PACIO Sample Data Depot
0.1.0 - draft
PACIO Sample Data Depot, published by MITRE. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/paciowg/sample-data-fsh/ and changes regularly. See the Directory of published versions
| Official URL: http://loinc.org/q/90473-0 | Version: 0.1.0 | |||
| Draft as of 2026-03-26 | Computable Name: MDS_v3_RAI_v1_Nursing_home_comprehensive_NC_item_set | |||
Copyright/Legal: This material contains content from LOINC (http://loinc.org). LOINC is copyright © Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. All rights reserved. LOINC is available at no cost under the license at http://loinc.org/license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc. Copyright © 2003 Sharon K. Inouye, M.D., MPH. Adapted from: Inouye SK, vanDyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: The Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med. 1990; 113: 941-948. Confusion Assessment Method: Training Manual and Coding Guide. Used with permission. Copyright © Pfizer Inc. All rights reserved. Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute. |
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version: 14; Last updated: 2025-02-26 20:49:17+0000;
Information Source: #e6hBXlNCA3ym4tDd
| LinkID | Text | Cardinality | Type | Description & Constraints![]() |
|---|---|---|---|---|
![]() | Questionnaire | http://loinc.org/q/90473-0#0.1.0 | ||
![]() ![]() | A. Identification Information | 1..1 | group | Value Set: |
![]() ![]() ![]() | A0050. Type of Record | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | A0100. Facility Provider Numbers | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | A0100A. National Provider Identifier (NPI) | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | A0100B. CMS Certification Number (CCN) | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | A0100C. State Provider Number | 0..1 | string | Value Set: |
![]() ![]() ![]() | A0200. Type of Provider | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | A0300. Optional State Assessment | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | A0300A. Is this assessment for state payment purposes only? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | A0310. Type of Assessment | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | A0310A. Federal OBRA Reason for Assessment | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() ![]() | A0310B. PPS Assessment | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | A0310E. Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | A0310F. Entry/discharge reporting | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | A0310G. Type of discharge | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | A0310G1. Is this a SNF Part A Interrupted Stay? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | A0310H. Is this a SNF Part A PPS Discharge Assessment? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | A0410. Unit Certification or Licensure Designation | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | A0500. Legal Name of Resident | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | A0500A. First name | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | A0500B. Middle initial | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | A0500C. Last name | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | A0500D. Suffix | 0..1 | string | Value Set: |
![]() ![]() ![]() | A0600. Social Security and Medicare Numbers | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | A0600A. Social Security Number | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | A0600B. Medicare number | 0..1 | string | Value Set: |
![]() ![]() ![]() | A0700. Medicaid Number | 0..1 | string | Value Set: |
![]() ![]() ![]() | A0800. Gender | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | A0900. Birth Date | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | A1000. Race/Ethnicity | 0..* | choice | Value Set: Options: 6 options |
![]() ![]() ![]() | A1100. Language | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | A1100A. Does the resident need or want an interpreter to communicate with a doctor or health care staff? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | A1100B. Preferred language | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() | A1200. Marital Status | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() | A1300. Optional Resident Items | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | A1300A. Medical record number | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | A1300B. Room number | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | A1300C. Name by which resident prefers to be addressed | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | A1300D. Lifetime occupation(s) | 0..1 | choice | Value Set: Options: 1 option |
![]() ![]() ![]() | A1500. Preadmission Screening and Resident Review (PASRR). Is the resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | A1510. Level II Preadmission Screening and Resident Review (PASRR) Conditions | 0..* | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | A1550. Conditions Related to ID/DD Status | 0..* | choice | Value Set: Options: 6 options |
![]() ![]() ![]() | Most Recent Admission/Entry or Reentry into this Facility | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | A1600. Entry Date | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | A1700. Type of Entry | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | A1800. Entered From | 0..1 | choice | Value Set: Options: 9 options |
![]() ![]() ![]() | A1900. Admission Date | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | A2000. Discharge Date | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | A2100. Discharge Status | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() | A2200. Previous Assessment Reference Date for Significant Correction | 0..1 | date | Value Set: |
![]() ![]() ![]() | A2300. Assessment Reference Date. Observation end date | 0..1 | date | Value Set: |
![]() ![]() ![]() | A2400. Medicare Stay | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | A2400A. Has the resident had a Medicare-covered stay since the most recent entry? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | A2400B. Start date of most recent Medicare stay | 0..1 | date | Value Set: |
![]() ![]() ![]() ![]() | A2400C. End date of most recent Medicare stay | 0..1 | date | Value Set: |
![]() ![]() | B. Hearing, Speech, and Vision | 1..1 | group | Value Set: |
![]() ![]() ![]() | B0100. Comatose | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | B0200. Hearing | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | B0300. Hearing Aid | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | B0600. Speech Clarity | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | B0700. Makes Self Understood | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | B0800. Ability to Understand Others | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | B1000. Vision | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() | B1200. Corrective Lenses | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() | C. Cognitive Patterns | 1..1 | group | Value Set: |
