LTCH-CARE 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
A0055 Control Number 2 412-413 Correction number
STATE_CD Control Code 2 34-35 Facility"s state postal code
FAC_ID Control Text 16 36-51 Assigned facility/provider submission ID
SFTWR_VNDR_ID Control Text 9 52-60 Software vendor federal employer tax ID
SFTWR_VNDR_NAME Control Text 30 61-90 Software vendor company name
SFTWR_VNDR_EMAIL_ADR Control Text 50 91-140 Software vendor email address
SFTWR_PROD_NAME Control Text 50 141-190 Software product name
SFTWR_PROD_VRSN_CD Control Text 20 191-210 Software product version code
CONTROL_ITEMS_FILLER Filler Text 200 211-410 Control items filler
A0050 Asmt Code 1 411-411 Type of record
A0100A Asmt Text 10 414-423 Facility National Provider Identifier (NPI)
A0100B Asmt Text 12 424-435 Facility CMS Certification Number (CCN)
A0100C Asmt Text 15 436-450 State Medicaid provider number
A0200 Asmt Code 1 451-451 Type of provider
A0210 Asmt Date 8 452-459 Assessment reference date
A0220 Asmt Date 8 460-467 Admission date
A0250 Asmt Code 2 468-469 Reason for Assessment
A0270 Asmt Date 8 470-477 Discharge date
A0500A Asmt Text 12 478-489 Patient first name
A0500B Asmt Text 1 490-490 Patient middle initial
A0500C Asmt Text 18 491-508 Patient last name
A0500D Asmt Text 3 509-511 Patient name suffix
A0600A Asmt Text 9 512-520 Social Security Number
A0600B Asmt Text 12 521-532 Medicare/railroad insurance number
A0700 Asmt Text 14 533-546 Medicaid number
A0800 Asmt Code 1 547-547 Gender
A0900 Asmt Date 8 548-555 Birth Date
A1005A Asmt Checklist 1 1029-1029 No, not of Hispanic, Latino/a, or Spanish origin
A1005B Asmt Checklist 1 1030-1030 Yes, Mexican, Mexican American, Chicano/
A1005C Asmt Checklist 1 1031-1031 Yes, Puerto Rican
A1005D Asmt Checklist 1 1032-1032 Yes, Cuban
A1005E Asmt Checklist 1 1033-1033 Yes, another Hispanic, Latino, or Spanish origin
A1005X Asmt Checklist 1 1034-1034 Patient unable to respond
A1010A Asmt Checklist 1 1035-1035 Race: White
A1010B Asmt Checklist 1 1036-1036 Race: Black or African American
A1010C Asmt Checklist 1 1037-1037 Race: American Indian or Alaska Native
A1010D Asmt Checklist 1 1038-1038 Race: Asian Indian
A1010E Asmt Checklist 1 1039-1039 Race: Chinese
A1010F Asmt Checklist 1 1040-1040 Race: Filipino
A1010G Asmt Checklist 1 1041-1041 Race: Japanese
A1010H Asmt Checklist 1 1042-1042 Race: Korean
A1010I Asmt Checklist 1 1043-1043 Race: Vietnamese
A1010J Asmt Checklist 1 1044-1044 Race: Other Asian
A1010K Asmt Checklist 1 1045-1045 Race: Native Hawaiian
A1010L Asmt Checklist 1 1046-1046 Race: Guamanian or Chamorro
A1010M Asmt Checklist 1 1047-1047 Race: Samoan
A1010N Asmt Checklist 1 1048-1048 Race: Other Pacific Islander
A1010X Asmt Checklist 1 1049-1049 Race: Patient unable to respond
A1110A Asmt Text 15 1050-1064 Preferred language
A1110B Asmt Code 1 1065-1065 Do you need or want an interpreter
A1200 Asmt Code 1 579-579 Marital status
A1250A Asmt Checklist 1 1066-1066 Transportation: Yes, medical
A1250B Asmt Checklist 1 1067-1067 Transportation: Yes, non-medical
A1250C Asmt Checklist 1 1068-1068 Transportation: No
A1250X Asmt Checklist 1 1069-1069 Transportation: Patient unable to respond
A1400A Asmt Checklist 1 603-603 Payer: Medicare (FFS)
A1400B Asmt Checklist 1 604-604 Payer: Medicare (managed care/Part C/Mcr Advant.)
A1400C Asmt Checklist 1 605-605 Payer: Medicaid (FFS)
A1400D Asmt Checklist 1 606-606 Payer: Medicaid (managed care)
A1400E Asmt Checklist 1 607-607 Payer: Workers" compensation
A1400F Asmt Checklist 1 608-608 Payer: Title programs
A1400G Asmt Checklist 1 609-609 Payer: Other Government
A1400H Asmt Checklist 1 610-610 Payer: Private insurance/Medigap
A1400I Asmt Checklist 1 611-611 Payer: Private managed care
A1400J Asmt Checklist 1 612-612 Payer: Self-pay
A1400K Asmt Checklist 1 613-613 Payer: No payer source
A1400X Asmt Checklist 1 614-614 Payer: Unknown
A1400Y Asmt Checklist 1 615-615 Payer: Other
A1805 Asmt Code 2 1070-1071 Admitted from
A1990 Asmt Code 1 1072-1072 Discharged against medical advice
A2105 Asmt Code 2 1073-1074 Discharge location
A2121 Asmt Code 1 1075-1075 Provision Current Reconciled Medication List
A2122A Asmt Checklist 1 1076-1076 Electronic Health Record
A2122B Asmt Checklist 1 1077-1077 Health Information Exchange Organization
A2122C Asmt Checklist 1 1078-1078 Verbal
A2122D Asmt Checklist 1 1079-1079 Paper-based
A2122E Asmt Checklist 1 1080-1080 Other Methods
A2123 Asmt Code 1 1081-1081 Provision Current Reconciled Medication
A2124A Asmt Checklist 1 1082-1082 Electronic Health Record
A2124B Asmt Checklist 1 1083-1083 Health Information Exchange Organization
A2124C Asmt Checklist 1 1084-1084 Verbal
A2124D Asmt Checklist 1 1085-1085 Paper-based
A2124E Asmt Checklist 1 1086-1086 Other Methods
B0100 Asmt Code 1 645-645 Comatose
B0200 Asmt Code 1 1087-1087 Hearing
B1000 Asmt Code 1 1088-1088 Vision
B1300 Asmt Code 1 1089-1089 Health Literacy
BB0700 Asmt Code 1 772-772 Expression of Ideas and Wants (3-day asmt period)
BB0800 Asmt Code 1 773-773 Understand Verbal/Non-Verbal Content (3-day asmt)
C0100 Asmt Code 1 1090-1090 Brief Interview for Mental Status
C0200 Asmt Code 1 1091-1091 Repetition of three words
C0300A Asmt Code 1 1092-1092 Able to report correct year
C0300B Asmt Code 1 1093-1093 Able to report correct month
C0300C Asmt Code 1 1094-1094 Able to report correct day of the week
C0400A Asmt Code 1 1095-1095 Able to recall "sock"
C0400B Asmt Code 1 1096-1096 Able to recall "blue"
C0400C Asmt Code 1 1097-1097 Able to recall "bed"
C0500 Asmt Number 2 1098-1099 BIMS Summary Score
C1310A Asmt Code 1 1100-1100 Acute Onset Mental Status Change
C1310B Asmt Code 1 1101-1101 Inattention
C1310C Asmt Code 1 1102-1102 Disorganized thinking
C1310D Asmt Code 1 1103-1103 Altered level of consciousness
D0150A1 Asmt Code 1 1104-1104 Little interest or pleasure in doing things: Pres
D0150A2 Asmt Code 1 1105-1105 Little interest or pleasure in doing things: Freq
D0150B1 Asmt Code 1 1106-1106 Feeling down, depressed, or hopeless: Pres
D0150B2 Asmt Code 1 1107-1107 Feeling down, depressed, or hopeless: Freq
D0150C1 Asmt Code 1 1108-1108 Trouble falling or staying asleep: Pres
D0150C2 Asmt Code 1 1109-1109 Trouble falling or staying asleep: Freq
D0150D1 Asmt Code 1 1110-1110 Feeling tired or having little energy: Pres
D0150D2 Asmt Code 1 1111-1111 Feeling tired or having little energy: Freq
D0150E1 Asmt Code 1 1112-1112 Poor appetite or overeating: Pres
D0150E2 Asmt Code 1 1113-1113 Poor appetite or overeating: Freq
D0150F1 Asmt Code 1 1114-1114 Feeling bad about yourself: Pres
D0150F2 Asmt Code 1 1115-1115 Feeling bad about yourself: Freq
D0150G1 Asmt Code 1 1116-1116 Trouble concentrating on things: Pres
D0150G2 Asmt Code 1 1117-1117 Trouble concentrating on things: Freq
D0150H1 Asmt Code 1 1118-1118 Moving or speaking so slowly: Pres
D0150H2 Asmt Code 1 1119-1119 Moving or speaking so slowly: Freq
D0150I1 Asmt Code 1 1120-1120 Thoughts that you would be better off dead: Pres
D0150I2 Asmt Code 1 1121-1121 Thoughts that you would be better off dead: Freq
D0160 Asmt Number 2 1122-1123 Total severity score
D0700 Asmt Code 1 1124-1124 Social Isolation
GG0100B Asmt Code 1 780-780 Indoor Mobility (Ambulation)
GG0110A Asmt Checklist 1 781-781 Manual wheelchair
GG0110B Asmt Checklist 1 782-782 Motorized wheelchair and/or scooter
GG0110C Asmt Checklist 1 783-783 Mechanical lift
GG0110Z Asmt Checklist 1 784-784 None of the above
GG0130A1 Asmt Code 2 785-786 Self-Care (Adm Perf) - Eating
GG0130A2 Asmt Code 2 787-788 Self-Care (Dschg Goal) - Eating
GG0130A3 Asmt Code 2 789-790 Self-Care (Dschg Perf) - Eating
GG0130B1 Asmt Code 2 791-792 Self-Care (Adm Perf) - Oral hygiene
GG0130B2 Asmt Code 2 793-794 Self-Care (Dschg Goal) - Oral hygiene
GG0130B3 Asmt Code 2 795-796 Self-Care (Dschg Perf) - Oral hygiene
GG0130C1 Asmt Code 2 797-798 Self-Care (Adm Perf) - Toileting hygiene
GG0130C2 Asmt Code 2 799-800 Self-Care (Dschg Goal) - Toileting hygiene
GG0130C3 Asmt Code 2 801-802 Self-Care (Dschg Perf) - Toileting hygiene
GG0130D1 Asmt Code 2 803-804 Self-Care (Adm Perf) - Wash upper body
GG0130D2 Asmt Code 2 805-806 Self-Care (Dschg Goal) - Wash upper body
GG0130D3 Asmt Code 2 807-808 Self-Care (Dschg Perf) - Wash upper body
GG0170A1 Asmt Code 2 809-810 Func Mobil (Adm Perf) - Roll left and right
GG0170A2 Asmt Code 2 811-812 Func Mobil (Dschg Goal) - Roll left and right
GG0170A3 Asmt Code 2 813-814 Func Mobil (Dschg Perf) - Roll left and right
GG0170B1 Asmt Code 2 815-816 Func Mobil (Adm Perf) - Sit to lying
GG0170B2 Asmt Code 2 817-818 Func Mobil (Dschg Goal) - Sit to lying
GG0170B3 Asmt Code 2 819-820 Func Mobil (Dschg Perf) - Sit to lying
GG0170C1 Asmt Code 2 821-822 Func Mobil (Adm Perf) - Lying to sitting on side
GG0170C2 Asmt Code 2 823-824 Func Mobil (Dschg Goal) - Lying to sitting on side
GG0170C3 Asmt Code 2 825-826 Func Mobil (Dschg Perf) - Lying to sitting on side
GG0170D1 Asmt Code 2 827-828 Func Mobil (Adm Perf) - Sit to stand
GG0170D2 Asmt Code 2 829-830 Func Mobil (Dschg Goal) - Sit to stand
GG0170D3 Asmt Code 2 831-832 Func Mobil (Dschg Perf) - Sit to stand
GG0170E1 Asmt Code 2 833-834 Func Mobil (Adm Perf) - Chair/bed-to-chair trans
GG0170E2 Asmt Code 2 835-836 Func Mobil (Dschg Goal) - Chair/bed-to-chair trans
GG0170E3 Asmt Code 2 837-838 Func Mobil (Dschg Perf) - Chair/bed-to-chair trans
GG0170F1 Asmt Code 2 839-840 Func Mobil (Adm Perf) - Toilet transfer
GG0170F2 Asmt Code 2 841-842 Func Mobil (Dschg Goal) - Toilet transfer
GG0170F3 Asmt Code 2 843-844 Func Mobil (Dschg Perf) - Toilet transfer
GG0170G1 Asmt Code 2 1125-1126 Func Mobil (Adm Perf) - Car Transfer
GG0170G2 Asmt Code 2 1127-1128 Func Mobil (Dschg Goal) - Car Transfer
GG0170G3 Asmt Code 2 1129-1130 Mobil Perf (Dischrg Perf) - Car Transfer
GG0170I1 Asmt Code 2 847-848 Func Mobil (Adm Perf) - Walk 10 feet
GG0170I2 Asmt Code 2 849-850 Func Mobil (Dschg Goal) - Walk 10 feet
GG0170I3 Asmt Code 2 851-852 Func Mobil (Dschg Perf) - Walk 10 feet
GG0170J1 Asmt Code 2 853-854 Func Mobil (Adm Perf) - Walk 50 feet w/2 turns
GG0170J2 Asmt Code 2 855-856 Func Mobil (Dschg Goal) - Walk 50 feet w/2 turns
GG0170J3 Asmt Code 2 857-858 Func Mobil (Dschg Perf) - Walk 50 feet w/2 turns
GG0170K1 Asmt Code 2 859-860 Func Mobil (Adm Perf) - Walk 150 feet
GG0170K2 Asmt Code 2 861-862 Func Mobil (Dschg Goal) - Walk 150 feet
GG0170K3 Asmt Code 2 863-864 Func Mobil (Dschg Perf) - Walk 150 feet
GG0170L1 Asmt Code 2 1131-1132 Func Mobil (Adm Perf) - Walking 10ft uneven surf
GG0170L2 Asmt Code 2 1133-1134 Func Mobil (Dschg Goal) - Walk 10ft uneven surf
GG0170L3 Asmt Code 2 1135-1136 Func Mobil (Dschg Perf) - Walk 10ft uneven surf
GG0170M1 Asmt Code 2 1137-1138 Func Mobil (Adm Perf) - 1 step (curb)
GG0170M2 Asmt Code 2 1139-1140 Func Mobil (Dschg Goal) - 1 step (crub)
GG0170M3 Asmt Code 2 1141-1142 Func Mobil (Dschg Perf) - 1 step (curb)
GG0170N1 Asmt Code 2 1143-1144 Func Mobil (Adm Perf) - 4 steps
GG0170N2 Asmt Code 2 1145-1146 Func Mobil (Dschg Goal) - 4 steps
GG0170N3 Asmt Code 2 1147-1148 Func Mobil (Dschg Perf) - 4 steps
GG0170O1 Asmt Code 2 1149-1150 Func Mobil (Adm Perf) - 12 steps
