RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification

                                 936             LOW-HIGH BASEID Count

SPHEALTH   12  2  GENHFMT                     HA43J     N Description of SPs general health

                                   8                    . Missing
                                   1                   -9 Not ascertained
                                  17                   -8 Don't know
                                  25                    1 Excellent
                                  83                    2 Very good
                                 287                    3 Good
                                 334                    4 Fair
                                 181                    5 Poor

                  Note: Inapplicable if COMATOSE = 1.

HLTHCOMP   14  2  COMPFMT                     HA43K     N SP's health compared to 1 year ago?

                                   8                    . Missing
                                   1                   -9 Not ascertained
                                  58                   -8 Don't know
                                  10                    1 Much better
                                  59                    2 Somewhat better
                                 429                    3 About the same
                                 306                    4 Somewhat worse
                                  65                    5 Much worse

                  Note: Inapplicable if COMATOSE = 1.

LIMACTIV   16  2  TIMEFMT                     HA43L     N Hlth limited soc activities in past mo?

                                   8                    . Missing
                                   1                   -9 Not ascertained
                                  32                   -8 Don't know
                                 439                    1 None of the time
                                 212                    2 Some of the time
                                 120                    3 Most of the time
                                 124                    4 All of the time

                  Note: Inapplicable if COMATOSE = 1.

VISAPPL    18  2  YES1FMT                     HA20A     N Does SP use a visual appliance?

                                   8                    . Inapplicable
                                  14                   -8 Don't know
                                 549                    1 Yes
                                 365                    2 No

                  Note: Inapplicable if COMATOSE = 1

VISION     20  2  VISION                      HA20      N Ability of SP to see?

                                   8                    . Inapplicable
                                  15                   -8 Don't know
                                 576                    1 Adequate
                                 188                    2 Impaired
                                  78                    3 Moderately impaired
                                  55                    4 Highly impaired
                                  16                    5 Severely impaired

                  Note: Inapplicable if COMATOSE = 1

CATAROP    22  2  YES1FMT                     HA33E     N SP ever have operation for cataracts?

                                 206                   -8 Don't know
                                  82                    1 Yes
                                 648                    2 No

HCHEAID    24  2  YES1FMT                     HA17      N SP use hearing aid?

                                   8                    . Inapplicable
                                  15                   -8 Don't know
                                 103                    1 Yes
                                 810                    2 No

                  Note: Inapplicable if COMATOSE = 1

HCHECOND   26  2  HEARING                     HA16      N Description of hearing

                                   8                    . Inapplicable
                                  19                   -8 Don't know
                                 630                    1 Hears adequately
                                 180                    2 Hears with minimal difficulty
                                  60                    3 Hears in special situations only
                                  39                    4 Hearing is highly impaired

                  Note: Inapplicable if COMATOSE = 1

HCUNCOND   28  2  UNDSTND                     HA18      N Ability of SP to make him/her understood

                                   8                    . Inapplicable
                                   1                   -8 Don't know
                                 466                    1 Understood
                                 221                    2 Usually understood
                                 149                    3 Sometimes understood
                                  91                    4 Rarely or never understood

                  Note: Inapplicable if COMATOSE = 1

HCUNDOTH   30  2  UNDSTND                     HA19      N Ability of SP to understand others

                                   8                    . Inapplicable
                                   1                   -8 Don't know
                                 409                    1 Understood
                                 281                    2 Usually understood
                                 165                    3 Sometimes understood
                                  72                    4 Rarely or never understood

                  Note: Inapplicable if COMATOSE = 1

HEIGHT     32  2  NUM2FMT                     HA38      N Height of SP in inches

                                  64                   -8 Don't know
                                 872                      Number

WEIGHTF    34  4  NUM2FMT                     HA39      N Weight of SP in pounds

                                  27                   -8 Don't know
                                   1                   -7 Refused
                                 908                      Number

MAMMOGR    38  2  YES1FMT                     HA43A     N SP had a mammogram in the last year?

                                 291                    . Inapplicable
                                   1                   -9 Not ascertained
                                  96                   -8 Don't know
                                  74                    1 Yes
                                 474                    2 No

                  Note: Inapplicable if SP is male

PAPSM      40  2  YES1FMT                     HA43B     N SP had a Pap smear in the last year?

                                 291                    . Inapplicable
                                   1                   -9 Not ascertained
                                  97                   -8 Don't know
                                  54                    1 Yes
                                 493                    2 No

                  Note: Inapplicable if SP is male

HYSTLAST   42  2  YES1FMT                     HA43C     N SP had a hysterectomy in the last year?

