52522-0
Overall Plan of Care/Advance Care Directives
Discouraged
52685-5 Have the patient (or representative) and the care team (or physician) documented agreed-upon care goals and expected dates of completion or re-evaluation?
Observation ID in Form
A1
Fully-Specified Name
- Component
- Care goals documented
- Property
- Find
- Time
- Pt
- System
- ^Patient
- Scale
- Ord
- Method
Basic Attributes
- Class
- SURVEY.CARE
- Type
- Surveys
- First Released
- Version 2.26
- Last Updated
- Version 2.64
- Change Reason
- Method removed and Answer List Type changed to Example because this generic term can be used across contexts
Survey Question
- Text
- Have the patient (or representative) and the care team (or physician) documented agreed-upon care goals and expected dates of completion or re-evaluation?
- Source
- CARE I.a01
Example Answer List LL588-5
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| No, but this work is in process | 0 | LA10025-7 | |
| Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) | 1 | LA33-6 | |
| Unclear or unknown | 9 | LA10109-9 |
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 |
Third Party Copyright
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52686-3 Which description best fits the patient's overall status?
Observation ID in Form
A2
Fully-Specified Name
- Component
- Overall status
- 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
- Which description best fits the patient's overall status?
- Source
- CARE I.a02
Normative Answer List LL589-3
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| The patient is stable with no risk for serious complications and death (beyond those typical of the patient’s age). | 1 | LA10098-4 | |
| The patient is temporarily facing high health risks but likely to return to being stable without risk for serious complications and death (beyond those typical of the patient's age). | 2 | LA10099-2 | |
| The patient is likely to remain in fragile health and have ongoing high risks of serious complications and death. | 3 | LA10097-6 | |
| The patient has serious progressive conditions that could lead to death within a year. | 4 | LA10096-8 | |
| The patient's situation is unknown or unclear to the respondent. | 9 | LA10100-8 |
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 |
52687-1 In anticipation of serious clinical complications, has the patient made care decisions which are documented in the medical record?
Observation ID in Form
A3
Form Coding Instructions
Check all that apply
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Decision authority documented
- 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
- In anticipation of serious clinical complications, has the patient made care decisions which are documented in the medical record?
- Source
- CARE I.A3
Normative Answer List LL590-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| The patient has designated a decision-maker (if the patient is unable to make decisions) which is documented in the medical record. | 1 | LA11786-3 | |
| The patient (or surrogate) has made a decision to forgo resuscitation which is documented in the medical record. | 2 | LA11787-1 |
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 |