Version 2.79

52603-8 Pain Interview Attempted?

Observation ID in Form

G1

Skip Logic

If No, skip to G6. Pain Observational Assessment.

Fully-Specified Name

Component
Pain interview was attempted
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Pain interview was attempted [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64 (MIN)

Normative Answer List LL251-0

Answer Code Score Answer ID
2: No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) 0 LA32-8
1: Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) 1 LA33-6

Member of these Panels

LOINC Long Common Name
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52604-6 Pain Presence. Ask patient: "Have you had pain or hurting at any time during the last 2 days?"

Observation ID in Form

G2

Skip Logic

If No, skip to Section V. Impairments. If Unable, skip to G6. Pain Observational Assessment.

Fully-Specified Name

Component
Pain presence during last 2D
Property
Find
Time
2D
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Pain presence during last 2 days [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64 (MIN)

Normative Answer List LL569-5

Answer Code Score Answer ID
2: No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) 0 LA32-8
1: Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) 1 LA33-6
Unable to answer or no response 8 LA10104-0

Member of these Panels

LOINC Long Common Name
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52742-4 Pain Severity. Ask patient: "Please rate your worst pain during the last 2 days on a zero to 10 scale, with zero being no pain and 10 as the worst pain you can imagine."

Observation ID in Form

G3

Skip Logic

If patient does not answer or is unable to respond and skip to G6. Pain Observational Assessment.

Form Coding Instructions

Enter 88 if patient does not answer or is unable to respond

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Pain severity during last 2D
Property
Score
Time
2D
System
^Patient
Scale
Ord
Method
Reported

Long Common Name

Pain severity during last 2 days [Reported]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.52 (MIN)

Preferred Answer List LL571-1

Answer Code Score Answer ID
0 0 LA6111-4
1 1 LA6112-2
2 or more 2 LA6113-0
3 3 LA6114-8
4 4 LA6115-5
5 5 LA10137-0
6 6 LA10138-8
7 7 LA10139-6
8 8 LA10140-4
9 9 LA10141-2
10 10 LA13942-0
Patient does not answer or is unable to respond 88 LA10056-2

Member of these Panels

LOINC Long Common Name
76464-7 American Physical Therapy Association registry panel
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52605-3 Pain Effect on Sleep. Ask patient: "During the past 2 days, has pain made it hard for you to sleep?"

Observation ID in Form

G4

Fully-Specified Name

Component
Pain has made it hard to sleep during last 2D
Property
Find
Time
2D
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Pain has made it hard to sleep during last 2 days [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64 (MIN)

Normative Answer List LL569-5

Answer Code Score Answer ID
2: No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) 0 LA32-8
1: Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) 1 LA33-6
Unable to answer or no response 8 LA10104-0

Member of these Panels

LOINC Long Common Name
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52606-1 Pain Effect on Activities. Ask patient: "During the past 2 days, have you limited your activities because of pain?"

Observation ID in Form

G5

Fully-Specified Name

Component
Limited activities because of pain during last 2D
Property
Find
Time
2D
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Limited activities because of pain during last 2 days [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64 (MIN)

Normative Answer List LL569-5

Answer Code Score Answer ID
2: No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) 0 LA32-8
1: Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) 1 LA33-6
Unable to answer or no response 8 LA10104-0

Member of these Panels

LOINC Long Common Name
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52607-9 Pain Observational Assessment. If the patient could not be interviewed for pain assessment, check all indicators of of pain or possible pain

Observation ID in Form

G6

Form Coding Instructions

Check all that apply.

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

Pain Observational Assessment. If patient could not be interviewed for pain assessment, check all indicators of pain or possible pain Check all that apply

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Pain Observational Assessment
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Pain Observational Assessment [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64 (MIN)

Normative Answer List LL572-9

Answer Code Score Answer ID
Non-verbal sounds (e.g., crying, whining, gasping, moaning, or groaning) A LA10034-9
Vocal complaints of pain (e.g., that hurts, ouch, stop) B LA10116-4
Facial expressions (e.g., grimaces, winces, wrinkled forehead, furrowed brow, clenched teeth or jaw) C LA9968-4
Protective body movements or postures (e.g., bracing, guarding, rubbing or massaging a body part/area, clutching or holding a body part during movement) D LA10063-8
None of these signs observed or documented E LA10032-3

Member of these Panels

LOINC Long Common Name
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission