Version 2.78

52537-8 Pre-admission Service Use

Observation ID in Form

A

Fully-Specified Name

Component
Pre-admission Service Use
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52722-6 Admitted From. Immediately preceding this admission, where was the patient?

Observation ID in Form

A1

Form Coding Instructions

If transferring within units of an acute setting, choose Other and indicate if transferring to ICU, stepdown, med/surg, or other unit

Source: Regenstrief Help

Fully-Specified Name

Component
Admitted from
Property
Type
Time
Pt
System
Facility
Scale
Nom
Method
CARE

Basic Attributes

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

Survey Question

Text
Admitted From. Immediately preceding this admission, where was the patient?
Source
CARE I.a02

Normative Answer List LL730-3

Answer Code Score Answer ID
Community residential setting (e.g., private home, assisted living, group home, adult foster care) 1 LA11501-6
Long-term nursing facility 2 LA11502-4
Skilled nursing facility (SNF/TCU) 3 LA10080-2
Hospital emergency department 4 LA11504-0
Short-stay acute hospital (IPPS) 5 LA10078-6
Long-Term Care Hospital (LTCH) 6 LA10000-0
Inpatient rehabilitation hospital or unit (IRF) 7 LA9986-6
Psychiatric hospital or unit 8 LA10065-3
Other (specify) 9 LA6310-2

Member of these Panels

LOINC Long Common Name
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
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

52723-4 Other (specify)

Observation ID in Form

A19

Fully-Specified Name

Component
Admitted from.other specified
Property
Type
Time
Pt
System
Facility
Scale
Nom
Method
CARE

Basic Attributes

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

Member of these Panels

LOINC Long Common Name
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
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

52724-2 If admitted from a medical setting, what was the primary diagnosis being treated in the previous setting?

Observation ID in Form

A2a

Fully-Specified Name

Component
Primary diagnosis code from previous setting
Property
Prid
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

Survey Question

Text
If admitted from a medical setting, what was the primary diagnosis being treated in the previous setting?
Source
CARE I.a03

Member of these Panels

LOINC Long Common Name
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
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

52725-9 In the last 2 months, what medical services other than those identified in A1. has the patient received?

Observation ID in Form

A3

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Medical services received in the last 2Mo
Property
Find
Time
2Mo
System
^Patient
Scale
Nom
Method
CARE

Basic Attributes

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

Survey Question

Text
In the last 2 months, what medical services other than those identified in A1. has the patient received?
Source
CARE I.A4

Normative Answer List LL722-0

Answer Code Score Answer ID
Skilled nursing facility (SNF/TCU) a LA10080-2
Short-stay acute hospital (IPPS) b LA10078-6
Long-Term Care Hospital (LTCH) c LA10000-0
Inpatient rehabilitation hospital or unit (IRF) d LA9986-6
Psychiatric hospital or unit e LA10065-3
Home Health Care (HHA) f LA9978-3
Hospice g LA6216-1
Outpatient Services h LA10053-9
None Copyright http://snomed.info/sct ID:260413007 None (qualifier value) i LA137-2

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

70129-2 Within this acute care hospital stay, on what other units has the patient been treated prior to coming to this unit?

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Within this acute care hospital stay, on what other units has the patient been treated prior to coming to this unit
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.64

Survey Question

Text
Within this acute care hospital stay, on what other units has the patient been treated prior to coming to this unit?
Source
A4

Normative Answer List LL2016-5

Answer Code Score Answer ID
Critical care/intensive care unit - 1-2 pts per nurse a LA18414-5
Step-down/intermediate unit - 3-6 pts per nurse b LA18415-2
General/medical unit or floor - 6 or more pts per nurse c LA18416-0
No previous units or not applicable d LA18417-8

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52538-6 Patient History Prior to this Current Illness, Exacerbation, or Injury

Observation ID in Form

B

Fully-Specified Name

Component
Patient History Prior to this Current Illness, Exacerbation, or Injury
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52726-7 Prior to this recent illness, where did the patient live?

