103991-6
CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
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Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
| LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
|---|---|---|---|---|
| 103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] | |||
| Indent93167-5 | Identification Information | |||
| Indent Indent85396-0 | Facility Information | |||
| Indent Indent Indent76696-4 | Facility Name | |||
| Indent Indent Indent69417-4 | Facility Medicare Provider Number | |||
| Indent Indent45397-7 | Patient Medicare Number | |||
| Indent Indent45400-9 | Patient Medicaid Number | |||
| Indent Indent45392-8 | Patient First Name | |||
| Indent Indent45394-4 | Patient Last Name | |||
| Indent Indent52463-7 | Patient Identification Number | |||
| Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent45396-9 | Social Security Number | |||
| Indent Indent46098-0 | Gender | |||
| Indent Indent45404-1 | Marital Status | |||
| Indent Indent52539-4 | Zip Code of Patient's Pre-Hospital Residence | |||
| Indent Indent52455-3 | Admission Date | {mm/dd/yyyy} | ||
| Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent85397-8 | Admission Class | |||
| Indent Indent85398-6 | Admit From | |||
| Indent Indent85399-4 | Pre-hospital Living Setting | |||
| Indent Indent85400-0 | Pre-hospital Living With | |||
| Indent85401-8 | Payer information | |||
| Indent Indent85813-4 | Payment Source | |||
| Indent Indent Indent85402-6 | Primary Source | |||
| Indent Indent Indent85403-4 | Secondary Source | |||
| Indent87415-6 | Medical Information | |||
| Indent Indent85405-9 | Impairment Group - Admission | |||
| Indent Indent Indent85845-6 | Impairment Group | |||
| Indent Indent85406-7 | Impairment Group - Discharge | |||
| Indent Indent Indent85845-6 | Impairment Group | |||
| Indent Indent52797-8 | Etiologic Diagnosis | 1..3 | ||
| Indent Indent85585-8 | Date of Onset of Impairment | {mm/dd/yyyy} | ||
| Indent Indent75618-9 | Comorbid Conditions | 0..25 | ||
| Indent Indent85407-5 | Are there any arthritis conditions recorded in items #21, #22, or #24 that meet all of the regulatory requirements for IRF classification (in 42 CFR 412.29(b)(2)(x), (xi), and (xii))? | |||
| Indent Indent54567-3 | Height and Weight | |||
| Indent Indent Indent103692-0 | Height on admission (in inches) | [in_us];cm;m | ||
| Indent Indent Indent103693-8 | Weight on admission (in pounds) | [lb_av];kg | ||
| Indent85410-9 | Discharge Information | |||
| Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent85411-7 | Patient discharged against medical advice? | |||
| Indent Indent85412-5 | Program Interruption(s) | |||
| Indent Indent85483-6 | Program Interruption Dates | 0..3 | ||
| Indent Indent Indent85413-3 | Program Interruption Date | 1..1 | {mm/dd/yyyy} | |
| Indent Indent Indent85414-1 | Program Return Date | 1..1 | {mm/dd/yyyy} | |
| Indent Indent85415-8 | Was the patient discharged alive? | |||
| Indent Indent55128-3 | Patient's discharge destination/living setting | |||
| Indent Indent85417-4 | Discharge to Living With | |||
| Indent Indent85418-2 | Diagnosis for Interruption or Death | |||
| Indent Indent85419-0 | Complications during rehabilitation stay | 0..6 | ||
| Indent85420-8 | Therapy Information | |||
| Indent Indent85494-3 | Week 1: Total Number of Minutes Provided | |||
| Indent Indent Indent85566-8 | Physical Therapy | |||
| Indent Indent Indent Indent85557-7 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85558-5 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85559-3 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85560-1 | Total minutes of co-treatment therapy | min | ||
| Indent Indent Indent85561-9 | Occupational Therapy | |||
| Indent Indent Indent Indent85562-7 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85563-5 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85564-3 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85565-0 | Total minutes of co-treatment therapy | min | ||
| Indent Indent Indent85493-5 | Speech-Language Pathology | |||
| Indent Indent Indent Indent85492-7 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85491-9 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85490-1 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85489-3 | Total minutes of co-treatment therapy | min | ||
| Indent Indent85495-0 | Week 2: Total Number of Minutes Provided | |||
| Indent Indent Indent85589-0 | Physical Therapy | |||
| Indent Indent Indent Indent85567-6 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85568-4 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85569-2 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85570-0 | Total minutes of co-treatment therapy | min | ||
| Indent Indent Indent85590-8 | Occupational Therapy | |||
| Indent Indent Indent Indent85571-8 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85572-6 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85573-4 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85574-2 | Total minutes of co-treatment therapy | min | ||
| Indent Indent Indent85591-6 | Speech-Language Pathology | |||
| Indent Indent Indent Indent85575-9 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85576-7 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85577-5 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85578-3 | Total minutes of co-treatment therapy | min | ||
| Indent93171-7 | Quality Indicators - Admission | |||
| Indent Indent93161-8 | Administrative Information | |||
| Indent Indent Indent69854-8 | Ethnicity. Are you of Hispanic, Latino/a, or Spanish origin? | 1..4 | ||
| Indent Indent Indent103708-4 | Race. What is your race? | 1..14 | ||
| Indent Indent Indent93186-5 | Language | |||
| Indent Indent Indent Indent54899-0 | What is your preferred language? | |||
| Indent Indent Indent Indent54588-9 | Do you need or want an interpreter to communicate with a doctor or health care staff? | |||
| Indent Indent Indent101351-5 | Transportation (from NACHC) | |||
| Indent Indent Indent52556-8 | Payer Information | 1..13 | ||
| Indent Indent93165-9 | Hearing, Speech, and Vision | |||
| Indent Indent Indent95744-9 | Hearing | |||
| Indent Indent Indent95745-6 | Vision | |||
| Indent Indent Indent103709-2 | Health Literacy | |||
| Indent Indent Indent95737-3 | Expression of Ideas and Wants | |||
| Indent Indent Indent95740-7 | Understanding Verbal and Non-Verbal Content | |||
| Indent Indent93162-6 | Cognitive patterns | |||
| Indent Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
| Indent Indent Indent103694-6 | Brief Interview for Mental Status | |||
| Indent Indent Indent Indent103696-1 | Repetition of Three Words | |||
| Indent Indent Indent Indent103702-7 | Temporal Orientation | |||
| Indent Indent Indent Indent Indent103697-9 | Able to report correct year | |||
| Indent Indent Indent Indent Indent103698-7 | Able to report correct month | |||
| Indent Indent Indent Indent Indent103703-5 | Able to report correct day of the week | |||
| Indent Indent Indent Indent103695-3 | Recall | |||
| Indent Indent Indent Indent Indent103699-5 | Able to recall "sock" | |||
| Indent Indent Indent Indent Indent103700-1 | Able to recall "blue" | |||
| Indent Indent Indent Indent Indent103701-9 | Able to recall "bed" | |||
| Indent Indent Indent Indent103704-3 | BIMS Summary Score | {score} | ||
| Indent Indent Indent54615-0 | Should the Staff Assessment for Mental Status (C0900) be Conducted? | |||
| Indent Indent Indent95944-5 | Staff Assessment for Mental Status | |||
| Indent Indent Indent Indent95743-1 | Memory/Recall Ability | 1..4 | ||
| Indent Indent Indent95816-5 | Signs and Symptoms of Delirium (from CAM) | |||
| Indent Indent Indent Indent95813-2 | Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the patient's baseline? | |||
| Indent Indent Indent Indent95812-4 | Inattention - Did the patient have difficulty focusing attention, for example being easily distractible or having difficulty keeping track of what was being said? | |||
| Indent Indent Indent Indent95814-0 | Disorganized thinking - Was the patient's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)? | |||
| Indent Indent Indent Indent95815-7 | Altered level of consciousness - Did the patient have altered level of consciousness, as indicated by any of the following criteria? | |||
| Indent Indent93170-9 | Mood | |||
| Indent Indent Indent54635-8 | Patient Mood Interview (PHQ-2 to 9) | |||
| Indent Indent Indent Indent86843-0 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent Indent86844-8 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent103705-0 | Total Severity Score | {score} | ||
| Indent Indent Indent93159-2 | Social Isolation | |||
| Indent Indent103998-1 | Functional Abilities - Admission | |||
| Indent Indent Indent83239-4 | Prior Functioning: Everyday Activities | |||
| Indent Indent Indent Indent85070-1 | Self-Care | |||
| Indent Indent Indent Indent85071-9 | Indoor Mobility (Ambulation) | |||
| Indent Indent Indent Indent85072-7 | Stairs | |||
| Indent Indent Indent Indent85073-5 | Functional Cognition | |||
| Indent Indent Indent83234-5 | Prior Device Use | 1..5 | ||
| Indent Indent Indent95732-4 | Self-Care - Admission Performance | |||
| Indent Indent Indent Indent95019-6 | Eating | |||
| Indent Indent Indent Indent95018-8 | Oral hygiene | |||
| Indent Indent Indent Indent95017-0 | Toileting hygiene | |||
| Indent Indent Indent Indent95015-4 | Shower/bathe self | |||
| Indent Indent Indent Indent95014-7 | Upper body dressing | |||
| Indent Indent Indent Indent95013-9 | Lower body dressing | |||
| Indent Indent Indent Indent95012-1 | Putting on/taking off footwear | |||
| Indent Indent Indent95741-5 | Mobility - Admission Performance | |||
| Indent Indent Indent Indent95011-3 | Roll left and right | |||
| Indent Indent Indent Indent95010-5 | Sit to lying | |||
| Indent Indent Indent Indent95009-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent95008-9 | Sit to stand | |||
| Indent Indent Indent Indent95007-1 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent95006-3 | Toilet transfer | |||
| Indent Indent Indent Indent95005-5 | Car transfer | |||
| Indent Indent Indent Indent95004-8 | Walk 10 feet | |||
| Indent Indent Indent Indent95003-0 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent95002-2 | Walk 150 feet | |||
| Indent Indent Indent Indent95001-4 | Walking 10 feet on uneven surfaces | |||
| Indent Indent Indent Indent95000-6 | 1 step (curb) | |||
| Indent Indent Indent Indent94999-0 | 4 steps | |||
| Indent Indent Indent Indent94998-2 | 12 steps | |||
| Indent Indent Indent Indent94997-4 | Picking up object | |||
| Indent Indent Indent Indent95738-1 | Does the patient use a wheelchair and/or scooter? | |||
| Indent Indent Indent Indent94992-5 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
| Indent Indent Indent Indent94991-7 | Wheel 150 feet | |||
| Indent Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
| Indent Indent95733-2 | Bladder and Bowel | |||
| Indent Indent Indent95735-7 | Bladder Continence | |||
| Indent Indent Indent95736-5 | Bowel Continence | |||
| Indent Indent83264-2 | Active Diagnoses | |||
| Indent Indent Indent83243-6 | Comorbidities and Co-existing Conditions | 1..2 | ||
| Indent Indent93164-2 | Health Conditions | |||
| Indent Indent Indent93156-8 | Pain Effect on Sleep. Over the past 5 days, how much of the time has pain made it hard for you to sleep at night? | |||
| Indent Indent Indent93160-0 | Pain Interference with Therapy Activities. Over the past 5 days, how often have you limited your participation in rehabilitation therapy sessions due to pain? | |||
| Indent Indent Indent93158-4 | Pain Interference with Day-to-Day Activities. Over the past 5 days, how often have you limited your day-to-day activities (excluding rehabilitation therapy sessions) because of pain? | |||
| Indent Indent Indent52552-7 | History of Falls. Has the patient had two or more falls in the past year or any fall with injury in the past year? | |||
| Indent Indent Indent83274-1 | Prior Surgery | |||
| Indent Indent93175-8 | Swallowing/Nutritional Status | |||
| Indent Indent Indent93178-2 | Nutritional Approaches - On Admission. Check all of the following nutritional approaches that apply on admission | 1..4 | ||
| Indent Indent85055-2 | Skin Conditions - Admission | |||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcers/Injuries | |||
| Indent Indent Indent83246-9 | Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage - Admission | |||
| Indent Indent Indent Indent54884-2 | Number of Stage 1 pressure injuries | {#} | ||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers/injuries due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure injuries presenting as deep tissue injury | {#} | ||
| Indent Indent93168-3 | Medications | |||
| Indent Indent Indent93155-0 | High-Risk Drug Classes: Use and Indication | |||
| Indent Indent Indent Indent93153-5 | Is taking. Check if the patient is taking any medications by pharmacological classification, not how it is used, in the following classes | 1..6 | ||
| Indent Indent Indent Indent93154-3 | Indication noted. If column 1 [Is Taking] is checked, check if there is an indication noted for all medications in the drug class | 0..6 | ||
| Indent Indent Indent57255-2 | Drug Regimen Review: Did a complete drug regimen review identify potential clinically significant medication issues? | |||
| Indent Indent Indent57281-8 | Medication Follow-up: Did the facility contact a physician (or physician-designee) by midnight of the next calendar day and complete prescribed/recommended actions in response to the identified potential clinically significant medication issues? | |||
| Indent Indent93173-3 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent83252-7 | Special Treatments, Procedures, and Programs - On Admission. Check all of the following treatments, procedures, and programs that apply on admission | |||
| Indent93172-5 | Quality Indicators - Discharge | |||
| Indent Indent93188-1 | Administrative Information | |||
| Indent Indent Indent101351-5 | Transportation | |||
| Indent Indent Indent93182-4 | Provision of Current Reconciled Medication List to Subsequent Provider at Discharge | |||
| Indent Indent Indent93184-0 | Route of Current Reconciled Medication List Transmission to Subsequent Provider. Indicate the route(s) of transmission of the current reconciled medication list to the subsequent provider | 1..5 | ||
| Indent Indent Indent93181-6 | Provision of Current Reconciled Medication List to Patient at Discharge | |||
| Indent Indent Indent93183-2 | Route of Current Reconciled Medication List Transmission to Patient. Indicate the route(s) of transmission of the current reconciled medication list to the patient/family/caregiver | 1..5 | ||
| Indent Indent93166-7 | Hearing, Speech, and Vision | |||
| Indent Indent Indent103709-2 | Health Literacy | |||
| Indent Indent93163-4 | Cognitive Patterns | |||
| Indent Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
| Indent Indent Indent103694-6 | Brief Interview for Mental Status | |||
| Indent Indent Indent Indent103696-1 | Repetition of Three Words | |||
| Indent Indent Indent Indent103702-7 | Temporal Orientation | |||
| Indent Indent Indent Indent Indent103697-9 | Able to report correct year | |||
| Indent Indent Indent Indent Indent103698-7 | Able to report correct month | |||
| Indent Indent Indent Indent Indent103703-5 | Able to report correct day of the week | |||
| Indent Indent Indent Indent103695-3 | Recall | |||
| Indent Indent Indent Indent Indent103699-5 | Able to recall "sock" | |||
| Indent Indent Indent Indent Indent103700-1 | Able to recall "blue" | |||
| Indent Indent Indent Indent Indent103701-9 | Able to recall "bed" | |||
| Indent Indent Indent Indent103704-3 | BIMS Summary Score | {score} | ||
| Indent Indent Indent95816-5 | Signs and Symptoms of Delirium (from CAM) | |||
| Indent Indent Indent Indent95813-2 | Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the patient's baseline? | |||
| Indent Indent Indent Indent95812-4 | Inattention - Did the patient have difficulty focusing attention, for example being easily distractible or having difficulty keeping track of what was being said? | |||
| Indent Indent Indent Indent95814-0 | Disorganized thinking - Was the patient's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)? | |||
| Indent Indent Indent Indent95815-7 | Altered level of consciousness - Did the patient have altered level of consciousness, as indicated by any of the following criteria? | |||
| Indent Indent93170-9 | Mood | |||
| Indent Indent Indent54635-8 | Patient Mood Interview (PHQ-2 to 9) | |||
| Indent Indent Indent Indent86843-0 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent Indent86844-8 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent103705-0 | Total Severity Score | {score} | ||
| Indent Indent Indent93159-2 | Social Isolation | |||
| Indent Indent103999-9 | Functional Abilities - Discharge | |||
| Indent Indent Indent95734-0 | Self-Care - Discharge Performance | |||
| Indent Indent Indent Indent95019-6 | Eating | |||
| Indent Indent Indent Indent95018-8 | Oral hygiene | |||
| Indent Indent Indent Indent95017-0 | Toileting hygiene | |||
| Indent Indent Indent Indent95015-4 | Shower/bathe self | |||
| Indent Indent Indent Indent95014-7 | Upper body dressing | |||
| Indent Indent Indent Indent95013-9 | Lower body dressing | |||
| Indent Indent Indent Indent95012-1 | Putting on/taking off footwear | |||
| Indent Indent Indent95742-3 | Mobility - Discharge Performance | |||
| Indent Indent Indent Indent95011-3 | Roll left and right | |||
| Indent Indent Indent Indent95010-5 | Sit to lying | |||
| Indent Indent Indent Indent95009-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent95008-9 | Sit to stand | |||
| Indent Indent Indent Indent95007-1 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent95006-3 | Toilet transfer | |||
| Indent Indent Indent Indent95005-5 | Car transfer | |||
| Indent Indent Indent Indent95004-8 | Walk 10 feet | |||
| Indent Indent Indent Indent95003-0 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent95002-2 | Walk 150 feet | |||
| Indent Indent Indent Indent95001-4 | Walking 10 feet on uneven surfaces | |||
| Indent Indent Indent Indent95000-6 | 1 step (curb) | |||
| Indent Indent Indent Indent94999-0 | 4 steps | |||
| Indent Indent Indent Indent94998-2 | 12 steps | |||
| Indent Indent Indent Indent94997-4 | Picking up object | |||
| Indent Indent Indent Indent95738-1 | Does the patient use a wheelchair and/or scooter? | |||
| Indent Indent Indent Indent94992-5 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
| Indent Indent Indent Indent94991-7 | Wheel 150 feet | |||
| Indent Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
| Indent Indent93177-4 | Health Conditions | |||
| Indent Indent Indent93156-8 | Pain Effect on Sleep. Over the past 5 days, how much of the time has pain made it hard for you to sleep at night? | |||
| Indent Indent Indent93160-0 | Pain Interference with Therapy Activities. Over the past 5 days, how often have you limited your participation in rehabilitation therapy sessions due to pain? | |||
| Indent Indent Indent93158-4 | Pain Interference with Day-to-Day Activities. Over the past 5 days, how often have you limited your day-to-day activities (excluding rehabilitation therapy sessions) because of pain? | |||
| Indent Indent Indent83280-8 | Any Falls Since Admission. Has the patient had any falls since admission? | |||
| Indent Indent Indent54854-5 | Number of Falls Since Admission | |||
| Indent Indent Indent Indent54855-2 | No injury | |||
| Indent Indent Indent Indent54856-0 | Injury (except major) | |||
| Indent Indent Indent Indent54857-8 | Major injury | |||
| Indent Indent93176-6 | Swallowing/Nutritional Status | |||
| Indent Indent Indent93180-8 | Nutritional Approaches | |||
| Indent Indent Indent Indent71445-1 | Nutritional Approaches - Last 7 Days. Check all of the nutritional approaches that were received in the last 7 days | 1..4 | ||
| Indent Indent Indent Indent93178-2 | Nutritional Approaches - At Discharge. Check all of the following nutritional approaches that apply at discharge | 1..4 | ||
| Indent Indent88332-2 | Skin Conditions - Discharge | |||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcers/Injuries | |||
| Indent Indent Indent83256-8 | Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage - Discharge | |||
| Indent Indent Indent Indent54884-2 | Number of Stage 1 pressure injuries | {#} | ||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54886-7 | Number of these Stage 2 pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54887-5 | Number of these Stage 3 pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54890-9 | Number of these Stage 4 pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers/injuries due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54894-1 | Number of these unstageable pressure ulcers/injuries that were present upon admission | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54947-7 | Number of these unstageable pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure injuries presenting as deep tissue injury | {#} | ||
| Indent Indent Indent Indent54951-9 | Number of these unstageable pressure injuries that were present upon admission | {#} | ||
| Indent Indent93169-1 | Medications | |||
| Indent Indent Indent93155-0 | High-Risk Drug Classes: Use and Indication | |||
| Indent Indent Indent Indent93153-5 | Is taking. Check if the patient is taking any medications by pharmacological classification, not how it is used, in the following classes | 1..6 | ||
| Indent Indent Indent Indent93154-3 | Indication noted. If column 1 [Is Taking] is checked, check if there is an indication noted for all medications in the drug class | 0..6 | ||
| Indent Indent Indent57256-0 | Did the facility contact and complete physician (or physician-designee) prescribed/recommended actions by midnight of the next calendar day each time potential clinically significant medication issues were identified since the admission? | |||
| Indent Indent93174-1 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent93185-7 | Special Treatments, Procedures, and Programs - At Discharge. Check all of the following treatments, procedures, and programs that apply at discharge | |||
| Indent Indent Indent103568-2 | Patient’s COVID-19 vaccination is up to date. | |||
| Indent85814-2 | Signature of Persons Completing the Assessment | |||
| Indent Indent85647-6 | Signature | |||
| Indent Indent85650-0 | Title | |||
| Indent Indent70158-1 | Date Information is Provided and Time | |||
| Indent85814-2 | Signature of Persons Completing the Assessment | |||
| Indent Indent85647-6 | Signature | |||
| Indent Indent85650-0 | Title | |||
| Indent Indent70158-1 | Date Information is Provided and Time |
Fully-Specified Name
- Component
- CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.2
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.77
- Last Updated
- Version 2.77
- Order vs. Observation
- Order
- Panel Type
- Panel
LOINC Terminology Service (API) using HL7® FHIR® Get Info
Requests to this service require a free LOINC username and password. Below is a sample of the possible capabilities. See the LOINC Terminology Service documentation for more information.
- CodeSystem lookup
- https:
//fhir.loinc.org/CodeSystem/$lookup?system=http: //loinc.org&code=103991-6 - Questionnaire definition
- https:
//fhir.loinc.org/Questionnaire/?url=http: //loinc.org/q/103991-6
LOINC Copyright
Copyright © 2024 Regenstrief Institute, Inc. All Rights Reserved. To the extent included herein, the LOINC table and LOINC codes are copyright