46102-0
Deprecated MDS quarterly assessment form - version 2.0
Deprecated
Status Information
- Status
- DEPRECATED
Reference Information
| Type | Source | Reference |
|---|---|---|
| Original Form | Centers for Medicare & Medicaid Services | Original form upon which the LOINC panel is based. MDS quarterly assessment form |
Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
| LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
|---|---|---|---|---|
| 46102-0 | Deprecated MDS quarterly assessment form - version 2.0 | |||
| Indent45965-1 | Resident Name | |||
| Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent45393-6 | Middle initial | |||
| Indent Indent45395-1 | Jr/Sr | |||
| Indent45403-3 | Room number [Location] | |||
| Indent54593-9 | Assessment reference date - observation end date during assessment period [CMS Assessment] | {mm/dd/yyyy} | ||
| Indent Indent45453-8 | Date of last day of MDS observation period [Minimum Data Set] | |||
| Indent Indent45454-6 | Original or corrected copy of form # [Minimum Data Set] | |||
| Indent45455-3 | Date of reentry to facility [Minimum Data Set] | |||
| Indent46106-1 | Medical record no. | |||
| Indent45482-7 | Deprecated Comatose [CMS Assessment] | |||
| Indent45988-3 | Memory Set | |||
| Indent Indent45483-5 | Short-term memory OK [Minimum Data Set] | |||
| Indent Indent45484-3 | Long-term memory OK [Minimum Data Set] | |||
| Indent45490-0 | Cognitive skills for daily decision making [Minimum Data Set] | |||
| Indent45990-9 | Indicators of delirium - periodic disorded thinking or awareness Set | |||
| Indent Indent45491-8 | Easily distracted [Minimum Data Set] | |||
| Indent Indent45492-6 | Periods of altered perception or awareness of surroundings [Minimum Data Set] | |||
| Indent Indent45493-4 | Episodes of disorganized speech [Minimum Data Set] | |||
| Indent Indent45494-2 | Periods of restlessness [Minimum Data Set] | |||
| Indent Indent45495-9 | Periods of lethargy [Minimum Data Set] | |||
| Indent Indent45496-7 | Mental function varies over the course of the day [Minimum Data Set] | |||
| Indent45510-5 | Making self understood [Minimum Data Set] | |||
| Indent45405-8 | Ability to understand others [Minimum Data Set] | |||
| Indent45997-4 | Indicators of depression, anxiety, sad mood Set | |||
| Indent Indent45998-2 | Verbal expressions of distress Set | |||
| Indent Indent Indent45516-2 | Resident made negative statements [Minimum Data Set] | |||
| Indent Indent Indent45517-0 | Repetitive questions [Minimum Data Set] | |||
| Indent Indent Indent45518-8 | Repetitive verbalizations [Minimum Data Set] | |||
| Indent Indent Indent45519-6 | Persistent anger with self or others [Minimum Data Set] | |||
| Indent Indent Indent45520-4 | Self deprecation [Minimum Data Set] | |||
| Indent Indent Indent45521-2 | Expression of what appear to be unrealistic fears [Minimum Data Set] | |||
| Indent Indent Indent45522-0 | Recurrent statements that something terrible is about to happen [Minimum Data Set] | |||
| Indent Indent Indent45547-7 | Repetitive health complaints [Minimum Data Set] | |||
| Indent Indent Indent45548-5 | Repetitive anxious complaints or concerns [Minimum Data Set] | |||
| Indent Indent45999-0 | Sleep-cycle issues Set | |||
| Indent Indent Indent45549-3 | Unpleasant mood in morning [Minimum Data Set] | |||
| Indent Indent Indent45550-1 | Insomnia/change in sleeping pattern [Minimum Data Set] | |||
| Indent Indent46000-6 | Sad, apethetic, anxious appearance Set | |||
| Indent Indent Indent45551-9 | Sad, pained, or worried facial expressions [Minimum Data Set] | |||
| Indent Indent Indent45552-7 | Crying or tearfulness [Minimum Data Set] | |||
| Indent Indent Indent45553-5 | Repetitive physical movements [Minimum Data Set] | |||
| Indent Indent46107-9 | Loss of interest Set | |||
| Indent Indent Indent45554-3 | Withdrawal from activities of interest [Minimum Data Set] | |||
| Indent Indent Indent45555-0 | Reduced social interaction [Minimum Data Set] | |||
| Indent45556-8 | Mood persistence [Minimum Data Set] | |||
| Indent46001-4 | Behavioral symptoms Set | |||
| Indent Indent45558-4 | Frequency of wandering [Minimum Data Set] | |||
| Indent Indent45559-2 | Alterability of wandering [Minimum Data Set] | |||
| Indent Indent45560-0 | Frequency of verbally abusive behavioral symptoms [Minimum Data Set] | {#} | ||
| Indent Indent45561-8 | Alterability of verbally abusive behavioral symptoms [Minimum Data Set] | |||
| Indent Indent45562-6 | Frequency of physically abusive behavioral symptoms [Minimum Data Set] | {#} | ||
| Indent Indent45563-4 | Alterability of physically abusive behavioral symptoms [Minimum Data Set] | |||
| Indent Indent45564-2 | Frequency of socially inappropriate or disruptive behavioral symptoms [Minimum Data Set] | {#} | ||
| Indent Indent45565-9 | Alterability of socially inappropriate or disruptive behavioral symptoms [Minimum Data Set] | |||
| Indent Indent45566-7 | Frequency of resists care [Minimum Data Set] | {#} | ||
| Indent Indent45567-5 | Alterability of resists care [Minimum Data Set] | |||
| Indent46147-5 | ADL self performance or support (quarterly) Set | |||
| Indent Indent45588-1 | Bed mobility - self-performance during assessment period [CMS Assessment] | |||
| Indent Indent45590-7 | Transfer - self-performance during assessment period [CMS Assessment] | |||
| Indent Indent45592-3 | Walk in room - self-performance during assessment period [CMS Assessment] | |||
| Indent Indent45594-9 | Walk in corridor - self-performance during assessment period [CMS Assessment] | |||
| Indent Indent45596-4 | Locomotion on unit - self-performance during assessment period [CMS Assessment] | |||
| Indent Indent45598-0 | Locomotion off unit - self-performance during assessment period [CMS Assessment] | |||
| Indent Indent45600-4 | Dressing - self-performance during assessment period [CMS Assessment] | |||
| Indent Indent45602-0 | Eating - self-performance during assessment period [CMS Assessment] | |||
| Indent Indent45604-6 | Toilet use - self-performance during assessment period [CMS Assessment] | |||
| Indent Indent45606-1 | Personal hygiene - self-performance during assessment period [CMS Assessment] | |||
| Indent46146-7 | Bathing (quarterly) | |||
| Indent Indent45608-7 | Bathing - self-performance during assessment period [CMS Assessment] | |||
| Indent46010-5 | Functional limitation in range of motion Set | |||
| Indent Indent45524-6 | Range of motion Neck [Minimum Data Set] | |||
| Indent Indent45525-3 | Voluntary movement Neck [Minimum Data Set] | |||
| Indent Indent45526-1 | Range of motion Upper extremity [Minimum Data Set] | |||
| Indent Indent45527-9 | Voluntary movement Upper extremity [Minimum Data Set] | |||
| Indent Indent45528-7 | Range of motion Hand [Minimum Data Set] | |||
| Indent Indent45529-5 | Voluntary movement Hand [Minimum Data Set] | |||
| Indent Indent45530-3 | Range of motion Lower extremity [Minimum Data Set] | |||
| Indent Indent45531-1 | Voluntary movement Lower extremity [Minimum Data Set] | |||
| Indent Indent45532-9 | Range of motion Foot [Minimum Data Set] | |||
| Indent Indent45533-7 | Voluntary movement Foot [Minimum Data Set] | |||
| Indent Indent45534-5 | Other limitation or loss - range of motion [Minimum Data Set] | |||
| Indent Indent45535-2 | Other limitation or loss - voluntary movement [Minimum Data Set] | |||
| Indent46145-9 | Modes of transfer (quarterly) Set | |||
| Indent Indent45541-0 | Bedfast all or most of the time [Minimum Data Set] | |||
| Indent Indent45542-8 | Bed rails used for bed mobility or transfer [Minimum Data Set] | |||
| Indent Indent45546-9 | No mode of transfer [Minimum Data Set] | |||
| Indent46015-4 | Continence self-control categories Set | |||
| Indent Indent45619-4 | Bladder continence [Minimum Data Set] | |||
| Indent Indent45618-6 | Bowel continence [Minimum Data Set] | |||
| Indent46144-2 | Bowel elimination pattern (quarterly) Set | |||
| Indent Indent45623-6 | Fecal impaction [Minimum Data Set] | |||
| Indent Indent45624-4 | Bowel elimination pattern - none of above [Minimum Data Set] | |||
| Indent46143-4 | Continence appliances and programs (quarterly) Set | |||
| Indent Indent45625-1 | Any scheduled toileting plan [Minimum Data Set] | |||
| Indent Indent45626-9 | Bladder retraining program [Minimum Data Set] | |||
| Indent Indent45627-7 | External catheter [Minimum Data Set] | |||
| Indent Indent45628-5 | Indwelling catheter [Minimum Data Set] | |||
| Indent Indent45633-5 | Ostomy present [Minimum Data Set] | |||
| Indent Indent45634-3 | Continence appliances and programs - none of above [Minimum Data Set] | |||
| Indent46142-6 | Infections (quarterly) Set | |||
| Indent Indent45689-7 | Urinary tract infection in last 30 days [Minimum Data Set] | |||
| Indent Indent45692-1 | Infections - none of above [Minimum Data Set] | |||
| Indent46141-8 | Other current diagnoses and ICD9 codes (quarterly) Set | |||
| Indent Indent45693-9 | Other current or more detailed diagnoses and ICD9 codes [Minimum Data Set] | |||
| Indent Indent45958-6 | Other current or more detailed diagnoses and ICD9 codes # 2 [Minimum Data Set] | |||
