94916-4 Self-care assistance (for example, bathing, dressing, toileting, or eating/feeding).

Observation ID in Form

F0920A2

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

AnswerCodeScoreAnswer ID
Assistance not needed - No assistance needed.05LA30938-7
Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance.04LA30939-5
Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support.03LA30940-3
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.02LA30941-1
Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home.01LA30942-9
Assistance needed but person declines assistance - Person needs caregiving but declines this assistance.00LA30943-7
Not applicable - Person does not do this activity.11LA30944-5

Member of these Panels

LOINCLong Common Name
105175-4Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]

94918-0 Mobility assistance (for example, bed mobility, transfers, ambulating, or wheeling).

Observation ID in Form

F0920B2

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

AnswerCodeScoreAnswer ID
Assistance not needed - No assistance needed.05LA30938-7
Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance.04LA30939-5
Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support.03LA30940-3
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.02LA30941-1
Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home.01LA30942-9
Assistance needed but person declines assistance - Person needs caregiving but declines this assistance.00LA30943-7
Not applicable - Person does not do this activity.11LA30944-5

Member of these Panels

LOINCLong Common Name
105175-4Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]

94920-6 IADL assistance (for example, making meals, housekeeping, telephone, shopping, or finances).

Observation ID in Form

F0920C2

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

AnswerCodeScoreAnswer ID
Assistance not needed - No assistance needed.05LA30938-7
Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance.04LA30939-5
Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support.03LA30940-3
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.02LA30941-1
Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home.01LA30942-9
Assistance needed but person declines assistance - Person needs caregiving but declines this assistance.00LA30943-7
Not applicable - Person does not do this activity.11LA30944-5

Member of these Panels

LOINCLong Common Name
105175-4Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]

94922-2 Medication administration (for example, oral, inhaled, or injectable medications).

Observation ID in Form

F0920D2

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

AnswerCodeScoreAnswer ID
Assistance not needed - No assistance needed.05LA30938-7
Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance.04LA30939-5
Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support.03LA30940-3
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.02LA30941-1
Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home.01LA30942-9
Assistance needed but person declines assistance - Person needs caregiving but declines this assistance.00LA30943-7
Not applicable - Person does not do this activity.11LA30944-5

Member of these Panels

LOINCLong Common Name
105175-4Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]

94924-8 Medical procedures/treatments (for example, changing wound dressing, or home exercise program).

Observation ID in Form

F0920E2

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

AnswerCodeScoreAnswer ID
Assistance not needed - No assistance needed.05LA30938-7
Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance.04LA30939-5
Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support.03LA30940-3
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.02LA30941-1
Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home.01LA30942-9
Assistance needed but person declines assistance - Person needs caregiving but declines this assistance.00LA30943-7
Not applicable - Person does not do this activity.11LA30944-5

Member of these Panels

LOINCLong Common Name
105175-4Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]

94926-3 Management of equipment (for example, oxygen, IV/infusion equipment, enteral/parenteral nutrition, or ventilator therapy equipment and supplies).

Observation ID in Form

F0920F2

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

AnswerCodeScoreAnswer ID
Assistance not needed - No assistance needed.05LA30938-7
Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance.04LA30939-5
Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support.03LA30940-3
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.02LA30941-1
Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home.01LA30942-9
Assistance needed but person declines assistance - Person needs caregiving but declines this assistance.00LA30943-7
Not applicable - Person does not do this activity.11LA30944-5

Member of these Panels

LOINCLong Common Name
105175-4Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]

94928-9 Supervision (for example, due to safety concerns).

Observation ID in Form

F0920G2

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

AnswerCodeScoreAnswer ID
Assistance not needed - No assistance needed.05LA30938-7
Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance.04LA30939-5
Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support.03LA30940-3
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.02LA30941-1
Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home.01LA30942-9
Assistance needed but person declines assistance - Person needs caregiving but declines this assistance.00LA30943-7
Not applicable - Person does not do this activity.11LA30944-5

Member of these Panels

LOINCLong Common Name
105175-4Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9Functional 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 (for example, transportation to or from appointments).

Observation ID in Form

F0920H2

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

AnswerCodeScoreAnswer ID
Assistance not needed - No assistance needed.05LA30938-7
Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance.04LA30939-5
Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support.03LA30940-3
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.02LA30941-1
Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home.01LA30942-9
Assistance needed but person declines assistance - Person needs caregiving but declines this assistance.00LA30943-7
Not applicable - Person does not do this activity.11LA30944-5

Member of these Panels

LOINCLong Common Name
105175-4Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment]
106517-6Functional assessment standardized items (FASI) - v1.2 during assessment period [CMS Assessment]
94848-9Functional assessment standardized items (FASI) - version 1.0 during assessment period [CMS Assessment]