52503-0 Bladder and Bowel Management - Use of Device(s) and Incontinence

Observation ID in Form

A

Form Coding Instructions

Complete during the 2-day assessment period

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Bladder and Bowel Management - Use of Device(s) and Incontinence
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52608-7 Does the patient have any impairments with bladder or bowel management (e.g., use of a device or incontinence)?

Observation ID in Form

A1

Skip Logic

If No, skip to Section B. Swallowing. If Yes, please complete this section.

Fully-Specified Name

Component
Impairments with bladder or bowel management
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Impairments with bladder or bowel management

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64 (MAJ)
Change Reason
Method removed and Answer List Type changed to Example because this generic term can be used across contexts

Example Answer List LL251-0

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52609-5 Bladder - Does this patient use an external or indwelling device or require intermittent catheterization?

Observation ID in Form

A2a

Fully-Specified Name

Component
Bladder - external or indwelling device or intermittent catheterization
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Bladder - external or indwelling device or intermittent catheterization [CARE]

Basic Attributes

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

Normative Answer List LL251-0

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52610-3 Bowel - Does this patient use an external or indwelling device or require intermittent catheterization?

Observation ID in Form

A2b

Fully-Specified Name

Component
Bowel - external or indwelling device or intermittent catheterization
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Bowel - external or indwelling device or intermittent catheterization [CARE]

Basic Attributes

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

Normative Answer List LL251-0

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52611-1 Bladder - Indicate the frequency of incontinence.

Observation ID in Form

A3a

Fully-Specified Name

Component
Bladder - frequency of incontinence during 2D assessment period
Property
Find
Time
2D
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Bladder - frequency of incontinence during 2 day assessment period [CARE]

Basic Attributes

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

Normative Answer List LL724-6

AnswerCodeScoreAnswer ID
Continent (no documented incontinence)0LA9956-9
Stress incontinence only (bladder only)1LA10088-5
Incontinence less than daily2LA11689-9
Incontinence daily (at least once a day)3LA11690-7
Always continent4LA11042-1
No urine/bowel output (e.g., renal failure)5LA10024-0
Not applicable (e.g., indwelling catheter)9LA11693-1

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52612-9 Bowel - Indicate the frequency of incontinence.

Observation ID in Form

A3b

Fully-Specified Name

Component
Bowel - frequency of incontinence during 2D assessment period
Property
Find
Time
2D
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Bowel - frequency of incontinence during 2 day assessment period [CARE]

Basic Attributes

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

Normative Answer List LL724-6

AnswerCodeScoreAnswer ID
Continent (no documented incontinence)0LA9956-9
Stress incontinence only (bladder only)1LA10088-5
Incontinence less than daily2LA11689-9
Incontinence daily (at least once a day)3LA11690-7
Always continent4LA11042-1
No urine/bowel output (e.g., renal failure)5LA10024-0
Not applicable (e.g., indwelling catheter)9LA11693-1

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52613-7 Bladder - Does the patient need assistance to manage equipment or devices related to bladder or bowel care (e.g., urinal, bedpan, indwelling catheter, intermittent catheterization, ostomy, incontinence pads/undergarments)?

Observation ID in Form

A4a

Fully-Specified Name

Component
Bladder - needs assistance to manage bladder care equipment
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Bladder - needs assistance to manage bladder care equipment [CARE]

Basic Attributes

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

Normative Answer List LL251-0

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52614-5 Bowel - Does the patient need assistance to manage equipment or devices related to bladder or bowel care (e.g., urinal, bedpan, indwelling catheter, intermittent catheterization, ostomy, incontinence pads/undergarments)?

Observation ID in Form

A4b

Fully-Specified Name

Component
Bowel - needs assistance to manage bowel care equipment
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Bowel - needs assistance to manage bowel care equipment [CARE]

Basic Attributes

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

Normative Answer List LL251-0

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52615-2 Bladder - If the patient is incontinent or has an indwelling device, was the patient incontinent (excluding stress incontinence) immediately prior to the current illness, exacerbation, or injury?

