106636-4 CPR Preference

Observation ID in Form

F2000

Type of Entry

Header section - not a question [H]

Fully-Specified Name

Component
CPR Preference
Property
-
Time
RptPeriod
System
^Patient
Scale
-
Method
CMS Assessment

Long Common Name

CPR Preference during assessment period [CMS Assessment]

Basic Attributes

Class
PANEL.SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.81 (PANEL)
Order vs. Observation
Subset
Panel Type
Organizer

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

106637-2 Was the patient/responsible party asked about preference regarding the use of cardiopulmonary resuscitation (CPR)?

Observation ID in Form

F2000A

Skip Logic

If 0, Skip to F2100, Other Life-Sustaining Treatment Preferences

Fully-Specified Name

Component
Was the patient or responsible party asked about preference regarding the use of cardiopulmonary resuscitation
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Long Common Name

Was the patient or responsible party asked about preference regarding the use of cardiopulmonary resuscitation during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.80 (ADD)
Order vs. Observation
Observation

Normative Answer List LL6956-8

AnswerCodeScoreAnswer ID
Yes, and discussion occurred1LA34599-3
Yes, but the patient/responsible party refused to discuss2LA34600-9
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)0LA32-8

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

106635-6 Date the patient/responsible party was first asked about preference regarding the use of CPR:

Observation ID in Form

F2000B

Fully-Specified Name

Component
Date the patient or responsible party was first asked about preference regarding the use of CPR
Property
Date
Time
RptPeriod
System
^Patient
Scale
Qn
Method
CMS Assessment

Long Common Name

Date the patient or responsible party was first asked about preference regarding the use of CPR during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.80 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

Example Units

UnitSource
{mm/dd/yyyy}Example UCUM Units

106638-0 Other Life-Sustaining Treatment Preferences

Observation ID in Form

F2100

Type of Entry

Header section - not a question [H]

Fully-Specified Name

Component
Other Life-Sustaining Treatment Preferences
Property
-
Time
RptPeriod
System
^Patient
Scale
-
Method
CMS Assessment

Long Common Name

Other Life-Sustaining Treatment Preferences during assessment period [CMS Assessment]

Basic Attributes

Class
PANEL.SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.81 (PANEL)
Order vs. Observation
Subset
Panel Type
Organizer

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

106639-8 Was the patient/responsible party asked about preferences regarding life-sustaining treatments other than CPR?

Observation ID in Form

F2100A

Skip Logic

If 0, Skip to F2200, Hospitalization Preference

Fully-Specified Name

Component
Was the patient or responsible party asked about preferences regarding life-sustaining treatments other than CPR
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Long Common Name

Was the patient or responsible party asked about preferences regarding life-sustaining treatments other than CPR during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.80 (ADD)
Order vs. Observation
Observation

Normative Answer List LL6956-8

AnswerCodeScoreAnswer ID
Yes, and discussion occurred1LA34599-3
Yes, but the patient/responsible party refused to discuss2LA34600-9
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)0LA32-8

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

106640-6 Date the patient/responsible party was first asked about preferences regarding life-sustaining treatments other than CPR:

Observation ID in Form

F2100B

Fully-Specified Name

Component
Date the patient or responsible party was first asked about preferences regarding life-sustaining treatments other than CPR
Property
Date
Time
RptPeriod
System
^Patient
Scale
Qn
Method
CMS Assessment

Long Common Name

Date the patient or responsible party was first asked about preferences regarding life-sustaining treatments other than CPR during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.80 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

Example Units

UnitSource
{mm/dd/yyyy}Example UCUM Units

106641-4 Hospitalization Preference

Observation ID in Form

F2200

Type of Entry

Header section - not a question [H]

Fully-Specified Name

Component
Hospitalization Preference
Property
-
Time
RptPeriod
System
^Patient
Scale
-
Method
CMS Assessment

Long Common Name

Hospitalization Preference during assessment period [CMS Assessment]

Basic Attributes

Class
PANEL.SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.81 (PANEL)
Order vs. Observation
Subset
Panel Type
Organizer

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

106646-3 Was the patient/responsible party asked about preference regarding hospitalization?

Observation ID in Form

F2200A

Skip Logic

If 0, Skip to F3000, Spiritual/Existential Concerns

Fully-Specified Name

Component
Was the patient or responsible party asked about preference regarding hospitalization
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Long Common Name

Was the patient or responsible party asked about preference regarding hospitalization during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.80 (ADD)
Order vs. Observation
Observation

Normative Answer List LL6956-8

AnswerCodeScoreAnswer ID
Yes, and discussion occurred1LA34599-3
Yes, but the patient/responsible party refused to discuss2LA34600-9
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)0LA32-8

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

106645-5 Date the patient/responsible party was first asked about preference regarding hospitalization:

Observation ID in Form

F2200B

Fully-Specified Name

Component
Date the patient or responsible party was first asked about preference regarding hospitalization
Property
Date
Time
RptPeriod
System
^Patient
Scale
Qn
Method
CMS Assessment

Long Common Name

Date the patient or responsible party was first asked about preference regarding hospitalization during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.80 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

Example Units

UnitSource
{mm/dd/yyyy}Example UCUM Units

106644-8 Spiritual/Existential Concerns

Observation ID in Form

F3000

Type of Entry

Header section - not a question [H]

Fully-Specified Name

Component
Spiritual or Existential Concerns
Property
-
Time
RptPeriod
System
^Patient
Scale
-
Method
CMS Assessment

Long Common Name

Spiritual or Existential Concerns during assessment period [CMS Assessment]

Basic Attributes

Class
PANEL.SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.81 (PANEL)
Order vs. Observation
Subset
Panel Type
Organizer

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

106643-0 Was the patient and/or caregiver asked about spiritual/existential concerns?

Observation ID in Form

F3000A

Skip Logic

If 0, Skip to I0100, Principal Diagnosis

Fully-Specified Name

Component
Was the patient and or caregiver asked about spiritual or existential concerns
Property
Find
Time
RptPeriod
System
^Patient
Scale
Ord
Method
CMS Assessment

Long Common Name

Was the patient and or caregiver asked about spiritual or existential concerns during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.80 (ADD)
Order vs. Observation
Observation

Normative Answer List LL6956-8

AnswerCodeScoreAnswer ID
Yes, and discussion occurred1LA34599-3
Yes, but the patient/responsible party refused to discuss2LA34600-9
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)0LA32-8

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

106642-2 Date the patient and/or caregiver was first asked about spiritual/existential concerns:

Observation ID in Form

F3000B

Fully-Specified Name

Component
Date the patient and or caregiver was first asked about spiritual or existential concerns
Property
Date
Time
RptPeriod
System
^Patient
Scale
Qn
Method
CMS Assessment

Long Common Name

Date the patient and or caregiver was first asked about spiritual or existential concerns during assessment period [CMS Assessment]

Basic Attributes

Class
SURVEY.CMS
Type
Surveys
First Released
Version 2.80
Last Updated
Version 2.80 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
106623-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment]
107632-2Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.01 during assessment period [CMS Assessment]

Example Units

UnitSource
{mm/dd/yyyy}Example UCUM Units