Version 2.78

94976-8 Makes a light cold meal

Observation ID in Form

GG0185A7

Form Context

The ability to plan and prepare all aspects of a light cold meal such as a bowl of cereal and sandwich and cold drink

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Makes a light cold meal - 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]

94977-6 Makes a light hot meal

Observation ID in Form

GG0185B7

Form Context

The ability to plan and prepare all aspects of a light hot meal such as heating a bowl of soup and reheating a prepared meal

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Makes a light hot meal - 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]

94978-4 Light daily housework

Observation ID in Form

GG0185C7

Form Context

The ability to complete light daily housework to maintain a safe home environment such that the person is not at risk for harm within their home. Examples include wiping counter tops or doing dishes

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Light daily housework - 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]

94979-2 Heavier periodic housework

Observation ID in Form

GG0185D7

Form Context

The ability to complete heavier periodic housework to maintain a safe home environment such that person is not at risk for harm within their home. Examples include doing laundry, vacuuming, cleaning bathroom

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Heavier periodic housework - 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]

94980-0 Light shopping

Observation ID in Form

GG0185E7

Form Coding Instructions

Once at store, can locate and select up to five needed goods, take to check out, and complete purchasing transaction

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Light shopping - 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]

94981-8 Telephone-answering call

Observation ID in Form

GG0185F7

Form Context

The ability to answer call in person's customary manner and maintain for 1 minute or longer. Does not include getting to the phone

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Answering telephone call - 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]

94982-6 Telephone-placing call

Observation ID in Form

GG0185G7

Form Context

The ability to place call in person's customary manner and maintain for 1 minute or longer. Does not include getting to the phone

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Placing telephone call - 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]

94983-4 Medication management-oral medications

Observation ID in Form

GG0185H7

Form Context

The ability to prepare and take all prescribed oral medications reliably and safely, including administration of the correct dosage at the appropriate times/intervals

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Medication management.oral medications - 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]

94984-2 Medication management-inhalant/mist medications

Observation ID in Form

GG0185I7

Form Context

The ability to prepare and take all prescribed inhalant/mist medications reliably and safely, including administration of the correct dosage at the appropriate times/intervals

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Medication management.inhalant &or mist medications - 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]

94985-9 Medication management-injectable medications

Observation ID in Form

GG0185J7

Form Context

The ability to prepare and take all prescribed injectable medications reliably and safely, including administration of the correct dosage at the appropriate times/intervals

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Medication management.injectable medications - 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]

94986-7 Simple financial management

Observation ID in Form

GG0185K7

Form Context

The ability to complete financial transactions such as counting coins, verifying change for a single item transaction, writing a check, online/mobile bill pay, banking, or shopping

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Simple financial management - 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]

94987-5 Complex financial management

Observation ID in Form

GG0185L7

Form Context

The ability to complete financial decision-making such as budget and remembering to pay bills

Source: Centers for Medicare & Medicaid Services

Fully-Specified Name

Component
Complex financial management - 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]