MDS Item Summary

Item

Group

Type

Length

Fixed Start-End

Description

ASMT_SYS_CD Control Code 10 1-10 Assessment system code
ITM_SBST_CD Control Code 3 11-13 Item subset code
ITM_SET_VRSN_CD Control Code 10 14-23 Item set version code
SPEC_VRSN_CD Control Code 10 24-33 Specifications version code
PRODN_TEST_CD Control Code 1 34-34 Production/test indicator
STATE_CD Control Code 2 35-36 Facility"s state postal code
FAC_ID Control Text 16 37-52 Assigned facility/provider submission ID
SFTWR_VNDR_ID Control Text 9 53-61 Software vendor federal employer tax ID
SFTWR_VNDR_NAME Control Text 30 62-91 Software vendor company name
SFTWR_VNDR_EMAIL_ADR Control Text 50 92-141 Software vendor email address
SFTWR_PROD_NAME Control Text 50 142-191 Software product name
SFTWR_PROD_VRSN_CD Control Text 20 192-211 Software product version code
FAC_DOC_ID Control Text 20 212-231 Facility document ID
STATE_PDPM_OBRA_CD Control Code 1 1827-1827 State calculation of PDPM for OBRA
A0050 Asmt Code 1 1216-1216 Type of transaction (formerly X0100)
A0100A Asmt Text 10 232-241 Facility National Provider Identifier (NPI)
A0100B Asmt Text 12 242-253 Facility CMS Certification Number (CCN)
A0100C Asmt Text 15 254-268 State provider number
A0200 Asmt Code 1 269-269 Type of provider
A0310A Asmt Code 2 270-271 Type of assessment: OBRA
A0310B Asmt Code 2 272-273 Type of assessment: PPS
A0310E Asmt Code 1 276-276 First assessment since most recent entry
A0310F Asmt Code 2 277-278 Entry/discharge reporting
A0310G Asmt Code 1 1439-1439 Planned/unplanned discharge
A0310G1 Asmt Code 1 1703-1703 Interrupted Stay
A0310H Asmt Code 1 1493-1493 SNF PPS Part A Discharge (End of Stay) Assessment
A0410 Asmt Code 1 279-279 Submission requirement
A0500A Asmt Text 12 280-291 Resident first name
A0500B Asmt Text 1 292-292 Resident middle initial
A0500C Asmt Text 18 293-310 Resident last name
A0500D Asmt Text 3 311-313 Resident name suffix
A0600A Asmt Text 9 314-322 Social Security Number
A0600B Asmt Text 12 323-334 Medicare number
A0700 Asmt Text 14 335-348 Medicaid number
A0800 Asmt Code 1 350-350 Gender
A0900 Asmt Date 8 351-358 Birthdate
A1005A Asmt Checklist 1 1828-1828 Ethnicity: No, not Hispanic, Latino/a, Spanish
A1005B Asmt Checklist 1 1829-1829 Ethnicity: Yes, Mex, Mex Amer, Chicano/a
A1005C Asmt Checklist 1 1830-1830 Ethnicity: Yes, Puerto Rican
A1005D Asmt Checklist 1 1831-1831 Ethnicity: Yes, Cuban
A1005E Asmt Checklist 1 1832-1832 Ethnicity: Yes, another Hispanic/Latino/Spanish
A1005X Asmt Checklist 1 1833-1833 Ethnicity: Resident unable to respond
A1005Y Asmt Checklist 1 1834-1834 Ethnicity: Resident declines to respond
A1010A Asmt Checklist 1 1835-1835 Race: White
A1010B Asmt Checklist 1 1836-1836 Race: Black or African American
A1010C Asmt Checklist 1 1837-1837 Race: American Indian or Alaska Native
A1010D Asmt Checklist 1 1838-1838 Race: Asian Indian
A1010E Asmt Checklist 1 1839-1839 Race: Chinese
A1010F Asmt Checklist 1 1840-1840 Race: Filipino
A1010G Asmt Checklist 1 1841-1841 Race: Japanese
A1010H Asmt Checklist 1 1842-1842 Race: Korean
A1010I Asmt Checklist 1 1843-1843 Race: Vietnamese
A1010J Asmt Checklist 1 1844-1844 Race: Other Asian
A1010K Asmt Checklist 1 1845-1845 Race: Native Hawaiian
A1010L Asmt Checklist 1 1846-1846 Race: Guamanian or Chamorro
A1010M Asmt Checklist 1 1847-1847 Race: Samoan
A1010N Asmt Checklist 1 1848-1848 Race: Other Pacific Islander
A1010X Asmt Checklist 1 1849-1849 Race: Resident unable to respond
A1010Y Asmt Checklist 1 1850-1850 Race: Resident declines to respond
A1010Z Asmt Checklist 1 1851-1851 Race: None of the above
A1110A Asmt Text 15 1852-1866 Preferred language
A1110B Asmt Code 1 1867-1867 Does the patient need or want an interpreter
A1200 Asmt Code 1 381-381 Marital status
A1250A Asmt Checklist 1 1868-1868 Transportation: Yes, medical
A1250B Asmt Checklist 1 1869-1869 Transportation: Yes, non-medical
A1250C Asmt Checklist 1 1870-1870 Transportation: No
A1250X Asmt Checklist 1 1871-1871 Transportation: Resident unable to respond
A1250Y Asmt Checklist 1 1872-1872 Transportation: Resident declines to respond
A1300A Asmt Text 12 382-393 Medical record number
A1300B Asmt Text 10 394-403 Room number
A1300C Asmt Text 23 404-426 Name by which resident prefers to be addressed
A1300D Asmt Text 23 427-449 Lifetime occupation(s)
A1500 Asmt Code 1 450-450 Resident evaluated by PASRR
A1510A Asmt Checklist 1 1440-1440 Level II PASRR conditions: Serious Mental Illness
A1510B Asmt Checklist 1 1441-1441 Level II PASRR conditions: Intellectual Disability
A1510C Asmt Checklist 1 1442-1442 Level II PASRR conditions: Other related condition
A1550A Asmt Checklist 1 451-451 ID/DD status: Down syndrome
A1550B Asmt Checklist 1 452-452 ID/DD status: Autism
A1550C Asmt Checklist 1 453-453 ID/DD status: Epilepsy
A1550D Asmt Checklist 1 454-454 ID/DD status: other organic ID/DD condition
A1550E Asmt Checklist 1 455-455 ID/DD status: ID/DD with no organic condition
A1550Z Asmt Checklist 1 456-456 ID/DD status: none of the above
A1600 Asmt Date 8 457-464 Entry date (date of admission/reentry in facility)
A1700 Asmt Code 1 465-465 Type of entry
A1805 Asmt Code 2 1873-1874 Admitted from
A1900 Asmt Date 8 1485-1492 Admission date
A2000 Asmt Date 8 468-475 Discharge date
A2105 Asmt Code 2 1875-1876 Discharge location
A2121 Asmt Code 1 1877-1877 Current Reconciled Medication List - Provider
A2122A Asmt Checklist 1 1878-1878 Provider Trans - Electronic Health Record
A2122B Asmt Checklist 1 1879-1879 Provider Trans - Health Info Exchange
A2122C Asmt Checklist 1 1880-1880 Provider Trans - Verbal
A2122D Asmt Checklist 1 1881-1881 Provider Trans - Paper-based
A2122E Asmt Checklist 1 1882-1882 Provider Trans - Other Methods
A2123 Asmt Code 1 1883-1883 Current Reconciled Medication List - Ptnt/Fam/Care
A2124A Asmt Checklist 1 1884-1884 Patient Trans - Electronic Health Record
A2124B Asmt Checklist 1 1885-1885 Patient Trans - Health Info Exchange
A2124C Asmt Checklist 1 1886-1886 Patient Trans - Verbal
A2124D Asmt Checklist 1 1887-1887 Patient Trans - Paper-based
A2124E Asmt Checklist 1 1888-1888 Patient Trans - Other Methods
A2200 Asmt Date 8 478-485 Previous asmt reference date for signif correction
A2300 Asmt Date 8 486-493 Assessment reference date
A2400A Asmt Code 1 494-494 Has resident had Medicare-covered stay
A2400B Asmt Date 8 495-502 Start date of most recent Medicare stay
A2400C Asmt Date 8 503-510 End date of most recent Medicare stay
B0100 Asmt Code 1 511-511 Comatose
B0200 Asmt Code 1 512-512 Hearing
B0300 Asmt Code 1 513-513 Hearing aid
B0600 Asmt Code 1 514-514 Speech clarity
B0700 Asmt Code 1 515-515 Makes self understood
B0800 Asmt Code 1 516-516 Ability to understand others
B1000 Asmt Code 1 517-517 Vision
B1200 Asmt Code 1 518-518 Corrective lenses
B1300 Asmt Code 1 1889-1889 Health Literacy
C0100 Asmt Code 1 519-519 BIMS: should resident interview be conducted
C0200 Asmt Code 1 520-520 BIMS res interview: repetition of three words
C0300A Asmt Code 1 521-521 BIMS res interview: able to report correct year
C0300B Asmt Code 1 522-522 BIMS res interview: able to report correct month
C0300C Asmt Code 1 523-523 BIMS res interview: can report correct day of week
C0400A Asmt Code 1 524-524 BIMS res interview: able to recall "sock"
C0400B Asmt Code 1 525-525 BIMS res interview: able to recall "blue"
C0400C Asmt Code 1 526-526 BIMS res interview: able to recall "bed"
C0500 Asmt Number 2 527-528 BIMS res interview: summary score
C0600 Asmt Code 1 529-529 Staff asmt mental status: conduct asmt
C0700 Asmt Code 1 530-530 Staff asmt mental status: short-term memory OK
C0800 Asmt Code 1 531-531 Staff asmt mental status: long-term memory OK
C0900A Asmt Checklist 1 532-532 Staff asmt mental status: recall current season
C0900B Asmt Checklist 1 533-533 Staff asmt mental status: recall location of room
C0900C Asmt Checklist 1 534-534 Staff asmt mental status: recall staff names/faces
C0900D Asmt Checklist 1 535-535 Staff asmt mental status: recall in nh/hosp sw bed
C0900Z Asmt Checklist 1 536-536 Staff asmt mental status: none of above recalled
C1000 Asmt Code 1 537-537 Cognitive skills for daily decision making
C1310A Asmt Code 1 1494-1494 Acute Onset Mental Status Change
C1310B Asmt Code 1 1495-1495 Inattention
C1310C Asmt Code 1 1496-1496 Disorganized Thinking
C1310D Asmt Code 1 1497-1497 Altered Level of Consciousness
D0100 Asmt Code 1 543-543 PHQ: should resident mood interview be conducted
D0150A1 Asmt Code 1 1890-1890 Mood: Little interest/pleasure doing things: Pres
D0150A2 Asmt Code 1 1891-1891 Mood: Little interest/pleasure doing things: Freq
D0150B1 Asmt Code 1 1892-1892 Mood: Feeling down, depressed, or hopeless: Pres
D0150B2 Asmt Code 1 1893-1893 Mood: Feeling down, depressed, or hopeless: Freq
D0150C1 Asmt Code 1 1894-1894 Mood: Trouble falling or staying asleep: Pres
D0150C2 Asmt Code 1 1895-1895 Mood: Trouble falling or staying asleep: Freq
D0150D1 Asmt Code 1 1896-1896 Mood: Feeling tired or having little energy: Pres
D0150D2 Asmt Code 1 1897-1897 Mood: Feeling tired or having little energy: Freq
D0150E1 Asmt Code 1 1898-1898 Mood: Poor appetite or overeating: Pres
D0150E2 Asmt Code 1 1899-1899 Mood: Poor appetite or overeating: Freq
D0150F1 Asmt Code 1 1900-1900 Mood: Feeling bad about yourself: Pres
D0150F2 Asmt Code 1 1901-1901 Mood: Feeling bad about yourself: Freq
D0150G1 Asmt Code 1 1902-1902 Mood: Trouble concentrating on things: Pres
D0150G2 Asmt Code 1 1903-1903 Mood: Trouble concentrating on things: Freq
D0150H1 Asmt Code 1 1904-1904 Mood: Moving or speaking so slowly: Pres
D0150H2 Asmt Code 1 1905-1905 Mood: Moving or speaking so slowly: Freq
D0150I1 Asmt Code 1 1906-1906 Mood: Thoughts of better off dead: Pres
D0150I2 Asmt Code 1 1907-1907 Mood: Thoughts of better off dead: Freq
D0160 Asmt Number 2 1908-1909 Total severity score
D0500A1 Asmt Code 1 565-565 PHQ staff: little interest or pleasure - presence
D0500A2 Asmt Code 1 566-566 PHQ staff: little interest or pleasure - frequency
D0500B1 Asmt Code 1 567-567 PHQ staff: feeling down, depressed - presence
D0500B2 Asmt Code 1 568-568 PHQ staff: feeling down, depressed - frequency
D0500C1 Asmt Code 1 569-569 PHQ staff: trouble with sleep - presence
D0500C2 Asmt Code 1 570-570 PHQ staff: trouble with sleep - frequency
D0500D1 Asmt Code 1 571-571 PHQ staff: feeling tired/little energy - presence
D0500D2 Asmt Code 1 572-572 PHQ staff: feeling tired/little energy - frequency
D0500E1 Asmt Code 1 573-573 PHQ staff: poor appetite or overeating - presence
D0500E2 Asmt Code 1 574-574 PHQ staff: poor appetite or overeating - frequency
D0500F1 Asmt Code 1 575-575 PHQ staff: feeling bad about self - presence
D0500F2 Asmt Code 1 576-576 PHQ staff: feeling bad about self - frequency
D0500G1 Asmt Code 1 577-577 PHQ staff: trouble concentrating - presence
D0500G2 Asmt Code 1 578-578 PHQ staff: trouble concentrating - frequency
D0500H1 Asmt Code 1 579-579 PHQ staff: slow, fidgety, restless - presence
D0500H2 Asmt Code 1 580-580 PHQ staff: slow, fidgety, restless - frequency
D0500I1 Asmt Code 1 581-581 PHQ staff: thoughts better off dead - presence
D0500I2 Asmt Code 1 582-582 PHQ staff: thoughts better off dead - frequency
D0500J1 Asmt Code 1 583-583 PHQ staff: short-tempered - presence
D0500J2 Asmt Code 1 584-584 PHQ staff: short-tempered - frequency
D0600 Asmt Number 2 585-586 PHQ staff: total mood score
D0700 Asmt Code 1 1910-1910 Social Isolation
E0100A Asmt Checklist 1 588-588 Psychosis: hallucinations
E0100B Asmt Checklist 1 589-589 Psychosis: delusions
E0100Z Asmt Checklist 1 590-590 Psychosis: none of the above
E0200A Asmt Code 1 591-591 Physical behav symptoms directed toward others
E0200B Asmt Code 1 592-592 Verbal behav symptoms directed toward others
E0200C Asmt Code 1 593-593 Other behav symptoms not directed toward others
E0300 Asmt Code 1 594-594 Overall presence of behavioral symptoms
E0500A Asmt Code 1 595-595 Behav symptoms put res at risk for illness/injury
E0500B Asmt Code 1 596-596 Behav symptoms interfere with resident care
E0500C Asmt Code 1 597-597 Behav symptoms interfere with social activities
E0600A Asmt Code 1 598-598 Behav symptoms put others at risk for injury
E0600B Asmt Code 1 599-599 Behav symptoms intrude on privacy of others
E0600C Asmt Code 1 600-600 Behav symptoms disrupt care or living environment
E0800 Asmt Code 1 601-601 Rejection of care: presence and frequency
E0900 Asmt Code 1 602-602 Wandering: presence and frequency
E1000A Asmt Code 1 603-603 Wandering: risk of getting to dangerous place
E1000B Asmt Code 1 604-604 Wandering: intrude on privacy of others
E1100 Asmt Code 1 605-605 Change in behavioral or other symptoms
F0300 Asmt Code 1 606-606 Conduct res interview for daily/activity prefs
F0400A Asmt Code 1 607-607 Res interview: choose clothes to wear
F0400B Asmt Code 1 608-608 Res interview: take care of personal belongings
F0400C Asmt Code 1 609-609 Res interview: choose tub, bath, shower, sponge
F0400D Asmt Code 1 610-610 Res interview: have snacks between meals
F0400E Asmt Code 1 611-611 Res interview: choose own bedtime
F0400F Asmt Code 1 612-612 Res interview: discuss care with family/friend
F0400G Asmt Code 1 613-613 Res interview: use phone in private
F0400H Asmt Code 1 614-614 Res interview: lock things to keep them safe
F0500A Asmt Code 1 615-615 Res interview: have books, newspaper, mags to read
F0500B Asmt Code 1 616-616 Res interview: listen to music
F0500C Asmt Code 1 617-617 Res interview: be around animals/pets
F0500D Asmt Code 1 618-618 Res interview: keep up with news
F0500E Asmt Code 1 619-619 Res interview: do things with groups of people
F0500F Asmt Code 1 620-620 Res interview: do favorite activities
F0500G Asmt Code 1 621-621 Res interview: go outside when good weather
F0500H Asmt Code 1 622-622 Res interview: participate in religious practices
F0600 Asmt Code 1 623-623 Primary respondent: daily/activities prefs
F0700 Asmt Code 1 624-624 Conduct staff assessment for daily/activity prefs
F0800A Asmt Checklist 1 625-625 Staff assessment: choosing clothes to wear
F0800B Asmt Checklist 1 626-626 Staff assessment: caring for personal belongings
F0800C Asmt Checklist 1 627-627 Staff assessment: receiving tub bath
F0800D Asmt Checklist 1 628-628 Staff assessment: receiving shower
F0800E Asmt Checklist 1 629-629 Staff assessment: receiving bed bath
F0800F Asmt Checklist 1 630-630 Staff assessment: receiving sponge bath
F0800G Asmt Checklist 1 631-631 Staff assessment: snacks between meals
F0800H Asmt Checklist 1 632-632 Staff assessment: staying up past 8PM
F0800I Asmt Checklist 1 633-633 Staff assessment: discuss care with family/other
F0800J Asmt Checklist 1 634-634 Staff assessment: use phone in private
F0800K Asmt Checklist 1 635-635 Staff assessment: place to lock personal things
F0800L Asmt Checklist 1 636-636 Staff assessment: reading books, newspapers, mags
F0800M Asmt Checklist 1 637-637 Staff assessment: listening to music
F0800N Asmt Checklist 1 638-638 Staff assessment: being around animals/pets
F0800O Asmt Checklist 1 639-639 Staff assessment: keeping up with news
F0800P Asmt Checklist 1 640-640 Staff assessment: doing things with groups
F0800Q Asmt Checklist 1 641-641 Staff assessment: participate favorite activities
F0800R Asmt Checklist 1 642-642 Staff assessment: spend time away from nursng home
F0800S Asmt Checklist 1 643-643 Staff assessment: spend time outdoors
F0800T Asmt Checklist 1 644-644 Staff assessment: participate religious activities
F0800Z Asmt Checklist 1 645-645 Staff assessment: none of above activities
GG0100A Asmt Code 1 1605-1605 Prior Functioning - Self Care
GG0100B Asmt Code 1 1606-1606 Prior Functioning - Indoor Mobility (Ambulation)
GG0100C Asmt Code 1 1607-1607 Prior Functioning - Stairs
GG0100D Asmt Code 1 1608-1608 Prior Functioning - Functional Cognition
GG0110A Asmt Checklist 1 1609-1609 Prior Device Use - Manual wheelchair
GG0110B Asmt Checklist 1 1610-1610 Prior Device Use - Mtrzd wheelchair and/or scooter
GG0110C Asmt Checklist 1 1611-1611 Prior Device Use - Mechanical lift
GG0110D Asmt Checklist 1 1612-1612 Prior Device Use - Walker
GG0110E Asmt Checklist 1 1613-1613 Prior Device Use - Orthotics/Prosthetics
GG0110Z Asmt Checklist 1 1614-1614 Prior Device Use - None of the above
GG0115A Asmt Code 1 1911-1911 Functional limits - Upper extremity
GG0115B Asmt Code 1 1912-1912 Functional limits - Lower extremity
GG0120A Asmt Checklist 1 1913-1913 Mobility Device - Cane/Crutch
GG0120B Asmt Checklist 1 1914-1914 Mobility Device - Walker
GG0120C Asmt Checklist 1 1915-1915 Mobility Device - Wheelchair (manual or electric)
GG0120D Asmt Checklist 1 1916-1916 Mobility Device - Limb prosthesis
GG0120Z Asmt Checklist 1 1917-1917 Mobility Device - None of the Above
GG0130A1 Asmt Code 2 1498-1499 Eating (Start of Stay Perf)
GG0130A2 Asmt Code 2 1500-1501 Eating (Dschg Goal)
GG0130A3 Asmt Code 2 1502-1503 Eating (Dischg Perf)
GG0130A5 Asmt Code 2 1704-1705 Eating (Interim Perf)
GG0130B1 Asmt Code 2 1504-1505 Oral hygiene (Start of Stay Perf)
GG0130B2 Asmt Code 2 1506-1507 Oral hygiene (Dschg Goal)
GG0130B3 Asmt Code 2 1508-1509 Oral hygiene (Dschg Perf)
GG0130B5 Asmt Code 2 1706-1707 Oral hygiene (Interim Perf)
GG0130C1 Asmt Code 2 1510-1511 Toileting hygiene (Start of Stay Perf)
GG0130C2 Asmt Code 2 1512-1513 Toileting hygiene (Dschg Goal)
GG0130C3 Asmt Code 2 1514-1515 Toileting hygiene (Dschg Perf)
GG0130C5 Asmt Code 2 1708-1709 Toileting hygiene (Interim Perf)
GG0130E1 Asmt Code 2 1615-1616 Shower/bathe self (Start of Stay Perf)
GG0130E2 Asmt Code 2 1617-1618 Shower/bathe self (Dschg Goal)
GG0130E3 Asmt Code 2 1619-1620 Shower/bathe self (Dschg Perf)
GG0130E5 Asmt Code 2 1918-1919 Shower/bathe self (Interim Perf)
GG0130F1 Asmt Code 2 1621-1622 Upper body dressing (Start of Stay Perf)
GG0130F2 Asmt Code 2 1623-1624 Upper body dressing (Dschg Goal)
GG0130F3 Asmt Code 2 1625-1626 Upper body dressing (Dschg Perf)
GG0130F5 Asmt Code 2 1920-1921 Upper body dressing (Interim Perf)
GG0130G1 Asmt Code 2 1627-1628 Lower body dressing (Start of Stay Perf)
GG0130G2 Asmt Code 2 1629-1630 Lower body dressing (Dschg Goal)
GG0130G3 Asmt Code 2 1631-1632 Lower body dressing (Dschg Perf)
GG0130G5 Asmt Code 2 1922-1923 Lower body dressing (Interim Perf)
GG0130H1 Asmt Code 2 1633-1634 Put on/take off footwear (Start of Stay Perf)
GG0130H2 Asmt Code 2 1635-1636 Put on/take off footwear (Dschg Goal)
GG0130H3 Asmt Code 2 1637-1638 Put on/take off footwear (Dschg Perf)
GG0130H5 Asmt Code 2 1924-1925 Put on/take off footwear (Interim Perf)
GG0130I1 Asmt Code 2 3297-3298 Personal Hygiene (Start of Stay Perf)
GG0130I3 Asmt Code 2 3299-3300 Personal Hygiene (Dschg Perf)
GG0130I5 Asmt Code 2 3301-3302 Personal Hygiene (Interim Perf)
GG0170A1 Asmt Code 2 1639-1640 Roll left and right (Start of Stay Perf)
GG0170A2 Asmt Code 2 1641-1642 Roll left and right (Dschg Goal)
GG0170A3 Asmt Code 2 1643-1644 Roll left and right (Dschg Perf)
GG0170A5 Asmt Code 2 3309-3310 Roll left and right (Interim Perf)
GG0170B1 Asmt Code 2 1516-1517 Sit to lying (Start of Stay Perf)
GG0170B2 Asmt Code 2 1518-1519 Sit to lying (Dschg Goal)
GG0170B3 Asmt Code 2 1520-1521 Sit to lying (Dschg Perf)
GG0170B5 Asmt Code 2 1710-1711 Sit to lying (Interim Perf)
GG0170C1 Asmt Code 2 1522-1523 Lying to sitting on bed side (Start of Stay Perf)
GG0170C2 Asmt Code 2 1524-1525 Lying to sitting on bed side (Dschg Goal)
GG0170C3 Asmt Code 2 1526-1527 Lying to sitting on bed side (Dschg Perf)
GG0170C5 Asmt Code 2 1712-1713 Lying to sitting on bed side (Interim Perf)
GG0170D1 Asmt Code 2 1528-1529 Sit to stand (Start of Stay Perf)
GG0170D2 Asmt Code 2 1530-1531 Sit to stand (Dschg Goal)
GG0170D3 Asmt Code 2 1532-1533 Sit to stand (Dschg Perf)
GG0170D5 Asmt Code 2 1714-1715 Sit to stand (Interim Perf)
GG0170E1 Asmt Code 2 1534-1535 Chair/bed-to-chair transfer (Start of Stay Perf)
GG0170E2 Asmt Code 2 1536-1537 Chair/bed-to-chair transfer (Dschg Goal)
GG0170E3 Asmt Code 2 1538-1539 Chair/bed-to-chair transfer (Dschg Perf)
GG0170E5 Asmt Code 2 1716-1717 Chair/bed-to-chair transfer (Interim Perf)
GG0170F1 Asmt Code 2 1540-1541 Toilet transfer (Start of Stay Perf)
GG0170F2 Asmt Code 2 1542-1543 Toilet transfer (Dschg Goal)
GG0170F3 Asmt Code 2 1544-1545 Toilet transfer (Dschg Perf)
GG0170F5 Asmt Code 2 1718-1719 Toilet transfer (Interim Perf)
GG0170FF1 Asmt Code 2 3303-3304 Tub/Showr Transfer (Start of Stay Perf)
GG0170FF3 Asmt Code 2 3305-3306 Tub/Showr Transfer (Dschg Perf)
GG0170FF5 Asmt Code 2 3307-3308 Tub/Showr Transfer (Interim Perf)
GG0170G1 Asmt Code 2 1645-1646 Car transfer (Start of Stay Perf)
GG0170G2 Asmt Code 2 1647-1648 Car transfer (Dschg Goal)
GG0170G3 Asmt Code 2 1649-1650 Car transfer (Dschg Perf)
GG0170I1 Asmt Code 2 1651-1652 Walk 10 feet (Start of Stay Perf)
GG0170I2 Asmt Code 2 1653-1654 Walk 10 feet (Dschg Goal)
GG0170I3 Asmt Code 2 1655-1656 Walk 10 feet (Dschg Perf)
GG0170I5 Asmt Code 2 1720-1721 Walk 10 feet (Interim Perf)
GG0170J1 Asmt Code 2 1548-1549 Walk 50 feet with two turns (Start of Stay Perf)
GG0170J2 Asmt Code 2 1550-1551 Walk 50 feet with two turns (Dschg Goal)
GG0170J3 Asmt Code 2 1552-1553 Walk 50 feet with two turns (Dschg Perf)
GG0170J5 Asmt Code 2 1722-1723 Walk 50 feet with two turns (Interim Perf)
GG0170K1 Asmt Code 2 1554-1555 Walk 150 feet (Start of Stay Perf)
GG0170K2 Asmt Code 2 1556-1557 Walk 150 feet (Dschg Goal)
GG0170K3 Asmt Code 2 1558-1559 Walk 150 feet (Dschg Perf)
GG0170K5 Asmt Code 2 1724-1725 Walk 150 feet (Interim Perf)
GG0170L1 Asmt Code 2 1657-1658 Walking 10 feet uneven surf (Start of Stay Perf)
GG0170L2 Asmt Code 2 1659-1660 Walking 10 feet uneven surf (Dschg Goal)
GG0170L3 Asmt Code 2 1661-1662 Walking 10 feet uneven surf (Dschg Perf)
GG0170M1 Asmt Code 2 1663-1664 1 step (curb) (Start of Stay Perf)
GG0170M2 Asmt Code 2 1665-1666 1 step (curb) (Dschg Goal)
GG0170M3 Asmt Code 2 1667-1668 1 step (curb) (Dschg Perf)
GG0170N1 Asmt Code 2 1669-1670 4 steps (Start of Stay Perf)
GG0170N2 Asmt Code 2 1671-1672 4 steps (Dschg Goal)
GG0170N3 Asmt Code 2 1673-1674 4 steps (Dschg Perf)
GG0170O1 Asmt Code 2 1675-1676 12 steps (Start of Stay Perf)
GG0170O2 Asmt Code 2 1677-1678 12 steps (Dschg Goal)
GG0170O3 Asmt Code 2 1679-1680 12 steps (Dschg Perf)
GG0170P1 Asmt Code 2 1681-1682 Picking up object (Start of Stay Perf)
GG0170P2 Asmt Code 2 1683-1684 Picking up object (Dschg Goal)
GG0170P3 Asmt Code 2 1685-1686 Picking up object (Dschg Perf)
GG0170Q1 Asmt Code 1 1560-1560 Use wheelchair and/or scooter (Start of Stay Perf)
GG0170Q3 Asmt Code 1 1561-1561 Use wheelchair and/or scooter (Dschg Perf)
GG0170Q5 Asmt Code 1 3311-3311 Use wheelchair and/or scooter (Interim Perf)
GG0170R1 Asmt Code 2 1562-1563 Wheel 50 feet with two turns (Start of Stay Perf)
GG0170R2 Asmt Code 2 1564-1565 Wheel 50 feet with two turns (Dschg Goal)
GG0170R3 Asmt Code 2 1566-1567 Wheel 50 feet with two turns (Dschg Perf)
GG0170R5 Asmt Code 2 3312-3313 Wheel 50 feet with two turns (Interim Perf)
GG0170RR1 Asmt Code 1 1568-1568 Type of wheelchair or scooter (Start of Stay Perf)
GG0170RR3 Asmt Code 1 1569-1569 Type of wheelchair or scooter (Dschg Perf)
GG0170RR5 Asmt Code 1 3314-3314 Type of wheelchair or scooter (Interim Perf)
GG0170S1 Asmt Code 2 1570-1571 Wheel 150 feet (Start of Stay Perf)
GG0170S2 Asmt Code 2 1572-1573 Wheel 150 feet (Dschg Goal)
GG0170S3 Asmt Code 2 1574-1575 Wheel 150 feet (Dschg Perf)
GG0170S5 Asmt Code 2 3315-3316 Wheel 150 feet (Interim Perf)
GG0170SS1 Asmt Code 1 1576-1576 Type of wheelchair or scooter (Start of Stay Perf)
GG0170SS3 Asmt Code 1 1577-1577 Type of wheelchair or scooter (Dschg Perf)
GG0170SS5 Asmt Code 1 3317-3317 Type of wheelchair or scooter (Interim Perf)
H0100A Asmt Checklist 1 682-682 Appliances: indwelling catheter
H0100B Asmt Checklist 1 683-683 Appliances: external catheter
H0100C Asmt Checklist 1 684-684 Appliances: ostomy
H0100D Asmt Checklist 1 685-685 Appliances: intermittent catheterization
H0100Z Asmt Checklist 1 686-686 Appliances: none of the above
H0200A Asmt Code 1 687-687 Urinary toileting program: has been attempted
H0200B Asmt Code 1 688-688 Urinary toileting program: response
H0200C Asmt Code 1 689-689 Urinary toileting program: current program/trial
H0300 Asmt Code 1 690-690 Urinary continence
H0400 Asmt Code 1 691-691 Bowel continence
H0500 Asmt Code 1 692-692 Bowel toileting program being used
H0600 Asmt Code 1 693-693 Constipation
I0020 Asmt Code 2 1687-1688 Primary Medical Condition Category
I0020B Asmt ICD 8 1726-1733 Primary Medical Condition ICD
I0100 Asmt Checklist 1 694-694 Cancer (with or without metastasis)
I0200 Asmt Checklist 1 695-695 Anemia
I0300 Asmt Checklist 1 696-696 Atrial fibrillation and other dysrhythmias
I0400 Asmt Checklist 1 697-697 Coronary artery disease (CAD)
I0500 Asmt Checklist 1 698-698 Deep venous thrombosis (DVT), PE, or PTE
I0600 Asmt Checklist 1 699-699 Heart failure
I0700 Asmt Checklist 1 700-700 Hypertension
I0800 Asmt Checklist 1 701-701 Orthostatic hypotension
I0900 Asmt Checklist 1 702-702 Peripheral vascular disease (PVD) or PAD
I1100 Asmt Checklist 1 703-703 Cirrhosis
I1200 Asmt Checklist 1 704-704 Gastroesophageal reflux disease (GERD) or ulcer
I1300 Asmt Checklist 1 705-705 Ulcerative colitis, Chrohn"s, inflam bowel disease
I1400 Asmt Checklist 1 706-706 Benign prostatic hyperplasia (BPH)
I1500 Asmt Checklist 1 707-707 Renal insufficiency, renal failure, ESRD
I1550 Asmt Checklist 1 708-708 Neurogenic bladder
I1650 Asmt Checklist 1 709-709 Obstructive uropathy
I1700 Asmt Checklist 1 710-710 Multidrug resistant organism (MDRO)
I2000 Asmt Checklist 1 711-711 Pneumonia
I2100 Asmt Checklist 1 712-712 Septicemia
I2200 Asmt Checklist 1 713-713 Tuberculosis
I2300 Asmt Checklist 1 714-714 Urinary tract infection (UTI) (LAST 30 DAYS)
I2400 Asmt Checklist 1 715-715 Viral hepatitis (includes type A, B, C, D, and E)
I2500 Asmt Checklist 1 716-716 Wound infection (other than foot)
I2900 Asmt Checklist 1 717-717 Diabetes mellitus (DM)
I3100 Asmt Checklist 1 718-718 Hyponatremia
I3200 Asmt Checklist 1 719-719 Hyperkalemia
I3300 Asmt Checklist 1 720-720 Hyperlipidemia (e.g., hypercholesterolemia)
I3400 Asmt Checklist 1 721-721 Thyroid disorder
I3700 Asmt Checklist 1 722-722 Arthritis
I3800 Asmt Checklist 1 723-723 Osteoporosis
I3900 Asmt Checklist 1 724-724 Hip fracture
I4000 Asmt Checklist 1 725-725 Other fracture
I4200 Asmt Checklist 1 726-726 Alzheimer"s disease
I4300 Asmt Checklist 1 727-727 Aphasia
I4400 Asmt Checklist 1 728-728 Cerebral palsy
I4500 Asmt Checklist 1 729-729 Cerebrovascular accident (CVA), TIA, or stroke
I4800 Asmt Checklist 1 730-730 Non-Alzheimer"s dementia
I4900 Asmt Checklist 1 731-731 Hemiplegia or hemiparesis
I5000 Asmt Checklist 1 732-732 Paraplegia
I5100 Asmt Checklist 1 733-733 Quadriplegia
I5200 Asmt Checklist 1 734-734 Multiple sclerosis
I5250 Asmt Checklist 1 735-735 Huntington"s disease
I5300 Asmt Checklist 1 736-736 Parkinson"s disease
I5350 Asmt Checklist 1 737-737 Tourette"s syndrome
I5400 Asmt Checklist 1 738-738 Seizure disorder or epilepsy
I5500 Asmt Checklist 1 739-739 Traumatic brain injury (TBI)
I5600 Asmt Checklist 1 740-740 Malnutrition (protein, calorie), risk of malnutrit
I5700 Asmt Checklist 1 741-741 Anxiety disorder
I5800 Asmt Checklist 1 742-742 Depression (other than bipolar)
I5900 Asmt Checklist 1 743-743 Bipolar disorder
I5950 Asmt Checklist 1 744-744 Psychotic disorder (other than schizophrenia)
I6000 Asmt Checklist 1 745-745 Schizophrenia
I6100 Asmt Checklist 1 746-746 Post-traumatic stress disorder (PTSD)
I6200 Asmt Checklist 1 747-747 Asthma (COPD) or chronic lung disease
I6300 Asmt Checklist 1 748-748 Respiratory failure
I6500 Asmt Checklist 1 749-749 Cataracts, glaucoma, or macular degeneration
I7900 Asmt Checklist 1 750-750 None of above active diseases within last 7 days
I8000A Asmt ICD 8 751-758 Additional active ICD diagnosis 1
I8000B Asmt ICD 8 759-766 Additional active ICD diagnosis 2
I8000C Asmt ICD 8 767-774 Additional active ICD diagnosis 3
I8000D Asmt ICD 8 775-782 Additional active ICD diagnosis 4
I8000E Asmt ICD 8 783-790 Additional active ICD diagnosis 5
I8000F Asmt ICD 8 791-798 Additional active ICD diagnosis 6
I8000G Asmt ICD 8 799-806 Additional active ICD diagnosis 7
I8000H Asmt ICD 8 807-814 Additional active ICD diagnosis 8
I8000I Asmt ICD 8 815-822 Additional active ICD diagnosis 9
I8000J Asmt ICD 8 823-830 Additional active ICD diagnosis 10
J0100A Asmt Code 1 831-831 Pain: received scheduled pain med regimen
J0100B Asmt Code 1 832-832 Pain: received PRN pain medications
J0100C Asmt Code 1 833-833 Pain: received non-medication intervention
J0200 Asmt Code 1 834-834 Should pain assessment interview be conducted
J0300 Asmt Code 1 835-835 Res pain interview: presence
J0410 Asmt Code 1 3318-3318 Pain Frequency
J0510 Asmt Code 1 3319-3319 Pain Effect on Sleep
J0520 Asmt Code 1 3320-3320 Pain Interference with Therapy Activities
J0530 Asmt Code 1 3321-3321 Pain Interference with Day-to-Day Activities
J0600A Asmt Number 2 839-840 Res pain interview: intensity rating scale
J0600B Asmt Code 1 841-841 Res pain interview: verbal descriptor scale
J0700 Asmt Code 1 842-842 Should staff assessment for pain be conducted
J0800A Asmt Checklist 1 843-843 Staff pain asmt: non-verbal sounds
J0800B Asmt Checklist 1 844-844 Staff pain asmt: vocal complaints of pain
J0800C Asmt Checklist 1 845-845 Staff pain asmt: facial expressions
J0800D Asmt Checklist 1 846-846 Staff pain asmt: protective movements/postures
J0800Z Asmt Checklist 1 847-847 Staff pain asmt: none of these signs observed
J0850 Asmt Code 1 848-848 Staff pain asmt: frequency of pain
J1100A Asmt Checklist 1 849-849 Short breath/trouble breathing: with exertion
J1100B Asmt Checklist 1 850-850 Short breath/trouble breathing: sitting at rest
J1100C Asmt Checklist 1 851-851 Short breath/trouble breathing: lying flat
J1100Z Asmt Checklist 1 852-852 Short breath/trouble breathing: none of above
J1300 Asmt Code 1 853-853 Current tobacco use
J1400 Asmt Code 1 854-854 Prognosis: life expectancy of less than 6 months
J1550A Asmt Checklist 1 855-855 Problem conditions: fever
J1550B Asmt Checklist 1 856-856 Problem conditions: vomiting
J1550C Asmt Checklist 1 857-857 Problem conditions: dehydrated
J1550D Asmt Checklist 1 858-858 Problem conditions: internal bleeding
J1550Z Asmt Checklist 1 859-859 Problem conditions: none of the above
J1700A Asmt Code 1 860-860 Fall history: fall during month before admission
J1700B Asmt Code 1 861-861 Fall history: fall 2-6 months before admission
J1700C Asmt Code 1 862-862 Fall history: fracture from fall 6 month pre admit
J1800 Asmt Code 1 863-863 Falls since admit/prior asmt: any falls
J1900A Asmt Code 1 864-864 Falls since admit/prior asmt: no injury
J1900B Asmt Code 1 865-865 Falls since admit/prior asmt: injury (not major)
J1900C Asmt Code 1 866-866 Falls since admit/prior asmt: major injury
J2000 Asmt Code 1 1697-1697 Prior Surgery (100 days)
J2100 Asmt Code 1 1734-1734 Recent Surgery Requiring Active SNF Care
J2300 Asmt Checklist 1 1735-1735 Knee Replacement - partial or total
J2310 Asmt Checklist 1 1736-1736 Hip Replacement - partial or total
J2320 Asmt Checklist 1 1737-1737 Ankle Replacement - partial or total
J2330 Asmt Checklist 1 1738-1738 Shoulder Replacement - partial or total
J2400 Asmt Checklist 1 1739-1739 Spinal Surgery-spinal cord or major spinal nerves
J2410 Asmt Checklist 1 1740-1740 Spinal surgery - fusion of spinal bones
J2420 Asmt Checklist 1 1741-1741 Spinal surgery - lamina, discs, or facets
J2499 Asmt Checklist 1 1742-1742 Spinal surgery - other
J2500 Asmt Checklist 1 1743-1743 Ortho srgry - rpr frctrd shoulder/arm
J2510 Asmt Checklist 1 1744-1744 Ortho srgry - rpr frctrd pelvis/hip/leg/knee/ankle
J2520 Asmt Checklist 1 1745-1745 Ortho srgry - rpr but not replace joints
J2530 Asmt Checklist 1 1746-1746 Ortho srgry - rpr other bones
J2599 Asmt Checklist 1 1747-1747 Ortho srgry - other
J2600 Asmt Checklist 1 1748-1748 Neuro surgery - brain, surrounding tissue
J2610 Asmt Checklist 1 1749-1749 Neuro surgery - nervous system
J2620 Asmt Checklist 1 1750-1750 Neuro surgery - nsrt neural/brain neurostimulators
J2699 Asmt Checklist 1 1751-1751 Neuro surgery - other
J2700 Asmt Checklist 1 1752-1752 Cardiopulmonary surgery - heart/mjr bld vssls
J2710 Asmt Checklist 1 1753-1753 Cardiopulmonary surgery - respiratory system
J2799 Asmt Checklist 1 1754-1754 Cardiopulmonary surgery - other
J2800 Asmt Checklist 1 1755-1755 Genitourinary surgery - male or female organs
J2810 Asmt Checklist 1 1756-1756 Genitourinary surgery - kidneys
J2899 Asmt Checklist 1 1757-1757 Genitourinary surgery - other
J2900 Asmt Checklist 1 1758-1758 Major surgery - tendons, ligament, or muscles
J2910 Asmt Checklist 1 1759-1759 Major surgery - GI tract/abdominal contents
J2920 Asmt Checklist 1 1760-1760 Major surgery - endocrine organs
J2930 Asmt Checklist 1 1761-1761 Major surgery - breast
J2940 Asmt Checklist 1 1762-1762 Major surgery - repair deep ulcers
J5000 Asmt Checklist 1 1763-1763 Major surgery - other not listed above
K0100A Asmt Checklist 1 867-867 Swallow disorder: loss liquids/solids from mouth
K0100B Asmt Checklist 1 868-868 Swallow disorder: holds food in mouth/cheeks
K0100C Asmt Checklist 1 869-869 Swallow disorder: cough/choke with meals/meds
K0100D Asmt Checklist 1 870-870 Swallow disorder: difficulty or pain swallowing
K0100Z Asmt Checklist 1 871-871 Swallow disorder: none of the above
K0200A Asmt Number 2 872-873 Height (in inches)
K0200B Asmt Number 3 874-876 Weight (in pounds)
K0300 Asmt Code 1 877-877 Weight loss
K0310 Asmt Code 1 1443-1443 Weight Gain
K0520A1 Asmt Checklist 1 3322-3322 Nutritional Approaches (Admission): Parenteral
K0520A2 Asmt Checklist 1 3323-3323 Nutritional Approaches (Non-res): Parenteral
K0520A3 Asmt Checklist 1 3324-3324 Nutritional Approaches (7 days): Parenteral
K0520A4 Asmt Checklist 1 3325-3325 Nutritional Approaches (Discharge): Parenteral
K0520B1 Asmt Checklist 1 3326-3326 Nutritional Approaches (Admission): Feeding tube
K0520B2 Asmt Checklist 1 3327-3327 Nutritional Approaches (Non-res): Feeding tube
K0520B3 Asmt Checklist 1 3328-3328 Nutritional Approaches (7 days): Feeding tube
K0520B4 Asmt Checklist 1 3329-3329 Nutritional Approaches (Discharge): Feeding tube
K0520C1 Asmt Checklist 1 3330-3330 Nutritional Approaches (Admission): Mech Alt Diet
K0520C3 Asmt Checklist 1 3331-3331 Nutritional Approaches (7-day): Mech Alt Diet
K0520C4 Asmt Checklist 1 3332-3332 Nutritional Approaches (Discharge): Mech Alt Diet
K0520D1 Asmt Checklist 1 3333-3333 Nutritional Approaches (Admission): Therapeutic
K0520D3 Asmt Checklist 1 3334-3334 Nutritional Approaches (7-day): Therapeutic
K0520D4 Asmt Checklist 1 3335-3335 Nutritional Approaches (Discharge): Therapeutic
K0520Z1 Asmt Checklist 1 3336-3336 Nutritional Approaches (Admission): None
K0520Z2 Asmt Checklist 1 3337-3337 Nutritional Approaches (Non-res): None
K0520Z3 Asmt Checklist 1 3338-3338 Nutritional Approaches (7-day): None
K0520Z4 Asmt Checklist 1 3339-3339 Nutritional Approaches (Discharge): None
K0710A2 Asmt Code 1 1467-1467 Prop calories parenteral/tube feed: while resident
K0710A3 Asmt Code 1 1468-1468 Prop calories parenteral/tube feed: 7 days
K0710B2 Asmt Code 1 1470-1470 Avg fluid intake per day IV/ tube: while resident
K0710B3 Asmt Code 1 1471-1471 Avg fluid intake per day IV/tube: 7 days
L0200A Asmt Checklist 1 885-885 Dental: broken or loosely fitting denture
L0200B Asmt Checklist 1 886-886 Dental: no natural teeth or tooth fragment(s)
L0200C Asmt Checklist 1 887-887 Dental: abnormal mouth tissue
L0200D Asmt Checklist 1 888-888 Dental: cavity or broken natural teeth
L0200E Asmt Checklist 1 889-889 Dental: inflamed/bleeding gums or loose teeth
L0200F Asmt Checklist 1 890-890 Dental: pain, discomfort, difficulty chewing
L0200G Asmt Checklist 1 891-891 Dental: unable to examine
L0200Z Asmt Checklist 1 892-892 Dental: none of the above
M0100A Asmt Checklist 1 893-893 Risk determination: has PU/injury, scar, dressing
M0100B Asmt Checklist 1 894-894 Risk determination: formal assessment
M0100C Asmt Checklist 1 895-895 Risk determination: clinical assessment
M0100Z Asmt Checklist 1 896-896 Risk determination: none of the above
M0150 Asmt Code 1 897-897 Is resident at risk of developing PU/injuries
M0210 Asmt Code 1 898-898 Resident has 1+ unhealed PU/injuries
M0300A Asmt Number 1 899-899 Stage 1 pressure injuries: number present
M0300B1 Asmt Number 1 900-900 Stage 2 pressure ulcers: number present
M0300B2 Asmt Number 1 901-901 Stage 2 pressure ulcers: number at admit/reentry
M0300C1 Asmt Number 1 910-910 Stage 3 pressure ulcers: number present
M0300C2 Asmt Number 1 911-911 Stage 3 pressure ulcers: number at admit/reentry
M0300D1 Asmt Number 1 912-912 Stage 4 pressure ulcers: number present
M0300D2 Asmt Number 1 913-913 Stage 4 pressure ulcers: number at admit/reentry
M0300E1 Asmt Number 1 914-914 Unstaged due to drssng/dvc: num present
M0300E2 Asmt Number 1 915-915 Unstaged due to drssng/dvc: num at admit/reentry
M0300F1 Asmt Number 1 916-916 Unstaged slough/eschar: number present
M0300F2 Asmt Number 1 917-917 Unstaged slough/eschar: number at admit/reentry
M0300G1 Asmt Number 1 918-918 Unstageable - deep tissue injury: # present
M0300G2 Asmt Number 1 919-919 Unstageable - deep tissue injury: # at adm/reent
M1030 Asmt Number 1 940-940 Number of venous and arterial ulcers
M1040A Asmt Checklist 1 941-941 Other skin probs: infection of the foot
M1040B Asmt Checklist 1 942-942 Other skin probs: diabetic foot ulcer(s)
M1040C Asmt Checklist 1 943-943 Other skin probs: other open lesion(s) on the foot
