RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                              23,339             LOW-HIGH BASEID Count

AA2        12  2  GEND                                  N ID; sex

                               5,753                    1 Male
                              17,586                    2 Female

AA3        14  8                                        N ID; birthdate

AA4        24  2  RACEETH                               N ID; race/ethnicity

                                  61                    . Missing
                                  78                    1 Amer Indian/Alaskan Native
                                 286                    2 Asian/Pacific Islander
                               2,693                    3 Black, not of Hispanic origin
                                 578                    4 Hispanic
                              19,643                    5 White, not of Hispanic origin

AA6A       26 15                                        C ID; facility provider number, state

AA6B       41 12                                        C ID, facility provider number, federal

AA8A       53  2  $PASSESS                              C ID; primary reason for assessment

                               4,227                   00 None of above
                               2,064                   01 Admission assessment
                               2,098                   02 Annual assessment
                                 931                   03 Signif change is status assessment
                                   6                   04 Signif correction of prior full
                               8,614                   05 Quarterly review assessment
                               1,780                   06 Discharged; return not anticipated
                               1,691                   07 Discharged; return anticipated
                                 369                   08 Discharged; prior to initial assessment
                               1,554                   09 Re-entry
                                   5                   10 Signif correction of prior quarterly

AA8B       55  1  $CASSESS                              C ID; codes for assessments required

                              16,886                      Missing
                               2,349                    1 Medicare 5 day assessment
                               1,011                    2 Medicare 30 day assessment
                                 411                    3 Medicare 60 day assessment
                                 204                    4 Medicare 90 day assessment
                                 283                    5 Medicare readmission/return assessment
                                 162                    6 Other state required assessment
                               1,846                    7 Medicare 14 day assessment
                                 187                    8 Other Medicare required assessment

AB1        56  8                                        N Residential; date of entry

AB2        66  2  ADMITFRM                              N Residential; admitted from

                              15,793                    . Missing
                                 883                    1 Private home w/ no home health services
                                 335                    2 Private home w/ home health services
                                 363                    3 Board and care/assist living/group home
                                 494                    4 Nursing home
                               5,130                    5 Acute care hospital
                                  71                    6 Psychiatric hospital, MR/DD facility
                                 187                    7 Rehabilitation hospital
                                  83                    8 Other

AB3        68  2  YESNOALO                              N Residential; lived alone

                              16,127                    . Missing
                               3,831                    0 No
                               2,514                    1 Yes
                                 867                    2 In other facility

AB4        70  5                                        C Residential; zip code, prior primary res

AB5A       75  2  INDIC                                 N Residential; prior stay in nursing home

                              13,575                    . Missing
                               7,285                    0 Not indicated
                               2,479                    1 Indicated

AB5B       77  2  INDIC                                 N Residential; stay in other nursing home

                              13,576                    . Missing
                               8,293                    0 Not indicated
                               1,470                    1 Indicated

AB5C       79  2  INDIC                                 N Residential; other residential facility

                              13,576                    . Missing
                               8,153                    0 Not indicated
                               1,610                    1 Indicated

AB5D       81  2  INDIC                                 N Residential; MH/psychiatric setting

                              13,576                    . Missing
                               9,640                    0 Not indicated
                                 123                    1 Indicated

AB5E       83  2  INDIC                                 N Residential; MR/DD setting

                              13,576                    . Missing
                               9,696                    0 Not indicated
                                  67                    1 Indicated

AB5F       85  2  INDIC                                 N Residential; none of above

                              13,575                    . Missing
                               4,877                    0 Not indicated
                               4,887                    1 Indicated

AB6        87 21                                        C Demo; lifetime occupation(s)

AB7       108  2  HIEDUCAT                              N Demo; highest of education complete

                              16,259                    . Missing
                                 120                    1 No schooling
                               1,527                    2 8th grade/less
                                 861                    3 9-11 grades
                               2,981                    4 High school
                                 268                    5 Technical or trade school
                                 847                    6 Some college
                                 238                    7 Bachelors degree
                                 238                    8 Graduate degree

AB8A      110  2  PRIMLANG                              N Demo; primary language

                              16,118                    . Missing
                               6,970                    0 English
                                 121                    1 Spanish
                                   4                    2 French
                                 126                    3 Other

AB8B      112  9                                        C Demo; other primary language

AB9       121  2  YESNO                                 N Mental; indication of MR/MI/DD history

                              16,129                    . Missing
                               6,443                    0 No
                                 767                    1 Yes

AB10A     123  2  INDIC                                 N Mental; status, no MR/DD

                              16,119                    . Missing
                                 225                    0 Not indicated
                               6,995                    1 Indicated

AB10B     125  2  INDIC                                 N Mental; status, downs syndrome

                              23,103                    . Missing
                                 227                    0 Not indicated
                                   9                    1 Indicated

AB10C     127  2  INDIC                                 N Mental; status, autism

                              23,103                    . Missing
                                 236                    0 Not indicated
                                   0                    1 Indicated

AB10D     129  2  INDIC                                 N Mental; status, epilepsy

                              23,103                    . Missing
                                 205                    0 Not indicated
                                  31                    1 Indicated

AB10E     131  2  INDIC                                 N Mental; status, other organic condition

                              23,103                    . Missing
                                 192                    0 Not indicated
                                  44                    1 Indicated

AB10F     133  2  INDIC                                 N Mental; status, MR/DD w/ no organic cond

                              23,103                    . Missing
                                  84                    0 Not indicated
                                 152                    1 Indicated

AB11      135  8                                        N Date background information completed

AC1A      145  2  INDIC                                 N Routine; event, stays up late at night

                              16,332                    . Missing
                               4,406                    0 Not indicated
                               2,601                    1 Indicated

AC1B      147  2  INDIC                                 N Routine; event, naps regularly

                              16,340                    . Missing
                               2,714                    0 Not indicated
                               4,285                    1 Indicated

AC1C      149  2  INDIC                                 N Routine; event, goes out 1+ days

                              16,332                    . Missing
                               3,871                    0 Not indicated
                               3,136                    1 Indicated

AC1D      151  2  INDIC                                 N Routine; event, stays busy

                              16,331                    . Missing
                               3,452                    0 Not indicated
                               3,556                    1 Indicated

AC1E      153  2  INDIC                                 N Routine; event, most of time spent alone

                              16,328                    . Missing
                               4,145                    0 Not indicated
                               2,866                    1 Indicated

AC1F      155  2  INDIC                                 N Routine; event, moves independent indoor

                              16,326                    . Missing
                               2,089                    0 Not indicated
                               4,924                    1 Indicated

AC1G      157  2  INDIC                                 N Routine; event, use of tobacco products

                              16,336                    . Missing
                               6,319                    0 Not indicated
                                 684                    1 Indicated

AC1H      159  2  INDIC                                 N Routine; event, none of above

                              16,326                    . Missing
                               6,749                    0 Not indicated
                                 264                    1 Indicated

AC1I      161  2  INDIC                                 N Routine; eating, distinct food pref

                              16,327                    . Missing
                               5,690                    0 Not indicated
                               1,322                    1 Indicated

AC1J      163  2  INDIC                                 N Routine; eating, eats between meals

                              16,335                    . Missing
                               4,549                    0 Not indicated
                               2,455                    1 Indicated

AC1K      165  2  INDIC                                 N Routine; eating, use of alcoholic bev

                              16,335                    . Missing
                               6,634                    0 Not indicated
                                 370                    1 Indicated

AC1L      167  2  INDIC                                 N Routine; eating, none of above

                              16,327                    . Missing
                               3,380                    0 Not indicated
                               3,632                    1 Indicated

AC1M      169  2  INDIC                                 N Routine; ADL, bedclothes most of day

                              16,336                    . Missing
                               6,599                    0 Not indicated
                                 404                    1 Indicated

AC1N      171  2  INDIC                                 N Routine; ADL, wakens to toilet

                              16,328                    . Missing
                               3,594                    0 Not indicated
                               3,417                    1 Indicated

AC1O      173  2  INDIC                                 N Routine; ADL, irregular bowel movement

                              16,336                    . Missing
                               6,132                    0 Not indicated
                                 871                    1 Indicated

AC1P      175  2  INDIC                                 N Routine; ADL, showers for bathing

                              16,328                    . Missing
                               2,906                    0 Not indicated
                               4,105                    1 Indicated

AC1Q      177  2  INDIC                                 N Routine; ADL, bathing in PM

                              16,337                    . Missing
                               6,134                    0 Not indicated
                                 868                    1 Indicated

AC1R      179  2  INDIC                                 N Routine; ADL, none of above

                              16,328                    . Missing
                               5,781                    0 Not indicated
                               1,230                    1 Indicated

AC1S      181  2  INDIC                                 N Routine; involve, daily contact family

                              16,327                    . Missing
                               1,300                    0 Not indicated
                               5,712                    1 Indicated

AC1T      183  2  INDIC                                 N Routine; involve, attends church

                              16,329                    . Missing
                               4,400                    0 Not indicated
                               2,610                    1 Indicated

AC1U      185  2  INDIC                                 N Routine; involve, strength in faith

                              16,330                    . Missing
                               3,170                    0 Not indicated
                               3,839                    1 Indicated

AC1V      187  2  INDIC                                 N Routine; involve, animal companion

                              16,336                    . Missing
                               6,163                    0 Not indicated
                                 840                    1 Indicated

AC1W      189  2  INDIC                                 N Routine; involve, group activities

                              16,340                    . Missing
                               5,046                    0 Not indicated
                               1,953                    1 Indicated

AC1X      191  2  INDIC                                 N Routine; involve, none of above

                              16,326                    . Missing
                               6,457                    0 Not indicated
                                 556                    1 Indicated

AC1Y      193  2  INDIC                                 N Routine; unknown routines

                              16,107                    . Missing
                               7,013                    0 Not indicated
                                 219                    1 Indicated

A2        195  5                                        C Background; room number

A3A       200  8                                        N Background; assessment reference date

A4B       210  2                                        N Background; original or copy number

A4A       212  8                                        N Background; date of reentry

A5        222  2  MARITAL                               N Background; marital status

                              12,451                    . Missing
                               1,337                    1 Never married
                               2,235                    2 Married
                               6,461                    3 Widowed
                                 149                    4 Separated
                                 706                    5 Divorced

A6        224 12                                        C Background; medical record number

A7A       236  2  INDIC                                 N Payment; Medicaid per diem

                              16,967                    . Missing
                               3,365                    0 Not indicated
                               3,007                    1 Indicated

A7B       238  2  INDIC                                 N Payment; Medicare per diem

                              16,964                    . Missing
                               4,224                    0 Not indicated
                               2,151                    1 Indicated

A7C       240  2  INDIC                                 N Payment; Medicare ancillary part A

                              16,966                    . Missing
                               5,108                    0 Not indicated
                               1,265                    1 Indicated

A7D       242  2  INDIC                                 N Payment; Medicare ancillary part B

                              16,965                    . Missing
                               5,630                    0 Not indicated
                                 744                    1 Indicated

A7E       244  2  INDIC                                 N Payment; CHAMPUS per diem

                              16,968                    . Missing
                               6,369                    0 Not indicated
                                   2                    1 Indicated

A7F       246  2  INDIC                                 N Payment; VA per diem

                              16,969                    . Missing
                               6,352                    0 Not indicated
                                  18                    1 Indicated

A7G       248  2  INDIC                                 N Payment; self/family pays full per diem

                              16,966                    . Missing
                               5,563                    0 Not indicated
                                 810                    1 Indicated

A7H       250  2  INDIC                                 N Payment; Mcaid res liab/Mcare co-payment

                              16,966                    . Missing
                               5,395                    0 Not indicated
                                 978                    1 Indicated

A7I       252  2  INDIC                                 N Payment; private insurance per diem

                              16,968                    . Missing
                               5,814                    0 Not indicated
                                 557                    1 Indicated

A7J       254  2  INDIC                                 N Payment; other per diem

                              16,969                    . Missing
                               6,246                    0 Not indicated
                                 124                    1 Indicated

A9A       256  2  INDIC                                 N Decisions; legal guardian

                              16,965                    . Missing
                               6,031                    0 Not indicated
                                 343                    1 Indicated

A9B       258  2  INDIC                                 N Decisions; other legal oversight

                              16,965                    . Missing
                               6,274                    0 Not indicated
                                 100                    1 Indicated

A9C       260  2  INDIC                                 N Decisions; dur power attorney/health

                              16,964                    . Missing
                               4,103                    0 Not indicated
                               2,272                    1 Indicated

A9D       262  2  INDIC                                 N Decisions; dur power attorney/financial

                              16,964                    . Missing
                               4,872                    0 Not indicated
                               1,503                    1 Indicated

A9E       264  2  INDIC                                 N Decisions; family member responsible

                              16,962                    . Missing
                               2,363                    0 Not indicated
                               4,014                    1 Indicated

