LOINC
Version 2.68

46103-8MDS quarterly assessment form - version 2.0 - optional version for RUG-IIIActive

Panel Hierarchy
Details for each LOINC in Panel LHC-Forms

LOINC Name R/O/C Cardinality Example UCUM Units
46103-8 MDS quarterly assessment form - version 2.0 - optional version for RUG-III
Indent45965-1 Resident Name
IndentIndent45394-4 Last name
IndentIndent45392-8 First name
IndentIndent45393-6 Middle initial
IndentIndent45395-1 Jr/Sr
Indent45403-3 Room number [Location]
Indent45983-4 Assessment reference date Set
IndentIndent45453-8 Date of last day of MDS observation period [Minimum Data Set]
IndentIndent45454-6 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 Comatose [Minimum Data Set]
Indent45988-3 Memory Set
IndentIndent45483-5 Short-term memory OK [Minimum Data Set]
IndentIndent45484-3 Long-term memory OK [Minimum Data Set]
Indent45989-1 Memory recall/ability Set
IndentIndent45485-0 Can recall current season [Minimum Data Set]
IndentIndent45486-8 Can recall location of own room [Minimum Data Set]
IndentIndent45487-6 Can recall staff names/faces [Minimum Data Set]
IndentIndent45488-4 Can recall that he or she is in nursing home [Minimum Data Set]
IndentIndent45489-2 Memory/recall - none of above are recalled [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
IndentIndent45491-8 Easily distracted [Minimum Data Set]
IndentIndent45492-6 Periods of altered perception or awareness of surroundings [Minimum Data Set]
IndentIndent45493-4 Episodes of disorganized speech [Minimum Data Set]
IndentIndent45494-2 Periods of restlessness [Minimum Data Set]
IndentIndent45495-9 Periods of lethargy [Minimum Data Set]
IndentIndent45496-7 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
IndentIndent45998-2 Verbal expressions of distress Set
IndentIndentIndent45516-2 Resident made negative statements [Minimum Data Set]
IndentIndentIndent45517-0 Repetitive questions [Minimum Data Set]
IndentIndentIndent45518-8 Repetitive verbalizations [Minimum Data Set]
IndentIndentIndent45519-6 Persistent anger with self or others [Minimum Data Set]
IndentIndentIndent45520-4 Self deprecation [Minimum Data Set]
IndentIndentIndent45521-2 Expression of what appear to be unrealistic fears [Minimum Data Set]
IndentIndentIndent45522-0 Recurrent statements that something terrible is about to happen [Minimum Data Set]
IndentIndentIndent45547-7 Repetitive health complaints [Minimum Data Set]
IndentIndentIndent45548-5 Repetitive anxious complaints or concerns [Minimum Data Set]
IndentIndent45999-0 Sleep-cycle issues Set
IndentIndentIndent45549-3 Unpleasant mood in morning [Minimum Data Set]
IndentIndentIndent45550-1 Insomnia/change in sleeping pattern [Minimum Data Set]
IndentIndent46000-6 Sad, apethetic, anxious appearance Set
IndentIndentIndent45551-9 Sad, pained, or worried facial expressions [Minimum Data Set]
IndentIndentIndent45552-7 Crying or tearfulness [Minimum Data Set]
IndentIndentIndent45553-5 Repetitive physical movements [Minimum Data Set]
IndentIndent46107-9 Loss of interest Set
IndentIndentIndent45554-3 Withdrawal from activities of interest [Minimum Data Set]
IndentIndentIndent45555-0 Reduced social interaction [Minimum Data Set]
Indent46107-9 Loss of interest Set
IndentIndent45554-3 Withdrawal from activities of interest [Minimum Data Set]
IndentIndent45555-0 Reduced social interaction [Minimum Data Set]
Indent45556-8 Mood persistence [Minimum Data Set]