Observation ID in Form

A5a

Fully-Specified Name

Component
Bladder - incontinent immediately prior to current illness, exacerbation, or injury
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Bladder - incontinent immediately prior to current illness, exacerbation, or injury [CARE]

Basic Attributes

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

Normative Answer List LL208-0

AnswerCodeScoreAnswer ID
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)0LA32-8
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)1LA33-6
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)9LA4489-6

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52616-0 Bowel - If the patient is incontinent or has an indwelling device, was the patient incontinent (excluding stress incontinence) immediately prior to the current illness, exacerbation, or injury?

Observation ID in Form

A5b

Fully-Specified Name

Component
Bowel - incontinent immediately prior to current illness, exacerbation, or injury
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Bowel - incontinent immediately prior to current illness, exacerbation, or injury [CARE]

Basic Attributes

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

Normative Answer List LL208-0

AnswerCodeScoreAnswer ID
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)0LA32-8
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)1LA33-6
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)9LA4489-6

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52504-8 Swallowing

Observation ID in Form

B

Form Coding Instructions

Complete during the 2-day assessment period

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Swallowing
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52618-6 Does the patient have any signs or symptoms of a possible swallowing disorder?

Observation ID in Form

B1

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

Check all that apply.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Swallowing disorder
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Swallowing disorder [CARE]

Basic Attributes

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

Normative Answer List LL574-5

AnswerCodeScoreAnswer ID
Complaints of difficulty or pain with swallowingaLA9952-8
Coughing or choking during meals or when swallowing medicationsbLA9961-9
Holding food in mouth/cheeks or residual food in mouth after mealscLA9977-5
Loss of liquids/solids from mouth when eating or drinkingdLA10001-8
NPO: intake not by moutheLA10043-0
Other (specify)fLA6310-2
None Copyright http://snomed.info/sct ID:260413007 None (qualifier value)gLA137-2

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52619-4 Other (specify)

Observation ID in Form

B1f

Fully-Specified Name

Component
Swallowing disorder.other specified
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Swallowing disorder.other specified [CARE]

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52620-2 Describe the patient's usual ability with swallowing.

Observation ID in Form

B2

Form Coding Instructions

Check one option only

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Swallowing usual ability
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Swallowing usual ability [CARE]

Basic Attributes

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

Normative Answer List LL575-2

AnswerCodeScoreAnswer ID
Regular food: solids and liquids swallowed safely without supervision and without modified food or liquid consistency.ALA10070-3
Modified food consistency/supervision: Patient requires modified food or liquid consistency and/or needs supervision during eating for safety.BLA10013-3
Tube/parenteral feeding: Tube/parenteral feeding used wholly or partially as a means of sustenance.CLA10103-2

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52505-5 Hearing, Vision, and Communication

Observation ID in Form

C

Form Coding Instructions

Complete during the 2-day assessment period

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Hearing, Vision, and Communication
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52621-0 Does the patient have any impairments with hearing, vision, or communication?

Observation ID in Form

C1

Skip Logic

If No impairments, skip to Section D. Weight-bearing. If Yes, please complete this section.

Fully-Specified Name

Component
Any impairments with hearing, vision, or communication
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Any impairments with hearing, vision, or communication

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64 (MAJ)
Change Reason
Method removed and Answer List Type changed to Example because this generic term can be used across contexts

Example Answer List LL251-0

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52622-8 Understanding verbal content - excluding language barriers [CARE]

Observation ID in Form

C1a

Fully-Specified Name

Component
Understanding verbal content - excluding language barriers
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

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

Normative Answer List LL576-0

AnswerCodeScoreAnswer ID
Understands: clear comprehension without cues or repetitions4LA10110-7
Usually understands: understands most conversations, but misses some part/intent of message. Requires cues at times to understand3LA10113-1
Sometimes understands: understands only basic conversations or simple, direct phrases. Frequently requires cues to understand2LA10083-6
Rarely/never understands1LA81-5
Unable to assess8LA10105-7
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)9LA4489-6

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52623-6 Expression of ideas and wants [CARE]

Observation ID in Form

C1b

Fully-Specified Name

Component
Expression of ideas and wants
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

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

Normative Answer List LL577-8

AnswerCodeScoreAnswer ID
Expresses complex messages without difficulty and with speech that is clear and easy to understand4LA9967-6
Exhibits some difficulty with expressing needs and ideas (e.g., some words or finishing thoughts) or speech is not clear3LA9966-8
Frequently exhibits difficulty with expressing needs and ideas2LA9972-6
Rarely/Never expresses self or speech is very difficult to understand.1LA10067-9
Unable to assess8LA10105-7
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)9LA4489-6

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52624-4 Ability to see in adequate light (with glasses or other visual appliances)

Observation ID in Form

C1c

Fully-Specified Name

Component
Seeing in adequate light - with glasses or other visual appliances
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Seeing in adequate light - with glasses or other visual appliances [CARE]

Basic Attributes

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

Normative Answer List LL578-6

AnswerCodeScoreAnswer ID
Adequate: Sees fine detail, including regular print in newspapers/books3LA9930-4
Mildly to Moderately Impaired: Can identify objects; may see large print2LA10006-7
Severely Impaired: No vision or object identification questionable1LA10077-8
Unable to assess8LA10105-7
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)9LA4489-6

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52625-1 Ability to hear (with hearing aid or hearing appliance, if normally used)

Observation ID in Form

C1d

Fully-Specified Name

Component
Hearing - with hearing aid or hearing appliance if normally used
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Hearing - with hearing aid or hearing appliance if normally used [CARE]

Basic Attributes

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

Normative Answer List LL579-4

AnswerCodeScoreAnswer ID
Adequate: Hears normal conversation and TV without difficulty3LA9929-6
Mildly to Moderately Impaired: Difficulty hearing in some environments or speaker may need to increase volume or speak distinctly2LA10007-5
Severely Impaired: Absence of useful hearing1LA10076-0
Unable to assess8LA10105-7
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)9LA4489-6

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52677-2 Medication management-oral medications during two day assessment period [CARE]

Term Description

The ability to prepare and take all prescribed oral medications reliably and safely, including administration of the correct dosage at the appropriate times/intervals.

Fully-Specified Name

Component
Medication management-oral medications during 2D assessment period
Property
Find
Time
2D
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

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

Normative Answer List LL587-7

AnswerCodeScoreAnswer ID
Independent - Patient completes the activity by themself with no assistance from a helper.6LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.5LA10073-7
Supervision or touching assistance - Helper provides verbal cues or touching/steadying assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.4LA11757-4
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.3LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.2LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task.1LA9964-3
Not attempted due to medical conditionMLA10039-8
Not attempted due to safety concernsSLA10040-6
Not attempted due to environmental constraintsELA10038-0
Task attempted but not completedALA10092-7
Not applicableNLA4720-4
Patient refusedPLA10058-8

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52679-8 Medication management-injectable medications during two day assessment period [CARE]

Term Description

The ability to prepare and take all prescribed injectable medications reliably and safely, including administration of the correct dosage at the appropriate times/intervals.

