Version 2.77

45970-1 Demographic information section

Observation ID in Form

AB

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Demographic information section
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.68
Order vs. Observation
Order
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

50786-3 Date of entry

Observation ID in Form

AB1

Type of Entry

Question expects user entry - requires response [Q]

Description

Intent: Normally, the MDS Face Sheet (Sections AB and AC) is completed once, when an individual first enters the facility. However, the face sheet is also required if the person is reentering your facility after a discharge where return had not previously been expected. Do not complete the face sheet following temporary discharges to hospitals or after therapeutic leaves/home visits. Given this definition, enter the date the person first became a resident/patient in your facility.

Admission and "bed-hold" policies vary among nursing homes across the country. Likewise, the way in which facilities "open" and "close" resident's medical records also varies. Some facilities choose to "close" a record when a resident is transferred for an overnight stay at an acute care hospital, and "open" a new record when the resident returns to the nursing facility. Other nursing homes maintain the resident's clinical record as open (current) even when the resident is transferred for a temporary hospital stay. For MDS purposes, the date of entry is the date the resident entered the facility for care, regardless of how the facility chooses to "open" or "close" its medical records during the course of the stay.

Definition: Date the stay began - The date the resident was most recently admitted to your facility. For example: if the resident was officially discharged in the past without the expectation of return (e.g., discharged home or to another nursing facility), enter the most recent admission date. However, if your facility begins a new record on each return from a temporary hospital stay or temporary leave, you will complete the face sheet only at the original assessment. Do not complete the face sheet at the time of return from a temporary leave, even if you are required to complete the remainder of the form (e.g., a significant change assessment is required).

Process: Review the clinical record. If dates are unclear or unavailable, ask the admissions office or medical record department at your facility.

Coding: Use all boxes. For a one-digit month or day, place a zero in the first box. For example: February 3, 1994, should be entered as:

02/03/1994 (Month/Day/Year)

Example: Mrs. F, a diabetic, had been living with her daughter when she fractured her left hip during a fall off a footstool. She spent a few days in the local hospital after surgery, followed by an admission to a nursing facility on 5/26/94 for rehabilitation. Three weeks later (6/16/94), Mrs. F was transferred back to the hospital for an infected incision site over her left hip and general state of decline. Mrs. F returned to the nursing home eight days later. In this instance, code the following date on the original face sheet. Rationale: The face sheet sections of the MDS - AB and AC are completed only when the resident first becomes a resident of the facility. In this case there is no need to complete a new face sheet upon return readmission from a temporary hospital stay where the resident is expected to return to the nursing home.

Source: Centers for Medicare & Medicaid Services

Form Consistency Checks

1. If RECTYPE D:
*a. Field is active if AA8a = 08.
b. Field is facility option if AA8a = 06 or 07.

2. For the RECTYPEs listed as facility option and for RECTYPE D with AA8a = 06 or 07, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*3. If this date is present in the record (not blank), it must be earlier than or the same as all of following dates that are present in the record (not blank): P_REC_DT, AT6, AB11, A3a, A4a, R2b, R4, VB2, and VB4. If this date is present, then it must be earlier than or the same as the current date.

4. Additional sequential date relationships involving this date are given in the consistency requirements for the following other dates: AA3.

5. If (a) the record is an admission assessment (AA8a = 01) and (b) no discharge prior to completing the admission assessment (AA8a = 08) has intervened between AB1 and this admission assessment, then:
a. AB1 should not be more than 14 days earlier than R2b.
b. AB1 should not be more than 14 days earlier than VB2.
If either of these relationships is violated, then the MDS assessment process has not been completed in timely fashion and a warning message will be issued.

6. If the record is an admission assessment (AA8a = 01) and the AB1 (admission date) equals the AB1 (admission date) on a prior admission assessment record in the state database, then it appears that a repeat admission assessment has been submitted and a warning message will be issued.

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

Date the stay began. Note - Does not include readmission if record was closed at time of temporary discharge to hospital, etc. In such cases, use prior admission date.

Source: Centers for Medicare & Medicaid Services

Description

The initial date of admission to the facility, or the date the resident most recently returned to your facility after being discharged.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Date of entry
Property
TmStp
Time
Pt
System
^Patient
Scale
Qn
Method

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.22
Last Updated
Version 2.63
Change Reason
Changed Class from SURVEY.MDS to SURVEY.CMS
Order vs. Observation
Observation

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0
86870-3 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed OMRA (NO/SO) item set [CMS Assessment]
86874-5 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed OMRA start of therapy (NS/SS) item set [CMS Assessment]
86875-2 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed tracking (NT/ST) item set [CMS Assessment]
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
86872-9 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
86871-1 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
86873-7 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
86877-8 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home part A PPS discharge (NPE) item set [CMS Assessment]
86856-2 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home PPS (NP) and Nursing home quarterly (NQ) item set [CMS Assessment]
86876-0 Deprecated MDS v3.0 - RAI v1.14.1 - Swing bed PPS (SP) item set [CMS Assessment]
88279-5 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home and Swing bed OMRA (NO and SO) item set [CMS Assessment]
88280-3 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home and Swing bed OMRA start of therapy (NS and SS) item set [CMS Assessment]
88281-1 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home and Swing bed tracking (NT and ST) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88283-7 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
88284-5 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
88285-2 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
88286-0 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home part A PPS discharge (NPE) item set [CMS Assessment]
88287-8 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home PPS (NP) item set [CMS Assessment]
88292-8 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88288-6 Deprecated MDS v3.0 - RAI v1.15.1 - Swing bed PPS (SP) item set [CMS Assessment]
88951-9 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home and Swing bed OMRA (NO and SO) item set [CMS Assessment]
88952-7 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home and Swing bed OMRA start of therapy (NS and SS) item set [CMS Assessment]
88953-5 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home and Swing bed tracking (NT and ST) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88945-1 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
88946-9 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
88947-7 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
88948-5 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home part A PPS discharge (NPE) item set [CMS Assessment]
88949-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home PPS (NP) item set [CMS Assessment]
88955-0 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88950-1 Deprecated MDS v3.0 - RAI v1.16.1 - Swing bed PPS (SP) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90479-7 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home and Swing bed tracking (NT and ST) item set during assessment period [CMS Assessment]
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90481-3 MDS v3.0 - RAI v1.17.1, 1.17.2 - Optional State Assessment (OSA) item set during assessment period [CMS Assessment]
91552-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3 MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
101108-9 MDS v3.0 - RAI v1.18.11 - Nursing home and Swing bed tracking (NT and ST) item set [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101107-1 MDS v3.0 - RAI v1.18.11 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
101109-7 MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
101110-5 MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
101106-3 MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
101113-9 MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
101112-1 MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]

Example Units

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

45410-8 Immediately preceeding this admission, where was the patient?

Observation ID in Form

AB2

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. If RECTYPE D:
*a. Field is active if AA8a = 08.
b. Field is facility option if AA8a = 06 or 07.

2. For the RECTYPEs listed as facility option and for RECTYPE D with AA8a = 06 or 07, the field may be submitted under the optional submission provision given in the Section AB General Notes.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Admitted from (at entry)
Property
Type
Time
Pt
System
Facility
Scale
Nom
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Survey Question

Text
Immediately preceeding this admission, where was the patient?

Normative Answer List LL5-0

Answer Code Score Answer ID
Private home/apt. with no home health services 1 LA24-5
Private home/apt. with home health services 2 LA25-2
Board and care/assisted living group home 3 LA26-0
Nursing Home 4 LA27-8
Acute care hospital 5 LA28-6
Psychiatric hospital, MR/DD facility 6 LA29-4
Rehabilitation hospital 7 LA30-2
Other 8 LA46-8

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45411-6 Lived alone prior to admission [Minimum Data Set]

Observation ID in Form

AB3

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Lived alone prior to admission
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL6-8

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
In other facility 2 LA34-4

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

52539-4 Zip code of prior primary residence

Observation ID in Form

AB4

Fully-Specified Name

Component
Prior postal code
Property
Loc
Time
Pt
System
^Patient
Scale
Nom
Method

Additional Names

Short Name
Prior postal code

Basic Attributes

Class
ADMIN.PATIENT.DEMOG
Type
Clinical
First Released
Version 2.26
Last Updated
Version 2.66
Change Reason
Updated Class from SURVEY.CARE to ADMIN; Updated "ZIP code" in Component name to "Postal code", the more universal nomenclature for this concept.
Order vs. Observation
Both

