Version 2.78

52514-7 Core Self Care

Observation ID in Form

A

Form Coding Instructions

Core Self Core: The core self care items should be completed on ALL patients. (Complete during the 2-day assessment period.) Code the patient's most usual performance using the 6-point scale below. CODING: Safety and Quality of Performance - If helper assistance is required because the patient's performance is unsafe or of poor quality, score according to amount of assistance provided. Activities may be completed with or without assistive devices

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Core Self Care
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

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

52642-6 Eating

Term Description

The ability to use suitable utensils to bring food to the mouth and swallow food once the meal is presented on a table/tray. Includes modified food consistency.
Source: Regenstrief LOINC

Observation ID in Form

A1

Fully-Specified Name

Component
Eating 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52643-4 Tube feeding

Term Description

The ability to manage all equipment/supplies related to obtaining nutrition.
Source: Regenstrief LOINC

Observation ID in Form

A2

Fully-Specified Name

Component
Tube feeding 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

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52644-2 Oral hygiene

Term Description

The ability to use suitable items to clean teeth. Dentures: The ability to remove and replace dentures from and to mouth, and manage equipment for soaking and rinsing.
Source: Regenstrief LOINC

Observation ID in Form

A3

Fully-Specified Name

Component
Oral hygiene 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52645-9 Toilet hygiene

Term Description

The ability to maintain perineal hygiene, adjust clothes before and after using toilet, commode, bedpan, urinal. If managing ostomy, include wiping opening but not managing equipment.
Source: Regenstrief LOINC

Observation ID in Form

A4

Fully-Specified Name

Component
Toilet hygiene 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52646-7 Upper body dressing

Term Description

The ability to put on and remove shirt or pajama top. Includes buttoning if applicable.
Source: Regenstrief LOINC

Observation ID in Form

A5

Fully-Specified Name

Component
Upper body dressing 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52647-5 Lower body dressing

Term Description

The ability to dress and undress below the waist, including fasteners. Does not include footwear.
Source: Regenstrief LOINC

Observation ID in Form

A6

Fully-Specified Name

Component
Lower body dressing 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52515-4 Core Functional Mobility

Observation ID in Form

B

Form Coding Instructions

Core Functional Mobility: The core functional mobility items should be completed on ALL patients. (Complete during the 2-day assessment period.) Complete for ALL patients: Code the patient's most usual performance using the 6-point scale below. CODING: Safety and Quality of Performance - If helper assistance is required because the patient's performance is unsafe or of poor quality, score according to amount of assistance provided. Activities may be completed with or without assistive devices

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Core Functional Mobility
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

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

52648-3 Lying to Sitting on Side of Bed

Term Description

The ability to safely move from lying on the back to sitting on side of bed with feet flat on the floor, no back support.
Source: Regenstrief LOINC

Observation ID in Form

B1

Fully-Specified Name

Component
Lying to sitting on side of bed 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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
69412-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52649-1 Sit to Stand

Term Description

The ability to safely come to a standing position from sitting in a chair or on the side of a bed.
Source: Regenstrief LOINC

Observation ID in Form

B2

Fully-Specified Name

Component
Sit to stand 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52650-9 Chair/Bed-to-Chair Transfer

Term Description

The ability to safely transfer to and from a chair (or wheelchair). The chairs are placed at right angles to each other.
Source: Regenstrief LOINC

Observation ID in Form

B3

Fully-Specified Name

Component
Chair-bed to chair transfer 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52651-7 Toilet Transfer

Term Description

The ability to safely get on and off a toilet or commode.
Source: Regenstrief LOINC

Observation ID in Form

B4

Fully-Specified Name

Component
Toilet transfer 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52516-2 Mode of Mobility - All Patients

Fully-Specified Name

Component
Mode of Mobility - All Patients
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

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

52652-5 Does this patient primarily use a wheelchair for mobility?

Observation ID in Form

B5

Skip Logic

If No, code B5a for the longest distance completed. If Yes, code B5b for the longest distance completed.