                                 469                    . Inapplicable
                                   3                   -9 Not ascertained
                                  67                   -8 Don't know
                                  11                    1 Yes
                                 386                    2 No

                  Note: Applies to females in supplemental sample or where PAPNHYST = 2

EVERHYST   44  2  YES1FMT                     HA43D     N SP ever had a hysterectomy?

                                 291                    . Inapplicable
                                 139                   -8 Don't know
                                 120                    1 Yes
                                 386                    2 No

                  Note: Applies to female SPs in continuing sample where HYSTLAST è= 1.

DRECEXAM   46  2  YES1FMT                     HA43DA    N Digital rectal prostate exam in past yr?

                                 644                    . Inapplicable
                                  71                   -8 Don't know
                                  54                    1 Yes
                                 167                    2 No

                  Note: Inapplicable if SP is female.  Also see DIGTEXAM in RIC 2.

BLOODSPA   48  2  YES1FMT                     HA43DB    N Prostate cancer blood test in past yr?

                                 644                    . Inapplicable
                                  59                   -8 Don't know
                                  85                    1 Yes
                                 148                    2 No

                  Note: Inapplicable if SP is female

FLUVACC    50  2  YES2FMT                     HA43DC    N SP had a flu shot in the past year?

                                 134                   -8 Don't know
                                 715                    1 Yes
                                  87                    2 No

                  Note: Facility data 91-96: FLUSHOT in RIC 2.

PNEUVACC   52  2  YES2FMT                     HA43DD    N Has SP ever had a shot for pneumonia?

                                 169                   -8 Don't know
                                 646                    1 Yes
                                 121                    2 No

                  Note: Facility data 91-96: PNEUSHOT in RIC 2.

EVRSMOKE   54  2  YES1FMT                     HA43E     N SP ever smoked cigars/cigarettes/pipe?

                                 233                   -8 Don't know
                                 129                    1 Yes
                                 574                    2 No

NOWSMOKE   56  2  YES1FMT                     HA43F     N Does SP smoke now?

                                 813                    . Inapplicable
                                   1                   -8 Don't know
                                  40                    1 Yes
                                  82                    2 No

                  Note: Applies only if EVRSMOKE = 1

IADSTOOP   58  2  DIF1FMT                     HA43G     N Was stooping/kneeling difficult?

                                   8                    . Inapplicable
                                  12                   -8 Don't know
                                  94                    1 No difficulty
                                  53                    2 A little difficulty
                                 101                    3 Some difficulty
                                 137                    4 A lot of difficulty
                                 531                    5 Unable to do it

                  Note: Inapplicable if COMATOSE = 1.

IADLIFT    60  2  DIF1FMT                     HA43G     N Was lifting heavy items difficult?

                                   8                    . Inapplicable
                                  16                   -8 Don't know
                                 106                    1 No difficulty
                                  48                    2 A little difficulty
                                  85                    3 Some difficulty
                                 121                    4 A lot of difficulty
                                 552                    5 Unable to do it

                  Note: Inapplicable if COMATOSE = 1.

IADREACH   62  2  DIF1FMT                     HA43G     N Was reaching/extending arms difficult?

                                   8                    . Inapplicable
                                  25                   -8 Don't know
                                 332                    1 No difficulty
                                 148                    2 A little difficulty
                                 176                    3 Some difficulty
                                 116                    4 A lot of difficulty
                                 131                    5 Unable to do it

                  Note: Inapplicable if COMATOSE = 1.

IADGRASP   64  2  DIF1FMT                     HA43G     N Was writing/grasping difficult?

                                   8                    . Inapplicable
                                  25                   -8 Don't know
                                 360                    1 No difficulty
                                 153                    2 A little difficulty
                                 156                    3 Some difficulty
                                 106                    4 A lot of difficulty
                                 128                    5 Unable to do it

                  Note: Inapplicable if COMATOSE = 1.

IADWALK    66  2  DIF1FMT                     HA43G     N Was walking 1/4 mi or 2-3 blk difficult?

                                   8                    . Inapplicable
                                   8                   -8 Don't know
                                 132                    1 No difficulty
                                  39                    2 A little difficulty
                                  49                    3 Some difficulty
                                  60                    4 A lot of difficulty
                                 640                    5 Unable to do it

                  Note: Inapplicable if COMATOSE = 1.

ASHD       68  2  SEL2FMT                     HA28      N SP has arteriosclerotic heart disease

                                  53                    1 Selected
                                 883                    2 Not Selected

HYPETENS   70  2  SEL2FMT                     HA28      N SP has hypertension

                                 392                    1 Selected
                                 544                    2 Not Selected

HYPETHYR   72  2  SEL2FMT                     HA28      N SP has hyperthyroidism

                                  67                    1 Selected
                                 869                    2 Not Selected

MYOCARD    74  2  YES1FMT                     HA33D     N Did SP have myocardial infarction?

                                  92                   -8 Don't know
                                  74                    1 Yes
                                 770                    2 No

CARDIOV    76  2  SEL2FMT                     HA28      N SP has cardiovascular disease

                                  97                    1 Selected
                                 839                    2 Not Selected

CRDVTYPE   78  2  YES1FMT                     HA33C     N SP have angina/coronary heart disease?

                                   2                   -9 Not ascertained
                                  14                   -8 Don't know
                                  44                    1 Yes
                                 876                    2 No

HRTFAIL    80  2  SEL2FMT                     HA28      N SP has congestive heart failure

                                 150                    1 Selected
                                 786                    2 Not Selected

STROKE     82  2  SEL2FMT                     HA28      N SP has a stroke

                                 122                    1 Selected
                                 814                    2 Not Selected

CNRSKIN    84  2  SEL2FMT                     HA33B     N Did SP have skin cancer?

                                   2                   -8 Don't know
                                   4                    1 Selected
                                 930                    2 Not Selected

CANCER     86  2  SEL2FMT                     HA28      N SP has cancer

                                  36                    1 Selected
                                 900                    2 Not Selected

CNRLUNG    88  2  SEL2FMT                     HA33B     N Did SP have lung cancer?

                                   2                   -8 Don't know
                                   2                    1 Selected
                                 932                    2 Not Selected

CNRBOWEL   90  2  SEL2FMT                     HA33B     N Did SP have colon/rectum/bowel cancer?

                                   2                   -8 Don't know
                                  12                    1 Selected
                                 922                    2 Not Selected

CNRBREAS   92  2  SEL2FMT                     HA33B     N Did SP have breast cancer?

                                   2                   -8 Don't know
                                   5                    1 Selected
                                 929                    2 Not Selected

CNRUTERU   94  2  SEL2FMT                     HA33B     N Did SP have uterus cancer?

                                   2                   -8 Don't know
                                   0                    1 Selected
                                 934                    2 Not Selected

CNRPROST   96  2  SEL2FMT                     HA33B     N Did SP have prostate cancer?

                                   2                   -8 Don't know
                                   9                    1 Selected
                                 925                    2 Not Selected

CNRBLADD   98  2  SEL2FMT                     HA33B     N Did SP have bladder cancer?

                                   2                   -8 Don't know
                                   1                    1 Selected
                                 933                    2 Not Selected

CNROVARY  100  2  SEL2FMT                     HA33B     N Did SP have ovarian cancer?

                                   2                   -8 Don't know
                                   0                    1 Selected
                                 934                    2 Not Selected

CNRCERVI  102  2  SEL2FMT                     HA33B     N Did SP have cervix cancer?

                                   2                   -8 Don't know
                                   0                    1 Selected
                                 934                    2 Not Selected

CNRSTOMA  104  2  SEL2FMT                     HA33B     N Did SP have stomach cancer?

                                   2                   -8 Don't know
                                   0                    1 Selected
                                 934                    2 Not Selected

CNROTHER  106  2  SEL2FMT                     HA33B     N Did SP have other cancer?

                                   2                   -8 Don't know
                                   7                    1 Selected
                                 927                    2 Not Selected

DIABMEL   108  2  SEL2FMT                     HA28      N SP has diabetes mellitus

                                 212                    1 Selected
                                 724                    2 Not Selected

ARTHRIT   110  2  SEL2FMT                     HA28      N SP has arthritis

                                 189                    1 Selected
                                 747                    2 Not Selected

ARTHARMS  112  2  SEL2FMT                     HA33A     N Were arms affected by arthritis?

                                  24                   -8 Don't know
                                  49                    1 Selected
                                 863                    2 Not Selected

ARTHLEGS  114  2  SEL2FMT                     HA33A     N Were legs affected by arthritis?

                                  24                   -8 Don't know
                                  61                    1 Selected
                                 851                    2 Not Selected

ARTHBACK  116  2  SEL2FMT                     HA33A     N Was back affected by arthritis?

                                  24                   -8 Don't know
                                  14                    1 Selected
                                 898                    2 Not Selected

ARTHNECK  118  2  SEL2FMT                     HA33A     N Was neck affected by arthritis?

                                  24                   -8 Don't know
                                   2                    1 Selected
                                 910                    2 Not Selected

ARTHJOIN  120  2  SEL2FMT                     HA33A     N Were joints affected by arthritis?