Indent46001-4 Behavioral symptoms Set
IndentIndent45558-4 Frequency of wandering [Minimum Data Set]
IndentIndent45559-2 Alterability of wandering [Minimum Data Set]
IndentIndent45560-0 Frequency of verbally abusive behavioral symptoms [Minimum Data Set] {#}
IndentIndent45561-8 Alterability of verbally abusive behavioral symptoms [Minimum Data Set]
IndentIndent45562-6 Frequency of physically abusive behavioral symptoms [Minimum Data Set] {#}
IndentIndent45563-4 Alterability of physically abusive behavioral symptoms [Minimum Data Set]
IndentIndent45564-2 Frequency of socially inappropriate or disruptive behavioral symptoms [Minimum Data Set] {#}
IndentIndent45565-9 Alterability of socially inappropriate or disruptive behavioral symptoms [Minimum Data Set]
IndentIndent45566-7 Frequency of resists care [Minimum Data Set] {#}
IndentIndent45567-5 Alterability of resists care [Minimum Data Set]
Indent46007-1 ADL self performance or support Set
IndentIndent45588-1 Bed mobility - self-performance during 7 day assessment period [CMS Assessment]
IndentIndent45589-9 Bed mobility - support provided during 7 day assessment period [CMS Assessment]
IndentIndent45590-7 Transfer - self-performance during 7 day assessment period [CMS Assessment]
IndentIndent45591-5 Transfer - support provided during 7 day assessment period [CMS Assessment]
IndentIndent45592-3 Walk in room - self-performance during 7 day assessment period [CMS Assessment]
IndentIndent45593-1 Walk in room - support provided during 7 day assessment period [CMS Assessment]
IndentIndent45594-9 Walk in corridor - self-performance during 7 day assessment period [CMS Assessment]
IndentIndent45595-6 Walk in corridor - support provided during 7 day assessment period [CMS Assessment]
IndentIndent45596-4 Locomotion on unit - self-performance during 7 day assessment period [CMS Assessment]
IndentIndent45597-2 Locomotion on unit - support provided during 7 day assessment period [CMS Assessment]
IndentIndent45598-0 Locomotion off unit - self-performance during 7 day assessment period [CMS Assessment]
IndentIndent45599-8 Locomotion off unit - support provided during 7 day assessment period [CMS Assessment]
IndentIndent45600-4 Dressing - self-performance during 7 day assessment period [CMS Assessment]
IndentIndent45601-2 Dressing - support provided during 7 day assessment period [CMS Assessment]
IndentIndent45602-0 Eating - self-performance during 7 day assessment period [CMS Assessment]
IndentIndent45603-8 Eating - support provided during 7 day assessment period [CMS Assessment]
IndentIndent45604-6 Toilet use - self-performance during 7 day assessment period [CMS Assessment]
IndentIndent45605-3 Toilet use - support provided during 7 day assessment period [CMS Assessment]
IndentIndent45606-1 Personal hygiene - self-performance during 7 day assessment period [CMS Assessment]
IndentIndent45607-9 Personal hygiene - support provided during 7 day assessment period [CMS Assessment]
Indent46146-7 Bathing (quarterly)
IndentIndent45608-7 Bathing - self-performance during 7 day assessment period [CMS Assessment]
Indent46009-7 Test for balance Set
IndentIndent45610-3 Balance while standing [Minimum Data Set]
IndentIndent45523-8 Balance while sitting - position, trunk control [Minimum Data Set]
Indent46010-5 Functional limitation in range of motion Set
IndentIndent45524-6 Range of motion Neck [Minimum Data Set]
IndentIndent45525-3 Voluntary movement Neck [Minimum Data Set]
IndentIndent45526-1 Range of motion Upper extremity [Minimum Data Set]
IndentIndent45527-9 Voluntary movement Upper extremity [Minimum Data Set]
IndentIndent45528-7 Range of motion Hand [Minimum Data Set]
IndentIndent45529-5 Voluntary movement Hand [Minimum Data Set]
IndentIndent45530-3 Range of motion Lower extremity [Minimum Data Set]
IndentIndent45531-1 Voluntary movement Lower extremity [Minimum Data Set]
IndentIndent45532-9 Range of motion Foot [Minimum Data Set]
IndentIndent45533-7 Voluntary movement Foot [Minimum Data Set]
IndentIndent45534-5 Other limitation or loss - range of motion [Minimum Data Set]
IndentIndent45535-2 Other limitation or loss - voluntary movement [Minimum Data Set]
Indent45611-1 Task segmentation [Minimum Data Set]
Indent46145-9 Modes of transfer (quarterly) Set
IndentIndent45541-0 Bedfast all or most of the time [Minimum Data Set]
IndentIndent45542-8 Bed rails used for bed mobility or transfer [Minimum Data Set]
IndentIndent45546-9 No mode of transfer [Minimum Data Set]
Indent46015-4 Continence self-control categories Set
IndentIndent45619-4 Bladder continence [Minimum Data Set]
IndentIndent45618-6 Bowel continence [Minimum Data Set]
Indent46151-7 Bowel elimination pattern (quarterly RUG-III) Set
IndentIndent45622-8 Diarrhea [Minimum Data Set]
IndentIndent45623-6 Fecal impaction [Minimum Data Set]
IndentIndent45624-4 Bowel elimination pattern - none of above [Minimum Data Set]
Indent46143-4 Continence appliances and programs (quarterly) Set
IndentIndent45625-1 Any scheduled toileting plan [Minimum Data Set]
IndentIndent45626-9 Bladder retraining program [Minimum Data Set]
IndentIndent45627-7 External catheter [Minimum Data Set]
IndentIndent45628-5 Indwelling catheter [Minimum Data Set]
IndentIndent45633-5 Ostomy present [Minimum Data Set]
IndentIndent45634-3 Continence appliances and programs - none of above [Minimum Data Set]
Indent46150-9 Diseases (quarterly RUG-III) Set
IndentIndent45648-3 Hip fracture [Minimum Data Set]
IndentIndent45653-3 Aphasia [Minimum Data Set]
IndentIndent45654-1 Cerebral palsy [Minimum Data Set]
IndentIndent45655-8 Cerebrovascular accident [Minimum Data Set]
IndentIndent45657-4 Hemiplegia or hemiparesis [Minimum Data Set]
IndentIndent45658-2 Multiple sclerosis [Minimum Data Set]
IndentIndent45661-6 Quadriplegia [Minimum Data Set]
IndentIndent45666-5 Depression [Minimum Data Set]
IndentIndent45667-3 Manic depression [Minimum Data Set]
IndentIndent45679-8 None of the listed diseases or conditions [Minimum Data Set]
Indent46028-7 Infections Set
IndentIndent45680-6 Antibiotic resistant infection [Minimum Data Set]
IndentIndent45681-4 Infection with Clostridioides difficile [Minimum Data Set]
IndentIndent45682-2 Conjunctivitis [Minimum Data Set]
IndentIndent45683-0 HIV infection [Minimum Data Set]
IndentIndent45684-8 Pneumonia [Minimum Data Set]
IndentIndent45685-5 Respiratory infection [Minimum Data Set]
IndentIndent45686-3 Septicemia [Minimum Data Set]
IndentIndent45687-1 Sexually transmitted diseases [Minimum Data Set]
IndentIndent45688-9 Tuberculosis [Minimum Data Set]
IndentIndent45689-7 Urinary tract infection in last 30 days [Minimum Data Set]
IndentIndent45690-5 Viral hepatitis [Minimum Data Set]
IndentIndent45691-3 Wound infection [Minimum Data Set]
IndentIndent45692-1 Infections - none of above [Minimum Data Set]
Indent46141-8 Other current diagnoses and ICD9 codes (quarterly) Set
IndentIndent45693-9 Other current or more detailed diagnoses and ICD9 codes [Minimum Data Set]
IndentIndent45958-6 Other current or more detailed diagnoses and ICD9 codes # 2 [Minimum Data Set]
Indent46149-1 Problem conditions (quarterly RUG-III) Set
IndentIndent46031-1 Indicators of fluid status Set
IndentIndentIndent45694-7 Weight gain or loss of 3+ Lbs. within a 7 day period [Minimum Data Set]
IndentIndentIndent45695-4 Inability to lie flat due to shortness of breath [Minimum Data Set]
IndentIndentIndent45696-2 Dehydrated [Minimum Data Set]
IndentIndentIndent45697-0 Insufficient fluid; did NOT consume all or almost all liquids provided during last 3 days [Minimum Data Set]
IndentIndent45698-8 Delusions [Minimum Data Set]
IndentIndent45700-2 Edema [Minimum Data Set]
IndentIndent45701-0 Fever [Minimum Data Set]
IndentIndent45702-8 Hallucinations [Minimum Data Set]
IndentIndent45703-6 Internal bleeding [Minimum Data Set]
IndentIndent45704-4 Recurrent lung aspirations in last 90 days [Minimum Data Set]
IndentIndent45705-1 Shortness of breath [Minimum Data Set]
IndentIndent45707-7 Unsteady gait [Minimum Data Set]
IndentIndent45708-5 Vomiting [Minimum Data Set]
IndentIndent45709-3 Problem conditions - none of above [Minimum Data Set]
Indent46033-7 Pain symptoms Set
IndentIndent45710-1 Pain frequency [Minimum Data Set]
IndentIndent45711-9 Pain intensity [Minimum Data Set]
Indent46035-2 Accidents Set
IndentIndent45722-6 Fell in past 30 days [Minimum Data Set]
IndentIndent45723-4 Fell in past 31-180 days [Minimum Data Set]
IndentIndent45724-2 Hip fracture in last 180 days [Minimum Data Set]
IndentIndent45725-9 Other fracture in last 180 days [Minimum Data Set]
IndentIndent45726-7 Accidents - none of above [Minimum Data Set]
Indent46036-0 Stability of conditions Set
IndentIndent45727-5 Conditions/diseases make resident's cognitive, ADL, mood or behavior patterns unstable [Minimum Data Set]
IndentIndent45728-3 Resident experiencing an acute episode or a flare-up of a recurrent or chronic problem [Minimum Data Set]
IndentIndent45729-1 End-Stage disease, 6 or fewer months to live [Minimum Data Set]
IndentIndent45730-9 Stability of conditions - none of above [Minimum Data Set]
Indent46153-3 Oral problems (quarterly RUG-II) Set
IndentIndent45732-5 Swallowing problem [Minimum Data Set]
IndentIndent45731-7 Chewing problem [Minimum Data Set]
IndentIndent45734-1 Oral problems - none of above [Minimum Data Set]
Indent46039-4 Height and weight Set
IndentIndent3137-7 Body height Measured [in_us];cm
IndentIndent3141-9 Body weight Measured 0..1 [lb_av];kg
Indent46040-2 Weight change Set
IndentIndent45735-8 Weight loss [Minimum Data Set]
IndentIndent45736-6 Weight gain [Minimum Data Set]
Indent46148-3 Nutritional approaches (quarterly RUG-III) Set
IndentIndent45741-6 Parenteral IV [Minimum Data Set]
IndentIndent45742-4 Feeding tube [Minimum Data Set]
IndentIndent45748-1 On a planned weight change program [Minimum Data Set]
IndentIndent45749-9 Nutritional approaches - none of above [Minimum Data Set]
Indent46047-7 Ulcers Set
IndentIndent45776-2 Ulcers.stage 1 # [Minimum Data Set] {#}
IndentIndent45777-0 Ulcers.stage 2 # [Minimum Data Set] {#}
IndentIndent45778-8 Ulcers.stage 3 # [Minimum Data Set] {#}
IndentIndent45779-6 Ulcers.stage 4 # [Minimum Data Set] {#}
Indent46048-5 Type of ulcer Set
IndentIndent45780-4 Pressure injury stage [Minimum Data Set]
IndentIndent45781-2 Stasis ulcer stage [Minimum Data Set]
Indent46049-3 Other skin problems or lesions present Set
IndentIndent45783-8 Abrasions or bruises [Minimum Data Set]
IndentIndent45784-6 Second or third degree burns [Minimum Data Set]
IndentIndent45785-3 Open lesions other than ulcers, rashes, cuts [Minimum Data Set]
IndentIndent45786-1 Rashes [Minimum Data Set]
IndentIndent45787-9 Skin desensitized to pain or pressure [Minimum Data Set]
IndentIndent45788-7 Skin tears or cuts (other than surgery) [Minimum Data Set]
IndentIndent45789-5 Surgical wounds [Minimum Data Set]
IndentIndent45790-3 Other skin problems - none of above [Minimum Data Set]
Indent46050-1 Skin treatments Set
IndentIndent45791-1 Pressure relieving devices for chair [Minimum Data Set]
IndentIndent45792-9 Pressure relieving devices for bed [Minimum Data Set]
IndentIndent45793-7 Turning or repositioning program [Minimum Data Set]
IndentIndent45794-5 Nutrition or hydration intervention to manage skin problems [Minimum Data Set]
IndentIndent45795-2 Ulcer care [Minimum Data Set]
IndentIndent45796-0 Surgical wound care [Minimum Data Set]
IndentIndent45797-8 Application of dressings (with or without topical medications) other than to feet [Minimum Data Set]
IndentIndent45798-6 Application of ointments or medications other than to feet [Minimum Data Set]
IndentIndent45799-4 Other preventative or protective skin care other than to feet [Minimum Data Set]
IndentIndent45800-0 Skin treatments - none of above [Minimum Data Set]
Indent46051-9 Foot problems and care Set
IndentIndent45801-8 One or more foot problems [Minimum Data Set]
IndentIndent45802-6 Infection of foot [Minimum Data Set]
IndentIndent45803-4 Open lesions on the foot [Minimum Data Set]
IndentIndent45804-2 Nails/calluses trimmed during last 90 days [Minimum Data Set]
IndentIndent45805-9 Received preventative or protective foot care [Minimum Data Set]
IndentIndent45806-7 Application of dressings (foot) - with or without topical medications [Minimum Data Set]
IndentIndent45807-5 Foot problems and care - none of above [Minimum Data Set]
Indent46053-5 Time awake Set
IndentIndent45808-3 Awake in morning [Minimum Data Set]
IndentIndent45809-1 Awake in afternoon [Minimum Data Set]
IndentIndent45810-9 Awake in evening [Minimum Data Set]
IndentIndent45811-7 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
IndentIndent45836-4 Number of days antipsychotic medication received [Minimum Data Set] d
IndentIndent45837-2 Number of days antianxiety medication received [Minimum Data Set] d
IndentIndent45838-0 Number of days antidepressant medication received [Minimum Data Set] d
IndentIndent45839-8 Number of days hypnotic medication received [Minimum Data Set] d
IndentIndent45840-6 Number of days diuretic medication received [Minimum Data Set] d
Indent46060-0 Special treatments, procedures and programs Set
IndentIndent46061-8 Special care Set
IndentIndentIndent46062-6 Treatments Set
IndentIndentIndentIndent45841-4 Chemotherapy [Minimum Data Set]
IndentIndentIndentIndent45842-2 Dialysis [Minimum Data Set]
IndentIndentIndentIndent45843-0 IV medication [Minimum Data Set]
IndentIndentIndentIndent45844-8 Intake/output [Minimum Data Set]
IndentIndentIndentIndent45845-5 Monitoring of acute medical condition [Minimum Data Set]
IndentIndentIndentIndent45846-3 Ostomy care [Minimum Data Set]
