LOINC
Version 2.66

90472-2Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.17.1 [CMS Assessment]Active

Component
Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.17.1
Property
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Time
Pt
System
^Patient
Scale
-
Method
CMS Assessment

Panel Hierarchy
Details for each LOINC in Panel

LOINC Name R/O/C Cardinality Example UCUM Units
90472-2 Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.17.1 [CMS Assessment]
Indent90473-0 MDS v3.0 - RAI v1.17.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
IndentIndent90499-5 Identification Information
IndentIndentIndent58198-3 Type of Record
IndentIndentIndent54581-4 Facility Provider Numbers
IndentIndentIndentIndent76468-8 National Provider Identifier (NPI)
IndentIndentIndentIndent69417-4 CMS Certification Number (CCN)
IndentIndentIndentIndent45398-5 State Provider Number
IndentIndentIndent85632-8 Type of Provider
IndentIndentIndent90521-6 Optional State Assessment
IndentIndentIndentIndent90522-4 Is this assessment for state payment purposes only?
IndentIndentIndent90489-6 Type of Assessment
IndentIndentIndentIndent54583-0 Federal OBRA Reason for Assessment
IndentIndentIndentIndent54584-8 PPS Assessment
IndentIndentIndentIndent54587-1 Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry?
IndentIndentIndentIndent58108-2 Entry/discharge reporting
IndentIndentIndentIndent71440-2 Type of discharge
IndentIndentIndentIndent90525-7 Is this a SNF Part A Interrupted Stay?
IndentIndentIndentIndent86525-3 Is this a SNF Part A PPS Discharge Assessment?
IndentIndentIndent86526-1 Unit Certification or Licensure Designation
IndentIndentIndent54503-8 Legal Name of Resident
IndentIndentIndentIndent45392-8 First name
IndentIndentIndentIndent45393-6 Middle initial
IndentIndentIndentIndent45394-4 Last name
IndentIndentIndentIndent45395-1 Suffix
IndentIndentIndent45966-9 Social Security and Medicare Numbers
IndentIndentIndentIndent45396-9 Social Security Number
IndentIndentIndentIndent45397-7 Medicare number
IndentIndentIndent45400-9 Medicaid Number
IndentIndentIndent46098-0 Gender
IndentIndentIndent21112-8 Birth Date {mm/dd/yyyy}
IndentIndentIndent59362-4 Race/Ethnicity 1..6
IndentIndentIndent54505-3 Language
IndentIndentIndentIndent54588-9 Does the resident need or want an interpreter to communicate with a doctor or health care staff?
IndentIndentIndentIndent54899-0 Preferred language
IndentIndentIndent45404-1 Marital Status
IndentIndentIndent54506-1 Optional Resident Items
IndentIndentIndentIndent46106-1 Medical record number
IndentIndentIndentIndent45403-3 Room number
IndentIndentIndentIndent52462-9 Name by which resident prefers to be addressed
IndentIndentIndentIndent21843-8 Lifetime occupation(s)
IndentIndentIndent54589-7 Preadmission Screening and Resident Review (PASRR). Is the resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition?
IndentIndentIndent71441-0 Level II Preadmission Screening and Resident Review (PASRR) Conditions 1..3
IndentIndentIndent86527-9 Conditions Related to ID/DD Status 1..4
IndentIndentIndent86528-7 Most Recent Admission/Entry or Reentry into this Facility
IndentIndentIndentIndent50786-3 Entry Date {mm/dd/yyyy}
IndentIndentIndentIndent54590-5 Type of Entry
IndentIndentIndentIndent85398-6 Entered From
IndentIndentIndent52455-3 Admission Date (Date this episode of care in this facility began) {mm/dd/yyyy}
IndentIndentIndent52525-3 Discharge Date {mm/dd/yyyy}
IndentIndentIndent55128-3 Discharge Status
IndentIndentIndent54592-1 Previous Assessment Reference Date for Significant Correction {mm/dd/yyyy}
IndentIndentIndent54593-9 Assessment Reference Date. Observation end date {mm/dd/yyyy}
IndentIndentIndent54507-9 Medicare Stay
IndentIndentIndentIndent54594-7 Has the resident had a Medicare-covered stay since the most recent entry?
IndentIndentIndentIndent54595-4 Start date of most recent Medicare stay {mm/dd/yyyy}
IndentIndentIndentIndent54596-2 End date of most recent Medicare stay {mm/dd/yyyy}
IndentIndent54508-7 Hearing, Speech, and Vision
IndentIndentIndent54597-0 Comatose. Persistent vegetative state/no discernible consciousness
IndentIndentIndent54598-8 Hearing. Ability to hear (with hearing aid or hearing appliances if normally used)
IndentIndentIndent54599-6 Hearing Aid. Hearing aid or other hearing appliance used in completing B0200, Hearing
IndentIndentIndent54600-2 Speech Clarity. Select best description of speech pattern
IndentIndentIndent54601-0 Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression
IndentIndentIndent54602-8 Ability to Understand Others. Understanding verbal content, however able (with hearing aid or device if used)
IndentIndentIndent54603-6 Vision. Ability to see in adequate light (with glasses or other visual appliances)
IndentIndentIndent54604-4 Corrective Lenses. Corrective lenses (contacts, glasses, or magnifying glass) used in completing B1000, Vision
IndentIndent86529-5 Cognitive Patterns
IndentIndentIndent54605-1 Should Brief Interview for Mental Status (C0200-C0500) be Conducted?
IndentIndentIndent52491-8 Brief Interview for Mental Status (BIMS)
IndentIndentIndentIndent52731-7 Repetition of Three Words. Number of words repeated after first attempt
IndentIndentIndentIndent54510-3 Temporal Orientation (orientation to year, month, and day)
IndentIndentIndentIndentIndent52732-5 Able to report correct year
IndentIndentIndentIndentIndent52733-3 Able to report correct month
IndentIndentIndentIndentIndent54609-3 Able to report correct day of the week
IndentIndentIndentIndent52493-4 Recall
IndentIndentIndentIndentIndent52735-8 Able to recall "sock"
IndentIndentIndentIndentIndent52736-6 Able to recall "blue"
IndentIndentIndentIndentIndent52737-4 Able to recall "bed"
IndentIndentIndentIndent54614-3 BIMS Summary Score {score}
IndentIndentIndent54615-0 Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted?
IndentIndentIndent86595-6 Staff Assessment for Mental Status
IndentIndentIndentIndent54616-8 Short-term Memory OK. Seems or appears to recall after 5 minutes
IndentIndentIndentIndent54617-6 Long-term Memory OK. Seems or appears to recall long past
IndentIndentIndentIndent86583-2 Memory/Recall Ability 1..4
IndentIndentIndentIndent54624-2 Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life
IndentIndentIndent86584-0 Delirium
IndentIndentIndentIndent86585-7 Signs and Symptoms of Delirium (from CAM)
IndentIndentIndentIndentIndent54632-5 Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline?
IndentIndentIndentIndentIndent54628-3 Inattention - Did the resident have difficulty focusing attention, for example, being easily distractible or having difficulty keeping track of what was being said?
IndentIndentIndentIndentIndent54629-1 Disorganized Thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)?
IndentIndentIndentIndentIndent54630-9 Altered Level of Consciousness - Did the resident have altered level of consciousness, as indicated by any of the following criteria?
IndentIndent90482-1 Mood
IndentIndentIndent54634-1 Should Resident Mood Interview be Conducted?
IndentIndentIndent54635-8 Resident Mood Interview (PHQ-9)
IndentIndentIndentIndent86843-0 Symptom Presence
IndentIndentIndentIndentIndent54636-6 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54638-2 Feeling down, depressed or hopeless
IndentIndentIndentIndentIndent54640-8 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54642-4 Feeling tired or having little energy
IndentIndentIndentIndentIndent54644-0 Poor appetite or overeating
IndentIndentIndentIndentIndent54646-5 Feeling bad about yourself - or that you are a failure or have let yourself or your family down
IndentIndentIndentIndentIndent54648-1 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54650-7 Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual
IndentIndentIndentIndentIndent54652-3 Thoughts that you would be better off dead, or of hurting yourself in some way
IndentIndentIndentIndent86844-8 Symptom Frequency
IndentIndentIndentIndentIndent54637-4 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54639-0 Feeling down, depressed or hopeless
IndentIndentIndentIndentIndent54641-6 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54643-2 Feeling tired or having little energy
IndentIndentIndentIndentIndent54645-7 Poor appetite or overeating
IndentIndentIndentIndentIndent54647-3 Feeling bad about yourself - or that you are a failure or have let yourself or your family down
IndentIndentIndentIndentIndent54649-9 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54651-5 Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual
IndentIndentIndentIndentIndent54653-1 Thoughts that you would be better off dead, or of hurting yourself in some way
IndentIndentIndent54654-9 Total Severity Score {score}
IndentIndentIndent54657-2 Staff Assessment of Resident Mood (PHQ-9-OV)
IndentIndentIndentIndent86833-1 Symptom Presence
IndentIndentIndentIndentIndent54658-0 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54660-6 Feeling or appearing down, depressed, or hopeless
IndentIndentIndentIndentIndent54662-2 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54664-8 Feeling tired or having little energy
IndentIndentIndentIndentIndent54666-3 Poor appetite or overeating
IndentIndentIndentIndentIndent54668-9 Indicating that s/he feels bad about self, is a failure, or has let self or family down
IndentIndentIndentIndentIndent54670-5 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54672-1 Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual
IndentIndentIndentIndentIndent54673-9 States that life isn't worth living, wishes for death, or attempts to harm self
IndentIndentIndentIndentIndent54675-4 Being short-tempered, easily annoyed
IndentIndentIndentIndent86891-9 Symptom Frequency
IndentIndentIndentIndentIndent54659-8 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54661-4 Feeling or appearing down, depressed, or hopeless
IndentIndentIndentIndentIndent54663-0 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54665-5 Feeling tired or having little energy
IndentIndentIndentIndentIndent54667-1 Poor appetite or overeating
IndentIndentIndentIndentIndent54669-7 Indicating that s/he feels bad about self, is a failure, or has let self or family down
IndentIndentIndentIndentIndent54671-3 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54904-8 Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual
IndentIndentIndentIndentIndent54674-7 States that life isn't worth living, wishes for death, or attempts to harm self
IndentIndentIndentIndentIndent54676-2 Being short-tempered, easily annoyed
IndentIndentIndent54677-0 Total Severity Score {score}
IndentIndent86596-4 Behavior
IndentIndentIndent86597-2 Potential Indicators of Psychosis 1..2
IndentIndentIndent54514-5 Behavioral Symptom - Presence & Frequency
IndentIndentIndentIndent54682-0 Physical behavioral symptoms directed toward others d/(7.d)
IndentIndentIndentIndent54683-8 Verbal behavioral symptoms directed toward others d/(7.d)
IndentIndentIndentIndent54684-6 Other behavioral symptoms not directed toward others d/(7.d)
IndentIndentIndent54685-3 Overall Presence of Behavioral Symptoms.Were any behavioral symptoms in questions E0200 coded 1, 2, or 3?
IndentIndentIndent54515-2 Impact on Resident
IndentIndentIndentIndent54686-1 Did any of the identified symptom(s): Put the resident at significant risk for physical illness or injury?
IndentIndentIndentIndent54687-9 Did any of the identified symptom(s): Significantly interfere with the resident's care?
IndentIndentIndentIndent54688-7 Did any of the identified symptom(s): Significantly interfere with the resident's participation in activities or social interactions?
IndentIndentIndent54516-0 Impact on Others
IndentIndentIndentIndent54689-5 Did any of the identified symptom(s): Put others at significant risk for physical injury?
IndentIndentIndentIndent54690-3 Did any of the identified symptom(s): Significantly intrude on the privacy or activity of others?
IndentIndentIndentIndent54691-1 Did any of the identified symptom(s): Significantly disrupt care or living environment?
IndentIndentIndent54692-9 Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? d/(7.d)
IndentIndentIndent54693-7 Wandering - Presence & Frequency. Has the resident wandered? d/(7.d)
IndentIndentIndent54517-8 Wandering - Impact
IndentIndentIndentIndent54694-5 Does the wandering place the resident at significant risk of getting to a potentially dangerous place?
IndentIndentIndentIndent54695-2 Does the wandering significantly intrude on the privacy or activities of others?
IndentIndentIndent54696-0 Change in Behavior or Other Symptoms.How does resident's current behavior status, care rejection, or wandering compare to prior assessment (OBRA or Scheduled PPS)?
IndentIndent86600-4 Preferences for Customary Routine and Activities
IndentIndentIndent54697-8 Should Interview for Daily and Activity Preferences be Conducted?
IndentIndentIndent54519-4 Interview for Daily Preferences
IndentIndentIndentIndent54698-6 While you are in this facility how important is it to you to choose what clothes to wear?
IndentIndentIndentIndent54699-4 While you are in this facility how important is it to you to take care of your personal belongings or things?
IndentIndentIndentIndent54700-0 While you are in this facility how important is it to you to choose between a tub bath, shower, bed bath, or sponge bath?
IndentIndentIndentIndent54701-8 While you are in this facility how important is it to you to have snacks available between meals?
IndentIndentIndentIndent54702-6 While you are in this facility how important is it to you to choose your own bedtime?
IndentIndentIndentIndent54703-4 While you are in this facility how important is it to you to have your family or a close friend involved in discussions about your care?
IndentIndentIndentIndent54704-2 While you are in this facility how important is it to you to be able to use the phone in private?
IndentIndentIndentIndent54705-9 While you are in this facility how important is it to you to have a place to lock your things to keep them safe?
IndentIndentIndent54520-2 Interview for Activity Preferences
IndentIndentIndentIndent54706-7 While you are in this facility how important is it to you to have books, newspapers, and magazines to read?
IndentIndentIndentIndent54707-5 While you are in this facility how important is it to you to listen to music you like?
IndentIndentIndentIndent54708-3 While you are in this facility how important is it to you to be around animals such as pets?
IndentIndentIndentIndent54709-1 While you are in this facility how important is it to you to keep up with the news?
IndentIndentIndentIndent54710-9 While you are in this facility how important is it to you to do things with groups of people?
IndentIndentIndentIndent54711-7 While you are in this facility how important is it to you to do your favorite activities?
IndentIndentIndentIndent54712-5 While you are in this facility how important is it to you to go outside to get fresh air when the weather is good?
IndentIndentIndentIndent54713-3 While you are in this facility how important is it to you to participate in religious services or practices?
IndentIndentIndent54714-1 Daily and Activity Preferences Primary Respondent. Indicate primary respondent for Daily and Activity Preferences (F0400 and F0500)
IndentIndentIndent54715-8 Should the Staff Assessment of Daily and Activity Preferences be Conducted?
IndentIndentIndent86599-8 Staff Assessment of Daily and Activity Preferences. Resident Prefers:
IndentIndent86601-2 Functional Status
IndentIndentIndent86880-2 Activities of Daily Living (ADL) Assistance. Self-Performance
IndentIndentIndentIndent45588-1 Bed mobility
IndentIndentIndentIndent45590-7 Transfer
IndentIndentIndentIndent45592-3 Walk in room
IndentIndentIndentIndent45594-9 Walk in corridor
IndentIndentIndentIndent45596-4 Locomotion on unit
IndentIndentIndentIndent45598-0 Locomotion off unit
IndentIndentIndentIndent45600-4 Dressing
IndentIndentIndentIndent45602-0 Eating
IndentIndentIndentIndent45604-6 Toilet use
IndentIndentIndentIndent45606-1 Personal hygiene
IndentIndentIndent86881-0 Activities of Daily Living (ADL) Assistance. Support Provided
IndentIndentIndentIndent45589-9 Bed mobility
IndentIndentIndentIndent45591-5 Transfer
IndentIndentIndentIndent45593-1 Walk in room
IndentIndentIndentIndent45595-6 Walk in corridor
IndentIndentIndentIndent45597-2 Locomotion on unit
IndentIndentIndentIndent45599-8 Locomotion off unit
IndentIndentIndentIndent45601-2 Dressing
IndentIndentIndentIndent45603-8 Eating
IndentIndentIndentIndent45605-3 Toilet use
IndentIndentIndentIndent45607-9 Personal hygiene
IndentIndentIndent46008-9 Bathing
IndentIndentIndentIndent45608-7 Self-performance
IndentIndentIndentIndent45609-5 Support provided
IndentIndentIndent54524-4 Balance During Transitions and Walking
IndentIndentIndentIndent54749-7 Moving from seated to standing position
IndentIndentIndentIndent54750-5 Walking (with assistive device if used)
IndentIndentIndentIndent54751-3 Turning around and facing the opposite direction while walking
IndentIndentIndentIndent54752-1 Moving on and off toilet
IndentIndentIndentIndent54753-9 Surface-to-surface transfer (transfer between bed and chair or wheelchair)
IndentIndentIndent92908-3 Functional Limitation in Range of Motion
IndentIndentIndentIndent92850-7 Upper extremity (shoulder, elbow, wrist, hand)
IndentIndentIndentIndent92851-5 Lower extremity (hip, knee, ankle, foot)
IndentIndentIndent86602-0 Mobility Devices 1..4
IndentIndentIndent54527-7 Functional Rehabilitation Potential
IndentIndentIndentIndent55123-4 Resident believes he or she is capable of increased independence in at least some ADLs.
IndentIndentIndentIndent45613-7 Direct care staff believe resident is capable of increased independence in at least some ADLs
IndentIndent88482-5 Functional Abilities and Goals - Admission (Start of SNF PPS Stay)
IndentIndentIndent83239-4 Prior Functioning: Everyday Activities
IndentIndentIndentIndent85070-1 Self-Care
IndentIndentIndentIndent85071-9 Indoor Mobility (Ambulation)
IndentIndentIndentIndent85072-7 Stairs
IndentIndentIndentIndent85073-5 Functional Cognition
IndentIndentIndent83234-5 Prior Device Use 1..5
IndentIndentIndent83233-7 Self-Care - Admission Performance
IndentIndentIndentIndent83232-9 Eating
IndentIndentIndentIndent83230-3 Oral hygiene
IndentIndentIndentIndent83228-7 Toileting hygiene
IndentIndentIndentIndent83226-1 Shower/bathe self
IndentIndentIndentIndent83224-6 Upper body dressing
IndentIndentIndentIndent83222-0 Lower body dressing
IndentIndentIndentIndent83220-4 Putting on/taking off footwear
IndentIndentIndent85054-5 Self-Care - Discharge Goal
IndentIndentIndentIndent83231-1 Eating
IndentIndentIndentIndent83229-5 Oral hygiene
IndentIndentIndentIndent83227-9 Toileting hygiene
IndentIndentIndentIndent83225-3 Shower/bathe self
IndentIndentIndentIndent83223-8 Upper body dressing
IndentIndentIndentIndent83221-2 Lower body dressing
IndentIndentIndentIndent83219-6 Putting on/taking off footwear
IndentIndentIndent88330-6 Mobility - Admission Performance
IndentIndentIndentIndent83218-8 Roll left and right
IndentIndentIndentIndent83216-2 Sit to lying
IndentIndentIndentIndent83214-7 Lying to sitting on side of bed
IndentIndentIndentIndent83212-1 Sit to stand
IndentIndentIndentIndent83210-5 Chair/bed-to-chair transfer
IndentIndentIndentIndent83208-9 Toilet transfer
IndentIndentIndentIndent83206-3 Car transfer
IndentIndentIndentIndent83204-8 Walk 10 feet
IndentIndentIndentIndent83202-2 Walk 50 feet with two turns
IndentIndentIndentIndent83200-6 Walk 150 feet
IndentIndentIndentIndent83198-2 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83196-6 1 step (curb)
IndentIndentIndentIndent83194-1 4 steps
IndentIndentIndentIndent83192-5 12 steps
IndentIndentIndentIndent83190-9 Picking up object
IndentIndentIndentIndent83271-7 Does the resident use a wheelchair and/or scooter?
IndentIndentIndentIndent83188-3 Wheel 50 feet with two turns
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndentIndentIndent83235-2 Wheel 150 feet
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndentIndent85056-0 Mobility - Discharge Goal
IndentIndentIndentIndent83217-0 Roll left and right
IndentIndentIndentIndent83215-4 Sit to lying
IndentIndentIndentIndent83213-9 Lying to sitting on side of bed
IndentIndentIndentIndent83211-3 Sit to stand
IndentIndentIndentIndent83209-7 Chair/Bed-to-chair transfer
IndentIndentIndentIndent83207-1 Toilet transfer
IndentIndentIndentIndent83205-5 Car transfer
IndentIndentIndentIndent83203-0 Walk 10 feet
IndentIndentIndentIndent83201-4 Walk 50 feet with two turns
IndentIndentIndentIndent83199-0 Walk 150 feet
IndentIndentIndentIndent83197-4 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83195-8 1 step (curb)
IndentIndentIndentIndent83193-3 4 steps
IndentIndentIndentIndent83191-7 12 steps
IndentIndentIndentIndent83189-1 Picking up object
IndentIndentIndentIndent83187-5 Wheel 50 feet with two turns
IndentIndentIndentIndent83236-0 Wheel 150 feet
IndentIndent88483-3 Functional Abilities and Goals - Discharge (End of SNF PPS Stay)
IndentIndentIndent83254-3 Self-Care - Discharge Performance
IndentIndentIndentIndent83232-9 Eating
IndentIndentIndentIndent83230-3 Oral hygiene
IndentIndentIndentIndent83228-7 Toileting hygiene
IndentIndentIndentIndent83226-1 Shower/bathe self
IndentIndentIndentIndent83224-6 Upper body dressing
IndentIndentIndentIndent83222-0 Lower body dressing
IndentIndentIndentIndent83220-4 Putting on/taking off footwear
IndentIndentIndent88331-4 Mobility - Discharge Performance
IndentIndentIndentIndent83218-8 Roll left and right
IndentIndentIndentIndent83216-2 Sit to lying
IndentIndentIndentIndent83214-7 Lying to sitting on side of bed
IndentIndentIndentIndent83212-1 Sit to stand
IndentIndentIndentIndent83210-5 Chair/bed-to-chair transfer
IndentIndentIndentIndent83208-9 Toilet transfer
IndentIndentIndentIndent83206-3 Car transfer
IndentIndentIndentIndent83204-8 Walk 10 feet
IndentIndentIndentIndent83202-2 Walk 50 feet with two turns
IndentIndentIndentIndent83200-6 Walk 150 feet
IndentIndentIndentIndent83198-2 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83196-6 1 step (curb)
IndentIndentIndentIndent83194-1 4 steps
IndentIndentIndentIndent83192-5 12 steps
IndentIndentIndentIndent83190-9 Picking up object
IndentIndentIndentIndent83271-7 Does the resident use a wheelchair and/or scooter?
IndentIndentIndentIndent83188-3 Wheel 50 feet with two turns
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndentIndentIndent83235-2 Wheel 150 feet
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndent89048-3 Bladder and Bowel
IndentIndentIndent86624-4 Appliances 1..4
IndentIndentIndent54530-1 Urinary Toileting Program
IndentIndentIndentIndent54767-9 Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility?
IndentIndentIndentIndent54768-7 Response - What was the resident's response to the trial program?
IndentIndentIndentIndent54769-5 Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence?
IndentIndentIndent54770-3 Urinary Continence 1..1
IndentIndentIndent54771-1 Bowel Continence 1..1
IndentIndentIndent88695-2 Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence?
IndentIndentIndent54773-7 Bowel Patterns. Constipation present?
IndentIndent90485-4 Active Diagnoses
IndentIndentIndent89045-9 Indicate the resident's primary medical condition category 1..1
IndentIndentIndent52797-8 ICD Code
IndentIndentIndent86671-5 Active Diagnoses in the last 7 days 1..*
IndentIndentIndent52797-8 Additional active diagnoses 0..10
IndentIndent90486-2 Health Conditions
IndentIndentIndent54557-4 Pain Management
IndentIndentIndentIndent71447-7 At any time in the last 5 days, has the resident: Received scheduled pain medication regimen?
IndentIndentIndentIndent71448-5 At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined?
IndentIndentIndentIndent71449-3 At any time in the last 5 days, has the resident: Received non-medication intervention for pain?
IndentIndentIndent54828-9 Should Pain Assessment Interview be Conducted?
IndentIndentIndent54558-2 Pain Assessment Interview
IndentIndentIndentIndent54829-7 Pain Presence. Have you had pain or hurting at any time in the last 5 days?
IndentIndentIndentIndent54830-5 Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days?
IndentIndentIndentIndent54559-0 Pain Effect on Function
IndentIndentIndentIndentIndent54831-3 Over the past 5 days, has pain made it hard for you to sleep at night?
IndentIndentIndentIndentIndent54832-1 Over the past 5 days, have you limited your day-to-day activities because of pain?
IndentIndentIndentIndent54560-8 Pain Intensity
IndentIndentIndentIndentIndent54833-9 Numeric Rating Scale (00-10)
IndentIndentIndentIndentIndent54834-7 Verbal Descriptor Scale
IndentIndentIndent58117-3 Should the Staff Assessment for Pain be Conducted?
IndentIndentIndent86672-3 Staff Assessment for Pain
IndentIndentIndentIndent86673-1 Indicators of Pain or Possible Pain in the last 5 days 1..4
IndentIndentIndentIndent58118-1 Frequency of Indicator of Pain or Possible Pain in the last 5 days. Frequency with which resident complains or shows evidence of pain or possible pain d/(5.d)
IndentIndentIndent86674-9 Other Health Conditions
IndentIndentIndentIndent86675-6 Shortness of Breath (dyspnea) 1..3
IndentIndentIndentIndent54845-3 Current Tobacco Use
IndentIndentIndentIndent54846-1 Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?
IndentIndentIndentIndent86676-4 Problem Conditions 1..4
IndentIndentIndentIndent54849-5 Fall History on Admission/Entry or Reentry
IndentIndentIndentIndentIndent54850-3 Did the resident have a fall any time in the last month prior to admission/entry or reentry?
IndentIndentIndentIndentIndent54851-1 Did the resident have a fall any time in the last 2-6 months prior to admission/entry or reentry?
IndentIndentIndentIndentIndent54852-9 Did the resident have any fracture related to a fall in the 6 months prior to admission/entry or reentry?
IndentIndentIndentIndent54853-7 Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent?
IndentIndentIndentIndent54854-5 Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent
IndentIndentIndentIndentIndent54855-2 No injury
IndentIndentIndentIndentIndent54856-0 Injury (except major)
IndentIndentIndentIndentIndent54857-8 Major injury
IndentIndentIndent83274-1 Prior Surgery. Did the resident have major surgery during the 100 days prior to admission?
IndentIndentIndent90542-2 Recent Surgery Requiring Active SNF Care-Did the resident have a major surgical procedure during the prior inpatient hospital stay that requires active care during the SNF stay?
IndentIndentIndent90745-1 Surgical Procedures
IndentIndent90483-9 Swallowing/Nutritional Status
IndentIndentIndent86677-2 Swallowing Disorder. Signs and symptoms of possible swallowing disorder 1..4
IndentIndentIndent54567-3 Height and Weight
IndentIndentIndentIndent3137-7 Height (in inches) [in_us];cm
IndentIndentIndentIndent3141-9 Weight (in pounds) [lb_av];kg
IndentIndentIndent54863-6 Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months
IndentIndentIndent86678-0 Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months
IndentIndentIndent54568-1 Nutritional Approaches
IndentIndentIndentIndent71444-4 Nutritional Approaches. While NOT a Resident 0..2
IndentIndentIndentIndent71445-1 Nutritional Approaches. While a Resident 1..4
IndentIndentIndent90543-0 Percent Intake by Artificial Route
IndentIndentIndentIndent86681-4 Proportion of total calories the resident received through parenteral or tube feeding. While a Resident
IndentIndentIndentIndent86687-1 Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days
IndentIndentIndentIndent86683-0 Average fluid intake per day by IV or tube feeding. While a Resident
IndentIndentIndentIndent86684-8 Average fluid intake per day by IV or tube feeding. During Entire 7 Days
IndentIndent86685-5 Oral/Dental Status
IndentIndentIndent86706-9 Dental 1..7
IndentIndent88960-0 Skin Conditions
IndentIndentIndent86708-5 Determination of Pressure Ulcer/Injury Risk 1..3
IndentIndentIndent57280-0 Risk of Pressure Ulcers/Injuries. Is this resident at risk of developing pressure ulcers/injuries?
IndentIndentIndent58214-8 Unhealed Pressure Ulcers/Injuries. Does this resident have one or more unhealed pressure ulcers/injuries?
IndentIndentIndent88961-8 Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage
IndentIndentIndentIndent54884-2 Number of Stage 1 pressure injuries {#}
IndentIndentIndentIndent55124-2 Number of Stage 2 pressure ulcers {#}
IndentIndentIndentIndent54886-7 Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent55125-9 Number of Stage 3 pressure ulcers {#}
IndentIndentIndentIndent54887-5 Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent55126-7 Number of Stage 4 pressure ulcers {#}
IndentIndentIndentIndent54890-9 Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent54893-3 Number of unstageable pressure ulcers/injuries due to non-removable dressing/device {#}
IndentIndentIndentIndent54894-1 Number of these unstageable pressure ulcers/injuries that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent54946-9 Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar {#}
IndentIndentIndentIndent54947-7 Number of these unstageable pressure ulcers that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent54950-1 Number of unstageable pressure injuries presenting as deep tissue injury {#}
IndentIndentIndentIndent54951-9 Number of these unstageable pressure injuries that were present upon admission/entry or reentry {#}
IndentIndentIndent54970-9 Number of Venous and Arterial Ulcers {#}
IndentIndentIndent88696-0 Other Ulcers, Wounds and Skin Problems 1..8
IndentIndentIndent86748-1 Skin and Ulcer/Injury Treatments 1..9
IndentIndent88962-6 Medications
IndentIndentIndent54982-4 Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days. d/(7.d)
IndentIndentIndent58217-1 Insulin
IndentIndentIndentIndent58127-2 Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days d/(7.d)
IndentIndentIndentIndent58128-0 Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days d/(7.d)
IndentIndentIndent88290-2 Medications Received
IndentIndentIndentIndent86751-5 Antipsychotic d/(7.d)
IndentIndentIndentIndent86752-3 Antianxiety d/(7.d)
IndentIndentIndentIndent86753-1 Antidepressant d/(7.d)
IndentIndentIndentIndent86754-9 Hypnotic d/(7.d)
IndentIndentIndentIndent86755-6 Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin) d/(7.d)
IndentIndentIndentIndent86756-4 Antibiotic d/(7.d)
IndentIndentIndentIndent86757-2 Diuretic d/(7.d)
IndentIndentIndentIndent88291-0 Opiod d/(7.d)
IndentIndentIndent88295-1 Antipsychotic Medication Review
IndentIndentIndentIndent88296-9 Did the resident receive antipsychotic medications since admission/entry or reentry or the prior OBRA assessment, whichever is more recent?
IndentIndentIndentIndent88297-7 Has a gradual dose reduction (GDR) been attempted?
IndentIndentIndentIndent88298-5 Date of last attempted GDR {mm/dd/yyyy}
IndentIndentIndentIndent88299-3 Physician documented GDR as clinically contraindicated
IndentIndentIndentIndent88300-9 Date physician documented GDR as clinically contraindicated {mm/dd/yyyy}
IndentIndentIndent57255-2 Drug Regimen Review: Did a complete drug regimen review identify potential clinically significant medication issues?
IndentIndentIndent57281-8 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?
IndentIndentIndent57256-0 Did the facility contact and complete physician (or physician-designee) prescribed/recommended actions by midnight of the next calendar day each time potential clinically significant medication issues were identified since the admission?
IndentIndent90514-1 Special Treatments, Procedures, and Programs
IndentIndentIndent86759-8 Special Treatments, Procedures, and Programs
IndentIndentIndentIndent86760-6 While NOT a Resident 1..12
IndentIndentIndentIndent86761-4 While a Resident 1..12
IndentIndentIndent69339-0 Influenza Vaccine
IndentIndentIndentIndent55019-4 Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season?
IndentIndentIndentIndent58131-4 Date influenza vaccine received {mm/dd/yyyy}
IndentIndentIndentIndent55020-2 If influenza vaccine not received, state reason:
IndentIndentIndent55021-0 Pneumococcal Vaccine
IndentIndentIndentIndent55022-8 Is the resident's Pneumococcal vaccination up to date?
IndentIndentIndentIndent45956-0 If Pneumococcal vaccine not received, state reason:
IndentIndentIndent86762-2 Therapies
IndentIndentIndentIndent86763-0 Speech-Language Pathology and Audiology Services
IndentIndentIndentIndentIndent58218-9 Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days min
IndentIndentIndentIndentIndent58133-0 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days min
IndentIndentIndentIndentIndent58134-8 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days min
IndentIndentIndentIndentIndent86765-5 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days min
IndentIndentIndentIndentIndent45760-6 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndentIndentIndent55025-1 Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started {mm/dd/yyyy}
IndentIndentIndentIndentIndent55026-9 Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended {mm/dd/yyyy}
IndentIndentIndentIndent86767-1 Occupational Therapy
IndentIndentIndentIndentIndent58219-7 Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days min
IndentIndentIndentIndentIndent58136-3 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days min
IndentIndentIndentIndentIndent58137-1 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days min
IndentIndentIndentIndentIndent86764-8 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days min
IndentIndentIndentIndentIndent45762-2 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndentIndentIndent55027-7 Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started {mm/dd/yyyy}
IndentIndentIndentIndentIndent55028-5 Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended {mm/dd/yyyy}
IndentIndentIndentIndent86768-9 Physical Therapy
IndentIndentIndentIndentIndent58220-5 Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days min
IndentIndentIndentIndentIndent58139-7 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days min
IndentIndentIndentIndentIndent58140-5 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days min
IndentIndentIndentIndentIndent86766-3 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days min
IndentIndentIndentIndentIndent45764-8 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndentIndentIndent55029-3 Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started {mm/dd/yyyy}
IndentIndentIndentIndentIndent55030-1 Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended {mm/dd/yyyy}
IndentIndentIndentIndent58141-3 Respiratory Therapy
IndentIndentIndentIndentIndent45767-1 Total minutes - record the total number of minutes this therapy was administered to the resident in the last 7 days min
IndentIndentIndentIndentIndent45766-3 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndentIndent58142-1 Psychological Therapy (by any licensed mental health professional)
IndentIndentIndentIndentIndent45852-1 Total minutes - record the total number of minutes this therapy was administered to the resident in the last 7 days min
IndentIndentIndentIndentIndent45768-9 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days. d/(7.d)
IndentIndentIndentIndent58143-9 Recreational Therapy (includes recreational and music therapy)
IndentIndentIndentIndentIndent55035-0 Total minutes - record the total number of minutes this therapy was administered to the resident in the last 7 days min
IndentIndentIndentIndentIndent55036-8 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndent86769-7 Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days. d
IndentIndentIndent90544-8 Part A Therapies
IndentIndentIndentIndent90545-5 Speech-Language Pathology and Audiology Services
IndentIndentIndentIndentIndent90539-8 Individual minutes - record the total number of minutes this therapy was administered to the resident individually since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90536-4 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90538-0 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90537-2 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90551-3 Days - record the number of days this therapy was administered for at least 15 minutes a day since the start date of the resident's most recent Medicare Part A stay (A2400B) d/{#}
IndentIndentIndentIndent90546-3 Occupational Therapy
IndentIndentIndentIndentIndent90531-5 Individual minutes - record the total number of minutes this therapy was administered to the resident individually since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90527-3 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident since the start date of the resident's most recent Medicare Part A stay (A2400B) min
IndentIndentIndentIndentIndent90529-9 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90528-1 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90530-7 Days - record the number of days this therapy was administered for at least 15 minutes a day since the start date of the resident's most recent Medicare Part A stay (A2400B) d/{#}
IndentIndentIndentIndent90547-1 Physical Therapy
IndentIndentIndentIndentIndent90535-6 Individual minutes - record the total number of minutes this therapy was administered to the resident individually since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90532-3 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90534-9 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90533-1 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90550-5 Days - record the number of days this therapy was administered for at least 15 minutes a day since the start date of the resident's most recent Medicare Part A stay (A2400B) d/{#}
IndentIndentIndent90548-9 Distinct Calendar Days of Part A Therapy {#}
IndentIndentIndent86773-9 Restorative Nursing Programs
IndentIndentIndentIndent86774-7 Technique. Range of motion (passive) d/(7.d)
IndentIndentIndentIndent86775-4 Technique. Range of motion (active) d/(7.d)
IndentIndentIndentIndent86776-2 Technique. Splint or brace assistance d/(7.d)
IndentIndentIndentIndent86777-0 Training and Skill Practice In: Bed mobility d/(7.d)
IndentIndentIndentIndent86778-8 Training and Skill Practice In: Transfer d/(7.d)
IndentIndentIndentIndent86779-6 Training and Skill Practice In: Walking d/(7.d)
IndentIndentIndentIndent86780-4 Training and Skill Practice In: Dressing and/or grooming d/(7.d)
IndentIndentIndentIndent86781-2 Training and Skill Practice In: Eating and/or swallowing d/(7.d)
IndentIndentIndentIndent86782-0 Training and Skill Practice In: Amputation/prostheses care d/(7.d)
IndentIndentIndentIndent86783-8 Training and Skill Practice In: Communication d/(7.d)
IndentIndentIndent55040-0 Physician Examinations. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) examine the resident? d/(14.d)
IndentIndentIndent55041-8 Physician Orders. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) change the resident's orders? d/(14.d)
IndentIndent88307-4 Restraints and Alarms
IndentIndentIndent86785-3 Physical Restraints
IndentIndentIndentIndent86786-1 Used in Bed. Bed rail d/(7.d)
IndentIndentIndentIndent86787-9 Used in Bed. Trunk restraint d/(7.d)
IndentIndentIndentIndent86788-7 Used in Bed. Limb restraint d/(7.d)
IndentIndentIndentIndent86789-5 Used in Bed. Other d/(7.d)
IndentIndentIndentIndent86790-3 Used in Chair or Out of Bed. Trunk restraint d/(7.d)
IndentIndentIndentIndent86791-1 Used in Chair or Out of Bed. Limb restraint d/(7.d)
IndentIndentIndentIndent86792-9 Used in Chair or Out of Bed. Chair prevents rising d/(7.d)
IndentIndentIndentIndent86793-7 Used in Chair or Out of Bed. Other d/(7.d)
IndentIndentIndent88309-0 Alarms
IndentIndentIndentIndent88310-8 Bed alarm
IndentIndentIndentIndent88311-6 Chair alarm
IndentIndentIndentIndent88312-4 Floor mat alarm
IndentIndentIndentIndent88313-2 Motion sensor alarm
IndentIndentIndentIndent88314-0 Wander/elopement alarm
IndentIndentIndentIndent88308-2 Other alarm
IndentIndent86794-5 Participation in Assessment and Goal Setting
IndentIndentIndent55053-3 Participation in Assessment
IndentIndentIndentIndent55054-1 Resident participated in assessment
IndentIndentIndentIndent55074-9 Family or significant other participated in assessment
IndentIndentIndentIndent58221-3 Guardian or legally authorized representative participated in assessment
IndentIndentIndent55056-6 Resident's Overall Expectation
IndentIndentIndentIndent55057-4 Select one for resident's overall goal established during assessment process
IndentIndentIndentIndent55058-2 Indicate information source for Q0300A
IndentIndentIndent58146-2 Discharge Plan. Is active discharge planning already occurring for the resident to return to the community?
IndentIndentIndent86795-2 Resident's Preference to Avoid Being Asked Question Q0500B. Does the resident's clinical record document a request that this question be asked only on comprehensive assessments?
IndentIndentIndent58149-6 Return to Community. Do you want to talk to someone about the possiblity of leaving this facility and returning to live and receive services in the community?
IndentIndentIndent86796-0 Resident's Preference to Avoid Being Asked Question Q0500B Again
IndentIndentIndentIndent86797-8 Does the resident (or family or significant other or guardian or legally authorized representative if resident is unable to understand or respond) want to be asked about returning to the community on all assessments?
IndentIndentIndentIndent86798-6 Indicate information source for Q0550A
IndentIndentIndent58150-4 Referral. Has a referral been made to the Local Contact Agency?
IndentIndent87207-7 Care Area Assessment (CAA) Summary
IndentIndentIndent87208-5 Items From the Most Recent Prior OBRA or Scheduled PPS Assessment
IndentIndentIndentIndent54583-0 Prior Assessment Federal OBRA Reason for Assessment
IndentIndentIndentIndent54584-8 Prior Assessment PPS Reason for Assessment
IndentIndentIndentIndent54593-9 Prior Assessment Reference Date {mm/dd/yyyy}
IndentIndentIndentIndent54614-3 Prior Assessment Brief Interview for Mental Status (BIMS) Summary Score {score}
IndentIndentIndentIndent54654-9 Prior Assessment Resident Mood Interview (PHQ-9©) Total Severity Score {score}
IndentIndentIndentIndent54677-0 Prior Assessment Staff Assessment of Resident Mood (PHQ-9-OV) Total Severity Score {score}
IndentIndentIndent87210-1 CAAs and Care Planning
IndentIndentIndentIndent87211-9 CAA Results
IndentIndentIndentIndentIndent87212-7 Care Area Triggered
IndentIndentIndentIndentIndent87213-5 Care Planning Decision
IndentIndent90490-4 Correction Request
IndentIndentIndent85632-8 Type of Provider
IndentIndentIndent87226-7 Name of Resident
IndentIndentIndentIndent45392-8 First name
IndentIndentIndentIndent45394-4 Last name
IndentIndentIndent46098-0 Gender
IndentIndentIndent21112-8 Birth Date {mm/dd/yyyy}
IndentIndentIndent45396-9 Social Security Number
IndentIndentIndent90522-4 Optional State Assessment. Is this assessment for state payment purposes only?
IndentIndentIndent90492-0 Type of Assessment
IndentIndentIndentIndent54583-0 Federal OBRA Reason for Assessment
IndentIndentIndentIndent54584-8 PPS Assessment
IndentIndentIndentIndent58108-2 Entry/discharge reporting
IndentIndentIndentIndent86525-3 Is this a SNF Part A PPS Discharge Assessment?
IndentIndentIndent87216-8 Date on existing record to be modified/inactivated
IndentIndentIndentIndent54593-9 Assessment Reference Date {mm/dd/yyyy}
IndentIndentIndentIndent52525-3 Discharge Date {mm/dd/yyyy}
IndentIndentIndentIndent50786-3 Entry Date {mm/dd/yyyy}
IndentIndentIndent87209-3 Correction Attestation Section
IndentIndentIndentIndent58200-7 Correction Number {#}
IndentIndentIndentIndent87217-6 Reasons for Modification 1..5
IndentIndentIndentIndent87225-9 Reasons for Inactivation 1..2
IndentIndentIndentIndent87218-4 RN Assessment Coordinator Attestation of Completion
IndentIndentIndentIndentIndent87219-2 Attesting individual's first name
IndentIndentIndentIndentIndent87220-0 Attesting individual's last name
IndentIndentIndentIndentIndent87221-8 Attesting individual's title
IndentIndentIndentIndentIndent87222-6 Attestation date {mm/dd/yyyy}
IndentIndent90497-9 Assessment Administration
IndentIndentIndent90498-7 Medicare Part A Billing
IndentIndentIndentIndent55065-7 Medicare Part A HIPPS code
IndentIndentIndentIndent55081-4 Version code
IndentIndentIndent93053-7 State Medicaid Billing (if required by the state)
IndentIndentIndentIndent55068-1 Case Mix group
IndentIndentIndentIndent55081-4 Version code
IndentIndentIndent93052-9 Alternate State Medicaid Billing (if required by the state)
IndentIndentIndentIndent58212-2 Case Mix group
IndentIndentIndentIndent55081-4 Version code
IndentIndentIndent93051-1 Insurance Billing
IndentIndentIndentIndent55071-5 Billing code
IndentIndentIndentIndent55081-4 Billing version
Indent90474-8 MDS v3.0 - RAI v1.17.1 - Nursing home PPS (NP) item set [CMS Assessment]
IndentIndent90500-0 Identification Information
IndentIndentIndent58198-3 Type of Record
IndentIndentIndent54581-4 Facility Provider Numbers
IndentIndentIndentIndent76468-8 National Provider Identifier (NPI)
IndentIndentIndentIndent69417-4 CMS Certification Number (CCN)
IndentIndentIndentIndent45398-5 State Provider Number
IndentIndentIndent85632-8 Type of Provider
IndentIndentIndent90521-6 Optional State Assessment
IndentIndentIndentIndent90522-4 Is this assessment for state payment purposes only?
IndentIndentIndent90489-6 Type of Assessment
IndentIndentIndentIndent54583-0 Federal OBRA Reason for Assessment
IndentIndentIndentIndent54584-8 PPS Assessment
IndentIndentIndentIndent54587-1 Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry?
IndentIndentIndentIndent58108-2 Entry/discharge reporting
IndentIndentIndentIndent71440-2 Type of discharge
IndentIndentIndentIndent90525-7 Is this a SNF Part A Interrupted Stay?
IndentIndentIndentIndent86525-3 Is this a SNF Part A PPS Discharge Assessment?
IndentIndentIndent86526-1 Unit Certification or Licensure Designation
IndentIndentIndent54503-8 Legal Name of Resident
IndentIndentIndentIndent45392-8 First name
IndentIndentIndentIndent45393-6 Middle initial
IndentIndentIndentIndent45394-4 Last name
IndentIndentIndentIndent45395-1 Suffix
IndentIndentIndent45966-9 Social Security and Medicare Numbers
IndentIndentIndentIndent45396-9 Social Security Number
IndentIndentIndentIndent45397-7 Medicare number
IndentIndentIndent45400-9 Medicaid Number
IndentIndentIndent46098-0 Gender
IndentIndentIndent21112-8 Birth Date {mm/dd/yyyy}
IndentIndentIndent59362-4 Race/Ethnicity 1..6
IndentIndentIndent54505-3 Language
IndentIndentIndentIndent54588-9 Does the resident need or want an interpreter to communicate with a doctor or health care staff?
IndentIndentIndentIndent54899-0 Preferred language
IndentIndentIndent45404-1 Marital Status
IndentIndentIndent54506-1 Optional Resident Items
IndentIndentIndentIndent46106-1 Medical record number
IndentIndentIndentIndent45403-3 Room number
IndentIndentIndentIndent52462-9 Name by which resident prefers to be addressed
IndentIndentIndentIndent21843-8 Lifetime occupation(s)
IndentIndentIndent86528-7 Most Recent Admission/Entry or Reentry into this Facility
IndentIndentIndentIndent50786-3 Entry Date {mm/dd/yyyy}
IndentIndentIndentIndent54590-5 Type of Entry
IndentIndentIndentIndent85398-6 Entered From
IndentIndentIndent52455-3 Admission Date (Date this episode of care in this facility began) {mm/dd/yyyy}
IndentIndentIndent52525-3 Discharge Date {mm/dd/yyyy}
IndentIndentIndent55128-3 Discharge Status
IndentIndentIndent54592-1 Previous Assessment Reference Date for Significant Correction {mm/dd/yyyy}
IndentIndentIndent54593-9 Assessment Reference Date. Observation end date {mm/dd/yyyy}
IndentIndentIndent54507-9 Medicare Stay
IndentIndentIndentIndent54594-7 Has the resident had a Medicare-covered stay since the most recent entry?
IndentIndentIndentIndent54595-4 Start date of most recent Medicare stay {mm/dd/yyyy}
IndentIndentIndentIndent54596-2 End date of most recent Medicare stay {mm/dd/yyyy}
IndentIndent54508-7 Hearing, Speech, and Vision
IndentIndentIndent54597-0 Comatose. Persistent vegetative state/no discernible consciousness
IndentIndentIndent54598-8 Hearing. Ability to hear (with hearing aid or hearing appliances if normally used)
IndentIndentIndent54599-6 Hearing Aid. Hearing aid or other hearing appliance used in completing B0200, Hearing
IndentIndentIndent54600-2 Speech Clarity. Select best description of speech pattern
IndentIndentIndent54601-0 Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression
IndentIndentIndent54602-8 Ability to Understand Others. Understanding verbal content, however able (with hearing aid or device if used)
IndentIndentIndent54603-6 Vision. Ability to see in adequate light (with glasses or other visual appliances)
IndentIndentIndent54604-4 Corrective Lenses. Corrective lenses (contacts, glasses, or magnifying glass) used in completing B1000, Vision
IndentIndent86529-5 Cognitive Patterns
IndentIndentIndent54605-1 Should Brief Interview for Mental Status (C0200-C0500) be Conducted?
IndentIndentIndent52491-8 Brief Interview for Mental Status (BIMS)
IndentIndentIndentIndent52731-7 Repetition of Three Words. Number of words repeated after first attempt
IndentIndentIndentIndent54510-3 Temporal Orientation (orientation to year, month, and day)
IndentIndentIndentIndentIndent52732-5 Able to report correct year
IndentIndentIndentIndentIndent52733-3 Able to report correct month
IndentIndentIndentIndentIndent54609-3 Able to report correct day of the week
IndentIndentIndentIndent52493-4 Recall
IndentIndentIndentIndentIndent52735-8 Able to recall "sock"
IndentIndentIndentIndentIndent52736-6 Able to recall "blue"
IndentIndentIndentIndentIndent52737-4 Able to recall "bed"
IndentIndentIndentIndent54614-3 BIMS Summary Score {score}
IndentIndentIndent54615-0 Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted?
IndentIndentIndent86595-6 Staff Assessment for Mental Status
IndentIndentIndentIndent54616-8 Short-term Memory OK. Seems or appears to recall after 5 minutes
IndentIndentIndentIndent54617-6 Long-term Memory OK. Seems or appears to recall long past
IndentIndentIndentIndent86583-2 Memory/Recall Ability 1..4
IndentIndentIndentIndent54624-2 Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life
IndentIndentIndent86584-0 Delirium
IndentIndentIndentIndent86585-7 Signs and Symptoms of Delirium (from CAM)
IndentIndentIndentIndentIndent54632-5 Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline?
IndentIndentIndentIndentIndent54628-3 Inattention - Did the resident have difficulty focusing attention, for example, being easily distractible or having difficulty keeping track of what was being said?
IndentIndentIndentIndentIndent54629-1 Disorganized Thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)?
IndentIndentIndentIndentIndent54630-9 Altered Level of Consciousness - Did the resident have altered level of consciousness, as indicated by any of the following criteria?
IndentIndent90482-1 Mood
IndentIndentIndent54634-1 Should Resident Mood Interview be Conducted?
IndentIndentIndent54635-8 Resident Mood Interview (PHQ-9)
IndentIndentIndentIndent86843-0 Symptom Presence
IndentIndentIndentIndentIndent54636-6 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54638-2 Feeling down, depressed or hopeless
IndentIndentIndentIndentIndent54640-8 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54642-4 Feeling tired or having little energy
IndentIndentIndentIndentIndent54644-0 Poor appetite or overeating
IndentIndentIndentIndentIndent54646-5 Feeling bad about yourself - or that you are a failure or have let yourself or your family down
IndentIndentIndentIndentIndent54648-1 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54650-7 Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual
IndentIndentIndentIndentIndent54652-3 Thoughts that you would be better off dead, or of hurting yourself in some way
IndentIndentIndentIndent86844-8 Symptom Frequency
IndentIndentIndentIndentIndent54637-4 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54639-0 Feeling down, depressed or hopeless
IndentIndentIndentIndentIndent54641-6 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54643-2 Feeling tired or having little energy
IndentIndentIndentIndentIndent54645-7 Poor appetite or overeating
IndentIndentIndentIndentIndent54647-3 Feeling bad about yourself - or that you are a failure or have let yourself or your family down
IndentIndentIndentIndentIndent54649-9 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54651-5 Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual
IndentIndentIndentIndentIndent54653-1 Thoughts that you would be better off dead, or of hurting yourself in some way
IndentIndentIndent54654-9 Total Severity Score {score}
IndentIndentIndent54657-2 Staff Assessment of Resident Mood (PHQ-9-OV)
IndentIndentIndentIndent86833-1 Symptom Presence
IndentIndentIndentIndentIndent54658-0 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54660-6 Feeling or appearing down, depressed, or hopeless
IndentIndentIndentIndentIndent54662-2 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54664-8 Feeling tired or having little energy
IndentIndentIndentIndentIndent54666-3 Poor appetite or overeating
IndentIndentIndentIndentIndent54668-9 Indicating that s/he feels bad about self, is a failure, or has let self or family down
IndentIndentIndentIndentIndent54670-5 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54672-1 Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual
IndentIndentIndentIndentIndent54673-9 States that life isn't worth living, wishes for death, or attempts to harm self
IndentIndentIndentIndentIndent54675-4 Being short-tempered, easily annoyed
IndentIndentIndentIndent86891-9 Symptom Frequency
IndentIndentIndentIndentIndent54659-8 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54661-4 Feeling or appearing down, depressed, or hopeless
IndentIndentIndentIndentIndent54663-0 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54665-5 Feeling tired or having little energy
IndentIndentIndentIndentIndent54667-1 Poor appetite or overeating
IndentIndentIndentIndentIndent54669-7 Indicating that s/he feels bad about self, is a failure, or has let self or family down
IndentIndentIndentIndentIndent54671-3 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54904-8 Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual
IndentIndentIndentIndentIndent54674-7 States that life isn't worth living, wishes for death, or attempts to harm self
IndentIndentIndentIndentIndent54676-2 Being short-tempered, easily annoyed
IndentIndentIndent54677-0 Total Severity Score {score}
IndentIndent86815-8 Behavior
IndentIndentIndent86597-2 Potential Indicators of Psychosis 1..2
IndentIndentIndent54514-5 Behavioral Symptom - Presence & Frequency
IndentIndentIndentIndent54682-0 Physical behavioral symptoms directed toward others d/(7.d)
IndentIndentIndentIndent54683-8 Verbal behavioral symptoms directed toward others d/(7.d)
IndentIndentIndentIndent54684-6 Other behavioral symptoms not directed toward others d/(7.d)
IndentIndentIndent54692-9 Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? d/(7.d)
IndentIndentIndent54693-7 Wandering - Presence & Frequency. Has the resident wandered? d/(7.d)
IndentIndent86816-6 Functional status
IndentIndentIndent86880-2 Activities of Daily Living (ADL) Assistance. Self-Performance
IndentIndentIndentIndent45588-1 Bed mobility
IndentIndentIndentIndent45590-7 Transfer
IndentIndentIndentIndent45592-3 Walk in room
IndentIndentIndentIndent45594-9 Walk in corridor
IndentIndentIndentIndent45596-4 Locomotion on unit
IndentIndentIndentIndent45598-0 Locomotion off unit
IndentIndentIndentIndent45600-4 Dressing
IndentIndentIndentIndent45602-0 Eating
IndentIndentIndentIndent45604-6 Toilet use
IndentIndentIndentIndent45606-1 Personal hygiene
IndentIndentIndent86881-0 Activities of Daily Living (ADL) Assistance. Support Provided
IndentIndentIndentIndent45589-9 Bed mobility
IndentIndentIndentIndent45591-5 Transfer
IndentIndentIndentIndent45593-1 Walk in room
IndentIndentIndentIndent45595-6 Walk in corridor
IndentIndentIndentIndent45597-2 Locomotion on unit
IndentIndentIndentIndent45599-8 Locomotion off unit
IndentIndentIndentIndent45601-2 Dressing
IndentIndentIndentIndent45603-8 Eating
IndentIndentIndentIndent45605-3 Toilet use
IndentIndentIndentIndent45607-9 Personal hygiene
IndentIndentIndent46008-9 Bathing
IndentIndentIndentIndent45608-7 Self-performance
IndentIndentIndentIndent45609-5 Support provided
IndentIndentIndent54524-4 Balance During Transitions and Walking
IndentIndentIndentIndent54749-7 Moving from seated to standing position
IndentIndentIndentIndent54750-5 Walking (with assistive device if used)
IndentIndentIndentIndent54751-3 Turning around and facing the opposite direction while walking
IndentIndentIndentIndent54752-1 Moving on and off toilet
IndentIndentIndentIndent54753-9 Surface-to-surface transfer (transfer between bed and chair or wheelchair)
IndentIndentIndent92908-3 Functional Limitation in Range of Motion
IndentIndentIndentIndent92850-7 Upper extremity (shoulder, elbow, wrist, hand)
IndentIndentIndentIndent92851-5 Lower extremity (hip, knee, ankle, foot)
IndentIndentIndent86602-0 Mobility Devices 1..4
IndentIndent88482-5 Functional Abilities and Goals - Admission (Start of SNF PPS Stay)
IndentIndentIndent83239-4 Prior Functioning: Everyday Activities
IndentIndentIndentIndent85070-1 Self-Care
IndentIndentIndentIndent85071-9 Indoor Mobility (Ambulation)
IndentIndentIndentIndent85072-7 Stairs
IndentIndentIndentIndent85073-5 Functional Cognition
IndentIndentIndent83234-5 Prior Device Use 1..5
IndentIndentIndent83233-7 Self-Care - Admission Performance
IndentIndentIndentIndent83232-9 Eating
IndentIndentIndentIndent83230-3 Oral hygiene
IndentIndentIndentIndent83228-7 Toileting hygiene
IndentIndentIndentIndent83226-1 Shower/bathe self
IndentIndentIndentIndent83224-6 Upper body dressing
IndentIndentIndentIndent83222-0 Lower body dressing
IndentIndentIndentIndent83220-4 Putting on/taking off footwear
IndentIndentIndent85054-5 Self-Care - Discharge Goal
IndentIndentIndentIndent83231-1 Eating
IndentIndentIndentIndent83229-5 Oral hygiene
IndentIndentIndentIndent83227-9 Toileting hygiene
IndentIndentIndentIndent83225-3 Shower/bathe self
IndentIndentIndentIndent83223-8 Upper body dressing
IndentIndentIndentIndent83221-2 Lower body dressing
IndentIndentIndentIndent83219-6 Putting on/taking off footwear
IndentIndentIndent88330-6 Mobility - Admission Performance
IndentIndentIndentIndent83218-8 Roll left and right
IndentIndentIndentIndent83216-2 Sit to lying
IndentIndentIndentIndent83214-7 Lying to sitting on side of bed
IndentIndentIndentIndent83212-1 Sit to stand
IndentIndentIndentIndent83210-5 Chair/bed-to-chair transfer
IndentIndentIndentIndent83208-9 Toilet transfer
IndentIndentIndentIndent83206-3 Car transfer
IndentIndentIndentIndent83204-8 Walk 10 feet
IndentIndentIndentIndent83202-2 Walk 50 feet with two turns
IndentIndentIndentIndent83200-6 Walk 150 feet
IndentIndentIndentIndent83198-2 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83196-6 1 step (curb)
IndentIndentIndentIndent83194-1 4 steps
IndentIndentIndentIndent83192-5 12 steps
IndentIndentIndentIndent83190-9 Picking up object
IndentIndentIndentIndent83271-7 Does the resident use a wheelchair and/or scooter?
IndentIndentIndentIndent83188-3 Wheel 50 feet with two turns
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndentIndentIndent83235-2 Wheel 150 feet
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndentIndent85056-0 Mobility - Discharge Goal
IndentIndentIndentIndent83217-0 Roll left and right
IndentIndentIndentIndent83215-4 Sit to lying
IndentIndentIndentIndent83213-9 Lying to sitting on side of bed
IndentIndentIndentIndent83211-3 Sit to stand
IndentIndentIndentIndent83209-7 Chair/Bed-to-chair transfer
IndentIndentIndentIndent83207-1 Toilet transfer
IndentIndentIndentIndent83205-5 Car transfer
IndentIndentIndentIndent83203-0 Walk 10 feet
IndentIndentIndentIndent83201-4 Walk 50 feet with two turns
IndentIndentIndentIndent83199-0 Walk 150 feet
IndentIndentIndentIndent83197-4 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83195-8 1 step (curb)
IndentIndentIndentIndent83193-3 4 steps
IndentIndentIndentIndent83191-7 12 steps
IndentIndentIndentIndent83189-1 Picking up object
IndentIndentIndentIndent83187-5 Wheel 50 feet with two turns
IndentIndentIndentIndent83236-0 Wheel 150 feet
IndentIndent88483-3 Functional Abilities and Goals - Discharge (End of SNF PPS Stay)
IndentIndentIndent83254-3 Self-Care - Discharge Performance
IndentIndentIndentIndent83232-9 Eating
IndentIndentIndentIndent83230-3 Oral hygiene
IndentIndentIndentIndent83228-7 Toileting hygiene
IndentIndentIndentIndent83226-1 Shower/bathe self
IndentIndentIndentIndent83224-6 Upper body dressing
IndentIndentIndentIndent83222-0 Lower body dressing
IndentIndentIndentIndent83220-4 Putting on/taking off footwear
IndentIndentIndent88331-4 Mobility - Discharge Performance
IndentIndentIndentIndent83218-8 Roll left and right
IndentIndentIndentIndent83216-2 Sit to lying
IndentIndentIndentIndent83214-7 Lying to sitting on side of bed
IndentIndentIndentIndent83212-1 Sit to stand
IndentIndentIndentIndent83210-5 Chair/bed-to-chair transfer
IndentIndentIndentIndent83208-9 Toilet transfer
IndentIndentIndentIndent83206-3 Car transfer
IndentIndentIndentIndent83204-8 Walk 10 feet
IndentIndentIndentIndent83202-2 Walk 50 feet with two turns
IndentIndentIndentIndent83200-6 Walk 150 feet
IndentIndentIndentIndent83198-2 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83196-6 1 step (curb)
IndentIndentIndentIndent83194-1 4 steps
IndentIndentIndentIndent83192-5 12 steps
IndentIndentIndentIndent83190-9 Picking up object
IndentIndentIndentIndent83271-7 Does the resident use a wheelchair and/or scooter?
IndentIndentIndentIndent83188-3 Wheel 50 feet with two turns
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndentIndentIndent83235-2 Wheel 150 feet
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndent89049-1 Bladder and Bowel
IndentIndentIndent86624-4 Appliances 1..4
IndentIndentIndent86866-1 Urinary Toileting Program
IndentIndentIndentIndent54767-9 Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility?
IndentIndentIndentIndent54769-5 Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence?
IndentIndentIndent54770-3 Urinary Continence 1..1
IndentIndentIndent54771-1 Bowel Continence 1..1
IndentIndentIndent88695-2 Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence?
IndentIndent90485-4 Active Diagnoses
IndentIndentIndent89045-9 Indicate the resident's primary medical condition category 1..1
IndentIndentIndent52797-8 ICD Code
IndentIndentIndent86671-5 Active Diagnoses in the last 7 days 1..*
IndentIndentIndent52797-8 Additional active diagnoses 0..10
IndentIndent90487-0 Health Conditions
IndentIndentIndent54557-4 Pain Management
IndentIndentIndentIndent71447-7 At any time in the last 5 days, has the resident: Received scheduled pain medication regimen?
IndentIndentIndentIndent71448-5 At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined?
IndentIndentIndentIndent71449-3 At any time in the last 5 days, has the resident: Received non-medication intervention for pain?
IndentIndentIndent54828-9 Should Pain Assessment Interview be Conducted?
IndentIndentIndent54558-2 Pain Assessment Interview
IndentIndentIndentIndent54829-7 Pain Presence. Have you had pain or hurting at any time in the last 5 days?
IndentIndentIndentIndent54830-5 Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days?
IndentIndentIndentIndent54559-0 Pain Effect on Function
IndentIndentIndentIndentIndent54831-3 Over the past 5 days, has pain made it hard for you to sleep at night?
IndentIndentIndentIndentIndent54832-1 Over the past 5 days, have you limited your day-to-day activities because of pain?
IndentIndentIndentIndent54560-8 Pain Intensity
IndentIndentIndentIndentIndent54833-9 Numeric Rating Scale (00-10)
IndentIndentIndentIndentIndent54834-7 Verbal Descriptor Scale
IndentIndentIndent58117-3 Should the Staff Assessment for Pain be Conducted?
IndentIndentIndent86672-3 Staff Assessment for Pain
IndentIndentIndentIndent86673-1 Indicators of Pain or Possible Pain in the last 5 days 1..4
IndentIndentIndentIndent58118-1 Frequency of Indicator of Pain or Possible Pain in the last 5 days. Frequency with which resident complains or shows evidence of pain or possible pain d/(5.d)
IndentIndentIndent86868-7 Other Health Conditions
IndentIndentIndentIndent86675-6 Shortness of Breath (dyspnea) 1..3
IndentIndentIndentIndent54846-1 Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?
IndentIndentIndentIndent86676-4 Problem Conditions 1..4
IndentIndentIndentIndent54849-5 Fall History on Admission/Entry or Reentry
IndentIndentIndentIndentIndent54850-3 Did the resident have a fall any time in the last month prior to admission/entry or reentry?
IndentIndentIndentIndentIndent54851-1 Did the resident have a fall any time in the last 2-6 months prior to admission/entry or reentry?
IndentIndentIndentIndentIndent54852-9 Did the resident have any fracture related to a fall in the 6 months prior to admission/entry or reentry?
IndentIndentIndentIndent54853-7 Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent?
IndentIndentIndentIndent54854-5 Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent
IndentIndentIndentIndentIndent54855-2 No injury
IndentIndentIndentIndentIndent54856-0 Injury (except major)
IndentIndentIndentIndentIndent54857-8 Major injury
IndentIndentIndent83274-1 Prior Surgery. Did the resident have major surgery during the 100 days prior to admission?
IndentIndentIndent90542-2 Recent Surgery Requiring Active SNF Care-Did the resident have a major surgical procedure during the prior inpatient hospital stay that requires active care during the SNF stay?
IndentIndentIndent90745-1 Surgical Procedures
IndentIndent90483-9 Swallowing/Nutritional Status
IndentIndentIndent86677-2 Swallowing Disorder. Signs and symptoms of possible swallowing disorder 1..4
IndentIndentIndent54567-3 Height and Weight
IndentIndentIndentIndent3137-7 Height (in inches) [in_us];cm
IndentIndentIndentIndent3141-9 Weight (in pounds) [lb_av];kg
IndentIndentIndent54863-6 Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months
IndentIndentIndent86678-0 Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months
IndentIndentIndent54568-1 Nutritional Approaches
IndentIndentIndentIndent71444-4 Nutritional Approaches. While NOT a Resident 0..2
IndentIndentIndentIndent71445-1 Nutritional Approaches. While a Resident 1..4
IndentIndentIndent90543-0 Percent Intake by Artificial Route
IndentIndentIndentIndent86681-4 Proportion of total calories the resident received through parenteral or tube feeding. While a Resident
IndentIndentIndentIndent86687-1 Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days
IndentIndentIndentIndent86683-0 Average fluid intake per day by IV or tube feeding. While a Resident
IndentIndentIndentIndent86684-8 Average fluid intake per day by IV or tube feeding. During Entire 7 Days
IndentIndent86685-5 Oral/Dental Status
IndentIndentIndent86706-9 Dental 1..2
IndentIndent88960-0 Skin Conditions
IndentIndentIndent86708-5 Determination of Pressure Ulcer/Injury Risk 1..3
IndentIndentIndent57280-0 Risk of Pressure Ulcers/Injuries. Is this resident at risk of developing pressure ulcers/injuries?
IndentIndentIndent58214-8 Unhealed Pressure Ulcers/Injuries. Does this resident have one or more unhealed pressure ulcers/injuries?
IndentIndentIndent88961-8 Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage
IndentIndentIndentIndent54884-2 Number of Stage 1 pressure injuries {#}
IndentIndentIndentIndent55124-2 Number of Stage 2 pressure ulcers {#}
IndentIndentIndentIndent54886-7 Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent55125-9 Number of Stage 3 pressure ulcers {#}
IndentIndentIndentIndent54887-5 Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent55126-7 Number of Stage 4 pressure ulcers {#}
IndentIndentIndentIndent54890-9 Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent54893-3 Number of unstageable pressure ulcers/injuries due to non-removable dressing/device {#}
IndentIndentIndentIndent54894-1 Number of these unstageable pressure ulcers/injuries that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent54946-9 Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar {#}
IndentIndentIndentIndent54947-7 Number of these unstageable pressure ulcers that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent54950-1 Number of unstageable pressure injuries presenting as deep tissue injury {#}
IndentIndentIndentIndent54951-9 Number of these unstageable pressure injuries that were present upon admission/entry or reentry {#}
IndentIndentIndent54970-9 Number of Venous and Arterial Ulcers {#}
IndentIndentIndent88696-0 Other Ulcers, Wounds and Skin Problems 1..8
IndentIndentIndent86748-1 Skin and Ulcer/Injury Treatments 1..9
IndentIndent88965-9 Medications
IndentIndentIndent54982-4 Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days. d/(7.d)
IndentIndentIndent58217-1 Insulin
IndentIndentIndentIndent58127-2 Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days d/(7.d)
IndentIndentIndentIndent58128-0 Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days d/(7.d)
IndentIndentIndent88290-2 Medications Received
IndentIndentIndentIndent86751-5 Antipsychotic d/(7.d)
IndentIndentIndentIndent86752-3 Antianxiety d/(7.d)
IndentIndentIndentIndent86753-1 Antidepressant d/(7.d)
IndentIndentIndentIndent86754-9 Hypnotic d/(7.d)
IndentIndentIndentIndent86755-6 Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin) d/(7.d)
IndentIndentIndentIndent86756-4 Antibiotic d/(7.d)
IndentIndentIndentIndent86757-2 Diuretic d/(7.d)
IndentIndentIndentIndent88291-0 Opiod d/(7.d)
IndentIndentIndent57255-2 Drug Regimen Review: Did a complete drug regimen review identify potential clinically significant medication issues?
IndentIndentIndent57281-8 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?
IndentIndentIndent57256-0 Did the facility contact and complete physician (or physician-designee) prescribed/recommended actions by midnight of the next calendar day each time potential clinically significant medication issues were identified since the admission?
IndentIndent90515-8 Special Treatments, Procedures, and Programs
IndentIndentIndent86759-8 Special Treatments, Procedures, and Programs
IndentIndentIndentIndent86760-6 While NOT a Resident 0..9
IndentIndentIndentIndent86761-4 While a Resident 0..11
IndentIndentIndent69339-0 Influenza Vaccine
IndentIndentIndentIndent55019-4 Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season?
IndentIndentIndentIndent58131-4 Date influenza vaccine received {mm/dd/yyyy}
IndentIndentIndentIndent55020-2 If influenza vaccine not received, state reason:
IndentIndentIndent55021-0 Pneumococcal Vaccine
IndentIndentIndentIndent55022-8 Is the resident's Pneumococcal vaccination up to date?
IndentIndentIndentIndent45956-0 If Pneumococcal vaccine not received, state reason:
IndentIndentIndent86841-4 Therapies
IndentIndentIndentIndent86763-0 Speech-Language Pathology and Audiology Services
IndentIndentIndentIndentIndent58218-9 Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days min
IndentIndentIndentIndentIndent58133-0 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days min
IndentIndentIndentIndentIndent58134-8 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days min
IndentIndentIndentIndentIndent86765-5 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days min
IndentIndentIndentIndentIndent45760-6 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndentIndentIndent55025-1 Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started {mm/dd/yyyy}
IndentIndentIndentIndentIndent55026-9 Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended {mm/dd/yyyy}
IndentIndentIndentIndent86767-1 Occupational Therapy
IndentIndentIndentIndentIndent58219-7 Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days min
IndentIndentIndentIndentIndent58136-3 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days min
IndentIndentIndentIndentIndent58137-1 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days min
IndentIndentIndentIndentIndent86764-8 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days min
IndentIndentIndentIndentIndent45762-2 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndentIndentIndent55027-7 Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started {mm/dd/yyyy}
IndentIndentIndentIndentIndent55028-5 Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended {mm/dd/yyyy}
IndentIndentIndentIndent86768-9 Physical Therapy
IndentIndentIndentIndentIndent58220-5 Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days min
IndentIndentIndentIndentIndent58139-7 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days min
IndentIndentIndentIndentIndent58140-5 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days min
IndentIndentIndentIndentIndent86766-3 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days min
IndentIndentIndentIndentIndent45764-8 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndentIndentIndent55029-3 Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started {mm/dd/yyyy}
IndentIndentIndentIndentIndent55030-1 Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended {mm/dd/yyyy}
IndentIndentIndentIndent86849-7 Respiratory therapy
IndentIndentIndentIndentIndent45766-3 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndentIndent86850-5 Psychological therapy
IndentIndentIndentIndentIndent45768-9 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days. d/(7.d)
IndentIndentIndent86769-7 Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days. d
IndentIndentIndent90544-8 Part A Therapies
IndentIndentIndentIndent90545-5 Speech-Language Pathology and Audiology Services
IndentIndentIndentIndentIndent90539-8 Individual minutes - record the total number of minutes this therapy was administered to the resident individually since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90536-4 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90538-0 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90537-2 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90551-3 Days - record the number of days this therapy was administered for at least 15 minutes a day since the start date of the resident's most recent Medicare Part A stay (A2400B) d/{#}
IndentIndentIndentIndent90546-3 Occupational Therapy
IndentIndentIndentIndentIndent90531-5 Individual minutes - record the total number of minutes this therapy was administered to the resident individually since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90527-3 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident since the start date of the resident's most recent Medicare Part A stay (A2400B) min
IndentIndentIndentIndentIndent90529-9 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90528-1 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90530-7 Days - record the number of days this therapy was administered for at least 15 minutes a day since the start date of the resident's most recent Medicare Part A stay (A2400B) d/{#}
IndentIndentIndentIndent90547-1 Physical Therapy
IndentIndentIndentIndentIndent90535-6 Individual minutes - record the total number of minutes this therapy was administered to the resident individually since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90532-3 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90534-9 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90533-1 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90550-5 Days - record the number of days this therapy was administered for at least 15 minutes a day since the start date of the resident's most recent Medicare Part A stay (A2400B) d/{#}
IndentIndentIndent90548-9 Distinct Calendar Days of Part A Therapy {#}
IndentIndentIndent86773-9 Restorative Nursing Programs
IndentIndentIndentIndent86774-7 Technique. Range of motion (passive) d/(7.d)
IndentIndentIndentIndent86775-4 Technique. Range of motion (active) d/(7.d)
IndentIndentIndentIndent86776-2 Technique. Splint or brace assistance d/(7.d)
IndentIndentIndentIndent86777-0 Training and Skill Practice In: Bed mobility d/(7.d)
IndentIndentIndentIndent86778-8 Training and Skill Practice In: Transfer d/(7.d)
IndentIndentIndentIndent86779-6 Training and Skill Practice In: Walking d/(7.d)
IndentIndentIndentIndent86780-4 Training and Skill Practice In: Dressing and/or grooming d/(7.d)
IndentIndentIndentIndent86781-2 Training and Skill Practice In: Eating and/or swallowing d/(7.d)
IndentIndentIndentIndent86782-0 Training and Skill Practice In: Amputation/prostheses care d/(7.d)
IndentIndentIndentIndent86783-8 Training and Skill Practice In: Communication d/(7.d)
IndentIndentIndent55040-0 Physician Examinations. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) examine the resident? d/(14.d)
IndentIndentIndent55041-8 Physician Orders. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) change the resident's orders? d/(14.d)
IndentIndent88328-0 Restraints and Alarms
IndentIndentIndent86785-3 Physical Restraints
IndentIndentIndentIndent86786-1 Used in Bed. Bed rail d/(7.d)
IndentIndentIndentIndent86787-9 Used in Bed. Trunk restraint d/(7.d)
IndentIndentIndentIndent86788-7 Used in Bed. Limb restraint d/(7.d)
IndentIndentIndentIndent86789-5 Used in Bed. Other d/(7.d)
IndentIndentIndentIndent86790-3 Used in Chair or Out of Bed. Trunk restraint d/(7.d)
IndentIndentIndentIndent86791-1 Used in Chair or Out of Bed. Limb restraint d/(7.d)
IndentIndentIndentIndent86792-9 Used in Chair or Out of Bed. Chair prevents rising d/(7.d)
IndentIndentIndentIndent86793-7 Used in Chair or Out of Bed. Other d/(7.d)
IndentIndent86794-5 Participation in Assessment and Goal Setting
IndentIndentIndent55053-3 Participation in Assessment
IndentIndentIndentIndent55054-1 Resident participated in assessment
IndentIndentIndentIndent55074-9 Family or significant other participated in assessment
IndentIndentIndentIndent58221-3 Guardian or legally authorized representative participated in assessment
IndentIndentIndent55056-6 Resident's Overall Expectation
IndentIndentIndentIndent55057-4 Select one for resident's overall goal established during assessment process
IndentIndentIndentIndent55058-2 Indicate information source for Q0300A
IndentIndentIndent58146-2 Discharge Plan. Is active discharge planning already occurring for the resident to return to the community?
IndentIndentIndent86795-2 Resident's Preference to Avoid Being Asked Question Q0500B. Does the resident's clinical record document a request that this question be asked only on comprehensive assessments?
IndentIndentIndent58149-6 Return to Community. Do you want to talk to someone about the possiblity of leaving this facility and returning to live and receive services in the community?
IndentIndentIndent86796-0 Resident's Preference to Avoid Being Asked Question Q0500B Again
IndentIndentIndentIndent86797-8 Does the resident (or family or significant other or guardian or legally authorized representative if resident is unable to understand or respond) want to be asked about returning to the community on all assessments?
IndentIndentIndentIndent86798-6 Indicate information source for Q0550A
IndentIndentIndent58150-4 Referral. Has a referral been made to the Local Contact Agency?
IndentIndent90490-4 Correction Request
IndentIndentIndent85632-8 Type of Provider
IndentIndentIndent87226-7 Name of Resident
IndentIndentIndentIndent45392-8 First name
IndentIndentIndentIndent45394-4 Last name
IndentIndentIndent46098-0 Gender
IndentIndentIndent21112-8 Birth Date {mm/dd/yyyy}
IndentIndentIndent45396-9 Social Security Number
IndentIndentIndent90522-4 Optional State Assessment. Is this assessment for state payment purposes only?
IndentIndentIndent90492-0 Type of Assessment
IndentIndentIndentIndent54583-0 Federal OBRA Reason for Assessment
IndentIndentIndentIndent54584-8 PPS Assessment
IndentIndentIndentIndent58108-2 Entry/discharge reporting
IndentIndentIndentIndent86525-3 Is this a SNF Part A PPS Discharge Assessment?
IndentIndentIndent87216-8 Date on existing record to be modified/inactivated
IndentIndentIndentIndent54593-9 Assessment Reference Date {mm/dd/yyyy}
IndentIndentIndentIndent52525-3 Discharge Date {mm/dd/yyyy}
IndentIndentIndentIndent50786-3 Entry Date {mm/dd/yyyy}
IndentIndentIndent87209-3 Correction Attestation Section
IndentIndentIndentIndent58200-7 Correction Number {#}
IndentIndentIndentIndent87217-6 Reasons for Modification 1..5
IndentIndentIndentIndent87225-9 Reasons for Inactivation 1..2
IndentIndentIndentIndent87218-4 RN Assessment Coordinator Attestation of Completion
IndentIndentIndentIndentIndent87219-2 Attesting individual's first name
IndentIndentIndentIndentIndent87220-0 Attesting individual's last name
IndentIndentIndentIndentIndent87221-8 Attesting individual's title
IndentIndentIndentIndentIndent87222-6 Attestation date {mm/dd/yyyy}
IndentIndent90497-9 Assessment Administration
IndentIndentIndent90498-7 Medicare Part A Billing
IndentIndentIndentIndent55065-7 Medicare Part A HIPPS code
IndentIndentIndentIndent55081-4 Version code
IndentIndentIndent93053-7 State Medicaid Billing (if required by the state)
IndentIndentIndentIndent55068-1 Case Mix group
IndentIndentIndentIndent55081-4 Version code
IndentIndentIndent93052-9 Alternate State Medicaid Billing (if required by the state)
IndentIndentIndentIndent58212-2 Case Mix group
IndentIndentIndentIndent55081-4 Version code
IndentIndentIndent93051-1 Insurance Billing
IndentIndentIndentIndent55071-5 Billing code
IndentIndentIndentIndent55081-4 Billing version
Indent90475-5 MDS v3.0 - RAI v1.17.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
IndentIndent90500-0 Identification Information
IndentIndentIndent58198-3 Type of Record
IndentIndentIndent54581-4 Facility Provider Numbers
IndentIndentIndentIndent76468-8 National Provider Identifier (NPI)
IndentIndentIndentIndent69417-4 CMS Certification Number (CCN)
IndentIndentIndentIndent45398-5 State Provider Number
IndentIndentIndent85632-8 Type of Provider
IndentIndentIndent90521-6 Optional State Assessment
IndentIndentIndentIndent90522-4 Is this assessment for state payment purposes only?
IndentIndentIndent90489-6 Type of Assessment
IndentIndentIndentIndent54583-0 Federal OBRA Reason for Assessment
IndentIndentIndentIndent54584-8 PPS Assessment
IndentIndentIndentIndent54587-1 Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry?
IndentIndentIndentIndent58108-2 Entry/discharge reporting
IndentIndentIndentIndent71440-2 Type of discharge
IndentIndentIndentIndent90525-7 Is this a SNF Part A Interrupted Stay?
IndentIndentIndentIndent86525-3 Is this a SNF Part A PPS Discharge Assessment?
IndentIndentIndent86526-1 Unit Certification or Licensure Designation
IndentIndentIndent54503-8 Legal Name of Resident
IndentIndentIndentIndent45392-8 First name
IndentIndentIndentIndent45393-6 Middle initial
IndentIndentIndentIndent45394-4 Last name
IndentIndentIndentIndent45395-1 Suffix
IndentIndentIndent45966-9 Social Security and Medicare Numbers
IndentIndentIndentIndent45396-9 Social Security Number
IndentIndentIndentIndent45397-7 Medicare number
IndentIndentIndent45400-9 Medicaid Number
IndentIndentIndent46098-0 Gender
IndentIndentIndent21112-8 Birth Date {mm/dd/yyyy}
IndentIndentIndent59362-4 Race/Ethnicity 1..6
IndentIndentIndent54505-3 Language
IndentIndentIndentIndent54588-9 Does the resident need or want an interpreter to communicate with a doctor or health care staff?
IndentIndentIndentIndent54899-0 Preferred language
IndentIndentIndent45404-1 Marital Status
IndentIndentIndent54506-1 Optional Resident Items
IndentIndentIndentIndent46106-1 Medical record number
IndentIndentIndentIndent45403-3 Room number
IndentIndentIndentIndent52462-9 Name by which resident prefers to be addressed
IndentIndentIndentIndent21843-8 Lifetime occupation(s)
IndentIndentIndent86528-7 Most Recent Admission/Entry or Reentry into this Facility
IndentIndentIndentIndent50786-3 Entry Date {mm/dd/yyyy}
IndentIndentIndentIndent54590-5 Type of Entry
IndentIndentIndentIndent85398-6 Entered From
IndentIndentIndent52455-3 Admission Date (Date this episode of care in this facility began) {mm/dd/yyyy}
IndentIndentIndent52525-3 Discharge Date {mm/dd/yyyy}
IndentIndentIndent55128-3 Discharge Status
IndentIndentIndent54592-1 Previous Assessment Reference Date for Significant Correction {mm/dd/yyyy}
IndentIndentIndent54593-9 Assessment Reference Date. Observation end date {mm/dd/yyyy}
IndentIndentIndent54507-9 Medicare Stay
IndentIndentIndentIndent54594-7 Has the resident had a Medicare-covered stay since the most recent entry?
IndentIndentIndentIndent54595-4 Start date of most recent Medicare stay {mm/dd/yyyy}
IndentIndentIndentIndent54596-2 End date of most recent Medicare stay {mm/dd/yyyy}
IndentIndent54508-7 Hearing, Speech, and Vision
IndentIndentIndent54597-0 Comatose. Persistent vegetative state/no discernible consciousness
IndentIndentIndent54598-8 Hearing. Ability to hear (with hearing aid or hearing appliances if normally used)
IndentIndentIndent54599-6 Hearing Aid. Hearing aid or other hearing appliance used in completing B0200, Hearing
IndentIndentIndent54600-2 Speech Clarity. Select best description of speech pattern
IndentIndentIndent54601-0 Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression
IndentIndentIndent54602-8 Ability to Understand Others. Understanding verbal content, however able (with hearing aid or device if used)
IndentIndentIndent54603-6 Vision. Ability to see in adequate light (with glasses or other visual appliances)
IndentIndentIndent54604-4 Corrective Lenses. Corrective lenses (contacts, glasses, or magnifying glass) used in completing B1000, Vision
IndentIndent86529-5 Cognitive Patterns
IndentIndentIndent54605-1 Should Brief Interview for Mental Status (C0200-C0500) be Conducted?
IndentIndentIndent52491-8 Brief Interview for Mental Status (BIMS)
IndentIndentIndentIndent52731-7 Repetition of Three Words. Number of words repeated after first attempt
IndentIndentIndentIndent54510-3 Temporal Orientation (orientation to year, month, and day)
IndentIndentIndentIndentIndent52732-5 Able to report correct year
IndentIndentIndentIndentIndent52733-3 Able to report correct month
IndentIndentIndentIndentIndent54609-3 Able to report correct day of the week
IndentIndentIndentIndent52493-4 Recall
IndentIndentIndentIndentIndent52735-8 Able to recall "sock"
IndentIndentIndentIndentIndent52736-6 Able to recall "blue"
IndentIndentIndentIndentIndent52737-4 Able to recall "bed"
IndentIndentIndentIndent54614-3 BIMS Summary Score {score}
IndentIndentIndent54615-0 Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted?
IndentIndentIndent86595-6 Staff Assessment for Mental Status
IndentIndentIndentIndent54616-8 Short-term Memory OK. Seems or appears to recall after 5 minutes
IndentIndentIndentIndent54617-6 Long-term Memory OK. Seems or appears to recall long past
IndentIndentIndentIndent86583-2 Memory/Recall Ability 1..4
IndentIndentIndentIndent54624-2 Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life
IndentIndentIndent86584-0 Delirium
IndentIndentIndentIndent86585-7 Signs and Symptoms of Delirium (from CAM)
IndentIndentIndentIndentIndent54632-5 Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline?
IndentIndentIndentIndentIndent54628-3 Inattention - Did the resident have difficulty focusing attention, for example, being easily distractible or having difficulty keeping track of what was being said?
IndentIndentIndentIndentIndent54629-1 Disorganized Thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)?
IndentIndentIndentIndentIndent54630-9 Altered Level of Consciousness - Did the resident have altered level of consciousness, as indicated by any of the following criteria?
IndentIndent90482-1 Mood
IndentIndentIndent54634-1 Should Resident Mood Interview be Conducted?
IndentIndentIndent54635-8 Resident Mood Interview (PHQ-9)
IndentIndentIndentIndent86843-0 Symptom Presence
IndentIndentIndentIndentIndent54636-6 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54638-2 Feeling down, depressed or hopeless
IndentIndentIndentIndentIndent54640-8 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54642-4 Feeling tired or having little energy
IndentIndentIndentIndentIndent54644-0 Poor appetite or overeating
IndentIndentIndentIndentIndent54646-5 Feeling bad about yourself - or that you are a failure or have let yourself or your family down
IndentIndentIndentIndentIndent54648-1 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54650-7 Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual
IndentIndentIndentIndentIndent54652-3 Thoughts that you would be better off dead, or of hurting yourself in some way
IndentIndentIndentIndent86844-8 Symptom Frequency
IndentIndentIndentIndentIndent54637-4 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54639-0 Feeling down, depressed or hopeless
IndentIndentIndentIndentIndent54641-6 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54643-2 Feeling tired or having little energy
IndentIndentIndentIndentIndent54645-7 Poor appetite or overeating
IndentIndentIndentIndentIndent54647-3 Feeling bad about yourself - or that you are a failure or have let yourself or your family down
IndentIndentIndentIndentIndent54649-9 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54651-5 Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual
IndentIndentIndentIndentIndent54653-1 Thoughts that you would be better off dead, or of hurting yourself in some way
IndentIndentIndent54654-9 Total Severity Score {score}
IndentIndentIndent54657-2 Staff Assessment of Resident Mood (PHQ-9-OV)
IndentIndentIndentIndent86833-1 Symptom Presence
IndentIndentIndentIndentIndent54658-0 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54660-6 Feeling or appearing down, depressed, or hopeless
IndentIndentIndentIndentIndent54662-2 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54664-8 Feeling tired or having little energy
IndentIndentIndentIndentIndent54666-3 Poor appetite or overeating
IndentIndentIndentIndentIndent54668-9 Indicating that s/he feels bad about self, is a failure, or has let self or family down
IndentIndentIndentIndentIndent54670-5 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54672-1 Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual
IndentIndentIndentIndentIndent54673-9 States that life isn't worth living, wishes for death, or attempts to harm self
IndentIndentIndentIndentIndent54675-4 Being short-tempered, easily annoyed
IndentIndentIndentIndent86891-9 Symptom Frequency
IndentIndentIndentIndentIndent54659-8 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54661-4 Feeling or appearing down, depressed, or hopeless
IndentIndentIndentIndentIndent54663-0 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54665-5 Feeling tired or having little energy
IndentIndentIndentIndentIndent54667-1 Poor appetite or overeating
IndentIndentIndentIndentIndent54669-7 Indicating that s/he feels bad about self, is a failure, or has let self or family down
IndentIndentIndentIndentIndent54671-3 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54904-8 Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual
IndentIndentIndentIndentIndent54674-7 States that life isn't worth living, wishes for death, or attempts to harm self
IndentIndentIndentIndentIndent54676-2 Being short-tempered, easily annoyed
IndentIndentIndent54677-0 Total Severity Score {score}
IndentIndent86815-8 Behavior
IndentIndentIndent86597-2 Potential Indicators of Psychosis 1..2
IndentIndentIndent54514-5 Behavioral Symptom - Presence & Frequency
IndentIndentIndentIndent54682-0 Physical behavioral symptoms directed toward others d/(7.d)
IndentIndentIndentIndent54683-8 Verbal behavioral symptoms directed toward others d/(7.d)
IndentIndentIndentIndent54684-6 Other behavioral symptoms not directed toward others d/(7.d)
IndentIndentIndent54692-9 Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? d/(7.d)
IndentIndentIndent54693-7 Wandering - Presence & Frequency. Has the resident wandered? d/(7.d)
IndentIndent86816-6 Functional status
IndentIndentIndent86880-2 Activities of Daily Living (ADL) Assistance. Self-Performance
IndentIndentIndentIndent45588-1 Bed mobility
IndentIndentIndentIndent45590-7 Transfer
IndentIndentIndentIndent45592-3 Walk in room
IndentIndentIndentIndent45594-9 Walk in corridor
IndentIndentIndentIndent45596-4 Locomotion on unit
IndentIndentIndentIndent45598-0 Locomotion off unit
IndentIndentIndentIndent45600-4 Dressing
IndentIndentIndentIndent45602-0 Eating
IndentIndentIndentIndent45604-6 Toilet use
IndentIndentIndentIndent45606-1 Personal hygiene
IndentIndentIndent86881-0 Activities of Daily Living (ADL) Assistance. Support Provided
IndentIndentIndentIndent45589-9 Bed mobility
IndentIndentIndentIndent45591-5 Transfer
IndentIndentIndentIndent45593-1 Walk in room
IndentIndentIndentIndent45595-6 Walk in corridor
IndentIndentIndentIndent45597-2 Locomotion on unit
IndentIndentIndentIndent45599-8 Locomotion off unit
IndentIndentIndentIndent45601-2 Dressing
IndentIndentIndentIndent45603-8 Eating
IndentIndentIndentIndent45605-3 Toilet use
IndentIndentIndentIndent45607-9 Personal hygiene
IndentIndentIndent46008-9 Bathing
IndentIndentIndentIndent45608-7 Self-performance
IndentIndentIndentIndent45609-5 Support provided
IndentIndentIndent54524-4 Balance During Transitions and Walking
IndentIndentIndentIndent54749-7 Moving from seated to standing position
IndentIndentIndentIndent54750-5 Walking (with assistive device if used)
IndentIndentIndentIndent54751-3 Turning around and facing the opposite direction while walking
IndentIndentIndentIndent54752-1 Moving on and off toilet
IndentIndentIndentIndent54753-9 Surface-to-surface transfer (transfer between bed and chair or wheelchair)
IndentIndentIndent92908-3 Functional Limitation in Range of Motion
IndentIndentIndentIndent92850-7 Upper extremity (shoulder, elbow, wrist, hand)
IndentIndentIndentIndent92851-5 Lower extremity (hip, knee, ankle, foot)
IndentIndentIndent86602-0 Mobility Devices 1..4
IndentIndent88482-5 Functional Abilities and Goals - Admission (Start of SNF PPS Stay)
IndentIndentIndent83239-4 Prior Functioning: Everyday Activities
IndentIndentIndentIndent85070-1 Self-Care
IndentIndentIndentIndent85071-9 Indoor Mobility (Ambulation)
IndentIndentIndentIndent85072-7 Stairs
IndentIndentIndentIndent85073-5 Functional Cognition
IndentIndentIndent83234-5 Prior Device Use 1..5
IndentIndentIndent83233-7 Self-Care - Admission Performance
IndentIndentIndentIndent83232-9 Eating
IndentIndentIndentIndent83230-3 Oral hygiene
IndentIndentIndentIndent83228-7 Toileting hygiene
IndentIndentIndentIndent83226-1 Shower/bathe self
IndentIndentIndentIndent83224-6 Upper body dressing
IndentIndentIndentIndent83222-0 Lower body dressing
IndentIndentIndentIndent83220-4 Putting on/taking off footwear
IndentIndentIndent85054-5 Self-Care - Discharge Goal
IndentIndentIndentIndent83231-1 Eating
IndentIndentIndentIndent83229-5 Oral hygiene
IndentIndentIndentIndent83227-9 Toileting hygiene
IndentIndentIndentIndent83225-3 Shower/bathe self
IndentIndentIndentIndent83223-8 Upper body dressing
IndentIndentIndentIndent83221-2 Lower body dressing
IndentIndentIndentIndent83219-6 Putting on/taking off footwear
IndentIndentIndent88330-6 Mobility - Admission Performance
IndentIndentIndentIndent83218-8 Roll left and right
IndentIndentIndentIndent83216-2 Sit to lying
IndentIndentIndentIndent83214-7 Lying to sitting on side of bed
IndentIndentIndentIndent83212-1 Sit to stand
IndentIndentIndentIndent83210-5 Chair/bed-to-chair transfer
IndentIndentIndentIndent83208-9 Toilet transfer
IndentIndentIndentIndent83206-3 Car transfer
IndentIndentIndentIndent83204-8 Walk 10 feet
IndentIndentIndentIndent83202-2 Walk 50 feet with two turns
IndentIndentIndentIndent83200-6 Walk 150 feet
IndentIndentIndentIndent83198-2 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83196-6 1 step (curb)
IndentIndentIndentIndent83194-1 4 steps
IndentIndentIndentIndent83192-5 12 steps
IndentIndentIndentIndent83190-9 Picking up object
IndentIndentIndentIndent83271-7 Does the resident use a wheelchair and/or scooter?
IndentIndentIndentIndent83188-3 Wheel 50 feet with two turns
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndentIndentIndent83235-2 Wheel 150 feet
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndentIndent85056-0 Mobility - Discharge Goal
IndentIndentIndentIndent83217-0 Roll left and right
IndentIndentIndentIndent83215-4 Sit to lying
IndentIndentIndentIndent83213-9 Lying to sitting on side of bed
IndentIndentIndentIndent83211-3 Sit to stand
IndentIndentIndentIndent83209-7 Chair/Bed-to-chair transfer
IndentIndentIndentIndent83207-1 Toilet transfer
IndentIndentIndentIndent83205-5 Car transfer
IndentIndentIndentIndent83203-0 Walk 10 feet
IndentIndentIndentIndent83201-4 Walk 50 feet with two turns
IndentIndentIndentIndent83199-0 Walk 150 feet
IndentIndentIndentIndent83197-4 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83195-8 1 step (curb)
IndentIndentIndentIndent83193-3 4 steps
IndentIndentIndentIndent83191-7 12 steps
IndentIndentIndentIndent83189-1 Picking up object
IndentIndentIndentIndent83187-5 Wheel 50 feet with two turns
IndentIndentIndentIndent83236-0 Wheel 150 feet
IndentIndent88483-3 Functional Abilities and Goals - Discharge (End of SNF PPS Stay)
IndentIndentIndent83254-3 Self-Care - Discharge Performance
IndentIndentIndentIndent83232-9 Eating
IndentIndentIndentIndent83230-3 Oral hygiene
IndentIndentIndentIndent83228-7 Toileting hygiene
IndentIndentIndentIndent83226-1 Shower/bathe self
IndentIndentIndentIndent83224-6 Upper body dressing
IndentIndentIndentIndent83222-0 Lower body dressing
IndentIndentIndentIndent83220-4 Putting on/taking off footwear
IndentIndentIndent88331-4 Mobility - Discharge Performance
IndentIndentIndentIndent83218-8 Roll left and right
IndentIndentIndentIndent83216-2 Sit to lying
IndentIndentIndentIndent83214-7 Lying to sitting on side of bed
IndentIndentIndentIndent83212-1 Sit to stand
IndentIndentIndentIndent83210-5 Chair/bed-to-chair transfer
IndentIndentIndentIndent83208-9 Toilet transfer
IndentIndentIndentIndent83206-3 Car transfer
IndentIndentIndentIndent83204-8 Walk 10 feet
IndentIndentIndentIndent83202-2 Walk 50 feet with two turns
IndentIndentIndentIndent83200-6 Walk 150 feet
IndentIndentIndentIndent83198-2 Walking 10 feet on uneven surfaces
IndentIndentIndentIndent83196-6 1 step (curb)
IndentIndentIndentIndent83194-1 4 steps
IndentIndentIndentIndent83192-5 12 steps
IndentIndentIndentIndent83190-9 Picking up object
IndentIndentIndentIndent83271-7 Does the resident use a wheelchair and/or scooter?
IndentIndentIndentIndent83188-3 Wheel 50 feet with two turns
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndentIndentIndent83235-2 Wheel 150 feet
IndentIndentIndentIndent83272-5 Indicate the type of wheelchair or scooter used
IndentIndent89049-1 Bladder and Bowel
IndentIndentIndent86624-4 Appliances 1..4
IndentIndentIndent86866-1 Urinary Toileting Program
IndentIndentIndentIndent54767-9 Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility?
IndentIndentIndentIndent54769-5 Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence?
IndentIndentIndent54770-3 Urinary Continence 1..1
IndentIndentIndent54771-1 Bowel Continence 1..1
IndentIndentIndent88695-2 Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence?
IndentIndent90485-4 Active Diagnoses
IndentIndentIndent89045-9 Indicate the resident's primary medical condition category 1..1
IndentIndentIndent52797-8 ICD Code
IndentIndentIndent86671-5 Active Diagnoses in the last 7 days 1..*
IndentIndentIndent52797-8 Additional active diagnoses 0..10
IndentIndent90487-0 Health Conditions
IndentIndentIndent54557-4 Pain Management
IndentIndentIndentIndent71447-7 At any time in the last 5 days, has the resident: Received scheduled pain medication regimen?
IndentIndentIndentIndent71448-5 At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined?
IndentIndentIndentIndent71449-3 At any time in the last 5 days, has the resident: Received non-medication intervention for pain?
IndentIndentIndent54828-9 Should Pain Assessment Interview be Conducted?
IndentIndentIndent54558-2 Pain Assessment Interview
IndentIndentIndentIndent54829-7 Pain Presence. Have you had pain or hurting at any time in the last 5 days?
IndentIndentIndentIndent54830-5 Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days?
IndentIndentIndentIndent54559-0 Pain Effect on Function
IndentIndentIndentIndentIndent54831-3 Over the past 5 days, has pain made it hard for you to sleep at night?
IndentIndentIndentIndentIndent54832-1 Over the past 5 days, have you limited your day-to-day activities because of pain?
IndentIndentIndentIndent54560-8 Pain Intensity
IndentIndentIndentIndentIndent54833-9 Numeric Rating Scale (00-10)
IndentIndentIndentIndentIndent54834-7 Verbal Descriptor Scale
IndentIndentIndent58117-3 Should the Staff Assessment for Pain be Conducted?
IndentIndentIndent86672-3 Staff Assessment for Pain
IndentIndentIndentIndent86673-1 Indicators of Pain or Possible Pain in the last 5 days 1..4
IndentIndentIndentIndent58118-1 Frequency of Indicator of Pain or Possible Pain in the last 5 days. Frequency with which resident complains or shows evidence of pain or possible pain d/(5.d)
IndentIndentIndent86868-7 Other Health Conditions
IndentIndentIndentIndent86675-6 Shortness of Breath (dyspnea) 1..3
IndentIndentIndentIndent54846-1 Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?
IndentIndentIndentIndent86676-4 Problem Conditions 1..4
IndentIndentIndentIndent54849-5 Fall History on Admission/Entry or Reentry
IndentIndentIndentIndentIndent54850-3 Did the resident have a fall any time in the last month prior to admission/entry or reentry?
IndentIndentIndentIndentIndent54851-1 Did the resident have a fall any time in the last 2-6 months prior to admission/entry or reentry?
IndentIndentIndentIndentIndent54852-9 Did the resident have any fracture related to a fall in the 6 months prior to admission/entry or reentry?
IndentIndentIndentIndent54853-7 Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent?
IndentIndentIndentIndent54854-5 Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent
IndentIndentIndentIndentIndent54855-2 No injury
IndentIndentIndentIndentIndent54856-0 Injury (except major)
IndentIndentIndentIndentIndent54857-8 Major injury
IndentIndentIndent83274-1 Prior Surgery. Did the resident have major surgery during the 100 days prior to admission?
IndentIndentIndent90542-2 Recent Surgery Requiring Active SNF Care-Did the resident have a major surgical procedure during the prior inpatient hospital stay that requires active care during the SNF stay?
IndentIndentIndent90745-1 Surgical Procedures
IndentIndent90483-9 Swallowing/Nutritional Status
IndentIndentIndent86677-2 Swallowing Disorder. Signs and symptoms of possible swallowing disorder 1..4
IndentIndentIndent54567-3 Height and Weight
IndentIndentIndentIndent3137-7 Height (in inches) [in_us];cm
IndentIndentIndentIndent3141-9 Weight (in pounds) [lb_av];kg
IndentIndentIndent54863-6 Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months
IndentIndentIndent86678-0 Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months
IndentIndentIndent54568-1 Nutritional Approaches
IndentIndentIndentIndent71444-4 Nutritional Approaches. While NOT a Resident 0..2
IndentIndentIndentIndent71445-1 Nutritional Approaches. While a Resident 1..4
IndentIndentIndent90543-0 Percent Intake by Artificial Route
IndentIndentIndentIndent86681-4 Proportion of total calories the resident received through parenteral or tube feeding. While a Resident
IndentIndentIndentIndent86687-1 Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days
IndentIndentIndentIndent86683-0 Average fluid intake per day by IV or tube feeding. While a Resident
IndentIndentIndentIndent86684-8 Average fluid intake per day by IV or tube feeding. During Entire 7 Days
IndentIndent86685-5 Oral/Dental Status
IndentIndentIndent86706-9 Dental 1..2
IndentIndent88960-0 Skin Conditions
IndentIndentIndent86708-5 Determination of Pressure Ulcer/Injury Risk 1..3
IndentIndentIndent57280-0 Risk of Pressure Ulcers/Injuries. Is this resident at risk of developing pressure ulcers/injuries?
IndentIndentIndent58214-8 Unhealed Pressure Ulcers/Injuries. Does this resident have one or more unhealed pressure ulcers/injuries?
IndentIndentIndent88961-8 Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage
IndentIndentIndentIndent54884-2 Number of Stage 1 pressure injuries {#}
IndentIndentIndentIndent55124-2 Number of Stage 2 pressure ulcers {#}
IndentIndentIndentIndent54886-7 Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent55125-9 Number of Stage 3 pressure ulcers {#}
IndentIndentIndentIndent54887-5 Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent55126-7 Number of Stage 4 pressure ulcers {#}
IndentIndentIndentIndent54890-9 Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent54893-3 Number of unstageable pressure ulcers/injuries due to non-removable dressing/device {#}
IndentIndentIndentIndent54894-1 Number of these unstageable pressure ulcers/injuries that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent54946-9 Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar {#}
IndentIndentIndentIndent54947-7 Number of these unstageable pressure ulcers that were present upon admission/entry or reentry {#}
IndentIndentIndentIndent54950-1 Number of unstageable pressure injuries presenting as deep tissue injury {#}
IndentIndentIndentIndent54951-9 Number of these unstageable pressure injuries that were present upon admission/entry or reentry {#}
IndentIndentIndent54970-9 Number of Venous and Arterial Ulcers {#}
IndentIndentIndent88696-0 Other Ulcers, Wounds and Skin Problems 1..8
IndentIndentIndent86748-1 Skin and Ulcer/Injury Treatments 1..9
IndentIndent88962-6 Medications
IndentIndentIndent54982-4 Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days. d/(7.d)
IndentIndentIndent58217-1 Insulin
IndentIndentIndentIndent58127-2 Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days d/(7.d)
IndentIndentIndentIndent58128-0 Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days d/(7.d)
IndentIndentIndent88290-2 Medications Received
IndentIndentIndentIndent86751-5 Antipsychotic d/(7.d)
IndentIndentIndentIndent86752-3 Antianxiety d/(7.d)
IndentIndentIndentIndent86753-1 Antidepressant d/(7.d)
IndentIndentIndentIndent86754-9 Hypnotic d/(7.d)
IndentIndentIndentIndent86755-6 Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin) d/(7.d)
IndentIndentIndentIndent86756-4 Antibiotic d/(7.d)
IndentIndentIndentIndent86757-2 Diuretic d/(7.d)
IndentIndentIndentIndent88291-0 Opiod d/(7.d)
IndentIndentIndent88295-1 Antipsychotic Medication Review
IndentIndentIndentIndent88296-9 Did the resident receive antipsychotic medications since admission/entry or reentry or the prior OBRA assessment, whichever is more recent?
IndentIndentIndentIndent88297-7 Has a gradual dose reduction (GDR) been attempted?
IndentIndentIndentIndent88298-5 Date of last attempted GDR {mm/dd/yyyy}
IndentIndentIndentIndent88299-3 Physician documented GDR as clinically contraindicated
IndentIndentIndentIndent88300-9 Date physician documented GDR as clinically contraindicated {mm/dd/yyyy}
IndentIndentIndent57255-2 Drug Regimen Review: Did a complete drug regimen review identify potential clinically significant medication issues?
IndentIndentIndent57281-8 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?
IndentIndentIndent57256-0 Did the facility contact and complete physician (or physician-designee) prescribed/recommended actions by midnight of the next calendar day each time potential clinically significant medication issues were identified since the admission?
IndentIndent90515-8 Special Treatments, Procedures, and Programs
IndentIndentIndent86759-8 Special Treatments, Procedures, and Programs
IndentIndentIndentIndent86760-6 While NOT a Resident 0..9
IndentIndentIndentIndent86761-4 While a Resident 0..11
IndentIndentIndent69339-0 Influenza Vaccine
IndentIndentIndentIndent55019-4 Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season?
IndentIndentIndentIndent58131-4 Date influenza vaccine received {mm/dd/yyyy}
IndentIndentIndentIndent55020-2 If influenza vaccine not received, state reason:
IndentIndentIndent55021-0 Pneumococcal Vaccine
IndentIndentIndentIndent55022-8 Is the resident's Pneumococcal vaccination up to date?
IndentIndentIndentIndent45956-0 If Pneumococcal vaccine not received, state reason:
IndentIndentIndent86841-4 Therapies
IndentIndentIndentIndent86763-0 Speech-Language Pathology and Audiology Services
IndentIndentIndentIndentIndent58218-9 Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days min
IndentIndentIndentIndentIndent58133-0 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days min
IndentIndentIndentIndentIndent58134-8 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days min
IndentIndentIndentIndentIndent86765-5 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days min
IndentIndentIndentIndentIndent45760-6 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndentIndentIndent55025-1 Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started {mm/dd/yyyy}
IndentIndentIndentIndentIndent55026-9 Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended {mm/dd/yyyy}
IndentIndentIndentIndent86767-1 Occupational Therapy
IndentIndentIndentIndentIndent58219-7 Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days min
IndentIndentIndentIndentIndent58136-3 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days min
IndentIndentIndentIndentIndent58137-1 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days min
IndentIndentIndentIndentIndent86764-8 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days min
IndentIndentIndentIndentIndent45762-2 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndentIndentIndent55027-7 Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started {mm/dd/yyyy}
IndentIndentIndentIndentIndent55028-5 Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended {mm/dd/yyyy}
IndentIndentIndentIndent86768-9 Physical Therapy
IndentIndentIndentIndentIndent58220-5 Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days min
IndentIndentIndentIndentIndent58139-7 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days min
IndentIndentIndentIndentIndent58140-5 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days min
IndentIndentIndentIndentIndent86766-3 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days min
IndentIndentIndentIndentIndent45764-8 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndentIndentIndent55029-3 Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started {mm/dd/yyyy}
IndentIndentIndentIndentIndent55030-1 Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended {mm/dd/yyyy}
IndentIndentIndentIndent86849-7 Respiratory therapy
IndentIndentIndentIndentIndent45766-3 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days d/(7.d)
IndentIndentIndentIndent86850-5 Psychological therapy
IndentIndentIndentIndentIndent45768-9 Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days. d/(7.d)
IndentIndentIndent86769-7 Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days. d
IndentIndentIndent90544-8 Part A Therapies
IndentIndentIndentIndent90545-5 Speech-Language Pathology and Audiology Services
IndentIndentIndentIndentIndent90539-8 Individual minutes - record the total number of minutes this therapy was administered to the resident individually since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90536-4 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90538-0 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90537-2 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90551-3 Days - record the number of days this therapy was administered for at least 15 minutes a day since the start date of the resident's most recent Medicare Part A stay (A2400B) d/{#}
IndentIndentIndentIndent90546-3 Occupational Therapy
IndentIndentIndentIndentIndent90531-5 Individual minutes - record the total number of minutes this therapy was administered to the resident individually since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90527-3 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident since the start date of the resident's most recent Medicare Part A stay (A2400B) min
IndentIndentIndentIndentIndent90529-9 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90528-1 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90530-7 Days - record the number of days this therapy was administered for at least 15 minutes a day since the start date of the resident's most recent Medicare Part A stay (A2400B) d/{#}
IndentIndentIndentIndent90547-1 Physical Therapy
IndentIndentIndentIndentIndent90535-6 Individual minutes - record the total number of minutes this therapy was administered to the resident individually since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90532-3 Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90534-9 Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90533-1 Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions since the start date of the resident's most recent Medicare Part A stay (A2400B)
IndentIndentIndentIndentIndent90550-5 Days - record the number of days this therapy was administered for at least 15 minutes a day since the start date of the resident's most recent Medicare Part A stay (A2400B) d/{#}
IndentIndentIndent90548-9 Distinct Calendar Days of Part A Therapy {#}
IndentIndentIndent86773-9 Restorative Nursing Programs
IndentIndentIndentIndent86774-7 Technique. Range of motion (passive) d/(7.d)
IndentIndentIndentIndent86775-4 Technique. Range of motion (active) d/(7.d)
IndentIndentIndentIndent86776-2 Technique. Splint or brace assistance d/(7.d)
IndentIndentIndentIndent86777-0 Training and Skill Practice In: Bed mobility d/(7.d)
IndentIndentIndentIndent86778-8 Training and Skill Practice In: Transfer d/(7.d)
IndentIndentIndentIndent86779-6 Training and Skill Practice In: Walking d/(7.d)
IndentIndentIndentIndent86780-4 Training and Skill Practice In: Dressing and/or grooming d/(7.d)
IndentIndentIndentIndent86781-2 Training and Skill Practice In: Eating and/or swallowing d/(7.d)
IndentIndentIndentIndent86782-0 Training and Skill Practice In: Amputation/prostheses care d/(7.d)
IndentIndentIndentIndent86783-8 Training and Skill Practice In: Communication d/(7.d)
IndentIndentIndent55040-0 Physician Examinations. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) examine the resident? d/(14.d)
IndentIndentIndent55041-8 Physician Orders. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) change the resident's orders? d/(14.d)
IndentIndent88307-4 Restraints and Alarms
IndentIndentIndent86785-3 Physical Restraints
IndentIndentIndentIndent86786-1 Used in Bed. Bed rail d/(7.d)
IndentIndentIndentIndent86787-9 Used in Bed. Trunk restraint d/(7.d)
IndentIndentIndentIndent86788-7 Used in Bed. Limb restraint d/(7.d)
IndentIndentIndentIndent86789-5 Used in Bed. Other d/(7.d)
IndentIndentIndentIndent86790-3 Used in Chair or Out of Bed. Trunk restraint d/(7.d)
IndentIndentIndentIndent86791-1 Used in Chair or Out of Bed. Limb restraint d/(7.d)
IndentIndentIndentIndent86792-9 Used in Chair or Out of Bed. Chair prevents rising d/(7.d)
IndentIndentIndentIndent86793-7 Used in Chair or Out of Bed. Other d/(7.d)
IndentIndentIndent88309-0 Alarms
IndentIndentIndentIndent88310-8 Bed alarm
IndentIndentIndentIndent88311-6 Chair alarm
IndentIndentIndentIndent88312-4 Floor mat alarm
IndentIndentIndentIndent88313-2 Motion sensor alarm
IndentIndentIndentIndent88314-0 Wander/elopement alarm
IndentIndentIndentIndent88308-2 Other alarm
IndentIndent86794-5 Participation in Assessment and Goal Setting
IndentIndentIndent55053-3 Participation in Assessment
IndentIndentIndentIndent55054-1 Resident participated in assessment
IndentIndentIndentIndent55074-9 Family or significant other participated in assessment
IndentIndentIndentIndent58221-3 Guardian or legally authorized representative participated in assessment
IndentIndentIndent55056-6 Resident's Overall Expectation
IndentIndentIndentIndent55057-4 Select one for resident's overall goal established during assessment process
IndentIndentIndentIndent55058-2 Indicate information source for Q0300A
IndentIndentIndent58146-2 Discharge Plan. Is active discharge planning already occurring for the resident to return to the community?
IndentIndentIndent86795-2 Resident's Preference to Avoid Being Asked Question Q0500B. Does the resident's clinical record document a request that this question be asked only on comprehensive assessments?
IndentIndentIndent58149-6 Return to Community. Do you want to talk to someone about the possiblity of leaving this facility and returning to live and receive services in the community?
IndentIndentIndent86796-0 Resident's Preference to Avoid Being Asked Question Q0500B Again
IndentIndentIndentIndent86797-8 Does the resident (or family or significant other or guardian or legally authorized representative if resident is unable to understand or respond) want to be asked about returning to the community on all assessments?
IndentIndentIndentIndent86798-6 Indicate information source for Q0550A
IndentIndentIndent58150-4 Referral. Has a referral been made to the Local Contact Agency?
IndentIndent90490-4 Correction Request
IndentIndentIndent85632-8 Type of Provider
IndentIndentIndent87226-7 Name of Resident
IndentIndentIndentIndent45392-8 First name
IndentIndentIndentIndent45394-4 Last name
IndentIndentIndent46098-0 Gender
IndentIndentIndent21112-8 Birth Date {mm/dd/yyyy}
IndentIndentIndent45396-9 Social Security Number
IndentIndentIndent90522-4 Optional State Assessment. Is this assessment for state payment purposes only?
IndentIndentIndent90492-0 Type of Assessment
IndentIndentIndentIndent54583-0 Federal OBRA Reason for Assessment
IndentIndentIndentIndent54584-8 PPS Assessment
IndentIndentIndentIndent58108-2 Entry/discharge reporting
IndentIndentIndentIndent86525-3 Is this a SNF Part A PPS Discharge Assessment?
IndentIndentIndent87216-8 Date on existing record to be modified/inactivated
IndentIndentIndentIndent54593-9 Assessment Reference Date {mm/dd/yyyy}
IndentIndentIndentIndent52525-3 Discharge Date {mm/dd/yyyy}
IndentIndentIndentIndent50786-3 Entry Date {mm/dd/yyyy}
IndentIndentIndent87209-3 Correction Attestation Section
IndentIndentIndentIndent58200-7 Correction Number {#}
IndentIndentIndentIndent87217-6 Reasons for Modification 1..5
IndentIndentIndentIndent87225-9 Reasons for Inactivation 1..2
IndentIndentIndentIndent87218-4 RN Assessment Coordinator Attestation of Completion
IndentIndentIndentIndentIndent87219-2 Attesting individual's first name
IndentIndentIndentIndentIndent87220-0 Attesting individual's last name
IndentIndentIndentIndentIndent87221-8 Attesting individual's title
IndentIndentIndentIndentIndent87222-6 Attestation date {mm/dd/yyyy}
IndentIndent90497-9 Assessment Administration
IndentIndentIndent90498-7 Medicare Part A Billing
IndentIndentIndentIndent55065-7 Medicare Part A HIPPS code
IndentIndentIndentIndent55081-4 Version code
IndentIndentIndent93053-7 State Medicaid Billing (if required by the state)
IndentIndentIndentIndent55068-1 Case Mix group
IndentIndentIndentIndent55081-4 Version code
IndentIndentIndent93052-9 Alternate State Medicaid Billing (if required by the state)
IndentIndentIndentIndent58212-2 Case Mix group
IndentIndentIndentIndent55081-4 Version code
IndentIndentIndent93051-1 Insurance Billing
IndentIndentIndentIndent55071-5 Billing code
IndentIndentIndentIndent55081-4 Billing version
Indent90476-3 MDS v3.0 - RAI v1.17.1 - Swing bed PPS (SP) item set [CMS Assessment]
IndentIndent90501-8 Identification Information
IndentIndentIndent58198-3 Type of Record
IndentIndentIndent54581-4 Facility Provider Numbers
IndentIndentIndentIndent76468-8 National Provider Identifier (NPI)
IndentIndentIndentIndent69417-4 CMS Certification Number (CCN)
IndentIndentIndentIndent45398-5 State Provider Number
IndentIndentIndent85632-8 Type of Provider
IndentIndentIndent90489-6 Type of Assessment
IndentIndentIndentIndent54583-0 Federal OBRA Reason for Assessment
IndentIndentIndentIndent54584-8 PPS Assessment
IndentIndentIndentIndent54587-1 Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry?
IndentIndentIndentIndent58108-2 Entry/discharge reporting
IndentIndentIndentIndent71440-2 Type of discharge
IndentIndentIndentIndent90525-7 Is this a SNF Part A Interrupted Stay?
IndentIndentIndentIndent86525-3 Is this a SNF Part A PPS Discharge Assessment?
IndentIndentIndent86526-1 Unit Certification or Licensure Designation
IndentIndentIndent54503-8 Legal Name of Resident
IndentIndentIndentIndent45392-8 First name
IndentIndentIndentIndent45393-6 Middle initial
IndentIndentIndentIndent45394-4 Last name
IndentIndentIndentIndent45395-1 Suffix
IndentIndentIndent45966-9 Social Security and Medicare Numbers
IndentIndentIndentIndent45396-9 Social Security Number
IndentIndentIndentIndent45397-7 Medicare number
IndentIndentIndent45400-9 Medicaid Number
IndentIndentIndent46098-0 Gender
IndentIndentIndent21112-8 Birth Date {mm/dd/yyyy}
IndentIndentIndent59362-4 Race/Ethnicity 1..6
IndentIndentIndent54505-3 Language
IndentIndentIndentIndent54588-9 Does the resident need or want an interpreter to communicate with a doctor or health care staff?
IndentIndentIndentIndent54899-0 Preferred language
IndentIndentIndent45404-1 Marital Status
IndentIndentIndent54506-1 Optional Resident Items
IndentIndentIndentIndent46106-1 Medical record number
IndentIndentIndentIndent45403-3 Room number
IndentIndentIndentIndent52462-9 Name by which resident prefers to be addressed
IndentIndentIndentIndent21843-8 Lifetime occupation(s)
IndentIndentIndent86528-7 Most Recent Admission/Entry or Reentry into this Facility
IndentIndentIndentIndent50786-3 Entry Date {mm/dd/yyyy}
IndentIndentIndentIndent54590-5 Type of Entry
IndentIndentIndentIndent85398-6 Entered From
IndentIndentIndent52455-3 Admission Date (Date this episode of care in this facility began) {mm/dd/yyyy}
IndentIndentIndent52525-3 Discharge Date {mm/dd/yyyy}
IndentIndentIndent55128-3 Discharge Status
IndentIndentIndent54593-9 Assessment Reference Date. Observation end date {mm/dd/yyyy}
IndentIndentIndent54507-9 Medicare Stay
IndentIndentIndentIndent54594-7 Has the resident had a Medicare-covered stay since the most recent entry?
IndentIndentIndentIndent54595-4 Start date of most recent Medicare stay {mm/dd/yyyy}
IndentIndentIndentIndent54596-2 End date of most recent Medicare stay {mm/dd/yyyy}
IndentIndent54508-7 Hearing, Speech, and Vision
IndentIndentIndent54597-0 Comatose. Persistent vegetative state/no discernible consciousness
IndentIndentIndent54598-8 Hearing. Ability to hear (with hearing aid or hearing appliances if normally used)
IndentIndentIndent54599-6 Hearing Aid. Hearing aid or other hearing appliance used in completing B0200, Hearing
IndentIndentIndent54600-2 Speech Clarity. Select best description of speech pattern
IndentIndentIndent54601-0 Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression
IndentIndentIndent54602-8 Ability to Understand Others. Understanding verbal content, however able (with hearing aid or device if used)
IndentIndentIndent54603-6 Vision. Ability to see in adequate light (with glasses or other visual appliances)
IndentIndentIndent54604-4 Corrective Lenses. Corrective lenses (contacts, glasses, or magnifying glass) used in completing B1000, Vision
IndentIndent86529-5 Cognitive Patterns
IndentIndentIndent54605-1 Should Brief Interview for Mental Status (C0200-C0500) be Conducted?
IndentIndentIndent52491-8 Brief Interview for Mental Status (BIMS)
IndentIndentIndentIndent52731-7 Repetition of Three Words. Number of words repeated after first attempt
IndentIndentIndentIndent54510-3 Temporal Orientation (orientation to year, month, and day)
IndentIndentIndentIndentIndent52732-5 Able to report correct year
IndentIndentIndentIndentIndent52733-3 Able to report correct month
IndentIndentIndentIndentIndent54609-3 Able to report correct day of the week
IndentIndentIndentIndent52493-4 Recall
IndentIndentIndentIndentIndent52735-8 Able to recall "sock"
IndentIndentIndentIndentIndent52736-6 Able to recall "blue"
IndentIndentIndentIndentIndent52737-4 Able to recall "bed"
IndentIndentIndentIndent54614-3 BIMS Summary Score {score}
IndentIndentIndent54615-0 Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted?
IndentIndentIndent86595-6 Staff Assessment for Mental Status
IndentIndentIndentIndent54616-8 Short-term Memory OK. Seems or appears to recall after 5 minutes
IndentIndentIndentIndent54617-6 Long-term Memory OK. Seems or appears to recall long past
IndentIndentIndentIndent86583-2 Memory/Recall Ability 1..4
IndentIndentIndentIndent54624-2 Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life
IndentIndentIndent86584-0 Delirium
IndentIndentIndentIndent86585-7 Signs and Symptoms of Delirium (from CAM)
IndentIndentIndentIndentIndent54632-5 Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline?
IndentIndentIndentIndentIndent54628-3 Inattention - Did the resident have difficulty focusing attention, for example, being easily distractible or having difficulty keeping track of what was being said?
IndentIndentIndentIndentIndent54629-1 Disorganized Thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)?
IndentIndentIndentIndentIndent54630-9 Altered Level of Consciousness - Did the resident have altered level of consciousness, as indicated by any of the following criteria?
IndentIndent90482-1 Mood
IndentIndentIndent54634-1 Should Resident Mood Interview be Conducted?
IndentIndentIndent54635-8 Resident Mood Interview (PHQ-9)
IndentIndentIndentIndent86843-0 Symptom Presence
IndentIndentIndentIndentIndent54636-6 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54638-2 Feeling down, depressed or hopeless
IndentIndentIndentIndentIndent54640-8 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54642-4 Feeling tired or having little energy
IndentIndentIndentIndentIndent54644-0 Poor appetite or overeating
IndentIndentIndentIndentIndent54646-5 Feeling bad about yourself - or that you are a failure or have let yourself or your family down
IndentIndentIndentIndentIndent54648-1 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54650-7 Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual
IndentIndentIndentIndentIndent54652-3 Thoughts that you would be better off dead, or of hurting yourself in some way
IndentIndentIndentIndent86844-8 Symptom Frequency
IndentIndentIndentIndentIndent54637-4 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54639-0 Feeling down, depressed or hopeless
IndentIndentIndentIndentIndent54641-6 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54643-2 Feeling tired or having little energy
IndentIndentIndentIndentIndent54645-7 Poor appetite or overeating
IndentIndentIndentIndentIndent54647-3 Feeling bad about yourself - or that you are a failure or have let yourself or your family down
IndentIndentIndentIndentIndent54649-9 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54651-5 Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual
IndentIndentIndentIndentIndent54653-1 Thoughts that you would be better off dead, or of hurting yourself in some way
IndentIndentIndent54654-9 Total Severity Score {score}
IndentIndentIndent54657-2 Staff Assessment of Resident Mood (PHQ-9-OV)
IndentIndentIndentIndent86833-1 Symptom Presence
IndentIndentIndentIndentIndent54658-0 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54660-6 Feeling or appearing down, depressed, or hopeless
IndentIndentIndentIndentIndent54662-2 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54664-8 Feeling tired or having little energy
IndentIndentIndentIndentIndent54666-3 Poor appetite or overeating
IndentIndentIndentIndentIndent54668-9 Indicating that s/he feels bad about self, is a failure, or has let self or family down
IndentIndentIndentIndentIndent54670-5 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54672-1 Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual
IndentIndentIndentIndentIndent54673-9 States that life isn't worth living, wishes for death, or attempts to harm self
IndentIndentIndentIndentIndent54675-4 Being short-tempered, easily annoyed
IndentIndentIndentIndent86891-9 Symptom Frequency
IndentIndentIndentIndentIndent54659-8 Little interest or pleasure in doing things
IndentIndentIndentIndentIndent54661-4 Feeling or appearing down, depressed, or hopeless
IndentIndentIndentIndentIndent54663-0 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndentIndent54665-5 Feeling tired or having little energy
IndentIndentIndentIndentIndent54667-1 Poor appetite or overeating
IndentIndentIndentIndentIndent54669-7 Indicating that s/he feels bad about self, is a failure, or has let self or family down
IndentIndentIndentIndentIndent54671-3 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndentIndent54904-8 Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual
IndentIndentIndentIndentIndent54674-7 States that life isn't worth living, wishes for death, or attempts to harm self
IndentIndentIndentIndentIndent54676-2 Being short-tempered, easily annoyed
IndentIndentIndent54677-0 Total Severity Score {score}
IndentIndent86815-8 Behavior
IndentIndentIndent86597-2 Potential Indicators of Psychosis 1..2
IndentIndentIndent54514-5 Behavioral Symptom - Presence & Frequency
IndentIndentIndentIndent54682-0 Physical behavioral symptoms directed toward others d/(7.d)
IndentIndentIndentIndent54683-8 Verbal behavioral symptoms directed toward others d/(7.d)
IndentIndentIndentIndent54684-6 Other behavioral symptoms not directed toward others d/(7.d)
IndentIndentIndent54692-9 Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? d/(7.d)
IndentIndentIndent54693-7 Wandering - Presence & Frequency. Has the resident wandered? d/(7.d)
IndentIndent86816-6 Functional Status
IndentIndentIndent86880-2 Activities of Daily Living (ADL) Assistance. Self-Performance
IndentIndentIndentIndent45588-1 Bed mobility
IndentIndentIndentIndent45590-7 Transfer
IndentIndentIndentIndent45592-3 Walk in room
IndentIndentIndentIndent45594-9 Walk in corridor
IndentIndentIndentIndent45596-4 Locomotion on unit
IndentIndentIndentIndent45598-0 Locomotion off unit
IndentIndentIndentIndent45600-4 Dressing
IndentIndentIndentIndent45602-0 Eating
IndentIndentIndentIndent45604-6 Toilet use
IndentIndentIndentIndent45606-1 Personal hygiene
IndentIndentIndent86881-0 Activities of Daily Living (ADL) Assistance. Support Provided
IndentIndentIndentIndent45589-9 Bed mobility
IndentIndentIndentIndent45591-5 Transfer
IndentIndentIndentIndent45593-1 Walk in room
IndentIndentIndentIndent45595-6 Walk in corridor
IndentIndentIndentIndent45597-2 Locomotion on unit
IndentIndentIndentIndent45599-8 Locomotion off unit
IndentIndentIndentIndent45601-2 Dressing
IndentIndentIndentIndent45603-8 Eating
IndentIndentIndentIndent45605-3 Toilet use
IndentIndentIndentIndent45607-9 Personal hygiene
IndentIndentIndent46008-9 Bathing
IndentIndentIndentIndent45608-7 Self-performance
IndentIndentIndentIndent45609-5 Support provided
IndentIndentIndent54524-4 Balance During Transitions and Walking
IndentIndentIndentIndent54749-7 Moving from seated to standing position
IndentIndentIndentIndent54750-5 Walking (with assistive device if used)
IndentIndentIndentIndent54751-3 Turning around and facing the opposite direction while walking
IndentIndentIndentIndent54752-1 Moving on and off toilet
IndentIndentIndentIndent54753-9 Surface-to-surface transfer (transfer between bed and chair or wheelchair)
IndentIndentIndent92908-3 Functional Limitation in Range of Motion
IndentIndentIndentIndent92850-7 Upper extremity (shoulder, elbow, wrist, hand)
IndentIndentIndentIndent92851-5 Lower extremity (hip, knee, ankle, foot)
IndentIndentIndent86602-0 Mobility Devices 1..4
IndentIndent88482-5 Functional Abilities and Goals - Admission (Start of SNF PPS Stay)
IndentIndentIndent83239-4 Prior Functioning: Everyday Activities
IndentIndentIndentIndent85070-1 Self-Care
IndentIndentIndentIndent85071-9 Indoor Mobility (Ambulation)
IndentIndentIndentIndent85072-7 Stairs
IndentIndentIndentIndent85073-5 Functional Cognition
IndentIndentIndent83234-5 Prior Device Use 1..5
IndentIndentIndent83233-7 Self-Care - Admission Performance
IndentIndentIndentIndent83232-9 Eating
IndentIndentIndentIndent83230-3 Oral hygiene
IndentIndentIndentIndent83228-7 Toileting hygiene
IndentIndentIndentIndent83226-1 Shower/bathe self
IndentIndentIndentIndent83224-6 Upper body dressing
IndentIndentIndentIndent83222-0 Lower body dressing
IndentIndentIndentIndent83220-4 Putting on/taking off footwear
IndentIndentIndent85054-5 Self-Care - Discharge Goal
IndentIndentIndentIndent83231-1 Eating
IndentIndentIndentIndent83229-5 Oral hygiene
IndentIndentIndentIndent83227-9 Toileting hygiene
IndentIndentIndentIndent83225-3 Shower/bathe self
IndentIndentIndentIndent83223-8 Upper body dressing
IndentIndentIndentIndent83221-2 Lower body dressing
Indent