86905-7
Deprecated Outcome and assessment information set (OASIS) form - version C2 [CMS Assessment]
Deprecated
Status Information
- Status
- DEPRECATED
Term Description
This panel should be used for CMS OASIS-C2 assessments performed between January 1, 2017 and December 31, 2018.
Source: Regenstrief LOINC
Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
| LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
|---|---|---|---|---|
| 86905-7 | Deprecated Outcome and assessment information set (OASIS) form - version C2 [CMS Assessment] | |||
| Indent85907-4 | Deprecated Outcome and assessment information set (OASIS) form - version C2 - Start of care [CMS Assessment] | |||
| Indent Indent85908-2 | Home Health Patient Tracking Sheet | |||
| Indent Indent Indent69417-4 | CMS Certification Number | |||
| Indent Indent Indent46494-1 | Branch State | |||
| Indent Indent Indent46495-8 | Branch ID Number | |||
| Indent Indent Indent68468-8 | National Provider Identifier (NPI) for the attending physician who has signed the plan of care | |||
| Indent Indent Indent46496-6 | Patient ID Number | |||
| Indent Indent Indent46497-4 | Start of Care Date | {mm/dd/yyyy} | ||
| Indent Indent Indent54503-8 | Patient Name | |||
| Indent Indent Indent Indent45392-8 | (First) | |||
| Indent Indent Indent Indent45393-6 | (MI) | |||
| Indent Indent Indent Indent45394-4 | (Last) | |||
| Indent Indent Indent Indent45395-1 | (Suffix) | |||
| Indent Indent Indent46499-0 | Patient State of Residence | |||
| Indent Indent Indent45401-7 | Patient ZIP Code | |||
| Indent Indent Indent45397-7 | Medicare Number | |||
| Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent59362-4 | Race/Ethnicity | 1..6 | ||
| Indent Indent Indent57199-2 | Current Payment Sources for Home Care | 1..11 | ||
| Indent Indent57040-8 | CLINICAL RECORD ITEMS | |||
| Indent Indent Indent46500-5 | Discipline of Person Completing Assessment | |||
| Indent Indent Indent46501-3 | Date Assessment Completed | {mm/dd/yyyy} | ||
| Indent Indent Indent57200-8 | This Assessment is Currently Being Completed for the Following Reason | |||
| Indent Indent Indent57201-6 | Date of Physician-ordered Start of Care (Resumption of Care) | {mm/dd/yyyy} | ||
| Indent Indent Indent57202-4 | Date of Referral | {mm/dd/yyyy} | ||
| Indent Indent Indent57203-2 | Episode Timing: Is the Medicare home health payment episode for which this assessment will define a case mix group an "early" episode or a "later" episode in the patient's current sequence of adjacent Medicare home health payment episodes? | |||
| Indent Indent85909-0 | PATIENT HISTORY AND DIAGNOSES | |||
| Indent Indent Indent57204-0 | From which of the following Inpatient Facilities was the patient discharged within the past 14 days? | 1..7 | ||
| Indent Indent Indent86470-2 | Inpatient Discharge Date (most recent) | {mm/dd/yyyy} | ||
| Indent Indent Indent46504-7 | Inpatient Facility Diagnosis: ICD-10-CM Code | 1..6 | ||
| Indent Indent Indent46507-0 | Diagnosis Requiring Medical or Treatment Regimen Change Within Past 14 Days | 1..6 | ||
| Indent Indent Indent86469-4 | Conditions Prior to Medical or Treatment Regimen Change or Inpatient Stay Within Past 14 Days | 1..6 | ||
| Indent Indent Indent85911-6 | Diagnoses, Symptom Control, and Optional Diagnoses | |||
| Indent Indent Indent Indent85912-4 | Primary Diagnosis | |||
| Indent Indent Indent Indent Indent86255-7 | Primary Diagnosis: ICD-10-code | |||
| Indent Indent Indent Indent Indent85920-7 | Primary Diagnosis Symptom Control Rating | |||
| Indent Indent Indent Indent Indent85914-0 | Optional Diagnosis: ICD-10-CM | |||
| Indent Indent Indent Indent Indent86254-0 | Optional Diagnosis: ICD-10-CM - multiple coding | |||
| Indent Indent Indent Indent85913-2 | Other Diagnoses | 0..5 | ||
| Indent Indent Indent Indent Indent81885-6 | Other Diagnoses: ICD-10-CM | |||
| Indent Indent Indent Indent Indent85920-7 | Other Diagnoses Symptom Control Rating | |||
| Indent Indent Indent Indent Indent85914-0 | Optional Diagnosis: ICD-10-CM | |||
| Indent Indent Indent Indent Indent86254-0 | Optional Diagnosis: ICD-10-CM - multiple coding | |||
| Indent Indent Indent83243-6 | Active Diagnoses-Comorbidities and Co-existing Conditions | 0..2 | ||
| Indent Indent Indent46466-9 | Therapies the patient receives at home | 1..3 | ||
| Indent Indent Indent57319-6 | Risk for Hospitalization: Which of the following signs or symptoms characterize this patient as at risk for hospitalization? | 1..9 | ||
| Indent Indent Indent57206-5 | Overall Status: Which description best fits the patient's overall status? | |||
| Indent Indent Indent57207-3 | Risk factors, either present or past, likely to affect health status and/or outcome | 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 Indent85951-2 | Living Arrangements | |||
| Indent Indent Indent85950-4 | Patient Living Situation: Which of the following best describes the patient's residential circumstance and availability of assistance? | |||
| Indent Indent57042-4 | SENSORY STATUS | |||
| Indent Indent Indent57215-6 | Vision (with corrective lenses if the patient usually wears them) | |||
| Indent Indent Indent57216-4 | Ability to Hear (with hearing aid or hearing appliance if normally used) | |||
| Indent Indent Indent57217-2 | Understanding of Verbal Content in patient's own language (with hearing aid or device if used) | |||
| Indent Indent Indent57218-0 | Speech and Oral (Verbal) Expression of Language (in patient's own language) | |||
| Indent Indent Indent57219-8 | Has this patient had a formal Pain Assessment using a standardized, validated pain assessment tool (appropriate to the patient's ability to communicate the severity of pain)? | |||
| Indent Indent Indent57220-6 | Frequency of pain interfering with patient's activity or movement | |||
| Indent Indent85917-3 | INTEGUMENTARY STATUS | |||
| Indent Indent Indent57221-4 | Pressure Ulcer Assessment: Was this patient assessed for Risk of Developing Pressure Ulcers? | |||
| Indent Indent Indent57280-0 | Does this patient have a Risk of Developing Pressure Ulcers? | |||
| Indent Indent Indent85918-1 | Does this patient have at least one Unhealed Pressure Ulcer at Stage 2 or Higher or designated as Unstageable? | |||
| Indent Indent Indent85919-9 | 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 Indent54893-3 | Number of unstageable pressure ulcers due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure ulcers with suspected deep tissue injury in evolution | {#} | ||
| Indent Indent Indent57229-7 | Status of Most Problematic Pressure Ulcer that is Observable | |||
| Indent Indent Indent46536-9 | Current Number of Stage 1 Pressure Ulcers | {#} | ||
| Indent Indent Indent57231-3 | Stage of Most Problematic Unhealed Pressure Ulcer that is Stageable | |||