Member of these Panels

LOINC Long Common Name
103991-6 CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
83265-9 Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.4 [CMS Assessment]
87414-9 Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.5 [CMS Assessment]
88329-8 Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 2.0 [CMS Assessment]
45969-3 Deprecated MDS background information at admission form - version 2.0
89963-3 Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
93128-7 Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]

Language Variants Get Info

Tag Language Translation
es-MX Spanish (Mexico) Código postal anterior:Loc:Punto temporal:^ Paciente:Nominal:
it-IT Italian (Italy) Codice postale precedente:Loc:Pt:^Paziente:Nom:
Synonyms: Amministrativo CAP Dati demografici del paziente Paziente Posizione Punto nel tempo (episodio)
zh-CN Chinese (China) 既往邮政编码:位置:时间点:^患者:名义型:
Synonyms: 分类型应答;分类型结果;名义性;名称型;名词型;名词性;标称性;没有自然次序的名义型或分类型应答 医疗服务对象;客户;病人;病患;病号;超系统 - 病人 地点;场所 既往(过去的、曾用的)邮政编码(邮政区号、邮递区号、邮编);既往邮政区号;既往邮递区号;既往邮编;之前的邮政编码 时刻;随机;随意;瞬间 行政;管理;施行;执行;经营 行政管理(行政、管理、施行、执行、经营).患者(病人、病患、病号、伤病员) 行政管理(行政、管理、施行、执行、经营).患者(病人、病患、病号、伤病员).人口统计学信息(人口统计学、人口统计、人口统计数据、人口统计学数据、人口统计特征、人口统计学特征、个人基本信息、人员基本信息、个人基本资料、个人基本数据) 邮政区号;邮递区号;邮编

45971-9 Residential history 5 years prior to entry Set

Term Description

(Check all settings resident lived in during 5 years prior to date of entry given in item AB1 above)
Source: Regenstrief LOINC

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Residential history 5Y prior to entry
Property
-
Time
Pt
System
^Patient
Scale
Set
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.61
Change Reason
Changed 5 Y to 5Y in Component Name based on current LOINC model.
Order vs. Observation
Order
Panel Type
Organizer

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45412-4 History of prior stay at this nursing home [Minimum Data Set]

Observation ID in Form

AB5a

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AB5f consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
History of prior stay at this nursing home
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45413-2 History of stay in other nursing home [Minimum Data Set]

Observation ID in Form

AB5b

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AB5f consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
History of stay in other nursing home
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45414-0 History of stay in other residential facility [Minimum Data Set]

Observation ID in Form

AB5c

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AB5f consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
History of stay in other residential facility
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45415-7 History of stay at mental health/psychiatric setting [Minimum Data Set]

Observation ID in Form

AB5d

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AB5f consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
History of stay at mental health &or psychiatric setting
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45416-5 History of stay in mental retardation and developmental disabilities setting [Minimum Data Set]

Observation ID in Form

AB5e

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AB5f consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
History of stay in mental retardation and developmental disabilities setting
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.65

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45417-3 None of above

Observation ID in Form

AB5f

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. Value must be 0 (zero) if any AB5a thru AB5e = 1; value must be 1 if each AB5a thru AB5e = 0 (zero); value must be - if any AB5a thru AB5e = - and no AB5a thru AB5e = 1.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
None of the listed prior residential settings
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

21843-8 History of Usual occupation

Term Description

The occupation a person has held for the longest time during his or her life, regardless of the occupation currently held.
Source: Regenstrief LOINC

Observation ID in Form

AB6

Fully-Specified Name

Component
Usual occupation
Property
Hx
Time
Pt
System
^Patient
Scale
Nom
Method

Additional Names

Short Name
Hx of Usual occupation

Basic Attributes

Class
TUMRRGT
Type
Clinical
First Released
Version 1.0m
Last Updated
Version 2.63
Change Reason
Changed the Component from "Usual occupation hx" to "Usual occupation", the Method from "XXX" to methodless, and the Property from "Find" to 'Hx", and added an Answer List to clarify what is being reported.
Order vs. Observation
Both