Fully-Specified Name

Component
Primarily uses wheelchair for mobility 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

Survey Question

Text
Does this patient primarily use a wheelchair for mobility?
Source
CARE I.b05

Normative Answer List LL251-0

Answer Code Score Answer ID
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) 0 LA32-8
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

52517-0 Select the longest distance the patient walks and code his/her level of independence (Level 1-6) on that distance. Observe performance. (Select only one.)

Observation ID in Form

B5a

Fully-Specified Name

Component
Level of independence on longest distance walked
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

Survey Question

Text
Select the longest distance the patient walks and code his/her level of independence (Level 1-6) on that distance. Observe performance. (Select only one.)
Source
CARE I.b05a

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52653-3 Walk 150 ft (45 m)

Term Description

Once standing, can walk at least 150 feet (45 meters) in corridor or similar space.
Source: Regenstrief LOINC

Observation ID in Form

B5a.1

Fully-Specified Name

Component
Walk 150 ft (45 m) 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52654-1 Walk 100 ft (30 m)

Term Description

Once standing, can walk at least 100 feet (30 meters) in corridor or similar space.
Source: Regenstrief LOINC

Observation ID in Form

B5a.2

Fully-Specified Name

Component
Walk 100 ft (30 m) 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52655-8 Walk 50 ft (15m)

Term Description

Once standing, can walk at least 50 feet (15 meters) in corridor or similar space.
Source: Regenstrief LOINC

Observation ID in Form

B5a.3

Fully-Specified Name

Component
Walk 50 ft (15 m) 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

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52656-6 Walk in Room Once Standing

Term Description

Once standing, can walk at least 10 feet (3 meters) in room, corridor or similar space.
Source: Regenstrief LOINC

Observation ID in Form

B5a.4

Fully-Specified Name

Component
Walk 10 ft (3 m) 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52518-8 Select the longest distance the patient wheels and code his/her level of independence (Level 1-6). Observe performance. (Select only one.)

Observation ID in Form

B5b

Fully-Specified Name

Component
Level of independence on longest distance wheeled
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

Survey Question

Text
Select the longest distance the patient wheels and code his/her level of independence (Level 1-6). Observe performance. (Select only one.)
Source
CARE I.b05b

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52657-4 Wheel 150 ft (45 m)

Term Description

Once sitting, can wheel at least 150 feet (45 meters) in corridor or similar space.
Source: Regenstrief LOINC

Observation ID in Form

B5b.1

Fully-Specified Name

Component
Wheel 150 ft (45 m) 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52658-2 Wheel 100 ft (30 m)

Term Description

Once sitting, can wheel at least 100 feet (30 meters) in corridor or similar space.
Source: Regenstrief LOINC

Observation ID in Form

B5b.2

Fully-Specified Name

Component
Wheel 100 ft (30 m) 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52659-0 Wheel 50 ft (15 m)

Term Description

Once sitting, can wheel at least 50 feet (15 meters) in corridor or similar space.
Source: Regenstrief LOINC

Observation ID in Form

B5b.3

Fully-Specified Name

Component
Wheel 50 ft (15 m) 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52660-8 Wheel in Room Once Seated

Term Description

Once seated, can wheel at least 10 feet (3 meters) in room, corridor, or similar space.
Source: Regenstrief LOINC

Observation ID in Form

B5b.4

Fully-Specified Name

Component
Wheel 10 ft (3 m) 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 2.54

Normative Answer List LL586-9

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52519-6 Supplemental Functional Ability

Observation ID in Form

C

Form Coding Instructions

Supplemental Functional Ability (Complete during the 2-day assessment period.) Please code the patient on all activities they are able to participate in and which you can observe, or have assessed by other means, using the 6-point scale below. Coding: Safety and Quality and Performance - If helper assistance is required because patient's performance is unsafe or poor quality, score according to amount of assistance provided. Code for the most usual performance in the 2-day assessment period. Activities may be completed with or without assistive devices

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Supplemental Functional Ability
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

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

54066-6 Following discharge, is it anticipated that the patient will need post-acute care to improve their functional ability or other types of personal assistance?

Observation ID in Form

C

Skip Logic

If No, skip to Section VII. Overall Plan of Care/Advance Care Directives.