| Indent46140-0 | Problem conditions (quarterly) Set | |||
| Indent Indent45696-2 | Dehydrated [Minimum Data Set] | |||
| Indent Indent45702-8 | Hallucinations [Minimum Data Set] | |||
| Indent Indent45709-3 | Problem conditions - none of above [Minimum Data Set] | |||
| Indent46033-7 | Pain symptoms Set | |||
| Indent Indent45710-1 | Pain frequency [Minimum Data Set] | |||
| Indent Indent45711-9 | Pain intensity [Minimum Data Set] | |||
| Indent46035-2 | Accidents Set | |||
| Indent Indent45722-6 | Fell in past 30 days [Minimum Data Set] | |||
| Indent Indent45723-4 | Fell in past 31-180 days [Minimum Data Set] | |||
| Indent Indent45724-2 | Hip fracture in last 180 days [Minimum Data Set] | |||
| Indent Indent45725-9 | Other fracture in last 180 days [Minimum Data Set] | |||
| Indent Indent45726-7 | Accidents - none of above [Minimum Data Set] | |||
| Indent46036-0 | Stability of conditions Set | |||
| Indent Indent45727-5 | Conditions/diseases make resident's cognitive, ADL, mood or behavior patterns unstable [Minimum Data Set] | |||
| Indent Indent45728-3 | Resident experiencing an acute episode or a flare-up of a recurrent or chronic problem [Minimum Data Set] | |||
| Indent Indent45729-1 | End-Stage disease, 6 or fewer months to live [Minimum Data Set] | |||
| Indent Indent45730-9 | Stability of conditions - none of above [Minimum Data Set] | |||
| Indent46040-2 | Weight change Set | |||
| Indent Indent45735-8 | Weight loss [Minimum Data Set] | |||
| Indent Indent45736-6 | Weight gain [Minimum Data Set] | |||
| Indent46139-2 | Nutritional approaches (quarterly) Set | |||
| Indent Indent45742-4 | Feeding tube [Minimum Data Set] | |||
| Indent Indent45748-1 | On a planned weight change program [Minimum Data Set] | |||
| Indent Indent45749-9 | Nutritional approaches - none of above [Minimum Data Set] | |||
| Indent46047-7 | Ulcers Set | |||
| Indent Indent45776-2 | Ulcers.stage 1 # [Minimum Data Set] | {#} | ||
| Indent Indent45777-0 | Ulcers.stage 2 # [Minimum Data Set] | {#} | ||
| Indent Indent45778-8 | Ulcers.stage 3 # [Minimum Data Set] | {#} | ||
| Indent Indent45779-6 | Ulcers.stage 4 # [Minimum Data Set] | {#} | ||
| Indent46048-5 | Type of ulcer Set | |||
| Indent Indent45780-4 | Pressure injury stage [Minimum Data Set] | |||
| Indent Indent45781-2 | Stasis ulcer stage [Minimum Data Set] | |||
| Indent46053-5 | Time awake Set | |||
| Indent Indent45808-3 | Awake in morning [Minimum Data Set] | |||
| Indent Indent45809-1 | Awake in afternoon [Minimum Data Set] | |||
| Indent Indent45810-9 | Awake in evening [Minimum Data Set] | |||
| Indent Indent45811-7 | Time awake - none of above [Minimum Data Set] | |||
| Indent45812-5 | Average time involved in activities [Minimum Data Set] | |||
| Indent45833-1 | Number of medications [Minimum Data Set] | {#} | ||
| Indent46058-4 | Days received the following medication Set | |||
| Indent Indent45836-4 | Number of days antipsychotic medication received [Minimum Data Set] | d | ||
| Indent Indent45837-2 | Number of days antianxiety medication received [Minimum Data Set] | d | ||
| Indent Indent45838-0 | Number of days antidepressant medication received [Minimum Data Set] | d | ||
| Indent Indent45839-8 | Number of days hypnotic medication received [Minimum Data Set] | d | ||
| Indent Indent45840-6 | Number of days diuretic medication received [Minimum Data Set] | d | ||
| Indent46067-5 | Devices and restraints Set | |||
| Indent Indent45870-3 | Bed rails - full bed rails on all open sides of bed [Minimum Data Set] | |||
| Indent Indent45871-1 | Bed rails - other types of side rails used [Minimum Data Set] | |||
| Indent Indent45872-9 | Trunk restraint [Minimum Data Set] | |||
| Indent Indent45873-7 | Limb restraint [Minimum Data Set] | |||
| Indent Indent45874-5 | Chair prevents rising [Minimum Data Set] | |||
| Indent45883-6 | Overall change in care needs [Minimum Data Set] |
Fully-Specified Name
- Component
- MDS quarterly assessment form - version 2.0
- Property
- -
- Time
- Pt
- System
- ^Patient
- Scale
- -
- Method
Basic Attributes
- Class
- PANEL.SURVEY.MDS
- Type
- Surveys
- First Released
- Version 2.17
- Last Updated
- Version 2.73
- 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=46102-0 - Questionnaire definition
- https:
//fhir.loinc.org/Questionnaire/?url=http: //loinc.org/q/46102-0
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: bfries@umich.edu
- URL
- http://www.interrai.org
LOINC Copyright
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