A9F       266  2  INDIC                                 N Decisions; patient responsible for self

                              16,965                    . Missing
                               4,268                    0 Not indicated
                               2,106                    1 Indicated

A9G       268  2  INDIC                                 N Decisions; none of the above

                              16,962                    . Missing
                               6,196                    0 Not indicated
                                 181                    1 Indicated

A10A      270  2  INDIC                                 N Adv directives; living will

                              16,967                    . Missing
                               5,074                    0 Not indicated
                               1,298                    1 Indicated

A10B      272  2  INDIC                                 N Adv directives; do not resuscitate

                              12,544                    . Missing
                               5,991                    0 Not indicated
                               4,804                    1 Indicated

A10C      274  2  INDIC                                 N Adv directives; do not hospitalize

                              12,549                    . Missing
                              10,554                    0 Not indicated
                                 236                    1 Indicated

A10D      276  2  INDIC                                 N Adv directives; organ donation

                              16,969                    . Missing
                               6,354                    0 Not indicated
                                  16                    1 Indicated

A10E      278  2  INDIC                                 N Adv directives; autopsy request

                              16,968                    . Missing
                               6,366                    0 Not indicated
                                   5                    1 Indicated

A10F      280  2  INDIC                                 N Adv directives; feeding restrict

                              16,966                    . Missing
                               5,856                    0 Not indicated
                                 517                    1 Indicated

A10G      282  2  INDIC                                 N Adv directives; medication restrict

                              16,968                    . Missing
                               6,241                    0 Not indicated
                                 130                    1 Indicated

A10H      284  2  INDIC                                 N Adv directives; other treatment restrict

                              16,968                    . Missing
                               6,037                    0 Not indicated
                                 334                    1 Indicated

A10I      286  2  INDIC                                 N Adv directives; none of above

                              16,965                    . Missing
                               3,499                    0 Not indicated
                               2,875                    1 Indicated

B1        288  2  YESNO                                 N Cognitive; comatose

                               5,396                    . Missing
                              17,927                    0 No
                                  16                    1 Yes

B2A       290  2  MEMORY                                N Cognitive; short-term memory OK

                               5,455                    . Missing
                               5,220                    0 Memory OK
                              12,664                    1 Memory problem

B2B       292  2  MEMORY                                N Cognitive; long-term memory OK

                               5,459                    . Missing
                               9,033                    0 Memory OK
                               8,847                    1 Memory problem

B3A       294  2  INDIC                                 N Cognitive; recall; current season

                               7,835                    . Missing
                               8,042                    0 Not indicated
                               7,462                    1 Indicated

B3B       296  2  INDIC                                 N Cognitive; recall; location of own room

                               7,832                    . Missing
                               5,934                    0 Not indicated
                               9,573                    1 Indicated

B3C       298  2  INDIC                                 N Cognitive; recall; staff names/faces

                               7,828                    . Missing
                               4,591                    0 Not indicated
                              10,920                    1 Indicated

B3D       300  2  INDIC                                 N Cognitive; recall; lives in nursing home

                               7,837                    . Missing
                               5,320                    0 Not indicated
                              10,182                    1 Indicated

B3E       302  2  INDIC                                 N Cognitive; recall; none of the above

                               7,827                    . Missing
                              12,462                    0 Not indicated
                               3,050                    1 Indicated

B4        304  2  COGNITIV                              N Cognitive; daily decision making skills

                               5,413                    . Missing
                               3,848                    0 Independent
                               3,974                    1 Modified independence
                               7,568                    2 Moderately impaired
                               2,536                    3 Severely impaired

B5A       306  2  COGNITIV                              N Cognitive; delirium, easily distracted

                               5,412                    . Missing
                              15,013                    0 Independent
                               2,814                    1 Modified independence
                                 100                    2 Moderately impaired
                                   0                    3 Severely impaired

B5B       308  2  COGNITIV                              N Cognitive; delirium, altered perception

                               5,412                    . Missing
                              15,888                    0 Independent
                               1,916                    1 Modified independence
                                 123                    2 Moderately impaired
                                   0                    3 Severely impaired

B5C       310  2  COGNITIV                              N Cognitive; delirium, disorganized speech

                               5,412                    . Missing
                              15,438                    0 Independent
                               2,370                    1 Modified independence
                                 119                    2 Moderately impaired
                                   0                    3 Severely impaired