M1040D Asmt Checklist 1 944-944 Other skin probs: lesions not ulcers, rashes, cuts
M1040E Asmt Checklist 1 945-945 Other skin probs: surgical wound(s)
M1040F Asmt Checklist 1 946-946 Other skin probs: burns (second or third degree)
M1040G Asmt Checklist 1 1454-1454 Skin Tear(s)
M1040H Asmt Checklist 1 1455-1455 Moisture Associated Skin Damage (MASD)
M1040Z Asmt Checklist 1 947-947 Other skin probs: none of the above
M1200A Asmt Checklist 1 948-948 Skin/ulcer/injry treat: prssr rduce dvc for chair
M1200B Asmt Checklist 1 949-949 Skin/ulcer/injry treat: prssr reducing dvc for bed
M1200C Asmt Checklist 1 950-950 Skin/ulcer/injry treat: turning/repositioning
M1200D Asmt Checklist 1 951-951 Skin/ulcer/injry treat: nutrition/hydration
M1200E Asmt Checklist 1 952-952 Skin/ulcer/injry treat: prssr ulcer/injry care
M1200F Asmt Checklist 1 953-953 Skin/ulcer/injry treat: surgical wound care
M1200G Asmt Checklist 1 954-954 Skin/ulcer/injry treat: application of dressings
M1200H Asmt Checklist 1 955-955 Skin/ulcer/injry treat: apply ointments/meds
M1200I Asmt Checklist 1 956-956 Skin/ulcer/injry treat: apply dressings to feet
M1200Z Asmt Checklist 1 957-957 Skin/ulcer/injry treat: none of the above
N0300 Asmt Number 1 958-958 Number of days injectable medications received
N0350A Asmt Number 1 959-959 Insulin: insulin injections
N0350B Asmt Number 1 960-960 Insulin: orders for insulin
N0415A1 Asmt Checklist 1 3340-3340 High-Risk Drug (Is Taking): Antipsychotic
N0415A2 Asmt Checklist 1 3341-3341 High-Risk Drug (Indication): Antipsychotic
N0415B1 Asmt Checklist 1 3342-3342 High-Risk Drug (Is Taking): Antianxiety
N0415B2 Asmt Checklist 1 3343-3343 High-Risk Drug (Indication): Antianxiety
N0415C1 Asmt Checklist 1 3344-3344 High-Risk Drug (Is Taking): Antidepressant
N0415C2 Asmt Checklist 1 3345-3345 High-Risk Drug (Indication): Antidepressant
N0415D1 Asmt Checklist 1 3346-3346 High-Risk Drug (Is Taking): Hypnotic
N0415D2 Asmt Checklist 1 3347-3347 High-Risk Drug (Indication): Hypnotic
N0415E1 Asmt Checklist 1 3348-3348 High-Risk Drug (Is Taking): Anticoagulant
N0415E2 Asmt Checklist 1 3349-3349 High-Risk Drug (Indication): Anticoagulant
N0415F1 Asmt Checklist 1 3350-3350 High-Risk Drug (Is Taking): Antibiotic
N0415F2 Asmt Checklist 1 3351-3351 High-Risk Drug (Indication): Antibiotic
N0415G1 Asmt Checklist 1 3352-3352 High-Risk Drug (Is Taking): Diuretic
N0415G2 Asmt Checklist 1 3353-3353 High-Risk Drug (Indication): Diuretic
N0415H1 Asmt Checklist 1 3354-3354 High-Risk Drug (Is Taking): Opioid
N0415H2 Asmt Checklist 1 3355-3355 High-Risk Drug (Indication): Opioid
N0415I1 Asmt Checklist 1 3356-3356 High-Risk Drug (Is Taking): Antiplatelet
N0415I2 Asmt Checklist 1 3357-3357 High-Risk Drug (Indication): Antiplatelet
N0415J1 Asmt Checklist 1 3358-3358 High-Risk Drug (Is Taking): Hypoglycemic
N0415J2 Asmt Checklist 1 3359-3359 High-Risk Drug (Indication): Hypoglycemic
N0415Z1 Asmt Checklist 1 3360-3360 High-Risk Drug (Is taking): None of the Above
N0450A Asmt Code 1 1580-1580 Resident received antipsychotic medications
N0450B Asmt Code 1 1581-1581 GDR attempted
N0450C Asmt Date 8 1582-1589 Date of last attempted GDR
N0450D Asmt Code 1 1590-1590 Physician documented GDR
N0450E Asmt Date 8 1591-1598 Date physician documented GDR
N2001 Asmt Code 1 1698-1698 Drug Regimen Review
N2003 Asmt Code 1 1699-1699 Medication Follow-up
N2005 Asmt Code 1 1700-1700 Medication Intervention
O0110A1A Asmt Checklist 1 3363-3363 Treatment: Chemotherapy (Admission)
O0110A1B Asmt Checklist 1 3364-3364 Treatment: Chemotherapy (14 days)
O0110A1C Asmt Checklist 1 3365-3365 Treatment: Chemotherapy (Discharge)
O0110A2A Asmt Checklist 1 3366-3366 Treatment: Chemo - IV (Admission)
O0110A2C Asmt Checklist 1 3367-3367 Treatment: Chemo - IV (Discharge)
O0110A3A Asmt Checklist 1 3368-3368 Treatment: Chemo - Oral (Admission)
O0110A3C Asmt Checklist 1 3369-3369 Treatment: Chemo - Oral (Discharge)
O0110A10A Asmt Checklist 1 3361-3361 Treatment: Chemo - Other (Admission)
O0110A10C Asmt Checklist 1 3362-3362 Treatment: Chemo - Other (Discharge)
O0110B1A Asmt Checklist 1 3370-3370 Treatment: Radiation (Admission)
O0110B1B Asmt Checklist 1 3371-3371 Treatment: Radiation (14 days)
O0110B1C Asmt Checklist 1 3372-3372 Treatment: Radiation (Discharge)
O0110C1A Asmt Checklist 1 3373-3373 Therapies: Oxygen Therapy (Admission)
O0110C1B Asmt Checklist 1 3374-3374 Therapies: Oxygen Therapy (14 days)
O0110C1C Asmt Checklist 1 3375-3375 Therapies: Oxygen Therapy (Discharge)
O0110C2A Asmt Checklist 1 3376-3376 Therapies: Oxygen - Continuous (Admission)
O0110C2C Asmt Checklist 1 3377-3377 Therapies: Oxygen - Continuous (Discharge)
O0110C3A Asmt Checklist 1 3378-3378 Therapies: Oxygen - Intermittent (Admission)
O0110C3C Asmt Checklist 1 3379-3379 Therapies: Oxygen - Intermittent (Discharge)
O0110C4A Asmt Checklist 1 3380-3380 Therapies: Oxygen - High-concentration (Admission)
O0110C4C Asmt Checklist 1 3381-3381 Therapies: Oxygen - High-concentration (Discharge)
O0110D1A Asmt Checklist 1 3382-3382 Therapies: Suctioning (Admission)
O0110D1B Asmt Checklist 1 3383-3383 Therapies: Suctioning (14 days)
O0110D1C Asmt Checklist 1 3384-3384 Therapies: Suctioning (Discharge)
O0110D2A Asmt Checklist 1 3385-3385 Therapies: Suctioning - Scheduled (Admission)
O0110D2C Asmt Checklist 1 3386-3386 Therapies: Suctioning - Scheduled (Discharge)
O0110D3A Asmt Checklist 1 3387-3387 Therapies: Suctioning - As Needed (Admission)
O0110D3C Asmt Checklist 1 3388-3388 Therapies: Suctioning - As Needed (Discharge)
O0110E1A Asmt Checklist 1 3389-3389 Therapies: Tracheostomy Care (Admission)
O0110E1B Asmt Checklist 1 3390-3390 Therapies: Tracheostomy Care (14 days)
O0110E1C Asmt Checklist 1 3391-3391 Therapies: Tracheostomy Care (Discharge)
O0110F1A Asmt Checklist 1 3392-3392 Therapies: Invasive Mechanical Ventilator (Admis)
O0110F1B Asmt Checklist 1 3393-3393 Therapies: Invasive Mechanical Ventilator (14day)
O0110F1C Asmt Checklist 1 3394-3394 Therapies: Invasive Mechanical Ventilator (Disch)
O0110G1A Asmt Checklist 1 3395-3395 Therapies: Non-Invas Mechanical Ventilator (Admis)
O0110G1B Asmt Checklist 1 3396-3396 Therapies: Non-Invas Mechanical Ventilator (14day)
O0110G1C Asmt Checklist 1 3397-3397 Therapies: Non-Invas Mechanical Ventilator (Disch)
O0110G2A Asmt Checklist 1 3398-3398 Therapies: BiPAP (Admission)
O0110G2C Asmt Checklist 1 3399-3399 Therapies: BiPAP (Discharge)
O0110G3A Asmt Checklist 1 3400-3400 Therapies: CPAP (Admission)
O0110G3C Asmt Checklist 1 3401-3401 Therapies: CPAP (Discharge)
O0110H1A Asmt Checklist 1 3404-3404 Other: IV Medications (Admission)
O0110H1B Asmt Checklist 1 3405-3405 Other: IV Medications (14 days)
O0110H1C Asmt Checklist 1 3406-3406 Other: IV Medications (Discharge)
O0110H2A Asmt Checklist 1 3407-3407 Other: IV - Vasoactive medications (Admission)
O0110H2C Asmt Checklist 1 3408-3408 Other: IV - Vasoactive medications (Discharge)
O0110H3A Asmt Checklist 1 3409-3409 Other: IV - Antibiotics (Admission)
O0110H3C Asmt Checklist 1 3410-3410 Other: IV - Antibiotics (Discharge)
O0110H4A Asmt Checklist 1 3411-3411 Other: IV - Anticoagulation (Admission)
O0110H4C Asmt Checklist 1 3412-3412 Other: IV - Anticoagulation (Discharge)
O0110H10A Asmt Checklist 1 3402-3402 Other: IV - Other (Admission)
O0110H10C Asmt Checklist 1 3403-3403 Other: IV - Other (Discharge)
O0110I1A Asmt Checklist 1 3413-3413 Other: Transfusions (Admission)
O0110I1B Asmt Checklist 1 3414-3414 Other: Transfusions (14 days)
O0110I1C Asmt Checklist 1 3415-3415 Other: Transfusions (Discharge)
O0110J1A Asmt Checklist 1 3416-3416 Other: Dialysis (Admission)
O0110J1B Asmt Checklist 1 3417-3417 Other: Dialysis (14 days)
O0110J1C Asmt Checklist 1 3418-3418 Other: Dialysis (Discharge)
O0110J2A Asmt Checklist 1 3419-3419 Other: Hemodialysis (Admission)
O0110J2C Asmt Checklist 1 3420-3420 Other: Hemodialysis (Discharge)
O0110J3A Asmt Checklist 1 3421-3421 Other: Peritoneal dialysis (Admission)
O0110J3C Asmt Checklist 1 3422-3422 Other: Peritoneal dialysis (Discharge)
O0110K1B Asmt Checklist 1 3423-3423 Other: Hospice care (14 days)
O0110M1B Asmt Checklist 1 3424-3424 Other: Isolation - Infectious Disease (14 days)
O0110O1A Asmt Checklist 1 3425-3425 Other: IV Access (Admission)
O0110O1B Asmt Checklist 1 3426-3426 Other: IV Access (14 days)
O0110O1C Asmt Checklist 1 3427-3427 Other: IV Access (Discharge)
O0110O2A Asmt Checklist 1 3428-3428 Other: IV Access - Peripheral (Admission)
O0110O2C Asmt Checklist 1 3429-3429 Other: IV Access - Peripheral (Discharge)
O0110O3A Asmt Checklist 1 3430-3430 Other: IV Access - Midline (Admission)
O0110O3C Asmt Checklist 1 3431-3431 Other: IV Access - Midline (Discharge)
O0110O4A Asmt Checklist 1 3432-3432 Other: IV Access - Central (Admission)
O0110O4C Asmt Checklist 1 3433-3433 Other: IV Access - Central (Discharge)
O0110Z1A Asmt Checklist 1 3434-3434 Other: None of the above (Admission)
O0110Z1B Asmt Checklist 1 3435-3435 Other: None of the above (14 days)
O0110Z1C Asmt Checklist 1 3436-3436 Other: None of the above (Discharge)
O0250A Asmt Code 1 996-996 Was influenza vaccine received
O0250B Asmt Date 8 997-1004 Date influenza vaccine received.
O0250C Asmt Code 1 1005-1005 If influenza vaccine not received, state reason
O0300A Asmt Code 1 1006-1006 Is pneumococcal vaccination up to date
O0300B Asmt Code 1 1007-1007 If pneumococcal vacc not received, state reason
O0400A1 Asmt Number 4 1008-1011 Speech-language/audiology: individ minutes
O0400A2 Asmt Number 4 1012-1015 Speech-language/audiology: concur minutes
O0400A3 Asmt Number 4 1016-1019 Speech-language/audiology: group minutes
O0400A3A Asmt Number 4 1472-1475 Speech-language/audiology: co-treatment minutes
O0400A4 Asmt Number 1 1020-1020 Speech-language/audiology: number of days
O0400A5 Asmt Date 8 1021-1028 Speech-language/audiology: start date
O0400A6 Asmt Date 8 1029-1036 Speech-language/audiology: end date
O0400B1 Asmt Number 4 1037-1040 Occupational therapy: individ minutes
O0400B2 Asmt Number 4 1041-1044 Occupational therapy: concur minutes
O0400B3 Asmt Number 4 1045-1048 Occupational therapy: group minutes
O0400B3A Asmt Number 4 1476-1479 Occupational therapy: co-treatment minutes
O0400B4 Asmt Number 1 1049-1049 Occupational therapy: number of days
O0400B5 Asmt Date 8 1050-1057 Occupational therapy: start date
O0400B6 Asmt Date 8 1058-1065 Occupational therapy: end date
O0400C1 Asmt Number 4 1066-1069 Physical therapy: individ minutes
O0400C2 Asmt Number 4 1070-1073 Physical therapy: concur minutes
O0400C3 Asmt Number 4 1074-1077 Physical therapy: group minutes
O0400C3A Asmt Number 4 1480-1483 Physical therapy: co-treatment minutes
O0400C4 Asmt Number 1 1078-1078 Physical therapy: number of days
O0400C5 Asmt Date 8 1079-1086 Physical therapy: start date
O0400C6 Asmt Date 8 1087-1094 Physical therapy: end date
O0400D1 Asmt Number 4 1095-1098 Respiratory therapy: number of minutes
O0400D2 Asmt Number 1 1099-1099 Respiratory therapy: number of days
O0400E1 Asmt Number 4 1100-1103 Psychological therapy: number of minutes
O0400E2 Asmt Number 1 1104-1104 Psychological therapy: number of days
O0400F1 Asmt Number 4 1105-1108 Recreational therapy: number of minutes
O0400F2 Asmt Number 1 1109-1109 Recreational therapy: number of days
O0420 Asmt Number 1 1484-1484 Distinct calendar days of therapy
O0425A1 Asmt Number 4 1764-1767 SLP and Audiology Services: Individual Minutes
O0425A2 Asmt Number 4 1768-1771 SLP and Audiology Services: Concurrent Minutes
O0425A3 Asmt Number 4 1772-1775 SLP and Audiology Services: Group Minutes
O0425A4 Asmt Number 4 1776-1779 SLP and Audiology Services: Co-treatment Minutes
O0425A5 Asmt Number 3 1780-1782 SLP and Audiology Services: Days
O0425B1 Asmt Number 4 1783-1786 Occupational Therapy: Individual Minutes
O0425B2 Asmt Number 4 1787-1790 Occupational Therapy: Concurrent Minutes
O0425B3 Asmt Number 4 1791-1794 Occupational Therapy: Group Minutes
O0425B4 Asmt Number 4 1795-1798 Occupational Therapy: Co-treatment Minutes
O0425B5 Asmt Number 3 1799-1801 Occupational Therapy: Days
O0425C1 Asmt Number 4 1802-1805 Physical Therapy: Individual Minutes
O0425C2 Asmt Number 4 1806-1809 Physical Therapy: Concurrent Minutes
O0425C3 Asmt Number 4 1810-1813 Physical Therapy: Group Minutes
O0425C4 Asmt Number 4 1814-1817 Physical Therapy: Co-treatment Minutes
O0425C5 Asmt Number 3 1818-1820 Physical Therapy: Days
O0430 Asmt Number 3 1821-1823 Distinct Calendar Days of Part A Therapy
O0450A Asmt Code 1 1429-1429 Has therapy resumed
O0500A Asmt Number 1 1110-1110 Range of motion (passive): number of days
O0500B Asmt Number 1 1111-1111 Range of motion (active): number of days
O0500C Asmt Number 1 1112-1112 Splint or brace assistance: number of days
O0500D Asmt Number 1 1113-1113 Bed mobility training: number of days
O0500E Asmt Number 1 1114-1114 Transfer training: number of days
O0500F Asmt Number 1 1115-1115 Walking training: number of days
O0500G Asmt Number 1 1116-1116 Dressing and/or grooming training: number of days
O0500H Asmt Number 1 1117-1117 Eating and/or swallowing training: number of days
O0500I Asmt Number 1 1118-1118 Amputation/prosthesis training: number of days
O0500J Asmt Number 1 1119-1119 Communication training: number of days
P0100A Asmt Code 1 1124-1124 Restraints used in bed: bed rail
P0100B Asmt Code 1 1125-1125 Restraints used in bed: trunk restraint
P0100C Asmt Code 1 1126-1126 Restraints used in bed: limb restraint
P0100D Asmt Code 1 1127-1127 Restraints used in bed: other
P0100E Asmt Code 1 1128-1128 Restraints in chair/out of bed: trunk restraint
P0100F Asmt Code 1 1129-1129 Restraints in chair/out of bed: limb restraint
P0100G Asmt Code 1 1130-1130 Restraints in chair/out of bed: chair stops rising
P0100H Asmt Code 1 1131-1131 Restraints in chair/out of bed: other
P0200A Asmt Code 1 1599-1599 Bed alarm
P0200B Asmt Code 1 1600-1600 Chair alarm
P0200C Asmt Code 1 1601-1601 Floor mat alarm
P0200D Asmt Code 1 1602-1602 Motion sensor alarm
P0200E Asmt Code 1 1603-1603 Wander/elopement alarm
P0200F Asmt Code 1 1604-1604 Other alarm
Q0110A Asmt Checklist 1 3437-3437 Participants: Resident
Q0110B Asmt Checklist 1 3438-3438 Participants: Family
Q0110C Asmt Checklist 1 3439-3439 Participants: Significant other
Q0110D Asmt Checklist 1 3440-3440 Participants: Legal guardian
Q0110E Asmt Checklist 1 3441-3441 Participants: Other legal representative
Q0110Z Asmt Checklist 1 3442-3442 Participants: None of the Above
Q0310A Asmt Code 1 3443-3443 Resident"s Overall Goal
Q0310B Asmt Code 1 3444-3444 Q0310A info source
Q0400A Asmt Code 1 1137-1137 Active discharge planning for return to community
Q0490 Asmt Code 1 1463-1463 Resident"s preference to avoid being asked
Q0500B Asmt Code 1 1140-1140 Do you want to talk about returning to community
Q0500C Asmt Code 1 3445-3445 Q0500B info source
Q0550A Asmt Code 1 1464-1464 Reasking resident preference
Q0550C Asmt Code 1 3446-3446 Q0550A info source
Q0610A Asmt Code 1 3447-3447 Referral
Q0620 Asmt Code 1 3448-3448 Reason referral not made
V0100A Asmt Code 2 1142-1143 Prior OBRA reason for assessment
V0100B Asmt Code 2 1144-1145 Prior PPS reason for assessment
V0100C Asmt Date 8 1146-1153 Prior assessment reference date
V0100D Asmt Number 2 1154-1155 Prior assessment BIMS summary score
V0100E Asmt Number 2 1156-1157 Prior asmt PHQ res: total mood severity score
V0100F Asmt Number 2 1158-1159 Prior asmt PHQ staff: total mood score
V0200A01A Asmt Checklist 1 1160-1160 CAA-Delirium: triggered
V0200A01B Asmt Checklist 1 1161-1161 CAA-Delirium: plan
V0200A02A Asmt Checklist 1 1162-1162 CAA-Cognitive loss/dementia: triggered
V0200A02B Asmt Checklist 1 1163-1163 CAA-Cognitive loss/dementia: plan
V0200A03A Asmt Checklist 1 1164-1164 CAA-Visual function: triggered
V0200A03B Asmt Checklist 1 1165-1165 CAA-Visual function: plan
V0200A04A Asmt Checklist 1 1166-1166 CAA-Communication: triggered
V0200A04B Asmt Checklist 1 1167-1167 CAA-Communication: plan
V0200A05A Asmt Checklist 1 1168-1168 CAA-ADL functional/rehab potential: triggered
V0200A05B Asmt Checklist 1 1169-1169 CAA-ADL functional/rehab potential: plan
V0200A06A Asmt Checklist 1 1170-1170 CAA-Urinary incont/indwell catheter: triggered
V0200A06B Asmt Checklist 1 1171-1171 CAA-Urinary incont/indwell catheter: plan
V0200A07A Asmt Checklist 1 1172-1172 CAA-Psychosocial well-being: triggered
V0200A07B Asmt Checklist 1 1173-1173 CAA-Psychosocial well-being: plan
V0200A08A Asmt Checklist 1 1174-1174 CAA-Mood state: triggered
V0200A08B Asmt Checklist 1 1175-1175 CAA-Mood state: plan
V0200A09A Asmt Checklist 1 1176-1176 CAA-Behavioral symptoms: triggered
V0200A09B Asmt Checklist 1 1177-1177 CAA-Behavioral symptoms: plan
V0200A10A Asmt Checklist 1 1178-1178 CAA-Activities: triggered
V0200A10B Asmt Checklist 1 1179-1179 CAA-Activities: plan
V0200A11A Asmt Checklist 1 1180-1180 CAA-Falls: triggered
V0200A11B Asmt Checklist 1 1181-1181 CAA-Falls: plan
V0200A12A Asmt Checklist 1 1182-1182 CAA-Nutritional status: triggered
V0200A12B Asmt Checklist 1 1183-1183 CAA-Nutritional status: plan
V0200A13A Asmt Checklist 1 1184-1184 CAA-Feeding tubes: triggered
V0200A13B Asmt Checklist 1 1185-1185 CAA-Feeding tubes: plan
V0200A14A Asmt Checklist 1 1186-1186 CAA-Dehydration/fluid maintenance: triggered
V0200A14B Asmt Checklist 1 1187-1187 CAA-Dehydration/fluid maintenance: plan
V0200A15A Asmt Checklist 1 1188-1188 CAA-Dental care: triggered
V0200A15B Asmt Checklist 1 1189-1189 CAA-Dental care: plan
V0200A16A Asmt Checklist 1 1190-1190 CAA-Pressure ulcer: triggered
V0200A16B Asmt Checklist 1 1191-1191 CAA-Pressure ulcer: plan
V0200A17A Asmt Checklist 1 1192-1192 CAA-Psychotropic drug use: triggered
V0200A17B Asmt Checklist 1 1193-1193 CAA-Psychotropic drug use: plan
V0200A18A Asmt Checklist 1 1194-1194 CAA-Physical restraints: triggered
V0200A18B Asmt Checklist 1 1195-1195 CAA-Physical restraints: plan
V0200A19A Asmt Checklist 1 1196-1196 CAA-Pain: triggered
V0200A19B Asmt Checklist 1 1197-1197 CAA-Pain: plan
V0200A20A Asmt Checklist 1 1198-1198 CAA-Return to community referral: triggered
V0200A20B Asmt Checklist 1 1199-1199 CAA-Return to community referral: plan
V0200B2 Asmt Date 8 1200-1207 CAA-Assessment process signature date
V0200C2 Asmt Date 8 1208-1215 CAA-Care planning signature date
X0150 Asmt Code 1 1217-1217 Correction: type of provider
X0200A Asmt Text 12 1218-1229 Correction: resident first name
X0200C Asmt Text 18 1230-1247 Correction: resident last name
X0300 Asmt Code 1 1248-1248 Correction: resident gender
X0400 Asmt Date 8 1249-1256 Correction: resident birth date
X0500 Asmt Text 9 1257-1265 Correction: resident social security number
X0600A Asmt Code 2 1266-1267 Correction: OBRA reason for assessment
X0600B Asmt Code 2 1268-1269 Correction: PPS reason for assessment
X0600F Asmt Code 2 1427-1428 Correction: entry/discharge reporting
X0600H Asmt Code 1 1578-1578 Correction: SNF PPS Part A Discharge (End of Stay)
X0700A Asmt Date 8 1273-1280 Correction: assessment reference date
X0700B Asmt Date 8 1281-1288 Correction: discharge date
X0700C Asmt Date 8 1289-1296 Correction: entry date
X0800 Asmt Number 2 1297-1298 Correction: correction number
X0900A Asmt Checklist 1 1299-1299 Correction: modif reasons - transcription error
X0900B Asmt Checklist 1 1300-1300 Correction: modif reasons - data entry error
X0900C Asmt Checklist 1 1301-1301 Correction: modif reasons - software error
X0900D Asmt Checklist 1 1302-1302 Correction: modif reasons - item coding error
X0900Z Asmt Checklist 1 1303-1303 Correction: modif reasons - other error
X1050A Asmt Checklist 1 1304-1304 Correction: inact reasons - event did not occur
X1050Z Asmt Checklist 1 1305-1305 Correction: inact reasons - other reason
X1100A Asmt Text 12 1306-1317 Correction: attestor first name
X1100B Asmt Text 18 1318-1335 Correction: attestor last name
X1100E Asmt Date 8 1336-1343 Correction: attestation date
Z0100A Asmt Text 7 1344-1350 Medicare Part A: HIPPS code
Z0100B Asmt Text 10 1351-1360 Medicare Part A: Version code
Z0200A Asmt Text 10 1379-1388 State case mix: Group
Z0200B Asmt Text 10 1389-1398 State case mix: Version code
Z0200C Asmt Code 1 1825-1825 State case mix: Short Stay Assessment
Z0250A Asmt Text 10 1399-1408 State case mix: Alternate group
Z0250B Asmt Text 10 1409-1418 State case mix: Alternate version code
Z0500B Asmt Date 8 1419-1426 Date RN signed assessment as complete
ITEM_FILLER_001 Filler Text 1 349-349 Item filler: replaces byte 15 of A0700
ITEM_FILLER_002 Filler Text 1 1272-1272 Item filler: replaces old X0600F
ITEM_FILLER_003 Filler Text 8 2943-2950 Item filler: replaces old EFFECTIVE_DATE
ITEM_FILLER_004 Filler Text 1 878-878 Item filler: replaces old K0500A
ITEM_FILLER_005 Filler Text 1 879-879 Item filler: replaces old K0500B
ITEM_FILLER_006 Filler Text 1 880-880 Item filler: replaces old K0500C
ITEM_FILLER_007 Filler Text 1 881-881 Item filler: replaces old K0500D
ITEM_FILLER_008 Filler Text 1 882-882 Item filler: replaces old K0500Z
ITEM_FILLER_009 Filler Text 1 961-961 Item filler: replaces old N0400A
ITEM_FILLER_010 Filler Text 1 962-962 Item filler: replaces old N0400B
ITEM_FILLER_011 Filler Text 1 963-963 Item filler: replaces old N0400C
ITEM_FILLER_012 Filler Text 1 964-964 Item filler: replaces old N0400D
ITEM_FILLER_013 Filler Text 1 965-965 Item filler: replaces old N0400E
ITEM_FILLER_014 Filler Text 1 966-966 Item filler: replaces old N0400F
ITEM_FILLER_015 Filler Text 1 967-967 Item filler: replaces old N0400G
ITEM_FILLER_016 Filler Text 1 968-968 Item filler: replaces old N0400Z
ITEM_FILLER_017 Filler Text 1 1138-1138 Item filler: replaces old Q0400B
ITEM_FILLER_018 Filler Text 1 1139-1139 Item filler: replaces old Q0500A
ITEM_FILLER_019 Filler Text 1 883-883 Item filler: replaces old K0700A
ITEM_FILLER_020 Filler Text 1 884-884 Item filler: replaces old K0700B
ITEM_FILLER_021 Filler Text 1 2082-2082 Item filler: replaces old S1200Z
ITEM_FILLER_022 Filler Text 1 2404-2404 Item filler: replaces S8510A in fixed-format
ITEM_FILLER_023 Filler Text 1 2405-2405 Item filler: replaces S8510B in fixed-format
ITEM_FILLER_024 Filler Text 1 2406-2406 Item filler: replaces S8512A in fixed-format
ITEM_FILLER_025 Filler Text 1 2407-2407 Item filler: replaces S8512B in fixed-format
ITEM_FILLER_026 Filler Text 1 538-538 Item filler: replaces old C1300A
ITEM_FILLER_027 Filler Text 1 539-539 Item filler: replaces old C1300B
ITEM_FILLER_028 Filler Text 1 540-540 Item filler: replaces old C1300C
ITEM_FILLER_029 Filler Text 1 541-541 Item filler: replaces old C1300D
ITEM_FILLER_030 Filler Text 1 542-542 Item filler: replaces old C1600
ITEM_FILLER_031 Filler Text 1 1546-1546 Item filler: replaces old GG0170H1
ITEM_FILLER_032 Filler Text 1 1547-1547 Item filler: replaces old GG0170H3
ITEM_FILLER_033 Filler Text 8 902-909 Item filler: replaces old M0300B3
ITEM_FILLER_034 Filler Text 4 920-923 Item filler: replaces old M0610A
ITEM_FILLER_035 Filler Text 4 924-927 Item filler: replaces old M0610B
ITEM_FILLER_036 Filler Text 4 928-931 Item filler: replaces old M0610C
ITEM_FILLER_037 Filler Text 1 932-932 Item filler: replaces old M0700
ITEM_FILLER_038 Filler Text 1 933-933 Item filler: replaces old M0800A
ITEM_FILLER_039 Filler Text 1 934-934 Item filler: replaces old M0800B
ITEM_FILLER_040 Filler Text 1 935-935 Item filler: replaces old M0800C
ITEM_FILLER_041 Filler Text 1 936-936 Item filler: replaces old M0900A
ITEM_FILLER_042 Filler Text 1 937-937 Item filler: replaces old M0900B
ITEM_FILLER_043 Filler Text 1 938-938 Item filler: replaces old M0900C
ITEM_FILLER_044 Filler Text 1 939-939 Item filler: replaces old M0900D
ITEM_FILLER_045 Filler Text 1 274-274 Item filler: replaces old A0310C
ITEM_FILLER_046 Filler Text 1 275-275 Item filler: replaces old A0310D
ITEM_FILLER_047 Filler Text 1 564-564 Item filler: replaces old D0350
ITEM_FILLER_048 Filler Text 1 587-587 Item filler: replaces old D0650
ITEM_FILLER_049 Filler Text 1 1448-1448 Item filler: replaces old K0510C1
ITEM_FILLER_050 Filler Text 1 1450-1450 Item filler: replaces old K0510D1
ITEM_FILLER_051 Filler Text 1 1466-1466 Item filler: replaces old K0710A1
ITEM_FILLER_052 Filler Text 1 1469-1469 Item filler: replaces old K0710B1
ITEM_FILLER_053 Filler Text 1 991-991 Item filler: replaces old O0100L2
ITEM_FILLER_054 Filler Text 8 1430-1437 Item filler: replaces old O0450B
ITEM_FILLER_055 Filler Text 1 1270-1270 Item filler: replaces old X0600C
ITEM_FILLER_056 Filler Text 1 1271-1271 Item filler: replaces old X0600D
ITEM_FILLER_057 Filler Text 1 1438-1438 Item filler: replaces old X0900E
ITEM_FILLER_058 Filler Text 1 1361-1361 Item filler: replaces old Z0100C
ITEM_FILLER_059 Filler Text 7 1362-1368 Item filler: replaces old Z0150A
ITEM_FILLER_060 Filler Text 10 1369-1378 Item filler: replaces old Z0150B
ITEM_FILLER_061 Filler Text 8 1689-1696 Item filler: replaces old I0020A
ITEM_FILLER_062 Filler Text 1 359-359 Item filler: replaces old A1000A
ITEM_FILLER_063 Filler Text 1 360-360 Item filler: replaces old A1000B
ITEM_FILLER_064 Filler Text 1 361-361 Item filler: replaces old A1000C
ITEM_FILLER_065 Filler Text 1 362-362 Item filler: replaces old A1000D