GG0170O2 Asmt Code 2 1151-1152 Func Mobil (Dschg Goal) - 12 steps
GG0170O3 Asmt Code 2 1153-1154 Func Mobil (Dschg Perf) - 12 steps
GG0170P1 Asmt Code 2 1155-1156 Func Mobil (Adm Perf) - Picking up an object
GG0170P2 Asmt Code 2 1157-1158 Func Mobil (Dschg Goal) - Picking up an object
GG0170P3 Asmt Code 2 1159-1160 Func Mobil (Dschg Perf) - Picking up an object
GG0170Q1 Asmt Code 1 865-865 Does the patient use a wheelchair and/or scooter
GG0170Q3 Asmt Code 1 866-866 Does the patient use a wheelchair and/or scooter
GG0170R1 Asmt Code 2 867-868 Func Mobil (Adm Perf) - Wheel 50 feet w/2 turns
GG0170R2 Asmt Code 2 869-870 Func Mobil (Dschg Goal) - Wheel 50 feet w/2 turns
GG0170R3 Asmt Code 2 871-872 Func Mobil (Dschg Perf) - Wheel 50 feet w/2 turns
GG0170RR1 Asmt Code 1 873-873 Indicate the type of wheelchair or scooter used
GG0170RR3 Asmt Code 1 874-874 Indicate the type of wheelchair or scooter used
GG0170S1 Asmt Code 2 875-876 Func Mobil (Adm Perf) - Wheel 150 feet
GG0170S2 Asmt Code 2 877-878 Func Mobil (Dschg Goal) - Wheel 150 feet
GG0170S3 Asmt Code 2 879-880 Func Mobil (Dschg Perf) - Wheel 150 feet
GG0170SS1 Asmt Code 1 881-881 Indicate the type of wheelchair or scooter used
GG0170SS3 Asmt Code 1 882-882 Indicate the type of wheelchair or scooter used.
H0350 Asmt Code 1 883-883 Bladder continence
H0400 Asmt Code 1 652-652 Bowel continence
I0050 Asmt Code 1 884-884 Patient primary medical condition
I0050A Asmt ICD 8 885-892 Other medical condition - ICD code
I0103 Asmt Checklist 1 1008-1008 Metastatic Cancer
I0104 Asmt Checklist 1 1009-1009 Severe Cancer
I0605 Asmt Checklist 1 1010-1010 Severe Left Systolic/Ventricular Dysfunction
I0900 Asmt Checklist 1 653-653 Peripheral vascular disease (PVD) or PAD
I1501 Asmt Checklist 1 894-894 Chronic Kidney Disease, Stage 5
I1502 Asmt Checklist 1 895-895 Acute Renal Failure
I2101 Asmt Checklist 1 896-896 Septicemia, Sepsis, Systemic Inflammatory Response
I2600 Asmt Checklist 1 897-897 CNS Infect, Oppor Infect, Bone/Joint/Muscle Infect
I2900 Asmt Checklist 1 654-654 Diabetes mellitus (DM)
I4100 Asmt Checklist 1 898-898 Major Lower Limb Amputation
I4501 Asmt Checklist 1 899-899 Stroke
I4801 Asmt Checklist 1 900-900 Dementia
I4900 Asmt Checklist 1 901-901 Hemiplegia or Hemiparesis
I5000 Asmt Checklist 1 902-902 Paraplegia
I5101 Asmt Checklist 1 903-903 Complete Tetraplegia
I5102 Asmt Checklist 1 904-904 Incomplete Tetraplegia
I5110 Asmt Checklist 1 905-905 Other Spinal Cord Disorder/Injury
I5200 Asmt Checklist 1 906-906 Multiple Sclerosis (MS)
I5250 Asmt Checklist 1 907-907 Huntington"s Disease
I5300 Asmt Checklist 1 908-908 Parkinson"s Disease
I5450 Asmt Checklist 1 909-909 Amyotrophic Lateral Sclerosis
I5455 Asmt Checklist 1 1011-1011 Other Progressive Neuromuscular Disease
I5460 Asmt Checklist 1 910-910 Locked-In State
I5470 Asmt Checklist 1 911-911 Severe Anoxic Brain Damage, Cerebral Edema
I5480 Asmt Checklist 1 1012-1012 Other Severe Neurological Injury-Disease-Dysfunc
I5601 Asmt Checklist 1 912-912 Malnutrition
I5602 Asmt Checklist 1 913-913 At Risk for Malnutrition
I7100 Asmt Checklist 1 1013-1013 Lung Transplant
I7101 Asmt Checklist 1 1014-1014 Heart Transplant
I7102 Asmt Checklist 1 1015-1015 Liver Transplant
I7103 Asmt Checklist 1 1016-1016 Kidney Transplant
I7104 Asmt Checklist 1 1017-1017 Bone Marrow Transplant
I7900 Asmt Checklist 1 914-914 None of the Above
J0510 Asmt Code 1 1161-1161 Pain effect on sleep
J0520 Asmt Code 1 1162-1162 Pain interference with therapy activities
J0530 Asmt Code 1 1163-1163 Pain interference with day-to-day activities
J1800 Asmt Code 1 915-915 Any Falls Since Admission
J1900A Asmt Code 1 916-916 Num Falls Since Admission - No injury
J1900B Asmt Code 1 917-917 Num Falls Since Admission - Injury (except major)
J1900C Asmt Code 1 918-918 Num Falls Since Admission - Major injury
K0200A Asmt Number 2 656-657 Height (in inches)
K0200B Asmt Number 3 658-660 Weight (in pounds)
K0520A1 Asmt Checklist 1 1164-1164 Nutritional approach (Admission): Parenteral
K0520A4 Asmt Checklist 1 1165-1165 Nutritional approaches (7 days): Parenteral
K0520A5 Asmt Checklist 1 1166-1166 Nutritional approaches (discharge): Parenteral
K0520B1 Asmt Checklist 1 1167-1167 Nutritional approaches (admission): Feeding tube
K0520B4 Asmt Checklist 1 1168-1168 Nutritional approaches (7 days): Feeding tube
K0520B5 Asmt Checklist 1 1169-1169 Nutritional approaches (discharge): Feeding Tube
K0520C1 Asmt Checklist 1 1170-1170 Nutritional approaches (admission) : Mechanically
K0520C4 Asmt Checklist 1 1171-1171 Nutritional approaches (7 days): mech altered diet
K0520C5 Asmt Checklist 1 1172-1172 Nutritional approaches (discharge): mech altered
K0520D1 Asmt Checklist 1 1173-1173 Nutritional approaches (admission) : Therapeutic
K0520D4 Asmt Checklist 1 1174-1174 Nutritional approaches (7 day): Therapeutic diet
K0520D5 Asmt Checklist 1 1175-1175 Nutritional approaches (discharge): Therapeutic
K0520Z1 Asmt Checklist 1 1176-1176 Nutritional approaches (admission) : None
K0520Z4 Asmt Checklist 1 1177-1177 Nutritional approaches (7 days): None
K0520Z5 Asmt Checklist 1 1178-1178 Nutritional approaches (discharge): None
M0210 Asmt Code 1 661-661 Patient has 1+ unhealed pressure ulcers/injuries
M0300A Asmt Number 1 662-662 Stage 1 pressure injuries: number present
M0300B1 Asmt Number 1 663-663 Stage 2 pressure ulcers: number present
M0300B2 Asmt Number 1 664-664 Stage 2 pressure ulcers: number at admit
M0300C1 Asmt Number 1 673-673 Stage 3 pressure ulcers: number present
M0300C2 Asmt Number 1 674-674 Stage 3 pressure ulcers: number at admit
M0300D1 Asmt Number 1 675-675 Stage 4 pressure ulcers: number present
M0300D2 Asmt Number 1 676-676 Stage 4 pressure ulcers: number at admit
M0300E1 Asmt Number 1 677-677 Unstageable due to dressing/device: number present
M0300E2 Asmt Number 1 678-678 Unstageable due to dressing/device: number at adm
M0300F1 Asmt Number 1 679-679 Unstageable slough/eschar: number present
M0300F2 Asmt Number 1 680-680 Unstageable slough/eschar: number at admit
M0300G1 Asmt Number 1 681-681 Unstageable as deep tissue: num present
M0300G2 Asmt Number 1 682-682 Unstageable as deep tissue: num at adm
N0415A1 Asmt Checklist 1 1179-1179 High-Risk Drug (Is Taking): Antipsychotic
N0415A2 Asmt Checklist 1 1180-1180 High-Risk Drug (Indication) : Antipsychotic
N0415E1 Asmt Checklist 1 1181-1181 High-Risk Drug (Is taking): Anticoagulant
N0415E2 Asmt Checklist 1 1182-1182 High-Risk Drug (Indication): Anticoagulant
N0415F1 Asmt Checklist 1 1183-1183 High-Risk Drug (Is taking): Antibiotic
N0415F2 Asmt Checklist 1 1184-1184 High-Risk Drug (Indication): Antibiotic
N0415H1 Asmt Checklist 1 1185-1185 High-Risk Drug (Is taking): Opioid
N0415H2 Asmt Checklist 1 1186-1186 High-Drug Risk (Indication): Opioid
N0415I1 Asmt Checklist 1 1187-1187 High-Risk Drug (Is taking): Antiplatelet
N0415I2 Asmt Checklist 1 1188-1188 High-Risk Drug (Indication): Antiplatelet
N0415J1 Asmt Checklist 1 1189-1189 High-Risk Drug (Is taking): Hypoglycemic
N0415J2 Asmt Checklist 1 1190-1190 High-Risk Drug (Indication): Hypoglycemic
N0415Z1 Asmt Checklist 1 1191-1191 High-Risk Drug (Is taking): None of the above
N2001 Asmt Code 1 1018-1018 Drug Regimen Review
N2003 Asmt Code 1 1019-1019 Medication Follow-up
N2005 Asmt Code 1 1020-1020 Medication Intervention
O0110A1a Asmt Checklist 1 1192-1192 Treatment: Chemotherapy (Admission)
O0110A2a Asmt Checklist 1 1193-1193 Treatment: IV (Admission)
O0110A3a Asmt Checklist 1 1194-1194 Treatment: Oral (Admission)
O0110A10a Asmt Checklist 1 1195-1195 Treatment: Other (Admission)
O0110B1a Asmt Checklist 1 1196-1196 Treatment: Radiation (Admission)
O0110C1a Asmt Checklist 1 1197-1197 Therapies: Oxygen Therapy (Admission)
O0110C2a Asmt Checklist 1 1198-1198 Therapies: Continuous (Admission)
O0110C3a Asmt Checklist 1 1199-1199 Therapies: Intermittent (Admission)
O0110C4a Asmt Checklist 1 1200-1200 Therapies: High-concentration (Admission)
O0110D1a Asmt Checklist 1 1201-1201 Therapies: Suctioning (Admission)
O0110D2a Asmt Checklist 1 1202-1202 Therapies: Scheduled
O0110D3a Asmt Checklist 1 1203-1203 Therapies: As Needed (Admission)
O0110E1a Asmt Checklist 1 1204-1204 Therapies: Tracheostomy Care (Admission)
O0110G1a Asmt Checklist 1 1205-1205 Therapies: Non-Invas Mechanical Ventilator (Admis)
O0110G2a Asmt Checklist 1 1206-1206 Therapies: BiPAP (Admission)
O0110G3a Asmt Checklist 1 1207-1207 Therapies: CPAP (Admission)
O0110H1a Asmt Checklist 1 1208-1208 Other: IV Medications (Admission)
O0110H2a Asmt Checklist 1 1209-1209 Other: Vasoactive medications (Admission)
O0110H3a Asmt Checklist 1 1210-1210 Other: Antibiotics (Admission)
O0110H4a Asmt Checklist 1 1211-1211 Other: Anticoagulation (Admission)
O0110H10a Asmt Checklist 1 1212-1212 Other: Other (Admission)
O0110I1a Asmt Checklist 1 1213-1213 Other: Transfusions (Admission)
O0110J1a Asmt Checklist 1 1214-1214 Other: Dialysis (Admission)
O0110J2a Asmt Checklist 1 1215-1215 Other: Hemodialysis (Admission)
O0110J3a Asmt Checklist 1 1216-1216 Other: Peritoneal dialysis (Admission)
O0110O1a Asmt Checklist 1 1217-1217 Other: IV Access (Admission)
O0110O2a Asmt Checklist 1 1218-1218 Other: Peripheral (Admission)
O0110O3a Asmt Checklist 1 1219-1219 Other: Midline (Admission)
O0110O4a Asmt Checklist 1 1220-1220 Other: Central (Admission)
O0110Z1a Asmt Checklist 1 1221-1221 Other: None of the above (Admission)
O0110A1c Asmt Checklist 1 1222-1222 Treatment: Chemotherapy (Discharge)
O0110A2c Asmt Checklist 1 1223-1223 Treatment: IV (Discharge)
O0110A3c Asmt Checklist 1 1224-1224 Treatment: Oral (Discharge)
O0110A10c Asmt Checklist 1 1225-1225 Treatment: Other (Discharge)
O0110B1c Asmt Checklist 1 1226-1226 Treatment: Radiation (Discharge)
O0110C1c Asmt Checklist 1 1227-1227 Therapies: Oxygen Therapy (Discharge)
O0110C2c Asmt Checklist 1 1228-1228 Therapies: Continuous (Discharge)
O0110C3c Asmt Checklist 1 1229-1229 Therapies: Intermittent (Discharge)
O0110C4c Asmt Checklist 1 1230-1230 Therapies: High-concentration (Discharge)
O0110D1c Asmt Checklist 1 1231-1231 Therapies: Suctioning (Discharge)
O0110D2c Asmt Checklist 1 1232-1232 Therapies: Scheduled (Discharge)
O0110D3c Asmt Checklist 1 1233-1233 Therapies: As Needed (Discharge)
O0110E1c Asmt Checklist 1 1234-1234 Therapies: Tracheostomy Care (Discharge)
O0110G1c Asmt Checklist 1 1235-1235 Therapies: Non-Invas Mechanical Ventilator (Disch)
O0110G2c Asmt Checklist 1 1236-1236 Therapies: BiPAP (Discharge)
O0110G3c Asmt Checklist 1 1237-1237 Therapies: CPAP (Discharge)
O0110F1c Asmt Checklist 1 1238-1238 Therapies: Invasive Mechanical Ventilator (Disch)
O0110H1c Asmt Checklist 1 1239-1239 Other: IV Medications (Discharge)
O0110H2c Asmt Checklist 1 1240-1240 Other: Vasoactive medications (Discharge)
O0110H3c Asmt Checklist 1 1241-1241 Other: Antibiotics (Discharge)
O0110H4c Asmt Checklist 1 1242-1242 Other: Anticoagulation (Discharge)
O0110H10c Asmt Checklist 1 1243-1243 Other: Other (Discharge)
O0110I1c Asmt Checklist 1 1244-1244 Other: Transfusions (Discharge)
O0110J1c Asmt Checklist 1 1245-1245 Other: Dialysis (Discharge)
O0110J2c Asmt Checklist 1 1246-1246 Other: Hemodialysis (Discharge)
O0110J3c Asmt Checklist 1 1247-1247 Other: Peritoneal dialysis (Discharge)
O0110O1c Asmt Checklist 1 1248-1248 Other: IV Access (Discharge)
O0110O2c Asmt Checklist 1 1249-1249 Other: Peripheral (Discharge)
O0110O3c Asmt Checklist 1 1250-1250 Other: Midline (Discharge)
O0110O4c Asmt Checklist 1 1251-1251 Other: Central (Discharge)
O0110Z1c Asmt Checklist 1 1252-1252 Other: None of the above (Discharge)
O0150A Asmt Code 1 1023-1023 SBT: Invasive Mechanical Ventilation Support
O0150A2 Asmt Code 1 1253-1253 SBT: Ventilator Weaning Status
O0150B Asmt Code 1 1024-1024 SBT: Assessed for readiness by day 2
O0150C Asmt Code 1 1025-1025 SBT: Deemed medically ready by day 2
O0150D Asmt Code 1 1026-1026 SBT: Documentation of reason(s) - patient unready
O0150E Asmt Code 1 1027-1027 SBT: Performed by day 2
O0200A Asmt Code 1 1028-1028 Invasive Mechanical Ventilator - Liberation Status
O0250A Asmt Code 1 758-758 Was influenza vaccine received
O0250B Asmt Date 8 759-766 Date influenza vaccine received
O0250C Asmt Code 1 767-767 If influenza vaccine not received, state reason
Z0500B Asmt Date 8 699-706 Date assessment signed as complete
ITEM_FILLER_001 Filler Text 1 562-562 Item filler: replaces old A1050
ITEM_FILLER_002 Filler Text 23 580-602 Item filler: replaces old A1300D
ITEM_FILLER_003 Filler Text 1 618-618 Item filler: replaces old A1810A
ITEM_FILLER_004 Filler Text 1 619-619 Item filler: replaces old A1810B
ITEM_FILLER_005 Filler Text 1 620-620 Item filler: replaces old A1810C
ITEM_FILLER_006 Filler Text 1 621-621 Item filler: replaces old A1810D
ITEM_FILLER_007 Filler Text 1 622-622 Item filler: replaces old A1810E
ITEM_FILLER_008 Filler Text 1 623-623 Item filler: replaces old A1810F
ITEM_FILLER_009 Filler Text 1 624-624 Item filler: replaces old A1810G
ITEM_FILLER_010 Filler Text 1 625-625 Item filler: replaces old A1810H
ITEM_FILLER_011 Filler Text 1 626-626 Item filler: replaces old A1810I
ITEM_FILLER_012 Filler Text 1 627-627 Item filler: replaces old A1810J
ITEM_FILLER_013 Filler Text 1 628-628 Item filler: replaces old A1810K
ITEM_FILLER_014 Filler Text 1 629-629 Item filler: replaces old A1810L
ITEM_FILLER_015 Filler Text 1 630-630 Item filler: replaces old A1810Z
ITEM_FILLER_016 Filler Text 8 631-638 Item filler: replaces old A1820
ITEM_FILLER_017 Filler Text 1 639-639 Item filler: replaces old A1955
ITEM_FILLER_018 Filler Text 2 640-641 Item filler: replaces old A1960
ITEM_FILLER_019 Filler Text 1 642-642 Item filler: replaces old A1970
ITEM_FILLER_020 Filler Text 8 665-672 Item filler: replaces old M0300B3
ITEM_FILLER_021 Filler Text 4 683-686 Item filler: replaces old M0610A
ITEM_FILLER_022 Filler Text 4 687-690 Item filler: replaces old M0610B
ITEM_FILLER_023 Filler Text 4 691-694 Item filler: replaces old M0610C
ITEM_FILLER_024 Filler Text 1 695-695 Item filler: replaces old M0700
ITEM_FILLER_025 Filler Text 2 616-617 Item filler: replaces old A1800
ITEM_FILLER_026 Filler Text 2 643-644 Item filler: replaces old A2100
ITEM_FILLER_027 Filler Text 2 646-647 Item filler: replaces old GG0160A
ITEM_FILLER_028 Filler Text 2 648-649 Item filler: replaces old GG0160B
ITEM_FILLER_029 Filler Text 2 650-651 Item filler: replaces old GG0160C
ITEM_FILLER_030 Filler Text 1 655-655 Item filler: replaces old I5600
ITEM_FILLER_031 Filler Text 8 710-717 Item filler: replaces old A2520A1
ITEM_FILLER_032 Filler Text 8 718-725 Item filler: replaces old A2520A2
ITEM_FILLER_033 Filler Text 8 726-733 Item filler: replaces old A2520B1
ITEM_FILLER_034 Filler Text 8 734-741 Item filler: replaces old A2520B2
ITEM_FILLER_035 Filler Text 8 742-749 Item filler: replaces old A2520C1
ITEM_FILLER_036 Filler Text 8 750-757 Item filler: replaces old A2520C2
ITEM_FILLER_037 Filler Text 1 707-707 Item filler: replaces old A2500
ITEM_FILLER_038 Filler Text 2 708-709 Item filler: replaces old A2510
ITEM_FILLER_039 Filler Text 8 925-932 Item filler: replaces old A2525A1
ITEM_FILLER_040 Filler Text 8 933-940 Item filler: replaces old A2525A2
ITEM_FILLER_041 Filler Text 8 941-948 Item filler: replaces old A2525B1
ITEM_FILLER_042 Filler Text 8 949-956 Item filler: replaces old A2525B2
ITEM_FILLER_043 Filler Text 8 957-964 Item filler: replaces old A2525C1
ITEM_FILLER_044 Filler Text 8 965-972 Item filler: replaces old A2525C2
ITEM_FILLER_045 Filler Text 8 973-980 Item filler: replaces old A2525D1
ITEM_FILLER_046 Filler Text 8 981-988 Item filler: replaces old A2525D2
ITEM_FILLER_047 Filler Text 8 989-996 Item filler: replaces old A2525E1
