Version 2.79

95036-0 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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment]

94927-1 Supervision

Observation ID in Form

F0920G1

Form Context

(for example, due to safety concerns)

Source: Centers for Medicare & Medicaid Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment]

94928-9 Supervision

Observation ID in Form

F0920G2

Form Context

(for example, due to safety concerns)

Source: Centers for Medicare & Medicaid Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [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 Services

Fully-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]
94848-9 Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment]