101265-7

Functional Abilities and Goals - Admission

Active

101321-8 Self-Care - Admission Performance

Observation ID in Form

GG0130_1

Skip Logic

Complete if A0310A = 01 or A0310B = 01. If A0310B = 01, the stay begins on A2400B and both columns are required. If A0310B = 99, the stay begins on A1600 and only column 1 is required.

Form Coding Instructions

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

Code the resident's usual performance at the start of the stay (admission) for each activity using the 6-point scale. If activity was not attempted at the start of the stay (admission), code the reason. Code the resident's end of SNF PPS stay (discharge) goal(s) using the 6-point scale. Use of codes 07, 09, 10, or 88 is permissible to code end of SNF PPS stay (discharge) goal(s). Safety and Quality of Performance - If helper assistance is required because resident's performance is unsafe or of poor quality, score according to amount of assistance provided. Activities may be completed with or without assistive devices. If activity was not attempted, code reason

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

(Assessment period is the first 3 days of the stay)

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: MDS v3.0 - RAI v1.18.11 - Self-Care - Admission Performance
Property: -
Time: RptPeriod
System: ^Patient
Scale: -
Method: CMS Assessment

Long Common Name

MDS v3.0 - RAI v1.18.11 - Self-Care - Admission Performance

Basic Attributes

Class: PANEL.SURVEY.CMS
Type: Surveys
First Released: Version 2.74
Last Updated: Version 2.78 (PANEL)
Order vs. Observation: Subset
Panel Type: Organizer

Member of these Panels

LOINC	Long Common Name
103564-1	MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Code System	Code	Code Text	Code Version
CMS MDS	GG0130_1		v1.18.11

95019-6 Eating

Term Description

The patient's usual ability to use suitable utensils to bring food/liquid to the mouth and swallow food once the meal is presented on a table/tray. Includes modified food consistency.

Observation ID in Form

GG0130A1

Form Context

The ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the resident

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Eating - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Eating - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90480-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment]
104608-5	MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0130A1	v1.18.11
CMS OASIS	GG0130A1	E
CMS OASIS	GG0130A4	E
CMS OASIS	GG0130A3	E
CMS OASIS	GG0130A1	D
CMS OASIS	GG0130A3	D
CMS OASIS	GG0130A4	D
CMS OASIS	GG0130A4	D1
CMS OASIS	GG0130A1	D1
CMS OASIS	GG0130A3	D1
CMS FASI	GG0130A7	1.0
CMS IRF-PAI	GG0130A1	3.0
CMS LCDS	GG0130A1	4.00
CMS LCDS	GG0130A3	4.00
CMS IRF-PAI	GG0130A1	4.0
CMS LCDS	GG0130A1	5.00
CMS LCDS	GG0130A3	5.00
CMS MDS	GG0130A1	1.17.1
CMS MDS	GG0130A3	1.17.1
CMS MDS	GG0130A5	1.17.1
CMS MDS	GG0130A1	1.17.2
CMS MDS	GG0130A3	1.17.2
CMS MDS	GG0130A5	1.17.2

95018-8 Oral hygiene

Observation ID in Form

GG0130B1

Form Context

The ability to use suitable items to clean teeth. Dentures (if applicable): The ability to insert and remove dentures into and from the mouth, and manage denture soaking and rinsing with use of equipment

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Oral hygiene - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Oral hygiene - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90480-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment]
104608-5	MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0130B1	v1.18.11
CMS OASIS	GG0130B1	E
CMS OASIS	GG0130B4	E
CMS OASIS	GG0130B3	E
CMS OASIS	GG0130B1	D
CMS OASIS	GG0130B3	D
CMS OASIS	GG0130B4	D
CMS OASIS	GG0130B4	D1
CMS OASIS	GG0130B1	D1
CMS OASIS	GG0130B3	D1
CMS FASI	GG0130B7	1.0
CMS IRF-PAI	GG0130B1	3.0
CMS IRF-PAI	GG0130B3	3.0
CMS LCDS	GG0130B1	4.00
CMS LCDS	GG0130B3	4.00
CMS IRF-PAI	GG0130B1	4.0
CMS IRF-PAI	GG0130B3	4.0
CMS LCDS	GG0130B1	5.00
CMS LCDS	GG0130B3	5.00
CMS MDS	GG0130B1	1.17.1
CMS MDS	GG0130B3	1.17.1
CMS MDS	GG0130B5	1.17.1
CMS MDS	GG0130B1	1.17.2
CMS MDS	GG0130B3	1.17.2
CMS MDS	GG0130B5	1.17.2

95017-0 Toileting hygiene

Observation ID in Form

GG0130C1

Form Context

The ability to maintain perineal hygiene, adjust clothes before and after voiding or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Toileting hygiene - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Toileting hygiene - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90480-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment]
104608-5	MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0130C1	v1.18.11
CMS OASIS	GG0130C1	E
CMS OASIS	GG0130C4	E
CMS OASIS	GG0130C3	E
CMS OASIS	GG0130C1	D
CMS OASIS	GG0130C3	D
CMS OASIS	GG0130C4	D
CMS OASIS	M1845	D
CMS OASIS	GG0130C4	D1
CMS OASIS	GG0130C1	D1
CMS OASIS	GG0130C3	D1
CMS OASIS	M1845	D1
CMS IRF-PAI	GG0130C1	3.0
CMS IRF-PAI	GG0130C3	3.0
CMS LCDS	GG0130C1	4.00
CMS LCDS	GG0130C3	4.00
CMS IRF-PAI	GG0130C1	4.0
CMS IRF-PAI	GG0130C3	4.0
CMS LCDS	GG0130C1	5.00
CMS LCDS	GG0130C3	5.00
CMS MDS	GG0130C1	1.17.1
CMS MDS	GG0130C3	1.17.1
CMS MDS	GG0130C5	1.17.1
CMS MDS	GG0130C1	1.17.2
CMS MDS	GG0130C3	1.17.2
CMS MDS	GG0130C5	1.17.2

95015-4 Shower/bathe self

Observation ID in Form

GG0130E1

Form Context

The ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair). Does not include transferring in/out of tub/shower

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Shower &or bathe self - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Shower/bathe self - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0130E1	v1.18.11
CMS OASIS	GG0130E1	E
CMS OASIS	GG0130E3	E
CMS OASIS	GG0130E1	D
CMS OASIS	GG0130E3	D
CMS OASIS	GG0130E1	D1
CMS OASIS	GG0130E3	D1
CMS FASI	GG0130EE7	1.0
CMS IRF-PAI	GG0130E1	3.0
CMS IRF-PAI	GG0130E3	3.0
CMS IRF-PAI	GG0130E1	4.0
CMS IRF-PAI	GG0130E3	4.0
CMS MDS	GG0130E1	1.17.1
CMS MDS	GG0130E3	1.17.1
CMS MDS	GG0130E1	1.17.2
CMS MDS	GG0130E3	1.17.2

95014-7 Upper body dressing

Observation ID in Form

GG0130F1

Form Context

The ability to dress and undress above the waist; including fasteners, if applicable

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Upper body dressing - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Upper body dressing - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0130F1	v1.18.11
CMS OASIS	GG0130F1	E
CMS OASIS	GG0130F3	E
CMS OASIS	GG0130F1	D
CMS OASIS	GG0130F3	D
CMS OASIS	GG0130F1	D1
CMS OASIS	GG0130F3	D1
CMS FASI	GG0130F7	1.0
CMS IRF-PAI	GG0130F1	3.0
CMS IRF-PAI	GG0130F3	3.0
CMS IRF-PAI	GG0130F1	4.0
CMS IRF-PAI	GG0130F3	4.0
CMS MDS	GG0130F1	1.17.1
CMS MDS	GG0130F3	1.17.1
CMS MDS	GG0130F1	1.17.2
CMS MDS	GG0130F3	1.17.2

95013-9 Lower body dressing

Observation ID in Form

GG0130G1

Form Context

The ability to dress and undress below the waist, including fasteners; does not include footwear

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Lower body dressing - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Lower body dressing - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0130G1	v1.18.11
CMS OASIS	GG0130G1	E
CMS OASIS	GG0130G3	E
CMS OASIS	GG0130G1	D
CMS OASIS	GG0130G3	D
CMS OASIS	GG0130G1	D1
CMS OASIS	GG0130G3	D1
CMS FASI	GG0130G7	1.0
CMS IRF-PAI	GG0130G1	3.0
CMS IRF-PAI	GG0130G3	3.0
CMS IRF-PAI	GG0130G1	4.0
CMS IRF-PAI	GG0130G3	4.0
CMS MDS	GG0130G1	1.17.1
CMS MDS	GG0130G3	1.17.1
CMS MDS	GG0130G1	1.17.2
CMS MDS	GG0130G3	1.17.2

95012-1 Putting on/taking off footwear

Observation ID in Form

GG0130H1

Form Context

The ability to put on and take off socks and shoes or other footwear that is appropriate for safe mobility; including fasteners, if applicable

