106704-0
Symptom Follow-up Visit (SFV)
Active
Form Context
An in-person Symptom Follow-up Visit (SFV) should occur within 2 calendar days as a follow-up for any moderate or severe pain or non-pain symptom identified during Symptom Impact assessment at Admission or HOPE Update Visit (HUV).
Source: Centers for Medicare & Medicaid Services106705-7 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] |
| 107632-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
| 107633-0 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.01 during assessment period [CMS Assessment] |
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.
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] |
| 107632-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
| 107633-0 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.01 during assessment period [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] |
| 107632-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
| 107633-0 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.01 during assessment period [CMS Assessment] |