ITEM_FILLER_066 Filler Text 1 363-363 Item filler: replaces old A1000E
ITEM_FILLER_067 Filler Text 1 364-364 Item filler: replaces old A1000F
ITEM_FILLER_068 Filler Text 1 365-365 Item filler: replaces old A1100A
ITEM_FILLER_069 Filler Text 15 366-380 Item filler: replaces old A1100B
ITEM_FILLER_070 Filler Text 2 466-467 Item filler: replaces old A1800
ITEM_FILLER_071 Filler Text 2 476-477 Item filler: replaces old A2100
ITEM_FILLER_073 Filler Text 1 544-544 Item filler: replaces old D0200A1
ITEM_FILLER_074 Filler Text 1 545-545 Item filler: replaces old D0200A2
ITEM_FILLER_075 Filler Text 1 546-546 Item filler: replaces old D0200B1
ITEM_FILLER_076 Filler Text 1 547-547 Item filler: replaces old D0200B2
ITEM_FILLER_077 Filler Text 1 548-548 Item filler: replaces old D0200C1
ITEM_FILLER_078 Filler Text 1 549-549 Item filler: replaces old D0200C2
ITEM_FILLER_079 Filler Text 1 550-550 Item filler: replaces old D0200D1
ITEM_FILLER_080 Filler Text 1 551-551 Item filler: replaces old D0200D2
ITEM_FILLER_081 Filler Text 1 552-552 Item filler: replaces old D0200E1
ITEM_FILLER_082 Filler Text 1 553-553 Item filler: replaces old D0200E2
ITEM_FILLER_083 Filler Text 1 554-554 Item filler: replaces old D0200F1
ITEM_FILLER_084 Filler Text 1 555-555 Item filler: replaces old D0200F2
ITEM_FILLER_085 Filler Text 1 556-556 Item filler: replaces old D0200G1
ITEM_FILLER_086 Filler Text 1 557-557 Item filler: replaces old D0200G2
ITEM_FILLER_087 Filler Text 1 558-558 Item filler: replaces old D0200H1
ITEM_FILLER_088 Filler Text 1 559-559 Item filler: replaces old D0200H2
ITEM_FILLER_089 Filler Text 1 560-560 Item filler: replaces old D0200I1
ITEM_FILLER_090 Filler Text 1 561-561 Item filler: replaces old D0200I2
ITEM_FILLER_091 Filler Text 2 562-563 Item filler: replaces old D0300
ITEM_FILLER_092 Filler Text 1 646-646 Item filler: replaces old G0110A1
ITEM_FILLER_093 Filler Text 1 647-647 Item filler: replaces old G0110A2
ITEM_FILLER_094 Filler Text 1 648-648 Item filler: replaces old G0110B1
ITEM_FILLER_095 Filler Text 1 649-649 Item filler: replaces old G0110B2
ITEM_FILLER_096 Filler Text 1 650-650 Item filler: replaces old G0110C1
ITEM_FILLER_097 Filler Text 1 651-651 Item filler: replaces old G0110C2
ITEM_FILLER_098 Filler Text 1 652-652 Item filler: replaces old G0110D1
ITEM_FILLER_099 Filler Text 1 653-653 Item filler: replaces old G0110D2
ITEM_FILLER_100 Filler Text 1 654-654 Item filler: replaces old G0110E1
ITEM_FILLER_101 Filler Text 1 655-655 Item filler: replaces old G0110E2
ITEM_FILLER_102 Filler Text 1 656-656 Item filler: replaces old G0110F1
ITEM_FILLER_103 Filler Text 1 657-657 Item filler: replaces old G0110F2
ITEM_FILLER_104 Filler Text 1 658-658 Item filler: replaces old G0110G1
ITEM_FILLER_105 Filler Text 1 659-659 Item filler: replaces old G0110G2
ITEM_FILLER_106 Filler Text 1 660-660 Item filler: replaces old G0110H1
ITEM_FILLER_107 Filler Text 1 661-661 Item filler: replaces old G0110H2
ITEM_FILLER_108 Filler Text 1 662-662 Item filler: replaces old G0110I1
ITEM_FILLER_109 Filler Text 1 663-663 Item filler: replaces old G0110I2
ITEM_FILLER_110 Filler Text 1 664-664 Item filler: replaces old G0110J1
ITEM_FILLER_111 Filler Text 1 665-665 Item filler: replaces old G0110J2
ITEM_FILLER_112 Filler Text 1 666-666 Item filler: replaces old G0120A
ITEM_FILLER_113 Filler Text 1 667-667 Item filler: replaces old G0120B
ITEM_FILLER_114 Filler Text 1 668-668 Item filler: replaces old G0300A
ITEM_FILLER_115 Filler Text 1 669-669 Item filler: replaces old G0300B
ITEM_FILLER_116 Filler Text 1 670-670 Item filler: replaces old G0300C
ITEM_FILLER_117 Filler Text 1 671-671 Item filler: replaces old G0300D
ITEM_FILLER_118 Filler Text 1 672-672 Item filler: replaces old G0300E
ITEM_FILLER_119 Filler Text 1 673-673 Item filler: replaces old G0400A
ITEM_FILLER_120 Filler Text 1 674-674 Item filler: replaces old G0400B
ITEM_FILLER_121 Filler Text 1 675-675 Item filler: replaces old G0600A
ITEM_FILLER_122 Filler Text 1 676-676 Item filler: replaces old G0600B
ITEM_FILLER_123 Filler Text 1 677-677 Item filler: replaces old G0600C
ITEM_FILLER_124 Filler Text 1 678-678 Item filler: replaces old G0600D
ITEM_FILLER_125 Filler Text 1 679-679 Item filler: replaces old G0600Z
ITEM_FILLER_126 Filler Text 1 680-680 Item filler: replaces old G0900A
ITEM_FILLER_127 Filler Text 1 681-681 Item filler: replaces old G0900B
ITEM_FILLER_128 Filler Text 1 836-836 Item filler: replaces old J0400
ITEM_FILLER_129 Filler Text 1 837-837 Item filler: replaces old J0500A
ITEM_FILLER_130 Filler Text 1 838-838 Item filler: replaces old J0500B
ITEM_FILLER_133 Filler Text 1 1444-1444 Item filler: replaces old K0510A1
ITEM_FILLER_134 Filler Text 1 1445-1445 Item filler: replaces old K0510A2
ITEM_FILLER_135 Filler Text 1 1446-1446 Item filler: replaces old K0510B1
ITEM_FILLER_136 Filler Text 1 1447-1447 Item filler: replaces old K0510B2
ITEM_FILLER_137 Filler Text 1 1449-1449 Item filler: replaces old K0510C2
ITEM_FILLER_138 Filler Text 1 1451-1451 Item filler: replaces old K0510D2
ITEM_FILLER_139 Filler Text 1 1452-1452 Item filler: replaces old K0510Z1
ITEM_FILLER_140 Filler Text 1 1453-1453 Item filler: replaces old K0510Z2
ITEM_FILLER_141 Filler Text 1 1456-1456 Item filler: replaces old N0410A
ITEM_FILLER_142 Filler Text 1 1457-1457 Item filler: replaces old N0410B
ITEM_FILLER_143 Filler Text 1 1458-1458 Item filler: replaces old N0410C
ITEM_FILLER_144 Filler Text 1 1459-1459 Item filler: replaces old N0410D
ITEM_FILLER_145 Filler Text 1 1460-1460 Item filler: replaces old N0410E
ITEM_FILLER_146 Filler Text 1 1461-1461 Item filler: replaces old N0410F
ITEM_FILLER_147 Filler Text 1 1462-1462 Item filler: replaces old N0410G
ITEM_FILLER_148 Filler Text 1 1579-1579 Item filler: replaces old N0410H
ITEM_FILLER_149 Filler Text 1 969-969 Item filler: replaces old O0100A1
ITEM_FILLER_150 Filler Text 1 970-970 Item filler: replaces old O0100A2
ITEM_FILLER_151 Filler Text 1 971-971 Item filler: replaces old O0100B1
ITEM_FILLER_152 Filler Text 1 972-972 Item filler: replaces old O0100B2
ITEM_FILLER_153 Filler Text 1 973-973 Item filler: replaces old O0100C1
ITEM_FILLER_154 Filler Text 1 974-974 Item filler: replaces old O0100C2
ITEM_FILLER_155 Filler Text 1 975-975 Item filler: replaces old O0100D1
ITEM_FILLER_156 Filler Text 1 976-976 Item filler: replaces old O0100D2
ITEM_FILLER_157 Filler Text 1 977-977 Item filler: replaces old O0100E1
ITEM_FILLER_158 Filler Text 1 978-978 Item filler: replaces old O0100E2
ITEM_FILLER_159 Filler Text 1 979-979 Item filler: replaces old O0100F1
ITEM_FILLER_160 Filler Text 1 980-980 Item filler: replaces old O0100F2
ITEM_FILLER_161 Filler Text 1 981-981 Item filler: replaces old O0100G1
ITEM_FILLER_162 Filler Text 1 982-982 Item filler: replaces old O0100G2
ITEM_FILLER_163 Filler Text 1 983-983 Item filler: replaces old O0100H1
ITEM_FILLER_164 Filler Text 1 984-984 Item filler: replaces old O0100H2
ITEM_FILLER_165 Filler Text 1 985-985 Item filler: replaces old O0100I1
ITEM_FILLER_166 Filler Text 1 986-986 Item filler: replaces old O0100I2
ITEM_FILLER_167 Filler Text 1 987-987 Item filler: replaces old O0100J1
ITEM_FILLER_168 Filler Text 1 988-988 Item filler: replaces old O0100J2
ITEM_FILLER_169 Filler Text 1 989-989 Item filler: replaces old O0100K1
ITEM_FILLER_170 Filler Text 1 990-990 Item filler: replaces old O0100K2
ITEM_FILLER_171 Filler Text 1 992-992 Item filler: replaces old O0100M1
ITEM_FILLER_172 Filler Text 1 993-993 Item filler: replaces old O0100M2
ITEM_FILLER_173 Filler Text 1 994-994 Item filler: replaces old O0100Z1
ITEM_FILLER_174 Filler Text 1 995-995 Item filler: replaces old O0100Z2
ITEM_FILLER_175 Filler Text 2 1120-1121 Item filler: replaces old O0600
ITEM_FILLER_176 Filler Text 2 1122-1123 Item filler: replaces old O0700
ITEM_FILLER_177 Filler Text 1 1132-1132 Item filler: replaces old Q0100A
ITEM_FILLER_178 Filler Text 1 1133-1133 Item filler: replaces old Q0100B
ITEM_FILLER_179 Filler Text 1 1134-1134 Item filler: replaces old Q0100C
ITEM_FILLER_180 Filler Text 1 1135-1135 Item filler: replaces old Q0300A
ITEM_FILLER_181 Filler Text 1 1136-1136 Item filler: replaces old Q0300B
ITEM_FILLER_182 Filler Text 1 1465-1465 Item filler: replaces old Q0550B
ITEM_FILLER_183 Filler Text 1 1141-1141 Item filler: replaces old Q0600
ITEM_FILLER_184 Filler Text 1 1826-1826 Item filler: replaces old X0570A
ITEM_FILLER_185 Filler Text 1 1824-1824 Item filler: replaces old X0570B
ITEM_FILLER_186 Filler Text 1 1701-1701 Item filler: replaces old A0300A
ITEM_FILLER_187 Filler Text 1 1702-1702 Item filler: replaces old A0300B
ASMT_ITEMS_FILLER Filler Text 1 1926-1926 Assessment items filler
S0101 Asmt Code 1 1927-1927 Admitted from Community
S0102 Asmt Code 1 1928-1928 Admitted from NH or SB
S0111 Asmt Code 1 1929-1929 Lived Alone
S0113 Asmt Code 2 2641-2642 Resident Living Situation Prior to Admission
S0114 Asmt Code 1 2643-2643 Resident has one or more support person(s)
S0115 Asmt Code 1 1930-1930 Spouse Location
S0120 Asmt Text 5 1931-1935 Prior Residence ZIP Code
S0122 Asmt Code 2 1936-1937 Prior Residence State
S0123 Asmt Text 3 1938-1940 Prior Residence County
S0125 Asmt Text 5 1941-1945 Prior Residence Town Code
S0130 Asmt Code 1 1946-1946 Highest Education Completed
S0140 Asmt Text 11 1947-1957 Physician License Number
S0141 Asmt Text 18 1958-1975 Physician Name
S0150 Asmt Text 9 1976-1984 State Resident ID
S0153 Asmt Text 11 2644-2654 Resident Identifier
S0160 Asmt Code 2 2509-2510 Specialty unit
S0161A Asmt Checklist 1 2536-2536 Requires specialized unit: dementia/Alzheimer
S0161B Asmt Checklist 1 2537-2537 Requires specialized unit: behavioral health
S0161C Asmt Checklist 1 2538-2538 Requires specialized unit: TBI
S0161D Asmt Checklist 1 2539-2539 Requires specialized unit: ventilator
S0161Z Asmt Checklist 1 2540-2540 Requires specialized unit: none of the above
S0165A Asmt Checklist 1 2565-2565 Specialty services: Dementia/Alzheimers
S0165B Asmt Checklist 1 2566-2566 Specialty services: Behavioral Health
S0165C Asmt Checklist 1 2567-2567 Specialty services: Traumatic Brain Injury
S0165D Asmt Checklist 1 2568-2568 Specialty services: Ventilator
S0165E Asmt Checklist 1 2569-2569 Specialty services: On-Site Dialysis
S0165Z Asmt Checklist 1 2570-2570 Specialty services: None of the Above
S0170A Asmt Code 1 2511-2511 Advanced directive: Guardian
S0170B Asmt Code 1 2512-2512 Advanced directive: DPOA-HC
S0170C Asmt Code 1 2513-2513 Advanced directive: Living will
S0170D Asmt Code 1 2514-2514 Advanced directive: Do not resuscitate
S0170E Asmt Code 1 2515-2515 Advanced directive: Do not hospitalize
S0170F Asmt Code 1 2516-2516 Advanced directive: Do not intubate
S0170G Asmt Code 1 2517-2517 Advanced directive: Feeding restrictions
S0170H Asmt Code 1 2518-2518 Advanced directive: Other treatment restrictions
S0170Z Asmt Code 1 2519-2519 Advanced directive: None of the above
S0171A Asmt Code 1 2520-2520 Resident healthcare proxy exists
S0171B Asmt Code 1 2521-2521 Resident healthcare proxy invoked
S0172A Asmt Code 1 2522-2522 Goal discussion: documentation received
S0172B Asmt Code 1 2523-2523 Goal discussion: hospital
S0172C Asmt Code 1 2524-2524 Goal discussion: previous NH
S0172D Asmt Code 1 2525-2525 Goal discussion: Home without home health services
S0172E Asmt Code 1 2526-2526 Goal discussion: Home with home health services
S0172F Asmt Code 1 2527-2527 Goal discussion: PCP office
S0172G Asmt Code 1 2528-2528 Goal discussion: Other
S0172H Asmt Code 1 2529-2529 Goal discussion: Not occur reason
S0173 Asmt Code 1 2535-2535 Documentation of goals of care discussion
S0174 Asmt Code 1 2571-2571 Resident has Advanced Directive
S0175 Asmt Code 1 2572-2572 Resident has POA for Health Care
S0180 Asmt Code 1 1985-1985 Discharged to Community
S0183 Asmt Code 1 2530-2530 Discharged prior to admission assessment
S0185 Asmt Code 1 2655-2655 Discharge to hospital-healthcare proxy involvement
S0200A Asmt Code 1 2716-2716 Local Contact Agency Referral Decision
S0200B Asmt Code 100 2717-2816 Local Contact Agency Referral Decision - Other
S0500 Asmt Code 2 1986-1987 Level of Care
S0501 Asmt Code 1 1988-1988 CCNH RHNS Level of Care
S0505 Asmt Code 1 2656-2656 Level of care
S0509 Asmt Code 1 2602-2602 PASRR Level 1 completed prior to admission
S0510 Asmt Code 1 1989-1989 PASRR Screening Complete
S0511 Asmt Date 8 1990-1997 PASRR Level 1 Complete Date
S0512 Asmt Code 1 1998-1998 PASRR Level 1
S0513 Asmt Code 1 2573-2573 PASRR Screening Outcome
S0514 Asmt Code 1 2657-2657 Was a PASRR Level 1 determination completed?