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Putting on &or taking off footwear - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Putting on/taking off footwear - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0130H1	v1.18.11
CMS OASIS	GG0130H1	E
CMS OASIS	GG0130H3	E
CMS OASIS	GG0130H1	D
CMS OASIS	GG0130H3	D
CMS OASIS	GG0130H1	D1
CMS OASIS	GG0130H3	D1
CMS FASI	GG0130H7	1.0
CMS IRF-PAI	GG0130H1	3.0
CMS IRF-PAI	GG0130H3	3.0
CMS IRF-PAI	GG0130H1	4.0
CMS IRF-PAI	GG0130H3	4.0
CMS MDS	GG0130H1	1.17.1
CMS MDS	GG0130H3	1.17.1
CMS MDS	GG0130H1	1.17.2
CMS MDS	GG0130H3	1.17.2

45606-1 Personal hygiene

Observation ID in Form

GG0130I1

Form Context

The ability to maintain personal hygiene, including combing hair, shaving, applying makeup, washing/drying face and hands (excludes baths, showers, and oral hygiene)

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Personal hygiene - self-performance during assessment period
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Personal hygiene - self-performance during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.17
Last Updated: Version 2.70 (NAM)
Change Reason: Release 2.70: COMPONENT: Removed "7D"; TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing panel terms (54523-6 and 46007-1) and answer list support that the Timing should have been 7D when the term was created. 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.;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
45981-8	Deprecated MDS full assessment form - version 2.0
46102-0	Deprecated MDS quarterly assessment form - version 2.0
46103-8	Deprecated MDS quarterly assessment form - version 2.0 - optional version for RUG-III
46104-6	Deprecated MDS quarterly assessment form - version 2.0 - optional version for RUG-III 1997 update
86522-0	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
86872-9	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
86871-1	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
86873-7	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
86856-2	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home PPS (NP) and Nursing home quarterly (NQ) item set [CMS Assessment]
86876-0	Deprecated MDS v3.0 - RAI v1.14.1 - Swing bed PPS (SP) item set [CMS Assessment]
88282-9	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88283-7	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
88284-5	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
88285-2	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
88287-8	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home PPS (NP) item set [CMS Assessment]
88292-8	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88288-6	Deprecated MDS v3.0 - RAI v1.15.1 - Swing bed PPS (SP) item set [CMS Assessment]
88954-3	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88945-1	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
88946-9	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
88947-7	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
88949-3	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home PPS (NP) item set [CMS Assessment]
88955-0	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88950-1	Deprecated MDS v3.0 - RAI v1.16.1 - Swing bed PPS (SP) item set [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
54580-6	Deprecated Minimum Data Set - version 3.0
103564-1	MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	G0110J1	v1.18.11
CMS MDS	GG0130I1	v1.18.11
CMS MDS	GG0130I2	v1.18.11
CMS MDS	GG0130I3	v1.18.11
CMS MDS	GG0130i5	v1.18.11
CMS MDS	G0110J1	1.17.2
CMS MDS	G0110J1	1.16.1
CMS MDS	G0110J1	1.14.1
CMS MDS	G0110J1	1.15.1
CMS MDS	G0110J1	1.17.1

101322-6 Self-Care - Discharge Goal (Assessment period is the first 3 days of the stay)

Observation ID in Form

GG0130_2

Skip Logic

Complete if A0310A = 01 or A0310B = 01. If A0310B = 01, the stay begins on A2400B and both columns are required. If A0310B = 99, the stay begins on A1600 and only column 1 is required.

Form Coding Instructions

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: MDS v3.0 - RAI v1.18.11 - Self-Care - Discharge Goal
Property: -
Time: RptPeriod
System: ^Patient
Scale: -
Method: CMS Assessment

Long Common Name

MDS v3.0 - RAI v1.18.11 - Self-Care - Discharge Goal

Basic Attributes

Class: PANEL.SURVEY.CMS
Type: Surveys
First Released: Version 2.74
Last Updated: Version 2.77 (PANEL)
Order vs. Observation: Subset
Panel Type: Organizer

Member of these Panels

LOINC	Long Common Name
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Code System	Code	Code Text	Code Version
CMS MDS	GG0130_2		v1.18.11
CMS MDS	GG0130_5		v1.18.11

89404-8 Oral hygiene - functional goal

Fully-Specified Name

Component: Oral hygiene - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Oral hygiene - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0130B2	E
CMS MDS	GG0130B2	v1.18.11
CMS MDS	GG0130B3	v1.18.11
CMS MDS	GG0130B5	v1.18.11
CMS IRF-PAI	GG0130B2	3.0
CMS LCDS	GG0130B2	4.00
CMS IRF-PAI	GG0130B2	4.0
CMS LCDS	GG0130B2	5.00
CMS OASIS	GG0130B2	D
CMS OASIS	GG0130B2	D1
CMS MDS	GG0130B2	1.17.1
CMS MDS	GG0130B2	1.17.2

89409-7 Eating

Observation ID in Form

GG0130A2

Fully-Specified Name

Component: Eating - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Eating - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0130A2	E
CMS MDS	GG0130A2	v1.18.11
CMS MDS	GG0130A3	v1.18.11
CMS MDS	GG0130A5	v1.18.11
CMS IRF-PAI	GG0130A2	3.0
CMS LCDS	GG0130A2	4.00
CMS IRF-PAI	GG0130A2	4.0
CMS LCDS	GG0130A2	5.00
CMS OASIS	GG0130A2	D
CMS OASIS	GG0130A2	D1
CMS MDS	GG0130A2	1.17.1
CMS MDS	GG0130A2	1.17.2

89389-1 Toileting hygiene

Observation ID in Form

GG0130C2

Form Context

The ability to maintain perineal hygiene, adjust clothes before and after voiding or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Toileting hygiene - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Toileting hygiene - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0130C2	E
CMS MDS	GG0130C2	1.17.1
CMS MDS	GG0130C2	1.17.2
CMS MDS	GG0130C2	v1.18.11
CMS MDS	GG0130C3	v1.18.11
CMS MDS	GG0130C5	v1.18.11
CMS IRF-PAI	GG0130C2	3.0
CMS LCDS	GG0130C2	4.00
CMS IRF-PAI	GG0130C2	4.0
CMS LCDS	GG0130C2	5.00
CMS OASIS	GG0130C2	D
CMS OASIS	GG0130C2	D1

89396-6 Shower/bathe self

Observation ID in Form

GG0130E2

Form Context

The ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair). Does not include transferring in/out of tub/shower

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Shower &or bathe self - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Shower/bathe self - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0130E2	E
CMS MDS	GG0130E2	1.17.1
CMS MDS	GG0130E2	1.17.2
CMS MDS	GG0130E2	v1.18.11
CMS MDS	GG0130e3	v1.18.11
CMS MDS	GG0130E5	v1.18.11
CMS OASIS	GG0130E2	D
CMS OASIS	GG0130E2	D1

89387-5 Upper body dressing

Observation ID in Form

GG0130F2

Form Context

The ability to dress and undress above the waist; including fasteners, if applicable

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Upper body dressing - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Upper body dressing - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0130F2	E
CMS MDS	GG0130F2	1.17.1
CMS MDS	GG0130F2	1.17.2
CMS MDS	GG0130F2	v1.18.11
CMS MDS	GG0130F3	v1.18.11
CMS MDS	GG0130F5	v1.18.11
CMS OASIS	GG0130F2	D
CMS OASIS	GG0130F2	D1

89406-3 Lower body dressing

Observation ID in Form

GG0130G2

Form Context

The ability to dress and undress below the waist, including fasteners; does not include footwear

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Lower body dressing - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Lower body dressing - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0130G2	E
CMS MDS	GG0130G2	v1.18.11
CMS MDS	GG0130G3	v1.18.11
CMS MDS	GG0130G5	v1.18.11
CMS OASIS	GG0130G2	D
CMS OASIS	GG0130G2	D1
CMS MDS	GG0130G2	1.17.1
CMS MDS	GG0130G2	1.17.2

89400-6 Putting on/taking off footwear

Observation ID in Form

GG0130H2

Form Context

The ability to put on and take off socks and shoes or other footwear that is appropriate for safe mobility; including fasteners, if applicable

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Putting on and taking off footwear - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Putting on and taking off footwear - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0130H2	E
CMS MDS	GG0130H2	1.17.1
CMS MDS	GG0130H2	1.17.2
CMS MDS	GG0130H2	v1.18.11
CMS MDS	GG0130H3	v1.18.11
CMS MDS	GG0130H5	v1.18.11
CMS OASIS	GG0130H2	D
CMS OASIS	GG0130H2	D1

45606-1 Personal hygiene

Observation ID in Form

GG0130I2

Form Context

The ability to maintain personal hygiene, including combing hair, shaving, applying makeup, washing/drying face and hands (excludes baths, showers, and oral hygiene)

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Personal hygiene - self-performance during assessment period
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Personal hygiene - self-performance during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.17
Last Updated: Version 2.70 (NAM)
Change Reason: Release 2.70: COMPONENT: Removed "7D"; TIME_ASPCT: Updated Timing to align with the new model representing various reporting periods across CMS assessment.; Previous Releases: Changed Timing to 7D and added 7D to the Component to represent the Timing on the form. The existing panel terms (54523-6 and 46007-1) and answer list support that the Timing should have been 7D when the term was created. 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.;Removed External Copyright Attribution because term originates from instruments made available without copyright restrictions by CMS
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
45981-8	Deprecated MDS full assessment form - version 2.0
46102-0	Deprecated MDS quarterly assessment form - version 2.0
46103-8	Deprecated MDS quarterly assessment form - version 2.0 - optional version for RUG-III
46104-6	Deprecated MDS quarterly assessment form - version 2.0 - optional version for RUG-III 1997 update
86522-0	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
86872-9	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
86871-1	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
86873-7	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
86856-2	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home PPS (NP) and Nursing home quarterly (NQ) item set [CMS Assessment]
86876-0	Deprecated MDS v3.0 - RAI v1.14.1 - Swing bed PPS (SP) item set [CMS Assessment]
88282-9	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88283-7	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
88284-5	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
88285-2	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
88287-8	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home PPS (NP) item set [CMS Assessment]
88292-8	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88288-6	Deprecated MDS v3.0 - RAI v1.15.1 - Swing bed PPS (SP) item set [CMS Assessment]
88954-3	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88945-1	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
88946-9	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
88947-7	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
88949-3	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home PPS (NP) item set [CMS Assessment]
88955-0	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88950-1	Deprecated MDS v3.0 - RAI v1.16.1 - Swing bed PPS (SP) item set [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
54580-6	Deprecated Minimum Data Set - version 3.0
103564-1	MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	G0110J1	v1.18.11
CMS MDS	GG0130I1	v1.18.11
CMS MDS	GG0130I2	v1.18.11
CMS MDS	GG0130I3	v1.18.11
CMS MDS	GG0130i5	v1.18.11
CMS MDS	G0110J1	1.17.2
CMS MDS	G0110J1	1.16.1
CMS MDS	G0110J1	1.14.1
CMS MDS	G0110J1	1.15.1
CMS MDS	G0110J1	1.17.1

101323-4 Mobility - Admission Performance (Assessment period is the first 3 days of the stay)

Observation ID in Form

GG0170_1

Skip Logic

Complete if A0310A = 01 or A0310B = 01. If A0310B = 01, the stay begins on A2400B and both columns are required. If A0310B = 99, the stay begins on A1600 and only column 1 is required.

Form Coding Instructions

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: MDS v3.0 - RAI v1.18.11 - Mobility - Admission Performance
Property: -
Time: RptPeriod
System: ^Patient
Scale: -
Method: CMS Assessment

Long Common Name

MDS v3.0 - RAI v1.18.11 - Mobility - Admission Performance during assessment period [CMS Assessment]

Basic Attributes

Class: PANEL.SURVEY.CMS
Type: Surveys
First Released: Version 2.74
Last Updated: Version 2.78 (PANEL)
Order vs. Observation: Subset
Panel Type: Organizer

Member of these Panels

LOINC	Long Common Name
103564-1	MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

95011-3 Roll left and right

Observation ID in Form

GG0170A1

Form Context

The ability to roll from lying on back to left and right side, and return to lying on back on the bed

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Roll left and right - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Roll left and right - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170A1	v1.18.11
CMS OASIS	GG0170A1	D
CMS OASIS	GG0170A3	D
CMS OASIS	GG0170A4	D1
CMS OASIS	GG0170A1	E
CMS OASIS	GG0170A4	E
CMS OASIS	GG0170A3	E
CMS OASIS	GG0170A1	D1
CMS OASIS	GG0170A3	D1
CMS FASI	GG0170A7	1.0
CMS IRF-PAI	GG0170A1	3.0
CMS IRF-PAI	GG0170A3	3.0
CMS LCDS	GG0170A1	4.00
CMS LCDS	GG0170A3	4.00
CMS IRF-PAI	GG0170A1	4.0
CMS IRF-PAI	GG0170A3	4.0
CMS LCDS	GG0170A1	5.00
CMS LCDS	GG0170A3	5.00
CMS MDS	GG0170A1	1.17.1
CMS MDS	GG0170A3	1.17.1
CMS MDS	GG0170A1	1.17.2
CMS MDS	GG0170A3	1.17.2

95010-5 Sit to lying

Observation ID in Form

GG0170B1

Form Context

The ability to move from sitting on side of bed to lying flat on the bed

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Sit to lying - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Sit to lying - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90480-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment]
104608-5	MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170B1	v1.18.11
CMS OASIS	GG0170B1	D
CMS OASIS	GG0170B3	D
CMS OASIS	GG0170B4	D1
CMS OASIS	GG0170B1	D1
CMS OASIS	GG0170B3	D1
CMS OASIS	GG0170B1	E
CMS OASIS	GG0170B4	E
CMS OASIS	GG0170B3	E
CMS FASI	GG0170B7	1.0
CMS IRF-PAI	GG0170B1	3.0
CMS IRF-PAI	GG0170B3	3.0
CMS LCDS	GG0170B1	4.00
CMS LCDS	GG0170B3	4.00
CMS IRF-PAI	GG0170B1	4.0
CMS IRF-PAI	GG0170B3	4.0
CMS LCDS	GG0170B1	5.00
CMS LCDS	GG0170B3	5.00
CMS MDS	GG0170B1	1.17.1
CMS MDS	GG0170B3	1.17.1
CMS MDS	GG0170B5	1.17.1
CMS MDS	GG0170B1	1.17.2
CMS MDS	GG0170B3	1.17.2
CMS MDS	GG0170B5	1.17.2

95009-7 Lying to sitting on side of bed

Observation ID in Form

GG0170C1

Form Context

The ability to move from lying on the back to sitting on the side of the bed with feet flat on the floor and with no back support

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Lying to sitting on side of bed - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Lying to sitting on side of bed - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90480-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment]
104608-5	MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170C1	v1.18.11
CMS MDS	GG0170C2	v1.18.11
CMS MDS	GG0170C3	v1.18.11
CMS MDS	GG0170C5	v1.18.11
CMS OASIS	GG0170C1	D
CMS OASIS	GG0170C3	D
CMS OASIS	GG0170C4	D1
CMS OASIS	GG0170C1	D1
CMS OASIS	GG0170C3	D1
CMS OASIS	GG0170C1	E
CMS OASIS	GG0170C4	E
CMS OASIS	GG0170C3	E
CMS FASI	GG0170C7	1.0
CMS IRF-PAI	GG0170C1	3.0
CMS IRF-PAI	GG0170C3	3.0
CMS LCDS	GG0170C1	4.00
CMS LCDS	GG0170C3	4.00
CMS IRF-PAI	GG0170C1	4.0
CMS IRF-PAI	GG0170C3	4.0
CMS LCDS	GG0170C1	5.00
CMS LCDS	GG0170C3	5.00
CMS MDS	GG0170C1	1.17.1
CMS MDS	GG0170C3	1.17.1
CMS MDS	GG0170C5	1.17.1
CMS MDS	GG0170C1	1.17.2
CMS MDS	GG0170C3	1.17.2
CMS MDS	GG0170C5	1.17.2

95008-9 Sit to stand

Observation ID in Form

GG0170D1

Form Context

The ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Sit to stand - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Sit to stand - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90480-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment]
104608-5	MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170D1	v1.18.11
CMS OASIS	GG0170D1	D
CMS OASIS	GG0170D3	D
CMS OASIS	GG0170D4	D1
CMS OASIS	GG0170D1	D1
CMS OASIS	GG0170D3	D1
CMS OASIS	GG0170D1	E
CMS OASIS	GG0170D4	E
CMS OASIS	GG0170D3	E
CMS FASI	GG0170D7	1.0
CMS IRF-PAI	GG0170D1	3.0
CMS IRF-PAI	GG0170D3	3.0
CMS LCDS	GG0170D1	4.00
CMS LCDS	GG0170D3	4.00
CMS IRF-PAI	GG0170D1	4.0
CMS IRF-PAI	GG0170D3	4.0
CMS LCDS	GG0170D1	5.00
CMS LCDS	GG0170D3	5.00
CMS MDS	GG0170D1	1.17.1
CMS MDS	GG0170D3	1.17.1
CMS MDS	GG0170D5	1.17.1
CMS MDS	GG0170D1	1.17.2
CMS MDS	GG0170D3	1.17.2
CMS MDS	GG0170D5	1.17.2

95007-1 Chair/bed-to-chair transfer

Observation ID in Form

GG0170E1

Form Context

The ability to transfer to and from a bed to a chair (or wheelchair)

