Form Coding Instructions

Complete during the 2-day assessment period

Source: Centers for Medicare & Medicaid Services

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

Observation ID in Form

F1a

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