S0515 Asmt Date 8 2658-2665 Most rcnt PASRR Lvl 1 or 2 determination cmpltn dt
S0520 Asmt Code 2 1999-2000 Reason for Admission
S0521 Asmt Code 2 2666-2667 Reason for Admission
S0600A Asmt Checklist 1 2541-2541 Meets criteria: requires ventilator 10+ hours
S0600B Asmt Checklist 1 2542-2542 Meets criteria: requires ventilator 16+ hours
S0600C Asmt Checklist 1 2543-2543 Meets criteria: Traumatic Brain Injury-Tier I
S0600D Asmt Checklist 1 2544-2544 Meets criteria: Traumatic Brain Injury-Tier II
S0600E Asmt Checklist 1 2545-2545 Meets criteria: Traumatic Brain Injury-Tier III
S0600Z Asmt Checklist 1 2546-2546 Meets criteria: none of the above
S1000 Asmt Code 1 2001-2001 Local Health Department Reporting
S1001 Asmt Code 1 2002-2002 State Health Department Reporting
S1002 Asmt Code 1 2603-2603 Local Health Department Reporting
S1003 Asmt Code 1 2604-2604 State Health Department Reporting
S1004 Asmt Code 1 2605-2605 Local/State Health Department Reporting
S1100A Asmt Checklist 1 2003-2003 Disease: Clostridium Difficile
S1100B Asmt Checklist 1 2004-2004 Disease: MRSA
S1100C Asmt Checklist 1 2005-2005 Disease: VRE
S1100D Asmt Checklist 1 2006-2006 Disease: VISA
S1100E Asmt Checklist 1 2007-2007 Disease: VRSA
S1100F Asmt Checklist 1 2008-2008 Disease: Other MDRO
S1100F1 Asmt Text 30 2009-2038 Disease: MDRO Name1
S1100F2 Asmt Text 30 2039-2068 Disease: MDRO Name2
S1100G Asmt Checklist 1 2069-2069 Disease: Tuberculosis
S1100H Asmt Checklist 1 2070-2070 Disease: Herpes Zoster
S1100I Asmt Checklist 1 2071-2071 Disease: Scabies
S1100J Asmt Checklist 1 2574-2574 Disease: CRE
S1100Z Asmt Checklist 1 2072-2072 Disease: None of the Above
S1150 Asmt Code 1 2606-2606 Active TBI Diagnosis
S1200A Asmt Code 1 2073-2073 Primary/secondary SMI dx: schizophrenia
S1200B Asmt Code 1 2074-2074 Primary/secondary SMI dx: delusional disorder
S1200C Asmt Code 1 2075-2075 Primary/secondary SMI dx: schizoaffective disorder
S1200D Asmt Code 1 2076-2076 Primary/secondary SMI dx: psychotic disorder NOS
S1200E Asmt Code 1 2077-2077 Primary/secondary SMI dx: bipolar disorder I
S1200F Asmt Code 1 2078-2078 Primary/secondary SMI dx: bipolar disorder II
S1200G Asmt Code 1 2079-2079 Primary/secondary SMI dx: cyclothymic disorder
S1200H Asmt Code 1 2080-2080 Primary/secondary SMI dx: bipolar disorder NOS
S1200I Asmt Code 1 2081-2081 Primary/secondary SMI dx: major depress recurrent
S1210A Asmt Checklist 1 2668-2668 Mental Health Diagnoses: Schizophrenia
S1210B Asmt Checklist 1 2669-2669 Mental Health Diagnoses: Delusional
S1210C Asmt Checklist 1 2670-2670 Mental Health Diagnoses: Schizoaffective disorder
S1210D Asmt Checklist 1 2671-2671 Mental Health Diagnoses: Psychotic disorder not sp
S1210E Asmt Checklist 1 2672-2672 Mental Health Diagnoses: Bipolar I mixed, manic
S1210F Asmt Checklist 1 2673-2673 Mental Health Diagnoses: Bipolar disorder II
S1210G Asmt Checklist 1 2674-2674 Mental Health Diagnoses: Cyclothymic disorder
S1210H Asmt Checklist 1 2675-2675 Mental Health Diagnoses: Bipolar disorder not sp
S1210I Asmt Checklist 1 2676-2676 Mental Health Diagnoses: Major depression, recur
S1210Z Asmt Checklist 1 2677-2677 Mental Health Diagnoses: None of the Above
S2000 Asmt Code 1 2083-2083 Capable of self-administration of medications
S2001 Asmt Code 1 2084-2084 Wishes to self-medicate
S2010 Asmt Code 1 2085-2085 Refused meds 3 days
S2011 Asmt Code 1 2086-2086 Staff support for meds 3 days
S2015 Asmt Code 1 2087-2087 Refused meds occasionally 30 days
S2016 Asmt Code 1 2088-2088 Refused meds frequently 30 days
S2040 Asmt Code 1 2089-2089 Behavior Management Program
S2050 Asmt Code 1 2090-2090 Resists grooming/hygiene
S2060A Asmt Code 1 2547-2547 Resident centered care: Oasis
S2060B Asmt Code 1 2548-2548 Resident centered care: habilitation therapy
S2060C Asmt Code 1 2549-2549 Resident centered care: hand in hand
S2060D Asmt Code 1 2550-2550 Resident centered care: consistent assignment
S2060E Asmt Code 1 2551-2551 Resident centered care: other
S2060Z Asmt Code 1 2552-2552 Resident centered care: none of the above
S3100A Asmt Code 1 2091-2091 Contractures: Hand
S3100B Asmt Code 1 2092-2092 Contractures: Wrist
S3100C Asmt Code 1 2093-2093 Contractures: Elbow
S3100D Asmt Code 1 2094-2094 Contractures: Shoulder
S3100E Asmt Code 1 2095-2095 Contractures: Neck
S3100F Asmt Code 1 2096-2096 Contractures: Ankle
S3100G Asmt Code 1 2097-2097 Contractures: Knee
S3100H Asmt Code 1 2098-2098 Contractures: Hip
S3100Z Asmt Code 1 2099-2099 Contractures: Other
S3200A Asmt Code 1 2100-2100 Dominant Side
S3200B Asmt Code 1 2101-2101 Use of dominant hand/arm
S3300 Asmt Code 1 2575-2575 Weight-based Equipment Need
S3305A Asmt Checklist 1 2576-2576 Lifting device for weight
S3305B Asmt Checklist 1 2577-2577 Wheelchair or mobility device for weight
S3305C Asmt Checklist 1 2578-2578 Bed for weight
S3305D Asmt Checklist 1 2579-2579 Seating for weight
S3305E Asmt Checklist 1 2580-2580 More than 2 staff for weight
S3305Y Asmt Checklist 1 2581-2581 Other for weight
S3310A Asmt Checklist 1 2607-2607 Therapy Services Billed - Medicare Part A
S3310B Asmt Checklist 1 2608-2608 Therapy Services Billed - Medicare Part B
S3310C Asmt Checklist 1 2609-2609 Therapy Services Billed - Managed Care Entity
S3310D Asmt Checklist 1 2610-2610 Therapy Services Billed - Medicaid
S3310Y Asmt Checklist 1 2611-2611 Therapy Services Billed - Other
S3310Z Asmt Checklist 1 2612-2612 Therapy Services Billed - None Of The Above
S3315A Asmt Checklist 1 2613-2613 COPD Treatment - Oxygen
S3315B Asmt Checklist 1 2614-2614 COPD Treatment - Inhaler/Nebulizer
S3315C Asmt Checklist 1 2615-2615 COPD Treatment - Acute Monitoring Of Respiratory
S3315D Asmt Checklist 1 2616-2616 COPD Treatment - Medications
S3315Y Asmt Checklist 1 2617-2617 COPD Treatment - Other
S3315Z Asmt Checklist 1 2618-2618 COPD Treatment - None Of The Above
S4000A Asmt Code 1 2102-2102 Harm: Self Injury/Self-injurious attempt
S4000B Asmt Code 1 2103-2103 Harm: Attempt was to kill self
S4000C Asmt Code 1 2104-2104 Harm: Considered injuring self
S4000D Asmt Code 1 2105-2105 Harm: Self-injury caregiver concern
S4010A Asmt Number 1 2106-2106 Hourly Interval Observation
S4010B Asmt Number 1 2107-2107 15- Min. Interval Observation
S4010C Asmt Number 1 2108-2108 5- Min. Interval Observation
S4010D Asmt Number 1 2109-2109 Constant Observation for < 1 hr
S4010E Asmt Number 1 2110-2110 Constant Observation for > 1 hr
S4500 Asmt Code 1 2111-2111 Substance Abuse: Alcoholic Drinks
S4510A Asmt Code 1 2112-2112 Substance Abuse: Inhalants
S4510B Asmt Code 1 2113-2113 Substance Abuse: Hallucinogens
S4510C Asmt Code 1 2114-2114 Substance Abuse: Cocaine and Crack
S4510D Asmt Code 1 2115-2115 Substance Abuse: Stimulants
S4510E Asmt Code 1 2116-2116 Substance Abuse: Opiates
S4510F Asmt Code 1 2117-2117 Substance Abuse: Cannabis
S5000 Asmt Number 1 2118-2118 Number of New Pressure Ulcers
S5005 Asmt Code 1 2119-2119 New Pressure Ulcer setting
S5010A1 Asmt Code 2 2120-2121 Pressure ulcer 1 location
S5010A2 Asmt Code 1 2122-2122 Pressure ulcer 1 status
S5010B1 Asmt Code 2 2123-2124 Pressure ulcer 2 location
S5010B2 Asmt Code 1 2125-2125 Pressure ulcer 2 status
S5010C1 Asmt Code 2 2126-2127 Pressure ulcer 3 location
S5010C2 Asmt Code 1 2128-2128 Pressure ulcer 3 status
S5010D1 Asmt Code 2 2129-2130 Pressure ulcer 4 location
S5010D2 Asmt Code 1 2131-2131 Pressure ulcer 4 status
S5010E1 Asmt Code 2 2132-2133 Pressure ulcer 5 location
S5010E2 Asmt Code 1 2134-2134 Pressure ulcer 5 status
S5010F1 Asmt Code 2 2135-2136 Pressure ulcer 6 location
S5010F2 Asmt Code 1 2137-2137 Pressure ulcer 6 status
S5010G1 Asmt Code 2 2138-2139 Pressure ulcer 7 location
S5010G2 Asmt Code 1 2140-2140 Pressure ulcer 7 status
S5010H1 Asmt Code 2 2141-2142 Pressure ulcer 8 location
S5010H2 Asmt Code 1 2143-2143 Pressure ulcer 8 status
S5010I1 Asmt Code 2 2144-2145 Pressure ulcer 9 location
S5010I2 Asmt Code 1 2146-2146 Pressure ulcer 9 status
S6000 Asmt Code 1 2147-2147 Parenteral/IV feeding in NH
S6005 Asmt Code 1 2148-2148 IV meds in NH
S6010 Asmt Code 1 2149-2149 Oxygen Therapy in NH
S6020A Asmt Checklist 1 2582-2582 Vent/resp specialized RN expertise
S6020B Asmt Checklist 1 2583-2583 Vent/resp specialized CNA training needed
S6020C Asmt Checklist 1 2584-2584 Vent/resp specialized therapy (PT,OT,RT) expertise
S6020D Asmt Checklist 1 2585-2585 Vent/resp specialized equipment
S6020Y Asmt Checklist 1 2586-2586 Vent/resp Other
S6020Z Asmt Checklist 1 2587-2587 Vent/resp None of the Above
S6022A Asmt Number 1 2588-2588 Vent/resp days licensed nurse: hourly intervals
S6022B Asmt Number 1 2589-2589 Vent/resp days licensed nurse: 15-minute intervals
S6022C Asmt Number 1 2590-2590 Vent/resp days licensed nurse: 5-minute intervals
S6023A Asmt Number 1 2591-2591 Vent/resp days CNA: hourly intervals
S6023B Asmt Number 1 2592-2592 Vent/resp days CNA: 15-minute intervals
S6023C Asmt Number 1 2593-2593 Vent/resp days CNA: 5-minute intervals
S6024A Asmt Number 1 2594-2594 Vent/resp days RT: hourly intervals
S6024B Asmt Number 1 2595-2595 Vent/resp days RT: 15-minute intervals
S6024C Asmt Number 1 2596-2596 Vent/resp days RT: 5-minute intervals
S6050 Asmt Code 1 2150-2150 Isolation precautions needed
S6051A Asmt Checklist 1 2151-2151 Isolation Precaution: Airborne
S6051B Asmt Checklist 1 2152-2152 Isolation Precaution: Contact
S6051C Asmt Checklist 1 2153-2153 Isolation Precaution: Droplet
S6051D Asmt Checklist 1 2154-2154 Isolation Precaution: Protective
S6052 Asmt Code 1 2619-2619 Isolation Required
S6053A Asmt Date 8 2620-2627 Met Isolation Requirements Start Date
S6053B Asmt Date 8 2628-2635 Met Isolation Requirements End Date
S6060A Asmt Code 1 2817-2817 Resident In Strict Isolation
S6060B Asmt Date 8 2818-2825 Strict Isolation Start Date
S6060C Asmt Date 8 2826-2833 Strict Isolation End Date
S6100A Asmt Checklist 1 2155-2155 Vaccination: Varicella
S6100B Asmt Checklist 1 2156-2156 Vaccination: Tetanus, diphtheria (Td)
S6100C Asmt Checklist 1 2157-2157 Vaccination: Tetanus, diphtheria, pertussis (Tdap)
S6100D Asmt Checklist 1 2158-2158 Vaccination: Measles, Mumps, Rubella (MMR)
S6100E Asmt Checklist 1 2159-2159 Vaccination: Other
S6100F1 Asmt Text 20 2160-2179 Vaccination: Other Name 1
S6100F2 Asmt Text 20 2180-2199 Vaccination: Other Name 2
S6100F3 Asmt Text 20 2200-2219 Vaccination: Other Name 3
S6100Z Asmt Checklist 1 2220-2220 Vaccination: None of the above
S6200 Asmt Number 2 2221-2222 Number of Hospital Stays
S6201 Asmt Number 2 2636-2637 Number of Unreported Hospital Stays
S6202 Asmt Number 2 2678-2679 Hosp admissions w/overnight stay in last 90 days
S6205 Asmt Number 1 2597-2597 Number of Observation Stays
S6210 Asmt Number 3 2223-2225 Number of ER visits
S6211 Asmt Number 3 2638-2640 Number of Unreported ER Visits
S6212 Asmt Number 2 2680-2681 ER visits w/o overnight stay in last 90 days
S6220 Asmt Code 1 2226-2226 Alzheimer"s/Dementia Special Care Unit
S6230 Asmt Code 1 2553-2553 Has resident received antipsychotic
S6232 Asmt Code 1 2554-2554 Is resident currently receiving antipsychotic
S6234 Asmt Code 1 2555-2555 Attempt to reduce amount of antipsychotic
S6236 Asmt Code 1 2556-2556 Was reduction in antipsychotic maintained
S6300 Asmt Code 1 2858-2858 Resident meds - opioid use disorder
S6301 Asmt Code 1 2859-2859 Standing order for Naloxone
S6302 Asmt Code 1 2860-2860 Buprenorphine prescribed
S6303A Asmt Checklist 1 2861-2861 Counseling for opioid use disorder - No
S6303B Asmt Checklist 1 2862-2862 Counseling for opioid use disorder - onsite
S6303C Asmt Checklist 1 2863-2863 Counseling for opioid use disorder - alt location
S6303D Asmt Checklist 1 2864-2864 Counseling for opioid use disorder - virtually
S6304A Asmt Checklist 1 2865-2865 Psychotropic med - Antidepressants
S6304B Asmt Checklist 1 2866-2866 Psychotropic med - Anxiolytics
S6304C Asmt Checklist 1 2867-2867 Psychotropic med - Antipsychotics
S6304D Asmt Checklist 1 2868-2868 Psychotropic med - Stimulants
S6304E Asmt Checklist 1 2869-2869 Psychotropic med - Chemical Dependency Adjuncts
S6304F Asmt Checklist 1 2870-2870 Psychotropic med - Monoamine Oxidase Inhibitors
S6304G Asmt Checklist 1 2871-2871 Psychotropic med - Mood Stabilizers
S6304H Asmt Checklist 1 2872-2872 Psychotropic med - Miscellaneous Drugs
S6304I Asmt Checklist 1 2873-2873 Psychotropic med - Other
S6305A Asmt Code 1 2874-2874 Active order for PRN psychotropics
S6305B Asmt Date 8 2875-2882 Last date received psychotropics
S6500 Asmt Code 1 2682-2682 Comfort care provided in the last 14 days
S7000 Asmt Code 1 2598-2598 Dental Care
S7001 Asmt Code 1 2834-2834 Dental Care Routine
S7002 Asmt Code 1 2835-2835 Dental Care Emergent
S7500A Asmt Code 1 2836-2836 Resident requires room w/o roommate
S7500B Asmt Date 8 2837-2844 Date resident placed in room w/o roommate
S7500C Asmt Code 1 2845-2845 Resident behavior puts roommate safety at risk
S7500D Asmt Code 1 2846-2846 Resident behavior infringes on roommate rights