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Chair &or bed-to-chair transfer - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Chair/bed-to-chair transfer - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90480-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment]
104608-5	MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170E1	v1.18.11
CMS OASIS	GG0170E1	D
CMS OASIS	GG0170E3	D
CMS OASIS	GG0170E4	D1
CMS OASIS	GG0170E1	D1
CMS OASIS	GG0170E3	D1
CMS OASIS	GG0170E1	E
CMS OASIS	GG0170E4	E
CMS OASIS	GG0170E3	E
CMS FASI	GG0170E7	1.0
CMS IRF-PAI	GG0170E1	3.0
CMS IRF-PAI	GG0170E3	3.0
CMS LCDS	GG0170E1	4.00
CMS LCDS	GG0170E3	4.00
CMS IRF-PAI	GG0170E1	4.0
CMS IRF-PAI	GG0170E3	4.0
CMS LCDS	GG0170E1	5.00
CMS LCDS	GG0170E3	5.00
CMS MDS	GG0170E1	1.17.1
CMS MDS	GG0170E3	1.17.1
CMS MDS	GG0170E5	1.17.1
CMS MDS	GG0170E1	1.17.2
CMS MDS	GG0170E3	1.17.2
CMS MDS	GG0170E5	1.17.2

95006-3 Toilet transfer

Observation ID in Form

GG0170F1

Form Context

The ability to get on and off a toilet or commode

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Toilet transfer - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Toilet transfer - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90480-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment]
104608-5	MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170F1	v1.18.11
CMS OASIS	GG0170F3	D
CMS OASIS	M1840	D
CMS OASIS	GG0170F4	D1
CMS OASIS	M1840	D1
CMS OASIS	GG0170F3	D1
CMS OASIS	GG0170F1	E
CMS OASIS	GG0170F4	E
CMS OASIS	GG0170F3	E
CMS FASI	GG0170F7	1.0
CMS IRF-PAI	GG0170F1	3.0
CMS IRF-PAI	GG0170F3	3.0
CMS LCDS	GG0170F1	4.00
CMS LCDS	GG0170F3	4.00
CMS IRF-PAI	GG0170F1	4.0
CMS IRF-PAI	GG0170F3	4.0
CMS LCDS	GG0170F1	5.00
CMS LCDS	GG0170F3	5.00
CMS MDS	GG0170F1	1.17.1
CMS MDS	GG0170F3	1.17.1
CMS MDS	GG0170F5	1.17.1
CMS MDS	GG0170F1	1.17.2
CMS MDS	GG0170F3	1.17.2
CMS MDS	GG0170F5	1.17.2

101325-9 Tub/shower transfer

Observation ID in Form

GG0170FF1

Form Context

The ability to get in and out of a tub/shower

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Tub &or shower transfer - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

MDS v3.0 - RAI v1.18.11 - Tub/shower transfer - functional goal [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.74
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103564-1	MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

95005-5 Car transfer

Observation ID in Form

GG0170G1

Form Context

The ability to transfer in and out of a car or van on the passenger side. Does not include the ability to open/close door or fasten seat belt

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Car transfer - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Car transfer - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170G1	v1.18.11
CMS OASIS	GG0170G1	D
CMS OASIS	GG0170G3	D
CMS OASIS	GG0170G1	D1
CMS OASIS	GG0170G3	D1
CMS OASIS	GG0170G1	E
CMS OASIS	GG0170G3	E
CMS FASI	GG0170G7	1.0
CMS IRF-PAI	GG0170G1	3.0
CMS IRF-PAI	GG0170G3	3.0
CMS IRF-PAI	GG0170G1	4.0
CMS IRF-PAI	GG0170G3	4.0
CMS LCDS	GG0170G1	5.00
CMS LCDS	GG0170G3	5.00
CMS MDS	GG0170G1	1.17.1
CMS MDS	GG0170G3	1.17.1
CMS MDS	GG0170G1	1.17.2
CMS MDS	GG0170G3	1.17.2

95004-8 Walk 10 feet

Observation ID in Form

GG0170I1

Skip Logic

If admission performance is coded 07, 09, 10, or 88, Skip to GG0170M, 1 step (curb)

Form Context

Once standing, the ability to walk at least 10 feet in a room, corridor, or similar space

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Walk 10 feet - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Walk 10 feet - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (NAM)
Change Reason: Release 2.69: COMPONENT: Corrected "Walks" to "Walk" to for consistency across CMS assessment forms.;
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90480-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment]
104608-5	MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170I1	v1.18.11
CMS OASIS	GG0170I1	D
CMS OASIS	GG0170I3	D
CMS OASIS	GG0170I4	D1
CMS OASIS	GG0170I1	D1
CMS OASIS	GG0170I3	D1
CMS OASIS	GG0170I1	E
CMS OASIS	GG0170I4	E
CMS OASIS	GG0170I3	E
CMS FASI	GG0170I7	1.0
CMS LCDS	GG0170I3	5.00
CMS IRF-PAI	GG0170I1	3.0
CMS IRF-PAI	GG0170I3	3.0
CMS LCDS	GG0170I1	4.00
CMS LCDS	GG0170I3	4.00
CMS IRF-PAI	GG0170I1	4.0
CMS IRF-PAI	GG0170I3	4.0
CMS LCDS	GG0170I1	5.00
CMS MDS	GG0170I1	1.17.1
CMS MDS	GG0170I3	1.17.1
CMS MDS	GG0170I5	1.17.1
CMS MDS	GG0170I1	1.17.2
CMS MDS	GG0170I3	1.17.2
CMS MDS	GG0170I5	1.17.2

95003-0 Walk 50 feet with two turns

Observation ID in Form

GG0170J1

Form Context

Once standing, the ability to walk at least 50 feet and make two turns

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Walk 50 feet with two turns - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Walk 50 feet with two turns - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (NAM)
Change Reason: Release 2.69: COMPONENT: Corrected "Walks" to "Walk" to for consistency across CMS assessment forms.;
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90480-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment]
104608-5	MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170J1	v1.18.11
CMS OASIS	GG0170J1	D
CMS OASIS	GG0170J3	D
CMS OASIS	GG0170J4	D1
CMS OASIS	GG0170J1	D1
CMS OASIS	GG0170J3	D1
CMS OASIS	GG0170J1	E
CMS OASIS	GG0170J4	E
CMS OASIS	GG0170J3	E
CMS FASI	GG0170J7	1.0
CMS IRF-PAI	GG0170J1	3.0
CMS IRF-PAI	GG0170J3	3.0
CMS LCDS	GG0170J1	4.00
CMS LCDS	GG0170J3	4.00
CMS IRF-PAI	GG0170J1	4.0
CMS IRF-PAI	GG0170J3	4.0
CMS LCDS	GG0170J1	5.00
CMS LCDS	GG0170J3	5.00
CMS MDS	GG0170J1	1.17.1
CMS MDS	GG0170J3	1.17.1
CMS MDS	GG0170J5	1.17.1
CMS MDS	GG0170J1	1.17.2
CMS MDS	GG0170J3	1.17.2
CMS MDS	GG0170J5	1.17.2

95002-2 Walk 150 feet

Observation ID in Form

GG0170K1

Form Context

Once standing, the ability to walk at least 150 feet in a corridor or similar space

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Walk 150 feet - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Walk 150 feet - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (NAM)
Change Reason: Release 2.69: COMPONENT: Corrected "Walks" to "Walk" to for consistency across CMS assessment forms.;
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90480-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment]
104608-5	MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170K1	v1.18.11
CMS OASIS	GG0170K1	D
CMS OASIS	GG0170K3	D
CMS OASIS	GG0170K1	D1
CMS OASIS	GG0170K3	D1
CMS MDS	GG0170K3	v1.18.11
CMS OASIS	GG0170K1	E
CMS OASIS	GG0170K3	E
CMS FASI	GG0170K7	1.0
CMS IRF-PAI	GG0170K1	3.0
CMS IRF-PAI	GG0170K3	3.0
CMS LCDS	GG0170K1	4.00
CMS LCDS	GG0170K3	4.00
CMS IRF-PAI	GG0170K1	4.0
CMS IRF-PAI	GG0170K3	4.0
CMS LCDS	GG0170K1	5.00
CMS LCDS	GG0170K3	5.00
CMS MDS	GG0170K1	1.17.1
CMS MDS	GG0170K3	1.17.1
CMS MDS	GG0170K5	1.17.1
CMS MDS	GG0170K1	1.17.2
CMS MDS	GG0170K3	1.17.2
CMS MDS	GG0170K5	1.17.2

95001-4 Walking 10 feet on uneven surfaces

Observation ID in Form

GG0170L1

Form Context

The ability to walk 10 feet on uneven or sloping surfaces (indoor or outdoor), such as turf or gravel

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Walking 10 feet on uneven surfaces - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Walking 10 feet on uneven surfaces - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (NAM)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170L1	v1.18.11
CMS OASIS	GG0170L1	D
CMS OASIS	GG0170L3	D
CMS OASIS	GG0170L4	D1
CMS OASIS	GG0170L1	D1
CMS OASIS	GG0170L3	D1
CMS OASIS	GG0170L1	E
CMS OASIS	GG0170L4	E
CMS OASIS	GG0170L3	E
CMS FASI	GG0170L7	1.0
CMS IRF-PAI	GG0170L1	3.0
CMS IRF-PAI	GG0170L3	3.0
CMS IRF-PAI	GG0170L1	4.0
CMS IRF-PAI	GG0170L3	4.0
CMS LCDS	GG0170L1	5.00
CMS LCDS	GG0170L3	5.00
CMS MDS	GG0170L1	1.17.1
CMS MDS	GG0170L3	1.17.1
CMS MDS	GG0170L1	1.17.2
CMS MDS	GG0170L3	1.17.2

95000-6 1 step (curb)

Observation ID in Form

GG0170M1

Skip Logic

If admission performance is coded 07, 09, 10, or 88, Skip to GG0170P, Picking up object

Form Context

The ability to go up and down a curb or up and down one step.

