Form Coding Instructions

Check one option only

Source: Centers for Medicare & Medicaid Services

57212-3 Patient lives alone

Observation ID in Form

M1100a

Fully-Specified Name

Component
Patient lives alone
Property
Find
Time
RptPeriod
System
^Patient
Scale
Nom
Method
CMS Assessment

Long Common Name

Patient lives alone during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.29
Last Updated
Version 2.77 (MAJ)
Change Reason
Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments; Previous Releases: Updated METHOD from OASIS-C to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee
Order vs. Observation
Observation

Normative Answer List LL783-2

AnswerCodeScoreAnswer ID
Around the clock1LA12163-4
Regular daytime2LA12164-2
Regular nighttime3LA12165-9
Occasional / short-term assistance4LA12166-7
No assistance available5LA12167-5

Member of these Panels

LOINCLong Common Name
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

57213-1 Patient lives with other person

Observation ID in Form

M1100b

Fully-Specified Name

Component
Patient lives with other person
Property
Find
Time
RptPeriod
System
^Patient
Scale
Nom
Method
CMS Assessment

Long Common Name

Patient lives with other person during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.29
Last Updated
Version 2.77 (MAJ)
Change Reason
Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments; Previous Releases: Updated METHOD from OASIS-C to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee
Order vs. Observation
Observation

Normative Answer List LL845-9

AnswerCodeScoreAnswer ID
Around the clock6LA12163-4
Regular daytime7LA12164-2
Regular nighttime8LA12165-9
Occasional / short-term assistance9LA12166-7
No assistance available10LA12167-5

Member of these Panels

LOINCLong Common Name
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care

57214-9 Patient lives in congregated situtation

Observation ID in Form

M1100c

Form Coding Instructions

e.g., assisted living

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Patient lives in congregated situtation
Property
Find
Time
RptPeriod
System
^Patient
Scale
Nom
Method
CMS Assessment

Long Common Name

Patient lives in congregated situtation during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.29
Last Updated
Version 2.77 (MAJ)
Change Reason
Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments; Previous Releases: Updated METHOD from OASIS-C to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee
Order vs. Observation
Observation

Normative Answer List LL848-3

AnswerCodeScoreAnswer ID
Around the clock11LA12163-4
Regular daytime12LA12164-2
Regular nighttime13LA12165-9
Occasional / short-term assistance14LA12166-7
No assistance available15LA12167-5

Member of these Panels

LOINCLong Common Name
57039-0Deprecated Outcome and assessment information set (OASIS) form - version C
57191-9Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care