B5D       312  2  COGNITIV                              N Cognitive; delirium, restlessness

                               5,412                    . Missing
                              15,143                    0 Independent
                               2,626                    1 Modified independence
                                 158                    2 Moderately impaired
                                   0                    3 Severely impaired

B5E       314  2  COGNITIV                              N Cognitive; delirium, lethargy

                               5,412                    . Missing
                              16,595                    0 Independent
                               1,178                    1 Modified independence
                                 154                    2 Moderately impaired
                                   0                    3 Severely impaired

B5F       316  2  COGNITIV                              N Cognitive; delirium, varied function

                               5,412                    . Missing
                              14,012                    0 Independent
                               3,718                    1 Modified independence
                                 197                    2 Moderately impaired
                                   0                    3 Severely impaired

B6        318  2  CHANGE                                N Cognitive; change in last 90 days

                              16,972                    . Missing
                               5,652                    0 No change
                                 141                    1 Improved
                                 574                    2 Deteriorated

C1        320  2  HEAR                                  N Comm; hearing ability

                              16,971                    . Missing
                               4,606                    0 Hears adequately
                               1,190                    1 Minimal difficulty
                                 507                    2 Hears in special situations only
                                  65                    3 Highly impaired

C2A       322  2  INDIC                                 N Comm; hearing aid, present and used

                              16,971                    . Missing
                               5,907                    0 Not indicated
                                 461                    1 Indicated

C2B       324  2  INDIC                                 N Comm; hearing aid, present and not used

                              16,971                    . Missing
                               6,204                    0 Not indicated
                                 164                    1 Indicated

C2C       326  2  INDIC                                 N Comm; other receptive used

                              16,971                    . Missing
                               6,324                    0 Not indicated
                                  44                    1 Indicated

C2D       328  2  INDIC                                 N Comm; none of above comm methods used

                              16,970                    . Missing
                                 666                    0 Not indicated
                               5,703                    1 Indicated

C3A       330  2  INDIC                                 N Comm; modes, speech

                              16,969                    . Missing
                                 310                    0 Not indicated
                               6,060                    1 Indicated

C3B       332  2  INDIC                                 N Comm; modes, writing messages to clarify

                              16,972                    . Missing
                               6,275                    0 Not indicated
                                  92                    1 Indicated

C3C       334  2  INDIC                                 N Comm; modes, ASL or braille

                              16,972                    . Missing
                               6,366                    0 Not indicated
                                   1                    1 Indicated

C3D       336  2  INDIC                                 N Comm; modes, signs, gestures, or sounds

                              16,971                    . Missing
                               5,649                    0 Not indicated
                                 719                    1 Indicated

C3E       338  2  INDIC                                 N Comm; modes, communication board

                              16,974                    . Missing
                               6,308                    0 Not indicated
                                  57                    1 Indicated

C3F       340  2  INDIC                                 N Comm; modes, other

                              16,972                    . Missing
                               6,343                    0 Not indicated
                                  24                    1 Indicated

C3G       342  2  INDIC                                 N Comm; modes, none of above

                              16,969                    . Missing
                               6,246                    0 Not indicated
                                 124                    1 Indicated

C4        344  2  UNDERSTO                              N Comm; ability to make self understood

                               5,413                    . Missing
                              10,279                    0 Understood
                               3,677                    1 Usually understood
                               2,620                    2 Sometimes understood
                               1,350                    3 Rarely/Never understood

C5        346  2  CLEAR                                 N Comm, speech clarity

                              16,968                    . Missing
                               5,095                    0 clear speech
                               1,027                    1 unclear speech
                                 249                    2 no speech

C6        348  2  UNDERSTA                              N Comm; ability to understand others

                               5,412                    . Missing
                               8,850                    0 Understands
                               4,894                    1 Usually understands
                               3,102                    2 Sometimes understands
                               1,081                    3 Rarely/Never understands

C7        350  2  CHANGE                                N Comm; change in last 90 days

                              16,968                    . Missing
                               5,980                    0 No change
                                  46                    1 Improved
                                 345                    2 Deteriorated

D1        352  2  ADEQUATE                              N Vision

                              13,113                    . Missing
                               6,840                    0 Adequate
                               2,101                    1 Impaired
                                 579                    2 Moderately impaired
                                 544                    3 Highly impaired
                                 162                    4 Severely impaired

D2A       354  2  INDIC                                 N Vision; limitation, side vision problems

                              17,040                    . Missing
                               6,156                    0 Not indicated
                                 143                    1 Indicated

D2B       356  2  INDIC                                 N Vision; limitation, halos/rings/flashes

                              17,040                    . Missing
                               6,275                    0 Not indicated
                                  24                    1 Indicated

D2C       358  2  INDIC                                 N Vision; limitation, none of above

                              17,039                    . Missing
                                 161                    0 Not indicated
                               6,139                    1 Indicated

D3        360  2  YESNO                                 N Vision; corrective eyewear, etc.

