LOINC Panel Details 67871-4 Patient demographics - end stage renal disease form 2728

56799-0 Address

Observation ID in Form

CMS-2728_A5

Observation Required in Panel

Required

Fully-Specified Name

Component: Address
Property: Addr
Time: Pt
System: ^Patient
Scale: Nom
Method

Basic Attributes

Class: ADMIN.PATIENT
Type: Clinical
First Released: Version 2.29
Last Updated: Version 2.73 (MIN)
Common Test Rank Get Info: 8050

HL7^® Attributes

HL7^® Field ID: PID-11

Member of these Panels

LOINC	Long Common Name
89070-7	ADAPTABLE patient reported item set [ADAPTABLE]
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
89724-9	Minimum Data Set (MDS) for Public Health Emergency Operations Centers (EOC) [CDC Emergency Operations Centers]
80399-9	Occupational exposure information panel
79191-3	Patient demographics panel
93149-3	PhenX - bone age protocol 220301
63052-5	PhenX - current address protocol 010801
93025-5	Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]

Language Variants Get Info

Tag	Language	Translation
el-GR	Greek (Greece)	Διεύθυνση:Addr:Pt:^Ασθενής:Nom: Synonyms: Addr Διεύθυνση
es-ES	Spanish (Spain)	Dirección:Dirección:Punto temporal:^paciente:Nom:
es-MX	Spanish (Mexico)	Dirección:Dirección:Punto temporal:^ Paciente:Nominal:
it-IT	Italian (Italy)	Indirizzo:Addr:Pt:^Paziente:Nom: Synonyms: Amministrativo Indirizzo (HL7 data type) Paziente Punto nel tempo (episodio)
nl-NL	Dutch (Netherlands)	adres:adres (HL7-datatype):moment:^patiënt:nominaal:
pt-BR	Portuguese (Brazil)	Endereço:#N/A:Pt:^Paciente:Nom: Synonyms: Point in time; Random; Nominal; EMERGENCY DEPARTMENT (DEEDS); DEEDS; EMERGENCY DEPARTMENT (DEEDS)
ru-RU	Russian (Russian Federation)	Адрес:Адр:ТчкВрм:^Пациент:Ном: Synonyms: Адрес (HL7 data type) Номинальный;Именной Точка во времени;Момент
zh-CN	Chinese (China)	地址:地址: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 - 病人地址(来自HL7) 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）

Related Codes

Code System	Code	Code Text	Code Version
https://www.phenxtoolkit.org	PX220301220000	PX220301_Bone_Age_Patient_Address

68997-6 Patient City (Mailing)

Observation ID in Form

CMS-2728_A5

Observation Required in Panel

Required

Fully-Specified Name

Component: City
Property: Loc
Time: Pt
System: ^Patient
Scale: Nom
Method

Long Common Name

City

Basic Attributes

Class: SURVEY.ESRD
Type: Surveys
First Released: Version 2.38
Last Updated: Version 2.73 (MIN)
Common Test Rank Get Info: 8343

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
80399-9	Occupational exposure information panel
79191-3	Patient demographics panel

46499-0 State of residence

Term Description

The state in which the patient is currently residing while receiving care.

Observation ID in Form

CMS-2728_A5

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component: State of residence
Property: Loc
Time: Pt
System: ^Patient
Scale: Nom
Method

Basic Attributes

Class: ADMIN.PATIENT.DEMOG
Type: Clinical
First Released: Version 2.19
Last Updated: Version 2.73 (MIN)
Order vs. Observation: Both
Common Test Rank Get Info: 7483

HL7^® Attributes

HL7^® Field ID: PID-11.4

Example Answer List LL3661-7

Externally Defined: Yes
Code System: CDC-PHIN
Code System OID: 1.3.6.1.4.1.12009.10.1.2296
Link to External List: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.830

Member of these Panels

LOINC	Long Common Name
46462-8	Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0	Deprecated Outcome and assessment information set (OASIS) form - version C
57190-1	Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care
85907-4	Deprecated Outcome and assessment information set (OASIS) form - version C2 - Start of care [CMS Assessment]
68359-9	End Stage Renal Disease (ESRD) Death Notification - OMB CMS form 2746
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
80399-9	Occupational exposure information panel
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
79191-3	Patient demographics panel

Language Variants Get Info

Tag	Language	Translation
el-GR	Greek (Greece)	Πολιτεία κατοικίας:Loc:Pt:^Ασθενής:Nom: Synonyms: Loc Κατάσταση Κατοικία Πολιτεία κατοικίας
es-MX	Spanish (Mexico)	Estado de residencia:Loc:Punto temporal:^ Paciente:Nominal:
it-IT	Italian (Italy)	Stato di residenza:Loc:Pt:^Paziente:Nom: Synonyms: Amministrativo Dati demografici del paziente Paziente Posizione Punto nel tempo (episodio)
zh-CN	Chinese (China)	居住州: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;场所州;邦;政府;国家;状况;情况所在州时刻;随机;随意;瞬间滞留;驻扎;住处;住所;住宅;居住地行政;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）

Related Codes

Code System	Code	Code Version
CMS OASIS	M0050	D1
CMS OASIS	M0050	D
CMS OASIS	M0050	C2
CMS OASIS	M0050	E

45401-7 Postal code [Location]

Observation ID in Form

CMS-2728_A5

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component: Postal code
Property: Loc
Time: Pt
System: ^Patient
Scale: Nom
Method

Basic Attributes

Class: ADMIN.PATIENT.DEMOG
Type: Clinical
First Released: Version 2.17
Last Updated: Version 2.73 (MIN)
Change Reason: Updated Component name from "ZIP code" to "Postal code", the more universal nomenclature for this concept.
Order vs. Observation: Both
Common Test Rank Get Info: 6911

HL7^® Attributes

HL7^® Field ID: PID-11.5

Member of these Panels

LOINC	Long Common Name
76464-7	American Physical Therapy Association registry panel
46462-8	Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0	Deprecated Outcome and assessment information set (OASIS) form - version C
57190-1	Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care
85907-4	Deprecated Outcome and assessment information set (OASIS) form - version C2 - Start of care [CMS Assessment]
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
80399-9	Occupational exposure information panel
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
79191-3	Patient demographics panel
63052-5	PhenX - current address protocol 010801
62611-9	PhenX domain - Respiratory

Language Variants Get Info

Tag	Language	Translation
el-GR	Greek (Greece)	Ταχυδρομικός κώδικας:Loc:Pt:^Ασθενής:Nom: Synonyms: Loc Ταχυδρομικός κώδικας
es-MX	Spanish (Mexico)	Código Postal:Loc:Punto temporal:^ Paciente:Nominal:
it-IT	Italian (Italy)	Codice di avviamento postale:Loc:Pt:^Paziente:Nom: Synonyms: Amministrativo CAP Dati demografici del paziente Paziente Posizione Punto nel tempo (episodio)
zh-CN	Chinese (China)	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

Related Codes

Code System	Code	Code Text	Code Version
CMS OASIS	M0060		D1
CMS OASIS	M0060		E
CMS OASIS	M0060		D
CMS OASIS	M0060		C2
https://www.phenxtoolkit.org	PX010801060000	PX010801_ZIP_Code

42077-8 Patient phone number

Term Description

The patient's telephone number.

