||
| Indent Indent101266-5 | Functional Abilities and Goals - Discharge | |||
| Indent Indent Indent101429-9 | Self-Care - Discharge Performance | |||
| Indent Indent Indent Indent89409-7 | Eating | |||
| Indent Indent Indent Indent89404-8 | Oral hygiene | |||
| Indent Indent Indent Indent89389-1 | Toileting hygiene | |||
| Indent Indent Indent Indent89396-6 | Shower/bathe self | |||
| Indent Indent Indent Indent89387-5 | Upper body dressing | |||
| Indent Indent Indent Indent89406-3 | Lower body dressing | |||
| Indent Indent Indent Indent89400-6 | Putting on/taking off footwear | |||
| Indent Indent Indent101431-5 | Mobility - Discharge Performance (Assessment period is the last 3 days of the Stay) | |||
| Indent Indent Indent Indent89398-2 | Roll left and right | |||
| Indent Indent Indent Indent89394-1 | Sit to lying | |||
| Indent Indent Indent Indent95009-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent89392-5 | Sit to stand | |||
| Indent Indent Indent Indent89414-7 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent89390-9 | Toilet transfer | |||
| Indent Indent Indent Indent89412-1 | Car transfer | |||
| Indent Indent Indent Indent89385-9 | Walk 10 feet | |||
| Indent Indent Indent Indent89381-8 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent89383-4 | Walk 150 feet | |||
| Indent Indent Indent Indent89379-2 | Walking 10 feet on uneven surfaces | |||
| Indent Indent Indent Indent95000-6 | 1 step (curb) | |||
| Indent Indent Indent Indent89416-2 | 4 steps | |||
| Indent Indent Indent Indent89418-8 | 12 steps | |||
| Indent Indent Indent Indent89402-2 | Picking up object | |||
| Indent Indent Indent Indent95738-1 | Does the resident use a wheelchair and/or scooter? | |||
| Indent Indent Indent Indent94992-5 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
| Indent Indent Indent Indent94991-7 | Wheel 150 feet | |||
| Indent Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
| Indent101270-7 | Health Conditions | |||
| Indent Indent54828-9 | Should Pain Assessment Interview be Conducted? | |||
| Indent Indent101326-7 | Pain Assessment Interview | |||
| Indent Indent Indent54829-7 | Pain Presence | |||
| Indent Indent Indent93156-8 | Pain Effect on Sleep | |||
| Indent Indent Indent93160-0 | Pain Interference with Therapy Activities | |||
| Indent Indent Indent93158-4 | Pain Interference with Day-to-Day Activities | |||
| Indent Indent54853-7 | Any Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent | |||
| Indent Indent54854-5 | Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent | |||
| Indent Indent Indent54855-2 | No injury | |||
| Indent Indent Indent54856-0 | Injury (except major) | |||
| Indent Indent Indent54857-8 | Major injury | |||
| Indent101271-5 | Swallowing &or Nutritional Status | |||
| Indent Indent54568-1 | Nutritional Approaches | |||
| Indent Indent Indent101328-3 | Nutritional Approaches. At Discharge | 1..4 | ||
| Indent101273-1 | Skin Conditions | |||
| Indent Indent58214-8 | Unhealed Pressure Ulcers/Injuries | |||
| Indent Indent88961-8 | Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage | |||
| Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent54886-7 | Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent54887-5 | Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent54890-9 | Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent54893-3 | Number of unstageable pressure ulcers/injuries due to non-removable dressing/device | {#} | ||
| Indent Indent Indent54894-1 | Number of these unstageable pressure ulcers/injuries that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent54947-7 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent54950-1 | Number of unstageable pressure injuries presenting as deep tissue injury | {#} | ||
| Indent Indent Indent54951-9 | Number of these unstageable pressure injuries that were present upon admission/entry or reentry | {#} | ||
