LOINC
Version 2.66

83265-9Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.4 [CMS Assessment]Active

Component
Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 1.4
Property
-
Time
Pt
System
^Patient
Scale
-
Method
CMS Assessment

Panel Hierarchy
Details for each LOINC in Panel LHC-Forms

LOINC Name R/O/C Cardinality Example UCUM Units
83265-9 Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 1.4
Indent85395-2 Identification Information
IndentIndent85396-0 Facility Information
IndentIndentIndent76696-4 Facility Name
IndentIndentIndent69417-4 Facility Medicare Provider Number
IndentIndent45397-7 Patient Medicare Number
IndentIndent45400-9 Patient Medicaid Number
IndentIndent45392-8 Patient First Name
IndentIndent45394-4 Patient Last Name
IndentIndent52463-7 Patient Identification Number
IndentIndent21112-8 Birth Date {mm/dd/yyyy}
IndentIndent45396-9 Social Security Number
IndentIndent46098-0 Gender
IndentIndent59362-4 Race/Ethnicity 0..6
IndentIndent45404-1 Marital status
IndentIndent52539-4 Zip Code of Patient's Pre-Hospital Residence
IndentIndent52455-3 Admission Date {mm/dd/yyyy}
IndentIndent52456-1 Assessment Reference Date
IndentIndent85397-8 Admission Class
IndentIndent85398-6 Admit From
IndentIndent85399-4 Pre-hospital Living Setting
IndentIndent85400-0 Pre-hospital Living With
Indent85401-8 Payer information
IndentIndent85813-4 Payment Source
IndentIndentIndent85402-6 Primary Source
IndentIndentIndent85403-4 Secondary Source
Indent85404-2 Medical Information
IndentIndent85405-9 Impairment Group - Admission
IndentIndentIndent85845-6 Impairment Group
IndentIndent85406-7 Impairment Group - Discharge
IndentIndentIndent85845-6 Impairment Group
IndentIndent52797-8 Etiologic Diagnosis 1..3
IndentIndent85585-8 Date of Onset of Impairment {mm/dd/yyyy}
IndentIndent75618-9 Comorbid Conditions 0..25
IndentIndent85407-5 Are there any arthritis conditions recorded in items #21, #22, or #24 that meet all of the regulatory requirements for IRF classification (in 42 CFR 412.29(b)(2)(x), (xi), and (xii))?
IndentIndent54567-3 Height and Weight
IndentIndentIndent3137-7 Height on admission (in inches) [in_us];cm
IndentIndentIndent3141-9 Weight on admission (in pounds) [lb_av];kg
IndentIndent85408-3 Swallowing Status - Admission
IndentIndentIndent85846-4 Swallowing Status
IndentIndent85409-1 Swallowing Status - Discharge
IndentIndentIndent85846-4 Swallowing Status
Indent85410-9 Discharge Information
IndentIndent52525-3 Discharge Date {mm/dd/yyyy}
IndentIndent85411-7 Patient discharged against medical advice?
IndentIndent85412-5 Program Interruption(s)
IndentIndent85483-6 Program Interruption Dates 0..3
IndentIndentIndent85413-3 Program Interruption Date 1..1 {mm/dd/yyyy}
IndentIndentIndent85414-1 Program Return Date 1..1 {mm/dd/yyyy}
IndentIndent85415-8 Was the patient discharged alive?
IndentIndent55128-3 Patient's discharge destination/living setting
IndentIndent85417-4 Discharge to Living With
IndentIndent85418-2 Diagnosis for Interruption or Death
IndentIndent85419-0 Complications during rehabilitation stay 0..6
Indent85420-8 Therapy Information
IndentIndent85494-3 Week 1: Total Number of Minutes Provided
IndentIndentIndent85566-8 Physical Therapy
IndentIndentIndentIndent85557-7 Total minutes of individual therapy min
IndentIndentIndentIndent85558-5 Total minutes of concurrent therapy min
IndentIndentIndentIndent85559-3 Total minutes of group therapy min
