93128-7
Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment]
Active
Term Description
The effective date of this panel has been delayed due to the COVID-19 PHE. For the latest information, please see announcements on https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/LTCH-Quality-Reporting-Spotlight-Announcements.
Source: Regenstrief LOINC
Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
| LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
|---|---|---|---|---|
| 93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] | |||
| Indent93167-5 | Identification Information | |||
| Indent Indent85396-0 | Facility Information | |||
| Indent Indent Indent76696-4 | Facility Name | |||
| Indent Indent Indent69417-4 | Facility Medicare Provider Number | |||
| Indent Indent45397-7 | Patient Medicare Number | |||
| Indent Indent45400-9 | Patient Medicaid Number | |||
| Indent Indent45392-8 | Patient First Name | |||
| Indent Indent45394-4 | Patient Last Name | |||
| Indent Indent52463-7 | Patient Identification Number | |||
| Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent45396-9 | Social Security Number | |||
| Indent Indent46098-0 | Gender | |||
| Indent Indent45404-1 | Marital Status | |||
| Indent Indent52539-4 | Zip Code of Patient's Pre-Hospital Residence | |||
| Indent Indent52455-3 | Admission Date | {mm/dd/yyyy} | ||
| Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
| Indent Indent85397-8 | Admission Class | |||
| Indent Indent85398-6 | Admit From | |||
| Indent Indent85399-4 | Pre-hospital Living Setting | |||
| Indent Indent85400-0 | Pre-hospital Living With | |||
| Indent85401-8 | Payer information | |||
| Indent Indent85813-4 | Payment Source | |||
| Indent Indent Indent85402-6 | Primary Source | |||
| Indent Indent Indent85403-4 | Secondary Source | |||
| Indent87415-6 | Medical Information | |||
| Indent Indent85405-9 | Impairment Group - Admission | |||
| Indent Indent Indent85845-6 | Impairment Group | |||
| Indent Indent85406-7 | Impairment Group - Discharge | |||
| Indent Indent Indent85845-6 | Impairment Group | |||
| Indent Indent52797-8 | Etiologic Diagnosis | 1..3 | ||
| Indent Indent85585-8 | Date of Onset of Impairment | {mm/dd/yyyy} | ||
| Indent Indent75618-9 | Comorbid Conditions | 0..25 | ||
| Indent Indent85407-5 | Are there any arthritis conditions recorded in items #21, #22, or #24 that meet all of the regulatory requirements for IRF classification (in 42 CFR 412.29(b)(2)(x), (xi), and (xii))? | |||
| Indent Indent54567-3 | Height and Weight | |||
| Indent Indent Indent103692-0 | Height on admission (in inches) | [in_us];cm;m | ||
| Indent Indent Indent103693-8 | Weight on admission (in pounds) | [lb_av];kg | ||
| Indent85410-9 | Discharge Information | |||
| Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent85411-7 | Patient discharged against medical advice? | |||
| Indent Indent85412-5 | Program Interruption(s) | |||
| Indent Indent85483-6 | Program Interruption Dates | 0..3 | ||
| Indent Indent Indent85413-3 | Program Interruption Date | 1..1 | {mm/dd/yyyy} | |
| Indent Indent Indent85414-1 | Program Return Date | 1..1 | {mm/dd/yyyy} | |
| Indent Indent85415-8 | Was the patient discharged alive? | |||
| Indent Indent55128-3 | Patient's discharge destination/living setting | |||
| Indent Indent85417-4 | Discharge to Living With | |||
| Indent Indent85418-2 | Diagnosis for Interruption or Death | |||
| Indent Indent85419-0 | Complications during rehabilitation stay | 0..6 | ||
| Indent85420-8 | Therapy Information | |||
| Indent Indent85494-3 | Week 1: Total Number of Minutes Provided | |||
| Indent Indent Indent85566-8 | Physical Therapy | |||
| Indent Indent Indent Indent85557-7 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85558-5 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85559-3 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85560-1 | Total minutes of co-treatment therapy | min | ||
| Indent Indent Indent85561-9 | Occupational Therapy | |||
| Indent Indent Indent Indent85562-7 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85563-5 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85564-3 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85565-0 | Total minutes of co-treatment therapy | min | ||
| Indent Indent Indent85493-5 | Speech-Language Pathology | |||
| Indent Indent Indent Indent85492-7 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85491-9 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85490-1 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85489-3 | Total minutes of co-treatment therapy | min | ||
| Indent Indent85495-0 | Week 2: Total Number of Minutes Provided | |||
| Indent Indent Indent85589-0 | Physical Therapy | |||
| Indent Indent Indent Indent85567-6 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85568-4 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85569-2 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85570-0 | Total minutes of co-treatment therapy | min | ||
| Indent Indent Indent85590-8 | Occupational Therapy | |||
| Indent Indent Indent Indent85571-8 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85572-6 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85573-4 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85574-2 | Total minutes of co-treatment therapy | min | ||
| Indent Indent Indent85591-6 | Speech-Language Pathology | |||
| Indent Indent Indent Indent85575-9 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85576-7 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85577-5 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85578-3 | Total minutes of co-treatment therapy | min | ||
| Indent93171-7 | Quality Indicators - Admission | |||
| Indent Indent93161-8 | Administrative Information | |||
| Indent Indent Indent69854-8 | Ethnicity. Are you of Hispanic, Latino/a, or Spanish origin? | 1..4 | ||
| Indent Indent Indent103708-4 | Race. What is your race? | 1..14 | ||
| Indent Indent Indent93186-5 | Language | |||
| Indent Indent Indent Indent54899-0 | What is your preferred language? | |||
| Indent Indent Indent Indent54588-9 | Do you need or want an interpreter to communicate with a doctor or health care staff? | |||
| Indent Indent Indent101351-5 | Transportation. Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living? | |||
| Indent Indent93165-9 | Hearing, Speech, and Vision | |||
| Indent Indent Indent95744-9 | Hearing. Ability to hear (with hearing aid or hearing appliances if normally used) | |||
| Indent Indent Indent95745-6 | Vision. Ability to see in adequate light (with glasses or other visual appliances) | |||
| Indent Indent Indent103709-2 | Health Literacy. How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy? | |||
| Indent Indent Indent95737-3 | Expression of Ideas and Wants | |||
| Indent Indent Indent95740-7 | Understanding Verbal and Non-Verbal Content | |||
| Indent Indent93162-6 | Cognitive patterns | |||
| Indent Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
| Indent Indent Indent103694-6 | Brief Interview for Mental Status | |||
| Indent Indent Indent Indent103696-1 | Repetition of Three Words. Number of words repeated after first attempt | |||
| Indent Indent Indent Indent103702-7 | Temporal Orientation (orientation to year, month, and day) | |||
| Indent Indent Indent Indent Indent103697-9 | Able to report correct year | |||
| Indent Indent Indent Indent Indent103698-7 | Able to report correct month | |||
| Indent Indent Indent Indent Indent103703-5 | Able to report correct day of the week | |||
| Indent Indent Indent Indent103695-3 | Recall | |||
| Indent Indent Indent Indent Indent103699-5 | Able to recall "sock" | |||
| Indent Indent Indent Indent Indent103700-1 | Able to recall "blue" | |||
| Indent Indent Indent Indent Indent103701-9 | Able to recall "bed" | |||
| Indent Indent Indent Indent103704-3 | BIMS Summary Score | {score} | ||
| Indent Indent Indent54615-0 | Should the Staff Assessment for Mental Status (C0900) be Conducted? | |||
| Indent Indent Indent95944-5 | Staff Assessment for Mental Status | |||
| Indent Indent Indent Indent95743-1 | Memory/Recall Ability | 1..4 | ||
| Indent Indent Indent95816-5 | Signs and Symptoms of Delirium (from CAM) | |||
| Indent Indent Indent Indent95813-2 | Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the patient's baseline? | |||
| Indent Indent Indent Indent95812-4 | Inattention - Did the patient have difficulty focusing attention, for example being easily distractible or having difficulty keeping track of what was being said? | |||
| Indent Indent Indent Indent95814-0 | Disorganized thinking - Was the patient's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)? | |||
| Indent Indent Indent Indent95815-7 | Altered level of consciousness - Did the patient have altered level of consciousness, as indicated by any of the following criteria? | |||
| Indent Indent93170-9 | Mood | |||
| Indent Indent Indent54635-8 | Patient Mood Interview (PHQ-2 to 9) | |||
| Indent Indent Indent Indent86843-0 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent Indent86844-8 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent103705-0 | Total Severity Score | {score} | ||
| Indent Indent Indent93159-2 | Social Isolation. How often do you feel lonely or isolated from those around you? | |||
| Indent Indent95811-6 | Functional Abilities and Goals - Admission | |||
| Indent Indent Indent83239-4 | Prior Functioning: Everyday Activities | |||
| Indent Indent Indent Indent85070-1 | Self-Care | |||
| Indent Indent Indent Indent85071-9 | Indoor Mobility (Ambulation) | |||
| Indent Indent Indent Indent85072-7 | Stairs | |||
| Indent Indent Indent Indent85073-5 | Functional Cognition | |||
| Indent Indent Indent83234-5 | Prior Device Use | 1..5 | ||
| Indent Indent Indent95732-4 | Self-Care - Admission Performance | |||
| Indent Indent Indent Indent95019-6 | Eating | |||
| Indent Indent Indent Indent95018-8 | Oral hygiene | |||
| Indent Indent Indent Indent95017-0 | Toileting hygiene | |||
| Indent Indent Indent Indent95015-4 | Shower/bathe self | |||
| Indent Indent Indent Indent95014-7 | Upper body dressing | |||
| Indent Indent Indent Indent95013-9 | Lower body dressing | |||
| Indent Indent Indent Indent95012-1 | Putting on/taking off footwear | |||
| Indent Indent Indent89478-2 | Self-Care - Discharge Goal | |||
| Indent Indent Indent Indent89404-8 | Oral hygiene - functional goal during assessment period [CMS Assessment] | |||
| Indent Indent Indent Indent89409-7 | Eating | |||
| Indent Indent Indent Indent89389-1 | Toileting hygiene | |||
| Indent Indent Indent Indent89396-6 | Shower/bathe self | |||
| Indent Indent Indent Indent89387-5 | Upper body dressing | |||
| Indent Indent Indent Indent89406-3 | Lower body dressing | |||
| Indent Indent Indent Indent89400-6 | Putting on/taking off footwear | |||
| Indent Indent Indent95741-5 | Mobility - Admission Performance | |||
| Indent Indent Indent Indent95011-3 | Roll left and right | |||
| Indent Indent Indent Indent95010-5 | Sit to lying | |||
| Indent Indent Indent Indent95009-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent95008-9 | Sit to stand | |||
| Indent Indent Indent Indent95007-1 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent95006-3 | Toilet transfer | |||
| Indent Indent Indent Indent95005-5 | Car transfer | |||
| Indent Indent Indent Indent95004-8 | Walk 10 feet | |||
| Indent Indent Indent Indent95003-0 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent95002-2 | Walk 150 feet | |||
| Indent Indent Indent Indent95001-4 | Walking 10 feet on uneven surfaces | |||
| Indent Indent Indent Indent95000-6 | 1 step (curb) | |||
| Indent Indent Indent Indent94999-0 | 4 steps | |||
| Indent Indent Indent Indent94998-2 | 12 steps | |||
| Indent Indent Indent Indent94997-4 | Picking up object | |||
| Indent Indent Indent Indent95738-1 | Does the patient use a wheelchair and/or scooter? | |||
| Indent Indent Indent Indent94992-5 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
| Indent Indent Indent Indent94991-7 | Wheel 150 feet | |||
| Indent Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
| Indent Indent Indent89476-6 | Mobility - Discharge Goal | |||
| Indent Indent Indent Indent89398-2 | Roll left and right | |||
| Indent Indent Indent Indent89394-1 | Sit to lying | |||
| Indent Indent Indent Indent85927-2 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent89392-5 | Sit to stand | |||
| Indent Indent Indent Indent89414-7 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent89390-9 | Toilet transfer | |||
| Indent Indent Indent Indent89412-1 | Car transfer | |||
| Indent Indent Indent Indent89385-9 | Walk 10 feet | |||
| Indent Indent Indent Indent89381-8 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent89383-4 | Walk 150 feet | |||
| Indent Indent Indent Indent89379-2 | Walking 10 feet on uneven surfaces | |||
| Indent Indent Indent Indent89420-4 | 1 step (curb) | |||
| Indent Indent Indent Indent89416-2 | 4 steps | |||
| Indent Indent Indent Indent89418-8 | 12 steps | |||
| Indent Indent Indent Indent89402-2 | Picking up object | |||
| Indent Indent Indent Indent89375-0 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent89377-6 | Wheel 150 feet | |||
| Indent Indent95733-2 | Bladder and Bowel | |||
| Indent Indent Indent95735-7 | Bladder Continence | |||
| Indent Indent Indent95736-5 | Bowel Continence | |||
| Indent Indent83264-2 | Active Diagnoses | |||
| Indent Indent Indent83243-6 | Comorbidities and Co-existing Conditions | 1..2 | ||
| Indent Indent93164-2 | Health Conditions | |||
| Indent Indent Indent93156-8 | Pain Effect on Sleep. Over the past 5 days, how much of the time has pain made it hard for you to sleep at night? | |||
| Indent Indent Indent93160-0 | Pain Interference with Therapy Activities. Over the past 5 days, how often have you limited your participation in rehabilitation therapy sessions due to pain? | |||
| Indent Indent Indent93158-4 | Pain Interference with Day-to-Day Activities. Over the past 5 days, how often have you limited your day-to-day activities (excluding rehabilitation therapy sessions) because of pain? | |||
| Indent Indent Indent52552-7 | History of Falls. Has the patient had two or more falls in the past year or any fall with injury in the past year? | |||
| Indent Indent Indent83274-1 | Prior Surgery. Did the patient have major surgery during the 100 days prior to admission? | |||
| Indent Indent93175-8 | Swallowing/Nutritional Status | |||
| Indent Indent Indent93178-2 | Nutritional Approaches - On Admission. Check all of the following nutritional approaches that apply on admission. | 1..4 | ||
| Indent Indent85055-2 | Skin Conditions - Admission | |||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcers/Injuries. Does this patient have one or more unhealed pressure ulcers/injuries? | |||
| Indent Indent Indent83246-9 | Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage - Admission | |||
| Indent Indent Indent Indent54884-2 | Number of Stage 1 pressure injuries | {#} | ||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers/injuries due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure injuries presenting as deep tissue injury | {#} | ||
| Indent Indent93168-3 | Medications | |||
| Indent Indent Indent93155-0 | High-Risk Drug Classes: Use and Indication | |||
| Indent Indent Indent Indent93153-5 | Is taking. Check if the patient is taking any medications by pharmacological classification, not how it is used, in the following classes | 1..6 | ||
| Indent Indent Indent Indent93154-3 | Indication noted. If column 1 [Is Taking] is checked, check if there is an indication noted for all medications in the drug class | 0..6 | ||
| Indent Indent Indent57255-2 | Drug Regimen Review: Did a complete drug regimen review identify potential clinically significant medication issues? | |||
| Indent Indent Indent57281-8 | Medication Follow-up: Did the 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? | |||
| Indent Indent93173-3 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent83252-7 | Special Treatments, Procedures, and Programs - On Admission. Check all of the following treatments, procedures, and programs that apply on admission. | |||
| Indent93172-5 | Quality Indicators - Discharge | |||
| Indent Indent93188-1 | Administrative Information | |||
| Indent Indent Indent101351-5 | Transportation. Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living? | |||
| Indent Indent Indent93182-4 | Provision of Current Reconciled Medication List to Subsequent Provider at Discharge. At the time of discharge to another provider, did your facility provide the patient's current reconciled medication list to the subsequent provider? | |||
| Indent Indent Indent93184-0 | Route of Current Reconciled Medication List Transmission to Subsequent Provider. Indicate the route(s) of transmission of the current reconciled medication list to the subsequent provider. | 1..5 | ||
| Indent Indent Indent93181-6 | Provision of Current Reconciled Medication List to Patient at Discharge. At the time of discharge, did your facility provide the patient's current reconciled medication list to the patient, family and/or caregiver? | |||
| Indent Indent Indent93183-2 | Route of Current Reconciled Medication List Transmission to Patient. Indicate the route(s) of transmission of the current reconciled medication list to the patient/family/caregiver. | 1..5 | ||
| Indent Indent93166-7 | Hearing, Speech, and Vision | |||
| Indent Indent Indent103709-2 | Health Literacy. How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy? | |||
| Indent Indent93163-4 | Cognitive Patterns | |||
| Indent Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
| Indent Indent Indent103694-6 | Brief Interview for Mental Status | |||
| Indent Indent Indent Indent103696-1 | Repetition of Three Words. Number of words repeated after first attempt | |||
| Indent Indent Indent Indent103702-7 | Temporal Orientation (orientation to year, month, and day) | |||
| Indent Indent Indent Indent Indent103697-9 | Able to report correct year | |||
| Indent Indent Indent Indent Indent103698-7 | Able to report correct month | |||
| Indent Indent Indent Indent Indent103703-5 | Able to report correct day of the week | |||
| Indent Indent Indent Indent103695-3 | Recall | |||
| Indent Indent Indent Indent Indent103699-5 | Able to recall "sock" | |||
| Indent Indent Indent Indent Indent103700-1 | Able to recall "blue" | |||
| Indent Indent Indent Indent Indent103701-9 | Able to recall "bed" | |||
| Indent Indent Indent Indent103704-3 | BIMS Summary Score | {score} | ||
| Indent Indent Indent95816-5 | Signs and Symptoms of Delirium (from CAM) | |||
| Indent Indent Indent Indent95813-2 | Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the patient's baseline? | |||
| Indent Indent Indent Indent95812-4 | Inattention - Did the patient have difficulty focusing attention, for example being easily distractible or having difficulty keeping track of what was being said? | |||
| Indent Indent Indent Indent95814-0 | Disorganized thinking - Was the patient's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)? | |||
| Indent Indent Indent Indent95815-7 | Altered level of consciousness - Did the patient have altered level of consciousness, as indicated by any of the following criteria? | |||
| Indent Indent93170-9 | Mood | |||
| Indent Indent Indent54635-8 | Patient Mood Interview (PHQ-2 to 9) | |||
| Indent Indent Indent Indent86843-0 | Symptom Presence | |||
| Indent Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent Indent86844-8 | Symptom Frequency | |||
| Indent Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
| Indent Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
| Indent Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
| Indent Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
| Indent Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
| Indent Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
| Indent Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
| Indent Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
| Indent Indent Indent103705-0 | Total Severity Score | {score} | ||
| Indent Indent Indent93159-2 | Social Isolation. How often do you feel lonely or isolated from those around you? | |||
| Indent Indent95810-8 | Functional Abilities and Goals - Discharge | |||
| Indent Indent Indent95734-0 | Self-Care - Discharge Performance | |||
| Indent Indent Indent Indent95019-6 | Eating | |||
| Indent Indent Indent Indent95018-8 | Oral hygiene | |||
| Indent Indent Indent Indent95017-0 | Toileting hygiene | |||
| Indent Indent Indent Indent95015-4 | Shower/bathe self | |||
| Indent Indent Indent Indent95014-7 | Upper body dressing | |||
| Indent Indent Indent Indent95013-9 | Lower body dressing | |||
| Indent Indent Indent Indent95012-1 | Putting on/taking off footwear | |||
| Indent Indent Indent95742-3 | Mobility - Discharge Performance | |||
| Indent Indent Indent Indent95011-3 | Roll left and right | |||
| Indent Indent Indent Indent95010-5 | Sit to lying | |||
| Indent Indent Indent Indent95009-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent95008-9 | Sit to stand | |||
| Indent Indent Indent Indent95007-1 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent95006-3 | Toilet transfer | |||
| Indent Indent Indent Indent95005-5 | Car transfer | |||
| Indent Indent Indent Indent95004-8 | Walk 10 feet | |||
| Indent Indent Indent Indent95003-0 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent95002-2 | Walk 150 feet | |||
| Indent Indent Indent Indent95001-4 | Walking 10 feet on uneven surfaces | |||
| Indent Indent Indent Indent95000-6 | 1 step (curb) | |||
| Indent Indent Indent Indent94999-0 | 4 steps | |||
| Indent Indent Indent Indent94998-2 | 12 steps | |||
| Indent Indent Indent Indent94997-4 | Picking up object | |||
| Indent Indent Indent Indent95738-1 | Does the patient use a wheelchair and/or scooter? | |||
| Indent Indent Indent Indent94992-5 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
| Indent Indent Indent Indent94991-7 | Wheel 150 feet | |||
| Indent Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
| Indent Indent93177-4 | Health Conditions | |||
| Indent Indent Indent93156-8 | Pain Effect on Sleep. Over the past 5 days, how much of the time has pain made it hard for you to sleep at night? | |||
| Indent Indent Indent93160-0 | Pain Interference with Therapy Activities. Over the past 5 days, how often have you limited your participation in rehabilitation therapy sessions due to pain? | |||
| Indent Indent Indent93158-4 | Pain Interference with Day-to-Day Activities. Over the past 5 days, how often have you limited your day-to-day activities (excluding rehabilitation therapy sessions) because of pain? | |||
| Indent Indent Indent83280-8 | Any Falls Since Admission. Has the patient had any falls since admission? | |||
| Indent Indent Indent54854-5 | Number of Falls Since Admission | |||
| Indent Indent Indent Indent54855-2 | No injury | |||
| Indent Indent Indent Indent54856-0 | Injury (except major) | |||
| Indent Indent Indent Indent54857-8 | Major injury | |||
| Indent Indent93176-6 | Swallowing/Nutritional Status | |||
| Indent Indent Indent93180-8 | Nutritional Approaches | |||
| Indent Indent Indent Indent71445-1 | Nutritional Approaches - Last 7 Days. Check all of the nutritional approaches that were received in the last 7 days. | 1..4 | ||
| Indent Indent Indent Indent93178-2 | Nutritional Approaches - At Discharge. Check all of the following nutritional approaches that apply at discharge. | 1..4 | ||
| Indent Indent88332-2 | Skin Conditions - Discharge | |||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcers/Injuries. Does this patient have one or more unhealed pressure ulcers/injuries? | |||
| Indent Indent Indent83256-8 | Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage - Discharge | |||
| Indent Indent Indent Indent54884-2 | Number of Stage 1 pressure injuries | {#} | ||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54886-7 | Number of these Stage 2 pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54887-5 | Number of these Stage 3 pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54890-9 | Number of these Stage 4 pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers/injuries due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54894-1 | Number of these unstageable pressure ulcers/injuries that were present upon admission | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54947-7 | Number of these unstageable pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure injuries presenting as deep tissue injury | {#} | ||
| Indent Indent Indent Indent54951-9 | Number of these unstageable pressure injuries that were present upon admission | {#} | ||
| Indent Indent93169-1 | Medications | |||
| Indent Indent Indent93155-0 | High-Risk Drug Classes: Use and Indication | |||
| Indent Indent Indent Indent93153-5 | Is taking. Check if the patient is taking any medications by pharmacological classification, not how it is used, in the following classes | 1..6 | ||
| Indent Indent Indent Indent93154-3 | Indication noted. If column 1 [Is Taking] is checked, check if there is an indication noted for all medications in the drug class | 0..6 | ||
| Indent Indent Indent57256-0 | 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? | |||
| Indent Indent93174-1 | Special Treatments, Procedures, and Programs | |||
| Indent Indent Indent93185-7 | Special Treatments, Procedures, and Programs - At Discharge. Check all of the following treatments, procedures, and programs that apply at discharge. |
Fully-Specified Name
- Component
- Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 4.0
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.67
- Last Updated
- Version 2.77
- Change Reason
- Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;
- Order vs. Observation
- Order
- Panel Type
- Panel
LOINC Terminology Service (API) using HL7® FHIR® Get Info
Requests to this service require a free LOINC username and password. Below is a sample of the possible capabilities. See the LOINC Terminology Service documentation for more information.
- CodeSystem lookup
- https:
//fhir.loinc.org/CodeSystem/$lookup?system=http: //loinc.org&code=93128-7 - Questionnaire definition
- https:
//fhir.loinc.org/Questionnaire/?url=http: //loinc.org/q/93128-7
LOINC Copyright
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