ITEM_FILLER_048 Filler Text 8 997-1004 Item filler: replaces old A2525E2
ITEM_FILLER_049 Filler Text 1 845-845 Item filler: replaces old GG0170H1
ITEM_FILLER_050 Filler Text 1 846-846 Item filler: replaces old GG0170H3
ITEM_FILLER_051 Filler Text 1 696-696 Item filler: replaces old M0800A
ITEM_FILLER_052 Filler Text 1 697-697 Item filler: replaces old M0800B
ITEM_FILLER_053 Filler Text 1 698-698 Item filler: replaces old M0800C
ITEM_FILLER_054 Filler Text 1 1005-1005 Item filler: replaces old M0800D
ITEM_FILLER_055 Filler Text 1 1006-1006 Item filler: replaces old M0800E
ITEM_FILLER_056 Filler Text 1 1007-1007 Item filler: replaces old M0800F
ITEM_FILLER_057 Filler Text 1 919-919 Item filler: replaces old O0100F3
ITEM_FILLER_058 Filler Text 1 920-920 Item filler: replaces old O0100F4
ITEM_FILLER_059 Filler Text 1 893-893 Item filler: replaces old I0101
ITEM_FILLER_060 Filler Text 1 556-556 Item filler: replaces old A1000A
ITEM_FILLER_061 Filler Text 1 557-557 Item filler: replaces old A1000B
ITEM_FILLER_062 Filler Text 1 558-558 Item filler: replaces old A1000C
ITEM_FILLER_063 Filler Text 1 559-559 Item filler: replaces old A1000D
ITEM_FILLER_064 Filler Text 1 560-560 Item filler: replaces old A1000E
ITEM_FILLER_065 Filler Text 1 561-561 Item filler: replaces old A1000F
ITEM_FILLER_066 Filler Text 1 563-563 Item filler: replaces old A1100A
ITEM_FILLER_067 Filler Text 15 564-578 Item filler: replaces item A1100B
ITEM_FILLER_068 Filler Text 2 768-769 Item Filler: replaces item A1802
ITEM_FILLER_069 Filler Text 2 770-771 Item filler: replaces old A2110
ITEM_FILLER_070 Filler Text 1 774-774 Item filler: replaces old C1610A
ITEM_FILLER_071 Filler Text 1 775-775 Item filler: replaces old C1610B
ITEM_FILLER_072 Filler Text 1 776-776 Item filler: replaces old C1610C
ITEM_FILLER_073 Filler Text 1 777-777 Item filler: replaces old C1610D
ITEM_FILLER_074 Filler Text 1 778-778 Item filler: replaces old C1610E1
ITEM_FILLER_075 Filler Text 1 779-779 Item filler: replaces old C1610E2
ITEM_FILLER_076 Filler Text 1 921-921 Item filler: replaces old O0100G
ITEM_FILLER_077 Filler Text 1 1021-1021 Item filler: replaces old O0100H
ITEM_FILLER_078 Filler Text 1 1022-1022 Item filler: replaces old O0100H2A
ITEM_FILLER_079 Filler Text 1 922-922 Item filler: replaces old O0100J
ITEM_FILLER_080 Filler Text 1 923-923 Item filler: replaces old O0100N
ITEM_FILLER_081 Filler Text 1 924-924 Item filler: replaces old O0100Z
ASMT_ITEMS_FILLER Filler Text 404 1254-1931 Assessment items filler
ASSESSMENT_ID Calc Number 15 1932-1946 Assessment internal ID
ORIGINAL_ASSESSMENT_ID Calc Number 15 1947-1961 Original assessment ID
RESIDENT_INTERNAL_ID Calc Number 10 1962-1971 Patient internal ID
TARGET_DATE Calc Date 8 1972-1979 Target date
PROVIDER_INTERNAL_ID Calc Number 10 1980-1989 Provider internal ID
SUBMISSION_ID Calc Number 15 1990-2004 Submission ID
SUBMISSION_DATE Calc Date 8 2005-2012 Submission date
SUBMISSION_COMPLETE_DATE Calc Date 8 2013-2020 Submission processing completion date
SUBMITTING_USER_ID Calc Text 30 2021-2050 Submitter user ID
RESIDENT_MATCH_CRITERIA Calc Number 2 2051-2052 Resident matching criteria
RESIDENT_AGE Calc Number 3 2053-2055 Age of patient on the target date
BIRTHDATE_SUBMIT_CODE Calc Code 1 2056-2056 Birth date submit code
C_CCN_NUM Calc Text 12 2057-2068 Calculated Facility Certification Number (CCN)
C_HICN_MBI_IND Calc Text 1 2069-2069 Calculated HICN MBI Indicator
C_SSNRI_TRNSLTN_HICN_TXT Calc Text 12 2070-2081 SSNRI Translation HICN Text
C_SSNRI_TRNSLTN_MBI_TXT Calc Text 12 2082-2093 SSNRI Translation MBI Text
CALCULATED_ITEMS_FILLER Filler Text 400 2094-2493 Calculated items filler
DATA_END_INDICATOR Calc Code 1 2494-2494 End of data terminator code
CR Calc Code 1 2495-2495 Carriage return (ASCII 013)
LF Calc Code 1 2496-2496 Line feed character (ASCII 010)

NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 02/29/2020 10:39:12 PM