IndentIndentIndentIndent85560-1 Total minutes of co-treatment therapy min
IndentIndentIndent85561-9 Occupational Therapy
IndentIndentIndentIndent85562-7 Total minutes of individual therapy min
IndentIndentIndentIndent85563-5 Total minutes of concurrent therapy min
IndentIndentIndentIndent85564-3 Total minutes of group therapy min
IndentIndentIndentIndent85565-0 Total minutes of co-treatment therapy min
IndentIndentIndent85493-5 Speech-language Pathology
IndentIndentIndentIndent85492-7 Total minutes of individual therapy min
IndentIndentIndentIndent85491-9 Total minutes of concurrent therapy min
IndentIndentIndentIndent85490-1 Total minutes of group therapy min
IndentIndentIndentIndent85489-3 Total minutes of co-treatment therapy min
IndentIndent85495-0 Week 2: Total Number of Minutes Provided
IndentIndentIndent85589-0 Physical Therapy
IndentIndentIndentIndent85567-6 Total minutes of individual therapy min
IndentIndentIndentIndent85568-4 Total minutes of concurrent therapy min
IndentIndentIndentIndent85569-2 Total minutes of group therapy min
IndentIndentIndentIndent85570-0 Total minutes of co-treatment therapy min
IndentIndentIndent85590-8 Occupational Therapy
IndentIndentIndentIndent85571-8 Total minutes of individual therapy min
IndentIndentIndentIndent85572-6 Total minutes of concurrent therapy min
IndentIndentIndentIndent85573-4 Total minutes of group therapy min
IndentIndentIndentIndent85574-2 Total minutes of co-treatment therapy min
IndentIndentIndent85591-6 Speech-language Pathology
IndentIndentIndentIndent85575-9 Total minutes of individual therapy min
IndentIndentIndentIndent85576-7 Total minutes of concurrent therapy min
IndentIndentIndentIndent85577-5 Total minutes of group therapy min
IndentIndentIndentIndent85578-3 Total minutes of co-treatment therapy min
Indent83266-7 Quality Indicators - Admission
IndentIndent83251-9 Hearing, Speech, and Vision
IndentIndentIndent83250-1 Expression of Ideas and Wants
IndentIndentIndent83249-3 Understanding Verbal Content (with hearing aid or device, if used and excluding language barriers)
IndentIndent83267-5 Cognitive Patterns
IndentIndentIndent83248-5 Should Brief Interview for Mental Status (C0200-C0500) be conducted?
IndentIndentIndent52491-8 Brief Interview for Mental Status
IndentIndentIndentIndent52731-7 Repetition of Three Words. Number of words repeated by patient after first attempt
IndentIndentIndentIndent54510-3 Temporal Orientation: Year, Month, and Day
IndentIndentIndentIndentIndent52732-5 Please tell me what year it is right now
IndentIndentIndentIndentIndent52733-3 What month are we in right now?
IndentIndentIndentIndentIndent54609-3 What day of the week is today?
IndentIndentIndentIndent52493-4 Recall
IndentIndentIndentIndentIndent52735-8 Recalls "sock"?
IndentIndentIndentIndentIndent52736-6 Recalls "blue"?
IndentIndentIndentIndentIndent52737-4 Recalls "bed"?
IndentIndentIndentIndent54614-3 BIMS Summary Score {score}
IndentIndentIndent54615-0 Should the Staff Assessment for Mental Status (C0900) be Conducted?
IndentIndentIndent83241-0 Staff Assessment for Mental Status
IndentIndentIndentIndent83240-2 Memory/Recall Ability 1..4
IndentIndent83268-3 Functional Abilities and Goals - Admission
IndentIndentIndent83239-4 Prior Functioning: Everyday Activities
IndentIndentIndentIndent85070-1 Self-Care
IndentIndentIndentIndent85071-9 Indoor Mobility (Ambulation)
IndentIndentIndentIndent85072-7 Stairs
IndentIndentIndentIndent85073-5 Functional Cognition
IndentIndentIndent83234-5 Prior Device Use 1..5
IndentIndentIndent83233-7 Self-Care - Admission Performance
IndentIndentIndentIndent83232-9 Eating
IndentIndentIndentIndent83230-3 Oral hygiene
IndentIndentIndentIndent83228-7 Toileting hygiene
IndentIndentIndentIndent83226-1 Shower/bathe self
IndentIndentIndentIndent83224-6 Upper body dressing
IndentIndentIndentIndent83222-0 Lower body dressing
IndentIndentIndentIndent83220-4 Putting on/taking off footwear
IndentIndentIndent85054-5 Self-Care - Discharge Goal
IndentIndentIndentIndent83231-1 Eating
IndentIndentIndentIndent83229-5 Oral hygiene
IndentIndentIndentIndent83227-9 Toileting hygiene
IndentIndentIndentIndent83225-3 Shower/bathe self
IndentIndentIndentIndent83223-8 Upper body dressing
IndentIndentIndentIndent83221-2 Lower body dressing
IndentIndentIndentIndent83219-6 Putting on/taking off footwear
IndentIndentIndent83269-1 Mobility - Admission Performance
IndentIndentIndentIndent83218-8 Roll left and right
IndentIndentIndentIndent83216-2 Sit to lying
IndentIndentIndentIndent83214-7 Lying to sitting on side of bed
IndentIndentIndentIndent83212-1 Sit to stand
IndentIndentIndentIndent83210-5 Chair/bed-to-chair transfer
IndentIndentIndentIndent83208-9 Toilet transfer
IndentIndentIndentIndent83206-3 Car transfer
IndentIndentIndentIndent83270-9 Does the patient walk?
IndentIndentIndentIndent83204-8 Walk 10 feet
IndentIndentIndentIndent83202-2 Walk 50 feet with two turns
IndentIndentIndentIndent83200-6 Walk 150 feet
IndentIndentIndentIndent83198-2 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83196-6 1 step (curb)
IndentIndentIndentIndent83194-1 4 steps
IndentIndentIndentIndent83192-5 12 steps
IndentIndentIndentIndent83190-9 Picking up object
IndentIndentIndentIndent83271-7 Does the patient use a wheelchair/scooter?
IndentIndentIndentIndent83188-3 Wheel 50 feet with two turns
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair/scooter used
IndentIndentIndentIndent83235-2 Wheel 150 feet
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair/scooter used
IndentIndentIndent85056-0 Mobility - Discharge Goal
IndentIndentIndentIndent83217-0 Roll left and right
IndentIndentIndentIndent83215-4 Sit to lying
IndentIndentIndentIndent83213-9 Lying to sitting on side of bed
IndentIndentIndentIndent83211-3 Sit to stand
IndentIndentIndentIndent83209-7 Chair/Bed-to-chair transfer
IndentIndentIndentIndent83207-1 Toilet transfer
IndentIndentIndentIndent83205-5 Car transfer
IndentIndentIndentIndent83203-0 Walk 10 feet
IndentIndentIndentIndent83201-4 Walk 50 feet with two turns
IndentIndentIndentIndent83199-0 Walk 150 feet
IndentIndentIndentIndent83197-4 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83195-8 1 step (curb)
IndentIndentIndentIndent83193-3 4 steps
IndentIndentIndentIndent83191-7 12 steps
IndentIndentIndentIndent83189-1 Picking up object
IndentIndentIndentIndent83187-5 Wheel 50 feet with two turns
IndentIndentIndentIndent83236-0 Wheel 150 feet
IndentIndent83237-8 Bladder and Bowel
IndentIndentIndent83238-6 Bladder continence
IndentIndentIndent83242-8 Bowel continence
IndentIndent83264-2 Active diagnoses
IndentIndentIndent83243-6 Comorbidities and Co-existing Conditions 1..2
IndentIndent83273-3 Health Conditions - Admission
IndentIndentIndent52552-7 History of Falls. Has the patient had two or more falls in the past year or any fall with injury in the past year?
IndentIndentIndent83274-1 Prior Surgery. Did the resident have major surgery during the 100 days prior to admission?
IndentIndent83244-4 Swallowing/Nutritional Status
IndentIndentIndent83245-1 Swallowing/Nutritional Status 1..3
IndentIndent85055-2 Skin Conditions - Admission
IndentIndentIndent58214-8 Unhealed Pressure Ulcer(s). Does this patient have one or more unhealed pressure ulcer(s) at Stage 1 or higher?
IndentIndentIndent83246-9 Current Number of Unhealed Pressure Ulcers at Each Stage - Admission
IndentIndentIndentIndent54884-2 Number of Stage 1 pressure ulcers {#}
IndentIndentIndentIndent55124-2 Number of Stage 2 pressure ulcers {#}
IndentIndentIndentIndent55125-9 Number of Stage 3 pressure ulcers {#}
IndentIndentIndentIndent55126-7 Number of Stage 4 pressure ulcers {#}
IndentIndentIndentIndent54893-3 Number of unstageable pressure ulcers due to non-removable dressing/device {#}
IndentIndentIndentIndent54946-9 Number of pressure unstageable ulcers due to coverage of wound bed by slough and/or eschar {#}
IndentIndentIndentIndent54950-1 Number of unstageable pressure ulcers with suspected deep tissue injury in evolution {#}
IndentIndent83261-8 Special Treatments, Procedures, and Programs - Admission
IndentIndentIndent83252-7 Special Treatments, Procedures, and Programs 0..1
Indent83275-8 Quality Indicators - Discharge
IndentIndent83276-6 Functional Abilities and Goals - Discharge
IndentIndentIndent83254-3 Self-Care - Discharge Performance
IndentIndentIndentIndent83232-9 Eating
IndentIndentIndentIndent83230-3 Oral hygiene
IndentIndentIndentIndent83228-7 Toileting hygiene
IndentIndentIndentIndent83226-1 Shower/bathe self
IndentIndentIndentIndent83224-6 Upper body dressing
IndentIndentIndentIndent83222-0 Lower body dressing
IndentIndentIndentIndent83220-4 Putting on/taking off footwear
IndentIndentIndent83277-4 Mobility - Discharge Performance
IndentIndentIndentIndent83218-8 Roll left and right
IndentIndentIndentIndent83216-2 Sit to lying
IndentIndentIndentIndent83214-7 Lying to sitting on side of bed
IndentIndentIndentIndent83212-1 Sit to stand
IndentIndentIndentIndent83210-5 Chair/bed-to-chair transfer
IndentIndentIndentIndent83208-9 Toilet transfer
IndentIndentIndentIndent83206-3 Car transfer
IndentIndentIndentIndent83278-2 Does the patient walk?
IndentIndentIndentIndent83204-8 Walk 10 feet
IndentIndentIndentIndent83202-2 Walk 50 feet with two turns
IndentIndentIndentIndent83200-6 Walk 150 feet
IndentIndentIndentIndent83198-2 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83196-6 1 step (curb)
IndentIndentIndentIndent83194-1 4 steps
IndentIndentIndentIndent83192-5 12 steps
IndentIndentIndentIndent83190-9 Picking up object
IndentIndentIndentIndent83271-7 Does the patient use a wheelchair/scooter?
IndentIndentIndentIndent83188-3 Wheel 50 feet with two turns
IndentIndentIndentIndent83272-5 Indicate the type of wheelchairscooter used
IndentIndentIndentIndent83235-2 Wheel 150 feet
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair/scooter used
IndentIndent83279-0 Health Conditions - Discharge
IndentIndentIndent83280-8 Any falls since admission. Has the patient had any falls since admission?
IndentIndentIndent54854-5 Number of Falls Since Admission
IndentIndentIndentIndent54855-2 No injury
IndentIndentIndentIndent54856-0 Injury (except major)
IndentIndentIndentIndent54857-8 Major injury
IndentIndent83281-6 Skin Conditions - Discharge
IndentIndentIndent58214-8 Unhealed Pressure Ulcer(s). Does this patient have one or more unhealed pressure ulcer(s) at Stage 1 or higher?
IndentIndentIndent83256-8 Current Number of Unhealed Pressure Ulcers at Each Stage - Discharge
IndentIndentIndentIndent54884-2 Number of Stage 1 pressure ulcers {#}
IndentIndentIndentIndent55124-2 Number of Stage 2 pressure ulcers {#}
IndentIndentIndentIndent54886-7 Number of these Stage 2 pressure ulcers that were present upon admission {#}
IndentIndentIndentIndent55125-9 Number of Stage 3 pressure ulcers {#}
IndentIndentIndentIndent54887-5 Number of these Stage 3 pressure ulcers that were present upon admission {#}
IndentIndentIndentIndent55126-7 Number of Stage 4 pressure ulcers {#}
IndentIndentIndentIndent54890-9 Number of these Stage 4 pressure ulcers that were present upon admission {#}
IndentIndentIndentIndent54893-3 Number of unstageable pressure ulcers due to non-removable dressing {#}
IndentIndentIndentIndent54894-1 Number of these unstageable pressure ulcers that were present upon admission {#}
IndentIndentIndentIndent54946-9 Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar {#}
IndentIndentIndentIndent54947-7 Number of these unstageable pressure ulcers that were present upon admission {#}
IndentIndentIndentIndent54950-1 Number of unstageable pressure ulcers with suspected deep tissue injury in evolution {#}
IndentIndentIndentIndent54951-9 Number of these unstageable pressure ulcers that were present upon admission {#}
IndentIndentIndent83282-4 Worsening in Pressure Ulcer Status Since Admission
IndentIndentIndentIndent83283-2 Stage 2 {#}
IndentIndentIndentIndent83284-0 Stage 3 {#}
IndentIndentIndentIndent83285-7 Stage 4 {#}
IndentIndentIndentIndent83286-5 Unstageable - Non-removable dressing {#}
IndentIndentIndentIndent83287-3 Unstageable - Slough and/or eschar {#}
IndentIndentIndentIndent83288-1 Unstageable - Deep tissue injury {#}
IndentIndentIndent83258-4 Healed Pressure Ulcers
IndentIndentIndentIndent83260-0 Stage 1 {#}
IndentIndentIndentIndent54958-4 Stage 2 {#}
IndentIndentIndentIndent54959-2 Stage 3 {#}
IndentIndentIndentIndent54960-0 Stage 4 {#}
IndentIndent83247-7 Special Treatments, Procedures, and Programs - Discharge
IndentIndentIndent69339-0 Influenza Vaccine
IndentIndentIndentIndent55019-4 Did the patient receive the influenza vaccine in this facility for this year's influenza vaccination season?
IndentIndentIndentIndent58131-4 Date influenza vaccine received {mm/dd/yyyy}
IndentIndentIndentIndent55020-2 If influenza vaccine not received, state reason: C
Indent85814-2 Signature of Persons Completing the Assessment
IndentIndent85647-6 Signature
IndentIndent85650-0 Title
IndentIndent70158-1 Date Information is Provided and Time

Term Description

This panel only includes the IRF-PAI items that are not a part of the FIM Instrument (an instrument copyrighted by UBFA, Inc ©1993, 2001). This panel should be used for CMS IRF-PAI v1.4 assessments performed between October 1, 2016 and September 30, 2017.
Source: Regenstrief LOINC

Basic Attributes

Class
PANEL.SURVEY.CMS
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.66
Order vs. Observation
Order
Panel Type
Panel

LOINC FHIR® API Example - CodeSystem Request Get Info

https://fhir.loinc.org/CodeSystem/$lookup?system=http://loinc.org&code=83265-9