Observation ID in Form

CMS-2728_A6

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component: Phone number
Property: Tele
Time: Pt
System: ^Patient
Scale: Nom
Method

Basic Attributes

Class: ADMIN.PATIENT
Type: Clinical
First Released: Version 2.16
Last Updated: Version 2.73 (MIN)
Change Reason: Revised description and removed NORMATIVE answer list, which only included results for unknown or no phone number available. The answer choices did not include entering the patient's phone number. This term was originally created for the NAACCR v11 tumor registry. The coding instructions in the term description and as part of the answer list are now available as Form Coding Instructions for the term in the instance of the NAACCR version 11 panel [LOINC: 49083-9].
Order vs. Observation: Observation
Common Test Rank Get Info: 7124

HL7^® Attributes

HL7^® Field ID: PID-13

Member of these Panels

LOINC	Long Common Name
89070-7	ADAPTABLE patient reported item set [ADAPTABLE]
55168-9	Data Elements for Emergency Department Systems (DEEDS) Release 1.1
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
47245-6	HIV treatment form Document
49083-9	North American Association of Central Cancer Registries, Inc (NAACCR, Inc) version 11 panel
59852-4	North American Association of Central Cancer Registries, Inc (NAACCR, Inc) version 12 panel
80399-9	Occupational exposure information panel
79191-3	Patient demographics panel
55140-8	Vaccine Adverse Event Reporting System (VAERS) panel

Language Variants Get Info

Tag	Language	Translation
el-GR	Greek (Greece)	Τηλεφωνικός αριθμός:Tele:Pt:^Ασθενής:Nom: Synonyms: Tele Αριθμός Τηλεφωνικός αριθμός
es-ES	Spanish (Spain)	Número de teléfono:Teléfono:Punto temporal:^paciente:Nom: Synonyms: Número de teléfono (datos de HL7)
es-MX	Spanish (Mexico)	Número de teléfono:NúmeroTeléfono:Punto temporal:^ Paciente:Nominal:
it-IT	Italian (Italy)	Numero telefonico:Tele:Pt:^Paziente:Nom: Synonyms: Amministrativo Numero di telefono (HL7 datatype) Paziente Punto nel tempo (episodio)
nl-NL	Dutch (Netherlands)	telefoonnummer:telefoonnummer (HL7-datatype):moment:^patiënt:nominaal:
pt-BR	Portuguese (Brazil)	Telefone:Tele:Pt:^Paciente:Nom: Synonyms: Telecommunication number; Telephone number; Point in time; Random; Nominal; TUMOR REGISTRY(NAACCR); TUMOR REGISTRY(NAACCR)
ru-RU	Russian (Russian Federation)	Телефонный номер:Тел:ТчкВрм:^Пациент:Ном: Synonyms: Номинальный;Именной Телефонный номер (HL7 datatype) Точка во времени;Момент
zh-CN	Chinese (China)	电话号码:电话号码:时间点:^患者:名义型: Synonyms: 个数;数目分类型应答;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 - 病人无线电通讯号码;无线电通讯编号;电话号码(来自HL7);远程通信号码;远程通信编号;长途通信号码;长途通信编号时刻;随机;随意;瞬间电话行政;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）

Related Codes

Code System	Code	Code Text	Code Version
NAACCR_ID	2360

46098-0 Sex

Part Descriptions

LP101395-4 Sex
In LOINC, sex refers to the biological sex of an organism, which is most commonly determined based on anatomy and physiology or genetic (chromosome) analysis. Our definition is based on the World Health Organization's definition of sex and gender: sex (male, female) refers to biological and physiological characteristics, and gender (masculine, feminine) refers to socially constructed roles, behaviors, activities, and attributes. (http://www.who.int/gender/whatisgender/en) Source: Regenstrief LOINC , WHO: gender

Observation ID in Form

CMS-2728_A7

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component: Sex
Property: Type
Time: Pt
System: ^Patient
Scale: Nom
Method

Basic Attributes

Class: ADMIN.PATIENT.DEMOG
Type: Clinical
First Released: Version 2.17
Last Updated: Version 2.73 (MIN)
Change Reason: Changed Component from 'Gender' to 'Sex' to align with the World Health Organization (WHO) definition of this concept.
Order vs. Observation: Both
Common Test Rank Get Info: 2086

HL7^® Attributes

HL7^® Field ID: PID-8

Example Answer List LL1-9

Answer	Code	Score	Answer ID
Male	1		LA2-8
Female	2		LA3-6

Member of these Panels

LOINC	Long Common Name
89070-7	ADAPTABLE patient reported item set [ADAPTABLE]
95556-7	Adrenal cancer risk assessment and urine steroid fractions panel
72110-0	Alcohol Use Disorder Identification Test [AUDIT]
95405-7	Assay related variables panel [PhenX]
103991-6	CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment]
52747-3	Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7	Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
55168-9	Data Elements for Emergency Department Systems (DEEDS) Release 1.1
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
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]
85645-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 3.00 [CMS Assessment]
85671-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 3.00 [CMS Assessment]
85662-5	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 3.00 [CMS Assessment]
85668-2	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 3.00 [CMS Assessment]
45963-6	Deprecated MDS basic assessment tracking form - version 2.0
86870-3	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed OMRA (NO/SO) item set [CMS Assessment]
86874-5	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed OMRA start of therapy (NS/SS) item set [CMS Assessment]
86875-2	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed tracking (NT/ST) item set [CMS Assessment]
86522-0	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
86872-9	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
86871-1	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
86873-7	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
86877-8	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home part A PPS discharge (NPE) item set [CMS Assessment]
86856-2	Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home PPS (NP) and Nursing home quarterly (NQ) item set [CMS Assessment]
86876-0	Deprecated MDS v3.0 - RAI v1.14.1 - Swing bed PPS (SP) item set [CMS Assessment]
88279-5	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home and Swing bed OMRA (NO and SO) item set [CMS Assessment]
88280-3	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home and Swing bed OMRA start of therapy (NS and SS) item set [CMS Assessment]
88281-1	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home and Swing bed tracking (NT and ST) item set [CMS Assessment]
88282-9	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88283-7	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
88284-5	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
88285-2	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
88286-0	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home part A PPS discharge (NPE) item set [CMS Assessment]
88287-8	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home PPS (NP) item set [CMS Assessment]
88292-8	Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88288-6	Deprecated MDS v3.0 - RAI v1.15.1 - Swing bed PPS (SP) item set [CMS Assessment]
88951-9	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home and Swing bed OMRA (NO and SO) item set [CMS Assessment]
88952-7	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home and Swing bed OMRA start of therapy (NS and SS) item set [CMS Assessment]
88953-5	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home and Swing bed tracking (NT and ST) item set [CMS Assessment]
88954-3	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
88945-1	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
88946-9	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
88947-7	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
88948-5	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home part A PPS discharge (NPE) item set [CMS Assessment]
88949-3	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home PPS (NP) item set [CMS Assessment]
88955-0	Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
88950-1	Deprecated MDS v3.0 - RAI v1.16.1 - Swing bed PPS (SP) item set [CMS Assessment]
54580-6	Deprecated Minimum Data Set - version 3.0
46462-8	Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0	Deprecated Outcome and assessment information set (OASIS) form - version C
57190-1	Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care
85907-4	Deprecated Outcome and assessment information set (OASIS) form - version C2 - Start of care [CMS Assessment]
68359-9	End Stage Renal Disease (ESRD) Death Notification - OMB CMS form 2746
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
70297-7	ESRD patient information panel
86636-8	Family planning report - FPAR 2.0 set
96452-8	Hepatocellular carcinoma risk panel - Serum or Plasma
47245-6	HIV treatment form Document
106623-2	Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
106625-7	Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.0 during assessment period [CMS Assessment]
106933-5	Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [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]
85626-0	Kidney failure 2-year and 5-year risk panel by KFRE
100203-9	Knee Society Score post-op panel [Knee Society Score]
100159-3	Knee Society Score pre-op panel [Knee Society Score]
78699-6	Liver fibrosis score panel - Serum or Plasma Calculated by FibroMeter
78698-8	Liver fibrosis score panel - Serum or Plasma Calculated by HepaScore
87509-6	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
87506-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 4.00 during assessment period [CMS Assessment]
93219-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.00 during assessment period [CMS Assessment]
103948-6	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.1 during assessment period [CMS Assessment]
87507-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
87508-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 4.00 during assessment period [CMS Assessment]
93220-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.00 during assessment period [CMS Assessment]
103947-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.1 during assessment period [CMS Assessment]
90480-5	MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
90479-7	MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home and Swing bed tracking (NT and ST) item set during assessment period [CMS Assessment]
90473-0	MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
90477-1	MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
90478-9	MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
90474-8	MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
90475-5	MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
90481-3	MDS v3.0 - RAI v1.17.1, 1.17.2 - Optional State Assessment (OSA) item set during assessment period [CMS Assessment]
91552-0	MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
90476-3	MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
101111-3	MDS v3.0 - RAI v1.18.11 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
101108-9	MDS v3.0 - RAI v1.18.11 - Nursing home and Swing bed tracking (NT and ST) item set [CMS Assessment]
101105-5	MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
101107-1	MDS v3.0 - RAI v1.18.11 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
101109-7	MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
101110-5	MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
101106-3	MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
101113-9	MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment]
101112-1	MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
104608-5	MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
105008-7	MDS v3.0 - RAI v1.19.1 - Nursing home and Swing bed tracking (NT ST) item set during assessment period [CMS Assessment]
103564-1	MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment]
104606-9	MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment]
105201-8	MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
104552-5	MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment]
104554-1	MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment]
104607-7	MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment]
104609-3	MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment]
82259-3	Metabolic equivalent of task and Resting metabolic rate panel
89724-9	Minimum Data Set (MDS) for Public Health Emergency Operations Centers (EOC) [CDC Emergency Operations Centers]
91393-9	Opioid risk tool panel
88373-6	Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
99131-5	Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment]
106523-4	Outcome and assessment information set (OASIS) form - version E1 - Start of Care during assessment period [CMS Assessment]
69723-5	Patient Health Questionnaire (PHQ) [Reported]
93149-3	PhenX - bone age protocol 220301
62787-7	PhenX domain - Diabetes
62863-6	PhenX domain - Infectious diseases and immunity
62755-4	PhenX domain - Neurology
62263-9	PhenX domain - Nutrition and dietary supplements
62812-3	PhenX domain - Physical activity and physical fitness
62611-9	PhenX domain - Respiratory
63009-5	PhenX domain - Social environments
63067-3	PhenX domain - Speech and hearing
82287-4	Physical activity panel
69919-9	Race, ethnicity, sex, primary language, disability - Health and Human Services (HHS) panel [HHS.ACA Section 4302]
55140-8	Vaccine Adverse Event Reporting System (VAERS) panel

Language Variants Get Info

Tag	Language	Translation
el-GR	Greek (Greece)	Φύλο:Type:Pt:^Ασθενής:Nom: Synonyms: Type Φύλο
es-MX	Spanish (Mexico)	Sexo:Tipo:Punto temporal:^ Paciente:Nominal:
es-ES	Spanish (Spain)	Sexo:Tipo:Punto temporal:^paciente:Nom:
et-EE	Estonian (Estonia)	Sugu:Tüüp:Pt:^patsient:Nom: Synonyms: Juhuslik
fr-BE	French (Belgium)	Sexe:Type:Temps ponctuel:^Patient:Nominal:
fr-CA	French (Canada)	Sexe:Type:Temps ponctuel:^Patient:Nominal:
it-IT	Italian (Italy)	Sesso:Tipo:Pt:^Paziente:Nom: Synonyms: Amministrativo Dati demografici del paziente Paziente Punto nel tempo (episodio)
nl-NL	Dutch (Netherlands)	geslacht:type:moment:^patiënt:nominaal:
ru-RU	Russian (Russian Federation)	Пол:Тип:ТчкВрм:^Пациент:Ном: Synonyms: Номинальный;Именной Точка во времени;Момент
tr-TR	Turkish (Turkey)	Cinsiyet:Tip:Zmlı:^Hasta:Snf: Synonyms: Seks Tür
zh-CN	Chinese (China)	性别:类型: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 - 病人型性;性别特征;性行为;性交;性活动时刻;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）