| Indent101274-9 | Medications | |||
| Indent Indent93155-0 | High-Risk Drug Classes: Use and Indication | |||
| Indent Indent Indent93153-5 | Is taking | 1..10 | ||
| Indent Indent Indent93154-3 | Indication noted | 1..10 | ||
| Indent Indent57256-0 | Medication Intervention | |||
| Indent101275-6 | Special Treatments, Procedures, and Programs | |||
| Indent Indent101346-5 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent93185-7 | Special Treatments, Procedures, and Programs - At Discharge | 1..31 | ||
| Indent Indent90544-8 | Part A Therapies | |||
| Indent Indent Indent90545-5 | Speech-Language Pathology and Audiology Services | |||
| Indent Indent Indent Indent90539-8 | Individual minutes | min | ||
| Indent Indent Indent Indent90536-4 | Concurrent minutes | min | ||
| Indent Indent Indent Indent90538-0 | Group minutes | min | ||
| Indent Indent Indent Indent90537-2 | Co-treatment minutes | min | ||
| Indent Indent Indent Indent90551-3 | Days | d/{#} | ||
| Indent Indent Indent90546-3 | Occupational Therapy | |||
| Indent Indent Indent Indent90531-5 | Individual minutes | min | ||
| Indent Indent Indent Indent90527-3 | Concurrent minutes | min | ||
| Indent Indent Indent Indent90529-9 | Group minutes | min | ||
| Indent Indent Indent Indent90528-1 | Co-treatment minutes | min | ||
| Indent Indent Indent Indent90530-7 | Days | d/{#} | ||
| Indent Indent Indent90547-1 | Physical Therapy | |||
| Indent Indent Indent Indent90535-6 | Individual minutes | min | ||
| Indent Indent Indent Indent90532-3 | Concurrent minutes | min | ||
| Indent Indent Indent Indent90534-9 | Group minutes | min | ||
| Indent Indent Indent Indent90533-1 | Co-treatment minutes | min | ||
| Indent Indent Indent Indent90550-5 | Days | d/{#} | ||
| Indent Indent90548-9 | Distinct Calendar Days of Part A Therapy | {#} | ||
| Indent101279-8 | Correction Request | |||
| Indent Indent85632-8 | Type of Provider | 1..1 | ||
| Indent Indent87226-7 | Name of Resident | |||
| Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent45394-4 | Last name | |||
| Indent Indent46098-0 | Gender | |||
| Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent45396-9 | Social Security Number | |||
| Indent Indent90492-0 | Type of Assessment | |||
| Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent87216-8 | Date on existing record to be modified/inactivated | |||
| Indent Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent87209-3 | Correction Attestation Section | |||
| Indent Indent Indent58200-7 | Correction Number | {#} | ||
| Indent Indent Indent87217-6 | Reasons for Modification | 1..5 | ||
| Indent Indent Indent87225-9 | Reasons for Inactivation | 1..2 | ||
| Indent Indent Indent87218-4 | RN Assessment Coordinator Attestation of Completion | |||
| Indent Indent Indent Indent87219-2 | Attesting individual's first name | |||
| Indent Indent Indent Indent87220-0 | Attesting individual's last name | |||
| Indent Indent Indent Indent87221-8 | Attesting individual's title | |||
| Indent Indent Indent Indent87222-6 | Attestation date | {mm/dd/yyyy} | ||
| Indent101280-6 | Assessment Administration | |||
| Indent Indent85648-4 | Signature of Persons Completing the Assessment or Entry/Death Reporting | |||
| Indent Indent70127-6 | Signature of RN Assessment Coordinator Verifying Assessment Completion | |||
| Indent Indent Indent70127-6 | Signature: | |||
| Indent Indent Indent30947-6 | Date RN Assessment Coordinator signed assessment as complete: | {mm/dd/yyyy} |
Fully-Specified Name
- Component
- MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.75
- Last Updated
- Version 2.77
- Change Reason
- Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;
- Order vs. Observation
- Order
- Panel Type
- Panel
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