Version 2.78

52464-5 Primary and Other Diagnoses, Comorbidities, and Complications

Observation ID in Form

A

Type of Entry

Question expects user entry - requires response [Q]

Form Coding Instructions

Indicate the primary diagnosis and up to 14 other diagnoses being treated, managed, or monitored in this setting. Please include all diagnoses (e.g., depression, schizophrenia, dementia, protein calorie malnutrition)

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Primary and Other Diagnoses, Comorbidities, and Complications
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

18630-4 Primary Diagnosis at Assessment

Observation ID in Form

A1

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Diagnosis.primary
Property
Imp
Time
Pt
System
^Patient
Scale
Nom
Method

Basic Attributes

Class
ATTACH.REHAB
Type
Claims Attachments
First Released
Version 1.0l
Last Updated
Version 2.70
Change Reason
Release 2.70: AnswerListId: Added example answer list;
Order vs. Observation
Observation

Example Answer List LL4747-3

Answer Code Score Answer ID
Other LA46-8
Alcoholism LA20350-7
Bleeding disorder LA20352-3
Currently receiving chemotherapy for cancer LA20353-1
Congenital anomalies LA20354-9
Congestive heart failure (CHF) LA12740-9
Current smoker LA20356-4
Chronic renal failure LA20357-2
Cerebrovascular accident LA22244-0
Diabetes mellitus LA14291-1
Disseminated cancer LA20360-6
Advanced directive limiting care LA20361-4
Functionally dependent health status LA20363-0
Hypertension LA7444-8
Prematurity LA20368-9
Chronic obstructive pulmonary disease LA28200-6
Steroid use LA20370-5
Cirrhosis LA9639-1
Dementia LA20372-1
Attention deficit disorder/Attention deficit hyperactivity disorder (ADD/ADHD) LA28412-7
Anticoagulant therapy LA28199-0
Angina pectoris Copyright http://snomed.info/sct ID:194828000 Angina (disorder) LA14275-4
Mental/personality disorder LA28198-2
Myocardial infarction Copyright http://snomed.info/sct ID:22298006 Myocardial infarction (disorder) LA14274-7
Peripheral arterial disease Copyright http://snomed.info/sct ID:399957001 Peripheral arterial occlusive disease (disorder) LA28197-4
Substance abuse disorder Copyright http://snomed.info/sct ID:66214007 Substance abuse (disorder) LA28195-8

Member of these Panels

LOINC Long Common Name
76464-7 American Physical Therapy Association registry panel
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
97782-7 Spine Tango Surgery 2017

Language Variants Get Info

Tag Language Translation
es-AR Spanish (Argentina) diagnóstico.primario:impresión/interpretación del estudio:punto en el tiempo:^paciente:Nominal:
it-IT Italian (Italy) Diagnosi.primaria:Imp:Pt:^Paziente:Nom:
Synonyms: Allegato Allegato riabilitazione Impressione/interpretazione di studio paziente Punto nel tempo (episodio)
ru-RU Russian (Russian Federation) Диагноз.основной:Впчт:ТчкВрм:^Пациент:Ном:
Synonyms: Впечатление/интерпретация исследования Номинальный;Именной Точка во времени;Момент
zh-CN Chinese (China) 诊断.主要:印象:时间点:^患者:名义型:
Synonyms: Health Insurance Portability and Accountability Act of 1996;HIPAA;健康保險可攜與責任法;HIPAA法案;健康保险可移植性和问责法1996年;美国健康保险携带和责任法案;医疗保险便携性和责任法案;医疗保险便携性与责任法案;醫療保險可攜性與責任法;HIPAA 信息附件.康复治疗;健康保险便携与责任法案信息附件.康复;健康保险便携与责任法案信息附件.康复治疗;康复信息附件;康复治疗HIPAA信息附件;康复治疗信息附件;康复治疗健康保险便携与责任法 主要诊断 信息附件;健康保险便携与责任法案信息附件;附件 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 印象是一种诊断陈述，始终是对其他某种观察指标的解释或抽象（一系列检验项目结果、一幅图像或者整个某位病人），而且几乎总是由某位专业人员产生。;检查印象;检查印象/解释;检查的印象/解释;检查解释;解释;阐释 时刻;随机;随意;瞬间 诊断结论;判断;结论

52465-2 Other Diagnoses, Comorbidities, and Complications

Observation ID in Form

B

Type of Entry

Question expects user entry - requires response [Q]

Form Coding Instructions

List other diagnoses being treated, managed, or monitored in this setting. Include all diagnoses (e.g., depression, schizophrenia, dementia, protein calorie malnutrition)

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Other Diagnoses, Comorbidities, and Complications
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

29308-4 Diagnosis

Part Descriptions

LP72437-4   Diagnosis
The end result of a diagnostic process that identifies a disease. Source: Regenstrief LOINC

Observation ID in Form

B1a

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Diagnosis
Property
Imp
Time
Pt
System
^Patient
Scale
Nom
Method

Additional Names

Short Name
Dx

Basic Attributes

Class
H&P.PX
Type
Clinical
First Released
Version 2.03
Last Updated
Version 2.73
Order vs. Observation
Observation
Common Test Rank Get Info
4809

Member of these Panels

LOINC Long Common Name
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
74293-2 Oncology plan of care and summary - recommended CDA set
93149-3 PhenX - bone age protocol 220301
62863-6 PhenX domain - Infectious diseases and immunity
62896-6 PhenX domain - Skin, bone, muscle and joint

Language Variants Get Info

Tag Language Translation
de-DE German (Germany) Diagnose:Interpretation:Zeitpunkt:^Patient:Nominal:
es-MX Spanish (Mexico) Diagnóstico:Interpretación:Punto temporal:^ Paciente:Nominal:
es-ES Spanish (Spain) Diagnóstico:Impresión/interpretación del estudio:Punto temporal:^paciente:Nom:
es-AR Spanish (Argentina) diagnóstico:impresión/interpretación del estudio:punto en el tiempo:^paciente:Nominal:
fr-CA French (Canada) Diagnostic:Impression:Temps ponctuel:^Patient:Nominal:
fr-BE French (Belgium) Diagnostic:Impression/interprétation d'étude:Temps ponctuel:^Patient:Nominal:
it-IT Italian (Italy) Diagnosi:Imp:Pt:^Paziente:Nom:
Synonyms: Esame obbiettivo Impressione/interpretazione di studio paziente Punto nel tempo (episodio)
pt-BR Portuguese (Brazil) Diagnóstico:Imp:Pt:^Paciente:Nom:
Synonyms: ; Dx; Interpretation; Interp; Impression; Impressions; Point in time; Random; Nominal
ru-RU Russian (Russian Federation) Диагноз:Впчт:ТчкВрм:^Пациент:Ном:
Synonyms: Впечатление/интерпретация исследования Номинальный;Именной Точка во времени;Момент
uk-UA Ukrainian (Ukraine) Діагноз:Інтерпретація:МоментЧасу:^Пацієнт:Категорійно:
Synonyms: Dx; H+P; H+P.PX; Impression; Impression/interpretation of study; Impressions; Interp; Interpretation; Nominal; P prime; Point in time; Random
zh-CN Chinese (China) 诊断:印象:时间点:^患者:名义型:
Synonyms: 体格检查小节与指标;体格检查小节与测量指标;历史纪录与体格检查.体格检查小节与指标;历史纪录与体格检查.体格检查小节与测量指标;历史纪录与体格检查小节.体格检查小节与指标;历史纪录与体格检查小节.体格检查小节与测量指标;病史与体格检查.体格检查小节与指标;病史与体格检查.体格检查小节与测量指标;病史与体格检查小节.体格检查小节与指标 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 印象是一种诊断陈述，始终是对其他某种观察指标的解释或抽象（一系列检验项目结果、一幅图像或者整个某位病人），而且几乎总是由某位专业人员产生。;检查印象;检查印象/解释;检查的印象/解释;检查解释;解释;阐释 历史纪录与体格检查 历史纪录与体格检查小节 时刻;随机;随意;瞬间 病史与体格检查 诊断结论;判断;结论

52466-0 Major Procedures (Diagnostic, Surgical, and Therapeutic Interventions)

Observation ID in Form

C

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Major Procedures (Diagnostic, Surgical, and Therapeutic Interventions)
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim

52558-4 Did the patient have one or more major procedures (e.g., G-tube placement, EEG, abdominal, cat scans; do not include x-rays, EKGs, ultrasounds) during this admission?

Observation ID in Form

C1

Type of Entry

Question expects user entry - requires response [Q]

Skip Logic

If No, skip to Section D. Major Treatments.

Form Coding Instructions

List up to 15 procedures (diagnostic, surgical and therapeutic interventions). Indicate if a procedure was left, right, or not applicable (N/A). If procedure was bilateral (e.g., bilateral knee replacement), check both left and right boxes

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Procedure this admission
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64

Survey Question

Text
Did the patient have one or more major procedures (e.g., G-tube placement, EEG, abdominal, cat scans; do not include x-rays, EKGs, ultrasounds) during this admission?
Source
CARE I.c01

Normative 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
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim

52467-8 Procedure [CARE]

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Procedure
Property
-
Time
Pt
System
^Patient
Scale
-
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim

29300-1 Procedure type

Observation ID in Form

C1a

Fully-Specified Name

Component
Procedure
Property
Type
Time
Pt
System
^Patient
Scale
Nom
Method

Additional Names

Short Name
Procedure type

Basic Attributes

Class
H&P.PX
Type
Clinical
First Released
Version 2.03
Last Updated
Version 2.73
Common Test Rank Get Info
2979

Member of these Panels

LOINC Long Common Name
84907-5 Cancer pathology panel - Colorectal cancer specimen
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
74028-2 Virtual Medical Record for Clinical Decision Support panel HL7.VMR-CDS

Language Variants Get Info

Tag Language Translation
es-MX Spanish (Mexico) Procedimiento:Tipo:Punto temporal:^ Paciente:Nominal:
es-ES Spanish (Spain) Procedimiento:Tipo:Punto temporal:^paciente:Nom:
es-AR Spanish (Argentina) procedimiento:tipo:punto en el tiempo:^paciente:Nominal:
it-IT Italian (Italy) Procedura:Tipo:Pt:^Paziente:Nom:
Synonyms: Esame obbiettivo paziente Punto nel tempo (episodio)
nl-NL Dutch (Netherlands) verrichting:type:moment:^patiënt:nominaal:
pt-BR Portuguese (Brazil) Procedimento:Tipo:Pt:^Paciente:Nom:
Synonyms: Typ; Point in time; Random; Nominal
ru-RU Russian (Russian Federation) Вмешательство:Тип:ТчкВрм:^Пациент:Ном:
Synonyms: Номинальный;Именной Процедура Точка во времени;Момент
zh-CN Chinese (China) 操作项目:类型:时间点:^患者:名义型:
Synonyms: 体格检查小节与指标;体格检查小节与测量指标;历史纪录与体格检查.体格检查小节与指标;历史纪录与体格检查.体格检查小节与测量指标;历史纪录与体格检查小节.体格检查小节与指标;历史纪录与体格检查小节.体格检查小节与测量指标;病史与体格检查.体格检查小节与指标;病史与体格检查.体格检查小节与测量指标;病史与体格检查小节.体格检查小节与指标 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小节 型 操作;程序;手续;步骤;规程;程序流程 时刻;随机;随意;瞬间 病史与体格检查

52560-0 Procedure.left [CARE]

Observation ID in Form

C1b

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Procedure.left
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64

Normative 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
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim

52561-8 Procedure.right [CARE]

Observation ID in Form

C1c

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Procedure.right
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64

Normative 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
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim

52562-6 Procedure.side not applicable [CARE]

Observation ID in Form

C1d

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Procedure.side not applicable
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64

Normative 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
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
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
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim

69455-4 Major treatments

Observation ID in Form

D

Fully-Specified Name

Component
Major treatments - expired
Property
-
Time
Pt
System
^Patient
Scale
-
Method
CARE