Related Codes

Code System	Code	Code Text	Code Version
CMS IRF-PAI	8		4.0
CMS LCDS	A0800		5.00
CMS OASIS	M0069		D1
CMS MDS	A0800		1.17.2
CMS MDS	X0300		1.17.2
CMS OASIS	M0069		E
CMS MDS	A0800		v1.18.11
CMS MDS	X0300		v1.18.11
CMS LCDS	A0800		3.00
CMS IRF-PAI	8		2.0
CMS MDS	A0800		1.16.1
CMS OASIS	M0069		D
CMS MDS	X0300		1.16.1
CMS IRF-PAI	8		1.4
CMS IRF-PAI	8		1.5
CMS IRF-PAI	8		3.0
CMS LCDS	A0800		4.00
CMS MDS	A0800		1.14.1
CMS MDS	A0800		1.15.1
CMS MDS	X0300		1.14.1
CMS MDS	X0300		1.15.1
CMS OASIS	M0069		C2
https://www.phenxtoolkit.org	PX070601010100	PX070601_Self_Gender
https://www.phenxtoolkit.org	PX091501010400	PX091501_Sleep_Apnea_Gender
https://www.phenxtoolkit.org	PX091502040000	PX091502_Child_Gender
https://www.phenxtoolkit.org	PX091601390000	PX091601_Sex
https://www.phenxtoolkit.org	PX130501020200	PX130501_Gender
https://www.phenxtoolkit.org	PX140201010100	PX140201_Spouse_Sex
https://www.phenxtoolkit.org	PX150101020000	PX150101_Sex
https://www.phenxtoolkit.org	PX150102010000	PX150102_Sex
https://www.phenxtoolkit.org	PX150201020000	PX150201_Gender
https://www.phenxtoolkit.org	PX150202020000	PX150202_Gender
https://www.phenxtoolkit.org	PX150203010000	PX150203_Gender
https://www.phenxtoolkit.org	PX161201010000	PX161201_Gender
https://www.phenxtoolkit.org	PX201501170101	PX201501_Sibling1_Sex
https://www.phenxtoolkit.org	PX201501170104	PX201501_Sibling1_Cause_Of_Hearing_Difficulty
https://www.phenxtoolkit.org	PX201501170203	PX201501_Sibling2_Age_Onset_Hearing_Difficulty
https://www.phenxtoolkit.org	PX201501170302	PX201501_Sibling3_Birth_Year
https://www.phenxtoolkit.org	PX201501170401	PX201501_Sibling4_Sex
https://www.phenxtoolkit.org	PX211101010400	PX211101_Person1_Gender
https://www.phenxtoolkit.org	PX211101020400	PX211101_Person2_Gender
https://www.phenxtoolkit.org	PX211101030400	PX211101_Person3_Gender
https://www.phenxtoolkit.org	PX211101040400	PX211101_Person4_Gender
https://www.phenxtoolkit.org	PX211101050400	PX211101_Person5_Gender
https://www.phenxtoolkit.org	PX211101060400	PX211101_Person6_Gender
https://www.phenxtoolkit.org	PX211101070400	PX211101_Person7_Gender
https://www.phenxtoolkit.org	PX211101080400	PX211101_Person8_Gender
https://www.phenxtoolkit.org	PX211101090400	PX211101_Person9_Gender
https://www.phenxtoolkit.org	PX211101100400	PX211101_Person10_Gender
https://www.phenxtoolkit.org	PX211101110400	PX211101_Person11_Gender
https://www.phenxtoolkit.org	PX211101120400	PX211101_Person12_Gender
https://www.phenxtoolkit.org	PX211101130400	PX211101_Person13_Gender
https://www.phenxtoolkit.org	PX211101140400	PX211101_Person14_Gender
https://www.phenxtoolkit.org	PX211101150400	PX211101_Person15_Gender
https://www.phenxtoolkit.org	PX211101160400	PX211101_Person16_Gender
https://www.phenxtoolkit.org	PX211101170400	PX211101_Person17_Gender
https://www.phenxtoolkit.org	PX211101180400	PX211101_Person18_Gender
https://www.phenxtoolkit.org	PX211101190400	PX211101_Person19_Gender
https://www.phenxtoolkit.org	PX211101200400	PX211101_Person20_Gender
CMS MDS	A0800		1.17.1
CMS MDS	X0300		1.17.1
https://www.phenxtoolkit.org	PX220301250000	PX220301_Bone_Age_Patient_Gender
https://www.phenxtoolkit.org	PX811301030000	PX811301_SerumPlasmaFerritin_Gender

54133-4 Ethnicity [USSG-FHT]

Observation ID in Form

CMS-2728_A8

Observation Required in Panel

Optional

Fully-Specified Name

Component: Ethnicity
Property: Type
Time: Pt
System: ^Patient
Scale: Nom
Method: USSG-FHT

Basic Attributes

Class: SURVEY.USSGFHT
Type: Surveys
First Released: Version 2.26
Last Updated: Version 2.73 (MIN)
Common Test Rank Get Info: 19111

HL7^® Attributes

HL7^® Field ID: PID-22

Normative Answer List LL628-9

Answer	Code	Answer ID
Hispanic or Latino	2135-2	LA6214-6
Central American	2155-0	LA10599-1
Cuban	2182-4	LA4190-0
Dominican(Republic)	2184-0	LA10601-5
Mexican	2148-5	LA4611-5
Puerto Rican	2180-8	LA4364-1
South American	2165-9	LA10606-4
Other Latin American		LA14055-0
Other Hispanic/Latino/Spanish		LA10603-1
Non-Hispanic or Latino	2186-5	LA10597-5
Ashkenazi Jewish		LA10598-3
Unknown/No answer		LA10607-2

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
54127-6	US Surgeon General family health portrait [USSG-FHT]

Related Codes

Code System	Code	Code Text	Code Version
https://www.phenxtoolkit.org	PX221001110000	PX221001_MFHP_Ethnicity

68329-2 Country of origin

Observation ID in Form

CMS-2728_A9

Observation Required in Panel

Conditional

Fully-Specified Name

Component: Country of origin
Property: Loc
Time: Pt
System: ^Patient
Scale: Nom
Method

Basic Attributes

Class: SURVEY.ESRD
Type: Surveys
First Released: Version 2.38
Last Updated: Version 2.52 (MAJ)

Member of these Panels

LOINC	Long Common Name
78000-7	Case notification panel [CDC.PHIN]
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

54134-2 Race [USSG-FHT]

Observation ID in Form

CMS-2728_A10

Observation Required in Panel

Required

Fully-Specified Name

Component: Race
Property: Type
Time: Pt
System: ^Patient
Scale: Nom
Method: USSG-FHT

Basic Attributes

Class: SURVEY.USSGFHT
Type: Surveys
First Released: Version 2.26
Last Updated: Version 2.44 (MIN)

HL7^® Attributes

HL7^® Field ID: PID-10

Normative Answer List LL629-7

Answer	Code	Answer ID
American Indian or Alaska Native	1002-5	LA6155-1
Asian	2028-5	LA6156-9
Asian Indian	2029-7	LA14048-5
Chinese	2034-7	LA4168-6
Filipino	2036-2	LA3969-8
Japanese	2039-6	LA4595-0
Korean	2040-4	LA4603-2
Vietnamese	2047-9	LA4443-3
Other Asian		LA14049-3
Black or African American	2054-5	LA10610-6
Native Hawaiian or Other Pacific Islander	2076-8	LA10611-4
Native Hawaiian	2079-2	LA14045-1
Guamanian	2087-5	LA14046-9
Chamorro	2088-3	LA10621-3
Samoan	2080-0	LA4300-5
Other Pacific Islander	2500-7	LA14047-7
White	2106-3	LA4457-3
Other/Unknown/Refuse To Answer		LA10613-0

