Version 2.78

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 Services

Fully-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 Services

Fully-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 Services

Fully-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 Services

Fully-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 Services

Fully-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 Services

Fully-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 Services

Fully-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 Services

Fully-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]