| Indent Indent Indent57232-1 | Does this patient have a Stasis Ulcer? | |||
| Indent Indent Indent57233-9 | Current Number of Stasis Ulcer(s) that are Observable | {#} | ||
| Indent Indent Indent57234-7 | Status of Most Problematic Stasis Ulcer that is Observable | |||
| Indent Indent Indent57235-4 | Does this patient have a Surgical Wound? | |||
| Indent Indent Indent57236-2 | Status of Most Problematic Surgical Wound that is Observable | |||
| Indent Indent Indent46534-4 | Does this patient have a Skin Lesion or Open Wound (excluding bowel ostomy), other than those described above, that is receiving intervention by the home health agency? | |||
| Indent Indent85921-5 | RESPIRATORY STATUS | |||
| Indent Indent Indent57237-0 | When is the patient dyspneic or noticeably Short of Breath? | |||
| Indent Indent Indent57238-8 | Respiratory Treatments utilized at home | 1..3 | ||
| Indent Indent85922-3 | ELIMINATION STATUS | |||
| Indent Indent Indent46552-6 | Has this patient been treated for a Urinary Tract Infection in the past 14 days? | |||
| Indent Indent Indent46553-4 | Urinary Incontinence or Urinary Catheter Presence | |||
| Indent Indent Indent57241-2 | When does Urinary Incontinence occur? | |||
| Indent Indent Indent46587-2 | Bowel Incontinence Frequency | |||
| Indent Indent Indent86471-0 | Ostomy for Bowel Elimination: Does this patient have an ostomy for bowel elimination that (within the last 14 days): a) was related to an inpatient facility stay; or b) necessitated a change in medical or treatment regimen? | |||
| Indent Indent57047-3 | NEURO/EMOTIONAL/BEHAVIORAL STATUS | |||
| Indent Indent Indent46589-8 | Cognitive Functioning: Patient's current (day of assessment) level of alertness, orientation, comprehension, concentration, and immediate memory for simple commands. | |||
| Indent Indent Indent58104-1 | When Confused (Reported or Observed Within the Last 14 Days) | |||
| Indent Indent Indent86495-9 | When Anxious (Reported or Observed Within the Last 14 Days) | |||
| Indent Indent Indent57242-0 | Depression Screening: Has the patient been screened for depression, using a standardized, validated depression screening tool? | |||
| Indent Indent Indent Indent58120-7 | PHQ-2© | |||
| Indent Indent Indent Indent Indent44250-9 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent44255-8 | Feeling down, depressed, or hopeless? | |||
| Indent Indent Indent46473-5 | Cognitive, behavorial, and psychiatric symptoms that are demonstrated at least once a week (Reported or Observed) | |||
| Indent Indent Indent46592-2 | Frequency of Disruptive Behavior Symptoms (Reported or Observed): Any physical, verbal, or other disruptive/dangerous symptoms that are injurious to self or others or jeopardize personal safety. | |||
| Indent Indent Indent46593-0 | Is this patient receiving Psychiatric Nursing Services at home provided by a qualified psychiatric nurse? | |||
| Indent Indent85923-1 | ADL & IADLs | |||
| Indent Indent Indent46595-5 | Grooming: Current ability to tend safely to personal hygiene needs (specifically: washing face and hands, hair care, shaving or make up, teeth or denture care, or fingernail care). | |||
| Indent Indent Indent46597-1 | Current Ability to Dress Upper Body safely (with or without dressing aids) including undergarments, pullovers, front-opening shirts and blouses, managing zippers, buttons, and snaps. | |||
| Indent Indent Indent46599-7 | Current Ability to Dress Lower Body safely (with or without dressing aids) including undergarments, slacks, socks or nylons, shoes. | |||
| Indent Indent Indent57243-8 | Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair). | |||
| Indent Indent Indent57244-6 | Toilet Transferring: Current ability to get to and from the toilet or bedside commode safely and transfer on and off toilet/commode. | |||
| Indent Indent Indent57245-3 | Toileting Hygiene: Current ability to maintain perineal hygiene safely, adjust clothes and/or incontinence pads before and after using toilet, commode, bedpan, urinal. If managing ostomy, includes cleaning area around stoma, but not managing equipment. | |||
| Indent Indent Indent57246-1 | Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast. | |||
| Indent Indent Indent85924-9 | FUNCTIONAL ABILITIES and GOALS - SOC/ROC | |||
| Indent Indent Indent Indent85925-6 | Mobility | |||
| Indent Indent Indent Indent Indent85926-4 | Lying to Sitting on Side of Bed - SOC Performance | |||
| Indent Indent Indent Indent Indent85927-2 | Lying to Sitting on Side of Bed - Discharge Goal | |||
| Indent Indent Indent57247-9 | Ambulation/Locomotion: Current ability to walk safely, once in a standing position, or use a wheelchair, once in a seated position, on a variety of surfaces. | |||
| Indent Indent Indent57248-7 | Feeding or Eating: Current ability to feed self meals and snacks safely. | |||
| Indent Indent Indent57249-5 | Current Ability to Plan and Prepare Light Meals (for example, cereal, sandwich) or reheat delivered meals safely. | |||
| Indent Indent Indent46569-0 | Ability to Use Telephone: Current ability to answer the phone safely, including dialing numbers, and effectively using the telephone to communicate. | |||
| Indent Indent Indent58121-5 | Prior Functioning ADL/IADL | |||
| Indent Indent Indent Indent85070-1 | Self-Care (specifically: grooming, dressing, bathing, and toileting hygiene) | |||
| Indent Indent Indent Indent86185-6 | Ambulation | |||
| Indent Indent Indent Indent86186-4 | Transfer | |||
| Indent Indent Indent Indent86187-2 | Household tasks (specifically: light meal preparation, laundry, shopping, and phone use.) | |||
| Indent Indent Indent57254-5 | Has this patient had a multi-factor Falls Risk Assessment using a standardized, validated assessment tool? | |||
| Indent Indent85928-0 | MEDICATIONS | |||
| Indent Indent Indent57255-2 | Drug Regimen Review: Did a complete drug regimen review identify potential clinically significant medication issues? | |||
| Indent Indent Indent57281-8 | Medication Follow-up: Did the agency contact a physician (or physician-designee) by midnight of the next calendar day and complete prescribed/recommended actions in response to the identified potential clinically significant medication issues? | |||
| Indent Indent Indent57257-8 | Patient/Caregiver High-Risk Drug Education: Has the patient/caregiver received instruction on special precautions for all high-risk medications (such as hypoglycemics, anticoagulants, etc.) and how and when to report problems that may occur? | |||
| Indent Indent Indent57285-9 | Management of Oral Medications: Patient's current ability to prepare and take all oral medications reliably and safely, including administration of the correct dosage at the appropriate times/intervals. | |||
| Indent Indent Indent57284-2 | Management of Injectable Medications: Patient's current ability to prepare and take all prescribed injectable medications reliably and safely, including administration of correct dosage at the appropriate times/intervals. | |||
| Indent Indent Indent57196-8 | Prior Medication Management: Indicate the patient's usual ability with managing oral and injectable medications prior to his/her most recent illness, exacerbation or injury. | |||
| Indent Indent Indent Indent57258-6 | Oral medications | |||
| Indent Indent Indent Indent57259-4 | Injectable medications | |||
| Indent Indent57049-9 | CARE MANAGEMENT | |||
| Indent Indent Indent57306-3 | Types and Sources of Assistance | |||
| Indent Indent Indent Indent57260-2 | ADL assistance (for example, transfer/ ambulation, bathing, dressing, toileting, eating/feeding) | |||
| Indent Indent Indent Indent57261-0 | IADL assistance (for example, meals, housekeeping, laundry, telephone, shopping, finances) | |||
| Indent Indent Indent Indent57262-8 | Medication administration (for example, oral, inhaled or injectable) | |||
| Indent Indent Indent Indent57263-6 | Medical procedures/treatments (for example, changing wound dressing, home exercise program) | |||
| Indent Indent Indent Indent57264-4 | Management of equipment (for example, oxygen, IV/infusion equipment, enteral/parenteral nutrition, ventilator therapy equipment or supplies) | |||
| Indent Indent Indent Indent57265-1 | Supervision and safety (for example, due to cognitive impairment) | |||
| Indent Indent Indent Indent57266-9 | Advocacy or facilitation of patient's participation in appropriate medical care (for example, transportation to or from appointments) | |||
| Indent Indent Indent57267-7 | How Often does the patient receive ADL or IADL assistance from any caregiver(s) (other than home health agency staff)? | |||
| Indent Indent57050-7 | THERAPY NEED AND PLAN OF CARE | |||
| Indent Indent Indent57268-5 | Therapy need: Number of therapy visits indicated (total of physical, occupational and speech-language pathology combined). | {#} | ||
| Indent Indent Indent57197-6 | Plan of Care Synopsis | |||
| Indent Indent Indent Indent57269-3 | Patient-specific parameters for notifying physician of changes in vital signs or other clinical findings | |||
| Indent Indent Indent Indent57270-1 | Diabetic foot care including monitoring for the presence of skin lesions on the lower extremities and patient/caregiver education on proper foot care | |||
| Indent Indent Indent Indent57271-9 | Fall prevention interventions | |||
| Indent Indent Indent Indent57272-7 | Depression intervention(s) such as medication, referral for other treatment, or a monitoring plan for current treatment and/or physician notified that patient screened positive for depression | |||
| Indent Indent Indent Indent57273-5 | Intervention(s) to monitor and mitigate pain | |||
| Indent Indent Indent Indent57274-3 | Intervention(s) to prevent pressure ulcers | |||
| Indent Indent Indent Indent57275-0 | Pressure ulcer treatment based on principles of moist wound healing OR order for treatment based on moist wound healing has been requested from physician | |||
| Indent86189-8 | Deprecated Outcome and assessment information set (OASIS) form - version C2 - Resumption of care [CMS Assessment] | |||
| Indent Indent85906-6 | Home health patient tracking sheet | |||
| Indent Indent Indent46498-2 | Resumption of Care Date | {mm/dd/yyyy} | ||
| Indent Indent57040-8 | CLINICAL RECORD ITEMS | |||
| Indent Indent Indent46500-5 | Discipline of Person Completing Assessment | |||
| Indent Indent Indent46501-3 | Date Assessment Completed | {mm/dd/yyyy} | ||
| Indent Indent Indent57200-8 | This Assessment is Currently Being Completed for the Following Reason: | |||
| Indent Indent Indent57201-6 | Date of Physician-ordered Start of Care (Resumption of Care) | {mm/dd/yyyy} | ||
| Indent Indent Indent57202-4 | Date of Referral | {mm/dd/yyyy} | ||
| Indent Indent Indent57203-2 | Episode Timing: Is the Medicare home health payment episode for which this assessment will define a case mix group an "early" episode or a "later" episode in the patient's current sequence of adjacent Medicare home health payment episodes? | |||
| Indent Indent85909-0 | PATIENT HISTORY AND DIAGNOSES | |||
| Indent Indent Indent57204-0 | From which of the following Inpatient Facilities was the patient discharged within the past 14 days? | 1..7 | ||
| Indent Indent Indent86470-2 | Inpatient Discharge Date (most recent) | {mm/dd/yyyy} | ||
| Indent Indent Indent46504-7 | Inpatient Facility Diagnosis: ICD-10-CM Code | 1..6 | ||
| Indent Indent Indent46507-0 | Diagnosis Requiring Medical or Treatment Regimen Change Within Past 14 Days | 1..6 | ||
| Indent Indent Indent86469-4 | Conditions Prior to Medical or Treatment Regimen Change or Inpatient Stay Within Past 14 Days | 1..6 | ||
| Indent Indent Indent85911-6 | Diagnoses, Symptom Control, and Optional Diagnoses | |||
| Indent Indent Indent Indent85912-4 | Primary Diagnosis | |||
| Indent Indent Indent Indent Indent86255-7 | Primary Diagnosis: ICD-10-code | |||
| Indent Indent Indent Indent Indent85920-7 | Primary Diagnosis Symptom Control Rating | |||
| Indent Indent Indent Indent Indent85914-0 | Optional Diagnosis: ICD-10-CM | |||
| Indent Indent Indent Indent Indent86254-0 | Optional Diagnosis: ICD-10-CM - multiple coding | |||
| Indent Indent Indent Indent85913-2 | Other Diagnoses | 0..5 | ||
| Indent Indent Indent Indent Indent81885-6 | Other Diagnoses: ICD-10-CM | |||
| Indent Indent Indent Indent Indent85920-7 | Other Diagnoses Symptom Control Rating | |||
| Indent Indent Indent Indent Indent85914-0 | Optional Diagnosis: ICD-10-CM | |||
| Indent Indent Indent Indent Indent86254-0 | Optional Diagnosis: ICD-10-CM - multiple coding | |||
| Indent Indent Indent83243-6 | Active Diagnoses-Comorbidities and Co-existing Conditions | 0..2 | ||
| Indent Indent Indent46466-9 | Therapies the patient receives at home | 1..3 | ||
| Indent Indent Indent57319-6 | Risk for Hospitalization: Which of the following signs or symptoms characterize this patient as at risk for hospitalization? | 1..9 | ||
| Indent Indent Indent57206-5 | Overall Status: Which description best fits the patient's overall status? | |||
| Indent Indent Indent57207-3 | Risk factors, either present or past, likely to affect health status and/or outcome | 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 Indent85951-2 | Living Arrangements | |||
| Indent Indent Indent85950-4 | Patient Living Situation: Which of the following best describes the patient's residential circumstance and availability of assistance? | |||
| Indent Indent57042-4 | SENSORY STATUS | |||
| Indent Indent Indent57215-6 | Vision (with corrective lenses if the patient usually wears them) | |||
| Indent Indent Indent57216-4 | Ability to Hear (with hearing aid or hearing appliance if normally used) | |||
| Indent Indent Indent57217-2 | Understanding of Verbal Content in patient's own language (with hearing aid or device if used) | |||
| Indent Indent Indent57218-0 | Speech and Oral (Verbal) Expression of Language (in patient's own language) | |||
| Indent Indent Indent57219-8 | Has this patient had a formal Pain Assessment using a standardized, validated pain assessment tool (appropriate to the patient's ability to communicate the severity of pain)? | |||
| Indent Indent Indent57220-6 | Frequency of pain interfering with patient's activity or movement | |||
| Indent Indent85917-3 | INTEGUMENTARY STATUS | |||
| Indent Indent Indent57221-4 | Pressure Ulcer Assessment: Was this patient assessed for Risk of Developing Pressure Ulcers? | |||
| Indent Indent Indent57280-0 | Does this patient have a Risk of Developing Pressure Ulcers? | |||
| Indent Indent Indent85918-1 | Does this patient have at least one Unhealed Pressure Ulcer at Stage 2 or Higher or designated as Unstageable? | |||
| Indent Indent Indent85919-9 | 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 Indent54893-3 | Number of unstageable pressure ulcers due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure ulcers with suspected deep tissue injury in evolution | {#} | ||
| Indent Indent Indent57229-7 | Status of Most Problematic Pressure Ulcer that is Observable | |||
| Indent Indent Indent46536-9 | Current Number of Stage 1 Pressure Ulcers | {#} | ||
| Indent Indent Indent57231-3 | Stage of Most Problematic Unhealed Pressure Ulcer that is Stageable | |||
| Indent Indent Indent57232-1 | Does this patient have a Stasis Ulcer? | |||
| Indent Indent Indent57233-9 | Current Number of Stasis Ulcer(s) that are Observable | {#} | ||
| Indent Indent Indent57234-7 | Status of Most Problematic Stasis Ulcer that is Observable | |||
| Indent Indent Indent57235-4 | Does this patient have a Surgical Wound? | |||
| Indent Indent Indent57236-2 | Status of Most Problematic Surgical Wound that is Observable | |||
| Indent Indent Indent46534-4 | Does this patient have a Skin Lesion or Open Wound (excluding bowel ostomy), other than those described above, that is receiving intervention by the home health agency? | |||
| Indent Indent85921-5 | RESPIRATORY STATUS | |||
| Indent Indent Indent57237-0 | When is the patient dyspneic or noticeably Short of Breath? | |||
| Indent Indent Indent57238-8 | Respiratory Treatments utilized at home | 1..3 | ||
| Indent Indent85922-3 | ELIMINATION STATUS | |||
| Indent Indent Indent46552-6 | Has this patient been treated for a Urinary Tract Infection in the past 14 days? | |||
| Indent Indent Indent46553-4 | Urinary Incontinence or Urinary Catheter Presence | |||
| Indent Indent Indent57241-2 | When does Urinary Incontinence occur? | |||
| Indent Indent Indent46587-2 | Bowel Incontinence Frequency | |||
| Indent Indent Indent86471-0 | Ostomy for Bowel Elimination: Does this patient have an ostomy for bowel elimination that (within the last 14 days): a) was related to an inpatient facility stay; or b) necessitated a change in medical or treatment regimen? | |||
| Indent Indent57047-3 | NEURO/EMOTIONAL/BEHAVIORAL STATUS | |||
| Indent Indent Indent46589-8 | Cognitive Functioning: Patient's current (day of assessment) level of alertness, orientation, comprehension, concentration, and immediate memory for simple commands. | |||
| Indent Indent Indent58104-1 | When Confused (Reported or Observed Within the Last 14 Days) | |||
| Indent Indent Indent86495-9 | When Anxious (Reported or Observed Within the Last 14 Days) | |||
| Indent Indent Indent57242-0 | Depression Screening: Has the patient been screened for depression, using a standardized, validated depression screening tool? | |||
| Indent Indent Indent Indent58120-7 | PHQ-2© | |||
| Indent Indent Indent Indent Indent44250-9 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent44255-8 | Feeling down, depressed, or hopeless? | |||
| Indent Indent Indent46473-5 | Cognitive, behavorial, and psychiatric symptoms that are demonstrated at least once a week (Reported or Observed) | 1..6 | ||
| Indent Indent Indent46592-2 | Frequency of Disruptive Behavior Symptoms (Reported or Observed): Any physical, verbal, or other disruptive/dangerous symptoms that are injurious to self or others or jeopardize personal safety. | |||
| Indent Indent Indent46593-0 | Is this patient receiving Psychiatric Nursing Services at home provided by a qualified psychiatric nurse? | |||
| Indent Indent85923-1 | ADL & IADLs | |||
| Indent Indent Indent46595-5 | Grooming: Current ability to tend safely to personal hygiene needs (specifically: washing face and hands, hair care, shaving or make up, teeth or denture care, or fingernail care). | |||
| Indent Indent Indent46597-1 | Current Ability to Dress Upper Body safely (with or without dressing aids) including undergarments, pullovers, front-opening shirts and blouses, managing zippers, buttons, and snaps. | |||
| Indent Indent Indent46599-7 | Current Ability to Dress Lower Body safely (with or without dressing aids) including undergarments, slacks, socks or nylons, shoes. | |||
| Indent Indent Indent57243-8 | Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair). | |||
| Indent Indent Indent57244-6 | Toilet Transferring: Current ability to get to and from the toilet or bedside commode safely and transfer on and off toilet/commode. | |||
| Indent Indent Indent57245-3 | Toileting Hygiene: Current ability to maintain perineal hygiene safely, adjust clothes and/or incontinence pads before and after using toilet, commode, bedpan, urinal. If managing ostomy, includes cleaning area around stoma, but not managing equipment. | |||
| Indent Indent Indent57246-1 | Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast. | |||
| Indent Indent Indent85924-9 | FUNCTIONAL ABILITIES and GOALS - SOC/ROC | |||
| Indent Indent Indent Indent85925-6 | Mobility | |||
| Indent Indent Indent Indent Indent85926-4 | Lying to Sitting on Side of Bed - ROC Performance | |||
| Indent Indent Indent Indent Indent85927-2 | Lying to Sitting on Side of Bed - Discharge Goal | |||
| Indent Indent Indent57247-9 | Ambulation/Locomotion: Current ability to walk safely, once in a standing position, or use a wheelchair, once in a seated position, on a variety of surfaces. | |||
| Indent Indent Indent57248-7 | Feeding or Eating: Current ability to feed self meals and snacks safely. | |||
| Indent Indent Indent57249-5 | Current Ability to Plan and Prepare Light Meals (for example, cereal, sandwich) or reheat delivered meals safely. | |||
| Indent Indent Indent46569-0 | Ability to Use Telephone: Current ability to answer the phone safely, including dialing numbers, and effectively using the telephone to communicate. | |||
| Indent Indent Indent58121-5 | Prior Functioning ADL/IADL | |||
| Indent Indent Indent Indent85070-1 | Self-Care (specifically: grooming, dressing, bathing, and toileting hygiene) | |||
| Indent Indent Indent Indent86185-6 | Ambulation | |||
| Indent Indent Indent Indent86186-4 | Transfer | |||
| Indent Indent Indent Indent86187-2 | Household tasks (specifically: light meal preparation, laundry, shopping, and phone use.) | |||
| Indent Indent Indent57254-5 | Has this patient had a multi-factor Falls Risk Assessment using a standardized, validated assessment tool? | |||
| Indent Indent85928-0 | MEDICATIONS | |||
| Indent Indent Indent57255-2 | Drug Regimen Review: Did a complete drug regimen review identify potential clinically significant medication issues? | |||
| Indent Indent Indent57281-8 | Medication Follow-up: Did the agency contact a physician (or physician-designee) by midnight of the next calendar day and complete prescribed/recommended actions in response to the identified potential clinically significant medication issues? | |||
| Indent Indent Indent57257-8 | Patient/Caregiver High-Risk Drug Education: Has the patient/caregiver received instruction on special precautions for all high-risk medications (such as hypoglycemics, anticoagulants, etc.) and how and when to report problems that may occur? | |||
| Indent Indent Indent57285-9 | Management of Oral Medications: Patient's current ability to prepare and take all oral medications reliably and safely, including administration of the correct dosage at the appropriate times/intervals. | |||
| Indent Indent Indent57284-2 | Management of Injectable Medications: Patient's current ability to prepare and take all prescribed injectable medications reliably and safely, including administration of correct dosage at the appropriate times/intervals. | |||
| Indent Indent Indent57196-8 | Prior Medication Management: Indicate the patient's usual ability with managing oral and injectable medications prior to his/her most recent illness, exacerbation or injury. | |||
| Indent Indent Indent Indent57258-6 | Oral medications | |||
| Indent Indent Indent Indent57259-4 | Injectable medications | |||
| Indent Indent57049-9 | CARE MANAGEMENT | |||
| Indent Indent Indent57306-3 | Types and Sources of Assistance | |||
| Indent Indent Indent Indent57260-2 | ADL assistance (for example, transfer/ ambulation, bathing, dressing, toileting, eating/feeding) | |||
| Indent Indent Indent Indent57261-0 | IADL assistance (for example, meals, housekeeping, laundry, telephone, shopping, finances) | |||
| Indent Indent Indent Indent57262-8 | Medication administration (for example, oral, inhaled or injectable) | |||
| Indent Indent Indent Indent57263-6 | Medical procedures/treatments (for example, changing wound dressing, home exercise program) | |||
| Indent Indent Indent Indent57264-4 | Management of equipment (for example, oxygen, IV/infusion equipment, enteral/parenteral nutrition, ventilator therapy equipment or supplies) | |||
| Indent Indent Indent Indent57265-1 | Supervision and safety (for example, due to cognitive impairment) | |||
| Indent Indent Indent Indent57266-9 | Advocacy or facilitation of patient's participation in appropriate medical care (for example, transportation to or from appointments) | |||
| Indent Indent Indent57267-7 | How Often does the patient receive ADL or IADL assistance from any caregiver(s) (other than home health agency staff)? | |||
| Indent Indent57050-7 | THERAPY NEED AND PLAN OF CARE | |||
| Indent Indent Indent57268-5 | Therapy need: Number of therapy visits indicated (total of physical, occupational and speech-language pathology combined). | {#} | ||
| Indent Indent Indent57197-6 | Plan of Care Synopsis | |||
| Indent Indent Indent Indent57269-3 | Patient-specific parameters for notifying physician of changes in vital signs or other clinical findings | |||
| Indent Indent Indent Indent57270-1 | Diabetic foot care including monitoring for the presence of skin lesions on the lower extremities and patient/caregiver education on proper foot care | |||
| Indent Indent Indent Indent57271-9 | Fall prevention interventions | |||
| Indent Indent Indent Indent57272-7 | Depression intervention(s) such as medication, referral for other treatment, or a monitoring plan for current treatment and/or physician notified that patient screened positive for depression | |||
| Indent Indent Indent Indent57273-5 | Intervention(s) to monitor and mitigate pain | |||
| Indent Indent Indent Indent57274-3 | Intervention(s) to prevent pressure ulcers | |||
| Indent Indent Indent Indent57275-0 | Pressure ulcer treatment based on principles of moist wound healing OR order for treatment based on moist wound healing has been requested from physician | |||
| Indent86244-1 | Deprecated Outcome and assessment information set (OASIS) form - version C2 - Follow-up - recertification or other follow-up [CMS Assessment] | |||
| Indent Indent86245-8 | CLINICAL RECORD ITEMS | |||
| Indent Indent Indent46500-5 | Discipline of Person Completing Assessment | |||
| Indent Indent Indent46501-3 | Date Assessment Completed | {mm/dd/yyyy} | ||
| Indent Indent Indent57200-8 | This Assessment is Currently Being Completed for the Following Reason | |||
| Indent Indent Indent57203-2 | Episode Timing: Is the Medicare home health payment episode for which this assessment will define a case mix group an "early" episode or a "later" episode in the patient's current sequence of adjacent Medicare home health payment episodes? | |||
| Indent Indent86246-6 | PATIENT HISTORY AND DIAGNOSES | |||
| Indent Indent Indent46504-7 | Inpatient Facility Diagnosis: ICD-10-CM Code | 1..6 | ||
| Indent Indent Indent85911-6 | Diagnoses, Symptom Control, and Optional Diagnoses | |||
| Indent Indent Indent Indent85912-4 | Primary Diagnosis | |||
| Indent Indent Indent Indent Indent86255-7 | Primary Diagnosis: ICD-10-code | |||
| Indent Indent Indent Indent Indent85920-7 | Primary Diagnosis Symptom Control Rating | |||
| Indent Indent Indent Indent Indent85914-0 | Optional Diagnosis: ICD-10-CM | |||
| Indent Indent Indent Indent Indent86254-0 | Optional Diagnosis: ICD-10-CM - multiple coding | |||
| Indent Indent Indent Indent85913-2 | Other Diagnoses | 0..5 | ||
| Indent Indent Indent Indent Indent81885-6 | Other Diagnoses: ICD-10-CM | |||
| Indent Indent Indent Indent Indent85920-7 | Other Diagnoses Symptom Control Rating | |||
| Indent Indent Indent Indent Indent85914-0 | Optional Diagnosis: ICD-10-CM | |||
| Indent Indent Indent Indent Indent86254-0 | Optional Diagnosis: ICD-10-CM - multiple coding | |||
| Indent Indent Indent46466-9 | Therapies the patient receives at home | 1..3 | ||
| Indent Indent86247-4 | SENSORY STATUS | |||
| Indent Indent Indent57215-6 | Vision (with corrective lenses if the patient usually wears them) | |||
| Indent Indent Indent57220-6 | Frequency of pain interfering with patient's activity or movement | |||
| Indent Indent86248-2 | INTEGUMENTARY STATUS | |||
| Indent Indent Indent85918-1 | Does this patient have at least one Unhealed Pressure Ulcer at Stage 2 or Higher or designated as Unstageable? | |||
| 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 at most recent SOC/ROC | {#} | ||
| 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 at most recent SOC/ROC | {#} | ||
| 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 at most recent SOC/ROC | {#} | ||
| 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 at most recent SOC/ROC | {#} | ||
| 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 at most recent SOC/ROC | {#} | ||
| 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 at most recent SOC/ROC | {#} | ||
| Indent Indent Indent46536-9 | Current Number of Stage 1 Pressure Ulcers | {#} | ||
| Indent Indent Indent57231-3 | Stage of Most Problematic Unhealed Pressure Ulcer that is Stageable | |||
| Indent Indent Indent57232-1 | Does this patient have a Stasis Ulcer? | |||
| Indent Indent Indent57233-9 | Current Number of Stasis Ulcer(s) that are Observable | {#} | ||
| Indent Indent Indent57234-7 | Status of Most Problematic Stasis Ulcer that is Observable | |||
| Indent Indent Indent57235-4 | Does this patient have a Surgical Wound? | |||
| Indent Indent Indent57236-2 | Status of Most Problematic Surgical Wound that is Observable | |||
| Indent Indent86249-0 | RESPIRATORY STATUS | |||
| Indent Indent Indent57237-0 | When is the patient dyspneic or noticeably Short of Breath? | |||
| Indent Indent86250-8 | ELIMINATION STATUS | |||
| Indent Indent Indent46553-4 | Urinary Incontinence or Urinary Catheter Presence | |||
| Indent Indent Indent46587-2 | Bowel Incontinence Frequency | |||
| Indent Indent Indent86471-0 | Ostomy for Bowel Elimination: Does this patient have an ostomy for bowel elimination that (within the last 14 days): a) was related to an inpatient facility stay; or b) necessitated a change in medical or treatment regimen? | |||
| Indent Indent86251-6 | ADL & IADLs | |||
| Indent Indent Indent46597-1 | Current Ability to Dress Upper Body safely (with or without dressing aids) including undergarments, pullovers, front-opening shirts and blouses, managing zippers, buttons, and snaps. | |||
| Indent Indent Indent46599-7 | Current Ability to Dress Lower Body safely (with or without dressing aids) including undergarments, slacks, socks or nylons, shoes. | |||
| Indent Indent Indent57243-8 | Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair). | |||
| Indent Indent Indent57244-6 | Toilet Transferring: Current ability to get to and from the toilet or bedside commode safely and transfer on and off toilet/commode. | |||
| Indent Indent Indent57246-1 | Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast. | |||
| Indent Indent Indent57247-9 | Ambulation/Locomotion: Current ability to walk safely, once in a standing position, or use a wheelchair, once in a seated position, on a variety of surfaces. | |||
| Indent Indent86252-4 | MEDICATIONS | |||
| Indent Indent Indent57284-2 | Management of Injectable Medications: Patient's current ability to prepare and take all prescribed injectable medications reliably and safely, including administration of correct dosage at the appropriate times/intervals. | |||
| Indent Indent86253-2 | THERAPY NEED AND PLAN OF CARE | |||
| Indent Indent Indent57268-5 | Therapy need: Number of therapy visits indicated (total of physical, occupational and speech-language pathology combined). | {#} | ||
| Indent86259-9 | Deprecated Outcome and assessment information set (OASIS) form - version C2 - Transfer To inpatient facility - patient discharged or not discharged [CMS Assessment] | |||
| Indent Indent86257-3 | CLINICAL RECORD ITEMS | |||
| Indent Indent Indent46500-5 | Discipline of Person Completing Assessment | |||
| Indent Indent Indent46501-3 | Date Assessment Completed | {mm/dd/yyyy} | ||
| Indent Indent Indent57200-8 | This Assessment is Currently Being Completed for the Following Reason | |||
| Indent Indent86256-5 | PATIENT HISTORY AND DIAGNOSIS | |||
| Indent Indent Indent85915-7 | InfluenzaVaccine Data Collection Period: Does this episode of care (SOC/ROC to Transfer/Discharge) include any dates on or between October 1 and March 31? | |||
| Indent Indent Indent57208-1 | Influenza Vaccine Received: Did the patient receive the influenza vaccine for this year's flu season | |||
| Indent Indent Indent72057-3 | Pneumococcal vaccination been received | |||
| Indent Indent Indent45956-0 | Reason Pneumococcal Vaccine not received: If patient has never received the pneumococcal vaccination (for example, pneumovax), state reason | |||
| Indent Indent57045-7 | CARDIAC STATUS | |||
| Indent Indent Indent57239-6 | Symptoms in Heart Failure Patients | |||
| Indent Indent Indent57240-4 | Heart Failure Follow-up: If patient has been diagnosed with heart failure and has exhibited symptoms indicative of heart failure at the time of or at any time since the most recent SOC/ROC assessment, what action(s) has (have) been taken to respond? | 1..5 | ||
| Indent Indent86258-1 | MEDICATIONS | |||
| Indent Indent Indent57256-0 | Medication Intervention | |||
| Indent Indent Indent57195-0 | Patient/Caregiver Drug Education Intervention | |||
| Indent Indent57052-3 | EMERGENT CARE | |||
| Indent Indent Indent57276-8 | Emergent Care: At the time of or at any time since the most recent SOC/ROC assessment has the patient utilized a hospital emergency department (includes holding/observation status)? | |||
| Indent Indent Indent57277-6 | Reason For Emergent Care: For what reason(s) did the patient seek and/or receive emergent care (with or without hospitalization)? | 1..19 | ||
| Indent Indent86260-7 | DATA ITEMS COLLECTED AT INPATIENT FACILITY ADMISSION OR AGENCY DISCHARGE ONLY | |||
| Indent Indent Indent57198-4 | Intervention Synopsis: At the time of or at any time since the most recent SOC/ROC assessment, were the following interventions BOTH included in the physician-ordered plan or care AND implemented? | |||
| Indent Indent Indent Indent57270-1 | Diabetic foot care including monitoring for the presence of skin lesions on the lower extremities and patient/caregiver education on proper foot care | |||
| Indent Indent Indent Indent57271-9 | Falls prevention interventions | |||
| Indent Indent Indent Indent57272-7 | Depression intervention(s) such as medication, referral for other treatment, or a monitoring plan for current treatment | |||
| Indent Indent Indent Indent57273-5 | Intervention(s) to monitor and mitigate pain | |||
| Indent Indent Indent Indent57274-3 | Intervention(s) to prevent pressure ulcers | |||
| Indent Indent Indent Indent57275-0 | Pressure ulcer treatment based on principles of moist wound healing | |||
| Indent Indent Indent46578-1 | To which Inpatient Facility has the patient been admitted? | |||
| Indent Indent Indent57279-2 | Reason for Hospitalization: For what reason(s) did the patient require hospitalization? | 1..20 | ||
| Indent Indent Indent46581-5 | Date of Last (Most Recent) Home Visit | {mm/dd/yyyy} | ||
| Indent Indent Indent46582-3 | Discharge/Transfer/Death Date | {mm/dd/yyyy} | ||
| Indent86261-5 | Deprecated Outcome and assessment information set (OASIS) form - version C2 - Discharged from agency - death at home [CMS Assessment] | |||
| Indent Indent86257-3 | CLINICAL RECORD ITEMS | |||
| Indent Indent Indent46500-5 | Discipline of Person Completing Assessment | |||
| Indent Indent Indent46501-3 | Date Assessment Completed | {mm/dd/yyyy} | ||
| Indent Indent Indent57200-8 | This Assessment is Currently Being Completed for the Following Reason | |||
| Indent Indent86262-3 | MEDICATIONS | |||
| Indent Indent Indent57256-0 | Medication Intervention | |||
| Indent Indent86263-1 | DATA ITEMS COLLECTED AT INPATIENT FACILITY ADMISSION OR AGENCY DISCHARGE ONLY | |||
| Indent Indent Indent46581-5 | Date of Last (Most Recent) Home Visit | {mm/dd/yyyy} | ||
| Indent Indent Indent46582-3 | Discharge/Transfer/Death Date | {mm/dd/yyyy} | ||
| Indent86264-9 | Deprecated Outcome and assessment information set (OASIS) form - version C2 - Discharged from agency [CMS Assessment] | |||
| Indent Indent86257-3 | CLINICAL RECORD ITEMS | |||
| Indent Indent Indent46500-5 | Discipline of Person Completing Assessment | |||
| Indent Indent Indent46501-3 | Date Assessment Completed | {mm/dd/yyyy} | ||
| Indent Indent Indent57200-8 | This Assessment is Currently Being Completed for the Following Reason | |||
| Indent Indent86256-5 | PATIENT HISTORY AND DIAGNOSES | |||
| Indent Indent Indent85915-7 | InfluenzaVaccine Data Collection Period: Does this episode of care (SOC/ROC to Transfer/Discharge) include any dates on or between October 1 and March 31? | |||
| Indent Indent Indent57208-1 | Influenza Vaccine Received: Did the patient receive the influenza vaccine for this year's flu season | |||
| Indent Indent Indent72057-3 | Pneumococcal vaccination been received | |||
| Indent Indent Indent45956-0 | Reason Pneumococcal Vaccine not received: If patient has never received the pneumococcal vaccination (for example, pneumovax), state reason | |||
| Indent Indent86266-4 | SENSORY STATUS | |||
| Indent Indent Indent57218-0 | Speech and Oral (Verbal) Expression of Language (in patient's own language) | |||
| Indent Indent Indent57220-6 | Frequency of pain interfering with patient's activity or movement | |||
| Indent Indent86267-2 | INTEGUMENTARY STATUS | |||
| Indent Indent Indent85918-1 | Does this patient have at least one Unhealed Pressure Ulcer at Stage 2 or Higher or designated as Unstageable? | |||
| Indent Indent Indent57222-2 | The Oldest Stage 2 pressure ulcer that is present at discharge | |||
| Indent Indent Indent58052-2 | Record date pressure ulcer first identified | {mm/dd/yyyy} | ||
| 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 at most recent SOC/ROC | {#} | ||
| 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 at most recent SOC/ROC | {#} | ||
| 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 at most recent SOC/ROC | {#} | ||
| 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 at most recent SOC/ROC | {#} | ||
| 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 at most recent SOC/ROC | {#} | ||
| 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 at most recent SOC/ROC | {#} | ||
| Indent Indent Indent86268-0 | Worsening in Pressure Ulcer Status since SOC/ROC | |||
| Indent Indent Indent Indent83283-2 | Stage 2 | {#} | ||
| Indent Indent Indent Indent83284-0 | Stage 3 | {#} | ||
| Indent Indent Indent Indent83285-7 | Stage 4 | {#} | ||
| Indent Indent Indent Indent83286-5 | Unstageable - Known or likely but Unstageable due to non-removable dressing. | {#} | ||
| Indent Indent Indent Indent83287-3 | Unstageable - Known or likely but Unstageable due to coverage of wound bed by slough and/or eschar. | {#} | ||
| Indent Indent Indent Indent83288-1 | Unstageable - Suspected deep tissue injury in evolution. | {#} | ||
| Indent Indent Indent57229-7 | Status of Most Problematic Pressure Ulcer that is Observable | |||
| Indent Indent Indent46536-9 | Current Number of Stage 1 Pressure Ulcers | {#} | ||
| Indent Indent Indent57231-3 | Stage of Most Problematic Unhealed Pressure Ulcer that is Stageable | |||
| Indent Indent Indent57232-1 | Does this patient have a Stasis Ulcer? | |||
| Indent Indent Indent57233-9 | Current Number of Stasis Ulcer(s) that are Observable | {#} | ||
| Indent Indent Indent57234-7 | Status of Most Problematic Stasis Ulcer that is Observable | |||
| Indent Indent Indent57235-4 | Does this patient have a Surgical Wound? | |||
| Indent Indent Indent57236-2 | Status of Most Problematic Surgical Wound that is Observable | |||
| Indent Indent86249-0 | RESPIRATORY STATUS | |||
| Indent Indent Indent57237-0 | When is the patient dyspneic or noticeably Short of Breath? | |||
| Indent Indent57045-7 | CARDIAC STATUS | |||
| Indent Indent Indent57239-6 | Symptoms in Heart Failure Patients | |||
| Indent Indent Indent57240-4 | Heart Failure Follow-up: If patient has been diagnosed with heart failure and has exhibited symptoms indicative of heart failure at the time of or at any time since the most recent SOC/ROC assessment, what action(s) has (have) been taken to respond? | 1..5 | ||
| Indent Indent86269-8 | ELIMINATION STATUS | |||
| Indent Indent Indent46552-6 | Has this patient been treated for a Urinary Tract Infection in the past 14 days? | |||
| Indent Indent Indent46553-4 | Urinary Incontinence or Urinary Catheter Presence | |||
| Indent Indent Indent57241-2 | When does Urinary Incontinence occur? | |||
| Indent Indent Indent46587-2 | Bowel Incontinence Frequency | |||
| Indent Indent69332-5 | NEURO/EMOTIONAL/BEHAVIORAL STATUS | |||
| Indent Indent Indent46589-8 | Cognitive Functioning: Patient's current (day of assessment) level of alertness, orientation, comprehension, concentration, and immediate memory for simple commands. | |||
| Indent Indent Indent58104-1 | When Confused (Reported or Observed Within the Last 14 Days) | |||
