86521-2
Deprecated Minimum Data Set (MDS) - version 3.0 - Resident Assessment and Care Screening (RAI) version 1.14.1 [CMS Assessment]
Deprecated
Status Information
- Status
- DEPRECATED
Term Description
This panel should be used for CMS MDS3.0 v1.14.1 assessments performed between October 1, 2016 and September 30, 2017.
Source: Regenstrief LOINC
Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
| LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
|---|---|---|---|---|
| 86521-2 | Deprecated Minimum Data Set (MDS) - version 3.0 - Resident Assessment and Care Screening (RAI) version 1.14.1 [CMS Assessment] | |||
| Indent86522-0 | MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set | |||
| Indent Indent86523-8 | Identification Information | |||
| Indent Indent Indent58198-3 | Type of Record | |||
| Indent Indent Indent54581-4 | Facility Provider Numbers | |||
| Indent Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
| Indent Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
| Indent Indent Indent Indent45398-5 | State Provider Number | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent86524-6 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent54587-1 | Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent71440-2 | Type of discharge | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent86526-1 | Unit Certification or Licensure Designation | |||
| Indent Indent Indent54503-8 | Legal Name of Resident | |||
| Indent Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent Indent45394-4 | Last name | |||
| Indent Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent Indent45966-9 | Social Security and Medicare Numbers | |||
| Indent Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent Indent45397-7 | Medicare number (or comparable railroad insurance number) | |||
| Indent Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent59362-4 | Race/Ethnicity | 1..6 | ||
| Indent Indent Indent54505-3 | Language | |||
| Indent Indent Indent Indent54588-9 | Does the resident need or want an interpreter to communicate with a doctor or health care staff? | |||
| Indent Indent Indent Indent54899-0 | Preferred language | |||
| Indent Indent Indent45404-1 | Marital Status | |||
| Indent Indent Indent54506-1 | Optional Resident Items | |||
| Indent Indent Indent Indent46106-1 | Medical record number [Identifier] | |||
| Indent Indent Indent Indent45403-3 | Room number [Location] | |||
| Indent Indent Indent Indent52462-9 | Name by which resident prefers to be addressed | |||
| Indent Indent Indent Indent21843-8 | Lifetime occupation(s) | |||
| Indent Indent Indent54589-7 | Preadmission Screening and Resident Review (PASRR). Is the resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability ("mental retardation" in federal regulation) or a related condition? | |||
| Indent Indent Indent71441-0 | Level II Preadmission Screening and Resident Review (PASRR) Conditions | 1..3 | ||
| Indent Indent Indent86527-9 | Conditions Related to ID/DD Status | 1..4 | ||
| Indent Indent Indent86528-7 | Most Recent Admission/Entry or Reentry into this Facility | |||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54590-5 | Type of Entry | |||
| Indent Indent Indent Indent85398-6 | Entered From | |||
| Indent Indent Indent52455-3 | Admission Date (Date this episode of care in this facility began) | {mm/dd/yyyy} | ||
| Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent55128-3 | Discharge Status | |||
| Indent Indent Indent54592-1 | Previous Assessment Reference Date for Significant Correction | {mm/dd/yyyy} | ||
| Indent Indent Indent54593-9 | Assessment Reference Date. Observation end date | {mm/dd/yyyy} | ||
| Indent Indent Indent54507-9 | Medicare Stay | |||
| Indent Indent Indent Indent54594-7 | Has the resident had a Medicare-covered stay since the most recent entry? | |||
| Indent Indent Indent Indent54595-4 | Start date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54596-2 | End date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent54508-7 | Hearing, Speech, and Vision | |||
| Indent Indent Indent54597-0 | Comatose. Persistent vegetative state/no discernible consciousness | |||
| Indent Indent Indent54598-8 | Hearing. Ability to hear (with hearing aid or hearing appliances if normally used) | |||
| Indent Indent Indent54599-6 | Hearing Aid. Hearing aid or other hearing appliance used in completing B0200, Hearing | |||
| Indent Indent Indent54600-2 | Speech Clarity. Select best description of speech pattern | |||
| Indent Indent Indent54601-0 | Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression | |||
| Indent Indent Indent54602-8 | Ability to Understand Others. Understanding verbal content, however able (with hearing aid or device if used) | |||
| Indent Indent Indent54603-6 | Vision. Ability to see in adequate light (with glasses or other visual appliances) | |||
| Indent Indent Indent54604-4 | Corrective Lenses. Corrective lenses (contacts, glasses, or magnifying glass) used in completing B1000, Vision | |||
| Indent Indent86529-5 | Cognitive Patterns | |||
| Indent Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
| Indent Indent Indent52491-8 | Brief Interview for Mental Status (BIMS) | |||
| Indent Indent Indent Indent52731-7 | Repetition of Three Words. Number of words repeated after first attempt | |||
| Indent Indent Indent Indent54510-3 | Temporal Orientation (orientation to year, month, and day) | |||
| Indent Indent Indent Indent Indent52732-5 | Able to report correct year | |||
| Indent Indent Indent Indent Indent52733-3 | Able to report correct month | |||
| Indent Indent Indent Indent Indent54609-3 | Able to report correct day of the week | |||
| Indent Indent Indent Indent52493-4 | Recall | |||
| Indent Indent Indent Indent Indent52735-8 | Able to recall "sock" | |||
| Indent Indent Indent Indent Indent52736-6 | Able to recall "blue" | |||
| Indent Indent Indent Indent Indent52737-4 | Able to recall "bed" | |||
| Indent Indent Indent Indent54614-3 | BIMS Summary Score | {score} | ||
| Indent Indent Indent54615-0 | Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted? | |||
| Indent Indent Indent86595-6 | Staff Assessment for Mental Status | |||
| Indent Indent Indent Indent54616-8 | Short-term Memory OK. Seems or appears to recall after 5 minutes | |||
| Indent Indent Indent Indent54617-6 | Long-term Memory OK. Seems or appears to recall long past | |||
| Indent Indent Indent Indent86583-2 | Memory/Recall Ability | 1..4 | ||
| Indent Indent Indent Indent54624-2 | Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life | |||
| Indent Indent Indent86584-0 | Delirium | |||
| Indent Indent Indent Indent86585-7 | Signs and Symptoms of Delirium (from CAM) | |||
| Indent Indent Indent Indent Indent54632-5 | Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline? | |||
| Indent Indent Indent Indent Indent54628-3 | Inattention - Did the resident have difficulty focusing attention, for example being easily distractible, or having difficulty keeping track of what was being said? | |||
| Indent Indent Indent Indent Indent54629-1 | Disorganized thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)? | |||
| Indent Indent Indent Indent Indent54630-9 | Altered level of consciousness - Did the resident have altered level of consciousness as indicated by any of the following criteria? | |||
| Indent Indent54633-3 | Mood | |||
| Indent Indent Indent54634-1 | Should Resident Mood Interview be Conducted? | |||
| Indent Indent Indent54635-8 | Resident Mood Interview (PHQ-9) | |||
| Indent Indent Indent Indent86843-0 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent Indent86844-8 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent54654-9 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent Indent54657-2 | Staff Assessment of Resident Mood (PHQ-9-OV) | |||
| Indent Indent Indent Indent86833-1 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54658-0 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54660-6 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54662-2 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54664-8 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54666-3 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54668-9 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54670-5 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54672-1 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54673-9 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54675-4 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent Indent86891-9 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54659-8 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54661-4 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54663-0 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54665-5 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54667-1 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54669-7 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54671-3 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54904-8 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54674-7 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54676-2 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent54677-0 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent86596-4 | Behavior | |||
| Indent Indent Indent86597-2 | Potential Indicators of Psychosis | 1..2 | ||
| Indent Indent Indent54514-5 | Behavioral Symptom - Presence & Frequency | |||
| Indent Indent Indent Indent54682-0 | Physical behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54683-8 | Verbal behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54684-6 | Other behavioral symptoms not directed toward others | d/(7.d) | ||
| Indent Indent Indent54685-3 | Overall Presence of Behavioral Symptoms.Were any behavioral symptoms in questions E0200 coded 1, 2, or 3? | |||
| Indent Indent Indent54515-2 | Impact on Resident | |||
| Indent Indent Indent Indent54686-1 | Did any of the identified symptom(s): Put the resident at significant risk for physical illness or injury? | |||
| Indent Indent Indent Indent54687-9 | Did any of the identified symptom(s): Significantly interfere with the resident's care? | |||
| Indent Indent Indent Indent54688-7 | Did any of the identified symptom(s): Significantly interfere with the resident's participation in activities or social interactions? | |||
| Indent Indent Indent54516-0 | Impact on Others | |||
| Indent Indent Indent Indent54689-5 | Did any of the identified symptom(s): Put others at significant risk for physical injury? | |||
| Indent Indent Indent Indent54690-3 | Did any of the identified symptom(s): Significantly intrude on the privacy or activity of others? | |||
| Indent Indent Indent Indent54691-1 | Did any of the identified symptom(s): Significantly disrupt care or living environment? | |||
| Indent Indent Indent54692-9 | Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? | d/(7.d) | ||
| Indent Indent Indent54693-7 | Wandering - Presence & Frequency. Has the resident wandered? | d/(7.d) | ||
| Indent Indent Indent54517-8 | Wandering - Impact | |||
| Indent Indent Indent Indent54694-5 | Does the wandering place the resident at significant risk of getting to a potentially dangerous place? | |||
| Indent Indent Indent Indent54695-2 | Does the wandering significantly intrude on the privacy or activities of others? | |||
| Indent Indent Indent54696-0 | Change in Behavior or Other Symptoms.How does resident's current behavior status, care rejection, or wandering compare to prior assessment (OBRA or Scheduled PPS)? | |||
| Indent Indent86600-4 | Preferences for Customary Routine and Activities | |||
| Indent Indent Indent54697-8 | Should Interview for Daily and Activity Preferences be Conducted? | |||
| Indent Indent Indent54519-4 | Interview for Daily Preferences | |||
| Indent Indent Indent Indent54698-6 | While you are in this facility how important is it to you to choose what clothes to wear? | |||
| Indent Indent Indent Indent54699-4 | While you are in this facility how important is it to you to take care of your personal belongings or things? | |||
| Indent Indent Indent Indent54700-0 | While you are in this facility how important is it to you to choose between a tub bath, shower, bed bath, or sponge bath? | |||
| Indent Indent Indent Indent54701-8 | While you are in this facility how important is it to you to have snacks available between meals? | |||
| Indent Indent Indent Indent54702-6 | While you are in this facility how important is it to you to choose your own bedtime? | |||
| Indent Indent Indent Indent54703-4 | While you are in this facility how important is it to you to have your family or a close friend involved in discussions about your care? | |||
| Indent Indent Indent Indent54704-2 | While you are in this facility how important is it to you to be able to use the phone in private? | |||
| Indent Indent Indent Indent54705-9 | While you are in this facility how important is it to you to have a place to lock your things to keep them safe? | |||
| Indent Indent Indent54520-2 | Interview for Activity Preferences | |||
| Indent Indent Indent Indent54706-7 | While you are in this facility how important is it to you to have books, newspapers, and magazines to read? | |||
| Indent Indent Indent Indent54707-5 | While you are in this facility how important is it to you to listen to music you like? | |||
| Indent Indent Indent Indent54708-3 | While you are in this facility how important is it to you to be around animals such as pets? | |||
| Indent Indent Indent Indent54709-1 | While you are in this facility how important is it to you to keep up with the news? | |||
| Indent Indent Indent Indent54710-9 | While you are in this facility how important is it to you to do things with groups of people? | |||
| Indent Indent Indent Indent54711-7 | While you are in this facility how important is it to you to do your favorite activities? | |||
| Indent Indent Indent Indent54712-5 | While you are in this facility how important is it to you to go outside to get fresh air when the weather is good? | |||
| Indent Indent Indent Indent54713-3 | While you are in this facility how important is it to you to participate in religious services or practices? | |||
| Indent Indent Indent54714-1 | Daily and Activity Preferences Primary Respondent. Indicate primary respondent for Daily and Activity Preferences (F0400 and F0500) | |||
| Indent Indent Indent54715-8 | Should the Staff Assessment of Daily and Activity Preferences be Conducted? | |||
| Indent Indent Indent86599-8 | Staff Assessment of Daily and Activity Preferences. Resident Prefers: | |||
| Indent Indent86601-2 | Functional Status | |||
| Indent Indent Indent86880-2 | Activities of Daily Living (ADL) Assistance. Self-Performance | |||
| Indent Indent Indent Indent45588-1 | Bed mobility | |||
| Indent Indent Indent Indent45590-7 | Transfer | |||
| Indent Indent Indent Indent45592-3 | Walk in room | |||
| Indent Indent Indent Indent45594-9 | Walk in corridor | |||
| Indent Indent Indent Indent45596-4 | Locomotion on unit | |||
| Indent Indent Indent Indent45598-0 | Locomotion off unit | |||
| Indent Indent Indent Indent45600-4 | Dressing | |||
| Indent Indent Indent Indent45602-0 | Eating | |||
| Indent Indent Indent Indent45604-6 | Toilet use | |||
| Indent Indent Indent Indent45606-1 | Personal hygiene | |||
| Indent Indent Indent86881-0 | Activities of Daily Living (ADL) Assistance. Support Provided | |||
| Indent Indent Indent Indent45589-9 | Bed mobility | |||
| Indent Indent Indent Indent45591-5 | Transfer | |||
| Indent Indent Indent Indent45593-1 | Walk in room | |||
| Indent Indent Indent Indent45595-6 | Walk in corridor | |||
| Indent Indent Indent Indent45597-2 | Locomotion on unit | |||
| Indent Indent Indent Indent45599-8 | Locomotion off unit | |||
| Indent Indent Indent Indent45601-2 | Dressing | |||
| Indent Indent Indent Indent45603-8 | Eating | |||
| Indent Indent Indent Indent45605-3 | Toilet use | |||
| Indent Indent Indent Indent45607-9 | Personal hygiene | |||
| Indent Indent Indent46008-9 | Bathing | |||
| Indent Indent Indent Indent45608-7 | Self-performance | |||
| Indent Indent Indent Indent45609-5 | Support provided | |||
| Indent Indent Indent54524-4 | Balance During Transitions and Walking | |||
| Indent Indent Indent Indent54749-7 | Moving from seated to standing position | |||
| Indent Indent Indent Indent54750-5 | Walking (with assistive device if used) | |||
| Indent Indent Indent Indent54751-3 | Turning around and facing the opposite direction while walking | |||
| Indent Indent Indent Indent54752-1 | Moving on and off toilet | |||
| Indent Indent Indent Indent54753-9 | Surface-to-surface transfer (transfer between bed and chair or wheelchair) | |||
| Indent Indent Indent92908-3 | Functional Limitation in Range of Motion | |||
| Indent Indent Indent Indent92850-7 | Upper extremity (shoulder, elbow, wrist, hand) | |||
| Indent Indent Indent Indent92851-5 | Lower extremity (hip, knee, ankle, foot) | |||
| Indent Indent Indent86602-0 | Mobility Devices | 1..4 | ||
| Indent Indent Indent54527-7 | Functional Rehabilitation Potential | |||
| Indent Indent Indent Indent55123-4 | Resident believes he or she is capable of increased independence in at least some ADLs. | |||
| Indent Indent Indent Indent45613-7 | Direct care staff believe resident is capable of increased independence in at least some ADLs | |||
| Indent Indent86612-9 | Functional Abilities and Goals - Admission (Start of SNF PPS Stay) | |||
| Indent Indent Indent86613-7 | Self-care - Admission Performance | |||
| Indent Indent Indent Indent83232-9 | Eating | |||
| Indent Indent Indent Indent83230-3 | Oral hygiene | |||
| Indent Indent Indent Indent83228-7 | Toileting hygiene | |||
| Indent Indent Indent86618-6 | Self-Care - Discharge Goal | |||
| Indent Indent Indent Indent83231-1 | Eating | |||
| Indent Indent Indent Indent83229-5 | Oral hygiene | |||
| Indent Indent Indent Indent83227-9 | Toileting hygiene | |||
| Indent Indent Indent86614-5 | Mobility - Admission Performance | |||
| Indent Indent Indent Indent83216-2 | Sit to lying | |||
| Indent Indent Indent Indent83214-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83212-1 | Sit to stand | |||
| Indent Indent Indent Indent83210-5 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent83208-9 | Toilet transfer | |||
| Indent Indent Indent Indent83270-9 | Does the resident walk? | |||
| Indent Indent Indent Indent83202-2 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83200-6 | Walk 150 feet | |||
| Indent Indent Indent Indent83271-7 | Does the resident use a wheelchair/scooter? | |||
| Indent Indent Indent Indent83188-3 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent Indent83235-2 | Wheel 150 feet | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent86619-4 | Mobility - discharge goal | |||
| Indent Indent Indent Indent83215-4 | Sit to lying | |||
| Indent Indent Indent Indent83213-9 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83211-3 | Sit to stand | |||
| Indent Indent Indent Indent83209-7 | Chair/Bed-to-chair transfer | |||
| Indent Indent Indent Indent83207-1 | Toilet transfer | |||
| Indent Indent Indent Indent83201-4 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83199-0 | Walk 150 feet | |||
| Indent Indent Indent Indent83187-5 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83236-0 | Wheel 150 feet | |||
| Indent Indent86615-2 | Functional Abilities and Goals - Discharge (End of SNF PPS Stay) | |||
| Indent Indent Indent86616-0 | Self-Care - Discharge Performance | |||
| Indent Indent Indent Indent83232-9 | Eating | |||
| Indent Indent Indent Indent83230-3 | Oral hygiene | |||
| Indent Indent Indent Indent83228-7 | Toileting hygiene | |||
| Indent Indent Indent86617-8 | Mobility - Discharge Performance | |||
| Indent Indent Indent Indent83216-2 | Sit to lying | |||
| Indent Indent Indent Indent83214-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83212-1 | Sit to stand | |||
| Indent Indent Indent Indent83210-5 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent83208-9 | Toilet transfer | |||
| Indent Indent Indent Indent83278-2 | Does the resident walk? | |||
| Indent Indent Indent Indent83202-2 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83200-6 | Walk 150 feet | |||
| Indent Indent Indent Indent83271-7 | Does the resident use a wheelchair/scooter? | |||
| Indent Indent Indent Indent83188-3 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent Indent83235-2 | Wheel 150 feet | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent86623-6 | Bladder and Bowel | |||
| Indent Indent Indent86624-4 | Appliances | 1..4 | ||
| Indent Indent Indent54530-1 | Urinary Toileting Program | |||
| Indent Indent Indent Indent54767-9 | Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility? | |||
| Indent Indent Indent Indent54768-7 | Response - What was the resident's response to the trial program? | |||
| Indent Indent Indent Indent54769-5 | Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence? | |||
| Indent Indent Indent54770-3 | Urinary Continence | 1..1 | ||
| Indent Indent Indent54771-1 | Bowel Continence | 1..1 | ||
| Indent Indent Indent54772-9 | Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence? | |||
| Indent Indent Indent54773-7 | Bowel Patterns. Constipation present? | |||
| Indent Indent86670-7 | Active Diagnoses | |||
| Indent Indent Indent86671-5 | Active Diagnoses in the last 7 days | 1..* | ||
| Indent Indent Indent52797-8 | Additional active diagnoses | 0..10 | ||
| Indent Indent86686-3 | Health Conditions | |||
| Indent Indent Indent54557-4 | Pain Management | |||
| Indent Indent Indent Indent71447-7 | At any time in the last 5 days, has the resident: Received scheduled pain medication regimen? | |||
| Indent Indent Indent Indent71448-5 | At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined? | |||
| Indent Indent Indent Indent71449-3 | At any time in the last 5 days, has the resident: Received non-medication intervention for pain? | |||
| Indent Indent Indent54828-9 | Should Pain Assessment Interview be Conducted? | |||
| Indent Indent Indent54558-2 | Pain Assessment Interview | |||
| Indent Indent Indent Indent54829-7 | Pain Presence. Have you had pain or hurting at any time in the last 5 days? | |||
| Indent Indent Indent Indent54830-5 | Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days? | |||
| Indent Indent Indent Indent54559-0 | Pain Effect on Function | |||
| Indent Indent Indent Indent Indent54831-3 | Over the past 5 days, has pain made it hard for you to sleep at night? | |||
| Indent Indent Indent Indent Indent54832-1 | Over the past 5 days, have you limited your day-to-day activities because of pain? | |||
| Indent Indent Indent Indent54560-8 | Pain Intensity | |||
| Indent Indent Indent Indent Indent54833-9 | Numeric Rating Scale (00-10) | |||
| Indent Indent Indent Indent Indent54834-7 | Verbal Descriptor Scale | |||
| Indent Indent Indent58117-3 | Should the Staff Assessment for Pain be Conducted? | |||
| Indent Indent Indent86672-3 | Staff Assessment for Pain | |||
| Indent Indent Indent Indent86673-1 | Indicators of Pain or Possible Pain in the last 5 days | 1..4 | ||
| Indent Indent Indent Indent58118-1 | Frequency of Indicator of Pain or Possible Pain in the last 5 days. Frequency with which resident complains or shows evidence of pain or possible pain | d/(5.d) | ||
| Indent Indent Indent86674-9 | Other Health Conditions | |||
| Indent Indent Indent Indent86675-6 | Shortness of Breath (dyspnea) | 1..3 | ||
| Indent Indent Indent Indent54845-3 | Current Tobacco Use | |||
| Indent Indent Indent Indent54846-1 | Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months? | |||
| Indent Indent Indent Indent86676-4 | Problem Conditions | 1..4 | ||
| Indent Indent Indent Indent54849-5 | Fall History on Admission/Entry or Reentry | |||
| Indent Indent Indent Indent Indent54850-3 | Did the resident have a fall any time in the last month prior to admission/entry or reentry? | |||
| Indent Indent Indent Indent Indent54851-1 | Did the resident have a fall any time in the last 2-6 months prior to admission/entry or reentry? | |||
| Indent Indent Indent Indent Indent54852-9 | Did the resident have any fracture related to a fall in the 6 months prior to admission/entry or reentry? | |||
| Indent Indent Indent Indent54853-7 | Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent? | |||
| Indent Indent Indent Indent54854-5 | Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent | |||
| Indent Indent Indent Indent Indent54855-2 | No injury | |||
| Indent Indent Indent Indent Indent54856-0 | Injury (except major) | |||
| Indent Indent Indent Indent Indent54857-8 | Major injury | |||
| Indent Indent86625-1 | Swallowing/Nutritional Status | |||
| Indent Indent Indent86677-2 | Swallowing Disorder. Signs and symptoms of possible swallowing disorder | 1..4 | ||
| Indent Indent Indent54567-3 | Height and Weight | |||
| Indent Indent Indent Indent3137-7 | Height (in inches) | [in_us];cm;m | ||
| Indent Indent Indent Indent3141-9 | Weight (in pounds) | [lb_av];kg | ||
| Indent Indent Indent54863-6 | Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months | |||
| Indent Indent Indent86678-0 | Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months | |||
| Indent Indent Indent54568-1 | Nutritional Approaches | |||
| Indent Indent Indent Indent71444-4 | Nutritional Approaches. While NOT a Resident | 1..4 | ||
| Indent Indent Indent Indent71445-1 | Nutritional Approaches. While a Resident | 1..4 | ||
| Indent Indent Indent86679-8 | Percent Intake by Artificial Route | |||
| Indent Indent Indent Indent86680-6 | Proportion of total calories the resident received through parenteral or tube feeding. While NOT a Resident | |||
| Indent Indent Indent Indent86681-4 | Proportion of total calories the resident received through parenteral or tube feeding. While a Resident | |||
| Indent Indent Indent Indent86687-1 | Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days | |||
| Indent Indent Indent Indent86682-2 | Average fluid intake per day by IV or tube feeding. While NOT a Resident | mL/d;L/d | ||
| Indent Indent Indent Indent86683-0 | Average fluid intake per day by IV or tube feeding. While a Resident | mL/d;L/d | ||
| Indent Indent Indent Indent86684-8 | Average fluid intake per day by IV or tube feeding. During Entire 7 Days | mL/d;L/d | ||
| Indent Indent86685-5 | Oral/Dental Status | |||
| Indent Indent Indent86706-9 | Dental | 1..7 | ||
| Indent Indent86707-7 | Skin Conditions | |||
| Indent Indent Indent86708-5 | Determination of Pressure Ulcer Risk | 1..3 | ||
| Indent Indent Indent57280-0 | Risk of Pressure Ulcers. Is this resident at risk of developing pressure ulcers? | |||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher? | |||
| Indent Indent Indent86745-7 | Current Number of Unhealed Pressure Ulcers at Each Stage | |||
| Indent Indent Indent Indent54884-2 | Number of Stage 1 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54886-7 | Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent58123-1 | Date of oldest Stage 2 pressure ulcer | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54887-5 | Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54890-9 | Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54894-1 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54947-7 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure injuries presenting as deep tissue injury | {#} | ||
| Indent Indent Indent Indent54951-9 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent86746-5 | Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar | |||
| Indent Indent Indent Indent86901-6 | Pressure ulcer length: Longest length from head to toe | cm | ||
| Indent Indent Indent Indent86902-4 | Pressure ulcer width: Widest width of the same pressure ulcer, side-to-side perpendicular (90-degree angle) to length | cm | ||
| Indent Indent Indent Indent57228-9 | Pressure ulcer depth: Depth of the same pressure ulcer from the visible surface to the deepest area | cm | ||
| Indent Indent Indent86903-2 | Most Severe Tissue Type for Any Pressure Ulcer | |||
| Indent Indent Indent54952-7 | Worsening in Pressure Ulcer Status Since Prior Assessment (OBRA or Scheduled PPS) or Last Admission/Entry or Reentry | |||
| Indent Indent Indent Indent54953-5 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54954-3 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54955-0 | Stage 4 | {#} | ||
| Indent Indent Indent54956-8 | Healed Pressure Ulcers | |||
| Indent Indent Indent Indent54957-6 | Were pressure ulcers present on the prior assessment (OBRA or scheduled PPS)? | |||
| Indent Indent Indent Indent54958-4 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54959-2 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54960-0 | Stage 4 | {#} | ||
| Indent Indent Indent54970-9 | Number of Venous and Arterial Ulcers | {#} | ||
| Indent Indent Indent86747-3 | Other Ulcers, Wounds and Skin Problems | 1..8 | ||
| Indent Indent Indent86748-1 | Skin and Ulcer Treatments | 1..9 | ||
| Indent Indent86749-9 | Medications during assessment period [CMS Assessment] | |||
| Indent Indent Indent54982-4 | Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days. | d/(7.d) | ||
| Indent Indent Indent58217-1 | Insulin | |||
| Indent Indent Indent Indent58127-2 | Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days | d/(7.d) | ||
| Indent Indent Indent Indent58128-0 | Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days | d/(7.d) | ||
| Indent Indent Indent86750-7 | Medications Received | |||
| Indent Indent Indent Indent86751-5 | Antipsychotic | d/(7.d) | ||
| Indent Indent Indent Indent86752-3 | Antianxiety | d/(7.d) | ||
| Indent Indent Indent Indent86753-1 | Antidepressant | d/(7.d) | ||
| Indent Indent Indent Indent86754-9 | Hypnotic | d/(7.d) | ||
| Indent Indent Indent Indent86755-6 | Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin) | d/(7.d) | ||
| Indent Indent Indent Indent86756-4 | Antibiotic | d/(7.d) | ||
| Indent Indent Indent Indent86757-2 | Diuretic | d/(7.d) | ||
| Indent Indent86758-0 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent86759-8 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent Indent86760-6 | While NOT a Resident | 1..12 | ||
| Indent Indent Indent Indent86761-4 | While a Resident | 1..13 | ||
| Indent Indent Indent69339-0 | Influenza Vaccine | |||
| Indent Indent Indent Indent55019-4 | Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season? | |||
| Indent Indent Indent Indent58131-4 | Date influenza vaccine received | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent55020-2 | If influenza vaccine not received, state reason: | |||
| Indent Indent Indent55021-0 | Pneumococcal Vaccine | |||
| Indent Indent Indent Indent55022-8 | Is the resident's Pneumococcal vaccination up to date? | |||
| Indent Indent Indent Indent45956-0 | If Pneumococcal vaccine not received, state reason: | |||
| Indent Indent Indent86762-2 | Therapies | |||
| Indent Indent Indent Indent86763-0 | Speech-Language Pathology and Audiology Services | |||
| Indent Indent Indent Indent Indent58218-9 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58133-0 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58134-8 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86765-5 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45760-6 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55025-1 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55026-9 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86767-1 | Occupational Therapy | |||
| Indent Indent Indent Indent Indent58219-7 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58136-3 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58137-1 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86764-8 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45762-2 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55027-7 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55028-5 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86768-9 | Physical Therapy | |||
| Indent Indent Indent Indent Indent58220-5 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58139-7 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58140-5 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86766-3 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45764-8 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55029-3 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55030-1 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent58141-3 | Respiratory Therapy | |||
| Indent Indent Indent Indent Indent45767-1 | Total minutes - record the total number of minutes this therapy was administered to the resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45766-3 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent58142-1 | Psychological Therapy (by any licensed mental health professional) | |||
| Indent Indent Indent Indent Indent45852-1 | Total minutes - record the total number of minutes this therapy was administered to the resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45768-9 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days. | d/(7.d) | ||
| Indent Indent Indent Indent58143-9 | Recreational Therapy (includes recreational and music therapy) | |||
| Indent Indent Indent Indent Indent55035-0 | Total minutes - record the total number of minutes this therapy was administered to the resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent55036-8 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent86769-7 | Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days. | d | ||
| Indent Indent Indent86770-5 | Resumption of Therapy | |||
| Indent Indent Indent Indent86772-1 | Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline? | |||
| Indent Indent Indent Indent86771-3 | Date on which therapy regimen resumed | {mm/dd/yyyy} | ||
| Indent Indent Indent86773-9 | Restorative Nursing Programs | |||
| Indent Indent Indent Indent86774-7 | Technique. Range of motion (passive) | d/(7.d) | ||
| Indent Indent Indent Indent86775-4 | Technique. Range of motion (active) | d/(7.d) | ||
| Indent Indent Indent Indent86776-2 | Technique. Splint or brace assistance | d/(7.d) | ||
| Indent Indent Indent Indent86777-0 | Training and Skill Practice In: Bed mobility | d/(7.d) | ||
| Indent Indent Indent Indent86778-8 | Training and Skill Practice In: Transfer | d/(7.d) | ||
| Indent Indent Indent Indent86779-6 | Training and Skill Practice In: Walking | d/(7.d) | ||
| Indent Indent Indent Indent86780-4 | Training and Skill Practice In: Dressing and/or grooming | d/(7.d) | ||
| Indent Indent Indent Indent86781-2 | Training and Skill Practice In: Eating and/or swallowing | d/(7.d) | ||
| Indent Indent Indent Indent86782-0 | Training and Skill Practice In: Amputation/prostheses care | d/(7.d) | ||
| Indent Indent Indent Indent86783-8 | Training and Skill Practice In: Communication | d/(7.d) | ||
| Indent Indent Indent55040-0 | Physician Examinations. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) examine the resident? | d/(14.d) | ||
| Indent Indent Indent55041-8 | Physician Orders. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) change the resident's orders? | d/(14.d) | ||
| Indent Indent86784-6 | Restraints | |||
| Indent Indent Indent86785-3 | Physical Restraints | |||
| Indent Indent Indent Indent86786-1 | Used in Bed. Bed rail | d/(7.d) | ||
| Indent Indent Indent Indent86787-9 | Used in Bed. Trunk restraint | d/(7.d) | ||
| Indent Indent Indent Indent86788-7 | Used in Bed. Limb restraint | d/(7.d) | ||
| Indent Indent Indent Indent86789-5 | Used in Bed. Other | d/(7.d) | ||
| Indent Indent Indent Indent86790-3 | Used in Chair or Out of Bed. Trunk restraint | d/(7.d) | ||
| Indent Indent Indent Indent86791-1 | Used in Chair or Out of Bed. Limb restraint | d/(7.d) | ||
| Indent Indent Indent Indent86792-9 | Used in Chair or Out of Bed. Chair prevents rising | d/(7.d) | ||
| Indent Indent Indent Indent86793-7 | Used in Chair or Out of Bed. Other | d/(7.d) | ||
| Indent Indent86794-5 | Participation in Assessment and Goal Setting | |||
| Indent Indent Indent55053-3 | Participation in Assessment | |||
| Indent Indent Indent Indent55054-1 | Resident participated in assessment | |||
| Indent Indent Indent Indent55074-9 | Family or significant other participated in assessment | |||
| Indent Indent Indent Indent58221-3 | Guardian or legally authorized representative participated in assessment | |||
| Indent Indent Indent55056-6 | Resident's Overall Expectation | |||
| Indent Indent Indent Indent55057-4 | Select one for resident's overall goal established during assessment process | |||
| Indent Indent Indent Indent55058-2 | Indicate information source for Q0300A | |||
| Indent Indent Indent58146-2 | Discharge Plan. Is active discharge planning already occurring for the resident to return to the community? | |||
| Indent Indent Indent86795-2 | Resident's Preference to Avoid Being Asked Question Q0500B. Does the resident's clinical record document a request that this question be asked only on comprehensive assessments? | |||
| Indent Indent Indent58149-6 | Return to Community. Do you want to talk to someone about the possiblity of leaving this facility and returning to live and receive services in the community? | |||
| Indent Indent Indent86796-0 | Resident's Preference to Avoid Being Asked Question Q0500B Again | |||
| Indent Indent Indent Indent86797-8 | Does the resident (or family or significant other or guardian or legally authorized representative if resident is unable to understand or respond) want to be asked about returning to the community on all assessments? | |||
| Indent Indent Indent Indent86798-6 | Indicate information source for Q0550A | |||
| Indent Indent Indent58150-4 | Referral. Has a referral been made to the Local Contact Agency? | |||
| Indent Indent87207-7 | Care Area Assessment (CAA) Summary | |||
| Indent Indent Indent87208-5 | Items From the Most Recent Prior OBRA or Scheduled PPS Assessment | |||
| Indent Indent Indent Indent54583-0 | Prior Assessment Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | Prior Assessment PPS Reason for Assessment | |||
| Indent Indent Indent Indent54593-9 | Prior Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54614-3 | Prior Assessment Brief Interview for Mental Status (BIMS) Summary Score | {score} | ||
| Indent Indent Indent Indent54654-9 | Prior Assessment Resident Mood Interview (PHQ-9©) Total Severity Score | {score} | ||
| Indent Indent Indent Indent54677-0 | Prior Assessment Staff Assessment of Resident Mood (PHQ-9-OV) Total Severity Score | {score} | ||
| Indent Indent Indent87210-1 | CAAs and Care Planning | |||
| Indent Indent Indent Indent87211-9 | CAA Results | |||
| Indent Indent Indent Indent Indent87212-7 | Care Area Triggered | |||
| Indent Indent Indent Indent Indent87213-5 | Care Planning Decision | |||
| Indent Indent87224-2 | Correction Request | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent87226-7 | Name of Resident | |||
| Indent Indent Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent87227-5 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent87216-8 | Date on existing record to be modified/inactivated | |||
| Indent Indent Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent87209-3 | Correction Attestation Section | |||
| Indent Indent Indent Indent58200-7 | Correction Number | {#} | ||
| Indent Indent Indent Indent87217-6 | Reasons for Modification | 1..6 | ||
| Indent Indent Indent Indent87225-9 | Reasons for Inactivation | 1..2 | ||
| Indent Indent Indent Indent87218-4 | RN Assessment Coordinator Attestation of Completion | |||
| Indent Indent Indent Indent Indent87219-2 | Attesting individual's first name | |||
| Indent Indent Indent Indent Indent87220-0 | Attesting individual's last name | |||
| Indent Indent Indent Indent Indent87221-8 | Attesting individual's title | |||
| Indent Indent Indent Indent Indent87222-6 | Attestation date | {mm/dd/yyyy} | ||
| Indent Indent87223-4 | Assessment Administration | |||
| Indent Indent Indent55064-0 | Medicare Part A Billing | |||
| Indent Indent Indent Indent55065-7 | Medicare Part A HIPPS code | |||
| Indent Indent Indent Indent55066-5 | RUG version code | |||
| Indent Indent Indent Indent58421-9 | Is this a Medicare Short Stay assessment? | |||
| Indent Indent Indent59375-6 | Medicare Part A Non-Therapy Billing | |||
| Indent Indent Indent Indent58210-6 | Medicare Part A non-therapy HIPPS code | |||
| Indent Indent Indent Indent58211-4 | RUG version code | |||
| Indent Indent Indent55067-3 | State Medicaid Billing (if required by the state) | |||
| Indent Indent Indent Indent55068-1 | RUG Case Mix group | |||
| Indent Indent Indent Indent55069-9 | RUG version code | |||
| Indent Indent Indent58422-7 | Alternate State Medicaid Billing (if required by the state) | |||
| Indent Indent Indent Indent58212-2 | RUG Case Mix Group | |||
| Indent Indent Indent Indent58213-0 | RUG version code | |||
| Indent Indent Indent55070-7 | Insurance Billing | |||
| Indent Indent Indent Indent55071-5 | RUG billing code | |||
| Indent Indent Indent Indent55072-3 | RUG billing version | |||
| Indent86856-2 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home PPS (NP) and Nursing home quarterly (NQ) item set [CMS Assessment] | |||
| Indent Indent86809-1 | Identification Information | |||
| Indent Indent Indent58198-3 | Type of Record | |||
| Indent Indent Indent54581-4 | Facility Provider Numbers | |||
| Indent Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
| Indent Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
| Indent Indent Indent Indent45398-5 | State Provider Number | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent86524-6 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent54587-1 | Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent71440-2 | Type of discharge | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent86526-1 | Unit Certification or Licensure Designation | |||
| Indent Indent Indent54503-8 | Legal Name of Resident | |||
| Indent Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent Indent45394-4 | Last name | |||
| Indent Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent Indent45966-9 | Social Security and Medicare Numbers | |||
| Indent Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent Indent45397-7 | Medicare number (or comparable railroad insurance number) | |||
| Indent Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent59362-4 | Race/Ethnicity | 1..6 | ||
| Indent Indent Indent54505-3 | Language | |||
| Indent Indent Indent Indent54588-9 | Does the resident need or want an interpreter to communicate with a doctor or health care staff? | |||
| Indent Indent Indent Indent54899-0 | Preferred language | |||
| Indent Indent Indent45404-1 | Marital Status | |||
| Indent Indent Indent54506-1 | Optional Resident Items | |||
| Indent Indent Indent Indent46106-1 | Medical record number [Identifier] | |||
| Indent Indent Indent Indent45403-3 | Room number [Location] | |||
| Indent Indent Indent Indent52462-9 | Name by which resident prefers to be addressed | |||
| Indent Indent Indent Indent21843-8 | Lifetime occupation(s) | |||
| Indent Indent Indent86528-7 | Most Recent Admission/Entry or Reentry into this Facility | |||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54590-5 | Type of Entry | |||
| Indent Indent Indent Indent85398-6 | Entered From | |||
| Indent Indent Indent52455-3 | Admission Date (Date this episode of care in this facility began) | {mm/dd/yyyy} | ||
| Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent55128-3 | Discharge Status | |||
| Indent Indent Indent54592-1 | Previous Assessment Reference Date for Significant Correction | {mm/dd/yyyy} | ||
| Indent Indent Indent54593-9 | Assessment Reference Date. Observation end date | {mm/dd/yyyy} | ||
| Indent Indent Indent54507-9 | Medicare Stay | |||
| Indent Indent Indent Indent54594-7 | Has the resident had a Medicare-covered stay since the most recent entry? | |||
| Indent Indent Indent Indent54595-4 | Start date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54596-2 | End date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent54508-7 | Hearing, Speech, and Vision | |||
| Indent Indent Indent54597-0 | Comatose. Persistent vegetative state/no discernible consciousness | |||
| Indent Indent Indent54598-8 | Hearing. Ability to hear (with hearing aid or hearing appliances if normally used) | |||
| Indent Indent Indent54599-6 | Hearing Aid. Hearing aid or other hearing appliance used in completing B0200, Hearing | |||
| Indent Indent Indent54600-2 | Speech Clarity. Select best description of speech pattern | |||
| Indent Indent Indent54601-0 | Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression | |||
| Indent Indent Indent54602-8 | Ability to Understand Others. Understanding verbal content, however able (with hearing aid or device if used) | |||
| Indent Indent Indent54603-6 | Vision. Ability to see in adequate light (with glasses or other visual appliances) | |||
| Indent Indent Indent54604-4 | Corrective Lenses. Corrective lenses (contacts, glasses, or magnifying glass) used in completing B1000, Vision | |||
| Indent Indent86529-5 | Cognitive Patterns | |||
| Indent Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
| Indent Indent Indent52491-8 | Brief Interview for Mental Status (BIMS) | |||
| Indent Indent Indent Indent52731-7 | Repetition of Three Words. Number of words repeated after first attempt | |||
| Indent Indent Indent Indent54510-3 | Temporal Orientation (orientation to year, month, and day) | |||
| Indent Indent Indent Indent Indent52732-5 | Able to report correct year | |||
| Indent Indent Indent Indent Indent52733-3 | Able to report correct month | |||
| Indent Indent Indent Indent Indent54609-3 | Able to report correct day of the week | |||
| Indent Indent Indent Indent52493-4 | Recall | |||
| Indent Indent Indent Indent Indent52735-8 | Able to recall "sock" | |||
| Indent Indent Indent Indent Indent52736-6 | Able to recall "blue" | |||
| Indent Indent Indent Indent Indent52737-4 | Able to recall "bed" | |||
| Indent Indent Indent Indent54614-3 | BIMS Summary Score | {score} | ||
| Indent Indent Indent54615-0 | Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted? | |||
| Indent Indent Indent86595-6 | Staff Assessment for Mental Status | |||
| Indent Indent Indent Indent54616-8 | Short-term Memory OK. Seems or appears to recall after 5 minutes | |||
| Indent Indent Indent Indent54617-6 | Long-term Memory OK. Seems or appears to recall long past | |||
| Indent Indent Indent Indent86583-2 | Memory/Recall Ability | 1..4 | ||
| Indent Indent Indent Indent54624-2 | Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life | |||
| Indent Indent Indent86584-0 | Delirium | |||
| Indent Indent Indent Indent86585-7 | Signs and Symptoms of Delirium (from CAM) | |||
| Indent Indent Indent Indent Indent54632-5 | Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline? | |||
| Indent Indent Indent Indent Indent54628-3 | Inattention - Did the resident have difficulty focusing attention, for example being easily distractible, or having difficulty keeping track of what was being said? | |||
| Indent Indent Indent Indent Indent54629-1 | Disorganized thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)? | |||
| Indent Indent Indent Indent Indent54630-9 | Altered level of consciousness - Did the resident have altered level of consciousness as indicated by any of the following criteria? | |||
| Indent Indent54633-3 | Mood | |||
| Indent Indent Indent54634-1 | Should Resident Mood Interview be Conducted? | |||
| Indent Indent Indent54635-8 | Resident Mood Interview (PHQ-9) | |||
| Indent Indent Indent Indent86843-0 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent Indent86844-8 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent54654-9 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent Indent54657-2 | Staff Assessment of Resident Mood (PHQ-9-OV) | |||
| Indent Indent Indent Indent86833-1 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54658-0 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54660-6 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54662-2 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54664-8 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54666-3 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54668-9 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54670-5 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54672-1 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54673-9 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54675-4 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent Indent86891-9 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54659-8 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54661-4 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54663-0 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54665-5 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54667-1 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54669-7 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54671-3 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54904-8 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54674-7 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54676-2 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent54677-0 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent86815-8 | Behavior | |||
| Indent Indent Indent86597-2 | Potential Indicators of Psychosis | 1..2 | ||
| Indent Indent Indent54514-5 | Behavioral Symptom - Presence & Frequency | |||
| Indent Indent Indent Indent54682-0 | Physical behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54683-8 | Verbal behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54684-6 | Other behavioral symptoms not directed toward others | d/(7.d) | ||
| Indent Indent Indent54692-9 | Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? | d/(7.d) | ||
| Indent Indent Indent54693-7 | Wandering - Presence & Frequency. Has the resident wandered? | d/(7.d) | ||
| Indent Indent86816-6 | Functional status | |||
| Indent Indent Indent86880-2 | Activities of Daily Living (ADL) Assistance. Self-Performance | |||
| Indent Indent Indent Indent45588-1 | Bed mobility | |||
| Indent Indent Indent Indent45590-7 | Transfer | |||
| Indent Indent Indent Indent45592-3 | Walk in room | |||
| Indent Indent Indent Indent45594-9 | Walk in corridor | |||
| Indent Indent Indent Indent45596-4 | Locomotion on unit | |||
| Indent Indent Indent Indent45598-0 | Locomotion off unit | |||
| Indent Indent Indent Indent45600-4 | Dressing | |||
| Indent Indent Indent Indent45602-0 | Eating | |||
| Indent Indent Indent Indent45604-6 | Toilet use | |||
| Indent Indent Indent Indent45606-1 | Personal hygiene | |||
| Indent Indent Indent86881-0 | Activities of Daily Living (ADL) Assistance. Support Provided | |||
| Indent Indent Indent Indent45589-9 | Bed mobility | |||
| Indent Indent Indent Indent45591-5 | Transfer | |||
| Indent Indent Indent Indent45593-1 | Walk in room | |||
| Indent Indent Indent Indent45595-6 | Walk in corridor | |||
| Indent Indent Indent Indent45597-2 | Locomotion on unit | |||
| Indent Indent Indent Indent45599-8 | Locomotion off unit | |||
| Indent Indent Indent Indent45601-2 | Dressing | |||
| Indent Indent Indent Indent45603-8 | Eating | |||
| Indent Indent Indent Indent45605-3 | Toilet use | |||
| Indent Indent Indent Indent45607-9 | Personal hygiene | |||
| Indent Indent Indent46008-9 | Bathing | |||
| Indent Indent Indent Indent45608-7 | Self-performance | |||
| Indent Indent Indent Indent45609-5 | Support provided | |||
| Indent Indent Indent54524-4 | Balance During Transitions and Walking | |||
| Indent Indent Indent Indent54749-7 | Moving from seated to standing position | |||
| Indent Indent Indent Indent54750-5 | Walking (with assistive device if used) | |||
| Indent Indent Indent Indent54751-3 | Turning around and facing the opposite direction while walking | |||
| Indent Indent Indent Indent54752-1 | Moving on and off toilet | |||
| Indent Indent Indent Indent54753-9 | Surface-to-surface transfer (transfer between bed and chair or wheelchair) | |||
| Indent Indent Indent92908-3 | Functional Limitation in Range of Motion | |||
| Indent Indent Indent Indent92850-7 | Upper extremity (shoulder, elbow, wrist, hand) | |||
| Indent Indent Indent Indent92851-5 | Lower extremity (hip, knee, ankle, foot) | |||
| Indent Indent Indent86602-0 | Mobility Devices | 1..4 | ||
| Indent Indent86612-9 | Functional Abilities and Goals - Admission (Start of SNF PPS Stay) | |||
| Indent Indent Indent86613-7 | Self-care - Admission Performance | |||
| Indent Indent Indent Indent83232-9 | Eating | |||
| Indent Indent Indent Indent83230-3 | Oral hygiene | |||
| Indent Indent Indent Indent83228-7 | Toileting hygiene | |||
| Indent Indent Indent86618-6 | Self-Care - Discharge Goal | |||
| Indent Indent Indent Indent83231-1 | Eating | |||
| Indent Indent Indent Indent83229-5 | Oral hygiene | |||
| Indent Indent Indent Indent83227-9 | Toileting hygiene | |||
| Indent Indent Indent86614-5 | Mobility - Admission Performance | |||
| Indent Indent Indent Indent83216-2 | Sit to lying | |||
| Indent Indent Indent Indent83214-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83212-1 | Sit to stand | |||
| Indent Indent Indent Indent83210-5 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent83208-9 | Toilet transfer | |||
| Indent Indent Indent Indent83270-9 | Does the resident walk? | |||
| Indent Indent Indent Indent83202-2 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83200-6 | Walk 150 feet | |||
| Indent Indent Indent Indent83271-7 | Does the resident use a wheelchair/scooter? | |||
| Indent Indent Indent Indent83188-3 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent Indent83235-2 | Wheel 150 feet | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent86619-4 | Mobility - discharge goal | |||
| Indent Indent Indent Indent83215-4 | Sit to lying | |||
| Indent Indent Indent Indent83213-9 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83211-3 | Sit to stand | |||
| Indent Indent Indent Indent83209-7 | Chair/Bed-to-chair transfer | |||
| Indent Indent Indent Indent83207-1 | Toilet transfer | |||
| Indent Indent Indent Indent83201-4 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83199-0 | Walk 150 feet | |||
| Indent Indent Indent Indent83187-5 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83236-0 | Wheel 150 feet | |||
| Indent Indent86615-2 | Functional Abilities and Goals - Discharge (End of SNF PPS Stay) | |||
| Indent Indent Indent86616-0 | Self-Care - Discharge Performance | |||
| Indent Indent Indent Indent83232-9 | Eating | |||
| Indent Indent Indent Indent83230-3 | Oral hygiene | |||
| Indent Indent Indent Indent83228-7 | Toileting hygiene | |||
| Indent Indent Indent86617-8 | Mobility - Discharge Performance | |||
| Indent Indent Indent Indent83216-2 | Sit to lying | |||
| Indent Indent Indent Indent83214-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83212-1 | Sit to stand | |||
| Indent Indent Indent Indent83210-5 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent83208-9 | Toilet transfer | |||
| Indent Indent Indent Indent83278-2 | Does the resident walk? | |||
| Indent Indent Indent Indent83202-2 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83200-6 | Walk 150 feet | |||
| Indent Indent Indent Indent83271-7 | Does the resident use a wheelchair/scooter? | |||
| Indent Indent Indent Indent83188-3 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent Indent83235-2 | Wheel 150 feet | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent86820-8 | Bladder and Bowel | |||
| Indent Indent Indent86624-4 | Appliances | 1..4 | ||
| Indent Indent Indent86866-1 | Urinary Toileting Program | |||
| Indent Indent Indent Indent54767-9 | Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility? | |||
| Indent Indent Indent Indent54769-5 | Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence? | |||
| Indent Indent Indent54770-3 | Urinary Continence | 1..1 | ||
| Indent Indent Indent54771-1 | Bowel Continence | 1..1 | ||
| Indent Indent Indent54772-9 | Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence? | |||
| Indent Indent86670-7 | Active Diagnoses | |||
| Indent Indent Indent86671-5 | Active Diagnoses in the last 7 days | 1..* | ||
| Indent Indent Indent52797-8 | Additional active diagnoses | 0..10 | ||
| Indent Indent86867-9 | Health Conditions | |||
| Indent Indent Indent54557-4 | Pain Management | |||
| Indent Indent Indent Indent71447-7 | At any time in the last 5 days, has the resident: Received scheduled pain medication regimen? | |||
| Indent Indent Indent Indent71448-5 | At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined? | |||
| Indent Indent Indent Indent71449-3 | At any time in the last 5 days, has the resident: Received non-medication intervention for pain? | |||
| Indent Indent Indent54828-9 | Should Pain Assessment Interview be Conducted? | |||
| Indent Indent Indent54558-2 | Pain Assessment Interview | |||
| Indent Indent Indent Indent54829-7 | Pain Presence. Have you had pain or hurting at any time in the last 5 days? | |||
| Indent Indent Indent Indent54830-5 | Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days? | |||
| Indent Indent Indent Indent54559-0 | Pain Effect on Function | |||
| Indent Indent Indent Indent Indent54831-3 | Over the past 5 days, has pain made it hard for you to sleep at night? | |||
| Indent Indent Indent Indent Indent54832-1 | Over the past 5 days, have you limited your day-to-day activities because of pain? | |||
| Indent Indent Indent Indent54560-8 | Pain Intensity | |||
| Indent Indent Indent Indent Indent54833-9 | Numeric Rating Scale (00-10) | |||
| Indent Indent Indent Indent Indent54834-7 | Verbal Descriptor Scale | |||
| Indent Indent Indent58117-3 | Should the Staff Assessment for Pain be Conducted? | |||
| Indent Indent Indent86672-3 | Staff Assessment for Pain | |||
| Indent Indent Indent Indent86673-1 | Indicators of Pain or Possible Pain in the last 5 days | 1..4 | ||
| Indent Indent Indent Indent58118-1 | Frequency of Indicator of Pain or Possible Pain in the last 5 days. Frequency with which resident complains or shows evidence of pain or possible pain | d/(5.d) | ||
| Indent Indent Indent86868-7 | Other Health Conditions | |||
| Indent Indent Indent Indent86675-6 | Shortness of Breath (dyspnea) | 1..3 | ||
| Indent Indent Indent Indent54846-1 | Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months? | |||
| Indent Indent Indent Indent86676-4 | Problem Conditions | 1..4 | ||
| Indent Indent Indent Indent54849-5 | Fall History on Admission/Entry or Reentry | |||
| Indent Indent Indent Indent Indent54850-3 | Did the resident have a fall any time in the last month prior to admission/entry or reentry? | |||
| Indent Indent Indent Indent Indent54851-1 | Did the resident have a fall any time in the last 2-6 months prior to admission/entry or reentry? | |||
| Indent Indent Indent Indent Indent54852-9 | Did the resident have any fracture related to a fall in the 6 months prior to admission/entry or reentry? | |||
| Indent Indent Indent Indent54853-7 | Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent? | |||
| Indent Indent Indent Indent54854-5 | Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent | |||
| Indent Indent Indent Indent Indent54855-2 | No injury | |||
| Indent Indent Indent Indent Indent54856-0 | Injury (except major) | |||
| Indent Indent Indent Indent Indent54857-8 | Major injury | |||
| Indent Indent86625-1 | Swallowing/Nutritional Status | |||
| Indent Indent Indent86677-2 | Swallowing Disorder. Signs and symptoms of possible swallowing disorder | 1..4 | ||
| Indent Indent Indent54567-3 | Height and Weight | |||
| Indent Indent Indent Indent3137-7 | Height (in inches) | [in_us];cm;m | ||
| Indent Indent Indent Indent3141-9 | Weight (in pounds) | [lb_av];kg | ||
| Indent Indent Indent54863-6 | Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months | |||
| Indent Indent Indent86678-0 | Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months | |||
| Indent Indent Indent54568-1 | Nutritional Approaches | |||
| Indent Indent Indent Indent71444-4 | Nutritional Approaches. While NOT a Resident | 1..4 | ||
| Indent Indent Indent Indent71445-1 | Nutritional Approaches. While a Resident | 1..4 | ||
| Indent Indent Indent86679-8 | Percent Intake by Artificial Route | |||
| Indent Indent Indent Indent86680-6 | Proportion of total calories the resident received through parenteral or tube feeding. While NOT a Resident | |||
| Indent Indent Indent Indent86681-4 | Proportion of total calories the resident received through parenteral or tube feeding. While a Resident | |||
| Indent Indent Indent Indent86687-1 | Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days | |||
| Indent Indent Indent Indent86682-2 | Average fluid intake per day by IV or tube feeding. While NOT a Resident | mL/d;L/d | ||
| Indent Indent Indent Indent86683-0 | Average fluid intake per day by IV or tube feeding. While a Resident | mL/d;L/d | ||
| Indent Indent Indent Indent86684-8 | Average fluid intake per day by IV or tube feeding. During Entire 7 Days | mL/d;L/d | ||
| Indent Indent86685-5 | Oral/Dental Status | |||
| Indent Indent Indent86706-9 | Dental | 1..2 | ||
| Indent Indent86707-7 | Skin Conditions | |||
| Indent Indent Indent86708-5 | Determination of Pressure Ulcer Risk | 1..3 | ||
| Indent Indent Indent57280-0 | Risk of Pressure Ulcers. Is this resident at risk of developing pressure ulcers? | |||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher? | |||
| Indent Indent Indent86745-7 | Current Number of Unhealed Pressure Ulcers at Each Stage | |||
| Indent Indent Indent Indent54884-2 | Number of Stage 1 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54886-7 | Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent58123-1 | Date of oldest Stage 2 pressure ulcer | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54887-5 | Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54890-9 | Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54894-1 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54947-7 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure ulcers with suspected deep tissue injury in evolution | {#} | ||
| Indent Indent Indent Indent54951-9 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent86746-5 | Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar | |||
| Indent Indent Indent Indent86901-6 | Pressure ulcer length: Longest length from head to toe | cm | ||
| Indent Indent Indent Indent86902-4 | Pressure ulcer width: Widest width of the same pressure ulcer, side-to-side perpendicular (90-degree angle) to length | cm | ||
| Indent Indent Indent Indent57228-9 | Pressure ulcer depth: Depth of the same pressure ulcer from the visible surface to the deepest area | cm | ||
| Indent Indent Indent86903-2 | Most Severe Tissue Type for Any Pressure Ulcer | |||
| Indent Indent Indent54952-7 | Worsening in Pressure Ulcer Status Since Prior Assessment (OBRA or Scheduled PPS) or Last Admission/Entry or Reentry | |||
| Indent Indent Indent Indent54953-5 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54954-3 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54955-0 | Stage 4 | {#} | ||
| Indent Indent Indent54956-8 | Healed Pressure Ulcers | |||
| Indent Indent Indent Indent54957-6 | Were pressure ulcers present on the prior assessment (OBRA or scheduled PPS)? | |||
| Indent Indent Indent Indent54958-4 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54959-2 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54960-0 | Stage 4 | {#} | ||
| Indent Indent Indent54970-9 | Number of Venous and Arterial Ulcers | {#} | ||
| Indent Indent Indent86747-3 | Other Ulcers, Wounds and Skin Problems | 1..8 | ||
| Indent Indent Indent86748-1 | Skin and Ulcer Treatments | 1..9 | ||
| Indent Indent86749-9 | Medications during assessment period [CMS Assessment] | |||
| Indent Indent Indent54982-4 | Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days. | d/(7.d) | ||
| Indent Indent Indent58217-1 | Insulin | |||
| Indent Indent Indent Indent58127-2 | Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days | d/(7.d) | ||
| Indent Indent Indent Indent58128-0 | Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days | d/(7.d) | ||
| Indent Indent Indent86750-7 | Medications Received | |||
| Indent Indent Indent Indent86751-5 | Antipsychotic | d/(7.d) | ||
| Indent Indent Indent Indent86752-3 | Antianxiety | d/(7.d) | ||
| Indent Indent Indent Indent86753-1 | Antidepressant | d/(7.d) | ||
| Indent Indent Indent Indent86754-9 | Hypnotic | d/(7.d) | ||
| Indent Indent Indent Indent86755-6 | Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin) | d/(7.d) | ||
| Indent Indent Indent Indent86756-4 | Antibiotic | d/(7.d) | ||
| Indent Indent Indent Indent86757-2 | Diuretic | d/(7.d) | ||
| Indent Indent86834-9 | Special treatments, procedures, and programs | |||
| Indent Indent Indent86759-8 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent Indent86760-6 | While NOT a Resident | 0..9 | ||
| Indent Indent Indent Indent86761-4 | While a Resident | 0..11 | ||
| Indent Indent Indent69339-0 | Influenza Vaccine | |||
| Indent Indent Indent Indent55019-4 | Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season? | |||
| Indent Indent Indent Indent58131-4 | Date influenza vaccine received | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent55020-2 | If influenza vaccine not received, state reason: | |||
| Indent Indent Indent55021-0 | Pneumococcal Vaccine | |||
| Indent Indent Indent Indent55022-8 | Is the resident's Pneumococcal vaccination up to date? | |||
| Indent Indent Indent Indent45956-0 | If Pneumococcal vaccine not received, state reason: | |||
| Indent Indent Indent86841-4 | Therapies | |||
| Indent Indent Indent Indent86763-0 | Speech-Language Pathology and Audiology Services | |||
| Indent Indent Indent Indent Indent58218-9 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58133-0 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58134-8 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86765-5 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45760-6 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55025-1 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55026-9 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86767-1 | Occupational Therapy | |||
| Indent Indent Indent Indent Indent58219-7 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58136-3 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58137-1 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86764-8 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45762-2 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55027-7 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55028-5 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86768-9 | Physical Therapy | |||
| Indent Indent Indent Indent Indent58220-5 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58139-7 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58140-5 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86766-3 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45764-8 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55029-3 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55030-1 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86849-7 | Respiratory therapy | |||
| Indent Indent Indent Indent Indent45766-3 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent86850-5 | Psychological therapy | |||
| Indent Indent Indent Indent Indent45768-9 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days. | d/(7.d) | ||
| Indent Indent Indent86769-7 | Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days. | d | ||
| Indent Indent Indent86770-5 | Resumption of Therapy | |||
| Indent Indent Indent Indent86772-1 | Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline? | |||
| Indent Indent Indent Indent86771-3 | Date on which therapy regimen resumed | {mm/dd/yyyy} | ||
| Indent Indent Indent86773-9 | Restorative Nursing Programs | |||
| Indent Indent Indent Indent86774-7 | Technique. Range of motion (passive) | d/(7.d) | ||
| Indent Indent Indent Indent86775-4 | Technique. Range of motion (active) | d/(7.d) | ||
| Indent Indent Indent Indent86776-2 | Technique. Splint or brace assistance | d/(7.d) | ||
| Indent Indent Indent Indent86777-0 | Training and Skill Practice In: Bed mobility | d/(7.d) | ||
| Indent Indent Indent Indent86778-8 | Training and Skill Practice In: Transfer | d/(7.d) | ||
| Indent Indent Indent Indent86779-6 | Training and Skill Practice In: Walking | d/(7.d) | ||
| Indent Indent Indent Indent86780-4 | Training and Skill Practice In: Dressing and/or grooming | d/(7.d) | ||
| Indent Indent Indent Indent86781-2 | Training and Skill Practice In: Eating and/or swallowing | d/(7.d) | ||
| Indent Indent Indent Indent86782-0 | Training and Skill Practice In: Amputation/prostheses care | d/(7.d) | ||
| Indent Indent Indent Indent86783-8 | Training and Skill Practice In: Communication | d/(7.d) | ||
| Indent Indent Indent55040-0 | Physician Examinations. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) examine the resident? | d/(14.d) | ||
| Indent Indent Indent55041-8 | Physician Orders. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) change the resident's orders? | d/(14.d) | ||
| Indent Indent86784-6 | Restraints | |||
| Indent Indent Indent86785-3 | Physical Restraints | |||
| Indent Indent Indent Indent86786-1 | Used in Bed. Bed rail | d/(7.d) | ||
| Indent Indent Indent Indent86787-9 | Used in Bed. Trunk restraint | d/(7.d) | ||
| Indent Indent Indent Indent86788-7 | Used in Bed. Limb restraint | d/(7.d) | ||
| Indent Indent Indent Indent86789-5 | Used in Bed. Other | d/(7.d) | ||
| Indent Indent Indent Indent86790-3 | Used in Chair or Out of Bed. Trunk restraint | d/(7.d) | ||
| Indent Indent Indent Indent86791-1 | Used in Chair or Out of Bed. Limb restraint | d/(7.d) | ||
| Indent Indent Indent Indent86792-9 | Used in Chair or Out of Bed. Chair prevents rising | d/(7.d) | ||
| Indent Indent Indent Indent86793-7 | Used in Chair or Out of Bed. Other | d/(7.d) | ||
| Indent Indent86794-5 | Participation in Assessment and Goal Setting | |||
| Indent Indent Indent55053-3 | Participation in Assessment | |||
| Indent Indent Indent Indent55054-1 | Resident participated in assessment | |||
| Indent Indent Indent Indent55074-9 | Family or significant other participated in assessment | |||
| Indent Indent Indent Indent58221-3 | Guardian or legally authorized representative participated in assessment | |||
| Indent Indent Indent55056-6 | Resident's Overall Expectation | |||
| Indent Indent Indent Indent55057-4 | Select one for resident's overall goal established during assessment process | |||
| Indent Indent Indent Indent55058-2 | Indicate information source for Q0300A | |||
| Indent Indent Indent58146-2 | Discharge Plan. Is active discharge planning already occurring for the resident to return to the community? | |||
| Indent Indent Indent86795-2 | Resident's Preference to Avoid Being Asked Question Q0500B. Does the resident's clinical record document a request that this question be asked only on comprehensive assessments? | |||
| Indent Indent Indent58149-6 | Return to Community. Do you want to talk to someone about the possiblity of leaving this facility and returning to live and receive services in the community? | |||
| Indent Indent Indent86796-0 | Resident's Preference to Avoid Being Asked Question Q0500B Again | |||
| Indent Indent Indent Indent86797-8 | Does the resident (or family or significant other or guardian or legally authorized representative if resident is unable to understand or respond) want to be asked about returning to the community on all assessments? | |||
| Indent Indent Indent Indent86798-6 | Indicate information source for Q0550A | |||
| Indent Indent Indent58150-4 | Referral. Has a referral been made to the Local Contact Agency? | |||
| Indent Indent87224-2 | Correction Request | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent87226-7 | Name of Resident | |||
| Indent Indent Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent87227-5 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent87216-8 | Date on existing record to be modified/inactivated | |||
| Indent Indent Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent87209-3 | Correction Attestation Section | |||
| Indent Indent Indent Indent58200-7 | Correction Number | {#} | ||
| Indent Indent Indent Indent87217-6 | Reasons for Modification | 1..6 | ||
| Indent Indent Indent Indent87225-9 | Reasons for Inactivation | 1..2 | ||
| Indent Indent Indent Indent87218-4 | RN Assessment Coordinator Attestation of Completion | |||
| Indent Indent Indent Indent Indent87219-2 | Attesting individual's first name | |||
| Indent Indent Indent Indent Indent87220-0 | Attesting individual's last name | |||
| Indent Indent Indent Indent Indent87221-8 | Attesting individual's title | |||
| Indent Indent Indent Indent Indent87222-6 | Attestation date | {mm/dd/yyyy} | ||
| Indent Indent87223-4 | Assessment Administration | |||
| Indent Indent Indent55064-0 | Medicare Part A Billing | |||
| Indent Indent Indent Indent55065-7 | Medicare Part A HIPPS code | |||
| Indent Indent Indent Indent55066-5 | RUG version code | |||
| Indent Indent Indent Indent58421-9 | Is this a Medicare Short Stay assessment? | |||
| Indent Indent Indent59375-6 | Medicare Part A Non-Therapy Billing | |||
| Indent Indent Indent Indent58210-6 | Medicare Part A non-therapy HIPPS code | |||
| Indent Indent Indent Indent58211-4 | RUG version code | |||
| Indent Indent Indent55067-3 | State Medicaid Billing (if required by the state) | |||
| Indent Indent Indent Indent55068-1 | RUG Case Mix group | |||
| Indent Indent Indent Indent55069-9 | RUG version code | |||
| Indent Indent Indent58422-7 | Alternate State Medicaid Billing (if required by the state) | |||
| Indent Indent Indent Indent58212-2 | RUG Case Mix Group | |||
| Indent Indent Indent Indent58213-0 | RUG version code | |||
| Indent Indent Indent55070-7 | Insurance Billing | |||
| Indent Indent Indent Indent55071-5 | RUG billing code | |||
| Indent Indent Indent Indent55072-3 | RUG billing version | |||
| Indent86876-0 | Deprecated MDS v3.0 - RAI v1.14.1 - Swing bed PPS (SP) item set [CMS Assessment] | |||
| Indent Indent86811-7 | Identification Information | |||
| Indent Indent Indent58198-3 | Type of Record | |||
| Indent Indent Indent54581-4 | Facility Provider Numbers | |||
| Indent Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
| Indent Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
| Indent Indent Indent Indent45398-5 | State Provider Number | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent86524-6 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent54587-1 | Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent71440-2 | Type of discharge | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent86526-1 | Unit Certification or Licensure Designation | |||
| Indent Indent Indent54503-8 | Legal Name of Resident | |||
| Indent Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent Indent45394-4 | Last name | |||
| Indent Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent Indent45966-9 | Social Security and Medicare Numbers | |||
| Indent Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent Indent45397-7 | Medicare number (or comparable railroad insurance number) | |||
| Indent Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent59362-4 | Race/Ethnicity | 1..6 | ||
| Indent Indent Indent54505-3 | Language | |||
| Indent Indent Indent Indent54588-9 | Does the resident need or want an interpreter to communicate with a doctor or health care staff? | |||
| Indent Indent Indent Indent54899-0 | Preferred language | |||
| Indent Indent Indent45404-1 | Marital Status | |||
| Indent Indent Indent54506-1 | Optional Resident Items | |||
| Indent Indent Indent Indent46106-1 | Medical record number [Identifier] | |||
| Indent Indent Indent Indent45403-3 | Room number [Location] | |||
| Indent Indent Indent Indent52462-9 | Name by which resident prefers to be addressed | |||
| Indent Indent Indent Indent21843-8 | Lifetime occupation(s) | |||
| Indent Indent Indent86528-7 | Most Recent Admission/Entry or Reentry into this Facility | |||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54590-5 | Type of Entry | |||
| Indent Indent Indent Indent85398-6 | Entered From | |||
| Indent Indent Indent52455-3 | Admission Date (Date this episode of care in this facility began) | {mm/dd/yyyy} | ||
| Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent55128-3 | Discharge Status | |||
| Indent Indent Indent54593-9 | Assessment Reference Date. Observation end date | {mm/dd/yyyy} | ||
| Indent Indent Indent54507-9 | Medicare Stay | |||
| Indent Indent Indent Indent54594-7 | Has the resident had a Medicare-covered stay since the most recent entry? | |||
| Indent Indent Indent Indent54595-4 | Start date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54596-2 | End date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent54508-7 | Hearing, Speech, and Vision | |||
| Indent Indent Indent54597-0 | Comatose. Persistent vegetative state/no discernible consciousness | |||
| Indent Indent Indent54598-8 | Hearing. Ability to hear (with hearing aid or hearing appliances if normally used) | |||
| Indent Indent Indent54599-6 | Hearing Aid. Hearing aid or other hearing appliance used in completing B0200, Hearing | |||
| Indent Indent Indent54600-2 | Speech Clarity. Select best description of speech pattern | |||
| Indent Indent Indent54601-0 | Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression | |||
| Indent Indent Indent54602-8 | Ability to Understand Others. Understanding verbal content, however able (with hearing aid or device if used) | |||
| Indent Indent Indent54603-6 | Vision. Ability to see in adequate light (with glasses or other visual appliances) | |||
| Indent Indent Indent54604-4 | Corrective Lenses. Corrective lenses (contacts, glasses, or magnifying glass) used in completing B1000, Vision | |||
| Indent Indent86529-5 | Cognitive Patterns | |||
| Indent Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
| Indent Indent Indent52491-8 | Brief Interview for Mental Status (BIMS) | |||
| Indent Indent Indent Indent52731-7 | Repetition of Three Words. Number of words repeated after first attempt | |||
| Indent Indent Indent Indent54510-3 | Temporal Orientation (orientation to year, month, and day) | |||
| Indent Indent Indent Indent Indent52732-5 | Able to report correct year | |||
| Indent Indent Indent Indent Indent52733-3 | Able to report correct month | |||
| Indent Indent Indent Indent Indent54609-3 | Able to report correct day of the week | |||
| Indent Indent Indent Indent52493-4 | Recall | |||
| Indent Indent Indent Indent Indent52735-8 | Able to recall "sock" | |||
| Indent Indent Indent Indent Indent52736-6 | Able to recall "blue" | |||
| Indent Indent Indent Indent Indent52737-4 | Able to recall "bed" | |||
| Indent Indent Indent Indent54614-3 | BIMS Summary Score | {score} | ||
| Indent Indent Indent54615-0 | Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted? | |||
| Indent Indent Indent86595-6 | Staff Assessment for Mental Status | |||
| Indent Indent Indent Indent54616-8 | Short-term Memory OK. Seems or appears to recall after 5 minutes | |||
| Indent Indent Indent Indent54617-6 | Long-term Memory OK. Seems or appears to recall long past | |||
| Indent Indent Indent Indent86583-2 | Memory/Recall Ability | 1..4 | ||
| Indent Indent Indent Indent54624-2 | Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life | |||
| Indent Indent Indent86584-0 | Delirium | |||
| Indent Indent Indent Indent86585-7 | Signs and Symptoms of Delirium (from CAM) | |||
| Indent Indent Indent Indent Indent54632-5 | Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline? | |||
| Indent Indent Indent Indent Indent54628-3 | Inattention - Did the resident have difficulty focusing attention, for example being easily distractible, or having difficulty keeping track of what was being said? | |||
| Indent Indent Indent Indent Indent54629-1 | Disorganized thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)? | |||
| Indent Indent Indent Indent Indent54630-9 | Altered level of consciousness - Did the resident have altered level of consciousness as indicated by any of the following criteria? | |||
| Indent Indent54633-3 | Mood | |||
| Indent Indent Indent54634-1 | Should Resident Mood Interview be Conducted? | |||
| Indent Indent Indent54635-8 | Resident Mood Interview (PHQ-9) | |||
| Indent Indent Indent Indent86843-0 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent Indent86844-8 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent54654-9 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent Indent54657-2 | Staff Assessment of Resident Mood (PHQ-9-OV) | |||
| Indent Indent Indent Indent86833-1 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54658-0 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54660-6 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54662-2 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54664-8 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54666-3 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54668-9 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54670-5 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54672-1 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54673-9 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54675-4 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent Indent86891-9 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54659-8 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54661-4 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54663-0 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54665-5 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54667-1 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54669-7 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54671-3 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54904-8 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54674-7 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54676-2 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent54677-0 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent86815-8 | Behavior | |||
| Indent Indent Indent86597-2 | Potential Indicators of Psychosis | 1..2 | ||
| Indent Indent Indent54514-5 | Behavioral Symptom - Presence & Frequency | |||
| Indent Indent Indent Indent54682-0 | Physical behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54683-8 | Verbal behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54684-6 | Other behavioral symptoms not directed toward others | d/(7.d) | ||
| Indent Indent Indent54692-9 | Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? | d/(7.d) | ||
| Indent Indent Indent54693-7 | Wandering - Presence & Frequency. Has the resident wandered? | d/(7.d) | ||
| Indent Indent86816-6 | Functional Status | |||
| Indent Indent Indent86880-2 | Activities of Daily Living (ADL) Assistance. Self-Performance | |||
| Indent Indent Indent Indent45588-1 | Bed mobility | |||
| Indent Indent Indent Indent45590-7 | Transfer | |||
| Indent Indent Indent Indent45592-3 | Walk in room | |||
| Indent Indent Indent Indent45594-9 | Walk in corridor | |||
| Indent Indent Indent Indent45596-4 | Locomotion on unit | |||
| Indent Indent Indent Indent45598-0 | Locomotion off unit | |||
| Indent Indent Indent Indent45600-4 | Dressing | |||
| Indent Indent Indent Indent45602-0 | Eating | |||
| Indent Indent Indent Indent45604-6 | Toilet use | |||
| Indent Indent Indent Indent45606-1 | Personal hygiene | |||
| Indent Indent Indent86881-0 | Activities of Daily Living (ADL) Assistance. Support Provided | |||
| Indent Indent Indent Indent45589-9 | Bed mobility | |||
| Indent Indent Indent Indent45591-5 | Transfer | |||
| Indent Indent Indent Indent45593-1 | Walk in room | |||
| Indent Indent Indent Indent45595-6 | Walk in corridor | |||
| Indent Indent Indent Indent45597-2 | Locomotion on unit | |||
| Indent Indent Indent Indent45599-8 | Locomotion off unit | |||
| Indent Indent Indent Indent45601-2 | Dressing | |||
| Indent Indent Indent Indent45603-8 | Eating | |||
| Indent Indent Indent Indent45605-3 | Toilet use | |||
| Indent Indent Indent Indent45607-9 | Personal hygiene | |||
| Indent Indent Indent46008-9 | Bathing | |||
| Indent Indent Indent Indent45608-7 | Self-performance | |||
| Indent Indent Indent Indent45609-5 | Support provided | |||
| Indent Indent Indent54524-4 | Balance During Transitions and Walking | |||
| Indent Indent Indent Indent54749-7 | Moving from seated to standing position | |||
| Indent Indent Indent Indent54750-5 | Walking (with assistive device if used) | |||
| Indent Indent Indent Indent54751-3 | Turning around and facing the opposite direction while walking | |||
| Indent Indent Indent Indent54752-1 | Moving on and off toilet | |||
| Indent Indent Indent Indent54753-9 | Surface-to-surface transfer (transfer between bed and chair or wheelchair) | |||
| Indent Indent Indent92908-3 | Functional Limitation in Range of Motion | |||
| Indent Indent Indent Indent92850-7 | Upper extremity (shoulder, elbow, wrist, hand) | |||
| Indent Indent Indent Indent92851-5 | Lower extremity (hip, knee, ankle, foot) | |||
| Indent Indent Indent86602-0 | Mobility Devices | 1..4 | ||
| Indent Indent86612-9 | Functional Abilities and Goals - Admission (Start of SNF PPS Stay) | |||
| Indent Indent Indent86613-7 | Self-care - Admission Performance | |||
| Indent Indent Indent Indent83232-9 | Eating | |||
| Indent Indent Indent Indent83230-3 | Oral hygiene | |||
| Indent Indent Indent Indent83228-7 | Toileting hygiene | |||
| Indent Indent Indent86618-6 | Self-Care - Discharge Goal | |||
| Indent Indent Indent Indent83231-1 | Eating | |||
| Indent Indent Indent Indent83229-5 | Oral hygiene | |||
| Indent Indent Indent Indent83227-9 | Toileting hygiene | |||
| Indent Indent Indent86614-5 | Mobility - Admission Performance | |||
| Indent Indent Indent Indent83216-2 | Sit to lying | |||
| Indent Indent Indent Indent83214-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83212-1 | Sit to stand | |||
| Indent Indent Indent Indent83210-5 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent83208-9 | Toilet transfer | |||
| Indent Indent Indent Indent83270-9 | Does the resident walk? | |||
| Indent Indent Indent Indent83202-2 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83200-6 | Walk 150 feet | |||
| Indent Indent Indent Indent83271-7 | Does the resident use a wheelchair/scooter? | |||
| Indent Indent Indent Indent83188-3 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent Indent83235-2 | Wheel 150 feet | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent86619-4 | Mobility - discharge goal | |||
| Indent Indent Indent Indent83215-4 | Sit to lying | |||
| Indent Indent Indent Indent83213-9 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83211-3 | Sit to stand | |||
| Indent Indent Indent Indent83209-7 | Chair/Bed-to-chair transfer | |||
| Indent Indent Indent Indent83207-1 | Toilet transfer | |||
| Indent Indent Indent Indent83201-4 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83199-0 | Walk 150 feet | |||
| Indent Indent Indent Indent83187-5 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83236-0 | Wheel 150 feet | |||
| Indent Indent86615-2 | Functional Abilities and Goals - Discharge (End of SNF PPS Stay) | |||
| Indent Indent Indent86616-0 | Self-Care - Discharge Performance | |||
| Indent Indent Indent Indent83232-9 | Eating | |||
| Indent Indent Indent Indent83230-3 | Oral hygiene | |||
| Indent Indent Indent Indent83228-7 | Toileting hygiene | |||
| Indent Indent Indent86617-8 | Mobility - Discharge Performance | |||
| Indent Indent Indent Indent83216-2 | Sit to lying | |||
| Indent Indent Indent Indent83214-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83212-1 | Sit to stand | |||
| Indent Indent Indent Indent83210-5 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent83208-9 | Toilet transfer | |||
| Indent Indent Indent Indent83278-2 | Does the resident walk? | |||
| Indent Indent Indent Indent83202-2 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83200-6 | Walk 150 feet | |||
| Indent Indent Indent Indent83271-7 | Does the resident use a wheelchair/scooter? | |||
| Indent Indent Indent Indent83188-3 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent Indent83235-2 | Wheel 150 feet | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent86820-8 | Bladder and Bowel | |||
| Indent Indent Indent86624-4 | Appliances | 1..4 | ||
| Indent Indent Indent86866-1 | Urinary Toileting Program | |||
| Indent Indent Indent Indent54767-9 | Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility? | |||
| Indent Indent Indent Indent54769-5 | Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence? | |||
| Indent Indent Indent54770-3 | Urinary Continence | 1..1 | ||
| Indent Indent Indent54771-1 | Bowel Continence | 1..1 | ||
| Indent Indent Indent54772-9 | Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence? | |||
| Indent Indent86670-7 | Active Diagnoses | |||
| Indent Indent Indent86671-5 | Active Diagnoses in the last 7 days | 1..* | ||
| Indent Indent Indent52797-8 | Additional active diagnoses | 0..10 | ||
| Indent Indent86867-9 | Health Conditions | |||
| Indent Indent Indent54557-4 | Pain Management | |||
| Indent Indent Indent Indent71447-7 | At any time in the last 5 days, has the resident: Received scheduled pain medication regimen? | |||
| Indent Indent Indent Indent71448-5 | At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined? | |||
| Indent Indent Indent Indent71449-3 | At any time in the last 5 days, has the resident: Received non-medication intervention for pain? | |||
| Indent Indent Indent54828-9 | Should Pain Assessment Interview be Conducted? | |||
| Indent Indent Indent54558-2 | Pain Assessment Interview | |||
| Indent Indent Indent Indent54829-7 | Pain Presence. Have you had pain or hurting at any time in the last 5 days? | |||
| Indent Indent Indent Indent54830-5 | Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days? | |||
| Indent Indent Indent Indent54559-0 | Pain Effect on Function | |||
| Indent Indent Indent Indent Indent54831-3 | Over the past 5 days, has pain made it hard for you to sleep at night? | |||
| Indent Indent Indent Indent Indent54832-1 | Over the past 5 days, have you limited your day-to-day activities because of pain? | |||
| Indent Indent Indent Indent54560-8 | Pain Intensity | |||
| Indent Indent Indent Indent Indent54833-9 | Numeric Rating Scale (00-10) | |||
| Indent Indent Indent Indent Indent54834-7 | Verbal Descriptor Scale | |||
| Indent Indent Indent58117-3 | Should the Staff Assessment for Pain be Conducted? | |||
| Indent Indent Indent86672-3 | Staff Assessment for Pain | |||
| Indent Indent Indent Indent86673-1 | Indicators of Pain or Possible Pain in the last 5 days | 1..4 | ||
| Indent Indent Indent Indent58118-1 | Frequency of Indicator of Pain or Possible Pain in the last 5 days. Frequency with which resident complains or shows evidence of pain or possible pain | d/(5.d) | ||
| Indent Indent Indent86868-7 | Other Health Conditions | |||
| Indent Indent Indent Indent86675-6 | Shortness of Breath (dyspnea) | 1..3 | ||
| Indent Indent Indent Indent54846-1 | Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months? | |||
| Indent Indent Indent Indent86676-4 | Problem Conditions | 1..4 | ||
| Indent Indent Indent Indent54849-5 | Fall History on Admission/Entry or Reentry | |||
| Indent Indent Indent Indent Indent54850-3 | Did the resident have a fall any time in the last month prior to admission/entry or reentry? | |||
| Indent Indent Indent Indent Indent54851-1 | Did the resident have a fall any time in the last 2-6 months prior to admission/entry or reentry? | |||
| Indent Indent Indent Indent Indent54852-9 | Did the resident have any fracture related to a fall in the 6 months prior to admission/entry or reentry? | |||
| Indent Indent Indent Indent54853-7 | Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent? | |||
| Indent Indent Indent Indent54854-5 | Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent | |||
| Indent Indent Indent Indent Indent54855-2 | No injury | |||
| Indent Indent Indent Indent Indent54856-0 | Injury (except major) | |||
| Indent Indent Indent Indent Indent54857-8 | Major injury | |||
| Indent Indent86826-5 | Swallowing/Nutritional Status | |||
| Indent Indent Indent54567-3 | Height and Weight | |||
| Indent Indent Indent Indent3137-7 | Height (in inches) | [in_us];cm;m | ||
| Indent Indent Indent Indent3141-9 | Weight (in pounds) | [lb_av];kg | ||
| Indent Indent Indent54863-6 | Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months | |||
| Indent Indent Indent86678-0 | Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months | |||
| Indent Indent Indent54568-1 | Nutritional Approaches | |||
| Indent Indent Indent Indent71444-4 | Nutritional Approaches. While NOT a Resident | 1..4 | ||
| Indent Indent Indent Indent71445-1 | Nutritional Approaches. While a Resident | 1..4 | ||
| Indent Indent Indent86679-8 | Percent Intake by Artificial Route | |||
| Indent Indent Indent Indent86680-6 | Proportion of total calories the resident received through parenteral or tube feeding. While NOT a Resident | |||
| Indent Indent Indent Indent86681-4 | Proportion of total calories the resident received through parenteral or tube feeding. While a Resident | |||
| Indent Indent Indent Indent86687-1 | Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days | |||
| Indent Indent Indent Indent86682-2 | Average fluid intake per day by IV or tube feeding. While NOT a Resident | mL/d;L/d | ||
| Indent Indent Indent Indent86683-0 | Average fluid intake per day by IV or tube feeding. While a Resident | mL/d;L/d | ||
| Indent Indent Indent Indent86684-8 | Average fluid intake per day by IV or tube feeding. During Entire 7 Days | mL/d;L/d | ||
| Indent Indent86707-7 | Skin Conditions | |||
| Indent Indent Indent86708-5 | Determination of Pressure Ulcer Risk | 1..3 | ||
| Indent Indent Indent57280-0 | Risk of Pressure Ulcers. Is this resident at risk of developing pressure ulcers? | |||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher? | |||
| Indent Indent Indent86745-7 | Current Number of Unhealed Pressure Ulcers at Each Stage | |||
| Indent Indent Indent Indent54884-2 | Number of Stage 1 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54886-7 | Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent58123-1 | Date of oldest Stage 2 pressure ulcer | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54887-5 | Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54890-9 | Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54894-1 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54947-7 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure ulcers with suspected deep tissue injury in evolution | {#} | ||
| Indent Indent Indent Indent54951-9 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent86746-5 | Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar | |||
| Indent Indent Indent Indent86901-6 | Pressure ulcer length: Longest length from head to toe | cm | ||
| Indent Indent Indent Indent86902-4 | Pressure ulcer width: Widest width of the same pressure ulcer, side-to-side perpendicular (90-degree angle) to length | cm | ||
| Indent Indent Indent Indent57228-9 | Pressure ulcer depth: Depth of the same pressure ulcer from the visible surface to the deepest area | cm | ||
| Indent Indent Indent86903-2 | Most Severe Tissue Type for Any Pressure Ulcer | |||
| Indent Indent Indent54952-7 | Worsening in Pressure Ulcer Status Since Prior Assessment (OBRA or Scheduled PPS) or Last Admission/Entry or Reentry | |||
| Indent Indent Indent Indent54953-5 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54954-3 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54955-0 | Stage 4 | {#} | ||
| Indent Indent Indent54956-8 | Healed Pressure Ulcers | |||
| Indent Indent Indent Indent54957-6 | Were pressure ulcers present on the prior assessment (OBRA or scheduled PPS)? | |||
| Indent Indent Indent Indent54958-4 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54959-2 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54960-0 | Stage 4 | {#} | ||
| Indent Indent Indent54970-9 | Number of Venous and Arterial Ulcers | {#} | ||
| Indent Indent Indent86747-3 | Other Ulcers, Wounds and Skin Problems | 1..8 | ||
| Indent Indent Indent86748-1 | Skin and Ulcer Treatments | 1..9 | ||
| Indent Indent86749-9 | Medications during assessment period [CMS Assessment] | |||
| Indent Indent Indent54982-4 | Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days. | d/(7.d) | ||
| Indent Indent Indent58217-1 | Insulin | |||
| Indent Indent Indent Indent58127-2 | Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days | d/(7.d) | ||
| Indent Indent Indent Indent58128-0 | Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days | d/(7.d) | ||
| Indent Indent Indent86750-7 | Medications Received | |||
| Indent Indent Indent Indent86751-5 | Antipsychotic | d/(7.d) | ||
| Indent Indent Indent Indent86752-3 | Antianxiety | d/(7.d) | ||
| Indent Indent Indent Indent86753-1 | Antidepressant | d/(7.d) | ||
| Indent Indent Indent Indent86754-9 | Hypnotic | d/(7.d) | ||
| Indent Indent Indent Indent86755-6 | Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin) | d/(7.d) | ||
| Indent Indent Indent Indent86756-4 | Antibiotic | d/(7.d) | ||
| Indent Indent Indent Indent86757-2 | Diuretic | d/(7.d) | ||
| Indent Indent86840-6 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent86761-4 | While a Resident | 0..10 | ||
| Indent Indent Indent69339-0 | Influenza Vaccine | |||
| Indent Indent Indent Indent55019-4 | Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season? | |||
| Indent Indent Indent Indent58131-4 | Date influenza vaccine received | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent55020-2 | If influenza vaccine not received, state reason: | |||
| Indent Indent Indent55021-0 | Pneumococcal Vaccine | |||
| Indent Indent Indent Indent55022-8 | Is the resident's Pneumococcal vaccination up to date? | |||
| Indent Indent Indent Indent45956-0 | If Pneumococcal vaccine not received, state reason: | |||
| Indent Indent Indent86847-1 | Therapies | |||
| Indent Indent Indent Indent86763-0 | Speech-Language Pathology and Audiology Services | |||
| Indent Indent Indent Indent Indent58218-9 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58133-0 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58134-8 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86765-5 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45760-6 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55025-1 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55026-9 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86767-1 | Occupational Therapy | |||
| Indent Indent Indent Indent Indent58219-7 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58136-3 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58137-1 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86764-8 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45762-2 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55027-7 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55028-5 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86768-9 | Physical Therapy | |||
| Indent Indent Indent Indent Indent58220-5 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58139-7 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58140-5 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86766-3 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45764-8 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55029-3 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55030-1 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86849-7 | Respiratory therapy | |||
| Indent Indent Indent Indent Indent45766-3 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent86769-7 | Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days. | d | ||
| Indent Indent Indent86770-5 | Resumption of Therapy | |||
| Indent Indent Indent Indent86772-1 | Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline? | |||
| Indent Indent Indent Indent86771-3 | Date on which therapy regimen resumed | {mm/dd/yyyy} | ||
| Indent Indent Indent86773-9 | Restorative Nursing Programs | |||
| Indent Indent Indent Indent86774-7 | Technique. Range of motion (passive) | d/(7.d) | ||
| Indent Indent Indent Indent86775-4 | Technique. Range of motion (active) | d/(7.d) | ||
| Indent Indent Indent Indent86776-2 | Technique. Splint or brace assistance | d/(7.d) | ||
| Indent Indent Indent Indent86777-0 | Training and Skill Practice In: Bed mobility | d/(7.d) | ||
| Indent Indent Indent Indent86778-8 | Training and Skill Practice In: Transfer | d/(7.d) | ||
| Indent Indent Indent Indent86779-6 | Training and Skill Practice In: Walking | d/(7.d) | ||
| Indent Indent Indent Indent86780-4 | Training and Skill Practice In: Dressing and/or grooming | d/(7.d) | ||
| Indent Indent Indent Indent86781-2 | Training and Skill Practice In: Eating and/or swallowing | d/(7.d) | ||
| Indent Indent Indent Indent86782-0 | Training and Skill Practice In: Amputation/prostheses care | d/(7.d) | ||
| Indent Indent Indent Indent86783-8 | Training and Skill Practice In: Communication | d/(7.d) | ||
| Indent Indent Indent55040-0 | Physician Examinations. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) examine the resident? | d/(14.d) | ||
| Indent Indent Indent55041-8 | Physician Orders. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) change the resident's orders? | d/(14.d) | ||
| Indent Indent86784-6 | Restraints | |||
| Indent Indent Indent86785-3 | Physical Restraints | |||
| Indent Indent Indent Indent86786-1 | Used in Bed. Bed rail | d/(7.d) | ||
| Indent Indent Indent Indent86787-9 | Used in Bed. Trunk restraint | d/(7.d) | ||
| Indent Indent Indent Indent86788-7 | Used in Bed. Limb restraint | d/(7.d) | ||
| Indent Indent Indent Indent86789-5 | Used in Bed. Other | d/(7.d) | ||
| Indent Indent Indent Indent86790-3 | Used in Chair or Out of Bed. Trunk restraint | d/(7.d) | ||
| Indent Indent Indent Indent86791-1 | Used in Chair or Out of Bed. Limb restraint | d/(7.d) | ||
| Indent Indent Indent Indent86792-9 | Used in Chair or Out of Bed. Chair prevents rising | d/(7.d) | ||
| Indent Indent Indent Indent86793-7 | Used in Chair or Out of Bed. Other | d/(7.d) | ||
| Indent Indent86794-5 | Participation in Assessment and Goal Setting | |||
| Indent Indent Indent55053-3 | Participation in Assessment | |||
| Indent Indent Indent Indent55054-1 | Resident participated in assessment | |||
| Indent Indent Indent Indent55074-9 | Family or significant other participated in assessment | |||
| Indent Indent Indent Indent58221-3 | Guardian or legally authorized representative participated in assessment | |||
| Indent Indent Indent55056-6 | Resident's Overall Expectation | |||
| Indent Indent Indent Indent55057-4 | Select one for resident's overall goal established during assessment process | |||
| Indent Indent Indent Indent55058-2 | Indicate information source for Q0300A | |||
| Indent Indent Indent58146-2 | Discharge Plan. Is active discharge planning already occurring for the resident to return to the community? | |||
| Indent Indent Indent86795-2 | Resident's Preference to Avoid Being Asked Question Q0500B. Does the resident's clinical record document a request that this question be asked only on comprehensive assessments? | |||
| Indent Indent Indent58149-6 | Return to Community. Do you want to talk to someone about the possiblity of leaving this facility and returning to live and receive services in the community? | |||
| Indent Indent Indent86796-0 | Resident's Preference to Avoid Being Asked Question Q0500B Again | |||
| Indent Indent Indent Indent86797-8 | Does the resident (or family or significant other or guardian or legally authorized representative if resident is unable to understand or respond) want to be asked about returning to the community on all assessments? | |||
| Indent Indent Indent Indent86798-6 | Indicate information source for Q0550A | |||
| Indent Indent Indent58150-4 | Referral. Has a referral been made to the Local Contact Agency? | |||
| Indent Indent87224-2 | Correction Request | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent87226-7 | Name of Resident | |||
| Indent Indent Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent87227-5 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent87216-8 | Date on existing record to be modified/inactivated | |||
| Indent Indent Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent87209-3 | Correction Attestation Section | |||
| Indent Indent Indent Indent58200-7 | Correction Number | {#} | ||
| Indent Indent Indent Indent87217-6 | Reasons for Modification | 1..6 | ||
| Indent Indent Indent Indent87225-9 | Reasons for Inactivation | 1..2 | ||
| Indent Indent Indent Indent87218-4 | RN Assessment Coordinator Attestation of Completion | |||
| Indent Indent Indent Indent Indent87219-2 | Attesting individual's first name | |||
| Indent Indent Indent Indent Indent87220-0 | Attesting individual's last name | |||
| Indent Indent Indent Indent Indent87221-8 | Attesting individual's title | |||
| Indent Indent Indent Indent Indent87222-6 | Attestation date | {mm/dd/yyyy} | ||
| Indent Indent87228-3 | Assessment Administration | |||
| Indent Indent Indent55064-0 | Medicare Part A Billing | |||
| Indent Indent Indent Indent55065-7 | Medicare Part A HIPPS code | |||
| Indent Indent Indent Indent55066-5 | RUG version code | |||
| Indent Indent Indent Indent58421-9 | Is this a Medicare Short Stay assessment? | |||
| Indent Indent Indent59375-6 | Medicare Part A Non-Therapy Billing | |||
| Indent Indent Indent Indent58210-6 | Medicare Part A non-therapy HIPPS code | |||
| Indent Indent Indent Indent58211-4 | RUG version code | |||
| Indent Indent Indent55070-7 | Insurance Billing | |||
| Indent Indent Indent Indent55071-5 | RUG billing code | |||
| Indent Indent Indent Indent55072-3 | RUG billing version | |||
| Indent86873-7 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment] | |||
| Indent Indent86811-7 | Identification Information | |||
| Indent Indent Indent58198-3 | Type of Record | |||
| Indent Indent Indent54581-4 | Facility Provider Numbers | |||
| Indent Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
| Indent Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
| Indent Indent Indent Indent45398-5 | State Provider Number | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent86524-6 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent54587-1 | Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent71440-2 | Type of discharge | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent86526-1 | Unit Certification or Licensure Designation | |||
| Indent Indent Indent54503-8 | Legal Name of Resident | |||
| Indent Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent Indent45394-4 | Last name | |||
| Indent Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent Indent45966-9 | Social Security and Medicare Numbers | |||
| Indent Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent Indent45397-7 | Medicare number (or comparable railroad insurance number) | |||
| Indent Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent59362-4 | Race/Ethnicity | 1..6 | ||
| Indent Indent Indent54505-3 | Language | |||
| Indent Indent Indent Indent54588-9 | Does the resident need or want an interpreter to communicate with a doctor or health care staff? | |||
| Indent Indent Indent Indent54899-0 | Preferred language | |||
| Indent Indent Indent45404-1 | Marital Status | |||
| Indent Indent Indent54506-1 | Optional Resident Items | |||
| Indent Indent Indent Indent46106-1 | Medical record number [Identifier] | |||
| Indent Indent Indent Indent45403-3 | Room number [Location] | |||
| Indent Indent Indent Indent52462-9 | Name by which resident prefers to be addressed | |||
| Indent Indent Indent Indent21843-8 | Lifetime occupation(s) | |||
| Indent Indent Indent86528-7 | Most Recent Admission/Entry or Reentry into this Facility | |||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54590-5 | Type of Entry | |||
| Indent Indent Indent Indent85398-6 | Entered From | |||
| Indent Indent Indent52455-3 | Admission Date (Date this episode of care in this facility began) | {mm/dd/yyyy} | ||
| Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent55128-3 | Discharge Status | |||
| Indent Indent Indent54593-9 | Assessment Reference Date. Observation end date | {mm/dd/yyyy} | ||
| Indent Indent Indent54507-9 | Medicare Stay | |||
| Indent Indent Indent Indent54594-7 | Has the resident had a Medicare-covered stay since the most recent entry? | |||
| Indent Indent Indent Indent54595-4 | Start date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54596-2 | End date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent86813-3 | Hearing, Speech, and Vision | |||
| Indent Indent Indent54597-0 | Comatose. Persistent vegetative state/no discernible consciousness | |||
| Indent Indent Indent54601-0 | Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression | |||
| Indent Indent86882-8 | Cognitive Patterns | |||
| Indent Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
| Indent Indent Indent52491-8 | Brief Interview for Mental Status (BIMS) | |||
| Indent Indent Indent Indent52731-7 | Repetition of Three Words. Number of words repeated after first attempt | |||
| Indent Indent Indent Indent54510-3 | Temporal Orientation (orientation to year, month, and day) | |||
| Indent Indent Indent Indent Indent52732-5 | Able to report correct year | |||
| Indent Indent Indent Indent Indent52733-3 | Able to report correct month | |||
| Indent Indent Indent Indent Indent54609-3 | Able to report correct day of the week | |||
| Indent Indent Indent Indent52493-4 | Recall | |||
| Indent Indent Indent Indent Indent52735-8 | Able to recall "sock" | |||
| Indent Indent Indent Indent Indent52736-6 | Able to recall "blue" | |||
| Indent Indent Indent Indent Indent52737-4 | Able to recall "bed" | |||
| Indent Indent Indent Indent54614-3 | BIMS Summary Score | {score} | ||
| Indent Indent Indent54615-0 | Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted? | |||
| Indent Indent Indent86814-1 | Staff Assessment for Mental Status | |||
| Indent Indent Indent Indent54616-8 | Short-term Memory OK. Seems or appears to recall after 5 minutes | |||
| Indent Indent Indent Indent54624-2 | Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life | |||
| Indent Indent Indent86584-0 | Delirium | |||
| Indent Indent Indent Indent86585-7 | Signs and Symptoms of Delirium (from CAM) | |||
| Indent Indent Indent Indent Indent54632-5 | Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline? | |||
| Indent Indent Indent Indent Indent54628-3 | Inattention - Did the resident have difficulty focusing attention, for example being easily distractible, or having difficulty keeping track of what was being said? | |||
| Indent Indent Indent Indent Indent54629-1 | Disorganized thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)? | |||
| Indent Indent Indent Indent Indent54630-9 | Altered level of consciousness - Did the resident have altered level of consciousness as indicated by any of the following criteria? | |||
| Indent Indent54633-3 | Mood | |||
| Indent Indent Indent54634-1 | Should Resident Mood Interview be Conducted? | |||
| Indent Indent Indent54635-8 | Resident Mood Interview (PHQ-9) | |||
| Indent Indent Indent Indent86843-0 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent Indent86844-8 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent54654-9 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent Indent54657-2 | Staff Assessment of Resident Mood (PHQ-9-OV) | |||
| Indent Indent Indent Indent86833-1 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54658-0 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54660-6 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54662-2 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54664-8 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54666-3 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54668-9 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54670-5 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54672-1 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54673-9 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54675-4 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent Indent86891-9 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54659-8 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54661-4 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54663-0 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54665-5 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54667-1 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54669-7 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54671-3 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54904-8 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54674-7 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54676-2 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent54677-0 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent86815-8 | Behavior | |||
| Indent Indent Indent86597-2 | Potential Indicators of Psychosis | 1..2 | ||
| Indent Indent Indent54514-5 | Behavioral Symptom - Presence & Frequency | |||
| Indent Indent Indent Indent54682-0 | Physical behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54683-8 | Verbal behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54684-6 | Other behavioral symptoms not directed toward others | d/(7.d) | ||
| Indent Indent Indent54692-9 | Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? | d/(7.d) | ||
| Indent Indent Indent54693-7 | Wandering - Presence & Frequency. Has the resident wandered? | d/(7.d) | ||
| Indent Indent86818-2 | Functional Status | |||
| Indent Indent Indent86880-2 | Activities of Daily Living (ADL) Assistance. Self-Performance | |||
| Indent Indent Indent Indent45588-1 | Bed mobility | |||
| Indent Indent Indent Indent45590-7 | Transfer | |||
| Indent Indent Indent Indent45592-3 | Walk in room | |||
| Indent Indent Indent Indent45594-9 | Walk in corridor | |||
| Indent Indent Indent Indent45596-4 | Locomotion on unit | |||
| Indent Indent Indent Indent45598-0 | Locomotion off unit | |||
| Indent Indent Indent Indent45600-4 | Dressing | |||
| Indent Indent Indent Indent45602-0 | Eating | |||
| Indent Indent Indent Indent45604-6 | Toilet use | |||
| Indent Indent Indent Indent45606-1 | Personal hygiene | |||
| Indent Indent Indent86884-4 | Activities of daily living (ADL) assistance. Support provided | |||
| Indent Indent Indent Indent45589-9 | Bed mobility | |||
| Indent Indent Indent Indent45591-5 | Transfer | |||
| Indent Indent Indent Indent45603-8 | Eating | |||
| Indent Indent Indent Indent45605-3 | Toilet use | |||
| Indent Indent Indent86887-7 | Bathing | |||
| Indent Indent Indent Indent45608-7 | Self-performance | |||
| Indent Indent86615-2 | Functional Abilities and Goals - Discharge (End of SNF PPS Stay) | |||
| Indent Indent Indent86616-0 | Self-Care - Discharge Performance | |||
| Indent Indent Indent Indent83232-9 | Eating | |||
| Indent Indent Indent Indent83230-3 | Oral hygiene | |||
| Indent Indent Indent Indent83228-7 | Toileting hygiene | |||
| Indent Indent Indent86617-8 | Mobility - Discharge Performance | |||
| Indent Indent Indent Indent83216-2 | Sit to lying | |||
| Indent Indent Indent Indent83214-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83212-1 | Sit to stand | |||
| Indent Indent Indent Indent83210-5 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent83208-9 | Toilet transfer | |||
| Indent Indent Indent Indent83278-2 | Does the resident walk? | |||
| Indent Indent Indent Indent83202-2 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83200-6 | Walk 150 feet | |||
| Indent Indent Indent Indent83271-7 | Does the resident use a wheelchair/scooter? | |||
| Indent Indent Indent Indent83188-3 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent Indent83235-2 | Wheel 150 feet | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent86820-8 | Bladder and Bowel | |||
| Indent Indent Indent86624-4 | Appliances | 1..4 | ||
| Indent Indent Indent86866-1 | Urinary Toileting Program | |||
| Indent Indent Indent Indent54767-9 | Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility? | |||
| Indent Indent Indent Indent54769-5 | Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence? | |||
| Indent Indent Indent54770-3 | Urinary Continence | 1..1 | ||
| Indent Indent Indent54771-1 | Bowel Continence | 1..1 | ||
| Indent Indent Indent54772-9 | Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence? | |||
| Indent Indent86670-7 | Active Diagnoses | |||
| Indent Indent Indent86671-5 | Active Diagnoses in the last 7 days | 1..* | ||
| Indent Indent Indent52797-8 | Additional active diagnoses | 0..10 | ||
| Indent Indent86822-4 | Health Conditions | |||
| Indent Indent Indent54557-4 | Pain Management | |||
| Indent Indent Indent Indent71447-7 | At any time in the last 5 days, has the resident: Received scheduled pain medication regimen? | |||
| Indent Indent Indent Indent71448-5 | At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined? | |||
| Indent Indent Indent Indent71449-3 | At any time in the last 5 days, has the resident: Received non-medication intervention for pain? | |||
| Indent Indent Indent54828-9 | Should Pain Assessment Interview be Conducted? | |||
| Indent Indent Indent54558-2 | Pain Assessment Interview | |||
| Indent Indent Indent Indent54829-7 | Pain Presence. Have you had pain or hurting at any time in the last 5 days? | |||
| Indent Indent Indent Indent54830-5 | Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days? | |||
| Indent Indent Indent Indent54559-0 | Pain Effect on Function | |||
| Indent Indent Indent Indent Indent54831-3 | Over the past 5 days, has pain made it hard for you to sleep at night? | |||
| Indent Indent Indent Indent Indent54832-1 | Over the past 5 days, have you limited your day-to-day activities because of pain? | |||
| Indent Indent Indent Indent54560-8 | Pain Intensity | |||
| Indent Indent Indent Indent Indent54833-9 | Numeric Rating Scale (00-10) | |||
| Indent Indent Indent Indent Indent54834-7 | Verbal Descriptor Scale | |||
| Indent Indent Indent86890-1 | Other Health Conditions | |||
| Indent Indent Indent Indent86675-6 | Shortness of Breath (dyspnea) | 1..3 | ||
| Indent Indent Indent Indent54846-1 | Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months? | |||
| Indent Indent Indent Indent86676-4 | Problem Conditions | 1..4 | ||
| Indent Indent Indent54853-7 | Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent? | |||
| Indent Indent Indent54854-5 | Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent | |||
| Indent Indent Indent Indent54855-2 | No injury | |||
| Indent Indent Indent Indent54856-0 | Injury (except major) | |||
| Indent Indent Indent Indent54857-8 | Major injury | |||
| Indent Indent86826-5 | Swallowing/Nutritional Status | |||
| Indent Indent Indent54567-3 | Height and Weight | |||
| Indent Indent Indent Indent3137-7 | Height (in inches) | [in_us];cm;m | ||
| Indent Indent Indent Indent3141-9 | Weight (in pounds) | [lb_av];kg | ||
| Indent Indent Indent54863-6 | Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months | |||
| Indent Indent Indent86678-0 | Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months | |||
| Indent Indent Indent54568-1 | Nutritional Approaches | |||
| Indent Indent Indent Indent71444-4 | Nutritional Approaches. While NOT a Resident | 1..4 | ||
| Indent Indent Indent Indent71445-1 | Nutritional Approaches. While a Resident | 1..4 | ||
| Indent Indent Indent86679-8 | Percent Intake by Artificial Route | |||
| Indent Indent Indent Indent86680-6 | Proportion of total calories the resident received through parenteral or tube feeding. While NOT a Resident | |||
| Indent Indent Indent Indent86681-4 | Proportion of total calories the resident received through parenteral or tube feeding. While a Resident | |||
| Indent Indent Indent Indent86687-1 | Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days | |||
| Indent Indent Indent Indent86682-2 | Average fluid intake per day by IV or tube feeding. While NOT a Resident | mL/d;L/d | ||
| Indent Indent Indent Indent86683-0 | Average fluid intake per day by IV or tube feeding. While a Resident | mL/d;L/d | ||
| Indent Indent Indent Indent86684-8 | Average fluid intake per day by IV or tube feeding. During Entire 7 Days | mL/d;L/d | ||
| Indent Indent86829-9 | Skin Conditions | |||
| Indent Indent Indent86708-5 | Determination of Pressure Ulcer Risk | 0..1 | ||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher? | |||
| Indent Indent Indent86270-6 | Current Number of Unhealed Pressure Ulcers at Each Stage | |||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54886-7 | Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54887-5 | Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54890-9 | Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54894-1 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54947-7 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure ulcers with suspected deep tissue injury in evolution | {#} | ||
| Indent Indent Indent Indent54951-9 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent86746-5 | Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar | |||
| Indent Indent Indent Indent86901-6 | Pressure ulcer length: Longest length from head to toe | cm | ||
| Indent Indent Indent Indent86902-4 | Pressure ulcer width: Widest width of the same pressure ulcer, side-to-side perpendicular (90-degree angle) to length | cm | ||
| Indent Indent Indent Indent57228-9 | Pressure ulcer depth: Depth of the same pressure ulcer from the visible surface to the deepest area | cm | ||
| Indent Indent Indent54952-7 | Worsening in Pressure Ulcer Status Since Prior Assessment (OBRA or Scheduled PPS) or Last Admission/Entry or Reentry | |||
| Indent Indent Indent Indent54953-5 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54954-3 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54955-0 | Stage 4 | {#} | ||
| Indent Indent Indent54956-8 | Healed Pressure Ulcers | |||
| Indent Indent Indent Indent54957-6 | Were pressure ulcers present on the prior assessment (OBRA or scheduled PPS)? | |||
| Indent Indent Indent Indent54958-4 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54959-2 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54960-0 | Stage 4 | {#} | ||
| Indent Indent Indent54970-9 | Number of Venous and Arterial Ulcers | {#} | ||
| Indent Indent Indent86747-3 | Other Ulcers, Wounds and Skin Problems | 1..8 | ||
| Indent Indent Indent86748-1 | Skin and Ulcer Treatments | 1..9 | ||
| Indent Indent86749-9 | Medications during assessment period [CMS Assessment] | |||
| Indent Indent Indent54982-4 | Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days. | d/(7.d) | ||
| Indent Indent Indent58217-1 | Insulin | |||
| Indent Indent Indent Indent58127-2 | Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days | d/(7.d) | ||
| Indent Indent Indent Indent58128-0 | Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days | d/(7.d) | ||
| Indent Indent Indent86750-7 | Medications Received | |||
| Indent Indent Indent Indent86751-5 | Antipsychotic | d/(7.d) | ||
| Indent Indent Indent Indent86752-3 | Antianxiety | d/(7.d) | ||
| Indent Indent Indent Indent86753-1 | Antidepressant | d/(7.d) | ||
| Indent Indent Indent Indent86754-9 | Hypnotic | d/(7.d) | ||
| Indent Indent Indent Indent86755-6 | Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin) | d/(7.d) | ||
| Indent Indent Indent Indent86756-4 | Antibiotic | d/(7.d) | ||
| Indent Indent Indent Indent86757-2 | Diuretic | d/(7.d) | ||
| Indent Indent86839-8 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent86761-4 | While a Resident | 0..10 | ||
| Indent Indent Indent69339-0 | Influenza Vaccine | |||
| Indent Indent Indent Indent55019-4 | Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season? | |||
| Indent Indent Indent Indent58131-4 | Date influenza vaccine received | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent55020-2 | If influenza vaccine not received, state reason: | |||
| Indent Indent Indent55021-0 | Pneumococcal Vaccine | |||
| Indent Indent Indent Indent55022-8 | Is the resident's Pneumococcal vaccination up to date? | |||
| Indent Indent Indent Indent45956-0 | If Pneumococcal vaccine not received, state reason: | |||
| Indent Indent Indent86846-3 | Therapies | |||
| Indent Indent Indent Indent86763-0 | Speech-Language Pathology and Audiology Services | |||
| Indent Indent Indent Indent Indent58218-9 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58133-0 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58134-8 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86765-5 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45760-6 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55025-1 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55026-9 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86767-1 | Occupational Therapy | |||
| Indent Indent Indent Indent Indent58219-7 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58136-3 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58137-1 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86764-8 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45762-2 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55027-7 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55028-5 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86768-9 | Physical Therapy | |||
| Indent Indent Indent Indent Indent58220-5 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58139-7 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58140-5 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86766-3 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45764-8 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55029-3 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55030-1 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86849-7 | Respiratory therapy | |||
| Indent Indent Indent Indent Indent45766-3 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent86769-7 | Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days. | d | ||
| Indent Indent Indent86770-5 | Resumption of Therapy | |||
| Indent Indent Indent Indent86772-1 | Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline? | |||
| Indent Indent Indent Indent86771-3 | Date on which therapy regimen resumed | {mm/dd/yyyy} | ||
| Indent Indent Indent86773-9 | Restorative Nursing Programs | |||
| Indent Indent Indent Indent86774-7 | Technique. Range of motion (passive) | d/(7.d) | ||
| Indent Indent Indent Indent86775-4 | Technique. Range of motion (active) | d/(7.d) | ||
| Indent Indent Indent Indent86776-2 | Technique. Splint or brace assistance | d/(7.d) | ||
| Indent Indent Indent Indent86777-0 | Training and Skill Practice In: Bed mobility | d/(7.d) | ||
| Indent Indent Indent Indent86778-8 | Training and Skill Practice In: Transfer | d/(7.d) | ||
| Indent Indent Indent Indent86779-6 | Training and Skill Practice In: Walking | d/(7.d) | ||
| Indent Indent Indent Indent86780-4 | Training and Skill Practice In: Dressing and/or grooming | d/(7.d) | ||
| Indent Indent Indent Indent86781-2 | Training and Skill Practice In: Eating and/or swallowing | d/(7.d) | ||
| Indent Indent Indent Indent86782-0 | Training and Skill Practice In: Amputation/prostheses care | d/(7.d) | ||
| Indent Indent Indent Indent86783-8 | Training and Skill Practice In: Communication | d/(7.d) | ||
| Indent Indent86784-6 | Restraints | |||
| Indent Indent Indent86785-3 | Physical Restraints | |||
| Indent Indent Indent Indent86786-1 | Used in Bed. Bed rail | d/(7.d) | ||
| Indent Indent Indent Indent86787-9 | Used in Bed. Trunk restraint | d/(7.d) | ||
| Indent Indent Indent Indent86788-7 | Used in Bed. Limb restraint | d/(7.d) | ||
| Indent Indent Indent Indent86789-5 | Used in Bed. Other | d/(7.d) | ||
| Indent Indent Indent Indent86790-3 | Used in Chair or Out of Bed. Trunk restraint | d/(7.d) | ||
| Indent Indent Indent Indent86791-1 | Used in Chair or Out of Bed. Limb restraint | d/(7.d) | ||
| Indent Indent Indent Indent86792-9 | Used in Chair or Out of Bed. Chair prevents rising | d/(7.d) | ||
| Indent Indent Indent Indent86793-7 | Used in Chair or Out of Bed. Other | d/(7.d) | ||
| Indent Indent86853-9 | Participation in Assessment and Goal Setting | |||
| Indent Indent Indent55053-3 | Participation in Assessment | |||
| Indent Indent Indent Indent55054-1 | Resident participated in assessment | |||
| Indent Indent Indent Indent55074-9 | Family or significant other participated in assessment | |||
| Indent Indent Indent Indent58221-3 | Guardian or legally authorized representative participated in assessment | |||
| Indent Indent Indent58146-2 | Discharge Plan. Is active discharge planning already occurring for the resident to return to the community? | |||
| Indent Indent Indent58150-4 | Referral. Has a referral been made to the Local Contact Agency? | |||
| Indent Indent87224-2 | Correction Request | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent87226-7 | Name of Resident | |||
| Indent Indent Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent87227-5 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent87216-8 | Date on existing record to be modified/inactivated | |||
| Indent Indent Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent87209-3 | Correction Attestation Section | |||
| Indent Indent Indent Indent58200-7 | Correction Number | {#} | ||
| Indent Indent Indent Indent87217-6 | Reasons for Modification | 1..6 | ||
| Indent Indent Indent Indent87225-9 | Reasons for Inactivation | 1..2 | ||
| Indent Indent Indent Indent87218-4 | RN Assessment Coordinator Attestation of Completion | |||
| Indent Indent Indent Indent Indent87219-2 | Attesting individual's first name | |||
| Indent Indent Indent Indent Indent87220-0 | Attesting individual's last name | |||
| Indent Indent Indent Indent Indent87221-8 | Attesting individual's title | |||
| Indent Indent Indent Indent Indent87222-6 | Attestation date | {mm/dd/yyyy} | ||
| Indent Indent87228-3 | Assessment Administration | |||
| Indent Indent Indent55064-0 | Medicare Part A Billing | |||
| Indent Indent Indent Indent55065-7 | Medicare Part A HIPPS code | |||
| Indent Indent Indent Indent55066-5 | RUG version code | |||
| Indent Indent Indent Indent58421-9 | Is this a Medicare Short Stay assessment? | |||
| Indent Indent Indent59375-6 | Medicare Part A Non-Therapy Billing | |||
| Indent Indent Indent Indent58210-6 | Medicare Part A non-therapy HIPPS code | |||
| Indent Indent Indent Indent58211-4 | RUG version code | |||
| Indent Indent Indent55070-7 | Insurance Billing | |||
| Indent Indent Indent Indent55071-5 | RUG billing code | |||
| Indent Indent Indent Indent55072-3 | RUG billing version | |||
| Indent86870-3 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed OMRA (NO/SO) item set [CMS Assessment] | |||
| Indent Indent86811-7 | Identification Information | |||
| Indent Indent Indent58198-3 | Type of Record | |||
| Indent Indent Indent54581-4 | Facility Provider Numbers | |||
| Indent Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
| Indent Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
| Indent Indent Indent Indent45398-5 | State Provider Number | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent86524-6 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent54587-1 | Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent71440-2 | Type of discharge | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent86526-1 | Unit Certification or Licensure Designation | |||
| Indent Indent Indent54503-8 | Legal Name of Resident | |||
| Indent Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent Indent45394-4 | Last name | |||
| Indent Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent Indent45966-9 | Social Security and Medicare Numbers | |||
| Indent Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent Indent45397-7 | Medicare number (or comparable railroad insurance number) | |||
| Indent Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent59362-4 | Race/Ethnicity | 1..6 | ||
| Indent Indent Indent54505-3 | Language | |||
| Indent Indent Indent Indent54588-9 | Does the resident need or want an interpreter to communicate with a doctor or health care staff? | |||
| Indent Indent Indent Indent54899-0 | Preferred language | |||
| Indent Indent Indent45404-1 | Marital Status | |||
| Indent Indent Indent54506-1 | Optional Resident Items | |||
| Indent Indent Indent Indent46106-1 | Medical record number [Identifier] | |||
| Indent Indent Indent Indent45403-3 | Room number [Location] | |||
| Indent Indent Indent Indent52462-9 | Name by which resident prefers to be addressed | |||
| Indent Indent Indent Indent21843-8 | Lifetime occupation(s) | |||
| Indent Indent Indent86528-7 | Most Recent Admission/Entry or Reentry into this Facility | |||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54590-5 | Type of Entry | |||
| Indent Indent Indent Indent85398-6 | Entered From | |||
| Indent Indent Indent52455-3 | Admission Date (Date this episode of care in this facility began) | {mm/dd/yyyy} | ||
| Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent55128-3 | Discharge Status | |||
| Indent Indent Indent54593-9 | Assessment Reference Date. Observation end date | {mm/dd/yyyy} | ||
| Indent Indent Indent54507-9 | Medicare Stay | |||
| Indent Indent Indent Indent54594-7 | Has the resident had a Medicare-covered stay since the most recent entry? | |||
| Indent Indent Indent Indent54595-4 | Start date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54596-2 | End date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent86813-3 | Hearing, Speech, and Vision | |||
| Indent Indent Indent54597-0 | Comatose. Persistent vegetative state/no discernible consciousness | |||
| Indent Indent Indent54601-0 | Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression | |||
| Indent Indent86883-6 | Cognitive patterns | |||
| Indent Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
| Indent Indent Indent52491-8 | Brief Interview for Mental Status (BIMS) | |||
| Indent Indent Indent Indent52731-7 | Repetition of Three Words. Number of words repeated after first attempt | |||
| Indent Indent Indent Indent54510-3 | Temporal Orientation (orientation to year, month, and day) | |||
| Indent Indent Indent Indent Indent52732-5 | Able to report correct year | |||
| Indent Indent Indent Indent Indent52733-3 | Able to report correct month | |||
| Indent Indent Indent Indent Indent54609-3 | Able to report correct day of the week | |||
| Indent Indent Indent Indent52493-4 | Recall | |||
| Indent Indent Indent Indent Indent52735-8 | Able to recall "sock" | |||
| Indent Indent Indent Indent Indent52736-6 | Able to recall "blue" | |||
| Indent Indent Indent Indent Indent52737-4 | Able to recall "bed" | |||
| Indent Indent Indent Indent54614-3 | BIMS Summary Score | {score} | ||
| Indent Indent Indent54615-0 | Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted? | |||
| Indent Indent Indent86814-1 | Staff Assessment for Mental Status | |||
| Indent Indent Indent Indent54616-8 | Short-term Memory OK. Seems or appears to recall after 5 minutes | |||
| Indent Indent Indent Indent54624-2 | Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life | |||
| Indent Indent54633-3 | Mood | |||
| Indent Indent Indent54634-1 | Should Resident Mood Interview be Conducted? | |||
| Indent Indent Indent54635-8 | Resident Mood Interview (PHQ-9) | |||
| Indent Indent Indent Indent86843-0 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent Indent86844-8 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent54654-9 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent Indent54657-2 | Staff Assessment of Resident Mood (PHQ-9-OV) | |||
| Indent Indent Indent Indent86833-1 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54658-0 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54660-6 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54662-2 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54664-8 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54666-3 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54668-9 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54670-5 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54672-1 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54673-9 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54675-4 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent Indent86891-9 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54659-8 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54661-4 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54663-0 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54665-5 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54667-1 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54669-7 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54671-3 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54904-8 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54674-7 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54676-2 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent54677-0 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent86815-8 | Behavior | |||
| Indent Indent Indent86597-2 | Potential Indicators of Psychosis | 1..2 | ||
| Indent Indent Indent54514-5 | Behavioral Symptom - Presence & Frequency | |||
| Indent Indent Indent Indent54682-0 | Physical behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54683-8 | Verbal behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54684-6 | Other behavioral symptoms not directed toward others | d/(7.d) | ||
| Indent Indent Indent54692-9 | Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? | d/(7.d) | ||
| Indent Indent Indent54693-7 | Wandering - Presence & Frequency. Has the resident wandered? | d/(7.d) | ||
| Indent Indent86817-4 | Functional Status | |||
| Indent Indent Indent86885-1 | Activities of Daily Living (ADL) Assistance. Self-Performance | |||
| Indent Indent Indent Indent45588-1 | Bed mobility | |||
| Indent Indent Indent Indent45590-7 | Transfer | |||
| Indent Indent Indent Indent45602-0 | Eating | |||
| Indent Indent Indent Indent45604-6 | Toilet use | |||
| Indent Indent Indent86886-9 | Activities of Daily Living (ADL) Assistance. Support Provided | |||
| Indent Indent Indent Indent45589-9 | Bed mobility | |||
| Indent Indent Indent Indent45591-5 | Transfer | |||
| Indent Indent Indent Indent45603-8 | Eating | |||
| Indent Indent Indent Indent45605-3 | Toilet use | |||
| Indent Indent86878-6 | Bladder and Bowel | |||
| Indent Indent Indent86866-1 | Urinary Toileting Program | |||
| Indent Indent Indent Indent54767-9 | Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility? | |||
| Indent Indent Indent Indent54769-5 | Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence? | |||
| Indent Indent Indent54772-9 | Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence? | |||
| Indent Indent86821-6 | Active Diagnoses | |||
| Indent Indent Indent86671-5 | Active Diagnoses in the last 7 days | 1..* | ||
| Indent Indent86888-5 | Health conditions | |||
| Indent Indent Indent86889-3 | Other Health Conditions | |||
| Indent Indent Indent Indent86675-6 | Shortness of Breath (dyspnea) | 0..1 | ||
| Indent Indent Indent Indent86676-4 | Problem Conditions | 0..2 | ||
| Indent Indent86824-0 | Swallowing/Nutritional Status | |||
| Indent Indent Indent54863-6 | Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months | |||
| Indent Indent Indent86678-0 | Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months | |||
| Indent Indent Indent54568-1 | Nutritional Approaches | |||
| Indent Indent Indent Indent71444-4 | Nutritional Approaches. While NOT a Resident | 0..2 | ||
| Indent Indent Indent Indent71445-1 | Nutritional Approaches. While a Resident | 0..2 | ||
| Indent Indent Indent86679-8 | Percent Intake by Artificial Route | |||
| Indent Indent Indent Indent86680-6 | Proportion of total calories the resident received through parenteral or tube feeding. While NOT a Resident | |||
| Indent Indent Indent Indent86681-4 | Proportion of total calories the resident received through parenteral or tube feeding. While a Resident | |||
| Indent Indent Indent Indent86687-1 | Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days | |||
| Indent Indent Indent Indent86682-2 | Average fluid intake per day by IV or tube feeding. While NOT a Resident | mL/d;L/d | ||
| Indent Indent Indent Indent86683-0 | Average fluid intake per day by IV or tube feeding. While a Resident | mL/d;L/d | ||
| Indent Indent Indent Indent86684-8 | Average fluid intake per day by IV or tube feeding. During Entire 7 Days | mL/d;L/d | ||
| Indent Indent86827-3 | Skin Conditions | |||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher? | |||
| Indent Indent Indent86892-7 | Current Number of Unhealed Pressure Ulcers at Each Stage | |||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent54970-9 | Number of Venous and Arterial Ulcers | {#} | ||
| Indent Indent Indent86747-3 | Other Ulcers, Wounds and Skin Problems | 1..8 | ||
| Indent Indent Indent86748-1 | Skin and Ulcer Treatments | 1..9 | ||
| Indent Indent86831-5 | Medications | |||
| Indent Indent Indent54982-4 | Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days. | d/(7.d) | ||
| Indent Indent Indent58217-1 | Insulin | |||
| Indent Indent Indent Indent58127-2 | Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days | d/(7.d) | ||
| Indent Indent Indent Indent58128-0 | Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days | d/(7.d) | ||
| Indent Indent86836-4 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent86761-4 | While a Resident | 0..9 | ||
| Indent Indent Indent86846-3 | Therapies | |||
| Indent Indent Indent Indent86763-0 | Speech-Language Pathology and Audiology Services | |||
| Indent Indent Indent Indent Indent58218-9 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58133-0 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58134-8 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86765-5 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45760-6 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55025-1 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55026-9 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86767-1 | Occupational Therapy | |||
| Indent Indent Indent Indent Indent58219-7 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58136-3 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58137-1 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86764-8 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45762-2 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55027-7 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55028-5 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86768-9 | Physical Therapy | |||
| Indent Indent Indent Indent Indent58220-5 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58139-7 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58140-5 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86766-3 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45764-8 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55029-3 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55030-1 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86849-7 | Respiratory therapy | |||
| Indent Indent Indent Indent Indent45766-3 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent86769-7 | Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days. | d | ||
| Indent Indent Indent86770-5 | Resumption of Therapy | |||
| Indent Indent Indent Indent86772-1 | Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline? | |||
| Indent Indent Indent Indent86771-3 | Date on which therapy regimen resumed | {mm/dd/yyyy} | ||
| Indent Indent Indent86773-9 | Restorative Nursing Programs | |||
| Indent Indent Indent Indent86774-7 | Technique. Range of motion (passive) | d/(7.d) | ||
| Indent Indent Indent Indent86775-4 | Technique. Range of motion (active) | d/(7.d) | ||
| Indent Indent Indent Indent86776-2 | Technique. Splint or brace assistance | d/(7.d) | ||
| Indent Indent Indent Indent86777-0 | Training and Skill Practice In: Bed mobility | d/(7.d) | ||
| Indent Indent Indent Indent86778-8 | Training and Skill Practice In: Transfer | d/(7.d) | ||
| Indent Indent Indent Indent86779-6 | Training and Skill Practice In: Walking | d/(7.d) | ||
| Indent Indent Indent Indent86780-4 | Training and Skill Practice In: Dressing and/or grooming | d/(7.d) | ||
| Indent Indent Indent Indent86781-2 | Training and Skill Practice In: Eating and/or swallowing | d/(7.d) | ||
| Indent Indent Indent Indent86782-0 | Training and Skill Practice In: Amputation/prostheses care | d/(7.d) | ||
| Indent Indent Indent Indent86783-8 | Training and Skill Practice In: Communication | d/(7.d) | ||
| Indent Indent86852-1 | Participation in Assessment and Goal Setting | |||
| Indent Indent Indent55053-3 | Participation in Assessment | |||
| Indent Indent Indent Indent55054-1 | Resident participated in assessment | |||
| Indent Indent Indent Indent55074-9 | Family or significant other participated in assessment | |||
| Indent Indent Indent Indent58221-3 | Guardian or legally authorized representative participated in assessment | |||
| Indent Indent87224-2 | Correction Request | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent87226-7 | Name of Resident | |||
| Indent Indent Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent87227-5 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent87216-8 | Date on existing record to be modified/inactivated | |||
| Indent Indent Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent87209-3 | Correction Attestation Section | |||
| Indent Indent Indent Indent58200-7 | Correction Number | {#} | ||
| Indent Indent Indent Indent87217-6 | Reasons for Modification | 1..6 | ||
| Indent Indent Indent Indent87225-9 | Reasons for Inactivation | 1..2 | ||
| Indent Indent Indent Indent87218-4 | RN Assessment Coordinator Attestation of Completion | |||
| Indent Indent Indent Indent Indent87219-2 | Attesting individual's first name | |||
| Indent Indent Indent Indent Indent87220-0 | Attesting individual's last name | |||
| Indent Indent Indent Indent Indent87221-8 | Attesting individual's title | |||
| Indent Indent Indent Indent Indent87222-6 | Attestation date | {mm/dd/yyyy} | ||
| Indent Indent87228-3 | Assessment Administration | |||
| Indent Indent Indent55064-0 | Medicare Part A Billing | |||
| Indent Indent Indent Indent55065-7 | Medicare Part A HIPPS code | |||
| Indent Indent Indent Indent55066-5 | RUG version code | |||
| Indent Indent Indent Indent58421-9 | Is this a Medicare Short Stay assessment? | |||
| Indent Indent Indent59375-6 | Medicare Part A Non-Therapy Billing | |||
| Indent Indent Indent Indent58210-6 | Medicare Part A non-therapy HIPPS code | |||
| Indent Indent Indent Indent58211-4 | RUG version code | |||
| Indent Indent Indent55070-7 | Insurance Billing | |||
| Indent Indent Indent Indent55071-5 | RUG billing code | |||
| Indent Indent Indent Indent55072-3 | RUG billing version | |||
| Indent86874-5 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed OMRA start of therapy (NS/SS) item set [CMS Assessment] | |||
| Indent Indent86810-9 | Identification Information | |||
| Indent Indent Indent58198-3 | Type of Record | |||
| Indent Indent Indent54581-4 | Facility Provider Numbers | |||
| Indent Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
| Indent Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
| Indent Indent Indent Indent45398-5 | State Provider Number | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent86524-6 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent54587-1 | Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent71440-2 | Type of discharge | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent86526-1 | Unit Certification or Licensure Designation | |||
| Indent Indent Indent54503-8 | Legal Name of Resident | |||
| Indent Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent Indent45394-4 | Last name | |||
| Indent Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent Indent45966-9 | Social Security and Medicare Numbers | |||
| Indent Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent Indent45397-7 | Medicare number (or comparable railroad insurance number) | |||
| Indent Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent59362-4 | Race/Ethnicity | 1..6 | ||
| Indent Indent Indent45404-1 | Marital Status | |||
| Indent Indent Indent54506-1 | Optional Resident Items | |||
| Indent Indent Indent Indent46106-1 | Medical record number [Identifier] | |||
| Indent Indent Indent Indent45403-3 | Room number [Location] | |||
| Indent Indent Indent Indent52462-9 | Name by which resident prefers to be addressed | |||
| Indent Indent Indent Indent21843-8 | Lifetime occupation(s) | |||
| Indent Indent Indent86528-7 | Most Recent Admission/Entry or Reentry into this Facility | |||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54590-5 | Type of Entry | |||
| Indent Indent Indent Indent85398-6 | Entered From | |||
| Indent Indent Indent52455-3 | Admission Date (Date this episode of care in this facility began) | {mm/dd/yyyy} | ||
| Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent55128-3 | Discharge Status | |||
| Indent Indent Indent54593-9 | Assessment Reference Date. Observation end date | {mm/dd/yyyy} | ||
| Indent Indent Indent54507-9 | Medicare Stay | |||
| Indent Indent Indent Indent54594-7 | Has the resident had a Medicare-covered stay since the most recent entry? | |||
| Indent Indent Indent Indent54595-4 | Start date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54596-2 | End date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent86817-4 | Functional Status | |||
| Indent Indent Indent86885-1 | Activities of Daily Living (ADL) Assistance. Self-Performance | |||
| Indent Indent Indent Indent45588-1 | Bed mobility | |||
| Indent Indent Indent Indent45590-7 | Transfer | |||
| Indent Indent Indent Indent45602-0 | Eating | |||
| Indent Indent Indent Indent45604-6 | Toilet use | |||
| Indent Indent Indent86886-9 | Activities of Daily Living (ADL) Assistance. Support Provided | |||
| Indent Indent Indent Indent45589-9 | Bed mobility | |||
| Indent Indent Indent Indent45591-5 | Transfer | |||
| Indent Indent Indent Indent45603-8 | Eating | |||
| Indent Indent Indent Indent45605-3 | Toilet use | |||
| Indent Indent86878-6 | Bladder and Bowel | |||
| Indent Indent Indent86866-1 | Urinary Toileting Program | |||
| Indent Indent Indent Indent54767-9 | Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility? | |||
| Indent Indent Indent Indent54769-5 | Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence? | |||
| Indent Indent Indent54772-9 | Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence? | |||
| Indent Indent86835-6 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent86761-4 | While a Resident | 0..3 | ||
| Indent Indent Indent86842-2 | Therapies | |||
| Indent Indent Indent Indent86763-0 | Speech-Language Pathology and Audiology Services | |||
| Indent Indent Indent Indent Indent58218-9 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58133-0 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58134-8 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86765-5 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45760-6 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55025-1 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55026-9 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86767-1 | Occupational Therapy | |||
| Indent Indent Indent Indent Indent58219-7 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58136-3 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58137-1 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86764-8 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45762-2 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55027-7 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55028-5 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86768-9 | Physical Therapy | |||
| Indent Indent Indent Indent Indent58220-5 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58139-7 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58140-5 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86766-3 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45764-8 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55029-3 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55030-1 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent86769-7 | Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days. | d | ||
| Indent Indent Indent86770-5 | Resumption of Therapy | |||
| Indent Indent Indent Indent86772-1 | Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline? | |||
| Indent Indent Indent Indent86771-3 | Date on which therapy regimen resumed | {mm/dd/yyyy} | ||
| Indent Indent Indent86773-9 | Restorative Nursing Programs | |||
| Indent Indent Indent Indent86774-7 | Technique. Range of motion (passive) | d/(7.d) | ||
| Indent Indent Indent Indent86775-4 | Technique. Range of motion (active) | d/(7.d) | ||
| Indent Indent Indent Indent86776-2 | Technique. Splint or brace assistance | d/(7.d) | ||
| Indent Indent Indent Indent86777-0 | Training and Skill Practice In: Bed mobility | d/(7.d) | ||
| Indent Indent Indent Indent86778-8 | Training and Skill Practice In: Transfer | d/(7.d) | ||
| Indent Indent Indent Indent86779-6 | Training and Skill Practice In: Walking | d/(7.d) | ||
| Indent Indent Indent Indent86780-4 | Training and Skill Practice In: Dressing and/or grooming | d/(7.d) | ||
| Indent Indent Indent Indent86781-2 | Training and Skill Practice In: Eating and/or swallowing | d/(7.d) | ||
| Indent Indent Indent Indent86782-0 | Training and Skill Practice In: Amputation/prostheses care | d/(7.d) | ||
| Indent Indent Indent Indent86783-8 | Training and Skill Practice In: Communication | d/(7.d) | ||
| Indent Indent86852-1 | Participation in Assessment and Goal Setting | |||
| Indent Indent Indent55053-3 | Participation in Assessment | |||
| Indent Indent Indent Indent55054-1 | Resident participated in assessment | |||
| Indent Indent Indent Indent55074-9 | Family or significant other participated in assessment | |||
| Indent Indent Indent Indent58221-3 | Guardian or legally authorized representative participated in assessment | |||
| Indent Indent87224-2 | Correction Request | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent87226-7 | Name of Resident | |||
| Indent Indent Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent87227-5 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent87216-8 | Date on existing record to be modified/inactivated | |||
| Indent Indent Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent87209-3 | Correction Attestation Section | |||
| Indent Indent Indent Indent58200-7 | Correction Number | {#} | ||
| Indent Indent Indent Indent87217-6 | Reasons for Modification | 1..6 | ||
| Indent Indent Indent Indent87225-9 | Reasons for Inactivation | 1..2 | ||
| Indent Indent Indent Indent87218-4 | RN Assessment Coordinator Attestation of Completion | |||
| Indent Indent Indent Indent Indent87219-2 | Attesting individual's first name | |||
| Indent Indent Indent Indent Indent87220-0 | Attesting individual's last name | |||
| Indent Indent Indent Indent Indent87221-8 | Attesting individual's title | |||
| Indent Indent Indent Indent Indent87222-6 | Attestation date | {mm/dd/yyyy} | ||
| Indent Indent87228-3 | Assessment Administration | |||
| Indent Indent Indent55064-0 | Medicare Part A Billing | |||
| Indent Indent Indent Indent55065-7 | Medicare Part A HIPPS code | |||
| Indent Indent Indent Indent55066-5 | RUG version code | |||
| Indent Indent Indent Indent58421-9 | Is this a Medicare Short Stay assessment? | |||
| Indent Indent Indent59375-6 | Medicare Part A Non-Therapy Billing | |||
| Indent Indent Indent Indent58210-6 | Medicare Part A non-therapy HIPPS code | |||
| Indent Indent Indent Indent58211-4 | RUG version code | |||
| Indent Indent Indent55070-7 | Insurance Billing | |||
| Indent Indent Indent Indent55071-5 | RUG billing code | |||
| Indent Indent Indent Indent55072-3 | RUG billing version | |||
| Indent86871-1 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment] | |||
| Indent Indent86811-7 | Identification Information | |||
| Indent Indent Indent58198-3 | Type of Record | |||
| Indent Indent Indent54581-4 | Facility Provider Numbers | |||
| Indent Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
| Indent Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
| Indent Indent Indent Indent45398-5 | State Provider Number | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent86524-6 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent54587-1 | Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent71440-2 | Type of discharge | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent86526-1 | Unit Certification or Licensure Designation | |||
| Indent Indent Indent54503-8 | Legal Name of Resident | |||
| Indent Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent Indent45394-4 | Last name | |||
| Indent Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent Indent45966-9 | Social Security and Medicare Numbers | |||
| Indent Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent Indent45397-7 | Medicare number (or comparable railroad insurance number) | |||
| Indent Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent59362-4 | Race/Ethnicity | 1..6 | ||
| Indent Indent Indent54505-3 | Language | |||
| Indent Indent Indent Indent54588-9 | Does the resident need or want an interpreter to communicate with a doctor or health care staff? | |||
| Indent Indent Indent Indent54899-0 | Preferred language | |||
| Indent Indent Indent45404-1 | Marital Status | |||
| Indent Indent Indent54506-1 | Optional Resident Items | |||
| Indent Indent Indent Indent46106-1 | Medical record number [Identifier] | |||
| Indent Indent Indent Indent45403-3 | Room number [Location] | |||
| Indent Indent Indent Indent52462-9 | Name by which resident prefers to be addressed | |||
| Indent Indent Indent Indent21843-8 | Lifetime occupation(s) | |||
| Indent Indent Indent86528-7 | Most Recent Admission/Entry or Reentry into this Facility | |||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54590-5 | Type of Entry | |||
| Indent Indent Indent Indent85398-6 | Entered From | |||
| Indent Indent Indent52455-3 | Admission Date (Date this episode of care in this facility began) | {mm/dd/yyyy} | ||
| Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent55128-3 | Discharge Status | |||
| Indent Indent Indent54593-9 | Assessment Reference Date. Observation end date | {mm/dd/yyyy} | ||
| Indent Indent Indent54507-9 | Medicare Stay | |||
| Indent Indent Indent Indent54594-7 | Has the resident had a Medicare-covered stay since the most recent entry? | |||
| Indent Indent Indent Indent54595-4 | Start date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54596-2 | End date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent86869-5 | Hearing, Speech, and Vision | |||
| Indent Indent Indent54597-0 | Comatose. Persistent vegetative state/no discernible consciousness | |||
| Indent Indent86882-8 | Cognitive patterns | |||
| Indent Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
| Indent Indent Indent52491-8 | Brief Interview for Mental Status (BIMS) | |||
| Indent Indent Indent Indent52731-7 | Repetition of Three Words. Number of words repeated after first attempt | |||
| Indent Indent Indent Indent54510-3 | Temporal Orientation (orientation to year, month, and day) | |||
| Indent Indent Indent Indent Indent52732-5 | Able to report correct year | |||
| Indent Indent Indent Indent Indent52733-3 | Able to report correct month | |||
| Indent Indent Indent Indent Indent54609-3 | Able to report correct day of the week | |||
| Indent Indent Indent Indent52493-4 | Recall | |||
| Indent Indent Indent Indent Indent52735-8 | Able to recall "sock" | |||
| Indent Indent Indent Indent Indent52736-6 | Able to recall "blue" | |||
| Indent Indent Indent Indent Indent52737-4 | Able to recall "bed" | |||
| Indent Indent Indent Indent54614-3 | BIMS Summary Score | {score} | ||
| Indent Indent Indent54615-0 | Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted? | |||
| Indent Indent Indent86814-1 | Staff Assessment for Mental Status | |||
| Indent Indent Indent Indent54616-8 | Short-term Memory OK. Seems or appears to recall after 5 minutes | |||
| Indent Indent Indent Indent54624-2 | Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life | |||
| Indent Indent Indent86584-0 | Delirium | |||
| Indent Indent Indent Indent86585-7 | Signs and Symptoms of Delirium (from CAM) | |||
| Indent Indent Indent Indent Indent54632-5 | Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline? | |||
| Indent Indent Indent Indent Indent54628-3 | Inattention - Did the resident have difficulty focusing attention, for example being easily distractible, or having difficulty keeping track of what was being said? | |||
| Indent Indent Indent Indent Indent54629-1 | Disorganized thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)? | |||
| Indent Indent Indent Indent Indent54630-9 | Altered level of consciousness - Did the resident have altered level of consciousness as indicated by any of the following criteria? | |||
| Indent Indent54633-3 | Mood | |||
| Indent Indent Indent54634-1 | Should Resident Mood Interview be Conducted? | |||
| Indent Indent Indent54635-8 | Resident Mood Interview (PHQ-9) | |||
| Indent Indent Indent Indent86843-0 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent Indent86844-8 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent54654-9 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent Indent54657-2 | Staff Assessment of Resident Mood (PHQ-9-OV) | |||
| Indent Indent Indent Indent86833-1 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54658-0 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54660-6 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54662-2 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54664-8 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54666-3 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54668-9 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54670-5 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54672-1 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54673-9 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54675-4 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent Indent86891-9 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54659-8 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54661-4 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54663-0 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54665-5 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54667-1 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54669-7 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54671-3 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54904-8 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54674-7 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54676-2 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent54677-0 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent86815-8 | Behavior | |||
| Indent Indent Indent86597-2 | Potential Indicators of Psychosis | 1..2 | ||
| Indent Indent Indent54514-5 | Behavioral Symptom - Presence & Frequency | |||
| Indent Indent Indent Indent54682-0 | Physical behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54683-8 | Verbal behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54684-6 | Other behavioral symptoms not directed toward others | d/(7.d) | ||
| Indent Indent Indent54692-9 | Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? | d/(7.d) | ||
| Indent Indent Indent54693-7 | Wandering - Presence & Frequency. Has the resident wandered? | d/(7.d) | ||
| Indent Indent86818-2 | Functional Status | |||
| Indent Indent Indent86880-2 | Activities of Daily Living (ADL) Assistance. Self-Performance | |||
| Indent Indent Indent Indent45588-1 | Bed mobility | |||
| Indent Indent Indent Indent45590-7 | Transfer | |||
| Indent Indent Indent Indent45592-3 | Walk in room | |||
| Indent Indent Indent Indent45594-9 | Walk in corridor | |||
| Indent Indent Indent Indent45596-4 | Locomotion on unit | |||
| Indent Indent Indent Indent45598-0 | Locomotion off unit | |||
| Indent Indent Indent Indent45600-4 | Dressing | |||
| Indent Indent Indent Indent45602-0 | Eating | |||
| Indent Indent Indent Indent45604-6 | Toilet use | |||
| Indent Indent Indent Indent45606-1 | Personal hygiene | |||
| Indent Indent Indent86884-4 | Activities of daily living (ADL) assistance. Support provided | |||
| Indent Indent Indent Indent45589-9 | Bed mobility | |||
| Indent Indent Indent Indent45591-5 | Transfer | |||
| Indent Indent Indent Indent45603-8 | Eating | |||
| Indent Indent Indent Indent45605-3 | Toilet use | |||
| Indent Indent Indent86887-7 | Bathing | |||
| Indent Indent Indent Indent45608-7 | Self-performance | |||
| Indent Indent86615-2 | Functional Abilities and Goals - Discharge (End of SNF PPS Stay) | |||
| Indent Indent Indent86616-0 | Self-Care - Discharge Performance | |||
| Indent Indent Indent Indent83232-9 | Eating | |||
| Indent Indent Indent Indent83230-3 | Oral hygiene | |||
| Indent Indent Indent Indent83228-7 | Toileting hygiene | |||
| Indent Indent Indent86617-8 | Mobility - Discharge Performance | |||
| Indent Indent Indent Indent83216-2 | Sit to lying | |||
| Indent Indent Indent Indent83214-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83212-1 | Sit to stand | |||
| Indent Indent Indent Indent83210-5 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent83208-9 | Toilet transfer | |||
| Indent Indent Indent Indent83278-2 | Does the resident walk? | |||
| Indent Indent Indent Indent83202-2 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83200-6 | Walk 150 feet | |||
| Indent Indent Indent Indent83271-7 | Does the resident use a wheelchair/scooter? | |||
| Indent Indent Indent Indent83188-3 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent Indent83235-2 | Wheel 150 feet | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent86820-8 | Bladder and Bowel | |||
| Indent Indent Indent86624-4 | Appliances | 1..4 | ||
| Indent Indent Indent86866-1 | Urinary Toileting Program | |||
| Indent Indent Indent Indent54767-9 | Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility? | |||
| Indent Indent Indent Indent54769-5 | Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence? | |||
| Indent Indent Indent54770-3 | Urinary Continence | 1..1 | ||
| Indent Indent Indent54771-1 | Bowel Continence | 1..1 | ||
| Indent Indent Indent54772-9 | Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence? | |||
| Indent Indent86670-7 | Active Diagnoses | |||
| Indent Indent Indent86671-5 | Active Diagnoses in the last 7 days | 1..* | ||
| Indent Indent Indent52797-8 | Additional active diagnoses | 0..10 | ||
| Indent Indent86822-4 | Health Conditions | |||
| Indent Indent Indent54557-4 | Pain Management | |||
| Indent Indent Indent Indent71447-7 | At any time in the last 5 days, has the resident: Received scheduled pain medication regimen? | |||
| Indent Indent Indent Indent71448-5 | At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined? | |||
| Indent Indent Indent Indent71449-3 | At any time in the last 5 days, has the resident: Received non-medication intervention for pain? | |||
| Indent Indent Indent54828-9 | Should Pain Assessment Interview be Conducted? | |||
| Indent Indent Indent54558-2 | Pain Assessment Interview | |||
| Indent Indent Indent Indent54829-7 | Pain Presence. Have you had pain or hurting at any time in the last 5 days? | |||
| Indent Indent Indent Indent54830-5 | Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days? | |||
| Indent Indent Indent Indent54559-0 | Pain Effect on Function | |||
| Indent Indent Indent Indent Indent54831-3 | Over the past 5 days, has pain made it hard for you to sleep at night? | |||
| Indent Indent Indent Indent Indent54832-1 | Over the past 5 days, have you limited your day-to-day activities because of pain? | |||
| Indent Indent Indent Indent54560-8 | Pain Intensity | |||
| Indent Indent Indent Indent Indent54833-9 | Numeric Rating Scale (00-10) | |||
| Indent Indent Indent Indent Indent54834-7 | Verbal Descriptor Scale | |||
| Indent Indent Indent86890-1 | Other Health Conditions | |||
| Indent Indent Indent Indent86675-6 | Shortness of Breath (dyspnea) | 1..3 | ||
| Indent Indent Indent Indent54846-1 | Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months? | |||
| Indent Indent Indent Indent86676-4 | Problem Conditions | 1..4 | ||
| Indent Indent Indent54853-7 | Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent? | |||
| Indent Indent Indent54854-5 | Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent | |||
| Indent Indent Indent Indent54855-2 | No injury | |||
| Indent Indent Indent Indent54856-0 | Injury (except major) | |||
| Indent Indent Indent Indent54857-8 | Major injury | |||
| Indent Indent86825-7 | Swallowing/Nutritional Status | |||
| Indent Indent Indent54567-3 | Height and Weight | |||
| Indent Indent Indent Indent3137-7 | Height (in inches) | [in_us];cm;m | ||
| Indent Indent Indent Indent3141-9 | Weight (in pounds) | [lb_av];kg | ||
| Indent Indent Indent54863-6 | Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months | |||
| Indent Indent Indent86678-0 | Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months | |||
| Indent Indent Indent54568-1 | Nutritional Approaches | |||
| Indent Indent Indent Indent71444-4 | Nutritional Approaches. While NOT a Resident | 1..4 | ||
| Indent Indent Indent Indent71445-1 | Nutritional Approaches. While a Resident | 1..4 | ||
| Indent Indent86828-1 | Skin Conditions | |||
| Indent Indent Indent86708-5 | Determination of Pressure Ulcer Risk | 0..1 | ||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher? | |||
| Indent Indent Indent86270-6 | Current Number of Unhealed Pressure Ulcers at Each Stage | |||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54886-7 | Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54887-5 | Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54890-9 | Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54894-1 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54947-7 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure ulcers with suspected deep tissue injury in evolution | {#} | ||
| Indent Indent Indent Indent54951-9 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent86746-5 | Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar | |||
| Indent Indent Indent Indent86901-6 | Pressure ulcer length: Longest length from head to toe | cm | ||
| Indent Indent Indent Indent86902-4 | Pressure ulcer width: Widest width of the same pressure ulcer, side-to-side perpendicular (90-degree angle) to length | cm | ||
| Indent Indent Indent Indent57228-9 | Pressure ulcer depth: Depth of the same pressure ulcer from the visible surface to the deepest area | cm | ||
| Indent Indent Indent54952-7 | Worsening in Pressure Ulcer Status Since Prior Assessment (OBRA or Scheduled PPS) or Last Admission/Entry or Reentry | |||
| Indent Indent Indent Indent54953-5 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54954-3 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54955-0 | Stage 4 | {#} | ||
| Indent Indent Indent54956-8 | Healed Pressure Ulcers | |||
| Indent Indent Indent Indent54957-6 | Were pressure ulcers present on the prior assessment (OBRA or scheduled PPS)? | |||
| Indent Indent Indent Indent54958-4 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54959-2 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54960-0 | Stage 4 | {#} | ||
| Indent Indent86832-3 | Medications | |||
| Indent Indent Indent86750-7 | Medications Received | |||
| Indent Indent Indent Indent86751-5 | Antipsychotic | d/(7.d) | ||
| Indent Indent Indent Indent86752-3 | Antianxiety | d/(7.d) | ||
| Indent Indent Indent Indent86753-1 | Antidepressant | d/(7.d) | ||
| Indent Indent Indent Indent86754-9 | Hypnotic | d/(7.d) | ||
| Indent Indent Indent Indent86755-6 | Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin) | d/(7.d) | ||
| Indent Indent Indent Indent86756-4 | Antibiotic | d/(7.d) | ||
| Indent Indent Indent Indent86757-2 | Diuretic | d/(7.d) | ||
| Indent Indent86837-2 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent86761-4 | While a Resident | 0..4 | ||
| Indent Indent Indent69339-0 | Influenza Vaccine | |||
| Indent Indent Indent Indent55019-4 | Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season? | |||
| Indent Indent Indent Indent58131-4 | Date influenza vaccine received | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent55020-2 | If influenza vaccine not received, state reason: | |||
| Indent Indent Indent55021-0 | Pneumococcal Vaccine | |||
| Indent Indent Indent Indent55022-8 | Is the resident's Pneumococcal vaccination up to date? | |||
| Indent Indent Indent Indent45956-0 | If Pneumococcal vaccine not received, state reason: | |||
| Indent Indent Indent86842-2 | Therapies | |||
| Indent Indent Indent Indent86763-0 | Speech-Language Pathology and Audiology Services | |||
| Indent Indent Indent Indent Indent58218-9 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58133-0 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58134-8 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86765-5 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45760-6 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55025-1 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55026-9 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86767-1 | Occupational Therapy | |||
| Indent Indent Indent Indent Indent58219-7 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58136-3 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58137-1 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86764-8 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45762-2 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55027-7 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55028-5 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86768-9 | Physical Therapy | |||
| Indent Indent Indent Indent Indent58220-5 | Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58139-7 | Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | min | ||
| Indent Indent Indent Indent Indent58140-5 | Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | min | ||
| Indent Indent Indent Indent Indent86766-3 | Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | min | ||
| Indent Indent Indent Indent Indent45764-8 | Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | d/(7.d) | ||
| Indent Indent Indent Indent Indent55029-3 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55030-1 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent86769-7 | Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days. | d | ||
| Indent Indent Indent86770-5 | Resumption of Therapy | |||
| Indent Indent Indent Indent86772-1 | Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline? | |||
| Indent Indent Indent Indent86771-3 | Date on which therapy regimen resumed | {mm/dd/yyyy} | ||
| Indent Indent Indent86773-9 | Restorative Nursing Programs | |||
| Indent Indent Indent Indent86774-7 | Technique. Range of motion (passive) | d/(7.d) | ||
| Indent Indent Indent Indent86775-4 | Technique. Range of motion (active) | d/(7.d) | ||
| Indent Indent Indent Indent86776-2 | Technique. Splint or brace assistance | d/(7.d) | ||
| Indent Indent Indent Indent86777-0 | Training and Skill Practice In: Bed mobility | d/(7.d) | ||
| Indent Indent Indent Indent86778-8 | Training and Skill Practice In: Transfer | d/(7.d) | ||
| Indent Indent Indent Indent86779-6 | Training and Skill Practice In: Walking | d/(7.d) | ||
| Indent Indent Indent Indent86780-4 | Training and Skill Practice In: Dressing and/or grooming | d/(7.d) | ||
| Indent Indent Indent Indent86781-2 | Training and Skill Practice In: Eating and/or swallowing | d/(7.d) | ||
| Indent Indent Indent Indent86782-0 | Training and Skill Practice In: Amputation/prostheses care | d/(7.d) | ||
| Indent Indent Indent Indent86783-8 | Training and Skill Practice In: Communication | d/(7.d) | ||
| Indent Indent86784-6 | Restraints | |||
| Indent Indent Indent86785-3 | Physical Restraints | |||
| Indent Indent Indent Indent86786-1 | Used in Bed. Bed rail | d/(7.d) | ||
| Indent Indent Indent Indent86787-9 | Used in Bed. Trunk restraint | d/(7.d) | ||
| Indent Indent Indent Indent86788-7 | Used in Bed. Limb restraint | d/(7.d) | ||
| Indent Indent Indent Indent86789-5 | Used in Bed. Other | d/(7.d) | ||
| Indent Indent Indent Indent86790-3 | Used in Chair or Out of Bed. Trunk restraint | d/(7.d) | ||
| Indent Indent Indent Indent86791-1 | Used in Chair or Out of Bed. Limb restraint | d/(7.d) | ||
| Indent Indent Indent Indent86792-9 | Used in Chair or Out of Bed. Chair prevents rising | d/(7.d) | ||
| Indent Indent Indent Indent86793-7 | Used in Chair or Out of Bed. Other | d/(7.d) | ||
| Indent Indent86853-9 | Participation in Assessment and Goal Setting | |||
| Indent Indent Indent55053-3 | Participation in Assessment | |||
| Indent Indent Indent Indent55054-1 | Resident participated in assessment | |||
| Indent Indent Indent Indent55074-9 | Family or significant other participated in assessment | |||
| Indent Indent Indent Indent58221-3 | Guardian or legally authorized representative participated in assessment | |||
| Indent Indent Indent58146-2 | Discharge Plan. Is active discharge planning already occurring for the resident to return to the community? | |||
| Indent Indent Indent58150-4 | Referral. Has a referral been made to the Local Contact Agency? | |||
| Indent Indent87224-2 | Correction Request | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent87226-7 | Name of Resident | |||
| Indent Indent Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent87227-5 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent87216-8 | Date on existing record to be modified/inactivated | |||
| Indent Indent Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent87209-3 | Correction Attestation Section | |||
| Indent Indent Indent Indent58200-7 | Correction Number | {#} | ||
| Indent Indent Indent Indent87217-6 | Reasons for Modification | 1..6 | ||
| Indent Indent Indent Indent87225-9 | Reasons for Inactivation | 1..2 | ||
| Indent Indent Indent Indent87218-4 | RN Assessment Coordinator Attestation of Completion | |||
| Indent Indent Indent Indent Indent87219-2 | Attesting individual's first name | |||
| Indent Indent Indent Indent Indent87220-0 | Attesting individual's last name | |||
| Indent Indent Indent Indent Indent87221-8 | Attesting individual's title | |||
| Indent Indent Indent Indent Indent87222-6 | Attestation date | {mm/dd/yyyy} | ||
| Indent Indent87228-3 | Assessment Administration | |||
| Indent Indent Indent55064-0 | Medicare Part A Billing | |||
| Indent Indent Indent Indent55065-7 | Medicare Part A HIPPS code | |||
| Indent Indent Indent Indent55066-5 | RUG version code | |||
| Indent Indent Indent Indent58421-9 | Is this a Medicare Short Stay assessment? | |||
| Indent Indent Indent59375-6 | Medicare Part A Non-Therapy Billing | |||
| Indent Indent Indent Indent58210-6 | Medicare Part A non-therapy HIPPS code | |||
| Indent Indent Indent Indent58211-4 | RUG version code | |||
| Indent Indent Indent55070-7 | Insurance Billing | |||
| Indent Indent Indent Indent55071-5 | RUG billing code | |||
| Indent Indent Indent Indent55072-3 | RUG billing version | |||
| Indent86872-9 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment] | |||
| Indent Indent86811-7 | Identification Information | |||
| Indent Indent Indent58198-3 | Type of Record | |||
| Indent Indent Indent54581-4 | Facility Provider Numbers | |||
| Indent Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
| Indent Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
| Indent Indent Indent Indent45398-5 | State Provider Number | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent86524-6 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent54587-1 | Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent71440-2 | Type of discharge | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent86526-1 | Unit Certification or Licensure Designation | |||
| Indent Indent Indent54503-8 | Legal Name of Resident | |||
| Indent Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent Indent45394-4 | Last name | |||
| Indent Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent Indent45966-9 | Social Security and Medicare Numbers | |||
| Indent Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent Indent45397-7 | Medicare number (or comparable railroad insurance number) | |||
| Indent Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent59362-4 | Race/Ethnicity | 1..6 | ||
| Indent Indent Indent54505-3 | Language | |||
| Indent Indent Indent Indent54588-9 | Does the resident need or want an interpreter to communicate with a doctor or health care staff? | |||
| Indent Indent Indent Indent54899-0 | Preferred language | |||
| Indent Indent Indent45404-1 | Marital Status | |||
| Indent Indent Indent54506-1 | Optional Resident Items | |||
| Indent Indent Indent Indent46106-1 | Medical record number [Identifier] | |||
| Indent Indent Indent Indent45403-3 | Room number [Location] | |||
| Indent Indent Indent Indent52462-9 | Name by which resident prefers to be addressed | |||
| Indent Indent Indent Indent21843-8 | Lifetime occupation(s) | |||
| Indent Indent Indent86528-7 | Most Recent Admission/Entry or Reentry into this Facility | |||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54590-5 | Type of Entry | |||
| Indent Indent Indent Indent85398-6 | Entered From | |||
| Indent Indent Indent52455-3 | Admission Date (Date this episode of care in this facility began) | {mm/dd/yyyy} | ||
| Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent55128-3 | Discharge Status | |||
| Indent Indent Indent54593-9 | Assessment Reference Date. Observation end date | {mm/dd/yyyy} | ||
| Indent Indent Indent54507-9 | Medicare Stay | |||
| Indent Indent Indent Indent54594-7 | Has the resident had a Medicare-covered stay since the most recent entry? | |||
| Indent Indent Indent Indent54595-4 | Start date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54596-2 | End date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent86869-5 | Hearing, Speech, and Vision | |||
| Indent Indent Indent54597-0 | Comatose. Persistent vegetative state/no discernible consciousness | |||
| Indent Indent86882-8 | Cognitive Patterns | |||
| Indent Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
| Indent Indent Indent52491-8 | Brief Interview for Mental Status (BIMS) | |||
| Indent Indent Indent Indent52731-7 | Repetition of Three Words. Number of words repeated after first attempt | |||
| Indent Indent Indent Indent54510-3 | Temporal Orientation (orientation to year, month, and day) | |||
| Indent Indent Indent Indent Indent52732-5 | Able to report correct year | |||
| Indent Indent Indent Indent Indent52733-3 | Able to report correct month | |||
| Indent Indent Indent Indent Indent54609-3 | Able to report correct day of the week | |||
| Indent Indent Indent Indent52493-4 | Recall | |||
| Indent Indent Indent Indent Indent52735-8 | Able to recall "sock" | |||
| Indent Indent Indent Indent Indent52736-6 | Able to recall "blue" | |||
| Indent Indent Indent Indent Indent52737-4 | Able to recall "bed" | |||
| Indent Indent Indent Indent54614-3 | BIMS Summary Score | {score} | ||
| Indent Indent Indent54615-0 | Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted? | |||
| Indent Indent Indent86814-1 | Staff Assessment for Mental Status | |||
| Indent Indent Indent Indent54616-8 | Short-term Memory OK. Seems or appears to recall after 5 minutes | |||
| Indent Indent Indent Indent54624-2 | Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life | |||
| Indent Indent Indent86584-0 | Delirium | |||
| Indent Indent Indent Indent86585-7 | Signs and Symptoms of Delirium (from CAM) | |||
| Indent Indent Indent Indent Indent54632-5 | Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline? | |||
| Indent Indent Indent Indent Indent54628-3 | Inattention - Did the resident have difficulty focusing attention, for example being easily distractible, or having difficulty keeping track of what was being said? | |||
| Indent Indent Indent Indent Indent54629-1 | Disorganized thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)? | |||
| Indent Indent Indent Indent Indent54630-9 | Altered level of consciousness - Did the resident have altered level of consciousness as indicated by any of the following criteria? | |||
| Indent Indent54633-3 | Mood | |||
| Indent Indent Indent54634-1 | Should Resident Mood Interview be Conducted? | |||
| Indent Indent Indent54635-8 | Resident Mood Interview (PHQ-9) | |||
| Indent Indent Indent Indent86843-0 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent Indent86844-8 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent54654-9 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent Indent54657-2 | Staff Assessment of Resident Mood (PHQ-9-OV) | |||
| Indent Indent Indent Indent86833-1 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54658-0 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54660-6 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54662-2 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54664-8 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54666-3 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54668-9 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54670-5 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54672-1 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54673-9 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54675-4 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent Indent86891-9 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54659-8 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54661-4 | Feeling or appearing down, depressed, or hopeless | |||
| Indent Indent Indent Indent Indent54663-0 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54665-5 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54667-1 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54669-7 | Indicating that s/he feels bad about self, is a failure, or has let self or family down | |||
| Indent Indent Indent Indent Indent54671-3 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54904-8 | Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54674-7 | States that life isn't worth living, wishes for death, or attempts to harm self | |||
| Indent Indent Indent Indent Indent54676-2 | Being short-tempered, easily annoyed | |||
| Indent Indent Indent54677-0 | Total Severity Score | {score} | ||
| Indent Indent Indent54655-6 | Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm? | |||
| Indent Indent86815-8 | Behavior | |||
| Indent Indent Indent86597-2 | Potential Indicators of Psychosis | 1..2 | ||
| Indent Indent Indent54514-5 | Behavioral Symptom - Presence & Frequency | |||
| Indent Indent Indent Indent54682-0 | Physical behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54683-8 | Verbal behavioral symptoms directed toward others | d/(7.d) | ||
| Indent Indent Indent Indent54684-6 | Other behavioral symptoms not directed toward others | d/(7.d) | ||
| Indent Indent Indent54692-9 | Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? | d/(7.d) | ||
| Indent Indent Indent54693-7 | Wandering - Presence & Frequency. Has the resident wandered? | d/(7.d) | ||
| Indent Indent86819-0 | Functional Status | |||
| Indent Indent Indent86880-2 | Activities of Daily Living (ADL) Assistance. Self-Performance | |||
| Indent Indent Indent Indent45588-1 | Bed mobility | |||
| Indent Indent Indent Indent45590-7 | Transfer | |||
| Indent Indent Indent Indent45592-3 | Walk in room | |||
| Indent Indent Indent Indent45594-9 | Walk in corridor | |||
| Indent Indent Indent Indent45596-4 | Locomotion on unit | |||
| Indent Indent Indent Indent45598-0 | Locomotion off unit | |||
| Indent Indent Indent Indent45600-4 | Dressing | |||
| Indent Indent Indent Indent45602-0 | Eating | |||
| Indent Indent Indent Indent45604-6 | Toilet use | |||
| Indent Indent Indent Indent45606-1 | Personal hygiene | |||
| Indent Indent Indent86887-7 | Bathing | |||
| Indent Indent Indent Indent45608-7 | Self-performance | |||
| Indent Indent86615-2 | Functional Abilities and Goals - Discharge (End of SNF PPS Stay) | |||
| Indent Indent Indent86616-0 | Self-Care - Discharge Performance | |||
| Indent Indent Indent Indent83232-9 | Eating | |||
| Indent Indent Indent Indent83230-3 | Oral hygiene | |||
| Indent Indent Indent Indent83228-7 | Toileting hygiene | |||
| Indent Indent Indent86617-8 | Mobility - Discharge Performance | |||
| Indent Indent Indent Indent83216-2 | Sit to lying | |||
| Indent Indent Indent Indent83214-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83212-1 | Sit to stand | |||
| Indent Indent Indent Indent83210-5 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent83208-9 | Toilet transfer | |||
| Indent Indent Indent Indent83278-2 | Does the resident walk? | |||
| Indent Indent Indent Indent83202-2 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83200-6 | Walk 150 feet | |||
| Indent Indent Indent Indent83271-7 | Does the resident use a wheelchair/scooter? | |||
| Indent Indent Indent Indent83188-3 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent Indent83235-2 | Wheel 150 feet | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent86879-4 | Bladder and Bowel | |||
| Indent Indent Indent86624-4 | Appliances | 1..4 | ||
| Indent Indent Indent54770-3 | Urinary Continence | 1..1 | ||
| Indent Indent Indent54771-1 | Bowel Continence | 1..1 | ||
| Indent Indent86670-7 | Active Diagnoses | |||
| Indent Indent Indent86671-5 | Active Diagnoses in the last 7 days | 1..* | ||
| Indent Indent Indent52797-8 | Additional active diagnoses | 0..10 | ||
| Indent Indent86822-4 | Health Conditions | |||
| Indent Indent Indent54557-4 | Pain Management | |||
| Indent Indent Indent Indent71447-7 | At any time in the last 5 days, has the resident: Received scheduled pain medication regimen? | |||
| Indent Indent Indent Indent71448-5 | At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined? | |||
| Indent Indent Indent Indent71449-3 | At any time in the last 5 days, has the resident: Received non-medication intervention for pain? | |||
| Indent Indent Indent54828-9 | Should Pain Assessment Interview be Conducted? | |||
| Indent Indent Indent54558-2 | Pain Assessment Interview | |||
| Indent Indent Indent Indent54829-7 | Pain Presence. Have you had pain or hurting at any time in the last 5 days? | |||
| Indent Indent Indent Indent54830-5 | Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days? | |||
| Indent Indent Indent Indent54559-0 | Pain Effect on Function | |||
| Indent Indent Indent Indent Indent54831-3 | Over the past 5 days, has pain made it hard for you to sleep at night? | |||
| Indent Indent Indent Indent Indent54832-1 | Over the past 5 days, have you limited your day-to-day activities because of pain? | |||
| Indent Indent Indent Indent54560-8 | Pain Intensity | |||
| Indent Indent Indent Indent Indent54833-9 | Numeric Rating Scale (00-10) | |||
| Indent Indent Indent Indent Indent54834-7 | Verbal Descriptor Scale | |||
| Indent Indent Indent86890-1 | Other Health Conditions | |||
| Indent Indent Indent Indent86675-6 | Shortness of Breath (dyspnea) | 1..3 | ||
| Indent Indent Indent Indent54846-1 | Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months? | |||
| Indent Indent Indent Indent86676-4 | Problem Conditions | 1..4 | ||
| Indent Indent Indent54853-7 | Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent? | |||
| Indent Indent Indent54854-5 | Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent | |||
| Indent Indent Indent Indent54855-2 | No injury | |||
| Indent Indent Indent Indent54856-0 | Injury (except major) | |||
| Indent Indent Indent Indent54857-8 | Major injury | |||
| Indent Indent86825-7 | Swallowing/Nutritional Status | |||
| Indent Indent Indent54567-3 | Height and Weight | |||
| Indent Indent Indent Indent3137-7 | Height (in inches) | [in_us];cm;m | ||
| Indent Indent Indent Indent3141-9 | Weight (in pounds) | [lb_av];kg | ||
| Indent Indent Indent54863-6 | Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months | |||
| Indent Indent Indent86678-0 | Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months | |||
| Indent Indent Indent54568-1 | Nutritional Approaches | |||
| Indent Indent Indent Indent71444-4 | Nutritional Approaches. While NOT a Resident | 0..4 | ||
| Indent Indent Indent Indent71445-1 | Nutritional Approaches. While a Resident | 1..4 | ||
| Indent Indent86828-1 | Skin Conditions | |||
| Indent Indent Indent86708-5 | Determination of Pressure Ulcer Risk | 0..1 | ||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher? | |||
| Indent Indent Indent86270-6 | Current Number of Unhealed Pressure Ulcers at Each Stage | |||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54886-7 | Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54887-5 | Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54890-9 | Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54894-1 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54947-7 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure ulcers with suspected deep tissue injury in evolution | {#} | ||
| Indent Indent Indent Indent54951-9 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent86746-5 | Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar | |||
| Indent Indent Indent Indent86901-6 | Pressure ulcer length: Longest length from head to toe | cm | ||
| Indent Indent Indent Indent86902-4 | Pressure ulcer width: Widest width of the same pressure ulcer, side-to-side perpendicular (90-degree angle) to length | cm | ||
| Indent Indent Indent Indent57228-9 | Pressure ulcer depth: Depth of the same pressure ulcer from the visible surface to the deepest area | cm | ||
| Indent Indent Indent54952-7 | Worsening in Pressure Ulcer Status Since Prior Assessment (OBRA or Scheduled PPS) or Last Admission/Entry or Reentry | |||
| Indent Indent Indent Indent54953-5 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54954-3 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54955-0 | Stage 4 | {#} | ||
| Indent Indent Indent54956-8 | Healed Pressure Ulcers | |||
| Indent Indent Indent Indent54957-6 | Were pressure ulcers present on the prior assessment (OBRA or scheduled PPS)? | |||
| Indent Indent Indent Indent54958-4 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54959-2 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54960-0 | Stage 4 | {#} | ||
| Indent Indent86832-3 | Medications | |||
| Indent Indent Indent86750-7 | Medications Received | |||
| Indent Indent Indent Indent86751-5 | Antipsychotic | d/(7.d) | ||
| Indent Indent Indent Indent86752-3 | Antianxiety | d/(7.d) | ||
| Indent Indent Indent Indent86753-1 | Antidepressant | d/(7.d) | ||
| Indent Indent Indent Indent86754-9 | Hypnotic | d/(7.d) | ||
| Indent Indent Indent Indent86755-6 | Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin) | d/(7.d) | ||
| Indent Indent Indent Indent86756-4 | Antibiotic | d/(7.d) | ||
| Indent Indent Indent Indent86757-2 | Diuretic | d/(7.d) | ||
| Indent Indent86838-0 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent86761-4 | While a Resident | 0..1 | ||
| Indent Indent Indent69339-0 | Influenza Vaccine | |||
| Indent Indent Indent Indent55019-4 | Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season? | |||
| Indent Indent Indent Indent58131-4 | Date influenza vaccine received | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent55020-2 | If influenza vaccine not received, state reason: | |||
| Indent Indent Indent55021-0 | Pneumococcal Vaccine | |||
| Indent Indent Indent Indent55022-8 | Is the resident's Pneumococcal vaccination up to date? | |||
| Indent Indent Indent Indent45956-0 | If Pneumococcal vaccine not received, state reason: | |||
| Indent Indent Indent86845-5 | Therapies | |||
| Indent Indent Indent Indent86855-4 | Speech-Language Pathology and Audiology Services | |||
| Indent Indent Indent Indent Indent55025-1 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55026-9 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86848-9 | Occupational Therapy | |||
| Indent Indent Indent Indent Indent55027-7 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55028-5 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent86893-5 | Physical Therapy | |||
| Indent Indent Indent Indent Indent55029-3 | Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent Indent55030-1 | Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | {mm/dd/yyyy} | ||
| Indent Indent86784-6 | Restraints | |||
| Indent Indent Indent86785-3 | Physical Restraints | |||
| Indent Indent Indent Indent86786-1 | Used in Bed. Bed rail | d/(7.d) | ||
| Indent Indent Indent Indent86787-9 | Used in Bed. Trunk restraint | d/(7.d) | ||
| Indent Indent Indent Indent86788-7 | Used in Bed. Limb restraint | d/(7.d) | ||
| Indent Indent Indent Indent86789-5 | Used in Bed. Other | d/(7.d) | ||
| Indent Indent Indent Indent86790-3 | Used in Chair or Out of Bed. Trunk restraint | d/(7.d) | ||
| Indent Indent Indent Indent86791-1 | Used in Chair or Out of Bed. Limb restraint | d/(7.d) | ||
| Indent Indent Indent Indent86792-9 | Used in Chair or Out of Bed. Chair prevents rising | d/(7.d) | ||
| Indent Indent Indent Indent86793-7 | Used in Chair or Out of Bed. Other | d/(7.d) | ||
| Indent Indent86854-7 | Participation in Assessment and Goal Setting | |||
| Indent Indent Indent58146-2 | Discharge Plan. Is active discharge planning already occurring for the resident to return to the community? | |||
| Indent Indent Indent58150-4 | Referral. Has a referral been made to the Local Contact Agency? | |||
| Indent Indent87224-2 | Correction Request | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent87226-7 | Name of Resident | |||
| Indent Indent Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent87227-5 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent87216-8 | Date on existing record to be modified/inactivated | |||
| Indent Indent Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent87209-3 | Correction Attestation Section | |||
| Indent Indent Indent Indent58200-7 | Correction Number | {#} | ||
| Indent Indent Indent Indent87217-6 | Reasons for Modification | 1..6 | ||
| Indent Indent Indent Indent87225-9 | Reasons for Inactivation | 1..2 | ||
| Indent Indent Indent Indent87218-4 | RN Assessment Coordinator Attestation of Completion | |||
| Indent Indent Indent Indent Indent87219-2 | Attesting individual's first name | |||
| Indent Indent Indent Indent Indent87220-0 | Attesting individual's last name | |||
| Indent Indent Indent Indent Indent87221-8 | Attesting individual's title | |||
| Indent Indent Indent Indent Indent87222-6 | Attestation date | {mm/dd/yyyy} | ||
| Indent Indent87229-1 | Assessment Administration | |||
| Indent Indent Indent55070-7 | Insurance Billing | |||
| Indent Indent Indent Indent55071-5 | RUG billing code | |||
| Indent Indent Indent Indent55072-3 | RUG billing version | |||
| Indent86877-8 | MDS v3.0 - RAI v1.14.1 - Nursing Home Part A PPS Discharge (NPE) Item Set | |||
| Indent Indent86811-7 | Identification Information | |||
| Indent Indent Indent58198-3 | Type of Record | |||
| Indent Indent Indent54581-4 | Facility Provider Numbers | |||
| Indent Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
| Indent Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
| Indent Indent Indent Indent45398-5 | State Provider Number | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent86524-6 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent54587-1 | Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent71440-2 | Type of discharge | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent86526-1 | Unit Certification or Licensure Designation | |||
| Indent Indent Indent54503-8 | Legal Name of Resident | |||
| Indent Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent Indent45394-4 | Last name | |||
| Indent Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent Indent45966-9 | Social Security and Medicare Numbers | |||
| Indent Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent Indent45397-7 | Medicare number (or comparable railroad insurance number) | |||
| Indent Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent59362-4 | Race/Ethnicity | 1..6 | ||
| Indent Indent Indent54505-3 | Language | |||
| Indent Indent Indent Indent54588-9 | Does the resident need or want an interpreter to communicate with a doctor or health care staff? | |||
| Indent Indent Indent Indent54899-0 | Preferred language | |||
| Indent Indent Indent45404-1 | Marital Status | |||
| Indent Indent Indent54506-1 | Optional Resident Items | |||
| Indent Indent Indent Indent46106-1 | Medical record number [Identifier] | |||
| Indent Indent Indent Indent45403-3 | Room number [Location] | |||
| Indent Indent Indent Indent52462-9 | Name by which resident prefers to be addressed | |||
| Indent Indent Indent Indent21843-8 | Lifetime occupation(s) | |||
| Indent Indent Indent86528-7 | Most Recent Admission/Entry or Reentry into this Facility | |||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54590-5 | Type of Entry | |||
| Indent Indent Indent Indent85398-6 | Entered From | |||
| Indent Indent Indent52455-3 | Admission Date (Date this episode of care in this facility began) | {mm/dd/yyyy} | ||
| Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent55128-3 | Discharge Status | |||
| Indent Indent Indent54593-9 | Assessment Reference Date. Observation end date | {mm/dd/yyyy} | ||
| Indent Indent Indent54507-9 | Medicare Stay | |||
| Indent Indent Indent Indent54594-7 | Has the resident had a Medicare-covered stay since the most recent entry? | |||
| Indent Indent Indent Indent54595-4 | Start date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54596-2 | End date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent86615-2 | Functional Abilities and Goals - Discharge (End of SNF PPS Stay) | |||
| Indent Indent Indent86616-0 | Self-Care - Discharge Performance | |||
| Indent Indent Indent Indent83232-9 | Eating | |||
| Indent Indent Indent Indent83230-3 | Oral hygiene | |||
| Indent Indent Indent Indent83228-7 | Toileting hygiene | |||
| Indent Indent Indent86617-8 | Mobility - Discharge Performance | |||
| Indent Indent Indent Indent83216-2 | Sit to lying | |||
| Indent Indent Indent Indent83214-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83212-1 | Sit to stand | |||
| Indent Indent Indent Indent83210-5 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent83208-9 | Toilet transfer | |||
| Indent Indent Indent Indent83278-2 | Does the resident walk? | |||
| Indent Indent Indent Indent83202-2 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83200-6 | Walk 150 feet | |||
| Indent Indent Indent Indent83271-7 | Does the resident use a wheelchair/scooter? | |||
| Indent Indent Indent Indent83188-3 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent Indent83235-2 | Wheel 150 feet | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent86823-2 | Health Conditions | |||
| Indent Indent Indent54853-7 | Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent? | |||
| Indent Indent Indent54854-5 | Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent | |||
| Indent Indent Indent Indent54855-2 | No injury | |||
| Indent Indent Indent Indent54856-0 | Injury (except major) | |||
| Indent Indent Indent Indent54857-8 | Major injury | |||
| Indent Indent86830-7 | Skin Conditions | |||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher? | |||
| Indent Indent Indent86270-6 | Current Number of Unhealed Pressure Ulcers at Each Stage | |||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54886-7 | Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54887-5 | Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54890-9 | Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54894-1 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54947-7 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure ulcers with suspected deep tissue injury in evolution | {#} | ||
| Indent Indent Indent Indent54951-9 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
| Indent Indent Indent54952-7 | Worsening in Pressure Ulcer Status Since Prior Assessment (OBRA or Scheduled PPS) or Last Admission/Entry or Reentry | |||
| Indent Indent Indent Indent54953-5 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54954-3 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54955-0 | Stage 4 | {#} | ||
| Indent Indent87224-2 | Correction Request | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent87226-7 | Name of Resident | |||
| Indent Indent Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent87227-5 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent87216-8 | Date on existing record to be modified/inactivated | |||
| Indent Indent Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent87209-3 | Correction Attestation Section | |||
| Indent Indent Indent Indent58200-7 | Correction Number | {#} | ||
| Indent Indent Indent Indent87217-6 | Reasons for Modification | 1..6 | ||
| Indent Indent Indent Indent87225-9 | Reasons for Inactivation | 1..2 | ||
| Indent Indent Indent Indent87218-4 | RN Assessment Coordinator Attestation of Completion | |||
| Indent Indent Indent Indent Indent87219-2 | Attesting individual's first name | |||
| Indent Indent Indent Indent Indent87220-0 | Attesting individual's last name | |||
| Indent Indent Indent Indent Indent87221-8 | Attesting individual's title | |||
| Indent Indent Indent Indent Indent87222-6 | Attestation date | {mm/dd/yyyy} | ||
| Indent86875-2 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed tracking (NT/ST) item set [CMS Assessment] | |||
| Indent Indent86812-5 | Identification information | |||
| Indent Indent Indent58198-3 | Type of Record | |||
| Indent Indent Indent54581-4 | Facility Provider Numbers | |||
| Indent Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
| Indent Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
| Indent Indent Indent Indent45398-5 | State Provider Number | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent86524-6 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent54587-1 | Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent71440-2 | Type of discharge | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent86526-1 | Unit Certification or Licensure Designation | |||
| Indent Indent Indent54503-8 | Legal Name of Resident | |||
| Indent Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent Indent45394-4 | Last name | |||
| Indent Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent Indent45966-9 | Social Security and Medicare Numbers | |||
| Indent Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent Indent45397-7 | Medicare number (or comparable railroad insurance number) | |||
| Indent Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent59362-4 | Race/Ethnicity | 1..6 | ||
| Indent Indent Indent45404-1 | Marital Status | |||
| Indent Indent Indent54506-1 | Optional Resident Items | |||
| Indent Indent Indent Indent46106-1 | Medical record number [Identifier] | |||
| Indent Indent Indent Indent45403-3 | Room number [Location] | |||
| Indent Indent Indent Indent52462-9 | Name by which resident prefers to be addressed | |||
| Indent Indent Indent Indent21843-8 | Lifetime occupation(s) | |||
| Indent Indent Indent86528-7 | Most Recent Admission/Entry or Reentry into this Facility | |||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54590-5 | Type of Entry | |||
| Indent Indent Indent Indent85398-6 | Entered From | |||
| Indent Indent Indent52455-3 | Admission Date (Date this episode of care in this facility began) | {mm/dd/yyyy} | ||
| Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent55128-3 | Discharge Status | |||
| Indent Indent Indent54507-9 | Medicare Stay | |||
| Indent Indent Indent Indent54594-7 | Has the resident had a Medicare-covered stay since the most recent entry? | |||
| Indent Indent Indent Indent54595-4 | Start date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent54596-2 | End date of most recent Medicare stay | {mm/dd/yyyy} | ||
| Indent Indent87224-2 | Correction Request | |||
| Indent Indent Indent85632-8 | Type of Provider | |||
| Indent Indent Indent87226-7 | Name of Resident | |||
| Indent Indent Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent87227-5 | Type of Assessment | |||
| Indent Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
| Indent Indent Indent Indent54584-8 | PPS Assessment | |||
| Indent Indent Indent Indent54585-5 | PPS Other Medicare Required Assessment - OMRA | |||
| Indent Indent Indent Indent58107-4 | Is this a Swing Bed clinical change assessment? | |||
| Indent Indent Indent Indent58108-2 | Entry/discharge reporting | |||
| Indent Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
| Indent Indent Indent87216-8 | Date on existing record to be modified/inactivated | |||
| Indent Indent Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
| Indent Indent Indent87209-3 | Correction Attestation Section | |||
| Indent Indent Indent Indent58200-7 | Correction Number | {#} | ||
| Indent Indent Indent Indent87217-6 | Reasons for Modification | 1..6 | ||
| Indent Indent Indent Indent87225-9 | Reasons for Inactivation | 1..2 | ||
| Indent Indent Indent Indent87218-4 | RN Assessment Coordinator Attestation of Completion | |||
| Indent Indent Indent Indent Indent87219-2 | Attesting individual's first name | |||
| Indent Indent Indent Indent Indent87220-0 | Attesting individual's last name | |||
| Indent Indent Indent Indent Indent87221-8 | Attesting individual's title | |||
| Indent Indent Indent Indent Indent87222-6 | Attestation date | {mm/dd/yyyy} |
Fully-Specified Name
- Component
- Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.14.1
- Property
- -
- Time
- Pt
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.63
- Last Updated
- Version 2.73
- Change Reason
- Release 2.73: Status: LOINC will keep most current version and one prior version of CMS assessments active and discourage all older versions.; Release 2.67: DefinitionDescription: Added missing Term Description
- Order vs. Observation
- Order
- Panel Type
- Convenience group
LOINC Terminology Service (API) using HL7® FHIR® Get Info
Requests to this service require a free LOINC username and password. Below is a sample of the possible capabilities. See the LOINC Terminology Service documentation for more information.
- CodeSystem lookup
- https:
//fhir.loinc.org/CodeSystem/$lookup?system=http: //loinc.org&code=86521-2 - Questionnaire definition
- https:
//fhir.loinc.org/Questionnaire/?url=http: //loinc.org/q/86521-2
LOINC Copyright
Copyright © 2024 Regenstrief Institute, Inc. All Rights Reserved. To the extent included herein, the LOINC table and LOINC codes are copyright