Form Coding Instructions

Please code the patient on all activities they are able to particiate in and which you can observe, or have assessed by other means, using the 6-point scale below

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Post acute care or personal assistance anticipated following discharge
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

Survey Question

Text
Following discharge, is it anticipated that the patient will need post-acute care to improve their functional ability or other types of personal assistance?
Source
CARE_VI_C_C

Normative Answer List LL251-0

Answer Code Score Answer ID
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) 0 LA32-8
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

52661-6 Wash Upper Body

Term Description

The ability to wash, rinse, and dry the face, hands, chest, and arms while sitting in a chair or bed.
Source: Regenstrief LOINC

Observation ID in Form

C1

Fully-Specified Name

Component
Wash upper body 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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52662-4 Shower/bathe self

Term Description

The ability to bathe self in shower or tub, including washing and drying self. Does not include transferring in/out of tub/shower.
Source: Regenstrief LOINC

Observation ID in Form

C2

Fully-Specified Name

Component
Shower &or bathe self 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 2.54

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52663-2 Roll left and right

Term Description

The ability to roll from lying on back to left and right side, and roll back to back.
Source: Regenstrief LOINC

Observation ID in Form

C3

Fully-Specified Name

Component
Roll left and right 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 2.54

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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
69412-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52664-0 Sit to lying

Term Description

The ability to move from sitting on side of bed to lying flat on the bed.
Source: Regenstrief LOINC

Observation ID in Form

C4

Fully-Specified Name

Component
Sit to lying 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 2.54

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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
69412-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52665-7 Picking up object

Term Description

The ability to bend/stoop from a standing position to pick up small object such as a spoon from the floor.
Source: Regenstrief LOINC

Observation ID in Form

C5

Fully-Specified Name

Component
Picking up objects 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 2.54

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52666-5 Putting on/taking off footwear during 2 day assessment period [CARE]

Term Description

The ability to put on and take off socks and shoes or other footwear that are appropriate for safe mobility.
Source: Regenstrief LOINC

Observation ID in Form

C6

Fully-Specified Name

Component
Putting on &or taking off footwear 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 2.54

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52520-4 Mode of Mobility - PAC Patients

Fully-Specified Name

Component
Mode of Mobility - PAC Patients
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

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

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

52652-5 Does this patient primarily use a wheelchair for mobility?

Observation ID in Form

C7

Skip Logic

If No, code C7a-C7f. If Yes, code C7f-C7h.

Fully-Specified Name

Component
Primarily uses wheelchair for mobility 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

Survey Question

Text
Does this patient primarily use a wheelchair for mobility?
Source
CARE I.b05

Normative Answer List LL251-0

Answer Code Score Answer ID
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) 0 LA32-8
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

52667-3 1 step (curb)

Term Description

The ability to step over a curb or up and down one step.
Source: Regenstrief LOINC

Observation ID in Form

C7a

Fully-Specified Name

Component
One step (curb) 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 2.54

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52668-1 Walk 50 feet with two turns

Term Description

The ability to walk 50 feet and make two turns.
Source: Regenstrief LOINC

Observation ID in Form

C7b

Fully-Specified Name

Component
Walk 50 feet with two turns 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 2.54

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52669-9 12 steps-interior

Term Description

The ability to go up and down 12 interior steps with a rail.
Source: Regenstrief LOINC

Observation ID in Form

C7c

Fully-Specified Name

Component
12 steps-interior 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 2.54

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52670-7 Four steps-exterior

Term Description

The ability to go up and down 4 exterior steps with a rail.
Source: Regenstrief LOINC

Observation ID in Form

C7d

Fully-Specified Name

Component
Four steps-exterior 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 2.54

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52671-5 Walking 10 feet on uneven surfaces

Term Description

The ability to walk 10 feet on uneven or sloping surfaces, such as grass, gravel, ice or snow.
Source: Regenstrief LOINC

Observation ID in Form

C7e

Fully-Specified Name

Component
Walking 10 feet on uneven surfaces 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 2.54