                                  24                   -8 Don't know
                                  90                    1 Selected
                                 822                    2 Not Selected

ARTHOTHR  122  2  SEL2FMT                     HA33A     N Were other parts affected by arthritis?

                                  24                   -8 Don't know
                                   1                    1 Selected
                                 911                    2 Not Selected

MENTAL    124  2  YES1FMT                     HA9       N Did SP have any mental illnesses?

                                   1                   -8 Don't know
                                   1                   -7 Refused
                                 217                    1 Yes
                                 717                    2 No

ALZHMR    126  2  SEL2FMT                     HA28      N SP has Alzheimer's disease

                                 167                    1 Selected
                                 769                    2 Not Selected

OSTEOP    128  2  SEL2FMT                     HA28      N SP has osteoporosis

                                 162                    1 Selected
                                 774                    2 Not Selected

HIPFRACT  130  2  SEL2FMT                     HA28      N SP has a hip fracture

                                  26                    1 Selected
                                 910                    2 Not Selected

PARKNSON  132  2  SEL2FMT                     HA28      N SP has Parkinson's disease

                                  49                    1 Selected
                                 887                    2 Not Selected

EMPCOPD   134  2  SEL2FMT                     HA28      N SP has emphysema/COPD

                                  95                    1 Selected
                                 841                    2 Not Selected

MISSLIMB  136  2  SEL2FMT                     HA28      N SP has a missing limb

                                  14                    1 Selected
                                 922                    2 Not Selected

DIFUSEPH  138  2  ADL1FMT                     HA43H     N Any difficulty using telephone?

                                   8                    . Inapplicable
                                  17                   -8 Don't know
                                 266                    1 Yes
                                 346                    2 No
                                 299                    3 Doesn't do

                  Note: Inapplicable if COMATOSE = 1.

DIFSHOP   140  2  ADL1FMT                     HA43H     N Any difficulty shopping 4 personal item?

                                   8                    . Inapplicable
                                   9                   -8 Don't know
                                 272                    1 Yes
                                 169                    2 No
                                 478                    3 Doesn't do

                  Note: Inapplicable if COMATOSE = 1.

DIFMONEY  142  2  ADL1FMT                     HA43H     N Any difficulty with managing money?

                                   8                    . Inapplicable
                                   9                   -8 Don't know
                                 265                    1 Yes
                                 130                    2 No
                                 524                    3 Doesn't do

                  Note: Inapplicable if COMATOSE = 1.

REASNOPH  144  2  YES1FMT                     HA43I     N Don't use telephone b/c health problems?

                                 637                    . Inapplicable
                                   1                   -8 Don't know
                                 276                    1 Yes
                                  22                    2 No

                  Note: Inapplicable if DIFUSEPH is not equal to 3

REASNOSH  146  2  YES1FMT                     HA43I     N Don't do shopping b/c health problems?

                                 458                    . Inapplicable
                                 450                    1 Yes
                                  28                    2 No

                  Note: Inapplicable if DIFSHOP is not equal to 3

REASNOMM  148  2  YES1FMT                     HA43I     N Don't manage money b/c health problems?

                                 412                    . Inapplicable
                                   1                   -8 Don't know
                                 484                    1 Yes
                                  39                    2 No

                  Note: Inapplicable if DIFMONEY is not equal to 3

PFTRNSFR  150  2  PERFLEV                     HA22      N Level of self perform: transfer

                                   8                    . Inapplicable
                                   1                   -8 Don't know
                                 338                    1 Independent
                                  54                    2 Supervision
                                 136                    3 Limited assistance
                                 212                    4 Extensive assistance
                                 179                    5 Total dependence
                                   8                    6 Activity did not occur

                  Note: Inapplicable if COMATOSE = 1

PFLOCOMO  152  2  PERFLEV                     HA22      N Level of self perform: locomot. on unit

                                   8                    . Inapplicable
                                   1                   -8 Don't know
                                 375                    1 Independent
                                  88                    2 Supervision
                                 122                    3 Limited assistance
                                 100                    4 Extensive assistance
                                 221                    5 Total dependence
                                  21                    6 Activity did not occur

                  Note: Inapplicable if COMATOSE = 1

PFDRSSNG  154  2  PERFLEV                     HA22      N Level of self perform: dressing

                                   8                    . Inapplicable
                                   1                   -8 Don't know
                                 220                    1 Independent
                                  76                    2 Supervision
                                 180                    3 Limited assistance
                                 226                    4 Extensive assistance
                                 223                    5 Total dependence
                                   2                    6 Activity did not occur