Source: Centers for Medicare & Medicaid Services

Form Context

The ability to go up and down a curb and/or up and down one step

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Go up and down a curb &or step - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Go up and down a curb/step - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170M1	v1.18.11
CMS MDS	GG0170M2	v1.18.11
CMS MDS	GG0170M3	v1.18.11
CMS OASIS	GG0170M1	D
CMS OASIS	GG0170M3	D
CMS OASIS	GG0170M4	D1
CMS OASIS	GG0170M1	D1
CMS OASIS	GG0170M3	D1
CMS OASIS	GG0170M1	E
CMS OASIS	GG0170M4	E
CMS OASIS	GG0170M3	E
CMS FASI	GG0170M7	1.0
CMS IRF-PAI	GG0170M1	3.0
CMS IRF-PAI	GG0170M3	3.0
CMS IRF-PAI	GG0170M1	4.0
CMS IRF-PAI	GG0170M3	4.0
CMS LCDS	GG0170M1	5.00
CMS LCDS	GG0170M3	5.00
CMS MDS	GG0170M1	1.17.1
CMS MDS	GG0170M3	1.17.1
CMS MDS	GG0170M1	1.17.2
CMS MDS	GG0170M3	1.17.2

94999-0 4 steps

Observation ID in Form

GG0170N1

Skip Logic

If admission performance is coded 07, 09, 10, or 88, Skip to GG0170P, Picking up object

Form Context

The ability to go up and down four steps with or without a rail

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Go up and down 4 steps - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Go up and down 4 steps - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170N1	v1.18.11
CMS OASIS	GG0170N1	D
CMS OASIS	GG0170N3	D
CMS OASIS	GG0170N4	D1
CMS OASIS	GG0170N1	D1
CMS OASIS	GG0170N3	D1
CMS OASIS	GG0170N1	E
CMS OASIS	GG0170N4	E
CMS OASIS	GG0170N3	E
CMS FASI	GG0170N7	1.0
CMS IRF-PAI	GG0170N1	3.0
CMS IRF-PAI	GG0170N3	3.0
CMS IRF-PAI	GG0170N1	4.0
CMS IRF-PAI	GG0170N3	4.0
CMS LCDS	GG0170N1	5.00
CMS LCDS	GG0170N3	5.00
CMS MDS	GG0170N1	1.17.1
CMS MDS	GG0170N3	1.17.1
CMS MDS	GG0170N1	1.17.2
CMS MDS	GG0170N3	1.17.2

94998-2 12 steps

Observation ID in Form

GG0170O1

Form Context

The ability to go up and down 12 steps with or without a rail

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Go up and down 12 steps - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Go up and down 12 steps - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170O1	v1.18.11
CMS OASIS	GG0170O1	D
CMS OASIS	GG0170O3	D
CMS OASIS	GG0170O1	D1
CMS OASIS	GG0170O3	D1
CMS OASIS	GG0170O1	E
CMS OASIS	GG0170O3	E
CMS FASI	GG0170O7	1.0
CMS IRF-PAI	GG0170O1	3.0
CMS IRF-PAI	GG0170O3	3.0
CMS IRF-PAI	GG0170O1	4.0
CMS IRF-PAI	GG0170O3	4.0
CMS LCDS	GG0170O1	5.00
CMS LCDS	GG0170O3	5.00
CMS MDS	GG0170O1	1.17.1
CMS MDS	GG0170O3	1.17.1
CMS MDS	GG0170O1	1.17.2
CMS MDS	GG0170O3	1.17.2

94997-4 Picking up object

Observation ID in Form

GG0170P1

Form Context

The ability to bend/stoop from a standing position to pick up a small object, such as a spoon, from the floor

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Picking up object - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Picking up object - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170P1	v1.18.11
CMS OASIS	GG0170P1	D
CMS OASIS	GG0170P3	D
CMS OASIS	GG0170P1	D1
CMS OASIS	GG0170P3	D1
CMS OASIS	GG0170P1	E
CMS OASIS	GG0170P3	E
CMS FASI	GG0170P7	1.0
CMS IRF-PAI	GG0170P1	3.0
CMS IRF-PAI	GG0170P3	3.0
CMS IRF-PAI	GG0170P1	4.0
CMS IRF-PAI	GG0170P3	4.0
CMS LCDS	GG0170P1	5.00
CMS LCDS	GG0170P3	5.00
CMS MDS	GG0170P1	1.17.1
CMS MDS	GG0170P3	1.17.1
CMS MDS	GG0170P1	1.17.2
CMS MDS	GG0170P3	1.17.2

95738-1 Does the resident use a wheelchair and/or scooter?

Observation ID in Form

GG0170Q1

Skip Logic

If 0, skip to GG0130 Self Care (Discharge). If 1, continue to GG0170R. Wheel 50 feet with two turns

Fully-Specified Name

Component: Does the patient use a wheelchair or scooter
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Does the patient use a wheelchair/scooter during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.69
Last Updated: Version 2.69 (ADD)
Order vs. Observation: Observation

Normative Answer List LL251-0

Answer	Code	Score	Answer ID
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)	0		LA32-8
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)	1		LA33-6

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170Q1	v1.18.11
CMS MDS	GG0170Q12	v1.18.11
CMS MDS	GG0170Q3	v1.18.11
CMS MDS	GG0170Q5	v1.18.11
CMS IRF-PAI	GG0170Q1	3.0
CMS IRF-PAI	GG0170Q3	3.0
CMS LCDS	GG0170Q1	4.00
CMS LCDS	GG0170Q3	4.00
CMS IRF-PAI	GG0170Q1	4.0
CMS IRF-PAI	GG0170Q3	4.0
CMS LCDS	GG0170Q1	5.00
CMS LCDS	GG0170Q3	5.00
CMS OASIS	GG0170Q1	E
CMS OASIS	GG0170Q4	E
CMS OASIS	GG0170Q3	E
CMS OASIS	GG0170Q1	D
CMS OASIS	GG0170Q3	D
CMS OASIS	GG0170Q4	D1
CMS OASIS	GG0170Q1	D1
CMS OASIS	GG0170Q3	D1
CMS MDS	GG0170Q1	1.17.1
CMS MDS	GG0170Q3	1.17.1
CMS MDS	GG0170Q1	1.17.2
CMS MDS	GG0170Q3	1.17.2

Third Party Copyright

This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.

Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to https://www.snomed.org/get-snomed or [email protected]<mailto:[email protected]>. This may incur a fee in SNOMED International non-Member countries.

94992-5 Wheel 50 feet with two turns

Observation ID in Form

GG0170R1

Form Context

Once seated in wheelchair/scooter, the ability to wheel at least 50 feet and make two turns

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Wheel 50 feet with two turns - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Wheel 50 feet with two turns - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170R1	v1.18.11
CMS MDS	GG0170R2	v1.18.11
CMS MDS	GG0170R3	v1.18.11
CMS MDS	GG0170R5	v1.18.11
CMS OASIS	GG0170R1	D
CMS OASIS	GG0170R3	D
CMS OASIS	GG0170R4	D1
CMS OASIS	GG0170R1	D1
CMS OASIS	GG0170R3	D1
CMS OASIS	GG0170R1	E
CMS OASIS	GG0170R4	E
CMS OASIS	GG0170R3	E
CMS FASI	GG0175B7	1.0
CMS FASI	GG0175G7	1.0
CMS IRF-PAI	GG0170R1	3.0
CMS IRF-PAI	GG0170R3	3.0
CMS LCDS	GG0170R1	4.00
CMS LCDS	GG0170R3	4.00
CMS IRF-PAI	GG0170R1	4.0
CMS IRF-PAI	GG0170R3	4.0
CMS LCDS	GG0170R1	5.00
CMS LCDS	GG0170R3	5.00
CMS MDS	GG0170R1	1.17.1
CMS MDS	GG0170R3	1.17.1
CMS MDS	GG0170R1	1.17.2
CMS MDS	GG0170R3	1.17.2