![]() ![]() ![]() | C0100. Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | Brief Interview for Mental Status (BIMS) | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | C0200. Repetition of Three Words | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() | C0300. Temporal Orientation | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | C0300A. Able to report correct year | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | C0300B. Able to report correct month | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | C0300C. Able to report correct day of the week | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | C0400. Recall | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | C0400A. Able to recall "sock" | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | C0400B. Able to recall "blue" | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | C0400C. Able to recall "bed" | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | C0500. BIMS Summary Score | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | C0600. Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | Staff assessment for mental status | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | Short-term memory OK | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | Long-term memory OK | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | Memory &or recall ability | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | Cognitive skills for daily decision making | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | Delirium | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | Signs and Symptoms of Delirium (from CAM) | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | Acute onset mental change. Is there evidence of an acute change in mental status from the patient's baseline? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() ![]() | Inattention - Did the patient have difficulty focusing attention, for example, being easily distractible or having difficulty keeping track of what was being said? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | Disorganized thinking - Was the patient's thinking disorganized or incoherent, such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | Altered level of consciousness - Did the resident have altered level of consciousness, as indicated by any of the following crfiteria? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() | D. Mood | 1..1 | group | Value Set: |
![]() ![]() ![]() | D0100. Should Resident Mood Interview be Conducted? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | D0200. Resident Mood Interview (PHQ-9) | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | D0200_1. Symptom Presence | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | D0200A1. Little interest or pleasure in doing things | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | D0200B1. Feeling down, depressed or hopeless | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | D0200C1. Trouble falling or staying asleep, or sleeping too much | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | D0200D1. Feeling tired or having little energy | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | D0200E1. Poor appetite or overeating | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | D0200F1. Feeling bad about yourself - or that you are a failure or have let yourself or your family down | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | D0200G1. Trouble concentrating on things, such as reading the newspaper or watching television | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | D0200H1. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | D0200I1. Thoughts that you would be better off dead, or of hurting yourself in some way | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | D0200_2. Symptom Frequency | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | D0200A2. Little interest or pleasure in doing things | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0200B2. Feeling down, depressed or hopeless | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0200C2. Trouble falling or staying asleep, or sleeping too much | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0200D2. Feeling tired or having little energy | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0200E2. Poor appetite or overeating | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0200F2. Feeling bad about yourself - or that you are a failure or have let yourself or your family down | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0200G2. Trouble concentrating on things, such as reading the newspaper or watching television | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0150H2. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0200I2. Thoughts that you would be better off dead, or of hurting yourself in some way | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | D0300. Total Severity Score | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | D0500. Staff Assessment of Resident Mood (PHQ-9-OV) | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | D0500_1. Symptom Presence | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | D0500A1. Little interest or pleasure in doing things | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() ![]() | D0500B1. Feeling or appearing down, depressed, or hopeless | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() ![]() | D0500C1. Trouble falling or staying asleep, or sleeping too much | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() ![]() | D0500D1. Feeling tired or having little energy | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() ![]() | D0500E1. Poor appetite or overeating | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() ![]() | D0500F1. Indicating that s/he feels bad about self, is a failure, or has let self or family down | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() ![]() | D0500G1. Trouble concentrating on things, such as reading the newspaper or watching television | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() ![]() | D0500H1. Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() ![]() | D0500I1. States that life isn't worth living, wishes for death, or attempts to harm self | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() ![]() | D0500J1. Being short-tempered, easily annoyed | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | D0500_2. Symptom Frequency | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | D0500A2. Little interest or pleasure in doing things | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0500B2. Feeling or appearing down, depressed, or hopeless | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0500C2. Trouble falling or staying asleep, or sleeping too much | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0500D2. Feeling tired or having little energy | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0500E2. Poor appetite or overeating | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0500F2. Indicating that s/he feels bad about self, is a failure, or has let self or family down | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0500G2. Trouble concentrating on things, such as reading the newspaper or watching television | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0500H2. Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0500I2. States that life isn't worth living, wishes for death, or attempts to harm self | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() ![]() | D0500J2. Being short-tempered, easily annoyed | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | D0600. Total Severity Score | 0..1 | decimal | Value Set: |
![]() ![]() | E. Behavior | 1..1 | group | Value Set: |
![]() ![]() ![]() | E0100. Potential Indicators of Psychosis | 0..* | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | E0200. Behavioral Symptom - Presence & Frequency | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | E0200A. Physical behavioral symptoms directed toward others | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() | E0200B. Verbal behavioral symptoms directed toward others | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() | E0200C. Other behavioral symptoms not directed toward others | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | E0300. Overall Presence of Behavioral Symptoms.Were any behavioral symptoms in questions E0200 coded 1, 2, or 3? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | E0500. Impact on Resident | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | E0500A. Did any of the identified symptom(s): Put the resident at significant risk for physical illness or injury? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | E0500B. Did any of the identified symptom(s): Significantly interfere with the resident's care? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | E0500C. Did any of the identified symptom(s): Significantly interfere with the resident's participation in activities or social interactions? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | E0600. Impact on Others | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | E0600A. Did any of the identified symptom(s): Put others at significant risk for physical injury? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | E0600B. Did any of the identified symptom(s): Significantly intrude on the privacy or activity of others? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | E0600C. Did any of the identified symptom(s): Significantly disrupt care or living environment? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | E0800. Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | E0900. Wandering - Presence & Frequency. Has the resident wandered? | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | E1000. Wandering - Impact | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | E1000A. Does the wandering place the resident at significant risk of getting to a potentially dangerous place? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | E1000B. Does the wandering significantly intrude on the privacy or activities of others? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | E1100. Change in Behavior or Other Symptoms.How does resident's current behavior status, care rejection, or wandering compare to prior assessment (OBRA or Scheduled PPS)? | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() | F. Preferences for Customary Routine and Activities | 1..1 | group | Value Set: |
![]() ![]() ![]() | F0300. Should Interview for Daily and Activity Preferences be Conducted? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | F0400. Interview for Daily Preferences | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | F0400A. While you are in this facility how important is it to you to choose what clothes to wear? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0400B. While you are in this facility how important is it to you to take care of your personal belongings or things? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0400C. While you are in this facility how important is it to you to choose between a tub bath, shower, bed bath, or sponge bath? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0400D. While you are in this facility how important is it to you to have snacks available between meals? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0400E. While you are in this facility how important is it to you to choose your own bedtime? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0400F. While you are in this facility how important is it to you to have your family or a close friend involved in discussions about your care? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0400G. While you are in this facility how important is it to you to be able to use the phone in private? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0400H. While you are in this facility how important is it to you to have a place to lock your things to keep them safe? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() | F0500. Interview for Activity Preferences | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | F0500A. While you are in this facility how important is it to you to have books, newspapers, and magazines to read? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0500B. While you are in this facility how important is it to you to listen to music you like? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0500C. While you are in this facility how important is it to you to be around animals such as pets? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0500D. While you are in this facility how important is it to you to keep up with the news? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0500E. While you are in this facility how important is it to you to do things with groups of people? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0500F. While you are in this facility how important is it to you to do your favorite activities? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0500G. While you are in this facility how important is it to you to go outside to get fresh air when the weather is good? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | F0500H. While you are in this facility how important is it to you to participate in religious services or practices? | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() | F0600. Daily and Activity Preferences Primary Respondent. Indicate primary respondent for Daily and Activity Preferences (F0400 and F0500) | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | F0700. Should the Staff Assessment of Daily and Activity Preferences be Conducted? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | F0800. Staff Assessment of Daily and Activity Preferences. Resident Prefers: | 0..1 | choice | Value Set: Options: 21 options |
![]() ![]() | G. Functional Status | 1..1 | group | Value Set: |
![]() ![]() ![]() | G0110_1. Activities of Daily Living (ADL) Assistance. Self-Performance | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | G0110A1. Bed mobility | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() ![]() | G0110B1. Transfer | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() ![]() | G0110C1. Walk in room | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() ![]() | G0110D1. Walk in corridor | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() ![]() | G0110E1. Locomotion on unit | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() ![]() | G0110F1. Locomotion off unit | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() ![]() | G0110G1. Dressing | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() ![]() | G0110H1. Eating | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() ![]() | G0110I1. Toilet use | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() ![]() | G0110J1. Personal hygiene | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() | G0110_2. Activities of Daily Living (ADL) Assistance. Support Provided | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | G0110A2. Bed mobility | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | G0110B2. Transfer | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | G0110C2. Walk in room | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | G0110D2. Walk in corridor | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | G0110E2. Locomotion on unit | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | G0110F2. Locomotion off unit | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | G0110G2. Dressing | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | G0110H2. Eating | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | G0110I2. Toilet use | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | G0110J2. Personal hygiene | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() | G0120. Bathing | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | G0120A. Self-performance | 0..1 | choice | Value Set: Options: 6 options |
![]() ![]() ![]() ![]() | G0120B. Support provided | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() | G0300. Balance During Transitions and Walking | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | G0300A. Moving from seated to standing position | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() | G0300B. Walking (with assistive device if used) | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() | G0300C. Turning around and facing the opposite direction while walking | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() | G0300D. Moving on and off toilet | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() | G0300E. Surface-to-surface transfer (transfer between bed and chair or wheelchair) | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | G0400. Functional Limitation in Range of Motion | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | G0400A. Upper extremity (shoulder, elbow, wrist, hand) | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | G0400B. Lower extremity (hip, knee, ankle, foot) | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | G0600. Mobility Devices | 0..* | choice | Value Set: Options: 5 options |
![]() ![]() ![]() | G0900. Functional Rehabilitation Potential | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | G0900A. Resident believes he or she is capable of increased independence in at least some ADLs. | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | G0900B. Direct care staff believe resident is capable of increased independence in at least some ADLs | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() | GG. Functional Abilities and Goals - Start of SNF PPS Stay or State PDPM | 1..1 | group | Value Set: |
![]() ![]() ![]() | GG0100. Prior Functioning: Everyday Activities | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | GG0100A. Self-Care | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | GG0100B. Indoor Mobility (Ambulation) | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | GG0100C. Stairs | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | GG0100D. Functional Cognition | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() | GG0110. Prior Device Use | 0..* | choice | Value Set: Options: 6 options |
![]() ![]() ![]() | GG0130_1. Self-Care - Admission Performance | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | GG0130A1. Eating | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130B1. Oral hygiene | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130C1. Toileting hygiene | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130E1. Shower/bathe self | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130F1. Upper body dressing | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130G1. Lower body dressing | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130H1. Putting on/taking off footwear | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() | GG0130_2. Self-Care - Discharge Goal | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | Oral hygiene - functional goal | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130A2. Eating | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130C2. Toileting hygiene | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130E2. Shower/bathe self | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130F2. Upper body dressing | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130G2. Lower body dressing | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130H2. Putting on/taking off footwear | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() | GG0170_1. Mobility - Admission Performance | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | GG0170A1. Roll left and right | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170B1. Sit to lying | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170C1. Lying to sitting on side of bed | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170D1. Sit to stand | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170E1. Chair/bed-to-chair transfer | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170F1. Toilet transfer | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170G1. Car transfer | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170I1. Walk 10 feet | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170J1. Walk 50 feet with two turns | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170K1. Walk 150 feet | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170L1. Walking 10 feet on uneven surfaces | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170M1. 1 step (curb) | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170N1. 4 steps | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170O1. 12 steps | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170P1. Picking up object | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170Q1. Does the resident use a wheelchair and/or scooter? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | GG0170R1. Wheel 50 feet with two turns | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170RR1. Indicate the type of wheelchair or scooter used | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | GG0170S1. Wheel 150 feet | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170SS1. Indicate the type of wheelchair or scooter used | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | GG0170_2. Mobility - Discharge Goal | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | GG0170A2. Roll left and right | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170B2. Sit to lying | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170C2. Lying to sitting on side of bed | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170D2. Sit to stand | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170E2. Chair/bed-to-chair transfer | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170F2. Toilet transfer | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170G2. Car transfer | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170I2. Walk 10 feet | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170J2. Walk 50 feet with two turns | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170K2. Walk 150 feet | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170L2. Walking 10 feet on uneven surfaces | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170M2. 1 step (curb) | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170N2. 4 steps | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170O2. 12 steps | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170P2. Picking up object | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170R2. Wheel 50 feet with two turns | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170S2. Wheel 150 feet | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() | GG. Functional Abilities and Goals - Discharge (End of SNF PPS Stay) | 1..1 | group | Value Set: |