| Indent Indent Indent86495-9 | When Anxious (Reported or Observed Within the Last 14 Days) | |||
| Indent Indent Indent46473-5 | Cognitive, behavorial, and psychiatric symptoms that are demonstrated at least once a week (Reported or Observed): | 1..6 | ||
| Indent Indent Indent46592-2 | Frequency of Disruptive Behavior Symptoms (Reported or Observed): Any physical, verbal, or other disruptive/dangerous symptoms that are injurious to self or others or jeopardize personal safety. | |||
| Indent Indent69337-4 | ADL/IADLs | |||
| Indent Indent Indent46595-5 | Grooming: Current ability to tend safely to personal hygiene needs (specifically: washing face and hands, hair care, shaving or make up, teeth or denture care, or fingernail care). | |||
| Indent Indent Indent46597-1 | Current Ability to Dress Upper Body safely (with or without dressing aids) including undergarments, pullovers, front-opening shirts and blouses, managing zippers, buttons, and snaps. | |||
| Indent Indent Indent46599-7 | Current Ability to Dress Lower Body safely (with or without dressing aids) including undergarments, slacks, socks or nylons, shoes. | |||
| Indent Indent Indent57243-8 | Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair). | |||
| Indent Indent Indent57244-6 | Toilet Transferring: Current ability to get to and from the toilet or bedside commode safely and transfer on and off toilet/commode. | |||
| Indent Indent Indent57245-3 | Toileting Hygiene: Current ability to maintain perineal hygiene safely, adjust clothes and/or incontinence pads before and after using toilet, commode, bedpan, urinal. If managing ostomy, includes cleaning area around stoma, but not managing equipment. | |||
| Indent Indent Indent57246-1 | Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast. | |||
| Indent Indent Indent57247-9 | Ambulation/Locomotion: Current ability to walk safely, once in a standing position, or use a wheelchair, once in a seated position, on a variety of surfaces. | |||
| Indent Indent Indent57248-7 | Feeding or Eating: Current ability to feed self meals and snacks safely. | |||
| Indent Indent Indent57249-5 | Current Ability to Plan and Prepare Light Meals (for example, cereal, sandwich) or reheat delivered meals safely. | |||
| Indent Indent Indent46569-0 | Ability to Use Telephone: Current ability to answer the phone safely, including dialing numbers, and effectively using the telephone to communicate. | |||
| Indent Indent86265-6 | MEDICATIONS | |||
| Indent Indent Indent57256-0 | Medication Intervention | |||
| Indent Indent Indent57195-0 | Patient/Caregiver Drug Education Intervention | |||
| Indent Indent Indent57285-9 | Management of Oral Medications: Patient's current ability to prepare and take all oral medications reliably and safely, including administration of the correct dosage at the appropriate times/intervals. | |||
| Indent Indent Indent57284-2 | Management of Injectable Medications: Patient's current ability to prepare and take all prescribed injectable medications reliably and safely, including administration of correct dosage at the appropriate times/intervals. | |||
| Indent Indent57049-9 | CARE MANAGEMENT | |||
| Indent Indent Indent57306-3 | Types and Sources of Assistance | |||
| Indent Indent Indent Indent57260-2 | ADL assistance (for example, transfer/ ambulation, bathing, dressing, toileting, eating/feeding) | |||
| Indent Indent Indent Indent57261-0 | IADL assistance (for example, meals, housekeeping, laundry, telephone, shopping, finances) | |||
| Indent Indent Indent Indent57262-8 | Medication administration (for example, oral, inhaled or injectable) | |||
| Indent Indent Indent Indent57263-6 | Medical procedures/treatments (for example, changing wound dressing, home exercise program) | |||
| Indent Indent Indent Indent57264-4 | Management of equipment (for example, oxygen, IV/infusion equipment, enteral/parenteral nutrition, ventilator therapy equipment or supplies) | |||
| Indent Indent Indent Indent57265-1 | Supervision and safety (for example, due to cognitive impairment) | |||
| Indent Indent Indent Indent57266-9 | Advocacy or facilitation of patient's participation in appropriate medical care (for example, transportation to or from appointments) | |||
| Indent Indent Indent57267-7 | How Often does the patient receive ADL or IADL assistance from any caregiver(s) (other than home health agency staff)? | |||
| Indent Indent57052-3 | EMERGENT CARE | |||
| Indent Indent Indent57276-8 | Emergent Care: At the time of or at any time since the most recent SOC/ROC assessment has the patient utilized a hospital emergency department (includes holding/observation status)? | |||
| Indent Indent Indent57277-6 | Reason For Emergent Care: For what reason(s) did the patient receive emergent care (with or without hospitalization)? | 1..19 | ||
| Indent Indent69331-7 | DATA ITEMS COLLECTED AT INPATIENT FACILITY ADMISSION OR AGENCY ONLY | |||
| Indent Indent Indent57198-4 | Intervention Synopsis: At the time of or at any time since the most recent SOC/ROC assessment, were the following interventions BOTH included in the physician-ordered plan or care AND implemented? | |||
| Indent Indent Indent Indent57270-1 | Diabetic foot care including monitoring for the presence of skin lesions on the lower extremities and patient/caregiver education on proper foot care | |||
| Indent Indent Indent Indent57271-9 | Falls prevention interventions | |||
| Indent Indent Indent Indent57272-7 | Depression intervention(s) such as medication, referral for other treatment, or a monitoring plan for current treatment | |||
| Indent Indent Indent Indent57273-5 | Intervention(s) to monitor and mitigate pain | |||
| Indent Indent Indent Indent57274-3 | Intervention(s) to prevent pressure ulcers | |||
| Indent Indent Indent Indent57275-0 | Pressure ulcer treatment based on principles of moist wound healing | |||
| Indent Indent Indent46578-1 | To which Inpatient Facility has the patient been admitted? | |||
| Indent Indent Indent55128-3 | Discharge disposition: Where is the patient after discharge from your agency? | 1..1 | ||
| Indent Indent Indent46581-5 | Date of Last (Most Recent) Home Visit | {mm/dd/yyyy} | ||
| Indent Indent Indent46582-3 | Discharge/Transfer/Death Date | {mm/dd/yyyy} |
Fully-Specified Name
- Component
- Outcome and assessment information set (OASIS) form - version C2
- 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. ;
- 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=86905-7 - Questionnaire definition
- https:
//fhir.loinc.org/Questionnaire/?url=http: //loinc.org/q/86905-7
LOINC Copyright
Copyright © 2024 Regenstrief Institute, Inc. All Rights Reserved. To the extent included herein, the LOINC table and LOINC codes are copyright