95739-9 Indicate the type of wheelchair or scooter used

Observation ID in Form

GG0170RR1

Fully-Specified Name

Component: Indicate the type of wheelchair or scooter used
Property: Type
Time: RptPeriod
System: ^Patient
Scale: Nom
Method: CMS Assessment

Long Common Name

Indicate the type of wheelchair/scooter used during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.69
Last Updated: Version 2.69 (ADD)
Order vs. Observation: Observation

Normative Answer List LL4186-4

Answer	Code	Score	Answer ID
Manual	1		LA19016-7
Motorized	2		LA26847-6

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170RR1	v1.18.11
CMS MDS	GG0170SS1	v1.18.11
CMS MDS	GG0170RR2	v1.18.11
CMS MDS	GG0170SS2	v1.18.11
CMS MDS	GG0170RR3	v1.18.11
CMS MDS	GG0170SS3	v1.18.11
CMS MDS	GG0170RR5	v1.18.11
CMS MDS	GG0170SS5	v1.18.11
CMS IRF-PAI	GG0170RR1	3.0
CMS IRF-PAI	GG0170RR3	3.0
CMS IRF-PAI	GG0170SS1	3.0
CMS IRF-PAI	GG0170SS3	3.0
CMS LCDS	GG0170RR1	4.00
CMS LCDS	GG0170RR3	4.00
CMS LCDS	GG0170SS1	4.00
CMS LCDS	GG0170SS3	4.00
CMS IRF-PAI	GG0170RR1	4.0
CMS IRF-PAI	GG0170SS1	4.0
CMS IRF-PAI	GG0170RR3	4.0
CMS IRF-PAI	GG0170SS3	4.0
CMS LCDS	GG0170RR1	5.00
CMS LCDS	GG0170RR3	5.00
CMS LCDS	GG0170SS1	5.00
CMS LCDS	GG0170SS3	5.00
CMS OASIS	GG0170RR1	E
CMS OASIS	GG0170SS1	E
CMS OASIS	GG0170RR3	E
CMS OASIS	GG0170SS3	E
CMS OASIS	GG0170RR1	D
CMS OASIS	GG0170RR3	D
CMS OASIS	GG0170SS1	D
CMS OASIS	GG0170SS3	D
CMS OASIS	GG0170RR1	D1
CMS OASIS	GG0170RR3	D1
CMS OASIS	GG0170SS1	D1
CMS OASIS	GG0170SS3	D1
CMS MDS	GG0170RR1	1.17.1
CMS MDS	GG0170RR3	1.17.1
CMS MDS	GG0170SS1	1.17.1
CMS MDS	GG0170SS3	1.17.1
CMS MDS	GG0170RR1	1.17.2
CMS MDS	GG0170RR3	1.17.2
CMS MDS	GG0170SS1	1.17.2
CMS MDS	GG0170SS3	1.17.2

94991-7 Wheel 150 feet

Observation ID in Form

GG0170S1

Form Context

Once seated in wheelchair/scooter, the ability to wheel at least 150 feet in a corridor or similar space

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Wheel 150 feet - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Wheel 150 feet - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (NAM)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170S1	v1.18.11
CMS MDS	GG0170S2	v1.18.11
CMS MDS	GG0170S3	v1.18.11
CMS MDS	GG0170S5	v1.18.11
CMS OASIS	GG0170S1	D
CMS OASIS	GG0170S3	D
CMS OASIS	GG0170S1	D1
CMS OASIS	GG0170S3	D1
CMS OASIS	GG0170S1	E
CMS OASIS	GG0170S3	E
CMS FASI	GG0175C7	1.0
CMS FASI	GG0175H7	1.0
CMS IRF-PAI	GG0170S1	3.0
CMS IRF-PAI	GG0170S3	3.0
CMS LCDS	GG0170S1	4.00
CMS LCDS	GG0170S3	4.00
CMS IRF-PAI	GG0170S1	4.0
CMS IRF-PAI	GG0170S3	4.0
CMS LCDS	GG0170S1	5.00
CMS LCDS	GG0170S3	5.00
CMS MDS	GG0170S1	1.17.1
CMS MDS	GG0170S3	1.17.1
CMS MDS	GG0170S1	1.17.2
CMS MDS	GG0170S3	1.17.2

95739-9 Indicate the type of wheelchair or scooter used

Observation ID in Form

GG0170SS1

Fully-Specified Name

Component: Indicate the type of wheelchair or scooter used
Property: Type
Time: RptPeriod
System: ^Patient
Scale: Nom
Method: CMS Assessment

Long Common Name

Indicate the type of wheelchair/scooter used during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.69
Last Updated: Version 2.69 (ADD)
Order vs. Observation: Observation

Normative Answer List LL4186-4

Answer	Code	Score	Answer ID
Manual	1		LA19016-7
Motorized	2		LA26847-6

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170RR1	v1.18.11
CMS MDS	GG0170SS1	v1.18.11
CMS MDS	GG0170RR2	v1.18.11
CMS MDS	GG0170SS2	v1.18.11
CMS MDS	GG0170RR3	v1.18.11
CMS MDS	GG0170SS3	v1.18.11
CMS MDS	GG0170RR5	v1.18.11
CMS MDS	GG0170SS5	v1.18.11
CMS IRF-PAI	GG0170RR1	3.0
CMS IRF-PAI	GG0170RR3	3.0
CMS IRF-PAI	GG0170SS1	3.0
CMS IRF-PAI	GG0170SS3	3.0
CMS LCDS	GG0170RR1	4.00
CMS LCDS	GG0170RR3	4.00
CMS LCDS	GG0170SS1	4.00
CMS LCDS	GG0170SS3	4.00
CMS IRF-PAI	GG0170RR1	4.0
CMS IRF-PAI	GG0170SS1	4.0
CMS IRF-PAI	GG0170RR3	4.0
CMS IRF-PAI	GG0170SS3	4.0
CMS LCDS	GG0170RR1	5.00
CMS LCDS	GG0170RR3	5.00
CMS LCDS	GG0170SS1	5.00
CMS LCDS	GG0170SS3	5.00
CMS OASIS	GG0170RR1	E
CMS OASIS	GG0170SS1	E
CMS OASIS	GG0170RR3	E
CMS OASIS	GG0170SS3	E
CMS OASIS	GG0170RR1	D
CMS OASIS	GG0170RR3	D
CMS OASIS	GG0170SS1	D
CMS OASIS	GG0170SS3	D
CMS OASIS	GG0170RR1	D1
CMS OASIS	GG0170RR3	D1
CMS OASIS	GG0170SS1	D1
CMS OASIS	GG0170SS3	D1
CMS MDS	GG0170RR1	1.17.1
CMS MDS	GG0170RR3	1.17.1
CMS MDS	GG0170SS1	1.17.1
CMS MDS	GG0170SS3	1.17.1
CMS MDS	GG0170RR1	1.17.2
CMS MDS	GG0170RR3	1.17.2
CMS MDS	GG0170SS1	1.17.2
CMS MDS	GG0170SS3	1.17.2

101324-2 Mobility - Discharge Goal (Assessment period is the first 3 days of stay)

Observation ID in Form

GG0170_2

Skip Logic

Complete if A0310A = 01 or A0310B = 01. If A0310B = 01, the stay begins on A2400B and both columns are required. If A0310B = 99, the stay begins on A1600 and only column 1 is required.

Form Coding Instructions

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: MDS v3.0 - RAI v1.18.11 - Mobility - Discharge Goal
Property: -
Time: RptPeriod
System: ^Patient
Scale: -
Method: CMS Assessment

Long Common Name

MDS v3.0 - RAI v1.18.11 - Mobility - Discharge Goal during assessment period [CMS Assessment]

Basic Attributes

Class: PANEL.SURVEY.CMS
Type: Surveys
First Released: Version 2.74
Last Updated: Version 2.75 (PANEL)
Order vs. Observation: Subset
Panel Type: Organizer

Member of these Panels

LOINC	Long Common Name
100997-6	Respiratory Allergen Panel, Area 5 - Serum

89398-2 Roll left and right

Observation ID in Form

GG0170A2

Form Context

The ability to roll from lying on back to left and right side, and return to lying on back on the bed

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Roll left and right - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Roll left and right - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0170A2	E
CMS MDS	GG0170A2	1.17.1
CMS MDS	GG0170A2	1.17.2
CMS MDS	GG0170A2	v1.18.11
CMS MDS	GG0170A3	v1.18.11
CMS MDS	GG0170A5	v1.18.11
CMS IRF-PAI	GG0170A2	3.0
CMS LCDS	GG0170A2	4.00
CMS IRF-PAI	GG0170A2	4.0
CMS LCDS	GG0170A2	5.00
CMS OASIS	GG0170A2	D
CMS OASIS	GG0170A2	D1

89394-1 Sit to lying

Observation ID in Form

GG0170B2

Form Context

The ability to move from sitting on side of bed to lying flat on the bed

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Sit to lying - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Sit to lying - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0170B2	E
CMS MDS	GG0170B2	1.17.1
CMS MDS	GG0170B2	1.17.2
CMS MDS	GG0170B2	v1.18.11
CMS MDS	GG0170B3	v1.18.11
CMS MDS	GG0170B5	v1.18.11
CMS IRF-PAI	GG0170B2	3.0
CMS LCDS	GG0170B2	4.00
CMS IRF-PAI	GG0170B2	4.0
CMS LCDS	GG0170B2	5.00
CMS OASIS	GG0170B2	D
CMS OASIS	GG0170B2	D1

85927-2 Lying to sitting on side of bed

Term Description

Expected functional performance for the patient's usual ability to move from lying on the back to sitting on the side of the bed with feet flat on the floor, and with no back support.

Observation ID in Form

GG0170C2

Form Context

The ability to move from lying on the back to sitting on the side of the bed with feet flat on the floor and with no back support

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Lying to sitting on side of bed - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Lying to sitting on side of bed - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.63
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
86189-8	Deprecated Outcome and assessment information set (OASIS) form - version C2 - Resumption of care [CMS Assessment]
85907-4	Deprecated Outcome and assessment information set (OASIS) form - version C2 - Start of care [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS IRF-PAI	GG0170C2	3.0
CMS LCDS	GG0170C2	4.00
CMS IRF-PAI	GG0170C2	4.0
CMS LCDS	GG0170C2	5.00
CMS MDS	GG0170C2	v1.18.11
CMS MDS	GG0170C3	v1.18.11
CMS MDS	GG0170C5	v1.18.11
CMS OASIS	GG0170C2	E
CMS OASIS	GG0170C2	D
CMS OASIS	GG0170C2	C2
CMS MDS	GG0170C2	1.17.1
CMS MDS	GG0170C2	1.17.2
CMS OASIS	GG0170C2	D1

89392-5 Sit to stand

Observation ID in Form

GG0170D2

Form Context

The ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Sit to stand - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Sit to stand - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0170D2	E
CMS MDS	GG0170D2	1.17.1
CMS MDS	GG0170D2	1.17.2
CMS MDS	GG0170D2	v1.18.11
CMS MDS	GG0170D3	v1.18.11
CMS MDS	GG0170D5	v1.18.11
CMS IRF-PAI	GG0170D2	3.0
CMS LCDS	GG0170D2	4.00
CMS IRF-PAI	GG0170D2	4.0
CMS LCDS	GG0170D2	5.00
CMS OASIS	GG0170D2	D
CMS OASIS	GG0170D2	D1

89414-7 Chair/bed-to-chair transfer

Observation ID in Form

GG0170E2

Form Context

The ability to transfer to and from a bed to a chair (or wheelchair)

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Chair &or bed-to-chair transfer - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Chair/bed-to-chair transfer - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
Change Reason: Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments; Release 2.69: COMPONENT: Updated for consistency across terms and to clarify that assessment is for transfer from a chair and/or bed to a chair.;
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170E3	v1.18.11
CMS MDS	GG0170E5	v1.18.11
CMS OASIS	GG0170E2	E
CMS IRF-PAI	GG0170E2	3.0
CMS LCDS	GG0170E2	4.00
CMS IRF-PAI	GG0170E2	4.0
CMS LCDS	GG0170E2	5.00
CMS MDS	GG0170E2	v1.18.11
CMS OASIS	GG0170E2	D
CMS OASIS	GG0170E2	D1
CMS MDS	GG0170E2	1.17.1
CMS MDS	GG0170E2	1.17.2

89390-9 Toilet transfer

Observation ID in Form

GG0170F2

Form Context

The ability to get on and off a toilet or commode

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Toilet transfer - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Toilet transfer - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0170F2	E
CMS MDS	GG0170F2	1.17.1
CMS MDS	GG0170F2	1.17.2
CMS MDS	GG0170F2	v1.18.11
CMS MDS	GG0170F3	v1.18.11
CMS MDS	GG0170F5	v1.18.11
CMS IRF-PAI	GG0170F2	3.0
CMS LCDS	GG0170F2	4.00
CMS IRF-PAI	GG0170F2	4.0
CMS LCDS	GG0170F2	5.00
CMS OASIS	GG0170F2	D
CMS OASIS	GG0170F2	D1

101325-9 Tub/shower transfer

Observation ID in Form

GG0170FF2

Form Context

The ability to get in and out of a tub/shower

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Tub &or shower transfer - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

MDS v3.0 - RAI v1.18.11 - Tub/shower transfer - functional goal [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.74
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103564-1	MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

89412-1 Car transfer

Observation ID in Form

GG0170G2

Form Context

The ability to transfer in and out of a car or van on the passenger side. Does not include the ability to open/close door or fasten seat belt

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Car transfer - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Car transfer - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0170G2	E
CMS IRF-PAI	GG0170G2	3.0
CMS IRF-PAI	GG0170G2	4.0
CMS LCDS	GG0170G2	5.00
CMS MDS	GG0170G2	v1.18.11
CMS MDS	GG0170G3	v1.18.11
CMS MDS	GG0170G5	v1.18.11
CMS OASIS	GG0170G2	D
CMS OASIS	GG0170G2	D1
CMS MDS	GG0170G2	1.17.1
CMS MDS	GG0170G2	1.17.2

89385-9 Walk 10 feet

Observation ID in Form

GG0170I2

Skip Logic

If discharge performance is coded 07, 09, 10, or 88, Skip to GG0170M, 1 step (curb)

Form Context

Once standing, the ability to walk at least 10 feet in a room, corridor, or similar space

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Walk 10 feet - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Walk 10 feet - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0170I2	E
CMS MDS	GG0170I2	v1.18.11
CMS MDS	GG0170I2	1.17.1
CMS MDS	GG0170I2	1.17.2
CMS MDS	GG0710I2	v1.18.11
CMS MDS	GG0170I3	v1.18.11
CMS MDS	GG0170I5	v1.18.11
CMS IRF-PAI	GG0170I2	3.0
CMS LCDS	GG0170I2	4.00
CMS IRF-PAI	GG0170I2	4.0
CMS LCDS	GG0170I2	5.00
CMS OASIS	GG0170I2	D
CMS OASIS	GG0170I2	D1

89381-8 Walk 50 feet with two turns

Observation ID in Form

GG0170J2

Form Context

Once standing, the ability to walk at least 50 feet and make two turns

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Walk 50 feet with two turns - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Walk 50 feet with two turns - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0170J2	E
CMS IRF-PAI	GG0170J2	3.0
CMS LCDS	GG0170J2	4.00
CMS IRF-PAI	GG0170J2	4.0
CMS LCDS	GG0170J2	5.00
CMS MDS	GG0170J2	1.17.1
CMS MDS	GG0170J2	1.17.2
CMS MDS	GG0170J2	v1.18.11
CMS MDS	GG0170J3	v1.18.11
CMS MDS	GG0170J5	v1.18.11
CMS OASIS	GG0170J2	D
CMS OASIS	GG0170J2	D1

89383-4 Walk 150 feet

Observation ID in Form

GG0170K2

Form Context

Once standing, the ability to walk at least 150 feet in a corridor or similar space

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Walk 150 feet - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Walk 150 feet - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0170K2	E
CMS IRF-PAI	GG0170K2	3.0
CMS LCDS	GG0170K2	4.00
CMS MDS	GG0170K2	1.17.1
CMS MDS	GG0170K2	1.17.2
CMS MDS	GG0170K2	v1.18.11
CMS MDS	KGG	v1.18.11
CMS MDS	GG0170K5	v1.18.11
CMS IRF-PAI	GG0170K2	4.0
CMS LCDS	GG0170K2	5.00
CMS MDS	GG0170K3	v1.18.11
CMS OASIS	GG0170K2	D
CMS OASIS	GG0170K2	D1

89379-2 Walking 10 feet on uneven surfaces

Observation ID in Form

GG0170L2

Form Context

The ability to walk 10 feet on uneven or sloping surfaces (indoor or outdoor), such as turf or gravel

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Walking 10 feet on uneven surfaces - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Walking 10 feet on uneven surfaces - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0170L2	E
CMS IRF-PAI	GG0170L2	3.0
CMS IRF-PAI	GG0170L2	4.0
CMS LCDS	GG0170L2	5.00
CMS MDS	GG0170L2	1.17.1
CMS MDS	GG0170L2	1.17.2
CMS MDS	GG0170L2	v1.18.11
CMS MDS	GG0170L3	v1.18.11
CMS OASIS	GG0170L2	D
CMS OASIS	GG0170L2	D1

89420-4 1 step (curb)

Observation ID in Form

GG0170M2

Skip Logic

If discharge performance is coded 07, 09, 10, or 88, Skip to GG0170P, Picking up object

Form Context

The ability to go up and down a curb or up and down one step.

