Version 2.80

68995-0 Person completing form name Provider

Observation ID in Form

Z0400

Fully-Specified Name

Component
Person completing form name
Property
Pn
Time
Pt
System
Provider
Scale
Nom
Method

Basic Attributes

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

Member of these Panels

LOINC Long Common Name
69412-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0
68359-9 End Stage Renal Disease (ESRD) Death Notification - OMB CMS form 2746

46500-5 Discipline of Person Completing Assessment

Term Description

Identifies the discipline of the clinician completing the comprehensive assessment at the specified time points or the clinician reporting the transfer to an inpatient facility, death at home, or discharge (no further visits after start of care).

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Discipline of person completing assessment
Property
Type
Time
RptPeriod
System
Provider
Scale
Nom
Method
CMS Assessment

Long Common Name

Discipline of Person Completing Assessment during assessment period [CMS Assessment] Provider

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.19
Last Updated
Version 2.77 (MAJ)
Change Reason
Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments; Previous Releases: Updated METHOD from OASIS to CMS Assessment to use term across CMS instruments as approved by the Clinical LOINC committee
Order vs. Observation
Observation

Normative Answer List LL245-2

Answer Code Score Answer ID
RN 1 LA6367-2
PT 2 LA6353-2
SLP/ST 3 LA6378-9
OT 4 LA6309-4

Member of these Panels

LOINC Long Common Name
69412-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0
46462-8 Deprecated Outcome and assessment information set (OASIS) form - version B1
57039-0 Deprecated Outcome and assessment information set (OASIS) form - version C
57459-0 Deprecated Outcome and assessment information set (OASIS) form - version C - Death at home
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
86261-5 Deprecated Outcome and assessment information set (OASIS) form - version C2 - Discharged from agency - death at home [CMS Assessment]
86264-9 Deprecated Outcome and assessment information set (OASIS) form - version C2 - Discharged from agency [CMS Assessment]
86244-1 Deprecated Outcome and assessment information set (OASIS) form - version C2 - Follow-up - recertification or other follow-up [CMS Assessment]
86189-8 Deprecated Outcome and assessment information set (OASIS) form - version C2 - Resumption of care [CMS Assessment]
85907-4 Deprecated Outcome and assessment information set (OASIS) form - version C2 - Start of care [CMS Assessment]
86259-9 Deprecated Outcome and assessment information set (OASIS) form - version C2 - Transfer To inpatient facility - patient discharged or not discharged [CMS Assessment]
88369-4 Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
88370-2 Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency - death at home during assessment period [CMS Assessment]
88371-0 Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment]
88368-6 Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment]
88373-6 Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment]
88367-8 Outcome and assessment information set (OASIS) form - version D, D1 - Transfer to inpatient facility - patient discharged or not discharged during assessment period [CMS Assessment]
93058-6 Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment]
99158-8 Outcome and assessment information set (OASIS) form - version E - Death at Home during assessment period [CMS Assessment]
99178-6 Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment]
99153-9 Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment]
99160-4 Outcome and assessment information set (OASIS) form - version E - Resumption 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]
99174-5 Outcome and assessment information set (OASIS) form - version E - Transfer to an Inpatient Facility during assessment period [CMS Assessment]
106526-7 Outcome and assessment information set (OASIS) form - version E1 - Death at Home during assessment period [CMS Assessment]
106529-1 Outcome and assessment information set (OASIS) form - version E1 - Discharge from Agency during assessment period [CMS Assessment]
106528-3 Outcome and assessment information set (OASIS) form - version E1 - Follow Up during assessment period [CMS Assessment]
106525-9 Outcome and assessment information set (OASIS) form - version E1 - Resumption 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]
106527-5 Outcome and assessment information set (OASIS) form - version E1 - Transfer to an Inpatient Facility during assessment period [CMS Assessment]

70157-3 Form sections completed Provider

Fully-Specified Name

Component
Form sections completed
Property
Type
Time
Pt
System
Provider
Scale
Nom
Method

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.63 (MAJ)
Change Reason
Removed METHOD because this term is generic; Corrected Property and System
Order vs. Observation
Observation

Member of these Panels

LOINC Long Common Name
69412-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0
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]

70158-1 Date sections completed Provider

Fully-Specified Name

Component
Date sections completed
Property
TmStp
Time
Pt
System
Provider
Scale
Qn
Method

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.63 (MAJ)
Change Reason
Removed METHOD because this term is generic;Updated PROPERTY from Date to TmStp include electronic signature in which all time information is stored.; Corrected System
Order vs. Observation
Observation

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]
69412-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0
83265-9 Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.4 [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]

70127-6 Signature of assessment coordinator verifying assessment completion

Observation ID in Form

Z0500A

Fully-Specified Name

Component
Signature verifying assessment completion
Property
Pn
Time
Pt
System
^Patient
Scale
Nom
Method

Long Common Name

Signature verifying assessment completion

Basic Attributes

Class
PANEL.SURVEY.CMS
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.75 (PANEL)
Change Reason
Release 2.75: PanelType: changed from Observation to Subset Organizer; ORDER_OBS: changed from Observation to Subset Organizer; Previous Releases: Removed METHOD because this term is generic;Changed PROPERTY from Arb to Pn
Order vs. Observation
Subset
Panel Type
Organizer

Member of these Panels

LOINC Long Common Name
97887-4 Core Outcome Measures Index for the Back [COMI]
97327-1 Core Outcome Measures Index for the Neck [COMI]
69412-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0
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]
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]
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]
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]
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]
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]
101111-3 MDS v3.0 - RAI v1.18.11 - Interim Payment Assessment (IPA) item set during assessment period [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]

30947-6 Date form completed

Observation ID in Form

Z0500B

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Date form completed
Property
Date
Time
Pt
System
Form
Scale
Qn
Method

Basic Attributes

Class
ADMIN
Type
Clinical
First Released
Version 2.04
Last Updated
Version 2.61 (MIN)
Order vs. Observation
Observation

Member of these Panels

LOINC Long Common Name
97887-4 Core Outcome Measures Index for the Back [COMI]
97327-1 Core Outcome Measures Index for the Neck [COMI]
69412-5 Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0
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]
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]
100203-9 Knee Society Score post-op panel [Knee Society Score]
100159-3 Knee Society Score pre-op panel [Knee Society Score]
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]
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]
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]
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]
101111-3 MDS v3.0 - RAI v1.18.11 - Interim Payment Assessment (IPA) item set during assessment period [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]
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]
46611-0 Mental residual functional capacity (RFC) assessment form
74725-3 Patient safety event report - hospital - device or medical AndOr surgical supply, including health information technology (HIT) - version 1.2 [AHRQ]
74495-3 Patient safety event report - hospital - healthcare event reporting form (HERF) - version 1.2 [AHRQ]
74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]
74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
74501-8 Patient safety event report - hospital - summary of initial report (SIR) - version 1.2 [AHRQ]
105485-7 PhenX - healthcare communications protocol 281101
60687-1 Test of Infant Motor Performance Version 5.1
55140-8 Vaccine Adverse Event Reporting System (VAERS) panel

Language Variants Get Info

Tag Language Translation
el-GR Greek (Greece) Ημερομηνία συμπλήρωσης εντύπου:Ημερομηνία:Pt:Μορφή:Qn:
Synonyms: Ημερομηνία Ημερομηνία συμπλήρωσης εντύπου Μορφή
es-AR Spanish (Argentina) fecha de formulario completo:marca de tiempo:fecha y hora:punto en el tiempo:forma:cuantitativo:
es-MX Spanish (Mexico) Formulario de fecha completado:Fecha:Punto temporal:Formulario:Cuantitativo:
it-IT Italian (Italy) Data completamento form:Data:Pt:Modulo:Qn:
Synonyms: Amministrativo Punto nel tempo (episodio)
pt-BR Portuguese (Brazil) Data formulário preenchido:TmStp:Pt:Forma:Qn:
Synonyms: Time stamp; Date and time; Timestamp; Point in time; Random; Quantitative; QNT; Quant; Quan; VACCINE
ru-RU Russian (Russian Federation) Дата форма заполнение:Дата:ТчкВрм:Форма:Колич:
Synonyms: Дата заполнения формы Количественный Точка во времени;Момент
zh-CN Chinese (China) 表单完成日期:日期:时间点:表单:定量型:
Synonyms: 可用数量表示的;定量性;数值型;数量型;连续数值型标尺 日子;几号 时刻;随机;随意;瞬间 行政;管理;施行;执行;经营 表单填写日期 表格;表;窗体

Example Units

Unit Source
{mm/dd/yyyy} Example UCUM Units