![]() ![]() ![]() | GG0130_3. Self-Care - Discharge Performance | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | GG0130A3. Eating | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130B3. Oral hygiene | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130C3. Toileting hygiene | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130E3. Shower/bathe self | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130F3. Upper body dressing | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130G3. Lower body dressing | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0130H3. Putting on/taking off footwear | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() | GG0170_3. Mobility - Discharge Performance | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | GG0170A3. Roll left and right | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170B3. Sit to lying | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170C3. Lying to sitting on side of bed | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170D3. Sit to stand | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170E3. Chair/bed-to-chair transfer | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170F3. Toilet transfer | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170G3. Car transfer | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170I3. Walk 10 feet | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170J3. Walk 50 feet with two turns | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170K3. Walk 150 feet | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170L3. Walking 10 feet on uneven surfaces | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170M3. 1 step (curb) | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170N3. 4 steps | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170O3. 12 steps | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170P3. Picking up object | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170Q3. Does the resident use a wheelchair and/or scooter? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | GG0170R3. Wheel 50 feet with two turns | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170RR3. Indicate the type of wheelchair or scooter used | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | GG0170S3. Wheel 150 feet | 0..1 | choice | Value Set: Options: 10 options |
![]() ![]() ![]() ![]() | GG0170SS3. Indicate the type of wheelchair or scooter used | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() | H. Bladder and Bowel | 1..1 | group | Value Set: |
![]() ![]() ![]() | H0100. Appliances | 0..* | choice | Value Set: Options: 5 options |
![]() ![]() ![]() | H0200. Urinary Toileting Program | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | H0200A. Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | H0200B. Response - What was the resident's response to the trial program? | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() | H0200C. Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | H0300. Urinary Continence | 1..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() | H0400. Bowel Continence | 1..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() | H0500. Bowel Toileting Program | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | H0600. Bowel Patterns. Constipation present? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() | I. Active Diagnoses | 1..1 | group | Value Set: |
![]() ![]() ![]() | I0020. Indicate the resident's primary medical condition category | 1..1 | choice | Value Set: Options: 13 options |
![]() ![]() ![]() | I0020B. ICD Code | 0..1 | choice | Value Set: Options: 1 option |
![]() ![]() ![]() | I0100-I7900. Active Diagnoses in the last 7 days | 0..* | choice | Value Set: Options: 57 options |
![]() ![]() ![]() | I8000A-I8000J. Additional active diagnoses | 0..* | choice | Value Set: Options: 1 option |
![]() ![]() | J. Health Conditions | 1..1 | group | Value Set: |
![]() ![]() ![]() | J0100. Pain Management | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | J0100A. At any time in the last 5 days, has the resident: Received scheduled pain medication regimen? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | J0100B. At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | J0100C. At any time in the last 5 days, has the resident: Received non-medication intervention for pain? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | J0200. Should Pain Assessment Interview be Conducted? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | Pain Assessment Interview | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | J0300. Pain Presence. Have you had pain or hurting at any time in the last 5 days? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | J0400. Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days? | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | J0500. Pain Effect on Function | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | J0500A. Over the past 5 days, has pain made it hard for you to sleep at night? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | J0500B. Over the past 5 days, have you limited your day-to-day activities because of pain? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | J0600. Pain Intensity | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | J0600A. Numeric Rating Scale (00-10) | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() ![]() | J0600B. Verbal Descriptor Scale | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() | J0700. Should the Staff Assessment for Pain be Conducted? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | Staff Assessment for Pain | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | J0800. Indicators of Pain or Possible Pain in the last 5 days | 0..* | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | J0850. Frequency of Indicator of Pain or Possible Pain in the last 5 days. Frequency with which resident complains or shows evidence of pain or possible pain | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | Other Health Conditions | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | J1100. Shortness of Breath (dyspnea) | 0..* | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() | J1300. Current Tobacco Use | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | J1400. Prognosis | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | J1550. Problem Conditions | 0..* | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | J1700. Fall History on Admission/Entry or Reentry | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | J1700A. Did the resident have a fall any time in the last month prior to admission/entry or reentry? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | J1700B. Did the resident have a fall any time in the last 2-6 months prior to admission/entry or reentry? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | J1700C. Did the resident have any fracture related to a fall in the 6 months prior to admission/entry or reentry? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | J1800. Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | J1900. Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | J1900A. No injury | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | J1900B. Injury (except major) | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() ![]() | J1900C. Major injury | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | J2000. Prior Surgery | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | J2100. Recent Surgery Requiring Active SNF Care | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | J2300-J5000. Surgical Procedures | 0..1 | choice | Value Set: Options: 29 options |
![]() ![]() | K. Swallowing/Nutritional Status | 1..1 | group | Value Set: |
![]() ![]() ![]() | K0100. Swallowing Disorder. Signs and symptoms of possible swallowing disorder | 0..* | choice | Value Set: Options: 5 options |
![]() ![]() ![]() | K0200. Height and Weight | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | K0200A. Height (in inches) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | K0200B. Weight (in pounds) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | K0300. Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | K0310. Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | K0510. Nutritional Approaches | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | K0510_1. Nutritional Approaches. While NOT a Resident | 0..* | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | K0510_2. Nutritional Approaches. While a Resident | 0..* | choice | Value Set: Options: 5 options |
![]() ![]() ![]() | K0710. Percent Intake by Artificial Route | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | K0710A2. Proportion of total calories the resident received through parenteral or tube feeding. While a Resident | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | K0710A3. Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | K0710B2. Average fluid intake per day by IV or tube feeding. While a Resident | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | K0710B3. Average fluid intake per day by IV or tube feeding. During Entire 7 Days | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() | L. Oral/Dental Status | 1..1 | group | Value Set: |
![]() ![]() ![]() | L0200. Dental | 0..* | choice | Value Set: Options: 8 options |
![]() ![]() | M. Skin Conditions | 1..1 | group | Value Set: |
![]() ![]() ![]() | M0100. Determination of Pressure Ulcer/Injury Risk | 0..* | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | M0150. Risk of Pressure Ulcers/Injuries | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | M0210. Unhealed Pressure Ulcers/Injuries | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | M0300. Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | M0300A1. Number of Stage 1 pressure injuries | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | M0300B1. Number of Stage 2 pressure ulcers | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | M0300B2. Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | M0300C1. Number of Stage 3 pressure ulcers | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | M0300C2. Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | M0300D1. Number of Stage 4 pressure ulcers | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | M0300D2. Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | M0300E1. Number of unstageable pressure ulcers/injuries due to non-removable dressing/device | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | M0300E2. Number of these unstageable pressure ulcers/injuries that were present upon admission/entry or reentry | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | M0300F1. Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | M0300F2. Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | M0300G1. Number of unstageable pressure injuries presenting as deep tissue injury | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | M0300G2. Number of these unstageable pressure injuries that were present upon admission/entry or reentry | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | M1030. Number of Venous and Arterial Ulcers | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | M1040. Other Ulcers, Wounds and Skin Problems | 0..* | choice | Value Set: Options: 9 options |
![]() ![]() ![]() | M1200. Skin and Ulcer/Injury Treatments | 0..* | choice | Value Set: Options: 10 options |
![]() ![]() | N. Medications | 1..1 | group | Value Set: |
![]() ![]() ![]() | N0300. Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days. | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | N0350. Insulin | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | N0350A. Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | N0350B. Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | N0410. Medications Received | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | N0410A. Antipsychotic | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | N0410B. Antianxiety | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | N0410C. Antidepressant | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | N0410D. Hypnotic | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | N0410E. Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | N0410F. Antibiotic | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | N0410G. Diuretic | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | N0410H. Opioid | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | N0450. Antipsychotic Medication Review | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | N0450A. Did the resident receive antipsychotic medications since admission/entry or reentry or the prior OBRA assessment, whichever is more recent? | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() | N0450B. Has a gradual dose reduction (GDR) been attempted? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | N0450C. Date of last attempted GDR | 0..1 | date | Value Set: |
![]() ![]() ![]() ![]() | N0450D. Physician documented GDR as clinically contraindicated | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | N0450E. Date physician documented GDR as clinically contraindicated | 0..1 | date | Value Set: |
![]() ![]() ![]() | N2001. Drug Regimen Review: Did a complete drug regimen review identify potential clinically significant medication issues? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | N2003. Medication Follow-up: Did the facility contact a physician (or physician-designee) by midnight of the next calendar day and complete prescribed/recommended actions in response to the identified potential clinically significant medication issues? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | N2005. Did the facility contact and complete physician (or physician-designee) prescribed/recommended actions by midnight of the next calendar day each time potential clinically significant medication issues were identified since the admission? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() | O. Special Treatments, Procedures, and Programs | 1..1 | group | Value Set: |
![]() ![]() ![]() | O0100. Special Treatments, Procedures, and Programs | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | O0100_1. While NOT a Resident | 0..* | choice | Value Set: Options: 13 options |
![]() ![]() ![]() ![]() | O0100_2. While a Resident | 0..* | choice | Value Set: Options: 13 options |
![]() ![]() ![]() | O0250. Influenza Vaccine | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | O0250A. Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | O0250B. Date influenza vaccine received | 0..1 | date | Value Set: |
![]() ![]() ![]() ![]() | O0250C. If influenza vaccine not received, state reason: | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() | O0300. Pneumococcal Vaccine | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | O0300A. Is the resident's Pneumococcal vaccination up to date? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | O0300B. If Pneumococcal vaccine not received, state reason: | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | O0400. Therapies | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | O0400A. Speech-Language Pathology and Audiology Services | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400A1. Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400A2. Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400A3. Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400A3A. Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400A4. Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400A5. Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | 0..1 | date | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400A6. Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | 0..1 | date | Value Set: |