Basic Attributes

Class
PANEL.SURVEY.CARE
Type
Surveys
First Released
Version 2.38
Last Updated
Version 2.64
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired

52800-0 Used on the Day of Death or the Day Before the Day of Death:

Observation ID in Form

D1a

Type of Entry

Question expects user entry - requires response [Q]

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Major treatments used on or 1D prior to day of death
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64

Normative Answer List LL552-1

Answer Code Score Answer ID
None Copyright http://snomed.info/sct ID:260413007 None (qualifier value) D1 LA137-2
Insulin Drip D2 LA9988-2
Total parenteral nutrition D3 LA10101-6
Central Line Management D4 LA9943-7
Blood Transfusion(s) D5 LA9940-3
Controlled Parenteral Analgesia – Peripheral D6 LA9959-3
Controlled Parenteral Analgesia – Epidural D7 LA9958-5
Left Ventricular Assistive Device (LVAD) D8 LA9994-0
Continuous Cardiac Monitoring D9 LA9957-7
Chest Tube(s) D10 LA9948-6
Trach Tube with Suctioning D11 LA10102-4
High O2 Concentration Delivery System with FiO2 > 40% D12 LA9976-7
Non-invasive ventilation (CPAP) D13 LA10033-1
Ventilator – Weaning D14 LA10115-6
Ventilator – Non-Weaning D16 LA10114-9
Hemodialysis D17 LA9975-9
Peritoneal Dialysis D18 LA10059-6
Fistula or Other Drain Management D19 LA9971-8
Negative Pressure Wound Therapy D20 LA10019-0
Complex Wound Management with positioning and skin separation/traction that requires at least two persons or extensive & complex wound management by one person D21 LA9954-4
Halo D22 LA9974-2
Complex External Fixators (e.g., Ilizarov) D23 LA9953-6
One-on-One 24-Hour Staff Supervision D24 LA11601-4
Specialty Surface or Bed (i.e., air fluidized, bariatric, low air loss, or rotation bed) D25 LA10084-4
Multiple Types of IV Antibiotic Administration D26 LA11603-0
IV Vaso-actors (e.g., pressors, dilators, medication for pulmonary edema) D27 LA9992-4
IV Anti-coagulants D28 LA9990-8
IV Chemotherapy D28 LA9991-6
Indwelling Bowel Catheter Management System D29 LA9984-1
Other Major Treatments, e.g. isolation, hypothermia blanket D30 LA10050-5

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired

52565-9 Specify reason for continuous monitoring:

Observation ID in Form

D9c

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Reason for continuous cardiac monitoring
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64
Change Reason
Method removed because this generic term can be used across contexts

Survey Question

Text
Specify reason for continuous monitoring:
Source
CARE I.d09c

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52566-7 Specify most intensive frequency of suctioning during stay: Every____ hours

Observation ID in Form

D11c

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Suctioning frequency per H during stay.max
Property
NRat
Time
Pt
System
^Patient
Scale
Qn
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64

Survey Question

Text
Specify most intensive frequency of suctioning during stay: Every____ hours
Source
CARE I.d11c

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

55613-4 If patient is completely independent of the ventilator, specify the number of days it took to wean patient:

Observation ID in Form

D14c

Fully-Specified Name

Component
Number of D to wean patient who is now independent from ventilator
Property
Num
Time
Pt
System
^Patient
Scale
Qn
Method
CARE

Basic Attributes

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

Survey Question

Text
If patient is completely independent of the ventilator, specify the number of days it took to wean patient:
Source
CARE_D14c

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

Example Units

Unit Source
d Example UCUM Units

52567-5 Specify reason for 24-hour supervision

Observation ID in Form

D23c

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Reason for one on one 24H supervision
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64
Change Reason
Method removed because this generic term can be used across contexts

Survey Question

Text
Specify reason for 24-hour supervision
Source
CARE I.d23c

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52568-3 Specify

Observation ID in Form

D23c

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Other major treatments received.other specified
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52470-2 Used at Any Time During Stay

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Major treatments used at any time during stay panel
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

Class
PANEL.SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

52569-1 Used at Any Time During Stay

Observation ID in Form

D1b

Type of Entry

Question expects user entry - requires response [Q]

Form Coding Instructions

Check all that apply

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Major treatments used at any time during stay
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64

Normative Answer List LL552-1

Answer Code Score Answer ID
None Copyright http://snomed.info/sct ID:260413007 None (qualifier value) D1 LA137-2
Insulin Drip D2 LA9988-2
Total parenteral nutrition D3 LA10101-6
Central Line Management D4 LA9943-7
Blood Transfusion(s) D5 LA9940-3
Controlled Parenteral Analgesia – Peripheral D6 LA9959-3
Controlled Parenteral Analgesia – Epidural D7 LA9958-5
Left Ventricular Assistive Device (LVAD) D8 LA9994-0
Continuous Cardiac Monitoring D9 LA9957-7
Chest Tube(s) D10 LA9948-6
Trach Tube with Suctioning D11 LA10102-4
High O2 Concentration Delivery System with FiO2 > 40% D12 LA9976-7
Non-invasive ventilation (CPAP) D13 LA10033-1
Ventilator – Weaning D14 LA10115-6
Ventilator – Non-Weaning D16 LA10114-9
Hemodialysis D17 LA9975-9
Peritoneal Dialysis D18 LA10059-6
Fistula or Other Drain Management D19 LA9971-8
Negative Pressure Wound Therapy D20 LA10019-0
Complex Wound Management with positioning and skin separation/traction that requires at least two persons or extensive & complex wound management by one person D21 LA9954-4
Halo D22 LA9974-2
Complex External Fixators (e.g., Ilizarov) D23 LA9953-6
One-on-One 24-Hour Staff Supervision D24 LA11601-4
Specialty Surface or Bed (i.e., air fluidized, bariatric, low air loss, or rotation bed) D25 LA10084-4
Multiple Types of IV Antibiotic Administration D26 LA11603-0
IV Vaso-actors (e.g., pressors, dilators, medication for pulmonary edema) D27 LA9992-4
IV Anti-coagulants D28 LA9990-8
IV Chemotherapy D28 LA9991-6
Indwelling Bowel Catheter Management System D29 LA9984-1
Other Major Treatments, e.g. isolation, hypothermia blanket D30 LA10050-5

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
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

52565-9 Specify reason for continuous monitoring:

Observation ID in Form

D9c

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Reason for continuous cardiac monitoring
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64
Change Reason
Method removed because this generic term can be used across contexts

Survey Question

Text
Specify reason for continuous monitoring:
Source
CARE I.d09c

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52566-7 Specify most intensive frequency of suctioning during stay: Every____ hours

Observation ID in Form

D11c

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Suctioning frequency per H during stay.max
Property
NRat
Time
Pt
System
^Patient
Scale
Qn
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64

Survey Question

Text
Specify most intensive frequency of suctioning during stay: Every____ hours
Source
CARE I.d11c

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

55613-4 If patient is completely independent of the ventilator, specify the number of days it took to wean patient:

Observation ID in Form

D14c

Fully-Specified Name

Component
Number of D to wean patient who is now independent from ventilator
Property
Num
Time
Pt
System
^Patient
Scale
Qn
Method
CARE

Basic Attributes

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

Survey Question

Text
If patient is completely independent of the ventilator, specify the number of days it took to wean patient:
Source
CARE_D14c

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care

Example Units

Unit Source
d Example UCUM Units

52567-5 Specify reason for 24-hour supervision

Observation ID in Form

D23c

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Reason for one on one 24H supervision
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64
Change Reason
Method removed because this generic term can be used across contexts

Survey Question

Text
Specify reason for 24-hour supervision
Source
CARE I.d23c

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52568-3 Specify

Observation ID in Form

D23c

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Other major treatments received.other specified
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method
CARE

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52471-0 Medications (Optional)

Observation ID in Form

E

Observation Required in Panel

Optional

Type of Entry

Question expects user entry - requires response [Q]

Form Coding Instructions

List all current medications for the patient

Source: Centers for Medicare & Medicaid Services

Form Coding Instructions

List the ten most clinically relevant medications

Source: Regenstrief Help

Fully-Specified Name

Component
Medications
Property
-
Time
Pt
System
^Patient
Scale
-
Method

Basic Attributes

Class
PANEL.SURVEY.MDS
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.68
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
57039-0 Deprecated Outcome and assessment information set (OASIS) form - version C
57194-3 Deprecated Outcome and assessment information set (OASIS) form - version C - Discharge from agency
57192-7 Deprecated Outcome and assessment information set (OASIS) form - version C - Follow-Up
57191-9 Deprecated Outcome and assessment information set (OASIS) form - version C - Resumption of Care
57190-1 Deprecated Outcome and assessment information set (OASIS) form - version C - Start of care
57193-5 Deprecated Outcome and assessment information set (OASIS) form - version C - Transfer to facility

Language Variants Get Info

Tag Language Translation
de-AT German (Austria) Synonyms: Dokumente der e-Medikation

52418-1 Medication Name

Observation ID in Form

E1a

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Name
Property
ID
Time
Pt
System
Medication.current
Scale
Nom
Method

Basic Attributes

Class
ATTACH.MEDS
Type
Claims Attachments
First Released
Version 2.26
Last Updated
Version 2.27

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
18605-6 Medication current Set
62611-9 PhenX domain - Respiratory
63067-3 PhenX domain - Speech and hearing

Language Variants Get Info

Tag Language Translation
de-AT German (Austria) Synonyms: Medikation
fr-FR French (France) Nom:Identifiant:Ponctuel:Traitement courant:Résultat nominal:
it-IT Italian (Italy) Nome:ID:Pt:Farmaco.attuale:Nom:
Synonyms: Allegato Allegato farmaci Farmaco attuale Identificatore Medicazione Punto nel tempo (episodio)
pt-BR Portuguese (Brazil) Nome:ID:Pt:Medicação.atual:Nom:
Synonyms: Identifier; Ident; Point in time; Random; Nominal
ru-RU Russian (Russian Federation) Фамилия:ID:ТчкВрм:Лекарственный препарат.текущий:Ном:
Synonyms: Идентификатор Номинальный;Именной Точка во времени;Момент
zh-CN Chinese (China) 名称:标识符:时间点:药物.当前:名义型:
Synonyms: Health Insurance Portability and Accountability Act of 1996;HIPAA;健康保險可攜與責任法;HIPAA法案;健康保险可移植性和问责法1996年;美国健康保险携带和责任法案;医疗保险便携性和责任法案;医疗保险便携性与责任法案;醫療保險可攜性與責任法;HIPAA 信息附件.药物处理;健康保险便携与责任法案信息附件.药物处理;健康保险便携与责任法案信息附件.药物治疗;药物处理HIPAA信息附件;药物处理信息附件;药物处理健康保险便携与责任法案信息附件 信息附件;健康保险便携与责任法案信息附件;附件 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 处理用药.当前;处理用药物.当前;处理药物.当前;当前的处理用药;当前的处理用药物;当前的处理药物;当前的治疗用药;当前的治疗用药物;当前的治疗药物;当前的药物;治疗用药.当前;治疗用药物.当前;治疗药物.当前 处理用药;处理用药物;处理药物;治疗用药;治疗用药物;用药;药物处理;药物治疗;治疗药物 姓名;名字;名 时刻;随机;随意;瞬间 标识;身份标识符;身份标识 药物;药物处理;用药;使用药物

52809-1 Dose form Current medication

Observation ID in Form

E1b

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Dose form
Property
Type
Time
Pt
System
Medication.current
Scale
Nom
Method

Additional Names

Short Name
Dose form Medication.current

Basic Attributes

Class
MEDS
Type
Clinical
First Released
Version 2.26
Last Updated
Version 2.73
Order vs. Observation
Observation
Common Test Rank Get Info
2249

Example Answer List LL3146-9

Answer Code Score Answer ID
Pill LA16247-1
Tablet LA21908-1
Capsule LA21907-3
Extended-release capsule LA21911-5
Granules LA21912-3
Suspension LA21913-1
Elixir LA21914-9
Cream LA21915-6
Ointment LA21916-4
Injectable solution LA21917-2
Patch LA21918-0
Spray LA21919-8

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

Language Variants Get Info

Tag Language Translation
es-MX Spanish (Mexico) Forma de dosis:Tipo:Punto temporal:Medicación actual:Nominal:
fr-FR French (France) Forme posologique:Type:Ponctuel:Traitement courant:Résultat nominal:
it-IT Italian (Italy) Dose, forma:Tipo:Pt:Farmaco.attuale:Nom:
Synonyms: Farmaco attuale Medicazione Punto nel tempo (episodio)
pt-BR Portuguese (Brazil) Forma de apresentação:Ident:Pt:Medicação.atual:Nom:
Synonyms: Identity or presence; Point in time; Random; Nominal
ru-RU Russian (Russian Federation) Доза форма:Тип:ТчкВрм:Лекарственный препарат.текущий:Ном:
Synonyms: Номинальный;Именной Точка во времени;Момент Форма выпуска
zh-CN Chinese (China) 剂型:类型:时间点:药物.当前:名义型:
Synonyms: 一剂物质 一剂药物 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 剂量物质 型 处理用药.当前;处理用药物.当前;处理药物.当前;当前的处理用药;当前的处理用药物;当前的处理药物;当前的治疗用药;当前的治疗用药物;当前的治疗药物;当前的药物;治疗用药.当前;治疗用药物.当前;治疗药物.当前 处理用药;处理用药物;处理药物;治疗用药;治疗用药物;用药;药物处理;药物治疗;治疗药物 时刻;随机;随意;瞬间 药剂形式 药物;药物处理;用药;使用药物 表格;表;窗体

18609-8 Current medication, Route

Observation ID in Form

E1c

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Route
Property
Prid
Time
Pt
System
Medication.current
Scale
Nom
Method

Basic Attributes

Class
ATTACH.MEDS
Type
Claims Attachments
First Released
Version 1.0l
Last Updated
Version 2.27

Normative Answer List LL696-6

Answer Code Score Answer ID
Chew, oral CHEW LA11235-1
Diffusion, extracorporeal EXTCORPDIF LA11236-9
Diffusion, hemodialysis HEMODIFF LA11237-7
Diffusion, transdermal TRNSDERMD LA11238-5
Dissolve, oral DISSOLVE LA11239-3
Dissolve, sublingual SL LA11240-1
Douche, vaginal DOUCHE LA11241-9
Electro-osmosis ELECTOSMOS LA11242-7
Enema, rectal ENEMA LA11243-5
Enema, rectal retention RETENEMA LA11244-3
Flush, intravenous catheter IVFLUSH LA11245-0
Gargle GARGLE LA11246-8
Immersion (soak) SOAK LA11247-6
Implantation, intradermal IDIMPLNT LA11248-4
Implantation, intravitreal IVITIMPLNT LA11249-2
Implantation, subcutaneous SQIMPLNT LA11250-0
Infusion, epidural EPI LA11251-8
Infusion, intraarterial catheter IA LA11252-6
Infusion, intracardiac IC LA11253-4
Infusion, intracoronary ICOR LA11254-2
Infusion, intraosseous, continuous IOSSC LA11255-9
Infusion, intrathecal IT LA11256-7
Infusion, intravascular IVASCINFUS LA11257-5
Infusion, intravenous IV LA11258-3
Infusion, intravenous catheter IVC LA11259-1
Infusion, intravenous catheter, continuous IVCC LA11260-9
Infusion, intravenous catheter, intermittent IVCI LA11261-7
Infusion, intravenous catheter, pca pump PCA LA11262-5
Infusion, subcutaneous SQINFUS LA11263-3
Inhalation, intermittent positive pressure breathing (ippb) IPPB LA11264-1
Inhalation, nasal NASINHL LA11265-8
Inhalation, nasal cannula NASINHLC LA11266-6
Inhalation, nebulization NEB LA11268-2
Inhalation, nebulization, nasal NASNEB LA11269-0
Inhalation, nebulization, oral ORNEB LA11270-8
Inhalation, oral intermittent flow ORIFINHL LA11271-6
Inhalation, oral rebreather mask REBREATH LA11272-4
Inhalation, respiratory ORINHL LA11273-2
Inhalation, tracheostomy TRACH LA11274-0
Inhalation, ventilator VENT LA11275-7
Inhalation, ventimask VENTMASK LA11276-5
Injection, amniotic fluid AMNINJ LA11277-3
Injection, biliary tract BILINJ LA11278-1
Injection, cervical CERVINJ LA11279-9
Injection, endosinusial ENDOSININJ LA11280-7
Injection, epidural EPIDURINJ LA11281-5
Injection, epidural, push EPIINJ LA11282-3
Injection, epidural, slow push EPINJSP LA11283-1
Injection, extra-amniotic EXTRAMNINJ LA11284-9
Injection, extracorporeal EXTCORPINJ LA11285-6
Injection, for cholangiography CHOLINJ LA11286-4
Injection, gastric button GBINJ LA11287-2
Injection, gingival GINGINJ LA11288-0
Injection, hemodialysis port HEMOPORT LA11289-8
Injection, insulin pump IPUMPINJ LA11290-6
Injection, interameningeal INTERMENINJ LA11291-4
Injection, interstitial INTERSTITINJ LA11292-2
Injection, intra-abdominal IABDINJ LA11293-0
Injection, intraarterial IAINJ LA11294-8
Injection, intraarterial, push IAINJP LA11295-5
Injection, intraarterial, slow push IAINJSP LA11296-3
Injection, intraarticular IARTINJ LA11297-1
Injection, intrabursal IBURSINJ LA11298-9
Injection, intracardiac ICARDINJ LA11299-7
Injection, intracardiac, push ICARINJP LA11300-3
Injection, intracardiac, rapid push ICARDINJRP LA11301-1
Injection, intracardiac, slow push ICARDINJSP LA11302-9
Injection, intracartilaginous ICARTINJ LA11303-7
Injection, intracaudal ICAUDINJ LA11304-5
Injection, intracavernous ICAVINJ LA11305-2
Injection, intracavitary ICAVITINJ LA11306-0
Injection, intracerebral ICEREBINJ LA11307-8
Injection, intracervical (uterus) IUINJC LA11308-6
Injection, intracisternal ICISTERNINJ LA11309-4
Injection, intracoronary ICORONINJ LA11310-2
Injection, intracoronary, push ICORONINJP LA11311-0
Injection, intracorpus cavernosum ICORPCAVINJ LA11312-8
Injection, intradermal IDINJ LA11313-6
Injection, intradiscal IDISCINJ LA11314-4
Injection, intraductal IDUCTINJ LA11315-1
Injection, intradural IDURINJ LA11316-9
Injection, intraepidermal IEPIDINJ LA11317-7
Injection, intraepithelial IEPITHINJ LA11318-5
Injection, intralesional ILESINJ LA11319-3
Injection, intraluminal ILUMINJ LA11320-1
Injection, intralymphatic ILYMPJINJ LA11321-9
Injection, intramedullary IMEDULINJ LA11322-7
Injection, intramuscular IM LA11323-5
Injection, intramuscular, deep IMD LA11324-3
Injection, intramuscular, z track IMZ LA11325-0
Injection, intraocular IOINJ LA11326-8
Injection, intraosseous IOSSINJ LA11327-6
Injection, intraovarian IOVARINJ LA11328-4
Injection, intrapericardial IPCARDINJ LA11329-2
Injection, intraperitoneal IPERINJ LA11330-0
Injection, intrapleural IPLRINJ LA11331-8
Injection, intraprostatic IPROSTINJ LA11332-6
Injection, intrapulmonary IPINJ LA11333-4
Injection, intraspinal ISINJ LA11334-2
Injection, intrasternal ISTERINJ LA11335-9
Injection, intrasynovial ISYNINJ LA11336-7
Injection, intratendinous ITENDINJ LA11337-5
Injection, intratesticular ITESTINJ LA11338-3
Injection, intrathecal ITINJ LA11339-1
Injection, intrathoracic ITHORINJ LA11340-9
Injection, intratubular ITUBINJ LA11341-7
Injection, intratumor ITUMINJ LA11342-5
Injection, intratympanic ITYMPINJ LA11343-3
Injection, intraureteral, retrograde IURETINJ LA11344-1
Injection, intrauterine IUINJ LA11345-8
Injection, intravascular IVASCINJ LA11346-6
Injection, intravenous IVINJ LA11347-4
Injection, intravenous, bolus IVINJBOL LA11348-2
Injection, intravenous, push IVPUSH LA11349-0
Injection, intravenous, rapid push IVRPUSH LA11350-8
Injection, intravenous, slow push IVSPUSH LA11351-6
Injection, intraventricular (heart) IVENTINJ LA11352-4
Injection, intravesicle IVESINJ LA11353-2
Injection, intravitreal IVITINJ LA11354-0
Injection, paranasal sinuses PNSINJ LA11355-7
Injection, parenteral PARENTINJ LA11356-5
Injection, periarticular PAINJ LA11357-3
Injection, peridural PDURINJ LA11358-1
Injection, perineural PNINJ LA11359-9
Injection, periodontal PDONTINJ LA11360-7
Injection, peritoneal dialysis port PDPINJ LA11361-5
Injection, retrobulbar RBINJ LA11362-3
Injection, soft tissue SOFTISINJ LA11363-1
Injection, subarachnoid SUBARACHINJ LA11364-9
Injection, subconjunctival SCINJ LA11365-6
Injection, subcutaneous SQ LA11366-4
Injection, sublesional SLESINJ LA11367-2
Injection, submucosal SUBMUCINJ LA11368-0
Injection, transplacental TRPLACINJ LA11369-8
Injection, transtracheal TRTRACHINJ LA11370-6
Injection, ureteral URETINJ LA11371-4
Injection, urethral URETHINJ LA11372-2
Injection, urinary bladder BLADINJ LA11373-0
Insertion, cervical (uterine) CERVINS LA11374-8
Insertion, intraocular, surgical IOSURGINS LA11375-5
Insertion, intrauterine IU LA11376-3
Insertion, lacrimal puncta LPINS LA11377-1
Insertion, rectal PR LA11378-9
Insertion, subcutaneous, surgical SQSURGINS LA11379-7
Insertion, urethral URETHINS LA11380-5
Insertion, vaginal VAGINSI LA11381-3
Instillation, cecostomy CECINSTL LA11382-1
Instillation, chest tube CTINSTL LA11383-9
Instillation, continuous ambulatory peritoneal dialysis port CAPDINSTL LA11384-7
Instillation, endotracheal tube ETINSTL LA11385-4
Instillation, enteral ENTINSTL LA11386-2
Instillation, enteral feeding tube EFT LA11387-0
Instillation, gastro-jejunostomy tube GJT LA11388-8
Instillation, gastrostomy tube GT LA11389-6
Instillation, intrabronchial IBRONCHINSTIL LA11390-4
Instillation, intraduodenal IDUODINSTIL LA11391-2
Instillation, intraesophageal IESOPHINSTIL LA11392-0
Instillation, intragastric IGASTINSTIL LA11393-8
Instillation, intraileal IILEALINJ LA11394-6
Instillation, intraocular IOINSTL LA11395-3
Instillation, intrasinal ISININSTIL LA11396-1
Instillation, intratracheal ITRACHINSTIL LA11397-9
Instillation, intrauterine IUINSTL LA11398-7
Instillation, jejunostomy tube JJTINSTL LA11399-5
Instillation, laryngeal LARYNGINSTIL LA11400-1
Instillation, nasal NASALINSTIL LA11401-9
Instillation, nasogastric NASOGASINSTIL LA11402-7
Instillation, nasogastric tube NGT LA11403-5
Instillation, nasotracheal tube NTT LA11404-3
Instillation, orogastric tube OGT LA11405-0
Instillation, orojejunum tube OJJ LA11406-8
Instillation, otic OT LA11407-6
Instillation, paranasal sinuses PNSINSTL LA11408-4
Instillation, peritoneal dialysis port PDPINSTL LA11409-2
Instillation, rectal RECINSTL LA11410-0
Instillation, rectal tube RECTINSTL LA11411-8
Instillation, sinus, unspecified SININSTIL LA11412-6
Instillation, soft tissue SOFTISINSTIL LA11413-4
Instillation, tracheostomy TRACHINSTL LA11414-2
Instillation, transtympanic TRTYMPINSTIL LA11415-9
instillation, urethral URETHINSTL LA11416-7
Instillation, urinary catheter BLADINSTL LA11417-5
Insufflation INSUF LA11418-3
Irrigation, genitourinary GUIRR LA11419-1
Irrigation, intragastric IGASTIRR LA11420-9
Irrigation, intralesional ILESIRR LA11421-7
Irrigation, intraocular IOIRR LA11422-5
Irrigation, rectal RECIRR LA11423-3
Irrigation, urinary bladder BLADIRR LA11424-1
Irrigation, urinary bladder, continuous BLADIRRC LA11425-8
Irrigation, urinary bladder, tidal BLADIRRT LA11426-6
Lavage, intragastric IGASTLAV LA11427-4
Mucosal absorption, intraduodenal IDOUDMAB LA11428-2
Mucosal absorption, intratracheal ITRACHMAB LA11429-0
Mucosal absorption, submucosal SMUCMAB LA11430-8
Nebulization, endotracheal tube ETNEB LA11431-6
Occlusive dressing technique OCDRESTA LA11432-4
Rinse, dental DENRINSE LA11433-2
Rinse, oral ORRINSE LA11434-0
Shampoo SHAMPOO LA11435-7
Subconjunctival SUBCONJTA LA11436-5
Suck, oromucosal SUCK LA11437-3
Suppository, urethral URETHSUP LA11438-1
Swallow, oral PO LA11439-9
Swish and spit out, oromucosal SWISHSPIT LA11440-7
Swish and swallow, oromucosal SWISHSWAL LA11441-5
Topical TOPICAL LA9456-0
Topical absorption, transtympanic TTYMPTABSORP LA11443-1
Topical application, buccal BUC LA11444-9
Topical application, cervical CERV LA11445-6
Topical application, dental DEN LA11446-4
Topical application, gingival GIN LA11447-2
Topical application, hair HAIR LA11448-0
Topical application, intracorneal ICORNTA LA11449-8
Topical application, intracoronal (dental) ICORONTA LA11450-6
Topical application, intraesophageal IESOPHTA LA11451-4
Topical application, intraileal IILEALTA LA11452-2
Topical application, intralesional ILTOP LA11453-0
Topical application, intraluminal ILUMTA LA11454-8
Topical application, intraocular IOTOP LA11455-5
Topical application, iontophoresis IONTO LA11456-3
Topical application, laryngeal LARYNGTA LA11457-1
Topical application, mucous membrane MUC LA11458-9
Topical application, nail NAIL LA11459-7
Topical application, nasal NASAL LA11460-5
Topical application, ophthalmic OPTHALTA LA11461-3
Topical application, oral ORALTA LA11462-1
Topical application, oromucosal ORMUC LA11463-9
Topical application, oropharyngeal OROPHARTA LA11464-7
Topical application, perianal PERIANAL LA11465-4
Topical application, perineal PERINEAL LA11466-2
Topical application, periodontal PDONTTA LA11467-0
Topical application, rectal RECTAL LA11468-8
Topical application, scalp SCALP LA11469-6
Topical application, skin SKIN LA11470-4
Topical application, soaked dressing DRESS LA11471-2
Topical application, swab SWAB LA11472-0
Topical application, transmucosal TMUCTA LA11473-8
Topical application, vaginal VAGINS LA11474-6
Transdermal TRNSDERM LA9454-5
Translingual TRNSLING LA9455-2

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
18605-6 Medication current Set

Language Variants Get Info

Tag Language Translation
es-AR Spanish (Argentina) vía:presencia o identidad:punto en el tiempo:medicación.actual:Nominal:
fr-FR French (France) Voie d'administration:Identification:Ponctuel:Traitement courant:Résultat nominal:
it-IT Italian (Italy) Via:Prid:Pt:Farmaco.attuale:Nom:
Synonyms: Allegato Allegato farmaci Farmaco attuale Medicazione Presenza o Identità Punto nel tempo (episodio)
ru-RU Russian (Russian Federation) Путь:ПрИд:ТчкВрм:Лекарственный препарат.текущий:Ном:
Synonyms: Номинальный;Именной Присутствие или Идентификация Точка во времени;Момент
zh-CN Chinese (China) 途径:存在与否或特征标识:时间点:药物.当前:名义型:
Synonyms: Health Insurance Portability and Accountability Act of 1996;HIPAA;健康保險可攜與責任法;HIPAA法案;健康保险可移植性和问责法1996年;美国健康保险携带和责任法案;医疗保险便携性和责任法案;医疗保险便携性与责任法案;醫療保險可攜性與責任法;HIPAA 信息附件.药物处理;健康保险便携与责任法案信息附件.药物处理;健康保险便携与责任法案信息附件.药物治疗;药物处理HIPAA信息附件;药物处理信息附件;药物处理健康保险便携与责任法案信息附件 信息附件;健康保险便携与责任法案信息附件;附件 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 处理用药.当前;处理用药物.当前;处理药物.当前;当前的处理用药;当前的处理用药物;当前的处理药物;当前的治疗用药;当前的治疗用药物;当前的治疗药物;当前的药物;治疗用药.当前;治疗用药物.当前;治疗药物.当前 处理用药;处理用药物;处理药物;治疗用药;治疗用药物;用药;药物处理;药物治疗;治疗药物 存在;存在与否;特征标识;身份;身份标识 时刻;随机;随意;瞬间 药物;药物处理;用药;使用药物 路径;通道;通路

52810-9 Current medication, Frequency

Observation ID in Form

E1d

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Frequency
Property
NRat
Time
Pt
System
Medication.current
Scale
Qn
Method

Basic Attributes

Class
ATTACH.MEDS
Type
Claims Attachments
First Released
Version 2.26
Last Updated
Version 2.73
Common Test Rank Get Info
8478

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

Language Variants Get Info

Tag Language Translation
fr-FR French (France) Fréquence:Nombre/Temps:Ponctuel:Traitement courant:Numérique:
it-IT Italian (Italy) Frequenza:NRat:Pt:Farmaco.attuale:Qn:
Synonyms: Allegato Allegato farmaci Farmaco attuale Indice numerico Medicazione Punto nel tempo (episodio)
pt-BR Portuguese (Brazil) Frequência:NRat:Pt:Medicação.atual:Qn:
Synonyms: ; nRate; Number rate; Count/time; Point in time; Random; Quantitative; QNT; Quant; Quan
ru-RU Russian (Russian Federation) Частота:КолСкор:ТчкВрм:Лекарственный препарат.текущий:Колич:
Synonyms: Количественный Количество скорость Точка во времени;Момент
zh-CN Chinese (China) 频率:计数型速率:时间点:药物.当前:定量型:
Synonyms: Health Insurance Portability and Accountability Act of 1996;HIPAA;健康保險可攜與責任法;HIPAA法案;健康保险可移植性和问责法1996年;美国健康保险携带和责任法案;医疗保险便携性和责任法案;医疗保险便携性与责任法案;醫療保險可攜性與責任法;HIPAA 信息附件.药物处理;健康保险便携与责任法案信息附件.药物处理;健康保险便携与责任法案信息附件.药物治疗;药物处理HIPAA信息附件;药物处理信息附件;药物处理健康保险便携与责任法案信息附件 信息附件;健康保险便携与责任法案信息附件;附件 单位时间内的数量或计数;数量/时间;数量型速率;数量型速率或计数型速率;数量型速率或计数型速率(单位时间);数量或计数型速率;计数/时间;计数型速率(单位时间);数量或计数型速率(单位时间) 可用数量表示的;定量性;数值型;数量型;连续数值型标尺 处理用药.当前;处理用药物.当前;处理药物.当前;当前的处理用药;当前的处理用药物;当前的处理药物;当前的治疗用药;当前的治疗用药物;当前的治疗药物;当前的药物;治疗用药.当前;治疗用药物.当前;治疗药物.当前 处理用药;处理用药物;处理药物;治疗用药;治疗用药物;用药;药物处理;药物治疗;治疗药物 时刻;随机;随意;瞬间 药物;药物处理;用药;使用药物 频次;频度;频繁性;次数;频率分布;发生次数;周率;频繁程度

52796-0 Planned Stop Date (if applicable)

Observation ID in Form

E1e

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Planned stop date
Property
Date
Time
Pt
System
Medication.current
Scale
Qn
Method

Basic Attributes

Class
SURVEY.CARE
Type
Surveys
First Released
Version 2.26
Last Updated
Version 2.64

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
52743-2 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
52748-1 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
52746-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Interim
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52472-8 Allergies and Adverse Drug Reactions

Observation ID in Form

F

Fully-Specified Name

Component
Allergies & Adverse Drug Reactions
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
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52571-7 Does patient have allergies or any known adverse drug reactions?

Observation ID in Form

F1

Skip Logic

If None Known, skip to Section G. Skin Integrity. If Yes, list all allergies/causes of reaction [e.g., food, medications, other] and describe the adverse reactions.)

Fully-Specified Name

Component
Known allergies or adverse drug reactions
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
Does patient have allergies or any known adverse drug reactions?
Source
CARE I.f01

Normative Answer List LL553-9

Answer Code Score Answer ID
None known 0 LA10030-7
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) 1 LA33-6

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission

52473-6 Allergies/Causes of Reaction

Observation ID in Form

F1a

Fully-Specified Name

Component
Allergy or cause of reaction
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Basic Attributes

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

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
62863-6 PhenX domain - Infectious diseases and immunity

31044-1 Patient Reaction

Observation ID in Form

F1b

Fully-Specified Name

Component
Immunization reaction
Property
Find
Time
Pt
System
^Patient
Scale
Nom
Method

Additional Names

Short Name
Immunization reaction

Basic Attributes

Class
VACCIN
Type
Clinical
First Released
Version 2.05
Last Updated
Version 2.52
Order vs. Observation
Observation

Example Answer List LL3209-5

Answer Code Score Answer ID
Pain 7 LA7460-4
Hypotonic LA22435-4
Fever LA7435-6
Encephalopathy, disorder of the brain LA22437-0
Anaphylaxis within 24 hours LA22438-8
Redness LA22439-6
Swelling 6 LA22440-4

Member of these Panels

LOINC Long Common Name
52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
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
52744-0 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
62863-6 PhenX domain - Infectious diseases and immunity

Language Variants Get Info

Tag Language Translation
es-MX Spanish (Mexico) Reacción de inmunización:Tipo:Punto temporal:^ Paciente:Nominal:
es-AR Spanish (Argentina) reacción:hallazgo:punto en el tiempo:^paciente:Nominal:
fr-FR French (France) Réaction d'immunisation:Recherche:Ponctuel:Patient:Résultat nominal:
it-IT Italian (Italy) Immunizzazione, reazione:Osservazione:Pt:^Paziente:Nom:
Synonyms: Osservazione paziente Punto nel tempo (episodio) Vaccinazioni
pt-BR Portuguese (Brazil) Reação:Achado:Pt:^Paciente:Nom:
Synonyms: Finding; Findings; Point in time; Random; Nominal; Rxn; React; VACCINE
zh-CN Chinese (China) 疫苗接种反应:发现:时间点:^患者:名义型:
Synonyms: React Rxn 免疫接种历史;免疫史;接种史;免疫接种史 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 发现是一个原子型临床观察指标，并不是作为印象的概括陈述。体格检查、病史、系统检查及其他此类观察指标的属性均为发现。它们的标尺对于编码型发现可能是名义型，而对于叙述型文本之中所报告的发现，则可能是叙述型。;发现物;所见;结果;结论 响应 接种;接种记录;疫苗;疫苗接种 时刻;随机;随意;瞬间 疫苗接种（免疫接种、预防接种、接种）反应