95035-2
Availability of Paid and Unpaid Assistance
Active
Form Coding Instructions
Code the Paid and Unpaid caregiver's usual ability and willingness to provide assistance with each activity during the past 3 days. If the activity was not attempted, code as Not applicable (11). Please complete the Caregiving Priorities section F0925 at the bottom of this page. Code safety and quality of BOTH Paid and Unpaid caregiver assistance and their willingness to provide assistance with each of the following activities
Source: Centers for Medicare & Medicaid Services95036-0 Availability of Paid Assistance
Observation ID in Form
F0920_1
Fully-Specified Name
- Component
- FASI v1.0 - Availability of Paid Assistance
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Long Common Name
FASI v1.0 - Availability of Paid Assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78 (PANEL)
- 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
- 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] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94915-6 Self-care assistance
Observation ID in Form
F0920A1
Form Context
(for example, bathing, dressing, toileting, or eating/feeding)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide self-care assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Paid caregiver's ability and willingness to provide self-care assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94917-2 Mobility assistance
Observation ID in Form
F0920B1
Form Context
(for example, bed mobility, transfers, ambulating, or wheeling)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide mobility assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Paid caregiver's ability and willingness to provide mobility assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94919-8 IADL assistance
Observation ID in Form
F0920C1
Form Context
(for example, making meals, housekeeping, telephone, shopping, or finances)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide instrumental activities of daily living assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Paid caregiver's ability and willingness to provide instrumental activities of daily living assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94921-4 Medication administration
Observation ID in Form
F0920D1
Form Context
(for example, oral, inhaled, or injectable medications)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide medication administration assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Paid caregiver's ability and willingness to provide medication administration assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94923-0 Medical procedures/treatments
Observation ID in Form
F0920E1
Form Context
(for example, changing wound dressing, or home exercise program)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide medical procedure &or treatment assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Paid caregiver's ability and willingness to provide medical procedure/treatment assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94925-5 Management of equipment
Observation ID in Form
F0920F1
Form Context
(for example, oxygen, IV/infusion equipment, enteral/parenteral nutrition, or ventilator therapy equipment and supplies)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide management of equipment assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Paid caregiver's ability and willingness to provide management of equipment assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94927-1 Supervision
Observation ID in Form
F0920G1
Form Context
(for example, due to safety concerns)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide supervision
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Paid caregiver's ability and willingness to provide supervision during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94929-7 Advocacy or facilitation of person's participation in appropriate medical care
Observation ID in Form
F0920H1
Form Context
(for example, transportation to or from appointments)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide advocacy or facilitation of person's participation
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Paid caregiver's ability and willingness to provide advocacy or facilitation of person's participation during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
95037-8 Availability of Unpaid Assistance
Observation ID in Form
F0920_2
Fully-Specified Name
- Component
- FASI v1.0 - Availability of Unpaid Assistance
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Long Common Name
FASI v1.0 - Availability of Unpaid Assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78 (PANEL)
- 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
- 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] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94916-4 Self-care assistance
Observation ID in Form
F0920A2
Form Context
(for example, bathing, dressing, toileting, or eating/feeding)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide self-care assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Unpaid caregiver's ability and willingness to provide self-care assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94918-0 Mobility assistance
Observation ID in Form
F0920B2
Form Context
(for example, bed mobility, transfers, ambulating, or wheeling)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide mobility assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Unpaid caregiver's ability and willingness to provide mobility assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94920-6 IADL assistance
Observation ID in Form
F0920C2
Form Context
(for example, making meals, housekeeping, telephone, shopping, or finances)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide instrumental activities of daily living assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Unpaid caregiver's ability and willingness to provide instrumental activities of daily living assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94922-2 Medication administration
Observation ID in Form
F0920D2
Form Context
(for example, oral, inhaled, or injectable medications)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide medication administration assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Unpaid caregiver's ability and willingness to provide medication administration assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94924-8 Medical procedures/treatments
Observation ID in Form
F0920E2
Form Context
(for example, changing wound dressing, or home exercise program)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide medical procedure &or treatment assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Unpaid caregiver's ability and willingness to provide medical procedure/treatment assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94926-3 Management of equipment
Observation ID in Form
F0920F2
Form Context
(for example, oxygen, IV/infusion equipment, enteral/parenteral nutrition, or ventilator therapy equipment and supplies)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide management of equipment assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Unpaid caregiver's ability and willingness to provide management of equipment assistance during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94928-9 Supervision
Observation ID in Form
F0920G2
Form Context
(for example, due to safety concerns)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide supervision
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Unpaid caregiver's ability and willingness to provide supervision during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |
94930-5 Advocacy or facilitation of person's participation in appropriate medical care
Observation ID in Form
F0920H2
Form Context
(for example, transportation to or from appointments)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide advocacy or facilitation of person's participation
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
Unpaid caregiver's ability and willingness to provide advocacy or facilitation of person's participation during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69 (MIN)
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 106517-6 | Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment] |