S7500E Asmt Code 1 2847-2847 Resident care plan documents need for own room
S7500F Asmt Code 1 2848-2848 Resident requires own room - bariatric equipment
S7500G Asmt Date 8 2849-2856 Date resident placed in own room - bariatric equip
S7500H Asmt Code 1 2857-2857 Resident care plan - need for own room - bariatric
S8000A1 Asmt Checklist 1 2227-2227 Medicare - Primary Payor
S8000A2 Asmt Checklist 1 2228-2228 Medicare - Secondary Payor
S8000A3 Asmt Checklist 1 2229-2229 Medicare Payor
S8000B1 Asmt Checklist 1 2230-2230 Medicare Part A - Primary Payor
S8000B2 Asmt Checklist 1 2231-2231 Medicare Part A - Secondary Payor
S8000B3 Asmt Checklist 1 2232-2232 Medicare Part A Payor
S8000C1 Asmt Checklist 1 2233-2233 Medicare Part B - Primary Payor
S8000C2 Asmt Checklist 1 2234-2234 Medicare Part B - Secondary Payor
S8000C3 Asmt Checklist 1 2235-2235 Medicare Part B Payor
S8000D1 Asmt Checklist 1 2236-2236 Medicare Part C - Primary Payor
S8000D2 Asmt Checklist 1 2237-2237 Medicare Part C - Secondary Payor
S8000D3 Asmt Checklist 1 2238-2238 Medicare Part C Payor
S8000E1 Asmt Checklist 1 2239-2239 Medicare per diem - Primary Payor
S8000E2 Asmt Checklist 1 2240-2240 Medicare per diem - Secondary Payor
S8000E3 Asmt Checklist 1 2241-2241 Medicare per diem Payor
S8000Z Asmt Checklist 1 2242-2242 Medicare not a payment source
S8010A1 Asmt Checklist 1 2243-2243 In-state Medicaid - Primary Payor
S8010A2 Asmt Checklist 1 2244-2244 In-state Medicaid - Secondary Payor
S8010A3 Asmt Checklist 1 2245-2245 In-state Medicaid payor
S8010B1 Asmt Checklist 1 2246-2246 Out-of-state Medicaid - Primary Payor
S8010B2 Asmt Checklist 1 2247-2247 Out-of-state Medicaid - Secondary Payor
S8010B3 Asmt Checklist 1 2248-2248 Out-of-state Medicaid Payor
S8010C1 Asmt Checklist 1 2249-2249 Medicaid per diem - Primary Payor
S8010C2 Asmt Checklist 1 2250-2250 Medicaid per diem - Secondary Payor
S8010C3 Asmt Checklist 1 2251-2251 Medicaid per diem Payor
S8010D1 Asmt Checklist 1 2252-2252 Medicaid managed care per diem - Primary Payor
S8010D2 Asmt Checklist 1 2253-2253 Medicaid managed care per diem - Secondary Payor
S8010D3 Asmt Checklist 1 2254-2254 Medicaid managed care per diem Payor
S8010E1 Asmt Checklist 1 2255-2255 Medicaid per diem (not MC) - Primary Payor
S8010E2 Asmt Checklist 1 2256-2256 Medicaid per diem (not MC) - Secondary Payor
S8010E3 Asmt Checklist 1 2257-2257 Medicaid per diem (not MC) Payor
S8010F Asmt Code 1 2531-2531 Medicaid per diem type
S8010F1 Asmt Checklist 1 2258-2258 Medicaid Resident Liability - Primary Payor
S8010F2 Asmt Checklist 1 2259-2259 Medicaid Resident Liability - Secondary Payor
S8010F3 Asmt Checklist 1 2260-2260 Medicaid Resident Liability Payor
S8010G Asmt Code 1 2532-2532 Medicaid state source
S8010G1 Asmt Checklist 1 2261-2261 Medicare Co-Pay - Primary Payor
S8010G2 Asmt Checklist 1 2262-2262 Medicare Co-pay - Secondary Payor
S8010G3 Asmt Checklist 1 2263-2263 Medicare Co-pay Payor
S8010H1 Asmt Checklist 1 2264-2264 Picture Date reporting
S8010H2 Asmt Checklist 1 2265-2265 Medicaid Other - Secondary Payor
S8010H3 Asmt Checklist 1 2266-2266 Medicaid Other Payor
S8010I1 Asmt Checklist 1 2267-2267 Medicaid Pending - Primary Payor
S8010I2 Asmt Checklist 1 2268-2268 Medicaid Pending - Secondary Payor
S8010I3 Asmt Checklist 1 2269-2269 Medicaid Pending Payor
S8010Z Asmt Checklist 1 2270-2270 Medicaid not a payment source
S8015 Asmt Number 8 2683-2690 MMIS Identification Number
S8020A1 Asmt Checklist 1 2271-2271 Private - Primary Payor
S8020A2 Asmt Checklist 1 2272-2272 Private - Secondary Payor
S8020A3 Asmt Checklist 1 2273-2273 Private Payor
S8020B1 Asmt Checklist 1 2274-2274 Private per diem - Primary Payor
S8020B2 Asmt Checklist 1 2275-2275 Private per diem - Secondary Payor
S8020B3 Asmt Checklist 1 2276-2276 Private per diem Payor
S8020C1 Asmt Checklist 1 2277-2277 Private LTC insurance policy - Primary Payor
S8020C2 Asmt Checklist 1 2278-2278 Private LTC insurance policy - Secondary Payor
S8020C3 Asmt Checklist 1 2279-2279 Private LTC insurance policy
S8020Z Asmt Checklist 1 2280-2280 Private insurance not a payment source
S8030A1 Asmt Checklist 1 2281-2281 Self-pay - Primary Payor
S8030A2 Asmt Checklist 1 2282-2282 Self-pay - Secondary Payor
S8030A3 Asmt Checklist 1 2283-2283 Self-pay Payor
S8030B1 Asmt Checklist 1 2284-2284 Family pay - Primary Payor
S8030B2 Asmt Checklist 1 2285-2285 Family pay - Secondary Payor
S8030B3 Asmt Checklist 1 2286-2286 Family pay Payor
S8030C Asmt Checklist 1 2287-2287 Self or Family pay for full per diem
S8030Z Asmt Checklist 1 2288-2288 Self or Family not a payment source
S8040A1 Asmt Checklist 1 2289-2289 State Run Medical Assistance - Primary Payor
S8040A2 Asmt Checklist 1 2290-2290 State Run Medical Assistance - Secondary Payor
S8040A3 Asmt Checklist 1 2291-2291 State Run Medical Assistance Payor
S8040B1 Asmt Checklist 1 2292-2292 Tricare per diem - Primary Payor
S8040B2 Asmt Checklist 1 2293-2293 Tricare per diem - Secondary Payor
S8040B3 Asmt Checklist 1 2294-2294 Tricare per diem Payor
S8040C1 Asmt Checklist 1 2295-2295 VA per diem - Primary Payor
S8040C2 Asmt Checklist 1 2296-2296 VA per diem - Secondary Payor
S8040C3 Asmt Checklist 1 2297-2297 VA per diem Payor
S8040D1 Asmt Checklist 1 2298-2298 Other Public - Primary Payor
S8040D2 Asmt Checklist 1 2299-2299 Other Public - Secondary Payor
S8040D3 Asmt Checklist 1 2300-2300 Other Public Payor
S8040Z Asmt Checklist 1 2301-2301 Other government not a payment source
S8050A1 Asmt Checklist 1 2302-2302 Other - Primary Payor
S8050A2 Asmt Checklist 1 2303-2303 Other - Secondary Payor
S8050A3 Asmt Checklist 1 2304-2304 Other Payor
S8050B Asmt Text 30 2305-2334 Other Payor Name 1
S8050C Asmt Text 30 2335-2364 Other Payor Name 2
S8050D Asmt Text 30 2365-2394 Other Payor Name 3
S8055 Asmt Code 1 2533-2533 Primary payor
S8099 Asmt Checklist 1 2395-2395 Payor: None of the Above
S8500 Asmt Date 8 2396-2403 Medicaid begin date
S8510A Asmt Number 2 2557-2558 Medicaid Therapeutic bed-hold days since last asmt
S8510B Asmt Number 2 2559-2560 Medicaid Therapeutic bed-hold days - YTD
S8512A Asmt Number 2 2561-2562 Medicaid hospital bed-hold days since last asmt
S8512B Asmt Number 2 2563-2564 Medicaid hospital bed-hold days - YTD
S8520A Asmt Code 1 2408-2408 Medicaid Leave Days Type 1
S8520B Asmt Date 8 2409-2416 Leave Days for Medicaid begin date 1
S8520C Asmt Date 8 2417-2424 Leave Days for Medicaid end date 1
S8521A Asmt Code 1 2425-2425 Medicaid Leave Days Type 2
S8521B Asmt Date 8 2426-2433 Leave Days for Medicaid begin date 2
S8521C Asmt Date 8 2434-2441 Leave Days for Medicaid end date 2
S9000 Asmt Code 1 2442-2442 IL Skills Training
S9001 Asmt Code 1 2443-2443 IL IDPH Subpart S criteria
S9002A Asmt Checklist 1 2444-2444 IL IDPH Subpart S: Schizophrenia
S9002B Asmt Checklist 1 2445-2445 IL IDPH Subpart S: Delusional disorder
S9002C Asmt Checklist 1 2446-2446 IL IDPH Subpart S: Schizoaffective disorder
S9002D Asmt Checklist 1 2447-2447 IL IDPH Subpart S:Psychotic disorder not specified
S9002E Asmt Checklist 1 2448-2448 IL IDPH Subpart S: Bipolar I mixed, manic, & depr
S9002F Asmt Checklist 1 2449-2449 IL IDPH Subpart S: Bipolar disorder II
S9002G Asmt Checklist 1 2450-2450 IL IDPH Subpart S: Cyclothymic disorder
S9002H Asmt Checklist 1 2451-2451 IL IDPH Subpart S: Bipolar disorder not specified
S9002I Asmt Checklist 1 2452-2452 IL IDPH Subpart S: Major depression, recurrent
S9003 Asmt Code 1 2453-2453 IL IDPH Subpart S: Ancillary
S9020 Asmt Text 8 2454-2461 FL FRAES number
S9040A Asmt Code 1 2462-2462 CA POLST
S9040B Asmt Code 1 2463-2463 CA POLST Section A
S9040C Asmt Code 1 2464-2464 CA POLST Section B
S9040C1 Asmt Code 1 2599-2599 CA POLST Section B (revised)
S9040D Asmt Code 1 2465-2465 CA POLST Section C
S9040D1 Asmt Code 1 2600-2600 CA POLST Section C (revised)
S9040E Asmt Code 1 2466-2466 CA POLST D phys/nurse prac/phys asst signature
S9040F Asmt Code 1 2467-2467 CA POLST D resident signature
S9040G Asmt Code 1 2468-2468 CA POLST D discussed with patient or decisionmaker
S9040H Asmt Code 1 2534-2534 CA POLST advanced directive
S9060 Asmt Code 1 2469-2469 NY Medicaid add-on eligibility
S9080A Asmt Code 1 2470-2470 PA MA CASE-MIX
S9080B Asmt Date 8 2471-2478 PA MA CASE-MIX Date
S9080C Asmt Text 10 2479-2488 PA MA CASE-MIX Access Card Number
S9080D Asmt Date 8 2489-2496 PA MA CASE-MIX MA NF Effective Date
S9080E Asmt Code 1 2497-2497 PA MA CASE-MIX Day One MA
S9085A Asmt Code 1 2691-2691 Resident enrolled in Community HealthChoices (CHC)
S9085B Asmt Date 8 2692-2699 CHC effective date
S9085C Asmt Number 2 2700-2701 CHC product name
S9085D Asmt Text 14 2702-2715 CHC member ID
S9100A Asmt Code 1 2498-2498 VA Room & Board Payment Assessment Reference Date
S9100B Asmt Code 1 2499-2499 VA Room & Board Payment Entry Date
S9100C Asmt Date 8 2500-2507 VA Medicaid Room & Board initial date
S9120 Asmt Code 1 2508-2508 CT Approved LTC
S9140 Asmt Code 1 2601-2601 Completed LAPOST
STATE_ITEMS_FILLER Filler Text 44 2883-2926 Section S (State items) filler
ASSESSMENT_ID Calc Number 15 2951-2965 Assessment internal ID
ORIGINAL_ASSESSMENT_ID Calc Number 15 2966-2980 Original assessment ID
RESIDENT_INTERNAL_ID Calc Number 10 2981-2990 Resident internal ID
TARGET_DATE Calc Date 8 2927-2934 Target date
FACILITY_PROVIDER_INTERNAL_ID Calc Number 10 3063-3072 Facility/provider internal ID
SUBMISSION_ID Calc Number 15 3021-3035 Submission ID
SUBMISSION_DATE Calc Date 8 3036-3043 Submission date
SUBMISSION_COMPLETE_DATE Calc Date 8 3044-3051 Submission processing completion date
SUBMITTING_USER_ID Calc Text 30 2991-3020 Submitter user ID
RESIDENT_MATCH_CRITERIA Calc Number 2 3052-3053 Resident matching criteria
RESIDENT_AGE Calc Number 8 2935-2942 Age of resident on the target date
BIRTHDATE_SUBMIT_CODE Calc Code 1 3258-3258 Birth date submit code
CBSA_URBAN_RURAL_CODE Calc Code 1 3054-3054 CBSA urban/rural code.
STATE_EXTRACT_FILE_ID Calc Number 8 3055-3062 State extract file identifier
RECALCULATED_Z0100A Calc Text 7 3073-3079 Calculated Medicare Part A: HIPPS code
CALC_ITEM_FILLER_001 Filler Text 7 3091-3097 Item filler: replaces CMI_VALUE_FOR_RECALC_Z0100A
CALC_ITEM_FILLER_002 Filler Text 3 3098-3100 Item filler: replaces CMI_SET_FOR_RECALC_Z0100A
RECALCULATED_Z0100B Calc Text 10 3080-3089 Calculated Medicare Part A: Version Code
CALC_ITEM_FILLER_003 Filler Text 1 3090-3090 Item filler: replaces RECALCULATED_Z0100C
CALC_ITEM_FILLER_004 Filler Text 7 3101-3107 Item filler: replaces RECALCULATED_Z0150A
CALC_ITEM_FILLER_005 Filler Text 7 3118-3124 Item filler: replaces CMI_VALUE_FOR_RECALC_Z0150A
CALC_ITEM_FILLER_006 Filler Text 3 3125-3127 Item filler: replaces CMI_SET_FOR_RECALC_Z0150A
CALC_ITEM_FILLER_007 Calc Text 10 3108-3117 Item filler: replaces RECALCULATED_Z0150B
RECALCULATED_Z0200A Calc Text 10 3128-3137 Calculated State case mix: Group
CMI_VALUE_FOR_RECALC_Z0200A Calc Text 7 3148-3154 CMI value returned for State Group
CMI_SET_FOR_RECALC_Z0200A Calc Text 3 3155-3157 Set Code used for State Group
RECALCULATED_Z0200B Calc Text 10 3138-3147 Calculated State case mix: Version code
RECALCULATED_Z0200C Calc Text 1 3296-3296 Calculated State case mix: Short Stay Assessment
RECALCULATED_Z0250A Calc Text 10 3158-3167 Calculated State case mix: Alternative group
CMI_VALUE_FOR_RECALC_Z0250A Calc Text 7 3178-3184 Alternate CMI value returned for State Group
CMI_SET_FOR_RECALC_Z0250A Calc Text 3 3185-3187 Alternate Set Code used for State Group
RECALCULATED_Z0250B Calc Text 10 3168-3177 Calculated State case mix: Alt version code
MEDICARE_RUG4_HIER_GRP Calc Text 10 3188-3197 RUG IV Medicare hierarchical group
MEDICARE_RUG4_HIER_VERSION Calc Text 10 3198-3207 RUG IV Medicare hierarchical version
MEDICARE_RUG3_IDX_MAX_GRP Calc Text 10 3208-3217 RUG III Medicare index max group
MEDICARE_RUG3_IDX_MAX_VERSION Calc Text 10 3218-3227 RUG III Medicare index max version
MEDICARE_RUG3_IDX_MAX_CMI_VAL Calc Text 7 3228-3234 RUG III Medicare index max case mix index
MEDICARE_RUG3_IDX_MAX_CMI_SET Calc Text 3 3235-3237 RUG III Medicare index max case mix index set
MEDICARE_RUG3_HIER_GRP Calc Text 10 3238-3247 RUG III Medicare hierarchical group
MEDICARE_RUG3_HIER_VERSION Calc Text 10 3248-3257 RUG III Medicare hierarchical version
C_CCN_NUM Calc Text 12 3259-3270 Calculated facility CMS certification number (CCN)
HICN_MBI_IND Calc Text 1 3271-3271 Calculated HICN MBI Indicator
SSNRI_TRNSLTN_HICN_TXT Calc Text 12 3272-3283 SSNRI Translation HICN Text
SSNRI_TRNSLTN_MBI_TXT Calc Text 12 3284-3295 SSNRI Translation MBI Text
CALCULATED_ITEMS_FILLER1 Filler Text 239 3449-3687 Calculated items filler
DATA_END_INDICATOR Calc Code 1 3688-3688 End of data terminator code
CR Calc Code 1 3689-3689 Carriage return (ASCII 013)
LF Calc Code 1 3690-3690 Line feed character (ASCII 010)

NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 02/06/2023 10:33:18 PM