103696-1 Repetition of Three Words

Observation ID in Form

C0200

Form Coding Instructions

Ask resident: "I am going to say three words for you to remember. Please repeat the words after I have said all three. The words are: sock, blue, and bed. Now tell me the three words."

Form Coding Instructions

After the resident's first attempt, repeat the words using cues ("sock, something to wear; blue, a color; bed, a piece of furniture"). You may repeat the words up to two more times

Form Context

Number of words repeated after first attempt

Fully-Specified Name

Component

Repetition of three words

Property

Num

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Long Common Name

Repetition of three words during assessment period [CMS Assessment]

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.77

Last Updated

Version 2.77 (ADD)

Order vs. Observation

Observation

Normative Answer List LL687-5

Member of these Panels

Related Names

• 3
• Centers for Medicare and Medicaid Assessment
• Cnt
• Count
• Number
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

Third Party Copyright

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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.

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103702-7 Temporal Orientation

Observation ID in Form

C0300

Form Context

(orientation to year, month, and day)

Fully-Specified Name

Component

Temporal orientation (orientation to year, month, and day)

Property

-

Time

RptPeriod

System

^Patient

Scale

-

Method

CMS Assessment

Long Common Name

Temporal orientation (orientation to year, month, and day) during assessment period [CMS Assessment]

Basic Attributes

Class

PANEL.SURVEY.CMS

Type

Surveys

First Released

Version 2.77

Last Updated

Version 2.81 (PANEL)

Change Reason

Release 2.81: CLASS: Corrected Class for subset organizer;

Order vs. Observation

Subset

Panel Type

Organizer

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Pan
• Panel
• PANEL.SURVEY.CMS
• Panl
• Pnl
• Report period
• Survey
• Temporal orientation (orientation to year, month, and day) - MDSv3

Related Codes

103697-9 Able to report correct year

Observation ID in Form

C0300A

Form Coding Instructions

Ask resident: "Please tell me what year it is right now."

Fully-Specified Name

Component

Temporal orientation - current year

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Long Common Name

Temporal orientation - current year during assessment period [CMS Assessment]

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.77

Last Updated

Version 2.77 (ADD)

Order vs. Observation

Observation

Normative Answer List LL643-8

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

103698-7 Able to report correct month

Observation ID in Form

C0300B

Form Coding Instructions

Ask resident: "What month are we in right now?"

Fully-Specified Name

Component

Temporal orientation - current month

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Long Common Name

Temporal orientation - current month during assessment period [CMS Assessment]

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.77

Last Updated

Version 2.77 (ADD)

Order vs. Observation

Observation

Normative Answer List LL644-6

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

103703-5 Able to report correct day of the week

Observation ID in Form

C0300C

Form Coding Instructions

Ask resident: "What day of the week is today?"

Fully-Specified Name

Component

Temporal orientation - current day of the week

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Long Common Name

Temporal orientation - current day of the week [CMS Assessment]

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.77

Last Updated

Version 2.77 (ADD)

Order vs. Observation

Observation

Normative Answer List LL645-3

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

103695-3 Recall

Observation ID in Form

C0400

Form Coding Instructions

Ask resident: "Let's go back to an earlier question. What were those three words that I asked you to repeat?" If unable to remember a word, give cue (something to wear; a color; a piece of furniture) for that word

Fully-Specified Name

Component

Recall

Property

-

Time

RptPeriod

System

^Patient

Scale

-

Method

CMS Assessment

Long Common Name

Recall during assessment period [CMS Assessment]

Basic Attributes

Class

PANEL.SURVEY.CMS

Type

Surveys

First Released

Version 2.77

Last Updated

Version 2.81 (PANEL)

Change Reason

Release 2.81: CLASS: Corrected Class for subset organizer;

Order vs. Observation

Subset

Panel Type

Organizer

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Pan
• Panel
• PANEL.SURVEY.CMS
• Panl
• Pnl
• Report period
• Survey

Related Codes

103699-5 Able to recall "sock"

Observation ID in Form

C0400A

Fully-Specified Name

Component

Recall - sock

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Long Common Name

Recall - sock during assessment period [CMS Assessment]

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.77

Last Updated

Version 2.77 (ADD)

Order vs. Observation

Observation

Normative Answer List LL646-1

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

103700-1 Able to recall "blue"

Observation ID in Form

C0400B

Fully-Specified Name

Component

Recall - blue

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Long Common Name

Recall - blue during assessment period [CMS Assessment]

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.77

Last Updated

Version 2.77 (ADD)

Order vs. Observation

Observation

Normative Answer List LL647-9

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

103701-9 Able to recall "bed"

Observation ID in Form

C0400C

Fully-Specified Name

Component

Recall - bed

Property

Find

Time

RptPeriod

System

^Patient

Scale

Ord

Method

CMS Assessment

Long Common Name

Recall - bed during assessment period [CMS Assessment]

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.77

Last Updated

Version 2.77 (ADD)

Order vs. Observation

Observation

Normative Answer List LL648-7

Member of these Panels

Related Names

• Centers for Medicare and Medicaid Assessment
• Finding
• Findings
• Ordinal
• Ql
• Qual
• Qualitative
• Report period
• Screen
• Survey

Related Codes

103704-3 BIMS Summary Score

Observation ID in Form

C0500

Form Coding Instructions

Add scores for questions C0200-C0400 and fill in total score (00-15). Enter 99 if the resident was unable to complete interview

Fully-Specified Name

Component

Brief interview for mental status - summary score

Property

Score

Time

RptPeriod

System

^Patient

Scale

Qn

Method

CMS Assessment

Long Common Name

Brief Interview for Mental Status - summary score during assessment period [CMS Assessment]

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.77

Last Updated

Version 2.77 (ADD)

Order vs. Observation

Observation

Member of these Panels

Related Names

• BIMS
• BIMS summary score
• Centers for Medicare and Medicaid Assessment
• QNT
• Quan
• Quant
• Quantitative
• Report period
• Scale
• Scre
• Survey

Example Units

Related Codes