IndentIndentIndentIndent45847-1 Oxygen therapy [Minimum Data Set]
IndentIndentIndentIndent45848-9 Radiation [Minimum Data Set]
IndentIndentIndentIndent45849-7 Suctioning [Minimum Data Set]
IndentIndentIndentIndent45850-5 Tracheostomy care [Minimum Data Set]
IndentIndentIndentIndent45851-3 Transfusions [Minimum Data Set]
IndentIndentIndentIndent45752-3 Ventilator or respirator [Minimum Data Set]
IndentIndentIndent46063-4 Programs Set
IndentIndentIndentIndent45753-1 Alcohol or drug treatment program
IndentIndentIndentIndent45754-9 Alzheimer's or dementia special care unit [Minimum Data Set]
IndentIndentIndentIndent45755-6 Hospice care [Minimum Data Set]
IndentIndentIndentIndent45756-4 Pediatric unit [Minimum Data Set]
IndentIndentIndentIndent45757-2 Respite care [Minimum Data Set]
IndentIndentIndentIndent45758-0 Training in skills required to return to the community [Minimum Data Set]
IndentIndentIndentIndent45759-8 Special treatments/programs - none of above [Minimum Data Set]
IndentIndent46064-2 Therapies Set
IndentIndentIndent45760-6 Number of days with at least 15 minutes of speech language pathology and audiology services in the last 7 days [CMS Assessment] d/(7.d)
IndentIndentIndent45761-4 Total minutes of speech language pathology and audiology services in the last 7 days [Minimum Data Set] min
IndentIndentIndent45762-2 Number of days with at least 15 minutes of occupational therapy in the last 7 days [CMS Assessment] d/(7.d)
IndentIndentIndent45763-0 Total minutes of occupational therapy in the last 7 days [Minimum Data Set] min
IndentIndentIndent45764-8 Number of days with at least 15 minutes of physical therapy in the last 7 days [CMS Assessment] d/(7.d)
IndentIndentIndent45765-5 Total minutes of physical therapy in the last 7 days [Minimum Data Set] min
IndentIndentIndent45766-3 Number of days with at least 15 minutes of respiratory therapy in the last 7 days [CMS Assessment] d/(7.d)
IndentIndentIndent45767-1 Total minutes of respiratory therapy in the last 7 days [CMS Assessment] min
IndentIndentIndent45768-9 Number of days with at least 15 minutes of psychological therapy by any licensed mental health professional in the last 7 days [CMS Assessment] d/(7.d)
IndentIndentIndent45852-1 Total minutes of psychological therapy by any licensed mental health professional in the last 7 days [CMS Assessment] min
Indent46067-5 Devices and restraints Set
IndentIndent45870-3 Bed rails - full bed rails on all open sides of bed [Minimum Data Set]
IndentIndent45871-1 Bed rails - other types of side rails used [Minimum Data Set]
IndentIndent45872-9 Trunk restraint [Minimum Data Set]
IndentIndent45873-7 Limb restraint [Minimum Data Set]
IndentIndent45874-5 Chair prevents rising [Minimum Data Set]
Indent45877-8 Number of physician visits in last 14 days [Minimum Data Set] {#}/(14.d)
Indent45878-6 Number of days physician orders changed in last 14 days [Minimum Data Set] d/(14.d)
Indent45883-6 Overall change in care needs [Minimum Data Set]

Fully-Specified Name

Component
MDS quarterly assessment form - version 2.0 - optional version for RUG-III
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.17
Last Updated
Version 2.50
Order vs. Observation
Order
Panel Type
Panel

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 - optional version for RUG-III

LOINC FHIR® API Example - CodeSystem Request Get Info

https://fhir.loinc.org/CodeSystem/$lookup?system=http://loinc.org&code=46103-8