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
54127-6	US Surgeon General family health portrait [USSG-FHT]

Related Codes

Code System	Code	Code Text	Code Version
https://www.phenxtoolkit.org	PX221001100000	PX221001_MFHP_Race

67884-7 Tribal enrollment

Observation ID in Form

CMS-2728_A10a

Condition for Inclusion

American Indian selected for Race

Observation Required in Panel

Conditional

Fully-Specified Name

Component: Tribal enrollment
Property: Type
Time: Pt
System: ^Patient
Scale: Nom
Method

Basic Attributes

Class: ADMIN.DEMOG
Type: Clinical
First Released: Version 2.38
Last Updated: Version 2.68 (NAM)
Change Reason: Release 2.68: COMPONENT: Updated Component to match current LOINC conventions

Example Answer List LL5596-3

Externally Defined: Yes
Code System: CDC-PHIN
Code System OID: 1.3.6.1.4.1.12009.10.1.4413
Link to External List: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.876

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

Language Variants Get Info

Tag	Language	Translation
el-GR	Greek (Greece)	Εγγραφή σε φυλή:Type:Pt:^Ασθενής:Nom: Synonyms: Type Εγγραφή σε φυλή
es-MX	Spanish (Mexico)	Inscripción tribal:Tipo:Punto temporal:^ Paciente:Nominal:
it-IT	Italian (Italy)	Iscrizione tribale:Tipo:Pt:^Paziente:Nom: Synonyms: Amministrativo Demografia Iscrizione a tribù paziente Punto nel tempo (episodio)
zh-CN	Chinese (China)	部落登记情况:类型: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 - 病人型时刻;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）.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）部落登记（注册、参加、加入）情况

67872-2 Is the patient applying for ESRD Medicare coverage?

Observation ID in Form

CMS-2728_A11

Observation Required in Panel

Required

Fully-Specified Name

Component: Medicare end stage renal disease coverage requested
Property: Find
Time: Pt
System: ^Patient
Scale: Ord
Method

Long Common Name

Medicare end stage renal disease coverage requested

Basic Attributes

Class: SURVEY.ESRD
Type: Surveys
First Released: Version 2.38
Last Updated: Version 2.44 (MIN)

Normative Answer List LL361-7

Answer	Code	Score	Answer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)			LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)			LA32-8

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

Third Party Copyright

This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.

Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.

52556-8 Payment sources

Form Coding Instructions

Check all that apply.

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: Payment sources
Property: Type
Time: Pt
System: ^Patient
Scale: Nom
Method

Basic Attributes

Class: SURVEY.CMS
Type: Surveys
First Released: Version 2.26
Last Updated: Version 2.63 (MIN)
Change Reason: Changed METHOD to methodless - generic term that does not orginate from just one method; Removed "Current" from component because it is conveyed by TIMING = Pt;Updated PROPERTY from Find to Type
Order vs. Observation: Both

Example Answer List LL544-8

Answer	Code	Answer ID
None (no charge for current services)	D1	LA10028-1
Medicare (traditional fee-for-service)	D2	LA6259-1
Medicare (HMO/managed care)	D3	LA6258-3
Medicaid (traditional fee-for-service)	D4	LA6257-5
Medicaid (HMO/managed care)	D5	LA6256-7
Workers’ compensation	D6	LA10123-0
Title programs (e.g., Title III, V, or XX)	D7	LA6398-7
Other government (e.g., TRICARE, VA, etc.)	D8	LA10049-7
Private insurance/Medigap	D9	LA10061-2
Private HMO/managed care	D10	LA6349-0
Self-pay	D11	LA6369-8
Other (specify)	D12	LA6310-2
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)	D13	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]
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
85645-0	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 3.00 [CMS Assessment]
85671-6	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 3.00 [CMS Assessment]
85662-5	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 3.00 [CMS Assessment]
85668-2	Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 3.00 [CMS Assessment]
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
86636-8	Family planning report - FPAR 2.0 set
106623-2	Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
106933-5	Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment]
87509-6	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
93222-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment]
103949-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment]
87506-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 4.00 during assessment period [CMS Assessment]
93219-4	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.00 during assessment period [CMS Assessment]
103948-6	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.1 during assessment period [CMS Assessment]
87507-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment]
93221-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment]
103946-0	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment]
87508-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 4.00 during assessment period [CMS Assessment]
93220-2	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.00 during assessment period [CMS Assessment]
103947-8	Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.1 during assessment period [CMS Assessment]

Member of these Groups Get Info

LOINC Group	Group Name
LG51306-5	SDOH

Related Codes

Code System	Code	Code Version
CMS LCDS	A1400	5.00
CMS LCDS	A1400	3.00
CMS LCDS	A1400	4.00

Third Party Copyright

This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.

Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.

8302-2 Body height

Observation ID in Form

CMS-2728_A13

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component: Body height
Property: Len
Time: Pt
System: ^Patient
Scale: Qn
Method

Basic Attributes

Class: BDYHGT.ATOM
Type: Clinical
First Released: Version 1.0h(2)
Last Updated: Version 2.73 (MIN)
Common Test Rank Get Info: 46

Member of these Panels

LOINC	Long Common Name
58446-6	Creatinine 24H renal clearance adjusted for body surface area panel
55168-9	Data Elements for Emergency Department Systems (DEEDS) Release 1.1
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
70300-9	ESRD dialysis adequacy panel
86636-8	Family planning report - FPAR 2.0 set
75885-4	IEEE 11073 Rosetta panel
100203-9	Knee Society Score post-op panel [Knee Society Score]
100159-3	Knee Society Score pre-op panel [Knee Society Score]
89543-3	Laboratory ask at order entry panel
87825-6	National Trauma Data Standard - version 2018 set
74293-2	Oncology plan of care and summary - recommended CDA set
75854-0	PCORnet common data model set - version 1.0 [PCORnet]
85057-8	PCORnet Common Data Model set - version 3.0 [PCORnet]
93149-3	PhenX - bone age protocol 220301
62812-3	PhenX domain - Physical activity and physical fitness
97782-7	Spine Tango Surgery 2017
54127-6	US Surgeon General family health portrait [USSG-FHT]
74028-2	Virtual Medical Record for Clinical Decision Support panel HL7.VMR-CDS
34566-0	Vital signs with method details panel
72513-5	Vital signs with smoking status and pain scale [VSP]
34565-2	Vital signs, weight and height panel
67795-5	Vital signs, weight, height, head circumference and oximetry panel HITSP
74728-7	Vital signs, weight, height, head circumference, oximetry, BMI, and BSA panel
85353-1	Vital signs, weight, height, head circumference, oxygen saturation and BMI panel
55418-8	Weight and Height tracking panel

Member of these Groups Get Info

LOINC Group	Group Name
LG34373-7	Body height\|Len\|Pt\|^Patient

Language Variants Get Info

Tag	Language	Translation
de-DE	German (Germany)	Körpergröße:Länge:Zeitpunkt:^Patient:Quantitativ:
de-AT	German (Austria)	Synonyms: Körpergröße
el-GR	Greek (Greece)	Σωματικό ύψος:Len:Pt:^Ασθενής:Qn: Synonyms: Len Σωματικό ύψος Ύψος
es-MX	Spanish (Mexico)	Peso corporal:Len:Punto temporal:^ Paciente:Cuantitativo:
es-AR	Spanish (Argentina)	altura corporal:longitud:punto en el tiempo:^paciente:cuantitativo:
fr-BE	French (Belgium)	Taille corporelle:Longueur:Temps ponctuel:^Patient:Quantitatif:
fr-CA	French (Canada)	Taille:Longueur:Temps ponctuel:^Patient:Quantitatif:
fr-FR	French (France)	Taille du patient:Longueur:Ponctuel:Patient:Numérique:
it-IT	Italian (Italy)	Altezza corporea:Len:Pt:^Paziente:Qn: Synonyms: Altezza del corpo - atomica Lunghezza paziente Punto nel tempo (episodio)
nl-NL	Dutch (Netherlands)	lichaamslengte:afmeting:moment:^patiënt:kwantitatief: Synonyms: lengte
pt-BR	Portuguese (Brazil)	Estatura:Comprimento:Pt:^Paciente:Qn: Synonyms: ; Bdy height; Body length; Axial length; Length; Point in time; Random; Quantitative; QNT; Quant; Quan; bod; Bodies; BODY HEIGHT(LENGTH).ATOM; BODY HEIGHT(LENGTH).ATOM
ru-RU	Russian (Russian Federation)	Рост:Дл:ТчкВрм:^Пациент:Колич: Synonyms: Длина Количественный Тело высота Точка во времени;Момент
zh-CN	Chinese (China)	身高:长度:时间点:^患者:定量型: Synonyms: 一般体长;一般身高;一般身高(长度);体长.原子型;身高(长度).原子型医疗服务对象;客户;病人;病患;病号;超系统 - 病人可用数量表示的;定量性;数值型;数量型;连续数值型标尺时刻;随机;随意;瞬间物体身体长度;身体高度;身长身高;身长;身体高度长;长短

Example Units

Unit	Source
[in_us];cm;m	Example UCUM Units
INCH(S)	REGENSTRIEF

Related Codes

Code System	Code	Code Text
urn:iso:std:iso:11073:10101	68060	MDC_ATTR_PT_HEIGHT
https://www.phenxtoolkit.org	PX150203040100	PX150203_Height_Feet
https://www.phenxtoolkit.org	PX150203040200	PX150203_Height_Inches
https://www.phenxtoolkit.org	PX220301280000	PX220301_Bone_Age_Patient_Height
https://www.phenxtoolkit.org	PX220704040000	PX220704_Mitochondrial_Disease_Adult_Height
https://www.phenxtoolkit.org	PX230101390200	PX230101_PsychopathologyEatingDisorders_Height
https://www.phenxtoolkit.org	PX230102440000	PX230102_PsychopathologyEatingDisordersInterview_Height
https://www.phenxtoolkit.org	PX651201050100	PX651201_EatingWeightPatterns_Adult_Height_Feet
https://www.phenxtoolkit.org	PX651201050200	PX651201_EatingWeightPatterns_Adult_Height_Inches
https://www.phenxtoolkit.org	PX810301410000	PX810301_SingleBreath_CarbonMonoxide_DiffusingCapacity_Subject_Height
https://www.phenxtoolkit.org	PX810401070000	PX810401_Standardisation_LungVolumeMeasurement_Subject_Height
https://www.phenxtoolkit.org	PX020302140000	PX020302_BodyComposition_Dxa_WholeBody_Height
https://www.phenxtoolkit.org	PX090602210100	PX090602_Exercise_Capacity_Patient_Height_Feet
https://www.phenxtoolkit.org	PX090602210200	PX090602_Exercise_Capacity_Patient_Height_Inches
https://www.phenxtoolkit.org	PX090602220100	PX090602_Exercise_Capacity_Patient_Height_Meters
https://www.phenxtoolkit.org	PX221001060000	PX221001_MFHP_Height
https://www.phenxtoolkit.org	PX221201130000	PX221201_Growth_Chart_Current_LengthStature

8340-2 Dry body weight Estimated

Term Description

Relating to hemodialysis: Dry weight is the lowest weight a patient can tolerate without the development of symptoms or hypotension.

Part Descriptions

LP94912-0 Dry body weight
Dry body weight is the body weight of a hemodialysis patient post-dialysis, when the blood pressure is within normal limits without the use of antihypertensive medication. In patients with renal failure, decline in kidney function leads to increased total body sodium, which causes an increase in extracellular fluid volume (ECV) and hypertension. During dialysis, excess sodium and fluid is removed, with a consequent decrease in blood pressure. Recommended values for blood pressure are pre-dialysis pressure of <140/90 and post-dialysis pressure of <130/85, which indicate adequate volume control. Dry body weight can help monitor ECV but is difficult to determine since it is not a constant value and may vary between hemodialysis sessions. Other methods for measuring ECV include central venous pressure, examination of the external jugular vein, assessment of edema, and the cardiothoracic index. PMID: 25028642 Source: Regenstrief LOINC

Observation ID in Form

CMS-2728_A14

Observation Required in Panel

Required

Fully-Specified Name

Component: Dry body weight
Property: Mass
Time: Pt
System: ^Patient
Scale: Qn
Method: Estimated

Basic Attributes

Class: BDYWGT.MOLEC
Type: Clinical
First Released: Version 1.0h(2)
Last Updated: Version 2.48 (MIN)

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

Language Variants Get Info

Tag	Language	Translation
el-GR	Greek (Greece)	Ξηρό σωματικό βάρος:Mass:Pt:^Ασθενής:Qn:Εκτιμώμενο Synonyms: Mass Βάρος Ξηρό σωματικό βάρος Σωματικό βάρος
es-MX	Spanish (Mexico)	Peso corporal seco:Masa:Punto temporal:^ Paciente:Cuantitativo:Estimated
es-AR	Spanish (Argentina)	peso corporal^peso seco:masa:punto en el tiempo:^paciente:cuantitativo:estimativo
fr-FR	French (France)	Poids corporel sec:Masse:Ponctuel:Patient:Numérique:Résultat estimé
it-IT	Italian (Italy)	Peso corporeo secco:Massa:Pt:^Paziente:Qn:Stimato Synonyms: paziente Peso del corpo - molecolare Punto nel tempo (episodio)
pt-BR	Portuguese (Brazil)	Peso corporal enxugado:Massa:Pt:^Paciente:Qn:Estimado Synonyms: ; Wt; Dry weight; Bdy weight; Point in time; Random; Quantitative; QNT; Quant; Quan; Est; estimation; bod; Bodies; BODY WEIGHT.MOLEC; BODY WEIGHT.MOLEC
zh-CN	Chinese (China)	干体重:质量:时间点:^患者:定量型:估计法 Synonyms: 医疗服务对象;客户;病人;病患;病号;超系统 - 病人可用数量表示的;定量性;数值型;数量型;连续数值型标尺干式体重;干重时刻;随机;随意;瞬间标本重量;重物体特殊体重;特殊身体重量;身体重量.分子型胎龄估计法;孕龄估计法身体重量重量

Example Units

Unit	Source
kg;[lb_av]	Example UCUM Units

67873-0 Primary Cause of Renal Failure Code

Observation ID in Form

CMS-2728_A15

Observation Required in Panel

Conditional

Fully-Specified Name

Component: Cause of renal failure.primary
Property: Type
Time: Pt
System: ^Patient
Scale: Nom
Method: Reported

Long Common Name

Cause of renal failure.primary [Reported]

Basic Attributes

Class: SURVEY.ESRD
Type: Surveys
First Released: Version 2.38
Last Updated: Version 2.48 (MIN)

Normative Answer List LL1892-0

Externally Defined: Yes
Code System
Code System OID: 1.3.6.1.4.1.12009.10.1.1069
Link to External List: http://www.cdc.gov/nchs/icd.htm

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

67874-8 Patient Prior Employment Status (6 Months Prior)

Observation ID in Form

CMS-2728_A16a1

Observation Required in Panel

Required

Fully-Specified Name

Component: Employment status - 6Mo prior to renal failure
Property: Find
Time: Pt
System: ^Patient
Scale: Nom
Method: Reported

Long Common Name

Employment status - 6 months prior to renal failure [Reported]

Basic Attributes

Class: SURVEY.ESRD
Type: Surveys
First Released: Version 2.38
Last Updated: Version 2.61 (NAM)
Change Reason: Changed Mos to Mo in component based on current LOINC model

Normative Answer List LL1901-9

Answer	Code	Score	Answer ID
Unemployed			LA17956-6
Employed full time			LA17957-4
Employed part time			LA17958-2
Homemaker			LA17959-0
Retired due to age/preference			LA17960-8
Retired due to disability			LA17961-6
Medical leave of absence			LA17962-4
Student			LA15276-1

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

67875-5 Patient Current Employment Status (At Onset)

Observation ID in Form

CMS-2728_A16b1

Observation Required in Panel

Required

Fully-Specified Name

Component: Employment status - current
Property: Type
Time: Pt
System: ^Patient
Scale: Nom
Method

Long Common Name

Employment status - current

Basic Attributes

Class: H&P.HX
Type: Clinical
First Released: Version 2.38
Last Updated: Version 2.67 (MIN)
Change Reason: Updated Property from "Find" to "Type" since this concept represents current employment status types. Remove Method of Reported. Move ESRD Survey question text to the Override Display Name within the context of the ESRD panel.

Normative Answer List LL1901-9

Answer	Code	Score	Answer ID
Unemployed			LA17956-6
Employed full time			LA17957-4
Employed part time			LA17958-2
Homemaker			LA17959-0
Retired due to age/preference			LA17960-8
Retired due to disability			LA17961-6
Medical leave of absence			LA17962-4
Student			LA15276-1

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
93025-5	Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]
98154-8	SARS-CoV-2-related socioeconomic questionnaire for adults
97029-3	Spine Tango surgery follow-up 2017 Spine Tango

Member of these Groups Get Info

LOINC Group	Group Name
LG51306-5	SDOH

Language Variants Get Info

Tag	Language	Translation
el-GR	Greek (Greece)	Κατάσταση απασχόλησης - τρέχουσα:Type:Pt:^Ασθενής:Nom: Synonyms: Type Κατάσταση Κατάσταση απασχόλησης Κατάσταση απασχόλησης - τρέχουσα
es-MX	Spanish (Mexico)	Situación laboral - actual:Tipo:Punto temporal:^ Paciente:Nominal:
fr-CA	French (Canada)	Situation d'emploi — actuelle:Type:Temps ponctuel:^Patient:Nominal:
it-IT	Italian (Italy)	Stato occupazionale - attuale:Tipo:Pt:^Paziente:Nom: Synonyms: Anamnesi paziente Punto nel tempo (episodio)
ru-RU	Russian (Russian Federation)	Занятость статус - текущий:Тип:ТчкВрм:^Пациент:Ном: Synonyms: Номинальный;Именной Точка во времени;Момент
zh-CN	Chinese (China)	就业状况 - 当前:类型: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 - 病人历史纪录与体格检查历史纪录与体格检查.历史记录;历史纪录与体格检查.历史记录类;历史纪录与体格检查.历史记录类别;历史纪录与体格检查.病史;历史纪录与体格检查.病史类;历史纪录与体格检查.病史类别;历史纪录与体格检查.病史记录;历史纪录与体格检查.病史记录类;历史纪录与体格检查.病史记录类别;历史纪录与体格检查小节.历史记录;历史纪录与体格检查小节.历史记录类;历史纪录与体格检查小节.历史记录类别;历史纪录与体格检查小节.病史;历史纪录与体格检查小节.病史类;历史纪录与体格检查小节.病史类别历史纪录与体格检查小节型就业（聘用、雇佣、从业、应聘）状况（情况、状态）就业（聘用、雇佣、从业、应聘）状态 - 当前;雇佣状况 - 当前;工作情况 - 当前;就业情况 - 当前时刻;随机;随意;瞬间状况;情况病史与体格检查

Related Codes

Code System	Code	Code Text	Code Version
https://www.phenxtoolkit.org	PX730401140000	PX730401_Best_Describes_CurrentJob_Status
https://www.phenxtoolkit.org	PX751401010000	PX751401_Worksite_Policies_Employment_Status

67876-3 Co-Morbid Conditions

Observation ID in Form

CMS-2728_A17

Observation Required in Panel

Required

Form Coding Instructions

Check all that apply currently and/or during the last 10 years

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component: End stage renal disease co-morbidities ICD code
Property: Find
Time: Pt
System: ^Patient
Scale: Nom
Method

Long Common Name

End stage renal disease (ESRD) co-morbidities ICD code

Basic Attributes

Class: SURVEY.ESRD
Type: Surveys
First Released: Version 2.38
Last Updated: Version 2.67 (MIN)
Order vs. Observation: Observation

Normative Answer List LL1892-0

Externally Defined: Yes
Code System
Code System OID: 1.3.6.1.4.1.12009.10.1.1069
Link to External List: http://www.cdc.gov/nchs/icd.htm

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

67885-4 Received exogenous erythropoetin or equivalent prior to end stage renal disease therapy

Observation ID in Form

CMS-2728_A18a

Observation Required in Panel

Conditional

Fully-Specified Name

Component: Received exogenous erythropoetin or equivalent prior to end stage renal disease therapy
Property: Find
Time: Pt
System: ^Patient
Scale: Ord
Method

Basic Attributes

Class: SURVEY.ESRD
Type: Surveys
First Released: Version 2.38
Last Updated: Version 2.44 (MIN)

Normative Answer List LL1872-2

Answer	Code	Score	Answer ID
Yes, <6mos			LA17807-1
Yes, 6-12 mos			LA17808-9
Yes, >12 mos			LA17809-7
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)			LA32-8
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)			LA4489-6

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

Third Party Copyright

This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.

Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.

67886-2 Care by nephrologist prior to end stage renal disease therapy

Observation ID in Form

CMS-2728_A18b

Observation Required in Panel

Conditional

Fully-Specified Name

Component: Care by nephrologist prior to end stage renal disease therapy
Property: Find
Time: Pt
System: ^Patient
Scale: Ord
Method

Basic Attributes

Class: SURVEY.ESRD
Type: Surveys
First Released: Version 2.38
Last Updated: Version 2.44 (MIN)

Normative Answer List LL1872-2

Answer	Code	Score	Answer ID
Yes, <6mos			LA17807-1
Yes, 6-12 mos			LA17808-9
Yes, >12 mos			LA17809-7
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)			LA32-8
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)			LA4489-6

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

Third Party Copyright

This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.

Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.

67887-0 Care by kidney dietician prior to end stage renal disease therapy

Observation ID in Form

CMS-2728_A18c

Observation Required in Panel

Conditional

Fully-Specified Name

Component: Care by kidney dietitian prior to end stage renal disease therapy
Property: Find
Time: Pt
System: ^Patient
Scale: Ord
Method

Long Common Name

Care by kidney dietitian prior to end stage renal disease therapy

Basic Attributes

Class: SURVEY.ESRD
Type: Surveys
First Released: Version 2.38
Last Updated: Version 2.40 (MIN)

Normative Answer List LL1872-2

Answer	Code	Score	Answer ID
Yes, <6mos			LA17807-1
Yes, 6-12 mos			LA17808-9
Yes, >12 mos			LA17809-7
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)			LA32-8
Unknown Copyright http://snomed.info/sct ID:261665006 Unknown (qualifier value)			LA4489-6

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

Third Party Copyright

This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.

Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.

67888-8 Access Type for First Outpatient Dialysis

Observation ID in Form

CMS-2728_A18d

Observation Required in Panel

Conditional

Fully-Specified Name

Component: Vascular access for first outpatient dialysis
Property: Type
Time: Pt
System: ^Patient
Scale: Nom
Method

Long Common Name

Vascular access for first outpatient dialysis

Basic Attributes

Class: SURVEY.ESRD
Type: Surveys
First Released: Version 2.38
Last Updated: Version 2.40 (MIN)

Normative Answer List LL1873-0

Answer	Code	Answer ID
Arteriovenous fistula (AVF)	1	LA17810-5
Graft	2	LA17811-3
Catheter	3	LA17812-1
Other access type	4	LA17813-9

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728

68449-8 Is maturing AVF present?

Observation ID in Form

CMS-2728_A18e

Observation Required in Panel

Conditional

Fully-Specified Name

Component: Arteriovenous fistula maturity
Property: Find
Time: Pt
System: ^Patient
Scale: Ord
Method

Long Common Name

Arteriovenous fistula maturity

Basic Attributes

Class: SURVEY.ESRD
Type: Surveys
First Released: Version 2.38
Last Updated: Version 2.44 (MIN)

Normative Answer List LL1885-4

Answer	Code	Score	Answer ID
Yes, present but not mature			LA17835-2
No, access not present, or present and not maturing			LA17836-0

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
72055-7	Vascular access panel [ESRD]

68450-6 Is maturing graft present?

Observation ID in Form

CMS-2728_A18f

Observation Required in Panel

Conditional

Fully-Specified Name

Component: Graft maturity
Property: Find
Time: Pt
System: ^Patient
Scale: Ord
Method

Long Common Name

Graft maturity

Basic Attributes

Class: SURVEY.ESRD
Type: Surveys
First Released: Version 2.38
Last Updated: Version 2.44 (MIN)

Normative Answer List LL1885-4

Answer	Code	Score	Answer ID
Yes, present but not mature			LA17835-2
No, access not present, or present and not maturing			LA17836-0

Member of these Panels

LOINC	Long Common Name
67868-0	End Stage Renal Disease (ESRD) Medical Evidence Report, Medicare Entitlement AndOr Patient Registration - OMB CMS form 2728
72055-7	Vascular access panel [ESRD]

67871-4

Patient demographics - end stage renal disease form 2728

Trial

56799-0 Address

Observation ID in Form

Observation Required in Panel

Fully-Specified Name

Basic Attributes

HL7® Attributes

Member of these Panels

Language Variants Get Info

Related Names

Related Codes

68997-6 Patient City (Mailing)

Observation ID in Form

Observation Required in Panel

Fully-Specified Name

Long Common Name

Basic Attributes

Member of these Panels

Related Names

46499-0 State of residence

Term Description

Observation ID in Form

Observation Required in Panel

Type of Entry

Fully-Specified Name

Basic Attributes

HL7® Attributes

Example Answer List LL3661-7

Member of these Panels

Language Variants Get Info

Related Names

Related Codes

45401-7 Postal code [Location]

Observation ID in Form

Observation Required in Panel

Type of Entry

Fully-Specified Name

Basic Attributes

HL7® Attributes

Member of these Panels

Language Variants Get Info

Related Names

Related Codes

42077-8 Patient phone number

Term Description

Observation ID in Form

Observation Required in Panel

Type of Entry

Fully-Specified Name

Basic Attributes

HL7® Attributes

Member of these Panels

Language Variants Get Info

Related Names

Related Codes

46098-0 Sex

Part Descriptions

Observation ID in Form

Observation Required in Panel

Type of Entry

Fully-Specified Name

Basic Attributes

HL7® Attributes

Example Answer List LL1-9

Member of these Panels

Language Variants Get Info

Related Names

Related Codes

54133-4 Ethnicity [USSG-FHT]

Observation ID in Form

Observation Required in Panel

Fully-Specified Name

Basic Attributes

HL7® Attributes

Normative Answer List LL628-9

Member of these Panels

Related Names

Related Codes

HL7^® Attributes

HL7^® Attributes

HL7^® Attributes

HL7^® Attributes

HL7^® Attributes

HL7^® Attributes

HL7^® Attributes