Preferred Answer List LL3926-4

Externally Defined
Yes
Code System
CDC-PHIN
Code System OID
1.3.6.1.4.1.12009.10.1.2564
Link to External List
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7186

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0
86870-3 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed OMRA (NO/SO) item set [CMS Assessment]
86874-5 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed OMRA start of therapy (NS/SS) item set [CMS Assessment]
86875-2 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed tracking (NT/ST) item set [CMS Assessment]
86522-0 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
86872-9 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
86871-1 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
86873-7 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
86877-8 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home part A PPS discharge (NPE) item set [CMS Assessment]
86856-2 Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home PPS (NP) and Nursing home quarterly (NQ) item set [CMS Assessment]
86876-0 Deprecated MDS v3.0 - RAI v1.14.1 - Swing bed PPS (SP) item set [CMS Assessment]
88279-5 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home and Swing bed OMRA (NO and SO) item set [CMS Assessment]
88280-3 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home and Swing bed OMRA start of therapy (NS and SS) item set [CMS Assessment]
88281-1 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home and Swing bed tracking (NT and ST) item set [CMS Assessment]
88282-9 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88283-7 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
88284-5 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
88285-2 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
88286-0 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home part A PPS discharge (NPE) item set [CMS Assessment]
88287-8 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home PPS (NP) item set [CMS Assessment]
88292-8 Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88288-6 Deprecated MDS v3.0 - RAI v1.15.1 - Swing bed PPS (SP) item set [CMS Assessment]
88951-9 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home and Swing bed OMRA (NO and SO) item set [CMS Assessment]
88952-7 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home and Swing bed OMRA start of therapy (NS and SS) item set [CMS Assessment]
88953-5 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home and Swing bed tracking (NT and ST) item set [CMS Assessment]
88954-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88945-1 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
88946-9 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
88947-7 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
88948-5 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home part A PPS discharge (NPE) item set [CMS Assessment]
88949-3 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home PPS (NP) item set [CMS Assessment]
88955-0 Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88950-1 Deprecated MDS v3.0 - RAI v1.16.1 - Swing bed PPS (SP) item set [CMS Assessment]
54580-6 Deprecated Minimum Data Set - version 3.0
90480-5 MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90479-7 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home and Swing bed tracking (NT and ST) item set during assessment period [CMS Assessment]
90473-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5 MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90481-3 MDS v3.0 - RAI v1.17.1, 1.17.2 - Optional State Assessment (OSA) item set during assessment period [CMS Assessment]
91552-0 MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3 MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
101111-3 MDS v3.0 - RAI v1.18.11 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
101108-9 MDS v3.0 - RAI v1.18.11 - Nursing home and Swing bed tracking (NT and ST) item set [CMS Assessment]
101105-5 MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101107-1 MDS v3.0 - RAI v1.18.11 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
101109-7 MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
101110-5 MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
101106-3 MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
101113-9 MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
101112-1 MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
49083-9 North American Association of Central Cancer Registries, Inc (NAACCR, Inc) version 11 panel
59852-4 North American Association of Central Cancer Registries, Inc (NAACCR, Inc) version 12 panel
80399-9 Occupational exposure information panel
86345-6 U.S. standard certificate of death - recommended 2003 revision set

Language Variants Get Info

Tag Language Translation
es-AR Spanish (Argentina) antecedentes de ocupación usual:hallazgo:punto en el tiempo:^paciente:Nominal:xxx
es-MX Spanish (Mexico) Ocupación usual:Hx:Punto temporal:^ Paciente:Nominal:
it-IT Italian (Italy) Occupazione abituale:Hx:Pt:^Paziente:Nom:
Synonyms: paziente Punto nel tempo (episodio) Registro tumori Storia;Anamnesi
pt-BR Portuguese (Brazil) Ocupação Habitual Hx:Achado:Pt:^Paciente:Nom:XXX
Synonyms: Finding; Findings; Point in time; Random; Nominal; TUMOR REGISTRY(NAACCR); TUMOR REGISTRY(NAACCR)
ru-RU Russian (Russian Federation) Тип занятости:Hx:ТчкВрм:^Пациент:Ном:
Synonyms: История Номинальный;Именной Точка во времени;Момент
zh-CN Chinese (China) 通常职业:历史记录:时间点:^患者:名义型:
Synonyms: NAACCR 肿瘤登记;癌症登记中心北美协会肿瘤登记;肿瘤注册;肿瘤登记(NAACCR);肿瘤登记(癌症登记中心北美协会);癌症登记中心北美协会;North American Association of Central Cancer Registries;NAACCR 一般职业;普通职业;平常职业 分类型应答;分类型结果;名义性;名称型;名词型;名词性;标称性;没有自然次序的名义型或分类型应答 医疗服务对象;客户;病人;病患;病号;超系统 - 病人 历史;史;病史 时刻;随机;随意;瞬间 行业;工作;业务;专业

