Version 2.80

106705-7 Was an in-person SFV completed?

Observation ID in Form

J2052A

Skip Logic

If 0, Skip to J2052C, Reason SFV Not Completed.

Fully-Specified Name

Component
Was an in-person SFV completed
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Long Common Name

Was an in-person SFV completed 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

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
106623-2 Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
106933-5 Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment]

106706-5 Date of in-person SFV

Observation ID in Form

J2052B

Skip Logic

Complete and skip to J2053, SFV Symptom Impact.

Fully-Specified Name

Component
Date of in-person SFV
Property
Date
Time
RptPeriod
System
^Patient
Scale
Qn
Method
CMS Assessment

Long Common Name

Date of in-person SFV 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

LOINC Long Common Name
106623-2 Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
106933-5 Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment]

Example Units

Unit Source
{mm/dd/yyyy} Example UCUM Units

106707-3 Reason SFV Not Completed

Observation ID in Form

J2052C

Skip Logic

Skip to M1190, Skin Conditions.

Fully-Specified Name

Component
Reason SFV Not Completed
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Long Common Name

Reason SFV Not Completed 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 LL6963-4

Answer Code Score Answer ID
Patient and/or caregiver declined an in-person visit. 1 LA34629-8
Patient unavailable (e.g., in ED, hospital, travel outside of service area, expired). 2 LA34630-6
Attempts to contact patient and/or caregiver were unsuccessful. 3 LA34631-4
None of the above 9 LA9-3

Member of these Panels

LOINC Long Common Name
106623-2 Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
106933-5 Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment]