106665-3 Was the patient screened for pain?

Observation ID in Form

J0900A

Skip Logic

If 0, Skip to J0905, Pain Active Problem

Fully-Specified Name

Component
Was the patient screened for pain
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Long Common Name

Was the patient screened for pain during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.80 (ADD)
Order vs. Observation
Observation

Normative Answer List LL251-0

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

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

106666-1 Date of first screening for pain

Observation ID in Form

J0900B

Fully-Specified Name

Component
Date of first screening for pain
Property
Date
Time
RptPeriod
System
^Patient
Scale
Qn
Method
CMS Assessment

Long Common Name

Date of first screening for pain during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.80 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

Example Units

UnitSource
{mm/dd/yyyy}Example UCUM Units

106667-9 The patient’s pain severity was:

Observation ID in Form

J0900C

Fully-Specified Name

Component
Patient's pain severity
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Long Common Name

Patient's pain severity during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.80 (ADD)
Order vs. Observation
Observation

Normative Answer List LL6958-4

AnswerCodeScoreAnswer ID
None Copyright http://snomed.info/sct ID:260413007 None (qualifier value)0LA137-2
Mild1LA6752-5
Moderate Copyright http://snomed.info/sct ID:6736007 Moderate (severity modifier) (qualifier value)2LA6751-7
Severe3LA6750-9
Pain not rated9LA34607-4

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

106669-5 Type of standardized pain tool used:

Observation ID in Form

J0900D

Fully-Specified Name

Component
Type of standardized pain tool used
Property
Find
Time
RptPeriod
System
^Patient
Scale
Nom
Method
CMS Assessment

Long Common Name

Type of standardized pain tool used during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.80 (ADD)
Order vs. Observation
Observation

Normative Answer List LL6959-2

AnswerCodeScoreAnswer ID
Numeric1LA34570-4
Verbal descriptor2LA34608-2
Patient visual3LA34609-0
Staff observation4LA34610-8
No standardized tool used9LA34611-6

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]