Observation ID in Form

B1

Skip Logic

If permanently in long-term care, skip to B5. Prior Functioning. If Other, skip to B5. Prior Functioning. If Unknown, skip to B5. Prior Functioning.

Fully-Specified Name

Component
Prior residence
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

Survey Question

Text
Prior to this recent illness, where did the patient live?
Source
CARE I.b01

Normative Answer List LL545-5

Answer Code Score Answer ID
Private residence 1 LA10062-0
Community based residence (e.g., assisted living residence, group home, adult foster care) 2 LA9951-0
Long-term care facility (e.g., nursing home) 3 LA11521-4
Other (e.g., shelter, jail, no known address) 4 LA10047-1
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) 9 LA4489-6

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52539-4 If the patient lived in the community prior to this illness, provide the patient's zip code (if the patient 's residence was in U.S.).

Observation ID in Form

B2

Fully-Specified Name

Component
Prior postal code
Property
Loc
Time
Pt
System
^Patient
Scale
Nom
Method

Additional Names

Short Name
Prior postal code

Basic Attributes

Class
ADMIN.PATIENT.DEMOG
Type
Clinical
First Released
Version 2.26
Last Updated
Version 2.66
Change Reason
Updated Class from SURVEY.CARE to ADMIN; Updated "ZIP code" in Component name to "Postal code", the more universal nomenclature for this concept.
Order vs. Observation
Both

Member of these Panels

LOINC Long Common Name
103991-6 CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
83265-9 Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.4 [CMS Assessment]
87414-9 Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.5 [CMS Assessment]
88329-8 Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 2.0 [CMS Assessment]
45969-3 Deprecated MDS background information at admission form - version 2.0
89963-3 Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
93128-7 Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]

Language Variants Get Info

Tag Language Translation
es-MX Spanish (Mexico) Código postal anterior:Loc:Punto temporal:^ Paciente:Nominal:
it-IT Italian (Italy) Codice postale precedente:Loc:Pt:^Paziente:Nom:
Synonyms: Amministrativo CAP Dati demografici del paziente Paziente Posizione Punto nel tempo (episodio)
zh-CN Chinese (China) 既往邮政编码:位置:时间点:^患者:名义型:
Synonyms: 分类型应答;分类型结果;名义性;名称型;名词型;名词性;标称性;没有自然次序的名义型或分类型应答 医疗服务对象;客户;病人;病患;病号;超系统 - 病人 地点;场所 既往(过去的、曾用的)邮政编码(邮政区号、邮递区号、邮编);既往邮政区号;既往邮递区号;既往邮编;之前的邮政编码 时刻;随机;随意;瞬间 行政;管理;施行;执行;经营 行政管理(行政、管理、施行、执行、经营).患者(病人、病患、病号、伤病员) 行政管理(行政、管理、施行、执行、经营).患者(病人、病患、病号、伤病员).人口统计学信息(人口统计学、人口统计、人口统计数据、人口统计学数据、人口统计特征、人口统计学特征、个人基本信息、人员基本信息、个人基本资料、个人基本数据) 邮政区号;邮递区号;邮编

52727-5 Lives outside U.S.

Observation ID in Form

B2a

Fully-Specified Name

Component
Lives outside U.S.
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
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

Example 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
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52540-2 ZIP Code unknown

Observation ID in Form

B2b

Fully-Specified Name

Component
ZIP Code unknown
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64
Change Reason
Release 2.73: COMPONENT: Z-I-P and C in code should be capitalized; Previous Releases: Method removed and Answer List Type changed to Example because this generic term can be used across contexts

Example 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
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52541-0 If the patient lived in the community prior to this illness, what help was used?

Observation ID in Form

B3

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Prior help
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

Survey Question

Text
If the patient lived in the community prior to this illness, what help was used?
Source
CARE I.B3

Normative Answer List LL548-9

Answer Code Score Answer ID
No help received or no help necessary a LA10022-4
Unpaid Assistance b LA10111-5
Paid Assistance c LA10054-7
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) d LA4489-6

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52542-8 If the patient lived in the community prior to this illness, who did the patient live with?

Observation ID in Form

B3a

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Patient lived with prior to this illness
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

Survey Question

Text
If the patient lived in the community prior to this illness, who did the patient live with?
Source
CARE I.B3a

Normative Answer List LL549-7

Answer Code Score Answer ID
Lives alone a LA6255-9
Lives with paid helper b LA9997-3
Lives with other(s) c LA9996-5
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) d LA4489-6

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52543-6 If the patient lived in the community prior to this current illness, exacerbation, or injury, are there any structural barriers in the patient's prior residence that could interfere with the patient's discharge?

Observation ID in Form

B4

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Structural barriers in prior residence that could interfere with the patient's discharge
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
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
If the patient lived in the community prior to this current illness, exacerbation, or injury, are there any structural barriers in the patient's prior residence that could interfere with the patient's discharge?
Source
CARE I.B4

Example Answer List LL550-5

Answer Code Score Answer ID
Structural barriers are not an issue. a LA10089-3
Stairs inside the living setting that must be used by patient (e.g., to get to toileting, sleeping, eating areas). b LA10086-9
Stairs leading from inside to outside of living setting. c LA10087-7
Narrow or obstructed doorways for patients using wheelchairs or walkers. d LA10016-6
Insufficient space to accommodate extra equipment (e.g., hospital bed, vent equipment). e LA9987-4
Other (specify) f LA6310-2
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) g LA4489-6

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52544-4 Other (specify)

Observation ID in Form

B4f

Fully-Specified Name

Component
Structural barrier.other specified
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

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52449-6 Prior Functioning. Indicate the patient's usual ability with everyday activities prior to this current illness, exacerbation, or injury.

Observation ID in Form

B5

Form Coding Instructions

Indicate the patient's usual ability with everyday activities prior to this current illness, exacerbation, or injury. Check only one box in each row

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Prior Functioning
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64
Panel Type
Panel

Survey Question

Text
Prior Functioning. Indicate the patient's usual ability with everyday activities prior to this current illness, exacerbation, or injury.
Source
CARE I.B5

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52545-1 Self Care: Did the patient need help bathing, dressing, using the toilet, or eating?

Observation ID in Form

B5a

Fully-Specified Name

Component
Prior functioning.self care
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64
Change Reason
Edits made and then reverted

Survey Question

Text
Self Care: Did the patient need help bathing, dressing, using the toilet, or eating?
Source
CARE I.b05a

Normative Answer List LL546-3

Answer Code Score Answer ID
Independent – Patient completed the activities by him/herself, with or without an assistive device, with no assistance from a helper. 3 LA9982-5
Needed partial assistance – Patient needed partial assistance from another person to complete activities. 2 LA10018-2
Dependent – A helper completed the activity for the patient. 1 LA9963-5
Not applicable 8 LA4720-4
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) 9 LA4489-6

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52546-9 Indoor Mobility (Ambulation): Did the patient need assistance with walking from room to room (with or without devices such as cane, crutch, or walker)?

Observation ID in Form

B5b

Fully-Specified Name

Component
Prior functioning.mobility - ambulation
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64
Change Reason
Made edits and then reverted back

Survey Question

Text
Indoor Mobility (Ambulation): Did the patient need assistance with walking from room to room (with or without devices such as cane, crutch, or walker)?
Source
CARE I.b05b

Normative Answer List LL546-3

Answer Code Score Answer ID
Independent – Patient completed the activities by him/herself, with or without an assistive device, with no assistance from a helper. 3 LA9982-5
Needed partial assistance – Patient needed partial assistance from another person to complete activities. 2 LA10018-2
Dependent – A helper completed the activity for the patient. 1 LA9963-5
Not applicable 8 LA4720-4
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) 9 LA4489-6

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52547-7 Stairs (Ambulation): Did the patient need assistance with internal or external stairs (with or without devices such as cane, crutch, or walker)?