82589-3 Highest level of education

Part Descriptions

LP72877-1   Highest level of education
The highest level of education attained. Source: Centers for Disease Control and Prevention

Fully-Specified Name

Component
Highest level of education
Property
Hx
Time
Pt
System
^Patient
Scale
Ord
Method

Additional Names

Short Name
Highest level of educ

Basic Attributes

Class
ADMIN.PATIENT.DEMOG
Type
Clinical
First Released
Version 2.58
Last Updated
Version 2.73
Change Reason
Removed the Method of Reported
Order vs. Observation
Observation
Common Test Rank Get Info
294

Normative Answer List LL7-6

Answer Code Score Answer ID
No schooling 1 LA35-1
8th grade/less 2 LA36-9
9-11 grades 3 LA37-7
High school 4 LA38-5
Technical or trade school 5 LA39-3
Some college 6 LA40-1
Bachelor's degree 7 LA41-9
Graduate degree 8 LA42-7

Member of these Panels

LOINC Long Common Name
55169-7 Data Elements for Emergency Department Systems (DEEDS) Release 1.0
55168-9 Data Elements for Emergency Department Systems (DEEDS) Release 1.1
45969-3 Deprecated MDS background information at admission form - version 2.0
99192-7 Patient-reported outcomes with LASIK - pre-operative panel [Patient reported outcomes with LASIK]
93025-5 Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]
98154-8 SARS-CoV-2-related socioeconomic questionnaire for adults

Member of these Groups Get Info

LOINC Group Group Name
LG51306-5 SDOH

Language Variants Get Info

Tag Language Translation
es-MX Spanish (Mexico) El mas alto nivel de educación:Hx:Punto temporal:^ Paciente:Ordinal:
it-IT Italian (Italy) Livello più elevato di istruzione:Hx:Pt:^Paziente:Ord:
Synonyms: Amministrativo Dati demografici del paziente Paziente Punto nel tempo (episodio) Storia;Anamnesi
ru-RU Russian (Russian Federation) Уровень образования:Hx:ТчкВрм:^Пациент:Пор:
Synonyms: История Порядковый Точка во времени;Момент
zh-CN Chinese (China) 文化程度:历史记录:时间点:^患者:序数型:
Synonyms: 依次型;分类顺序型;定性的;序数型(或称等级型);性质上的;有序型;有序性分类应答;有序性分类结果;秩次型;等级型;筛查;顺序型 医疗服务对象;客户;病人;病患;病号;超系统 - 病人 历史;史;病史 教育程度;教育水平;教育等级;受教育程度 时刻;随机;随意;瞬间 程度 等级 级 级别 行政;管理;施行;执行;经营 行政管理(行政、管理、施行、执行、经营).患者(病人、病患、病号、伤病员) 行政管理(行政、管理、施行、执行、经营).患者(病人、病患、病号、伤病员).人口统计学信息(人口统计学、人口统计、人口统计数据、人口统计学数据、人口统计特征、人口统计学特征、个人基本信息、人员基本信息、个人基本资料、个人基本数据)

45972-7 Language Set

Term Description

(Code for correct response)
Source: Regenstrief LOINC

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Language
Property
-
Time
Pt
System
^Patient
Scale
Set
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.52
Order vs. Observation
Order
Panel Type
Organizer

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45402-5 Language.primary

Observation ID in Form

AB8a

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Language.primary
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Additional Names