                  Note: Inapplicable if COMATOSE = 1

PFEATING  156  2  PERFLEV                     HA22      N Level of self perform: eating

                                   8                    . Inapplicable
                                   1                   -8 Don't know
                                 461                    1 Independent
                                 173                    2 Supervision
                                  97                    3 Limited assistance
                                  67                    4 Extensive assistance
                                 129                    5 Total dependence
                                   0                    6 Activity did not occur

                  Note: Inapplicable if COMATOSE = 1

PFTOILET  158  2  PERFLEV                     HA22      N Level of self perform: toilet use

                                   8                    . Inapplicable
                                   2                   -8 Don't know
                                 277                    1 Independent
                                  63                    2 Supervision
                                 124                    3 Limited assistance
                                 202                    4 Extensive assistance
                                 253                    5 Total dependence
                                   7                    6 Activity did not occur

                  Note: Inapplicable if COMATOSE = 1

PFBATHNG  160  2  BATHLEV                     HA23      N Level of self perform: bathing

                                   8                    . Inapplicable
                                   1                   -8 Don't know
                                 112                    1 Independent
                                  95                    2 Supervision
                                  68                    3 Physical help limited to transfer only
                                 316                    4 Physical help in part of bathing actvty
                                 335                    5 Total dependence
                                   1                    6 Activity did not occur

                  Note: Inapplicable if COMATOSE = 1

MLCANE    162  2  YES1FMT                     HA24      N Did SP use cane/walker?

                                   8                    . Inapplicable
                                  17                   -8 Don't know
                                 265                    1 Yes
                                 646                    2 No

                  Note: Inapplicable if COMATOSE = 1

MLWLPRIM  164  2  YES1FMT                     HA24      N Did SP use wheelchair prim means?

                                   8                    . Inapplicable
                                  17                   -8 Don't know
                                 347                    1 Yes
                                 564                    2 No

                  Note: Inapplicable if COMATOSE = 1

MLWHLSLF  166  2  YES1FMT                     HA24      N Did SP wheel her/himself?

                                   8                    . Inapplicable
                                  17                   -8 Don't know
                                 239                    1 Yes
                                 672                    2 No

                  Note: Inapplicable if COMATOSE = 1

MLWHLOTH  168  2  YES1FMT                     HA24      N Did someone wheel SP?

                                   8                    . Inapplicable
                                  17                   -8 Don't know
                                 347                    1 Yes
                                 564                    2 No

                  Note: Inapplicable if COMATOSE = 1

CTBADDC   170  2  CONTLEV                     HA26      N Level of bladder control

                                   8                    . Inapplicable
                                 338                    1 Continent
                                  87                    2 Usually continent
                                  89                    3 Occasionally incontinent
                                 106                    4 Frequently incontinent
                                 308                    5 Incontinent

                  Note: Inapplicable if COMATOSE = 1

ADLIVWIL  172  2  YES1FMT                     HA10      N Did SP have living will?

                                  24                   -8 Don't know
                                 201                    1 Yes
                                 711                    2 No

ADDNRES   174  2  YES1FMT                     HA10      N Did SP have 'Do not resuscitate' order?

                                  24                   -8 Don't know
                                 437                    1 Yes
                                 475                    2 No

ADDNHOSP  176  2  YES1FMT                     HA10      N Did SP have 'Do not hospitalize' order?

                                  24                   -8 Don't know
                                  36                    1 Yes
                                 876                    2 No

ADOTREST  178  2  YES1FMT                     HA10      N Feeding/Medication/Other restrictions?

                                  24                   -8 Don't know
                                  58                    1 Yes
                                 854                    2 No

COMATOSE  180  2  YES1FMT                     HA11      N Was SP comatose?

                                   1                   -8 Don't know
                                   8                    1 Yes
                                 927                    2 No

CSMEMST   182  2  YES1FMT                     HA12      N SP has problem with short term memory

                                   8                    . Inapplicable
                                   6                   -8 Don't know
                                 625                    1 Yes
                                 297                    2 No

                  Note: Inapplicable if COMATOSE = 1

CSMEMLT   184  2  YES1FMT                     HA13      N SP has problem with long term memory

                                   8                    . Inapplicable
                                  11                   -8 Don't know
                                 489                    1 Yes
                                 428                    2 No

                  Note: Inapplicable if COMATOSE = 1

CSCURSEA  186  2  YES1FMT                     HA14      N Was SP able to recall current season?

                                   8                    . Inapplicable
                                  14                   -8 Don't know
                                 460                    1 Yes
                                 454                    2 No

                  Note: Inapplicable if COMATOSE = 1

CSLOCROM  188  2  YES1FMT                     HA14      N Was able to recall location of room?

                                   8                    . Inapplicable
                                  14                   -8 Don't know
                                 587                    1 Yes
                                 327                    2 No

                  Note: Inapplicable if COMATOSE = 1

CSNAMFAC  190  2  YES1FMT                     HA14      N Was able to recall names and faces?

                                   8                    . Inapplicable
                                  14                   -8 Don't know
                                 613                    1 Yes
                                 301                    2 No

                  Note: Inapplicable if COMATOSE = 1

CSINNH    192  2  YES1FMT                     HA14      N SP could recall he/she was in nurs. home

                                   8                    . Inapplicable
                                  14                   -8 Don't know
                                 577                    1 Yes
                                 337                    2 No

                  Note: Inapplicable if COMATOSE = 1

CSDECIS   194  2  CSDECIS                     HA15      N How skilled was SP in making decisions?

                                   8                    . Inapplicable
                                   2                   -8 Don't know
                                 184                    1 Independent
                                 234                    2 Modified independence
                                 314                    3 Moderately impaired
                                 194                    4 Severely impaired

                  Note: Inapplicable if COMATOSE = 1

BSWANDER  196  2  FREQUENT                    HA21      N How often did wandering occur?

                                   8                    . Inapplicable
                                   1                   -8 Don't know
                                 833                    1 Not at all
                                  51                    2 Less than daily
                                  43                    3 Daily or more frequently

                  Note: Inapplicable if COMATOSE = 1

BSVERBAB  198  2  FREQUENT                    HA21      N Occurrence of verbally abusive behavior?

                                   8                    . Inapplicable
                                   1                   -8 Don't know
                                 814                    1 Not at all
                                  82                    2 Less than daily
                                  31                    3 Daily or more frequently

                  Note: Inapplicable if COMATOSE = 1

BSPHYSAB  200  2  FREQUENT                    HA21      N Occurrence of phys abusive behavior?

                                   8                    . Inapplicable
                                   1                   -8 Don't know
                                 861                    1 Not at all
                                  54                    2 Less than daily
                                  12                    3 Daily or more frequently

                  Note: Inapplicable if COMATOSE = 1

BSDISRPT  202  2  FREQUENT                    HA21      N How often did disruptive behavior occur?

                                   8                    . Inapplicable
                                   1                   -8 Don't know
                                 792                    1 Not at all
                                  99                    2 Less than daily
                                  36                    3 Daily or more frequently

                  Note: Inapplicable if COMATOSE = 1

BSRESIST  204  2  FREQUENT                    HA21      N How often did SP resist care?

                                   8                    . Inapplicable
                                   1                   -8 Don't know
                                 743                    1 Not at all
                                 129                    2 Less than daily
                                  55                    3 Daily or more frequently

                  Note: Inapplicable if COMATOSE = 1

CTBOWEC   206  2  CONTLEV                     HA25      N Level of bowel control?

                                   8                    . Inapplicable
                                 431                    1 Continent
                                  89                    2 Usually continent
                                  60                    3 Occasionally incontinent
                                  67                    4 Frequently incontinent
                                 281                    5 Incontinent

                  Note: Inapplicable if COMATOSE = 1

PWINTOTH  208  2  YES1FMT                     HA27      N At ease interacting with others?

                                   8                    . Inapplicable
                                 679                    1 Yes
                                 249                    2 No

                  Note: Inapplicable if COMATOSE = 1

PWSTRACT  210  2  YES1FMT                     HA27      N At ease doing planned activities?

                                   8                    . Inapplicable
                                 527                    1 Yes
                                 401                    2 No

                  Note: Inapplicable if COMATOSE = 1

PWSLFACT  212  2  YES1FMT                     HA27      N At ease doing self-initiated activities?

                                   8                    . Inapplicable
                                 420                    1 Yes
                                 508                    2 No

                  Note: Inapplicable if COMATOSE = 1

PWGOALS   214  2  YES1FMT                     HA27      N At ease establishing goals?

                                   8                    . Inapplicable
                                 214                    1 Yes
                                 714                    2 No

                  Note: Inapplicable if COMATOSE = 1

PWFACLIF  216  2  YES1FMT                     HA27      N Involved with life at facility?

                                   8                    . Inapplicable
                                 301                    1 Yes
                                 627                    2 No

                  Note: Inapplicable if COMATOSE = 1

PWGRPACT  218  2  YES1FMT                     HA27      N Accepts invitations to group activities?