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52672-3 Car transfer

Term Description

The ability to transfer in and out of a car or van on the passenger side. Does not include the ability to open/close door or fasten seat belt.
Source: Regenstrief LOINC

Observation ID in Form

C7f

Fully-Specified Name

Component
Car transfer 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 2.54

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52673-1 Wheel short ramp

Term Description

Once seated in wheelchair, goes up and down a ramp of less than 12 feet (4 meters).
Source: Regenstrief LOINC

Observation ID in Form

C7g

Fully-Specified Name

Component
Wheel short ramp 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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52674-9 Wheel long ramp

Term Description

Once seated in wheelchair, goes up and down a ramp of more than 12 feet (4 meters).
Source: Regenstrief LOINC

Observation ID in Form

C7h

Fully-Specified Name

Component
Wheel long ramp 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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52675-6 Telephone answering

Term Description

The ability to pick up call in patient's customary manner and maintain for 1 minute. Does not include getting to the phone.
Source: Regenstrief LOINC

Observation ID in Form

C8

Fully-Specified Name

Component
Telephone-answering 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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52676-4 Telephone-placing call

Term Description

The ability to pick up and place call in patient's customary manner and maintain for 1 minute. Does not include getting to the phone.
Source: Regenstrief LOINC

Observation ID in Form

C9

Fully-Specified Name

Component
Telephone-placing call 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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52677-2 Medication management-oral medications

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.
Source: Regenstrief LOINC

Observation ID in Form

C10

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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52678-0 Medication management-inhalant/mist

Term Description

The ability to prepare and take all prescribed inhalant/mist medications reliably and safely, including administration of the correct dosage at the appropriate times/intervals.
Source: Regenstrief LOINC

Observation ID in Form

C11

Fully-Specified Name

Component
Medication management-inhalant &or mist 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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52679-8 Medication management-injectable medications

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.
Source: Regenstrief LOINC

Observation ID in Form

C12

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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52680-6 Make light meal

Term Description

The ability to plan and prepare all aspects of a light meal such as bowl of cereal or sandwich and cold drink, or reheat a prepared meal.
Source: Regenstrief LOINC

Observation ID in Form

C13

Fully-Specified Name

Component
Make light meal 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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52681-4 Wipe down surface

Term Description

The ability to use a damp cloth to wipe down surface such as table top or bench to remove small amounts of liquid or crumbs. Includes ability to clean cloth of debris in patient's customary manner.
Source: Regenstrief LOINC

Observation ID in Form

C14

Fully-Specified Name

Component
Wipe down surface 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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52682-2 Light shopping

Term Description

Once at store, can locate and select up to five needed goods, take to check out, and complete purchasing transaction.
Source: Regenstrief LOINC

Observation ID in Form

C15

Fully-Specified Name

Component
Light shopping during 2D assesssment
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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52683-0 Laundry

Term Description

Includes all aspects of completing a load of laundry using a washer and dryer. Includes sorting, loading and unloading, and adding laundry detergent.
Source: Regenstrief LOINC

Observation ID in Form

C16

Fully-Specified Name

Component
Laundry 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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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

52684-8 Use public transportation

Term Description

The ability to plan and use public transportation. Includes boarding, riding, and alighting from transportation.
Source: Regenstrief LOINC

Observation ID in Form

C17

Fully-Specified Name

Component
Use public transportation 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

Normative Answer List LL587-7

Answer Code Score Answer ID
Independent - Patient completes the activity by themself with no assistance from a helper. 6 LA9983-3
Setup or clean-up assistance - Helper sets up or cleans up; patient completes activity. Helper assists only prior to or following the activity. 5 LA10073-7
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. 4 LA11757-4
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. 3 LA10055-4
Substantial/maximal assistance – Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. 2 LA10090-1
Dependent - Helper does all of the effort. Patient does none of the effort to complete the task. 1 LA9964-3
Not attempted due to medical condition M LA10039-8
Not attempted due to safety concerns S LA10040-6
Not attempted due to environmental constraints E LA10038-0
Task attempted but not completed A LA10092-7
Not applicable N LA4720-4
Patient refused P LA10058-8

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