Short Name
Primary language

Basic Attributes

Class
ADMIN.PATIENT.DEMOG
Type
Clinical
First Released
Version 2.17
Last Updated
Version 2.70
Change Reason
Release 2.70: CLASS: Moved to Clinical, ADMIN.PATIENT.DEMOG as "Primary Language" is a generic concept; EXTERNAL_COPYRIGHT_LINK: Removed Copyright as Primary Language is a generic concept; CLASSTYPE: Moved to Clinical, ADMIN.PATIENT.DEMOG as "Primary Language" is a generic concept;

HL7® Attributes

HL7® Field ID
PID-15

Example Answer List LL8-4

Answer Code Score Answer ID
English LA43-5
French LA45-0
Mandarin LA31373-6
Spanish LA44-3
Tagalog LA15353-8
Vietnamese LA4443-3
Other LA46-8

Member of these Panels

LOINC Long Common Name
96749-7 Association of Asian Pacific Community Health Organizations enabling services and social intervention panel AAPCHO
45969-3 Deprecated MDS background information at admission form - version 2.0

Language Variants Get Info

Tag Language Translation
es-MX Spanish (Mexico) Idioma.primaria:Tipo:Punto temporal:^ Paciente:Nominal:
it-IT Italian (Italy) Lingua. primaria:Osservazione:Pt:^Paziente:Nom:
Synonyms: Amministrativo Dati demografici del paziente Osservazione Paziente Punto nel tempo (episodio)
zh-CN Chinese (China) 语言.主要:发现:时间点:^患者:名义型:
Synonyms: 分类型应答;分类型结果;名义性;名称型;名词型;名词性;标称性;没有自然次序的名义型或分类型应答 医疗服务对象;客户;病人;病患;病号;超系统 - 病人 发现是一个原子型临床观察指标,并不是作为印象的概括陈述。体格检查、病史、系统检查及其他此类观察指标的属性均为发现。它们的标尺对于编码型发现可能是名义型,而对于叙述型文本之中所报告的发现,则可能是叙述型。;发现物;所见;结果;结论 时刻;随机;随意;瞬间 行政;管理;施行;执行;经营 行政管理(行政、管理、施行、执行、经营).患者(病人、病患、病号、伤病员) 行政管理(行政、管理、施行、执行、经营).患者(病人、病患、病号、伤病员).人口统计学信息(人口统计学、人口统计、人口统计数据、人口统计学数据、人口统计特征、人口统计学特征、个人基本信息、人员基本信息、个人基本资料、个人基本数据) 语种 语种.主要

45419-9 Language.other [Minimum Data Set]

Observation ID in Form

AB8b

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. Must not be blank if AB8a = 3; but must be blank if AB8a = -,0,1,2.

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

If Other, specify

Source: Consensus measures for Phenotypes and Exposures

Fully-Specified Name

Component
Language.other
Property
Find
Time
Pt
System
^Patient
Scale
Nar
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45420-7 Mental health history [Minimum Data Set]

Observation ID in Form

AB9

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Mental health history
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45973-5 Conditions related to mental retardation and developmental disabilities status Set

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Conditions related to mental retardation and developmental disabilities status
Property
-
Time
Pt
System
^Patient
Scale
Set
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.65
Order vs. Observation
Order
Panel Type
Organizer

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45421-5 No mental retardation and developmental disabilities [Minimum Data Set]

Observation ID in Form

AB10a

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. If value is 1 then all AB10b thru AB10f must be blank.
*3. If value is 0 (zero) then each AB10b thru AB10f must be 0 (zero), 1, or -.
*4. If value is - then AB10b thru AB10f must consist of at least one -
and the rest 0 (zero).

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
No mental retardation and developmental disabilities
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.65

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
45969-3 Deprecated MDS background information at admission form - version 2.0

45974-3 Mental retardation and developmental disabilities with organic condition Set

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Mental retardation and developmental disabilities with organic condition
Property
-
Time
Pt
System
^Patient
Scale
Set
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.65
Order vs. Observation
Order
Panel Type
Organizer

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45422-3 Down's syndrome [Minimum Data Set]

Observation ID in Form

AB10b

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AB10a consistency notes #2, #3, and #4.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Down's syndrome
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

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
45969-3 Deprecated MDS background information at admission form - version 2.0
54580-6 Deprecated Minimum Data Set - version 3.0

45423-1 Autism [Minimum Data Set]

Observation ID in Form

AB10c

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AB10a consistency notes #2, #3, and #4.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Autism
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

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
45969-3 Deprecated MDS background information at admission form - version 2.0
54580-6 Deprecated Minimum Data Set - version 3.0

45424-9 Epilepsy [Minimum Data Set]

Observation ID in Form

AB10d

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AB10a consistency notes #2, #3, and #4.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Epilepsy
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

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
45969-3 Deprecated MDS background information at admission form - version 2.0
54580-6 Deprecated Minimum Data Set - version 3.0

45425-6 Other organic condition related to mental retardation and developmental disabilities [Minimum Data Set]

Observation ID in Form

AB10e

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AB10a consistency notes #2, #3, and #4.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Other organic condition related to mental retardation and developmental disabilities
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.65

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
45969-3 Deprecated MDS background information at admission form - version 2.0

45426-4 Mental retardation and developmental disabilities with no organic condition [Minimum Data Set]

Observation ID in Form

AB10f

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AB10a consistency notes #2, #3, and #4.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Mental retardation and developmental disabilities with no organic condition
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.65

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
45969-3 Deprecated MDS background information at admission form - version 2.0

45427-2 Date background information form completed [Minimum Data Set]

Observation ID in Form

AB11

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. If this date is present in the record (not blank), it must be earlier than or the same as the current date.

3. Additional sequential date relationships involving this date are given in the consistency requirements for the following other dates: AA3 and AB1.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Date background information form completed
Property
Date
Time
Pt
System
^Patient
Scale
Qn
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45975-0 Customary routine section

Term Description

(Check all that apply. If all information UNKNOWN, check last box only.)(In year prior to DATE OF ENTRY to this nursing home, or year last in community if now being admitted from another nursing home)
Source: Regenstrief LOINC

Observation ID in Form

AC

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Customary routine section
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.68
Order vs. Observation
Order
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45976-8 Customary routine in year prior to date of entry Set

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Customary routine in year prior to date of entry
Property
-
Time
Pt
System
^Patient
Scale
Set
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.52
Order vs. Observation
Order
Panel Type
Organizer

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45977-6 Cycle of daily events Set

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Cycle of daily events
Property
-
Time
Pt
System
^Patient
Scale
Set
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.52
Order vs. Observation
Order
Panel Type
Organizer

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45428-0 Stays up late at night [Minimum Data Set]

Term Description

(e.g., after 9 pm)
Source: Regenstrief LOINC

Observation ID in Form

AC1a

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1h consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Stays up late at night
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45429-8 Naps regularly during day [Minimum Data Set]

Term Description

(at least 1 hour)
Source: Regenstrief LOINC

Observation ID in Form

AC1b

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1h consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Naps regularly during day
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45430-6 Goes out 1 or more days a week [Minimum Data Set]

Observation ID in Form

AC1c

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1h consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Goes out 1 or more D a W
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45431-4 Stays busy with hobbies, reading or fixed daily routine [Minimum Data Set]

Observation ID in Form

AC1d

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1h consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Stays busy with hobbies, reading or fixed daily routine
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45432-2 Spends most time alone or watching TV [Minimum Data Set]

Observation ID in Form

AC1e

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1h consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Spends most time alone or watching TV
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45433-0 Moves independently indoors [Minimum Data Set]

Term Description

(with appliances, if used)
Source: Regenstrief LOINC

Observation ID in Form

AC1f

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1h consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Moves independently indoors
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45434-8 Use of tobacco products at least daily [Minimum Data Set]

Observation ID in Form

AC1g

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1h consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Use of tobacco products at least daily
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

Member of these Groups Get Info

LOINC Group Group Name
LG41856-2 Smoking-related terms

45435-5 None of above

Observation ID in Form

AC1h

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1y consistency note #2.

