Version 2.78

54697-8 Should Interview for Daily and Activity Preferences be Conducted?

Observation ID in Form

F0300

Skip Logic

If 0, Skip to and complete F0800, Staff Assessment of Daily Activity and Preferences. If 1, Continue to F0400, Interview for Daily Preferences

Form Coding Instructions

Attempt to interview all residents able to communicate. If resident is unable to complete, attempt to complete interview with family member or significant other

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Interview for daily and activity preferences should be conducted
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL1503-3

Answer Code Score Answer ID
No (resident is rarely/never understood and family/significant other not available) 0 LA16158-0
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) 1 LA33-6

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54519-4 Interview for Daily Preferences

Observation ID in Form

F0400

Form Coding Instructions

Show resident the response options and say: "While you are in this facility…"

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Interview for daily preferences
Property
-
Time
RptPeriod
System
^Patient
Scale
-
Method
CMS Assessment

Basic Attributes

Class
PANEL.SURVEY.CMS
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.78
Change Reason
Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.
Order vs. Observation
Subset
Panel Type
Organizer

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54698-6 While you are in this facility how important is it to you to choose what clothes to wear?

Observation ID in Form

F0400A

Fully-Specified Name

Component
How important it is to choose what clothes to wear while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54699-4 While you are in this facility how important is it to you to take care of your personal belongings or things?

Observation ID in Form

F0400B

Fully-Specified Name

Component
How important it is to take care of your personal belongings or things while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54700-0 While you are in this facility how important is it to you to choose between a tub bath, shower, bed bath, or sponge bath?

Observation ID in Form

F0400C

Fully-Specified Name

Component
How important it is to choose between a tub bath, shower, bed bath, or sponge bath while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54701-8 While you are in this facility how important is it to you to have snacks available between meals?

Observation ID in Form

F0400D

Fully-Specified Name

Component
How important it is to have snacks available between meals while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54702-6 While you are in this facility how important is it to you to choose your own bedtime?

Observation ID in Form

F0400E

Fully-Specified Name

Component
How important it is to choose your own bedtime while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54703-4 While you are in this facility how important is it to you to have your family or a close friend involved in discussions about your care?

Observation ID in Form

F0400F

Fully-Specified Name

Component
How important it is to have your family or a close friend involved in discussions about your care while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54704-2 While you are in this facility how important is it to you to be able to use the phone in private?

Observation ID in Form

F0400G

Fully-Specified Name

Component
How important it is to be able to use the phone in private while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54705-9 While you are in this facility how important is it to you to have a place to lock your things to keep them safe?

Observation ID in Form

F0400H

Fully-Specified Name

Component
How important it is to have a place to lock your things to keep them safe while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54520-2 Interview for Activity Preferences

Observation ID in Form

F0500

Form Coding Instructions

Show resident the response options and say: "While you are in this facility…"

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Interview for activity preferences
Property
-
Time
RptPeriod
System
^Patient
Scale
-
Method
CMS Assessment

Basic Attributes

Class
PANEL.SURVEY.CMS
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.78
Change Reason
Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.
Order vs. Observation
Subset
Panel Type
Organizer

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54706-7 While you are in this facility how important is it to you to have books, newspapers, and magazines to read?

Observation ID in Form

F0500A

Fully-Specified Name

Component
How important it is to have books, newspapers, and magazines to read while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54707-5 While you are in this facility how important is it to you to listen to music you like?

Observation ID in Form

F0500B

Fully-Specified Name

Component
How important it is to listen to music you like while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54708-3 While you are in this facility how important is it to you to be around animals such as pets?

Observation ID in Form

F0500C

Fully-Specified Name

Component
How important it is to be around animals such as pets while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54709-1 While you are in this facility how important is it to you to keep up with the news?

Observation ID in Form

F0500D

Fully-Specified Name

Component
How important it is to keep up with the news while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54710-9 While you are in this facility how important is it to you to do things with groups of people?

Observation ID in Form

F0500E

Fully-Specified Name

Component
How important it is to do things with groups of people while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54711-7 While you are in this facility how important is it to you to do your favorite activities?

Observation ID in Form

F0500F

Fully-Specified Name

Component
How important it is to do your favorite activities while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54712-5 While you are in this facility how important is it to you to go outside to get fresh air when the weather is good?

Observation ID in Form

F0500G

Fully-Specified Name

Component
How important it is to go outside to get fresh air when the weather is good while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54713-3 While you are in this facility how important is it to you to participate in religious services or practices?

Observation ID in Form

F0500H

Fully-Specified Name

Component
How important it is to participate in religious services or practices while in this facility
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL659-4

Answer Code Score Answer ID
Very important 1 LA11013-2
Somewhat important 2 LA11014-0
Not very important 3 LA11015-7
Not important at all 4 LA11016-5
Important, but can't do or no choice 5 LA11017-3
No response or non-responsive 9 LA11018-1

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54714-1 Daily and Activity Preferences Primary Respondent. Indicate primary respondent for Daily and Activity Preferences (F0400 and F0500)

Observation ID in Form

F0600

Fully-Specified Name

Component
Primary respondent for daily and activity preferences
Property
Find
Time
RptPeriod
System
^Patient
Scale
Nom
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments.
Order vs. Observation
Observation

Normative Answer List LL686-7

Answer Code Score Answer ID
Resident 1 LA11019-9
Family or significant other (close friend or other representative) 2 LA11020-7
Interview could not be completed by resident or family/significant other ("No response" to 3 or more items) 9 LA11021-5

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

54715-8 Should the Staff Assessment of Daily and Activity Preferences be Conducted?

Observation ID in Form

F0700

Skip Logic

If 0, Skip to and complete GG0100, Prior Functioning: Everyday Activities. if 1, Continue to F0800, Staff Assessment of Daily and Activity Preferences.

Fully-Specified Name

Component
Staff assessment of daily and activity preferences should be conducted
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
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; Previous Releases: Updated METHOD to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee; Changed CLASS from SURVEY.MDS to SURVEY.CMS because term is used across CMS assessments. Moved Survey Question text to Display Name for Form for consistent modeling across CMS forms.
Order vs. Observation
Observation

Normative Answer List LL692-5

Answer Code Score Answer ID
No (because Interview for Daily and Activity Preferences (F0400 and F0500) was completed by resident or family/significant other) 0 LA11151-0
Yes (because 3 or more items in Interview for Daily and Activity Preferences (F0400 and F0500) were not completed by resident or family/significant other) 1 LA11152-8

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]

86599-8 Staff Assessment of Daily and Activity Preferences. Resident Prefers:

Observation ID in Form

F0800

Skip Logic

Do not conduct if Interview for Daily and Activity Preferences (F0400 – F0500) was completed

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Staff assessment of daily and activity preferences
Property
Find
Time
RptPeriod
System
^Patient
Scale
Nom
Method
CMS Assessment

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.63
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
Observation

Normative Answer List LL4558-4

Answer Code Score Answer ID
Choosing clothes to wear A LA27797-2
Caring for personal belongings B LA27798-0
Receiving tub bath C LA27799-8
Receiving shower D LA27800-4
Receiving bed bath E LA27815-2
Receiving sponge bath F LA27801-2
Snacks between meals G LA27802-0
Staying up past 8:00 p.m. H LA27803-8
Family or significant other involvement in care discussions I LA27804-6
Use of phone in private J LA27805-3
Place to lock personal belongings K LA27806-1
Reading books, newspapers, or magazines L LA27807-9
Listening to music M LA17907-9
Being around animals such as pets N LA27808-7
Keeping up with the news O LA27809-5
Doing things with groups of people P LA27810-3
Participating in favorite activities Q LA27811-1
Spending time away from the nursing home R LA27812-9
Spending time outdoors S LA27813-7
Participating in religious activities or practices T LA27814-5
None of the above Z LA9-3

Member of these Panels

LOINC Long Common Name
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
103564-1 MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]