                                   8                    . Inapplicable
                                 368                    1 Yes
                                 560                    2 No

                  Note: Inapplicable if COMATOSE = 1

PWNOFC    220  2  YES1FMT                     HA27      N Absence of contact with family/friends?

                                   8                    . Inapplicable
                                  74                    1 Yes
                                 854                    2 No

                  Note: Inapplicable if COMATOSE = 1

ALLERGY   222  2  SEL2FMT                     HA28      N SP has allergies

                                 140                    1 Selected
                                 796                    2 Not Selected

ANEMIA    224  2  SEL2FMT                     HA28      N SP has anemia

                                 135                    1 Selected
                                 801                    2 Not Selected

ANXIETY   226  2  SEL2FMT                     HA28      N SP has anxiety disorder

                                  88                    1 Selected
                                 848                    2 Not Selected

APHASIA   228  2  SEL2FMT                     HA28      N SP has aphasia

                                  36                    1 Selected
                                 900                    2 Not Selected

ASTHMA    230  2  SEL2FMT                     HA28      N SP has asthma

                                  18                    1 Selected
                                 918                    2 Not Selected

CARDDYSR  232  2  SEL2FMT                     HA28      N SP has dysrhythmia

                                  64                    1 Selected
                                 872                    2 Not Selected

CATARCT   234  2  SEL2FMT                     HA28      N SP has cataracts

                                  46                    1 Selected
                                 890                    2 Not Selected

CERPALSY  236  2  SEL2FMT                     HA28      N SP has cerebral palsy

                                  18                    1 Selected
                                 918                    2 Not Selected

VEINTHR   238  2  SEL2FMT                     HA28      N SP has deep vein thrombosis

                                  16                    1 Selected
                                 920                    2 Not Selected

DEMENT    240  2  SEL2FMT                     HA28      N SP has dementia

                                 260                    1 Selected
                                 676                    2 Not Selected

DEPRESS   242  2  SEL2FMT                     HA28      N SP has depression

                                 339                    1 Selected
                                 597                    2 Not Selected

DIABRET   244  2  SEL2FMT                     HA28      N SP has diabetic retinopathy

                                   8                    1 Selected
                                 928                    2 Not Selected

GLAUCOMA  246  2  SEL2FMT                     HA28      N SP has glaucoma

                                  40                    1 Selected
                                 896                    2 Not Selected

HEMIPLPA  248  2  SEL2FMT                     HA28      N SP has hemiplegia/hemiparesis

                                  52                    1 Selected
                                 884                    2 Not Selected

HYPOTENS  250  2  SEL2FMT                     HA28      N SP has hypotension

                                  16                    1 Selected
                                 920                    2 Not Selected

HYPOTHYR  252  2  SEL2FMT                     HA28      N SP has hypothyroidism

                                  62                    1 Selected
                                 874                    2 Not Selected

MACDEGEN  254  2  SEL2FMT                     HA28      N SP has macular degeneration

                                  30                    1 Selected
                                 906                    2 Not Selected

MANICDEP  256  2  SEL2FMT                     HA28      N SP has manic depression

                                  28                    1 Selected
                                 908                    2 Not Selected

SCLEROS   258  2  SEL2FMT                     HA28      N SP has multiple sclerosis

                                  11                    1 Selected
                                 925                    2 Not Selected

PARAPLEG  260  2  SEL2FMT                     HA28      N SP has paraplegia

                                   5                    1 Selected
                                 931                    2 Not Selected

BONEFRAC  262  2  SEL2FMT                     HA28      N SP has pathological bone fracture

                                   1                    1 Selected
                                 935                    2 Not Selected

VASCULAR  264  2  SEL2FMT                     HA28      N SP has peripheral vascular disease

                                  80                    1 Selected
                                 856                    2 Not Selected

QUADPLEG  266  2  SEL2FMT                     HA28      N SP has quadriplegia

                                   9                    1 Selected
                                 927                    2 Not Selected

RENTFAIL  268  2  SEL2FMT                     HA28      N SP has renal failure

                                  33                    1 Selected
                                 903                    2 Not Selected

SCHIZOPH  270  2  SEL2FMT                     HA28      N SP has schizophrenia

                                  56                    1 Selected
                                 880                    2 Not Selected

SEIZURE   272  2  SEL2FMT                     HA28      N SP has a seizure disorder

                                  73                    1 Selected
                                 863                    2 Not Selected

TIA       274  2  SEL2FMT                     HA28      N SP has Transient Ischemic Attack (TIA)

                                  16                    1 Selected
                                 920                    2 Not Selected

BRAININJ  276  2  SEL2FMT                     HA28      N SP has traumatic brain injury

                                  11                    1 Selected
                                 925                    2 Not Selected

INFMRSA   278  2  SEL2FMT                     HA29      N SP have antibiotic resistant infection

                                   7                    1 Selected
                                 929                    2 Not Selected

INFCDIFF  280  2  SEL2FMT                     HA29      N SP has clostridium difficile

                                   3                    1 Selected
                                 933                    2 Not Selected

INFCONJ   282  2  SEL2FMT                     HA29      N SP has conjunctivitis

                                   7                    1 Selected
                                 929                    2 Not Selected

INFHIV    284  2  SEL2FMT                     HA29      N SP has HIV

                                   0                    1 Selected
                                 936                    2 Not Selected

INFPNEU   286  2  SEL2FMT                     HA29      N SP has pneumonia

                                  30                    1 Selected
                                 906                    2 Not Selected

INFRESP   288  2  SEL2FMT                     HA29      N SP has respiratory infection

                                  17                    1 Selected
                                 919                    2 Not Selected

INFSEPT   290  2  SEL2FMT                     HA29      N SP has septicemia

                                   3                    1 Selected
                                 933                    2 Not Selected

INFSEXTR  292  2  SEL2FMT                     HA29      N SP has sexually transmitted disease

                                   0                    1 Selected
                                 936                    2 Not Selected

INFTBRC   294  2  SEL2FMT                     HA29      N SP has tuberculosis

                                   1                    1 Selected
                                 935                    2 Not Selected

INFURNRY  296  2  SEL2FMT                     HA29      N SP has urinary tract infection

                                  80                    1 Selected
                                 856                    2 Not Selected

INFHPPTS  298  2  SEL2FMT                     HA29      N SP has viral hepatitis

                                   4                    1 Selected
                                 932                    2 Not Selected

INFWOUND  300  2  SEL2FMT                     HA29      N SP has wound infection

                                  17                    1 Selected
                                 919                    2 Not Selected

OTHDIAG   302  2  NUM2FMT                               N Additional diagnosis/condition

                                 936                      Number

                  Note: Note not created

DEHYD     304  2  YES1FMT                     HA34      N Did SP experience dehydration?

                                   8                    . Inapplicable
                                   2                   -8 Don't know
                                  15                    1 Yes
                                 911                    2 No

                  Note: Inapplicable if COMATOSE = 1.

DELUS     306  2  YES1FMT                     HA35      N Did SP experience delusions?

                                   8                    . Inapplicable
                                   5                   -8 Don't know
                                  56                    1 Yes
                                 867                    2 No

                  Note: Inapplicable if COMATOSE = 1.

HALLUC    308  2  YES1FMT                     HA36      N Did SP experience hallucinations?

                                   8                    . Inapplicable
                                   5                   -8 Don't know
                                  32                    1 Yes
                                 891                    2 No

                  Note: Inapplicable if COMATOSE = 1.

ONCHEW    310  2  YES1FMT                     HA37      N Did SP experience chewing problems?

                                   8                    . Inapplicable
                                  27                   -8 Don't know
                                 179                    1 Yes
                                 722                    2 No

                  Note: Inapplicable if COMATOSE = 1.

ONSWALL   312  2  YES1FMT                     HA37      N Did SP experience swallowing problems?

                                   8                    . Inapplicable
                                  27                   -8 Don't know
                                 146                    1 Yes
                                 755                    2 No

                  Note: Inapplicable if COMATOSE = 1.

ONMOUTHP  314  2  YES1FMT                     HA37      N Did SP experience any mouth pain?

                                   8                    . Inapplicable
                                  27                   -8 Don't know
                                  11                    1 Yes
                                 890                    2 No

                  Note: Inapplicable if COMATOSE = 1.

DHDEBRIS  316  2  YES1FMT                     HA40      N Did SP have debris in mouth?

                                  53                   -8 Don't know
                                   9                    1 Yes
                                 874                    2 No

DHBRIDGE  318  2  YES1FMT                     HA40      N Did SP have removable bridges?

                                  53                   -8 Don't know
                                 339                    1 Yes
                                 544                    2 No

DHTEELOS  320  2  YES1FMT                     HA40      N Did SP have any natural teeth lost?

                                  53                   -8 Don't know
                                 225                    1 Yes
                                 658                    2 No

DHBROKEN  322  2  YES1FMT                     HA40      N Did SP have any broken/loose teeth?

                                  53                   -8 Don't know
                                  30                    1 Yes
                                 853                    2 No

DHINFGUM  324  2  YES1FMT                     HA40      N Did SP have any gum infection?

                                  53                   -8 Don't know
                                  13                    1 Yes
                                 870                    2 No