*3. Value must be 0 (zero) if any AC1a thru AC1g = 1; value must be 1 if each AC1a thru AC1g = 0 (zero); value must be - if any AC1a thru AC1g = - and no AC1a thru AC1g = 1.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
None of the listed cycle of daily events
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45978-4 Eating patterns Set

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Eating patterns
Property
-
Time
Pt
System
^Patient
Scale
Set
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.52
Order vs. Observation
Order
Panel Type
Organizer

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45436-3 Distinct food preferences [Minimum Data Set]

Observation ID in Form

AC1i

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1l consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Distinct food preferences
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45437-1 Eats between meals all or most days [Minimum Data Set]

Observation ID in Form

AC1j

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1l consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Eats between meals all or most D
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45438-9 Use of alcohol at least weekly [Minimum Data Set]

Observation ID in Form

AC1k

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1l consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Use of alcohol at least weekly
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45439-7 None of above

Observation ID in Form

AC1l

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1y consistency note #2.

*3. Value must be 0 (zero) if any AC1i thru AC1k = 1; value must be 1 if each AC1i thru AC1k = 0 (zero); value must be - if any AC1i thru AC1k = - and no Ac1i thru AC1k = 1.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
None of the listed eating patterns
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45979-2 ADL patterns Set

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
ADL patterns
Property
-
Time
Pt
System
^Patient
Scale
Set
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.52
Order vs. Observation
Order
Panel Type
Organizer

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45440-5 In bedclothes much of day [Minimum Data Set]

Observation ID in Form

AC1m

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1r consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
In bedclothes much of day
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45441-3 Wakens to toilet all or most nights [Minimum Data Set]

Observation ID in Form

AC1n

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1r consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Wakens to toilet all or most nights
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45442-1 Has irregular bowel movement pattern [Minimum Data Set]

Observation ID in Form

AC1o

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1r consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Has irregular bowel movement pattern
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45443-9 Showers for bathing [Minimum Data Set]

Observation ID in Form

AC1p

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1r consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Showers for bathing
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45444-7 Bathing in PM [Minimum Data Set]

Observation ID in Form

AC1q

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1r consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Bathing in PM
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45445-4 None of above

Observation ID in Form

AC1r

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1y consistency note #2.

*3. Value must be 0 (zero) if any AC1m thru AC1q = 1; value must be 1 if each AC1m thru AC1q = 0 (zero); value must be - if any AC1m thru AC1q = - and no AC1m thru AC1q = 1.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
None of the listed additional ADL patterns
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45980-0 Involvement patterns Set

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Involvement patterns
Property
-
Time
Pt
System
^Patient
Scale
Set
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.52
Order vs. Observation
Order
Panel Type
Organizer

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45446-2 Daily contact with relatives/close friends [Minimum Data Set]

Observation ID in Form

AC1s

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1x consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Daily contact with relatives &or close friends
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45447-0 Usually attends church, temple, etc. [Minimum Data Set]

Observation ID in Form

AC1t

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1x consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Usually attends church, temple, etc.
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45448-8 Finds strength in faith [Minimum Data Set]

Observation ID in Form

AC1u

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1x consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Finds strength in faith
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45449-6 Daily animal companion/presence [Minimum Data Set]

Observation ID in Form

AC1v

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1x consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Daily animal companion &or presence
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45450-4 Involved in group activities [Minimum Data Set]

Observation ID in Form

AC1w

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1x consistency note #3.
*3. See AC1y consistency note #2.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Involved in group activities
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45451-2 None of above

Observation ID in Form

AC1x

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. See AC1y consistency note #2.

*3. Value must be 0 (zero) if any AC1s thru AC1w = 1; value must be 1 if each AC1s thru AC1w = 0 (zero); value must be - if any AC1s thru AC1w = - and no AC1s thru AC1w = 1.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
None of the listed involvement patterns
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0

45452-0 Unknown customary routine - resident/family unable to provide information [Minimum Data Set]

Observation ID in Form

AC1y

Type of Entry

Question expects user entry - requires response [Q]

Form Consistency Checks

1. For the RECTYPEs listed as facility option, the field may be submitted under the optional submission provision given in the Section AB General Notes.

*2. If value = 1, then each AC1a thru AC1x must be blank or = -; if value = 0 (zero) then at least 1 of AC1a thru AC1x must = 0 (zero) or 1.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Unknown customary routine - resident &or family unable to provide information
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
MDS

Basic Attributes

Class
SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50

Normative Answer List LL50-6

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
UTD LA1-0

Member of these Panels

LOINC Long Common Name
45969-3 Deprecated MDS background information at admission form - version 2.0