![]() ![]() ![]() ![]() | O0400B. Occupational Therapy | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400B1. Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400B2. Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400B3. Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400B3A. Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400B4. Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400B5. Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | 0..1 | date | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400B6. Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | 0..1 | date | Value Set: |
![]() ![]() ![]() ![]() | O0400C. Physical Therapy | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400C1. Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400C2. Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400C3. Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400C3A. Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400C4. Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400C5. Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started | 0..1 | date | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400C6. Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended | 0..1 | date | Value Set: |
![]() ![]() ![]() ![]() | O0400D. Respiratory Therapy | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400D1. Total minutes - record the total number of minutes this therapy was administered to the resident in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400D2. Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0400E. Psychological Therapy (by any licensed mental health professional) | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400E1. Total minutes - record the total number of minutes this therapy was administered to the resident in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400E2. Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days. | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0400F. Recreational Therapy (includes recreational and music therapy) | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400F1. Total minutes - record the total number of minutes this therapy was administered to the resident in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0400F2. Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | O0420. Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days. | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | O0425. Part A Therapies | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | O0425A. Speech-Language Pathology and Audiology Services | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425A1. Individual minutes - record the total number of minutes this therapy was administered to the resident individually since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425A2. Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425A3. Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425A4. Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425A5. Days - record the number of days this therapy was administered for at least 15 minutes a day since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0425B. Occupational Therapy | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425B1. Individual minutes - record the total number of minutes this therapy was administered to the resident individually since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425B2. Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425B3. Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425B4. Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425B5. Days - record the number of days this therapy was administered for at least 15 minutes a day since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0425C. Physical Therapy | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425C1. Individual minutes - record the total number of minutes this therapy was administered to the resident individually since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425C2. Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425C3. Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425C4. Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() ![]() | O0425C5. Days - record the number of days this therapy was administered for at least 15 minutes a day since the start date of the resident's most recent Medicare Part A stay (A2400B) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | O0430. Distinct Calendar Days of Part A Therapy | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | O0500. Restorative Nursing Programs | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | O0500A. Technique. Range of motion (passive) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0500B. Technique. Range of motion (active) | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0500C. Technique. Splint or brace assistance | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0500D. Training and Skill Practice In: Bed mobility | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0500E. Training and Skill Practice In: Transfer | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0500F. Training and Skill Practice In: Walking | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0500G. Training and Skill Practice In: Dressing and/or grooming | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0500H. Training and Skill Practice In: Eating and/or swallowing | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0500I. Training and Skill Practice In: Amputation/prostheses care | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | O0500J. Training and Skill Practice In: Communication | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | O0600. Physician Examinations. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) examine the resident? | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | O0700. Physician Orders. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) change the resident's orders? | 0..1 | decimal | Value Set: |
![]() ![]() | P. Restraints and Alarms | 1..1 | group | Value Set: |
![]() ![]() ![]() | P0100. Physical Restraints | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | P0100A. Used in Bed. Bed rail | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | P0100B. Used in Bed. Trunk restraint | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | P0100C. Used in Bed. Limb restraint | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | P0100D. Used in Bed. Other | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | P0100E. Used in Chair or Out of Bed. Trunk restraint | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | P0100F. Used in Chair or Out of Bed. Limb restraint | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | P0100G. Used in Chair or Out of Bed. Chair prevents rising | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | P0100H. Used in Chair or Out of Bed. Other | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | P0200. Alarms | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | P0200A. Bed alarm | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | P0200B. Chair alarm | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | P0200C. Floor mat alarm | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | P0200D. Motion sensor alarm | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | P0200E. Wander/elopement alarm | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | P0200F. Other alarm | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() | Q. Participation in Assessment and Goal Setting | 1..1 | group | Value Set: |
