87509-6
Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment]
Active
Term Description
This panel should be used for CMS LCDS v4.00 Admission assessments performed since July 1, 2018. The effective date of new versions of this form (e.g. v5.00) have been delayed due to the COVID-19 PHE. For the latest information, please see announcements on https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/LTCH-Quality-Reporting-Spotlight-Announcements.
Source: Regenstrief LOINC
Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
| LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
|---|---|---|---|---|
| 87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] | |||
| Indent85636-9 | Administrative Information | |||
| Indent Indent58198-3 | Type of Record | |||
| Indent Indent54581-4 | Facility Provider Numbers | |||
| Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
| Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
| Indent Indent Indent45398-5 | State Medicaid Provider Number | |||
| Indent Indent85632-8 | Type of Provider | |||
| Indent Indent54593-9 | Assessment Reference Date. Observation end date | {mm/dd/yyyy} | ||
| Indent Indent52455-3 | Admission Date | {mm/dd/yyyy} | ||
| Indent Indent52454-6 | Reason for Assessment | |||
| Indent Indent85816-7 | Patient Demographic Information | |||
| Indent Indent Indent54503-8 | Legal Name of Patient | |||
| Indent Indent Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent Indent45966-9 | Social Security and Medicare Numbers | |||
| Indent Indent Indent Indent45396-9 | Social Security Number | |||
| Indent Indent Indent Indent45397-7 | Medicare number (or comparable railroad insurance number) | |||
| Indent Indent Indent45400-9 | Medicaid Number | |||
| Indent Indent Indent46098-0 | Gender | |||
| Indent Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent Indent59362-4 | Race/Ethnicity | 1..6 | ||
| Indent Indent Indent54505-3 | Language | |||
| Indent Indent Indent Indent54588-9 | Does the patient need or want an interpreter to communicate with a doctor or health care staff? | |||
| Indent Indent Indent Indent54899-0 | Preferred language | |||
| Indent Indent Indent45404-1 | Marital Status | |||
| Indent Indent Indent52556-8 | Payer Information | 1..13 | ||
| Indent Indent85815-9 | Pre-Admission Service Use | |||
| Indent Indent Indent85398-6 | Admitted From | |||
| Indent87215-0 | Hearing, Speech, and Vision | |||
| Indent Indent54597-0 | Comatose | |||
| Indent Indent95737-3 | Expression of Ideas and Wants | |||
| Indent Indent95740-7 | Understanding Verbal and Non-Verbal Content | |||
| Indent95854-6 | Cognitive Patterns | |||
| Indent Indent95852-0 | Signs and Symptoms of Delirium (from CAM) | |||
| Indent Indent Indent95853-8 | Acute Onset and Fluctuating Course | |||
| Indent Indent Indent Indent95813-2 | Is there evidence of an acute change in mental status from the patient's baseline? | |||
| Indent Indent Indent Indent95855-3 | Did the (abnormal) behavior fluctuate during the day, that is, tend to come and go or increase and decrease in severity? | |||
| Indent Indent Indent95812-4 | Inattention.Did the patient have difficulty focusing attention, for example, being easily distractible or having difficulty keeping track of what was being said? | |||
| Indent Indent Indent95814-0 | Disorganized thinking.Was the patient's thinking disorganized or incoherent, such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject? | |||
| Indent Indent Indent95856-1 | Altered Level of Consciousness | |||
| Indent Indent Indent Indent95857-9 | Overall, how would you rate the patient's level of consciousness? Alert (Normal) | |||
| Indent Indent Indent Indent95858-7 | Overall, how would you rate the patient's level of consciousness? Vigilant (hyperalert) or Lethargic (drowsy, easily aroused) or Stupor (difficult to arouse) or Coma (unarousable) | |||
| Indent88238-1 | Functional Abilities and Goals | |||
| Indent Indent85642-7 | Prior Functioning: Everyday Activities | |||
| Indent Indent Indent85071-9 | Indoor Mobility (Ambulation) | |||
| Indent Indent83234-5 | Prior Device Use | 1..4 | ||
| Indent Indent95859-5 | Self-Care - Admission Performance | |||
| Indent Indent Indent95019-6 | Eating | |||
| Indent Indent Indent95018-8 | Oral hygiene | |||
| Indent Indent Indent95017-0 | Toileting hygiene | |||
| Indent Indent Indent95016-2 | Wash upper body | |||
| Indent Indent95860-3 | LCDS v4.00 - Self-care - discharge goal during assessment period [CMS Assessment] | |||
| Indent Indent87502-1 | Mobility - Admission Performance | |||
| Indent Indent Indent95011-3 | Roll left and right | |||
| Indent Indent Indent95010-5 | Sit to lying | |||
| Indent Indent Indent95009-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent95008-9 | Sit to stand | |||
| Indent Indent Indent95007-1 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent95006-3 | Toilet transfer | |||
| Indent Indent Indent95004-8 | Walk 10 feet | |||
| Indent Indent Indent95003-0 | Walk 50 feet with two turns | |||
| Indent Indent Indent95002-2 | Walk 150 feet | |||
| Indent Indent Indent95738-1 | Does the patient use a wheelchair and/or scooter? | |||
| Indent Indent Indent94992-5 | Wheel 50 feet with two turns | |||
| Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
| Indent Indent Indent94991-7 | Wheel 150 feet | |||
| Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
| Indent Indent95862-9 | Mobility - Discharge Goal | |||
| Indent Indent Indent89398-2 | Roll left and right | |||
| Indent Indent Indent89394-1 | Sit to lying | |||
| Indent Indent Indent85927-2 | Lying to sitting on side of bed | |||
| Indent Indent Indent89392-5 | Sit to stand | |||
| Indent Indent Indent89414-7 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent89390-9 | Toilet transfer | |||
| Indent Indent Indent89385-9 | Walk 10 feet | |||
| Indent Indent Indent89381-8 | Walk 50 feet with two turns | |||
| Indent Indent Indent89383-4 | Walk 150 feet | |||
| Indent Indent Indent89375-0 | Wheel 50 feet with two turns | |||
| Indent Indent Indent89377-6 | Wheel 150 feet | |||
| Indent95733-2 | Bladder and Bowel | |||
| Indent Indent95735-7 | Bladder Continence | |||
| Indent Indent95736-5 | Bowel Continence | |||
| Indent95864-5 | Active Diagnoses | |||
| Indent Indent96095-5 | Indicate the patient's primary medical condition category | |||
| Indent Indent52797-8 | Other medical condition | |||
| Indent Indent83243-6 | Comorbidities and Co-existing Conditions | 1..33 | ||
| Indent95865-2 | Swallowing/Nutritional Status | |||
| Indent Indent54567-3 | Height and Weight | |||
| Indent Indent Indent103692-0 | Height (in inches) | [in_us];cm;m | ||
| Indent Indent Indent103693-8 | Weight (in pounds) | [lb_av];kg | ||
| Indent85055-2 | Skin Conditions | |||
| Indent Indent58214-8 | Unhealed Pressure Ulcers/Injuries | |||
| Indent Indent83246-9 | Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage | |||
| Indent Indent Indent54884-2 | Number of Stage 1 pressure injuries | {#} | ||
| Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent54893-3 | Number of unstageable pressure ulcers/injuries due to non-removable dressing/device | {#} | ||
| Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent54950-1 | Number of unstageable pressure injuries presenting as deep tissue injury | {#} | ||
| Indent87521-1 | Medications | |||
| Indent Indent57255-2 | Drug Regimen Review: Did a complete drug regimen review identify potential clinically significant medication issues? | |||
| Indent Indent57281-8 | Medication Follow-up: Did the facility 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? | |||
| Indent87230-9 | Special Treatments, Procedures, and Programs | |||
| Indent Indent83252-7 | Special Treatments, Procedures, and Programs | 1..6 | ||
| Indent Indent87537-7 | Spontaneous Breathing Trial (SBT) (including Tracheostomy Collar or Continuous Positive Airway Pressure (CPAP) Breathing Trial) by Day 2 of the LTCH Stay | |||
| Indent Indent Indent87539-3 | Invasive Mechanical Ventilation Support upon Admission to the LTCH | |||
| Indent Indent Indent87538-5 | Assessed for readiness for SBT by day 2 of the LTCH stay | |||
| Indent Indent Indent87540-1 | Deemed medically ready for SBT by day 2 of the LTCH stay | |||
| Indent Indent Indent87541-9 | Is there documentation of reason(s) in the patient's medical record that the patient was deemed medically unready for SBT by day 2 of the LTCH stay? | |||
| Indent Indent Indent87542-7 | SBT performed by day 2 of the LTCH stay | |||
| Indent Indent69339-0 | Influenza Vaccine | |||
| Indent Indent Indent55019-4 | Did the patient receive the influenza vaccine in this facility for this year's influenza vaccination season? | |||
| Indent Indent Indent58131-4 | Date influenza vaccine received | {mm/dd/yyyy} | ||
| Indent Indent Indent55020-2 | If influenza vaccine not received, state reason: | C |
Fully-Specified Name
- Component
- Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.63
- Last Updated
- Version 2.77
- 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
- Both
- Panel Type
- Panel
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=87509-6 - Questionnaire definition
- https:
//fhir.loinc.org/Questionnaire/?url=http: //loinc.org/q/87509-6
LOINC Copyright
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