Observation ID in Form

B5c

Fully-Specified Name

Component
Prior functioning.stairs - ambulation
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64
Change Reason
Made edits and then reverted back

Survey Question

Text
Stairs (Ambulation): Did the patient need assistance with internal or external stairs (with or without devices such as cane, crutch, or walker)?
Source
CARE I.b05c

Normative Answer List LL546-3

Answer Code Score Answer ID
Independent – Patient completed the activities by him/herself, with or without an assistive device, with no assistance from a helper. 3 LA9982-5
Needed partial assistance – Patient needed partial assistance from another person to complete activities. 2 LA10018-2
Dependent – A helper completed the activity for the patient. 1 LA9963-5
Not applicable 8 LA4720-4
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) 9 LA4489-6

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52548-5 Indoor Mobility (Wheelchair): Did the patient need assistance with moving from room to room using a wheelchair, scooter, or other wheeled mobility device?

Observation ID in Form

B5d

Fully-Specified Name

Component
Prior functioning.mobility - wheelchair
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

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

Survey Question

Text
Indoor Mobility (Wheelchair): Did the patient need assistance with moving from room to room using a wheelchair, scooter, or other wheeled mobility device?
Source
CARE I.b05d

Normative Answer List LL546-3

Answer Code Score Answer ID
Independent – Patient completed the activities by him/herself, with or without an assistive device, with no assistance from a helper. 3 LA9982-5
Needed partial assistance – Patient needed partial assistance from another person to complete activities. 2 LA10018-2
Dependent – A helper completed the activity for the patient. 1 LA9963-5
Not applicable 8 LA4720-4
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) 9 LA4489-6

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52549-3 Functional Cognition: Did the patient need help planning regular tasks, such as shopping or remembering to take medication?

Observation ID in Form

B5e

Fully-Specified Name

Component
Prior functioning.functional cognition
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.64
Change Reason
Made edits and then reverted back

Survey Question

Text
Functional Cognition: Did the patient need help planning regular tasks, such as shopping or remembering to take medication?
Source
CARE I.b05e

Normative Answer List LL546-3

Answer Code Score Answer ID
Independent – Patient completed the activities by him/herself, with or without an assistive device, with no assistance from a helper. 3 LA9982-5
Needed partial assistance – Patient needed partial assistance from another person to complete activities. 2 LA10018-2
Dependent – A helper completed the activity for the patient. 1 LA9963-5
Not applicable 8 LA4720-4
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) 9 LA4489-6

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52550-1 Mobility devices and aids used prior to current illness, exacerbation, or injury [CARE]

Observation ID in Form

B6

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Mobility devices and aids used prior to current illness, exacerbation, or injury
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

Normative Answer List LL551-3

Answer Code Score Answer ID
Cane/crutch a LA9941-1
Walker b LA10117-2
Orthotics/Prosthetics c LA10046-3
Wheelchair/scooter full time d LA10119-8
Wheelchair/scooter part time e LA10120-6
Mechanical lift required f LA10003-4
Other (specify) g LA6310-2
None apply h LA10029-9
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) i LA4489-6

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52551-9 Other (specify)

Observation ID in Form

B6g

Fully-Specified Name

Component
Prior mobility device.other specified
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

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52552-7 Falls in the past year

Observation ID in Form

B7

Fully-Specified Name

Component
Falls in the past Y
Property
Hx
Time
1Y
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.27
Last Updated
Version 2.70
Change Reason
Release 2.70: METHOD_TYP: General concept not specific to CMS; Previous Releases: Changed Component from "History of falls in the past year" to "Falls in the past Y" and Property from "Find" to "Hx" based on current LOINC model.
Order vs. Observation
Observation

Normative Answer List LL208-0

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
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value) 9 LA4489-6

Member of these Panels

LOINC Long Common Name
103991-6 CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
83265-9 Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.4 [CMS Assessment]
87414-9 Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.5 [CMS Assessment]
88329-8 Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 2.0 [CMS Assessment]
89963-3 Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment]
93128-7 Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
97874-2 Stay Independent panel [Stay Independent]