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Form Coding Instructions

Please indicate whether the team considered the following services appropriate for the patient at discharge; for those identified as potentially appropriate, were they: unavailable, refused by family, or not covered by insurance. (Check all that apply.)

Source: Centers for Medicare & Medicaid Services

52702-8 Home Health Care (HHA)

Observation ID in Form

Da

Fully-Specified Name

Component
Home health care considered appropriate
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Home health care considered appropriate [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Normative Answer List LL596-8

AnswerCodeScoreAnswer ID
Considered Appropriate by the Provider1LA9955-1
No Bed/Services Available2LA11804-4
Refused by Patient/Family3LA10069-5
Not Covered by Insurance4LA10041-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

52703-6 Skilled Nursing Facility (SNF/TCU)

Fully-Specified Name

Component
Skilled nursing facility considered appropriate
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Skilled nursing facility considered appropriate [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Normative Answer List LL596-8

AnswerCodeScoreAnswer ID
Considered Appropriate by the Provider1LA9955-1
No Bed/Services Available2LA11804-4
Refused by Patient/Family3LA10069-5
Not Covered by Insurance4LA10041-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

52704-4 Inpatient Rehabilitation Hospital or Unit (IRF)

Fully-Specified Name

Component
Inpatient rehabilitation hospital considered appropriate
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Inpatient rehabilitation hospital considered appropriate [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Normative Answer List LL596-8

AnswerCodeScoreAnswer ID
Considered Appropriate by the Provider1LA9955-1
No Bed/Services Available2LA11804-4
Refused by Patient/Family3LA10069-5
Not Covered by Insurance4LA10041-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

52705-1 Long-Term Care Hospital (LTCH)

Fully-Specified Name

Component
Long term care hospital considered appropriate
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Long term care hospital considered appropriate [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Normative Answer List LL596-8

AnswerCodeScoreAnswer ID
Considered Appropriate by the Provider1LA9955-1
No Bed/Services Available2LA11804-4
Refused by Patient/Family3LA10069-5
Not Covered by Insurance4LA10041-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

52706-9 Psychiatric Hospital or Unit

Fully-Specified Name

Component
Psychiatric hospital considered appropriate
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Psychiatric hospital considered appropriate [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Normative Answer List LL596-8

AnswerCodeScoreAnswer ID
Considered Appropriate by the Provider1LA9955-1
No Bed/Services Available2LA11804-4
Refused by Patient/Family3LA10069-5
Not Covered by Insurance4LA10041-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

52707-7 Outpatient Services

Fully-Specified Name

Component
Outpatient services considered appropriate
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Outpatient services considered appropriate [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Normative Answer List LL596-8

AnswerCodeScoreAnswer ID
Considered Appropriate by the Provider1LA9955-1
No Bed/Services Available2LA11804-4
Refused by Patient/Family3LA10069-5
Not Covered by Insurance4LA10041-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

52708-5 Acute Hospital Admission

Fully-Specified Name

Component
Acute hospital admission considered appropriate
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Acute hospital admission considered appropriate [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Normative Answer List LL596-8

AnswerCodeScoreAnswer ID
Considered Appropriate by the Provider1LA9955-1
No Bed/Services Available2LA11804-4
Refused by Patient/Family3LA10069-5
Not Covered by Insurance4LA10041-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

52709-3 Hospice

Fully-Specified Name

Component
Hospice considered appropriate
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Hospice considered appropriate [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Normative Answer List LL596-8

AnswerCodeScoreAnswer ID
Considered Appropriate by the Provider1LA9955-1
No Bed/Services Available2LA11804-4
Refused by Patient/Family3LA10069-5
Not Covered by Insurance4LA10041-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

52710-1 Long-term Personal Care Services

Fully-Specified Name

Component
Long-term personal care services considered appropriate
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Long-term personal care services considered appropriate [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Normative Answer List LL596-8

AnswerCodeScoreAnswer ID
Considered Appropriate by the Provider1LA9955-1
No Bed/Services Available2LA11804-4
Refused by Patient/Family3LA10069-5
Not Covered by Insurance4LA10041-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

52711-9 Long-Term Nursing Facility

Fully-Specified Name

Component
Long term care nursing facility considered appropriate
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Long term care nursing facility considered appropriate [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Normative Answer List LL596-8

AnswerCodeScoreAnswer ID
Considered Appropriate by the Provider1LA9955-1
No Bed/Services Available2LA11804-4
Refused by Patient/Family3LA10069-5
Not Covered by Insurance4LA10041-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

52712-7 Other (specify)

Fully-Specified Name

Component
Other service considered appropriate
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Long Common Name

Other service considered appropriate [CARE]

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Normative Answer List LL596-8

AnswerCodeScoreAnswer ID
Considered Appropriate by the Provider1LA9955-1
No Bed/Services Available2LA11804-4
Refused by Patient/Family3LA10069-5
Not Covered by Insurance4LA10041-4

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

55760-3 Other service considered appropriate.other specified [CARE]

Fully-Specified Name

Component
Other service considered appropriate.other specified
Property
Type
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

55761-1 No services needed after discharge [CARE]

Fully-Specified Name

Component
No services needed after discharge
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64 (MIN)

Member of these Panels

LOINCLong Common Name
52745-7Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care