45963-6
Deprecated MDS basic assessment tracking form - version 2.0
Deprecated
Status Information
- Status
- DEPRECATED
Term Description
This form contains Identification Information Items 1-9, which consists of identifying information needed to uniquely identify each resident, the nursing facility in which he or she resides, the reason(s) for assessment; and Items AA9 a-l, Signatures of Persons Completing a Portion of the MDS or Tracking form. The information contained on this form must accompany each comprehensive, full, MPAF, or Quarterly assessment, as well as every Distcharge and Reentry Tracking form, submitted electronically to the State MDS database. This includes Federally required assessment records, (e.g., Admission, Annual, Significant Change in Status, and Quarterly assessments), as well as assessments required for Medicare or by the State. This section also contains the Attestation Statement that staff members must sign and date attesting to the accuracy of the portions of the MDS completed by each member of the interdisciplinary team.
Reference Information
| Type | Source | Reference |
|---|---|---|
| Original Form | Centers for Medicare & Medicaid Services | Original form upon which the LOINC panel is based. MDS basic assessment tracking form |
Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
| LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
|---|---|---|---|---|
| 45963-6 | Deprecated MDS basic assessment tracking form - version 2.0 | |||
| Indent45964-4 | Identification information section | |||
| Indent Indent45965-1 | Resident Name | |||
| Indent Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent45395-1 | Jr/Sr | |||
| Indent Indent46098-0 | Gender | |||
| Indent Indent21112-8 | Birth date | {mm/dd/yyyy} | ||
| Indent Indent32624-9 | Race | |||
| Indent Indent45966-9 | Social Security and Medicare numbers | |||
| Indent Indent Indent45396-9 | Social Security number [Identifier] | |||
| Indent Indent Indent45397-7 | Medicare or comparable number | |||
| Indent Indent45967-7 | Facility provider numbers Set | |||
| Indent Indent Indent45398-5 | State provider number for Facility | |||
| Indent Indent Indent45399-3 | Federal provider number Facility | |||
| Indent Indent45400-9 | Medicaid number | |||
| Indent Indent45968-5 | Reasons for assessment (basic) Set | |||
| Indent Indent Indent45408-2 | Primary reason for assessment [Minimum Data Set (MDS) basic] | |||
| Indent Indent Indent45409-0 | Codes for assessments required for Medicare PPS or the State [Minimum Data Set] |
LOINC Names Get Info
- Fully-Specified Name
- MDS basic assessment tracking form - version 2.0:
-: Pt: ^Patient: -: - Long Common Name
- Deprecated MDS basic assessment tracking form - version 2.0
Part Model Get Info
- Component
- MDS basic assessment tracking form - version 2.0
LP75084-1
- Analyte
- MDS basic assessment tracking form - version 2.0
LP75084-1
- Challenge
- NULL
- Adjustment
- NULL
- Count
- NULL
- Property
- -
LP6769-6
- Time
- Pt
LP6960-1
- Time Core
- Pt
LP6960-1
- Time Modifier
- NULL
- System
- ^Patient
LP310005-6
- System Core
- NULL
- Super System
- Patient
LP6985-8
- Scale
- -
LP7747-1
- Method
- NULL
Basic Attributes
- Class
- PANEL.SURVEY.MDS
- Type
- Surveys
- First Released
- Version 2.17
- Last Updated
- Version 2.73 (DEL)
- Change Reason
- Release 2.73: Status: LOINC will keep most current version and one prior version of CMS assessments active and discourage all older versions.;
- 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=45963-6 - Questionnaire definition
- https:
//fhir.loinc.org/Questionnaire/?url=http: //loinc.org/q/45963-6
Copyright
- Organization
- interRAI
- Copyright
- InterRAI holds the copyright to Version 2.0 of the RAI for long term care outside of the US. Supplemental help and contextual information for MDS items in LOINC was derived from Version 2.0 of the RAI/MDS manual, and should not be reproduced outside of the United States without permission of InterRAI. Within the US, Version 2.0 is in the public domain.
- Terms of Use
- As a not for profit corporation under the US Tax Code, interRAI holds the copyright to a number of assessment systems, including the Resident Assessment Instrument (RAI) for long term care facilities outside of the US (the RAI is in the public domain within the US), as well as the assessment systems for Home Care (HC), Assisted Living (AL), Palliative Care (PC), Mental Health (MH) (outside of Canada), and Acute Care (RAI-AC).The scales, algorithms, and case-mix measures based on these assessment instruments cannot be copyrighted and are thus available to everyone (although the individual items on which they are based are usually copyrighted).The major clauses of our royalty-free licenses follow:* the instrument is not to be changed substantially (excepting individual identifiers and demographics); * the license is limited to non-commercial use (i.e., the instrument will not be not incorporated into products to be sold to others); * no royalties will be charged; * the organization will make appropriate efforts to inform others of the copyright status of the instrument; * interRAI's logo and copyright notice are to appear on the form; * authors, author institutions, and translators (as appropriate) are to be acknowledged in any document where authors would regularly be indicated (e.g., publication of a training manual); * publication of any training manual is limited to the period until a commercially-published version is available; * data from use of the instrument are to be shared with interRAI, subject to existing laws on confidentiality.Commercial use usually requires royalties. In this instance, interRAI may omit the data requirement, but retains the other requirements for a logo, attribution, etc.We will be pleased in any contract negotiations to acknowledge the participation of individuals or organizations which have played a substantial role in getting the instrument to the point of implementation.For more information on licensing with interRAI, please contact the president of the Board:Brant E. Fries, Ph.D. Institute of Gerontology University of Michigan 300 North Ingalls Ann Arbor, Michigan USA 48109 Email: [email protected]
- URL
- http://www.interrai.org
LOINC Copyright
Copyright © Regenstrief Institute, Inc. All Rights Reserved. To the extent included herein, the LOINC table and LOINC codes are copyright © Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. See https://