Fully-Specified Name

Component
Medication management-injectable medications during 2D assessment period
Property
Find
Time
2D
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

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

Normative Answer List LL587-7

AnswerCodeScoreAnswer ID
Independent - Patient completes the activity by themself with no assistance from a helper.6LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity.5LA10073-7
Supervision or touching assistance - Helper provides verbal cues or touching/steadying assistance as patient completes activity. Assistance may be provided throughout the activity or intermittently.4LA11757-4
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.3LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.2LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task.1LA9964-3
Not attempted due to medical conditionMLA10039-8
Not attempted due to safety concernsSLA10040-6
Not attempted due to environmental constraintsELA10038-0
Task attempted but not completedALA10092-7
Not applicableNLA4720-4
Patient refusedPLA10058-8

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52506-3 Weight-bearing

Observation ID in Form

D

Form Coding Instructions

Complete during the 2-day assessment period

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Weight-bearing
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52626-9 Does the patient have any clinician-ordered weight-bearing or limb/spinal loading restrictions( including upper body lift, push, pull, or carry restrictions)?

Observation ID in Form

D1

Skip Logic

If No impairments, skip to Section E. Grip Strength. If Yes, please complete this section.

Fully-Specified Name

Component
Any impairments with weight-bearing
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Any impairments with weight-bearing

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64 (MAJ)
Change Reason
Method removed and Answer List Type changed to Example because this generic term can be used across contexts

Example Answer List LL251-0

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52507-1 Weight-bearing restrictions panel

Observation ID in Form

CODING

Form Coding Instructions

CODING: Indicate all the patient's weight-bearing restrictions

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

Indicate all the patient's weight-bearing restrictions

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Weight-bearing restrictions panel
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52627-7 Upper Extremity - Left

Observation ID in Form

D1a

Form Coding Instructions

CODING: Indicate all the patient's weight-bearing restrictions

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Weight-bearing restrictions during 2D assessment period
Property
Find
Time
2D
System
Upper extremity.left
Scale
Ord
Method
CARE

Long Common Name

Weight-bearing restrictions during 2 day assessment period Upper extremity - left [CARE]

Basic Attributes

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

Normative Answer List LL580-2

AnswerCodeScoreAnswer ID
Fully weight-bearing: No clinician ordered restrictions1LA9973-4
Not fully weight-bearing: Patient has clinician ordered restrictions0LA10042-2

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52628-5 Upper Extremity - Right

Observation ID in Form

D1b

Form Coding Instructions

CODING: Indicate all the patient's weight-bearing restrictions

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Weight-bearing restrictions during 2D assessment period
Property
Find
Time
2D
System
Upper extremity.right
Scale
Ord
Method
CARE

Long Common Name

Weight-bearing restrictions during 2 day assessment period Upper extremity - right [CARE]

Basic Attributes

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

Normative Answer List LL580-2

AnswerCodeScoreAnswer ID
Fully weight-bearing: No clinician ordered restrictions1LA9973-4
Not fully weight-bearing: Patient has clinician ordered restrictions0LA10042-2

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52629-3 Lower Extremity - Left

Observation ID in Form

D1c

Form Coding Instructions

CODING: Indicate all the patient's weight-bearing restrictions

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Weight-bearing restrictions during 2D assessment period
Property
Find
Time
2D
System
Lower extremity.left
Scale
Ord
Method
CARE

Long Common Name

Weight-bearing restrictions during 2 day assessment period Lower extremity - left [CARE]

Basic Attributes

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

Normative Answer List LL580-2

AnswerCodeScoreAnswer ID
Fully weight-bearing: No clinician ordered restrictions1LA9973-4
Not fully weight-bearing: Patient has clinician ordered restrictions0LA10042-2

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52630-1 Lower Extremity - Right

Observation ID in Form

D1d

Form Coding Instructions

CODING: Indicate all the patient's weight-bearing restrictions

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Weight-bearing restrictions during 2D assessment period
Property
Find
Time
2D
System
Lower extremity.right
Scale
Ord
Method
CARE

Long Common Name

Weight-bearing restrictions during 2 day assessment period Lower extremity - right [CARE]

Basic Attributes

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

Normative Answer List LL580-2

AnswerCodeScoreAnswer ID
Fully weight-bearing: No clinician ordered restrictions1LA9973-4
Not fully weight-bearing: Patient has clinician ordered restrictions0LA10042-2

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52508-9 Grip strength

Observation ID in Form

E

Form Coding Instructions

Complete during the 2-day assessment period

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Grip Strength
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52631-9 Does the patient have any impairments with grip strength (e.g. reduced/limited or absent)?

