87210-1
CAAs and Care Planning
Active
Form Coding Instructions
1. Check column A if Care Area is triggered. 2. For each triggered Care Area, indicate whether a new care plan, care plan revision, or continuation of current care plan is necessary to address the problem(s) identified in your assessment of the care area. The Care Planning Decision column must be completed within 7 days of completing the RAI (MDS and CAA(s)). Check column B if the triggered care area is addressed in the care plan. 3. Indicate in the Location and Date of CAA Documentation column where information related to the CAA can be found. CAA documentation should include information on the complicating factors, risks, and any referrals for this resident for this care area
Source: Centers for Medicare & Medicaid Services87211-9 CAA Results
Observation ID in Form
V0200A
Fully-Specified Name
- Component
- Care Area Assessment (CAA) results
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Long Common Name
Care Area Assessment (CAA) results during assessment period [CMS Assessment]
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.63
- Last Updated
- Version 2.78 (PANEL)
- Change Reason
- Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 86522-0 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment] |
| 88282-9 | Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment] |
| 88954-3 | Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment] |
| 90473-0 | Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 103564-1 | MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 108256-9 | Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment] |
| 100997-6 | Respiratory Allergen Panel, Area 5 - Serum |
87212-7 Care Area Triggered
Observation ID in Form
V0200A_A
Form Coding Instructions
Check all that apply.
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Care area triggered
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Nom
- Method
- CMS Assessment
Long Common Name
Care area triggered during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.63
- Last Updated
- Version 2.77 (MAJ)
- Change Reason
- Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;
- Order vs. Observation
- Observation
Normative Answer List LL4663-2
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Delirium | 01 | LA7426-5 | |
| Cognitive loss/dementia | 02 | LA28159-4 | |
| Visual function | 03 | LA28160-2 | |
| Communication | 04 | LA28161-0 | |
| ADL functional/rehabilitation potential | 05 | LA28162-8 | |
| Urinary incontinence and indwelling catheter | 06 | LA28163-6 | |
| Psychosocial well-being | 07 | LA28165-1 | |
| Mood state | 08 | LA28166-9 | |
| Behavioral symptoms | 09 | LA28167-7 | |
| Activities | 10 | LA28168-5 | |
| Falls | 11 | LA17133-2 | |
| Nutritional status | 12 | LA28169-3 | |
| Feeding tube | 13 | LA28170-1 | |
| Dehydration/fluid maintenance | 14 | LA28171-9 | |
| Dental care | 15 | LA28172-7 | |
| Pressure ulcer | 16 | LA19028-2 | |
| Psychotropic drug use | 17 | LA28173-5 | |
| Physical restraints | 18 | LA28174-3 | |
| Pain | 19 | LA7460-4 | |
| Return to community referral | 20 | LA28175-0 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 86522-0 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment] |
| 88282-9 | Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment] |
| 88954-3 | Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment] |
| 90473-0 | Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 103564-1 | MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 108256-9 | Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment] |
| 100997-6 | Respiratory Allergen Panel, Area 5 - Serum |
87213-5 Care Planning Decision
Observation ID in Form
V0200A_B
Form Coding Instructions
Check all that apply.
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Triggered care area included in care plan
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Nom
- Method
- CMS Assessment
Long Common Name
Triggered care area included in care plan during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.63
- Last Updated
- Version 2.77 (MAJ)
- Change Reason
- Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;
- Order vs. Observation
- Observation
Normative Answer List LL4663-2
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Delirium | 01 | LA7426-5 | |
| Cognitive loss/dementia | 02 | LA28159-4 | |
| Visual function | 03 | LA28160-2 | |
| Communication | 04 | LA28161-0 | |
| ADL functional/rehabilitation potential | 05 | LA28162-8 | |
| Urinary incontinence and indwelling catheter | 06 | LA28163-6 | |
| Psychosocial well-being | 07 | LA28165-1 | |
| Mood state | 08 | LA28166-9 | |
| Behavioral symptoms | 09 | LA28167-7 | |
| Activities | 10 | LA28168-5 | |
| Falls | 11 | LA17133-2 | |
| Nutritional status | 12 | LA28169-3 | |
| Feeding tube | 13 | LA28170-1 | |
| Dehydration/fluid maintenance | 14 | LA28171-9 | |
| Dental care | 15 | LA28172-7 | |
| Pressure ulcer | 16 | LA19028-2 | |
| Psychotropic drug use | 17 | LA28173-5 | |
| Physical restraints | 18 | LA28174-3 | |
| Pain | 19 | LA7460-4 | |
| Return to community referral | 20 | LA28175-0 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 86522-0 | Deprecated MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment] |
| 88282-9 | Deprecated MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment] |
| 88954-3 | Deprecated MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment] |
| 90473-0 | Deprecated MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 103564-1 | MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 108256-9 | Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment] |
| 100997-6 | Respiratory Allergen Panel, Area 5 - Serum |
70127-6 Signature of RN Coordinator for CAA Process and Date Signed
Observation ID in Form
V0200B
Fully-Specified Name
- Component
- Signature verifying assessment completion
- Property
- Pn
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Nom
- Method
- CMS Assessment
Long Common Name
Signature verifying assessment completion during assessment period [CMS Assessment]
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.40
- Last Updated
- Version 2.83 (PANEL)
- Change Reason
- Release 2.75: PanelType: changed from Observation to Subset Organizer; ORDER_OBS: changed from Observation to Subset Organizer; Previous Releases: Removed METHOD because this term is generic;Changed PROPERTY from Arb to Pn
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 97887-4 | Core Outcome Measures Index for the Back [COMI] |
| 97327-1 | Core Outcome Measures Index for the Neck [COMI] |
| 69412-5 | Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0 |
| 85645-0 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 3.00 [CMS Assessment] |
| 85671-6 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 3.00 [CMS Assessment] |
| 85662-5 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 3.00 [CMS Assessment] |
| 85668-2 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 3.00 [CMS Assessment] |
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 107632-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment] |
| 106625-7 | Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.0 during assessment period [CMS Assessment] |
| 107631-4 | Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.01 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
| 107633-0 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.01 during assessment period [CMS Assessment] |
| 103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
| 113119-2 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment] |
| 103948-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.1 during assessment period [CMS Assessment] |
| 113164-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.3 during assessment period [CMS Assessment] |
| 103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 113166-3 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment] |
| 103947-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 113165-5 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.3 during assessment period [CMS Assessment] |
| 104608-5 | MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
| 105008-7 | MDS v3.0 - RAI v1.19.1 - Nursing home and Swing bed tracking (NT ST) item set during assessment period [CMS Assessment] |
| 103564-1 | MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 104606-9 | MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
| 105201-8 | MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
| 104552-5 | MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
| 104554-1 | MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
| 104607-7 | MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment] |
| 104609-3 | MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
| 108256-9 | Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment] |
| 100997-6 | Respiratory Allergen Panel, Area 5 - Serum |
112580-6 Signature:
Observation ID in Form
V0200B1
Fully-Specified Name
- Component
- Signature
- Property
- Pn
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
- CMS Assessment
Long Common Name
Signature [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.82
- Last Updated
- Version 2.82 (ADD)
- Order vs. Observation
- Observation
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 107632-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment] |
| 106625-7 | Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.0 during assessment period [CMS Assessment] |
| 107631-4 | Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.01 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
| 107633-0 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.01 during assessment period [CMS Assessment] |
| 103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
| 113119-2 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment] |
| 103948-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.1 during assessment period [CMS Assessment] |
| 113164-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.3 during assessment period [CMS Assessment] |
| 103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 113166-3 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment] |
| 103947-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 113165-5 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.3 during assessment period [CMS Assessment] |
| 108256-9 | Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment] |
30947-6 Date:
Observation ID in Form
V0200B2
Type of Entry
Question expects user entry - requires response [Q]
Fully-Specified Name
- Component
- Date form completed
- Property
- Date
- Time
- Pt
- System
- Form
- Scale
- Qn
- Method
Long Common Name
Date form completed
Basic Attributes
- Class
- ADMIN
- Type
- Clinical
- First Released
- Version 2.04
- Last Updated
- Version 2.61 (MIN)
- Order vs. Observation
- Observation
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 97887-4 | Core Outcome Measures Index for the Back [COMI] |
| 97327-1 | Core Outcome Measures Index for the Neck [COMI] |
| 69412-5 | Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0 |
| 85645-0 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 3.00 [CMS Assessment] |
| 85671-6 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 3.00 [CMS Assessment] |
| 85662-5 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 3.00 [CMS Assessment] |
| 85668-2 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 3.00 [CMS Assessment] |
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 107632-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment] |
| 106625-7 | Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.0 during assessment period [CMS Assessment] |
| 107631-4 | Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.01 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
| 107633-0 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.01 during assessment period [CMS Assessment] |
| 100203-9 | Knee Society Score post-op panel [Knee Society Score] |
| 100159-3 | Knee Society Score pre-op panel [Knee Society Score] |
| 103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
| 113119-2 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment] |
| 103948-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.1 during assessment period [CMS Assessment] |
| 113164-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.3 during assessment period [CMS Assessment] |
| 103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 113166-3 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment] |
| 103947-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 113165-5 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.3 during assessment period [CMS Assessment] |
| 104608-5 | MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
| 103564-1 | MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 104606-9 | MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
| 105201-8 | MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
| 104552-5 | MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
| 104554-1 | MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
| 104607-7 | MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment] |
| 104609-3 | MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
| 46611-0 | Mental residual functional capacity (RFC) assessment form |
| 107107-5 | Mini nutritional assessment MNA |
| 108256-9 | Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment] |
| 74725-3 | Patient safety event report - hospital - device or medical AndOr surgical supply, including health information technology (HIT) - version 1.2 [AHRQ] |
| 74495-3 | Patient safety event report - hospital - healthcare event reporting form (HERF) - version 1.2 [AHRQ] |
| 74080-3 | Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ] |
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
| 74501-8 | Patient safety event report - hospital - summary of initial report (SIR) - version 1.2 [AHRQ] |
| 105485-7 | PhenX - healthcare communications protocol 281101 |
| 100997-6 | Respiratory Allergen Panel, Area 5 - Serum |
| 60687-1 | Test of Infant Motor Performance Version 5.1 |
| 55140-8 | Vaccine Adverse Event Reporting System (VAERS) panel |
Language Variants Get Info
| Tag | Language | Translation |
|---|---|---|
| el-GR | Greek (Greece) | Ημερομηνία συμπλήρωσης εντύπου: Synonyms: ADMIN Pt Qn Ημερομηνία Ημερομηνία συμπλήρωσης εντύπου Μορφή |
| es-AR | Spanish (Argentina) | fecha de formulario completo: |
| es-MX | Spanish (Mexico) | Formulario de fecha completado: |
| it-IT | Italian (Italy) | Data completamento form: Synonyms: Amministrativo Punto nel tempo (episodio) |
| pt-BR | Portuguese (Brazil) | Data formulário preenchido: Synonyms: Time stamp; |
| ru-RU | Russian (Russian Federation) | Дата форма заполнение: Synonyms: Дата заполнения формы Количественный Точка во времени; |
| zh-CN | Chinese (China) | 表单完成日期: Synonyms: 可用数量表示的; |
Example Units
| Unit | Source |
|---|---|
| {mm/dd/yyyy} | Example UCUM Units |
70127-6 Signature of Person Completing Care Plan Decision and Date Signed
Observation ID in Form
V0200C
Fully-Specified Name
- Component
- Signature verifying assessment completion
- Property
- Pn
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Nom
- Method
- CMS Assessment
Long Common Name
Signature verifying assessment completion during assessment period [CMS Assessment]
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.40
- Last Updated
- Version 2.83 (PANEL)
- Change Reason
- Release 2.75: PanelType: changed from Observation to Subset Organizer; ORDER_OBS: changed from Observation to Subset Organizer; Previous Releases: Removed METHOD because this term is generic;Changed PROPERTY from Arb to Pn
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 97887-4 | Core Outcome Measures Index for the Back [COMI] |
| 97327-1 | Core Outcome Measures Index for the Neck [COMI] |
| 69412-5 | Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0 |
| 85645-0 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 3.00 [CMS Assessment] |
| 85671-6 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 3.00 [CMS Assessment] |
| 85662-5 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 3.00 [CMS Assessment] |
| 85668-2 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 3.00 [CMS Assessment] |
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 107632-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment] |
| 106625-7 | Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.0 during assessment period [CMS Assessment] |
| 107631-4 | Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.01 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
| 107633-0 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.01 during assessment period [CMS Assessment] |
| 103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
| 113119-2 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment] |
| 103948-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.1 during assessment period [CMS Assessment] |
| 113164-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.3 during assessment period [CMS Assessment] |
| 103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 113166-3 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment] |
| 103947-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 113165-5 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.3 during assessment period [CMS Assessment] |
| 104608-5 | MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
| 105008-7 | MDS v3.0 - RAI v1.19.1 - Nursing home and Swing bed tracking (NT ST) item set during assessment period [CMS Assessment] |
| 103564-1 | MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 104606-9 | MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
| 105201-8 | MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
| 104552-5 | MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
| 104554-1 | MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
| 104607-7 | MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment] |
| 104609-3 | MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
| 108256-9 | Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment] |
| 100997-6 | Respiratory Allergen Panel, Area 5 - Serum |
112580-6 Signature:
Observation ID in Form
V0200C1
Fully-Specified Name
- Component
- Signature
- Property
- Pn
- Time
- Pt
- System
- ^Patient
- Scale
- Nom
- Method
- CMS Assessment
Long Common Name
Signature [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.82
- Last Updated
- Version 2.82 (ADD)
- Order vs. Observation
- Observation
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 107632-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment] |
| 106625-7 | Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.0 during assessment period [CMS Assessment] |
| 107631-4 | Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.01 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
| 107633-0 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.01 during assessment period [CMS Assessment] |
| 103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
| 113119-2 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment] |
| 103948-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.1 during assessment period [CMS Assessment] |
| 113164-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.3 during assessment period [CMS Assessment] |
| 103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 113166-3 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment] |
| 103947-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 113165-5 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.3 during assessment period [CMS Assessment] |
| 108256-9 | Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment] |
30947-6 Date:
Observation ID in Form
V0200C2
Type of Entry
Question expects user entry - requires response [Q]
Fully-Specified Name
- Component
- Date form completed
- Property
- Date
- Time
- Pt
- System
- Form
- Scale
- Qn
- Method
Long Common Name
Date form completed
Basic Attributes
- Class
- ADMIN
- Type
- Clinical
- First Released
- Version 2.04
- Last Updated
- Version 2.61 (MIN)
- Order vs. Observation
- Observation
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 97887-4 | Core Outcome Measures Index for the Back [COMI] |
| 97327-1 | Core Outcome Measures Index for the Neck [COMI] |
| 69412-5 | Deprecated Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0 |
| 85645-0 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 3.00 [CMS Assessment] |
| 85671-6 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 3.00 [CMS Assessment] |
| 85662-5 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 3.00 [CMS Assessment] |
| 85668-2 | Deprecated Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 3.00 [CMS Assessment] |
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 107632-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment] |
| 106625-7 | Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.0 during assessment period [CMS Assessment] |
| 107631-4 | Hospice Outcomes and Patient Evaluation (HOPE) Discharge v1.01 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
| 107633-0 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.01 during assessment period [CMS Assessment] |
| 100203-9 | Knee Society Score post-op panel [Knee Society Score] |
| 100159-3 | Knee Society Score pre-op panel [Knee Society Score] |
| 103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
| 113119-2 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.3 during assessment period [CMS Assessment] |
| 103948-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.1 during assessment period [CMS Assessment] |
| 113164-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 5.3 during assessment period [CMS Assessment] |
| 103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 113166-3 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.3 during assessment period [CMS Assessment] |
| 103947-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.1 during assessment period [CMS Assessment] |
| 113165-5 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 5.3 during assessment period [CMS Assessment] |
| 104608-5 | MDS v3.0 - RAI v1.19.1 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
| 103564-1 | MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
| 104606-9 | MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
| 105201-8 | MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
| 104552-5 | MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
| 104554-1 | MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
| 104607-7 | MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment] |
| 104609-3 | MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
| 46611-0 | Mental residual functional capacity (RFC) assessment form |
| 107107-5 | Mini nutritional assessment MNA |
| 108256-9 | Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.20.1 during assessment period [CMS Assessment] |
| 74725-3 | Patient safety event report - hospital - device or medical AndOr surgical supply, including health information technology (HIT) - version 1.2 [AHRQ] |
| 74495-3 | Patient safety event report - hospital - healthcare event reporting form (HERF) - version 1.2 [AHRQ] |
| 74080-3 | Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ] |
| 74502-6 | Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ] |
| 74501-8 | Patient safety event report - hospital - summary of initial report (SIR) - version 1.2 [AHRQ] |
| 105485-7 | PhenX - healthcare communications protocol 281101 |
| 100997-6 | Respiratory Allergen Panel, Area 5 - Serum |
| 60687-1 | Test of Infant Motor Performance Version 5.1 |
| 55140-8 | Vaccine Adverse Event Reporting System (VAERS) panel |
Language Variants Get Info
| Tag | Language | Translation |
|---|---|---|
| el-GR | Greek (Greece) | Ημερομηνία συμπλήρωσης εντύπου: Synonyms: ADMIN Pt Qn Ημερομηνία Ημερομηνία συμπλήρωσης εντύπου Μορφή |
| es-AR | Spanish (Argentina) | fecha de formulario completo: |
| es-MX | Spanish (Mexico) | Formulario de fecha completado: |
| it-IT | Italian (Italy) | Data completamento form: Synonyms: Amministrativo Punto nel tempo (episodio) |
| pt-BR | Portuguese (Brazil) | Data formulário preenchido: Synonyms: Time stamp; |
| ru-RU | Russian (Russian Federation) | Дата форма заполнение: Synonyms: Дата заполнения формы Количественный Точка во времени; |
| zh-CN | Chinese (China) | 表单完成日期: Synonyms: 可用数量表示的; |
Example Units
| Unit | Source |
|---|---|
| {mm/dd/yyyy} | Example UCUM Units |