![]() ![]() ![]() | Q0100. Participation in Assessment | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | Q0100A. Resident participated in assessment | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | Q0100B. Family or significant other participated in assessment | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | Q0100C. Guardian or legally authorized representative participated in assessment | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | Q0300. Resident's Overall Expectation | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | Q0300A. Select one for resident's overall goal established during assessment process | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() ![]() | Q0300B. Indicate information source for Q0300A | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | Q0400A. Discharge Plan. Is active discharge planning already occurring for the resident to return to the community? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | Q0490. Resident's Preference to Avoid Being Asked Question Q0500B | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | Q0500B. Return to Community. Do you want to talk to someone about the possiblity of leaving this facility and returning to live and receive services in the community? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() | Q0550. Resident's Preference to Avoid Being Asked Question Q0500B Again | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | Q0550A. Does the resident (or family or significant other or guardian or legally authorized representative if resident is unable to understand or respond) want to be asked about returning to the community on all assessments? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | Q0550B. Indicate information source for Q0550A | 0..1 | choice | Value Set: Options: 4 options |
![]() ![]() ![]() | Q0600. Referral. Has a referral been made to the Local Contact Agency? | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() | V. Care Area Assessment (CAA) Summary | 1..1 | group | Value Set: |
![]() ![]() ![]() | V0100. Items From the Most Recent Prior OBRA or Scheduled PPS Assessment | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | V0100A. Prior Assessment Federal OBRA Reason for Assessment | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() ![]() | V0100B. Prior Assessment PPS Reason for Assessment | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | V0100C. Prior Assessment Reference Date | 0..1 | date | Value Set: |
![]() ![]() ![]() ![]() | V0100D. Prior Assessment Brief Interview for Mental Status (BIMS) Summary Score | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | V0100E. Prior Assessment Resident Mood Interview (PHQ-9©) Total Severity Score | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | V0100F. Prior Assessment Staff Assessment of Resident Mood (PHQ-9-OV) Total Severity Score | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | V0200. CAAs and Care Planning | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | V0200A. CAA Results | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | V0200A_A. Care Area Triggered | 0..1 | choice | Value Set: Options: 20 options |
![]() ![]() ![]() ![]() ![]() | V0200A_B. Care Planning Decision | 0..1 | choice | Value Set: Options: 20 options |
![]() ![]() | X. Correction Request | 1..1 | group | Value Set: |
![]() ![]() ![]() | X0150. Type of Provider | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | X0200. Name of Resident | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | X0200A. Patient First name | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | X0200C. Patient Last name | 0..1 | string | Value Set: |
![]() ![]() ![]() | X0300. Gender | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | X0400. Birth Date | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | X0500. Social Security Number | 0..1 | string | Value Set: |
![]() ![]() ![]() | X0570A. Optional State Assessment. Is this assessment for state payment purposes only? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | X0600. Type of Assessment | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | X0600A. Federal OBRA Reason for Assessment | 0..1 | choice | Value Set: Options: 7 options |
![]() ![]() ![]() ![]() | X0600B. PPS Assessment | 0..1 | choice | Value Set: Options: 3 options |
![]() ![]() ![]() ![]() | X0600F. Entry/discharge reporting | 0..1 | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | X0600H. Is this a SNF Part A PPS Discharge Assessment? | 0..1 | choice | Value Set: Options: 2 options |
![]() ![]() ![]() | X0700. Date on existing record to be modified/inactivated | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | X0700A. Assessment Reference Date | 0..1 | date | Value Set: |
![]() ![]() ![]() ![]() | X0700B. Discharge Date | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | X0700C. Entry Date | 0..1 | decimal | Value Set: |
![]() ![]() ![]() | Correction Attestation Section | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | X0800. Correction Number | 0..1 | decimal | Value Set: |
![]() ![]() ![]() ![]() | X0900. Reasons for Modification | 0..* | choice | Value Set: Options: 5 options |
![]() ![]() ![]() ![]() | X1050. Reasons for Inactivation | 0..* | choice | Value Set: Options: 2 options |
![]() ![]() ![]() ![]() | X1100. RN Assessment Coordinator Attestation of Completion | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() ![]() | X1100A. Attesting individual's first name | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() ![]() | X1100B. Attesting individual's last name | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() ![]() | X1100C. Attesting individual's title | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() ![]() | X1100E. Attestation date | 0..1 | date | Value Set: |
![]() ![]() | Z. Assessment Administration | 1..1 | group | Value Set: |
![]() ![]() ![]() | Z0100. Medicare Part A Billing | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | Z0100A. Medicare Part A HIPPS code | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | Z0100B. Version code | 0..1 | string | Value Set: |
![]() ![]() ![]() | Z0200. State Medicaid Billing (if required by the state) | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | Z0200A. Case Mix group | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | Z0200B. Version code | 0..1 | string | Value Set: |
![]() ![]() ![]() | Z0250. Alternate State Medicaid Billing (if required by the state) | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | Z0250A. Case Mix group | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | Z0250B. Version code | 0..1 | string | Value Set: |
![]() ![]() ![]() | Z0300. Insurance Billing | 1..1 | group | Value Set: |
![]() ![]() ![]() ![]() | Z0300A. Billing code | 0..1 | string | Value Set: |
![]() ![]() ![]() ![]() | Z0300B. Billing version | 0..1 | string | Value Set: |
Documentation for this format | ||||
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