Observation ID in Form

E1

Skip Logic

If No impairments, skip to Section F. Repiratory Status. If Yes, please complete this section.

Fully-Specified Name

Component
Any impairments with grip strength
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Any impairments with grip strength

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64 (MAJ)
Change Reason
Method removed and Answer List Type changed to Example because this generic term can be used across contexts

Example Answer List LL251-0

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52509-7 Grip strength panel

Observation ID in Form

CODING

Form Coding Instructions

CODING: Indicate the patient's ability to squeeze your hand

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

Indicate the patient's ability to squeeze your hand

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Grip strength panel
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52632-7 Left Hand

Observation ID in Form

E1a

Form Coding Instructions

CODING: Indicate the patient's ability to squeeze your hand

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Grip strength during 2D assessment period
Property
Find
Time
2D
System
Hand.left
Scale
Ord
Method
CARE

Long Common Name

Grip strength during 2 day assessment period Hand - left [CARE]

Basic Attributes

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

Normative Answer List LL581-0

AnswerCodeScoreAnswer ID
Normal Copyright http://snomed.info/sct ID:17621005 Normal (qualifier value)2LA6626-1
Reduced/Limited1LA10068-7
Absent Copyright http://snomed.info/sct ID:2667000 Absent (qualifier value)0LA9634-2

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52633-5 Right Hand

Observation ID in Form

E1b

Form Coding Instructions

CODING: Indicate the patient's ability to squeeze your hand

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Grip strength during 2D assessment period
Property
Find
Time
2D
System
Hand.right
Scale
Ord
Method
CARE

Long Common Name

Grip strength during 2 day assessment period Hand - right [CARE]

Basic Attributes

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

Normative Answer List LL581-0

AnswerCodeScoreAnswer ID
Normal Copyright http://snomed.info/sct ID:17621005 Normal (qualifier value)2LA6626-1
Reduced/Limited1LA10068-7
Absent Copyright http://snomed.info/sct ID:2667000 Absent (qualifier value)0LA9634-2

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52510-5 Respiratory status

Observation ID in Form

F

Form Coding Instructions

Complete during the 2-day assessment period

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Respiratory status
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.68 (MIN)
Panel Type
Panel

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57194-3Deprecated Outcome and assessment information set (OASIS) form - version C - Discharge from agency
57192-7Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

Language Variants Get Info

TagLanguageTranslation
fr-FRFrench (France)Statut respiratoire:-:Ponctuel:Patient:-:

52634-3 Does the patient have any impairments with respiratory status?

Observation ID in Form

F1

Skip Logic

If No impairments, skip to Section G. Endurance. If Yes, please complete this section.

Fully-Specified Name

Component
Any impairments with respiratory status
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Any impairments with respiratory status

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64 (MAJ)
Change Reason
Method removed and Answer List Type changed to Example because this generic term can be used across contexts

Example Answer List LL251-0

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52635-0 Respiratory status with supplemental oxygen

Fully-Specified Name

Component
Respiratory status with oxygen therapy during 2D assessment period
Property
Find
Time
2D
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Respiratory status with oxygen therapy during 2 day assessment period [CARE]

Basic Attributes

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

Normative Answer List LL582-8

AnswerCodeScoreAnswer ID
Severe, with evidence the patient is struggling to breathe at rest5LA10075-2
Mild at rest (during day or night)4LA10005-9
With minimal exertion (for example, while eating, talking, or performing other ADLs) or with agitation3LA6445-6
With moderate exertion (e.g., while dressing, using commode or bedpan, walking between rooms)2LA10122-2
When climbing stairs1LA10121-4
Never, patient was not short of breath0LA10020-8
Not assessed (e.g., on ventilator)8LA10035-6
Not applicable9LA4720-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52636-8 Respiratory status without supplemental oxygen

Observation ID in Form

F1b

Fully-Specified Name

Component
Respiratory status without oxygen therapy during 2D assessment period
Property
Find
Time
2D
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Respiratory status without oxygen therapy during 2 day assessment period [CARE]

Basic Attributes

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

Normative Answer List LL582-8

AnswerCodeScoreAnswer ID
Severe, with evidence the patient is struggling to breathe at rest5LA10075-2
Mild at rest (during day or night)4LA10005-9
With minimal exertion (for example, while eating, talking, or performing other ADLs) or with agitation3LA6445-6
With moderate exertion (e.g., while dressing, using commode or bedpan, walking between rooms)2LA10122-2
When climbing stairs1LA10121-4
Never, patient was not short of breath0LA10020-8
Not assessed (e.g., on ventilator)8LA10035-6
Not applicable9LA4720-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52511-3 Endurance

Observation ID in Form

G

Form Coding Instructions

Complete during the 2-day assessment period

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Endurance
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52637-6 Does the patient have any impairments with endurance?

Observation ID in Form

G1

Skip Logic

If No impairments, skip to Section H. Mobility Devices and Aides Needed. If Yes, please complete this section.

Fully-Specified Name

Component
Any impairments with endurance
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Any impairments with endurance

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64 (MAJ)
Change Reason
Method removed and Answer List Type changed to Example because this generic term can be used across contexts

Example Answer List LL251-0

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52638-4 Mobility Endurance: Was the patient able to walk or wheel 50 feet (15 meters)?

Observation ID in Form

G1a

Fully-Specified Name

Component
Mobility endurance - able to walk or wheel 50 feet during 2D assessment period
Property
Find
Time
2D
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Mobility endurance - able to walk or wheel 50 feet during 2 day assessment period [CARE]

Basic Attributes

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

Normative Answer List LL583-6

AnswerCodeScoreAnswer ID
No, could not do0LA10026-5
Yes, can do with rest1LA10128-9
Yes, can do without rest2LA10129-7
Not assessed due to medical restriction8LA10036-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52639-2 Sitting Endurance: Was the patient able to tolerate sitting for 15 minutes?

Observation ID in Form

G1b

Fully-Specified Name

Component
Sitting endurance - able to tolerate sitting for 15M during 2D assessment period
Property
Find
Time
2D
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Sitting endurance - able to tolerate sitting for 15 minutes during 2 day assessment period [CARE]

Basic Attributes

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

Normative Answer List LL584-4

AnswerCodeScoreAnswer ID
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)0LA32-8
Yes, with support1LA10135-4
Yes, without support2LA10136-2
Not assessed due to medical restriction8LA10036-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52512-1 Mobility Devices and Aids Needed

Observation ID in Form

H

Form Coding Instructions

Complete during the 2-day assessment period

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Mobility devices and aids needed
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52640-0 Indicate all mobility devices and aids needed at time of assessment.

Observation ID in Form

H1

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

Check all that apply.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Mobility devices and aids needed
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Long Common Name

Mobility Devices and Aids Needed [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64 (MIN)
Change Reason
Method removed and Answer List Type changed to Example because this generic term can be used across contexts

Example Answer List LL585-1

AnswerCodeScoreAnswer ID
Canes/crutchaLA9942-9
WalkerbLA10117-2
Orthotics/ProstheticscLA10046-3
Wheelchair/scooter full timedLA10119-8
Wheelchair/scooter part timeeLA10120-6
Mechanical liftfLA11549-5
Other (specify)gLA6310-2
None applyhLA10029-9

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52641-8 Other (specify)

Observation ID in Form

H1g

Fully-Specified Name

Component
Mobility device.other specified
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Mobility device.other specified [CARE]

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission