94848-9
Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment]
Active
95032-9 Functional Abilities and Goals
Observation ID in Form
GG
Fully-Specified Name
- Component
- FASI v1.0 - Functional Abilities and Goals
- Property
- -
- Time
- -
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95020-4 Self-Care
Observation ID in Form
GG0130
Form Coding Instructions
Code the person's usual performance during the past 3 days using the 6-point scale in Column A. If the person's performance changed during the past month, also code their most dependent performance in Column B. If the person's self-care performance was unchanged during the past month, column B should be coded the same as column A. If the activity was not attempted, code the reason. Safety and Quality of Performance - If helper assistance is required because person's performance is unsafe or of poor quality, score according to amount of assistance provided. Activities may be completed with or without assistive devices
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- FASI v1.0 - Self-care
- Property
- -
- Time
- -
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94849-7 Self-Care.Usual
Observation ID in Form
GG0130_7
Fully-Specified Name
- Component
- FASI v1.0 - Self-care - usual performance
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95019-6 Eating
Term Description
The patient's usual ability to use suitable utensils to bring food/liquid to the mouth and swallow food once the meal is presented on a table/tray. Includes modified food consistency.
Source: Regenstrief LOINC
Observation ID in Form
GG0130A7
Form Context
The ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the person
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Eating - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90480-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95018-8 Oral hygiene
Observation ID in Form
GG0130B7
Form Context
The ability to use suitable items to clean teeth. Dentures (if applicable): The ability to insert and remove dentures into and from the mouth, and manage denture soaking and rinsing with use of equipment
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Oral hygiene - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90480-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95017-0 Toileting hygiene
Observation ID in Form
GG0130CC7
Form Context
The ability to maintain perineal/menstrual hygiene adjust clothes before and after voiding or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Toileting hygiene - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90480-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95016-2 Wash upper body
Observation ID in Form
GG0130D7
Form Context
The ability to wash, rinse, and dry the face, hands, chest, and arms while sitting in a chair or bed
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wash upper body - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
95015-4 Shower/bathe self
Observation ID in Form
GG0130EE7
Form Context
The ability to bathe self including washing, rinsing, and drying self . Does not include transferring in/out of tub/shower
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Shower &or bathe self - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95014-7 Upper body dressing
Observation ID in Form
GG0130F7
Form Context
The ability to dress and undress above the waist, including fasteners, if applicable
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Upper body dressing - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95013-9 Lower body dressing
Observation ID in Form
GG0130G7
Form Context
The ability to dress and undress below the waist, including fasteners; does not include footwear
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Lower body dressing - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95012-1 Putting on/taking off footwear
Observation ID in Form
GG0130H7
Form Context
The ability to put on and take off socks and shoes or other footwear that is appropriate for safe mobility; including fasteners, if applicable
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Putting on &or taking off footwear - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
94850-5 Self-Care.Most Dependent
Observation ID in Form
GG0130_8
Fully-Specified Name
- Component
- FASI v1.0 - Self-care - most dependent performance
- Property
- -
- Time
- 1Mo
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94933-9 Eating
Observation ID in Form
GG0130A8
Form Context
The ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the person
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Eating - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94934-7 Oral hygiene
Observation ID in Form
GG0130B8
Form Context
The ability to use suitable items to clean teeth. Dentures (if applicable): The ability to insert and remove dentures into and from the mouth, and manage denture soaking and rinsing with use of equipment
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Oral hygiene - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95043-6 Toileting hygiene
Observation ID in Form
GG0130CC8
Form Context
The ability to maintain perineal/menstrual hygiene adjust clothes before and after voiding or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Toileting hygiene - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94935-4 Wash upper body
Observation ID in Form
GG0130D8
Form Context
The ability to wash, rinse, and dry the face, hands, chest, and arms while sitting in a chair or bed
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wash upper body - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94936-2 Shower/bathe self
Observation ID in Form
GG0130EE8
Form Context
The ability to bathe self including washing, rinsing, and drying self . Does not include transferring in/out of tub/shower
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Shower &or bathe self - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94937-0 Upper body dressing
Observation ID in Form
GG0130F8
Form Context
The ability to dress and undress above the waist, including fasteners, if applicable
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Upper body dressing - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94938-8 Lower body dressing
Observation ID in Form
GG0130G8
Form Context
The ability to dress and undress below the waist, including fasteners; does not include footwear
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Lower body dressing - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94939-6 Putting on/taking off footwear
Observation ID in Form
GG0130H8
Form Context
The ability to put on and take off socks and shoes or other footwear that is appropriate for safe mobility; including fasteners, if applicable
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Putting on and taking off footwear - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94876-0 Self-Care Priorities
Observation ID in Form
GG0135
Form Context
Please ask the person to describe at least one or two personal priorities in the area of self-care for the next six months. If the person does not express any personal priorities in this area, please note this below
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Self-care priorities for the next 6Mo
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Nar
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- 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
- Observation
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95023-8 Mobility
Observation ID in Form
GG0170
Form Coding Instructions
Code the person's usual performance during the past 3 days using the 6-point scale in Column A. If the person's performance changed during the past month, also code their most dependent performance in Column B. If the person's transfer/bed mobility performance was unchanged during the past month, column B should be coded the same as column A. If the activity was not attempted, code the reason. Safety and Quality of Performance - If helper assistance is required because person's performance is unsafe or of poor quality, score according to amount of assistance provided. Activities may be completed with or without assistive devices
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- FASI v1.0 - Mobility
- Property
- -
- Time
- -
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94851-3 Mobility.Usual
Observation ID in Form
GG0170_7
Fully-Specified Name
- Component
- FASI v1.0 - Mobility - usual performance
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95011-3 Roll left and right
Observation ID in Form
GG0170A7
Form Context
The ability to roll from lying on back to left and right side, and return to lying on back
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Roll left and right - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95010-5 Sit to lying
Observation ID in Form
GG0170B7
Form Context
The ability to move from sitting on side of bed to lying flat on the bed
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Sit to lying - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90480-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95009-7 Lying to sitting on side of bed
Observation ID in Form
GG0170C7
Form Context
The ability to move from lying on the back to sitting on the side of the bed with feet flat on the floor and with no back support
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Lying to sitting on side of bed - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90480-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101111-3 | MDS v3.0 - RAI v1.18.11 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101107-1 | MDS v3.0 - RAI v1.18.11 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
101109-7 | MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95008-9 Sit to stand
Observation ID in Form
GG0170D7
Form Context
The ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Sit to stand - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90480-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95007-1 Chair/bed-to-chair transfer
Observation ID in Form
GG0170E7
Form Context
The ability to transfer to and from a bed to a chair (or wheelchair)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Chair &or bed-to-chair transfer - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90480-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95006-3 Toilet transfer
Observation ID in Form
GG0170F7
Form Context
The ability to get on and off a toilet or commode
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Toilet transfer - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90480-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95005-5 Car transfer
Observation ID in Form
GG0170G7
Form Context
The ability to transfer in and out of a car or van on the passenger side. Does not include the ability to open/close door or fasten seat belt
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Car transfer - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
94932-1 Does the patient walk?
Observation ID in Form
GG0170HH7
Skip Logic
If 0, Skip to GG0175A. If 1, Skip to GG0175A. If 2, Continue to GG0170I.
Fully-Specified Name
- Component
- Does the patient walk
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.77
- Change Reason
- Release 2.78: ANSWER_LIST_TYPE: FASI V1.1; Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;
- Order vs. Observation
- Observation
Normative Answer List LL4183-1
Answer | Code | Score | Answer ID |
---|---|---|---|
No, and walking goal is not clinically indicated | 0 | LA26845-0 | |
No, and walking goal is clinically indicated | 1 | LA26846-8 | |
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) | 2 | LA33-6 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
95004-8 Walks 10 feet
Observation ID in Form
GG0170I7
Skip Logic
If usual and most dependent performance are coded 07, 11, or 90, skip to GG0170M
Form Context
Once standing, the ability to walk at least 10 feet in a room, corridor or similar space
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walk 10 feet - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Change Reason
- Release 2.69: COMPONENT: Corrected "Walks" to "Walk" to for consistency across CMS assessment forms.;
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90480-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95003-0 Walks 50 feet with two turns
Observation ID in Form
GG0170J7
Form Context
Once standing, the ability to walk at least 50 feet and make two turns
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walk 50 feet with two turns - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Change Reason
- Release 2.69: COMPONENT: Corrected "Walks" to "Walk" to for consistency across CMS assessment forms.;
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90480-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95002-2 Walks 150 feet
Observation ID in Form
GG0170K7
Form Context
Once standing, the ability to walk at least 150 feet in a corridor or similar space
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walk 150 feet - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Change Reason
- Release 2.69: COMPONENT: Corrected "Walks" to "Walk" to for consistency across CMS assessment forms.;
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90480-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95001-4 Walks 10 feet on uneven surfaces
Observation ID in Form
GG0170L7
Form Context
The ability to walk 10 feet on uneven or sloping surfaces (indoor or outdoor), such as turf or gravel
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walking 10 feet on uneven surfaces - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
95000-6 1 step (curb)
Observation ID in Form
GG0170M7
Form Context
The ability to go up and down a curb or up and down one step
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Go up and down a curb &or step - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101107-1 | MDS v3.0 - RAI v1.18.11 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
101109-7 | MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
94999-0 4 steps
Observation ID in Form
GG0170N7
Skip Logic
If usual and most dependent performance are coded 07, 11, or 90, skip to GG0170P.
Form Context
The ability to go up and down four steps with or without a rail
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Go up and down 4 steps - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
94998-2 12 steps
Observation ID in Form
GG0170O7
Form Context
The ability to go up and down 12 steps with or without a rail
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Go up and down 12 steps - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
94997-4 Picking up object
Observation ID in Form
GG0170P7
Form Context
The ability to bend/stoop from a standing position to pick up a small object, such as a spoon, from the floor
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Picking up object - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
94996-6 Walk indoors
Observation ID in Form
GG0170U7
Form Context
The ability to walk from room to room, around furniture and other obstacles
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walks indoors - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94995-8 Carries something in both hands
Observation ID in Form
GG0170V7
Form Context
The ability to carry something in both hands while walking indoors e.g. several dishes, light laundry basket, tray with food
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Carries something in both hands - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94994-1 Walks for 15 minutes
Observation ID in Form
GG0170W7
Form Context
The ability to walk for 15 minutes without stopping or resting (e.g., department store, supermarket.)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walks for 15M - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94993-3 Walks across a street
Observation ID in Form
GG0170X7
Form Context
The ability to cross street before light turns red
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walks across a street - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94852-1 Mobility.Most Dependent
Observation ID in Form
GG0170_8
Fully-Specified Name
- Component
- FASI v1.0 - Mobility - most dependent performance
- Property
- -
- Time
- 1Mo
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94940-4 Roll left and right
Observation ID in Form
GG0170A8
Form Context
The ability to roll from lying on back to left and right side, and return to lying on back
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Roll left and right - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94941-2 Sit to lying
Observation ID in Form
GG0170B8
Form Context
The ability to move from sitting on side of bed to lying flat on the bed
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Sit to lying - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94942-0 Lying to sitting on side of bed
Observation ID in Form
GG0170C8
Form Context
The ability to move from lying on the back to sitting on the side of the bed with feet flat on the floor and with no back support
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Lying to sitting on side of bed - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94943-8 Sit to stand
Observation ID in Form
GG0170D8
Form Context
The ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Sit to stand - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94944-6 Chair/bed-to-chair transfer
Observation ID in Form
GG0170E8
Form Context
The ability to transfer to and from a bed to a chair (or wheelchair)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Chair &or bed-to-chair transfer - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Change Reason
- Release 2.69: COMPONENT: Updated for consistency across terms and to clarify that assessment is for transfer from a chair and/or bed to a chair.;
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94945-3 Toilet transfer
Observation ID in Form
GG0170F8
Form Context
The ability to get on and off a toilet or commode
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Toilet transfer - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94946-1 Car transfer
Observation ID in Form
GG0170G8
Form Context
The ability to transfer in and out of a car or van on the passenger side. Does not include the ability to open/close door or fasten seat belt
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Car transfer - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94947-9 Walks 10 feet
Observation ID in Form
GG0170I8
Form Context
Once standing, the ability to walk at least 10 feet in a room, corridor or similar space
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walk 10 feet - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94948-7 Walks 50 feet with two turns
Observation ID in Form
GG0170J8
Form Context
Once standing, the ability to walk at least 50 feet and make two turns
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walk 50 feet with two turns - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94949-5 Walks 150 feet
Observation ID in Form
GG0170K8
Form Context
Once standing, the ability to walk at least 150 feet in a corridor or similar space
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walk 150 feet - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94950-3 Walks 10 feet on uneven surfaces
Observation ID in Form
GG0170L8
Form Context
The ability to walk 10 feet on uneven or sloping surfaces (indoor or outdoor), such as turf or gravel
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walking 10 feet on uneven surfaces - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94951-1 1 step (curb)
Observation ID in Form
GG0170M8
Form Context
The ability to go up and down a curb or up and down one step
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Go up and down a curb &or step - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94952-9 4 steps
Observation ID in Form
GG0170N8
Skip Logic
If usual and most dependent performance are coded 07, 11, or 90, skip to GG0170P.
Form Context
The ability to go up and down four steps with or without a rail
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Go up and down 4 steps - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94953-7 12 steps
Observation ID in Form
GG0170O8
Form Context
The ability to go up and down 12 steps with or without a rail
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Go up and down 12 steps - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94954-5 Picking up object
Observation ID in Form
GG0170P8
Form Context
The ability to bend/stoop from a standing position to pick up a small object, such as a spoon, from the floor
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Picking up object - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94955-2 Walks indoors
Observation ID in Form
GG0170U8
Form Context
The ability to walk from room to room, around furniture and other obstacles
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walks indoors - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94956-0 Carries something in both hands
Observation ID in Form
GG0170V8
Form Context
The ability to carry something in both hands while walking indoors e.g. several dishes, light laundry basket, tray with food
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Carries something in both hands - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94957-8 Walks for 15 minutes
Observation ID in Form
GG0170W8
Form Context
The ability to walk for 15 minutes without stopping or resting (e.g., department store, supermarket.)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walks for 15M - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94958-6 Walks across a street
Observation ID in Form
GG0170X8
Form Context
The ability to cross street before light turns red
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Walks across a street - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95131-9 Mobility (Wheelchair)
Observation ID in Form
GG0175
Fully-Specified Name
- Component
- FASI v1.0 - Mobility (Wheelchair)
- Property
- -
- Time
- -
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95021-2 Does the person use a manual wheelchair?
Observation ID in Form
GG0175A
Skip Logic
If 0, Skip to GG0175F. If 1, Continue to GG0175B.
Fully-Specified Name
- Component
- Manual wheelchair use
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- 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
- Observation
Normative Answer List LL251-0
Answer | Code | Score | Answer ID |
---|---|---|---|
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) | 0 | LA32-8 | |
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) | 1 | LA33-6 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
95024-6 Manual wheelchair.Usual
Observation ID in Form
GG0175_7
Form Coding Instructions
Code the person's usual performance during the past 3 days using the 6-point scale in Column A. If the person's performance changed during the past month, also code their most dependent performance in Column B. If the person's wheelchair mobility performance was unchanged during the past month, column B should be coded the same as column A. If the activity was not attempted, code the reason. Safety and Quality of Performance - If helper assistance is required because person's performance is unsafe or of poor quality, score according to amount of assistance provided. Activities may be completed with or without assistive devices
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- FASI v1.0 - Manual wheelchair - usual performance
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94992-5 Wheel 50 feet with two turns
Observation ID in Form
GG0175B7
Skip Logic
If usual and most dependent performance are coded 07, 11, or 90, skip to GG0175E
Form Context
Once seated in wheelchair/scooter, the ability to wheel at least 50 feet and make two turns
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheel 50 feet with two turns - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101107-1 | MDS v3.0 - RAI v1.18.11 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
101109-7 | MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
103564-1 | MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
104606-9 | MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
105201-8 | MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
104552-5 | MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
104554-1 | MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
104607-7 | MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment] |
104609-3 | MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
94991-7 Wheels 150 feet
Observation ID in Form
GG0175C7
Form Context
Once seated in wheelchair/scooter, the ability to wheel at least 150 feet in a corridor or similar space
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheel 150 feet - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101107-1 | MDS v3.0 - RAI v1.18.11 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
101109-7 | MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
103564-1 | MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
104606-9 | MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
105201-8 | MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
104552-5 | MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
104554-1 | MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
104607-7 | MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment] |
104609-3 | MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
94990-9 Wheels for 15 minutes
Observation ID in Form
GG0175D7
Form Context
Once seated in wheelchair/scooter, the ability to wheel without stopping or resting (e.g., through a department store, supermarket)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheels for 15 minutes - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94989-1 Wheels across a street
Observation ID in Form
GG0175E7
Form Context
Once seated in wheelchair/scooter, the ability to wheel across a street before light turns red
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheels across a street - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95025-3 Manual Wheelchair.Most Dependent
Observation ID in Form
GG0175_8
Fully-Specified Name
- Component
- FASI v1.0 - Manual wheelchair - most dependent performance
- Property
- -
- Time
- 1Mo
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94959-4 Wheel 50 feet with two turns
Observation ID in Form
GG0175B8
Skip Logic
If usual and most dependent performance are coded 07, 11, or 90, skip to GG0175E
Form Context
Once seated in wheelchair/scooter, the ability to wheel at least 50 feet and make two turns
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheel 50 feet with two turns - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94960-2 Wheels 150 feet
Observation ID in Form
GG0175C8
Form Context
Once seated in wheelchair/scooter, the ability to wheel at least 150 feet in a corridor or similar space
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheel 150 feet - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94961-0 Wheels for 15M
Observation ID in Form
GG0175D8
Form Context
Once seated in wheelchair/scooter, the ability to wheel without stopping or resting (e.g., through a department store, supermarket)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheels for 15M - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94962-8 Wheels across a street
Observation ID in Form
GG0175E8
Form Context
Once seated in wheelchair/scooter, the ability to wheel across a street before light turns red
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheels across a street - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95022-0 Does the person use a motorized wheelchair and/or scooter?
Observation ID in Form
GG0175F
Skip Logic
If 0, Skip to GG0185. If 1, Continue to GG0175G.
Fully-Specified Name
- Component
- Motorized wheelchair &or scooter use
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- 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
- Observation
Normative Answer List LL251-0
Answer | Code | Score | Answer ID |
---|---|---|---|
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) | 0 | LA32-8 | |
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) | 1 | LA33-6 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
95027-9 Motorized Wheelchair/Scooter.Usual
Observation ID in Form
GG0175_7
Form Coding Instructions
Code the person's usual performance during the past 3 days using the 6-point scale in Column A. If the person's performance changed during the past month, also code their most dependent performance in Column B. If the person's wheelchair mobility performance was unchanged during the past month, column B should be coded the same as column A. If the activity was not attempted, code the reason. Safety and Quality of Performance - If helper assistance is required because person's performance is unsafe or of poor quality, score according to amount of assistance provided. Activities may be completed with or without assistive devices
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- FASI v1.0 - Motorized wheelchair &or scooter - usual performance
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94992-5 Wheel 50 feet with two turns
Observation ID in Form
GG0175G7
Skip Logic
If usual and most dependent performance are coded 07, 11,or 90, skip to GG0175J.
Form Context
Once seated in wheelchair/scooter, the ability to wheel at least 50 feet and make two turns
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheel 50 feet with two turns - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101107-1 | MDS v3.0 - RAI v1.18.11 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
101109-7 | MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
103564-1 | MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
104606-9 | MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
105201-8 | MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
104552-5 | MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
104554-1 | MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
104607-7 | MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment] |
104609-3 | MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88369-4 | Outcome and assessment information set (OASIS) form - version D - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
93058-6 | Outcome and assessment information set (OASIS) form - version D1 - Follow-up - recertification or other follow-up during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99153-9 | Outcome and assessment information set (OASIS) form - version E - Follow Up during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
94991-7 Wheels 150 feet
Observation ID in Form
GG0175H7
Form Context
Once seated in wheelchair/scooter, the ability to wheel at least 150 feet in a corridor or similar space
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheel 150 feet - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
103991-6 | CMS - Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.2 during assessment period [CMS Assessment] |
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
89963-3 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 during assessment period [CMS Assessment] |
93128-7 | Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 4.0 during assessment period [CMS Assessment] |
87509-6 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 during assessment period [CMS Assessment] |
93222-8 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.00 during assessment period [CMS Assessment] |
103949-4 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 5.1 during assessment period [CMS Assessment] |
87507-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 4.00 during assessment period [CMS Assessment] |
93221-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.00 during assessment period [CMS Assessment] |
103946-0 | Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 5.1 during assessment period [CMS Assessment] |
90473-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
90477-1 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
90478-9 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
90474-8 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
90475-5 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
91552-0 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
90476-3 | MDS v3.0 - RAI v1.17.1, 1.17.2 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
101105-5 | MDS v3.0 - RAI v1.18.11 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
101107-1 | MDS v3.0 - RAI v1.18.11 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
101109-7 | MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
101110-5 | MDS v3.0 - RAI v1.18.11 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
101106-3 | MDS v3.0 - RAI v1.18.11 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
101113-9 | MDS v3.0 - RAI v1.18.11 - Swing bed discharge (SD) item set during assessment period [CMS Assessment] |
101112-1 | MDS v3.0 - RAI v1.18.11 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
103564-1 | MDS v3.0 - RAI v1.19.1 - Nursing home comprehensive (NC) item set during assessment period [CMS Assessment] |
104606-9 | MDS v3.0 - RAI v1.19.1 - Nursing home discharge (ND) item set during assessment period [CMS Assessment] |
105201-8 | MDS v3.0 - RAI v1.19.1 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] |
104552-5 | MDS v3.0 - RAI v1.19.1 - Nursing home PPS (NP) item set during assessment period [CMS Assessment] |
104554-1 | MDS v3.0 - RAI v1.19.1 - Nursing home quarterly (NQ) item set during assessment period [CMS Assessment] |
104607-7 | MDS v3.0 - RAI v1.19.1 - Swing Bed discharge (SD) item set during assessment period [CMS Assessment] |
104609-3 | MDS v3.0 - RAI v1.19.1 - Swing bed PPS (SP) item set during assessment period [CMS Assessment] |
88371-0 | Outcome and assessment information set (OASIS) form - version D, D1 - Discharged from agency during assessment period [CMS Assessment] |
88368-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Resumption of care during assessment period [CMS Assessment] |
88373-6 | Outcome and assessment information set (OASIS) form - version D, D1 - Start of care during assessment period [CMS Assessment] |
99178-6 | Outcome and assessment information set (OASIS) form - version E - Discharge from Agency during assessment period [CMS Assessment] |
99160-4 | Outcome and assessment information set (OASIS) form - version E - Resumption of Care during assessment period [CMS Assessment] |
99131-5 | Outcome and assessment information set (OASIS) form - version E - Start of Care during assessment period [CMS Assessment] |
94990-9 Wheels for 15 minutes
Observation ID in Form
GG0175I7
Form Context
Once seated in wheelchair/scooter, the ability to wheel without stopping or resting (e.g., through a department store, supermarket)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheels for 15 minutes - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94989-1 Wheels across a street
Observation ID in Form
GG0175J7
Form Context
Once seated in wheelchair/scooter, the ability to wheel across a street before light turns red
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheels across a street - usual functional ability
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95026-1 Motorized Wheelchair/Scooter.Most Dependent
Observation ID in Form
GG0175_8
Fully-Specified Name
- Component
- FASI v1.0 - Motorized wheelchair &or scooter - most dependent performance
- Property
- -
- Time
- 1Mo
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94959-4 Wheel 50 feet with two turns
Observation ID in Form
GG0175G8
Skip Logic
If usual and most dependent performance are coded 07, 11,or 90, skip to GG0175J.
Form Context
Once seated in wheelchair/scooter, the ability to wheel at least 50 feet and make two turns
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheel 50 feet with two turns - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94960-2 Wheels 150 feet
Observation ID in Form
GG0175H8
Form Context
Once seated in wheelchair/scooter, the ability to wheel at least 150 feet in a corridor or similar space
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheel 150 feet - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94961-0 Wheels for 15M
Observation ID in Form
GG0175I8
Form Context
Once seated in wheelchair/scooter, the ability to wheel without stopping or resting (e.g., through a department store, supermarket)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheels for 15M - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity. | 01 | LA30914-8 | |
Person refused. | 07 | LA30915-5 | |
Not applicable - Person does not usually do this activity. | 11 | LA30916-3 | |
Not attempted due to short-term medical condition or safety concerns. | 90 | LA30917-1 |
Member of these Panels
LOINC | Long Common Name |
---|---|
105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94962-8 Wheels across a street
Observation ID in Form
GG0175J8
Form Context
Once seated in wheelchair/scooter, the ability to wheel across a street before light turns red
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Wheels across a street - most dependent performance during the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5571-6
Answer | Code | Score | Answer ID |
---|---|---|---|
Independent - Person completes the activity by themself with no assistance from a helper. | 06 | LA30909-8 | |
Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity. | 05 | LA30910-6 | |
Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently. | 04 | LA30911-4 | |
Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort. | 03 | LA10055-4 | |
Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | 02 | LA11759-0 | |
Dependent - Helper does all of the effort. Person does none of the effort |