Source: Centers for Medicare & Medicaid Services

Form Context

The ability to go up and down a curb and/or up and down one step

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Go up and down a curb &or step - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Go up and down a curb/step - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
Change Reason: Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments; Release 2.70: COMPONENT: Updated to align naming of similar concepts across CMS assessments.;
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170M2	v1.18.11
CMS MDS	GG0170M3	v1.18.11
CMS OASIS	GG0170M2	E
CMS IRF-PAI	GG0170M2	3.0
CMS IRF-PAI	GG0170M2	4.0
CMS LCDS	GG0170M2	5.00
CMS OASIS	GG0170M2	D
CMS OASIS	GG0170M2	D1
CMS MDS	GG0170M2	1.17.1
CMS MDS	GG0170M2	1.17.2

89416-2 4 steps

Observation ID in Form

GG0170N2

Skip Logic

If discharge performance is coded 07, 09, 10, or 88, Skip to GG0170P, Picking up object.

Form Context

The ability to go up and down four steps with or without a rail

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Go up and down 4 steps - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Go up and down 4 steps - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170N2	v1.18.11
CMS MDS	GG0170N3	v1.18.11
CMS OASIS	GG0170N2	E
CMS IRF-PAI	GG0170N2	3.0
CMS IRF-PAI	GG0170N2	4.0
CMS LCDS	GG0170N2	5.00
CMS OASIS	GG0170N2	D
CMS OASIS	GG0170N2	D1
CMS MDS	GG0170N2	1.17.1
CMS MDS	GG0170N2	1.17.2

89418-8 12 steps

Observation ID in Form

GG0170O2

Form Context

The ability to go up and down 12 steps with or without a rail

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Go up and down 12 steps - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Go up and down 12 steps - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170O2	v1.18.11
CMS MDS	GG0170O3	v1.18.11
CMS OASIS	GG0170O2	E
CMS IRF-PAI	GG0170O2	3.0
CMS IRF-PAI	GG0170O2	4.0
CMS LCDS	GG0170O2	5.00
CMS OASIS	GG0170O2	D
CMS OASIS	GG0170O2	D1
CMS MDS	GG0170O2	1.17.1
CMS MDS	GG0170O2	1.17.2

89402-2 Picking up object

Observation ID in Form

GG0170P2

Form Context

The ability to bend/stoop from a standing position to pick up a small object, such as a spoon, from the floor

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Picking up object - functional goal
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Picking up object - functional goal during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.64
Last Updated: Version 2.77 (MAJ)
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 LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS OASIS	GG0170P2	E
CMS IRF-PAI	GG0170P2	3.0
CMS IRF-PAI	GG0170P2	4.0
CMS LCDS	GG0170P2	5.00
CMS MDS	GG0170P2	v1.18.11
CMS MDS	GG0170P3	v1.18.11
CMS OASIS	GG0170P2	D
CMS OASIS	GG0170P2	D1
CMS MDS	GG0170P2	1.17.1
CMS MDS	GG0170P2	1.17.2

94992-5 Wheel 50 feet with two turns

Observation ID in Form

GG0170R2

Form Context

Once seated in wheelchair/scooter, the ability to wheel at least 50 feet and make two turns

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Wheel 50 feet with two turns - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Wheel 50 feet with two turns - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (MIN)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88369-4	Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
93058-6	Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9	Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3	Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108296-5	Outcome and assessment information set (OASIS) form - version E2 - Follow Up during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170R1	v1.18.11
CMS MDS	GG0170R2	v1.18.11
CMS MDS	GG0170R3	v1.18.11
CMS MDS	GG0170R5	v1.18.11
CMS OASIS	GG0170R1	D
CMS OASIS	GG0170R3	D
CMS OASIS	GG0170R4	D1
CMS OASIS	GG0170R1	D1
CMS OASIS	GG0170R3	D1
CMS OASIS	GG0170R1	E
CMS OASIS	GG0170R4	E
CMS OASIS	GG0170R3	E
CMS FASI	GG0175B7	1.0
CMS FASI	GG0175G7	1.0
CMS IRF-PAI	GG0170R1	3.0
CMS IRF-PAI	GG0170R3	3.0
CMS LCDS	GG0170R1	4.00
CMS LCDS	GG0170R3	4.00
CMS IRF-PAI	GG0170R1	4.0
CMS IRF-PAI	GG0170R3	4.0
CMS LCDS	GG0170R1	5.00
CMS LCDS	GG0170R3	5.00
CMS MDS	GG0170R1	1.17.1
CMS MDS	GG0170R3	1.17.1
CMS MDS	GG0170R1	1.17.2
CMS MDS	GG0170R3	1.17.2

94991-7 Wheel 150 feet

Observation ID in Form

GG0170S2

Form Context

Once seated in wheelchair/scooter, the ability to wheel at least 150 feet in a corridor or similar space

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Wheel 150 feet - usual functional ability
Property: Find
Time: RptPeriod
System: ^Patient
Scale: Ord
Method: CMS Assessment

Long Common Name

Wheel 150 feet - usual functional ability during assessment period [CMS Assessment]

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.68
Last Updated: Version 2.69 (NAM)
Order vs. Observation: Observation

Normative Answer List LL4681-4

Answer	Code	Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper.	06	LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.	05	LA10073-7
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.	04	LA28225-3
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.	03	LA10055-4
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.	02	LA11759-0
Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity.	01	LA27665-1
Patient refused	07	LA10058-8
Not applicable - Not attempted and the patient did not perform this activity prior to the current illness, exacerbation, or injury.	09	LA28226-1
Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints)	10	LA28227-9
Not attempted due to medical condition or safety concerns	88	LA26735-3

Member of these Panels

LOINC	Long Common Name
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
89963-3	Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
87509-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
87507-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
90473-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
91552-0	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
105175-4	Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6	Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9	Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]
113114-3	Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.4 during assessment period [CMS Assessment]
93128-7	Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
113119-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
113166-3	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 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]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
108256-9	Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment]
108293-2	OASIS E2 - DC during assessment period [CMS Assessment]
88371-0	Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6	Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99178-6	Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99160-4	Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106529-1	Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106525-9	Outcome and assessment information set (OASIS) form - version E1 - Resumption of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
108292-4	Outcome and assessment information set (OASIS) form - version E2 - Resumption of Care during assessment period [CMS Assessment]
108291-6	Outcome and assessment information set (OASIS) form - version E2 - Start of Care during assessment period [CMS Assessment]
100997-6	Respiratory Allergen Panel, Area 5 - Serum

Related Codes

Code System	Code	Code Version
CMS MDS	GG0170S1	v1.18.11
CMS MDS	GG0170S2	v1.18.11
CMS MDS	GG0170S3	v1.18.11
CMS MDS	GG0170S5	v1.18.11
CMS OASIS	GG0170S1	D
CMS OASIS	GG0170S3	D
CMS OASIS	GG0170S1	D1
CMS OASIS	GG0170S3	D1
CMS OASIS	GG0170S1	E
CMS OASIS	GG0170S3	E
CMS FASI	GG0175C7	1.0
CMS FASI	GG0175H7	1.0
CMS IRF-PAI	GG0170S1	3.0
CMS IRF-PAI	GG0170S3	3.0
CMS LCDS	GG0170S1	4.00
CMS LCDS	GG0170S3	4.00
CMS IRF-PAI	GG0170S1	4.0
CMS IRF-PAI	GG0170S3	4.0
CMS LCDS	GG0170S1	5.00
CMS LCDS	GG0170S3	5.00
CMS MDS	GG0170S1	1.17.1
CMS MDS	GG0170S3	1.17.1
CMS MDS	GG0170S1	1.17.2
CMS MDS	GG0170S3	1.17.2

101265-7

Functional Abilities and Goals - Admission

Active

101321-8 Self-Care - Admission Performance

Observation ID in Form

Skip Logic

Form Coding Instructions

Form Coding Instructions

Form Coding Instructions

Fully-Specified Name

Long Common Name

Basic Attributes

Member of these Panels

Related Names

Related Codes

95019-6 Eating

Term Description

Observation ID in Form

Form Context

Fully-Specified Name

Long Common Name

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Normative Answer List LL4681-4

Member of these Panels

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Related Codes

95018-8 Oral hygiene

Observation ID in Form

Form Context

Fully-Specified Name

Long Common Name

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Normative Answer List LL4681-4

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Related Codes

95017-0 Toileting hygiene

Observation ID in Form

Form Context

Fully-Specified Name

Long Common Name

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Normative Answer List LL4681-4

Member of these Panels

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Related Codes

95015-4 Shower/bathe self

Observation ID in Form

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Fully-Specified Name

Long Common Name

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Normative Answer List LL4681-4

Member of these Panels

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Related Codes

95014-7 Upper body dressing

Observation ID in Form

Form Context

Fully-Specified Name

Long Common Name

Basic Attributes

Normative Answer List LL4681-4

Member of these Panels

Related Names

Related Codes

95013-9 Lower body dressing

Observation ID in Form

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Fully-Specified Name

Long Common Name

Basic Attributes

Normative Answer List LL4681-4

Member of these Panels

Related Names

Related Codes

95012-1 Putting on/taking off footwear

Observation ID in Form

Form Context

Fully-Specified Name