                              17,039                    . Missing
                               1,945                    0 No
                               4,355                    1 Yes

E1A       362  2  INDICTH                               N Mood; negative statements

                               5,414                    . Missing
                              17,332                    0 Not exhibited in last 30 days
                                 540                    1 Exhibited up to 5 days week
                                  53                    2 Exhibited 6 to 7 days week

E1B       364  2  INDICTH                               N Mood; repetitive questions

                               5,412                    . Missing
                              16,941                    0 Not exhibited in last 30 days
                                 736                    1 Exhibited up to 5 days week
                                 250                    2 Exhibited 6 to 7 days week

E1C       366  2  INDICTH                               N Mood; repetitive verbalizations

                               5,412                    . Missing
                              16,762                    0 Not exhibited in last 30 days
                                 881                    1 Exhibited up to 5 days week
                                 284                    2 Exhibited 6 to 7 days week

E1D       368  2  INDICTH                               N Mood; persistent anger w/ self or others

                               5,412                    . Missing
                              15,607                    0 Not exhibited in last 30 days
                               1,907                    1 Exhibited up to 5 days week
                                 413                    2 Exhibited 6 to 7 days week

E1E       370  2  INDICTH                               N Mood; self deprecation

                               5,412                    . Missing
                              17,610                    0 Not exhibited in last 30 days
                                 299                    1 Exhibited up to 5 days week
                                  18                    2 Exhibited 6 to 7 days week

E1F       372  2  INDICTH                               N Mood; unrealistic fears

                               5,413                    . Missing
                              17,266                    0 Not exhibited in last 30 days
                                 570                    1 Exhibited up to 5 days week
                                  90                    2 Exhibited 6 to 7 days week

E1G       374  2  INDICTH                               N Mood; belief terrible going to happen

                               5,412                    . Missing
                              17,717                    0 Not exhibited in last 30 days
                                 171                    1 Exhibited up to 5 days week
                                  39                    2 Exhibited 6 to 7 days week

E1H       376  2  INDICTH                               N Mood; repetitive health complaints

                               5,412                    . Missing
                              15,982                    0 Not exhibited in last 30 days
                               1,570                    1 Exhibited up to 5 days week
                                 375                    2 Exhibited 6 to 7 days week

E1I       378  2  INDICTH                               N Mood; repetitive anxious complaints

                               5,412                    . Missing
                              15,634                    0 Not exhibited in last 30 days
                               1,795                    1 Exhibited up to 5 days week
                                 498                    2 Exhibited 6 to 7 days week

E1J       380  2  INDICTH                               N Mood; unpleasant mood in AM

                               5,412                    . Missing
                              17,104                    0 Not exhibited in last 30 days
                                 652                    1 Exhibited up to 5 days week
                                 171                    2 Exhibited 6 to 7 days week

E1K       382  2  INDICTH                               N Mood; insomnia/change in sleep pattern

                               5,412                    . Missing
                              16,574                    0 Not exhibited in last 30 days
                               1,246                    1 Exhibited up to 5 days week
                                 107                    2 Exhibited 6 to 7 days week

E1L       384  2  INDICTH                               N Mood; sad/worried facial expressions

                               5,412                    . Missing
                              13,853                    0 Not exhibited in last 30 days
                               3,123                    1 Exhibited up to 5 days week
                                 951                    2 Exhibited 6 to 7 days week

E1M       386  2  INDICTH                               N Mood; crying/tearfulness

                               5,413                    . Missing
                              16,635                    0 Not exhibited in last 30 days
                               1,163                    1 Exhibited up to 5 days week
                                 128                    2 Exhibited 6 to 7 days week

E1N       388  2  INDICTH                               N Mood; repetitive physical movements

                               5,413                    . Missing
                              15,523                    0 Not exhibited in last 30 days
                               1,713                    1 Exhibited up to 5 days week
                                 690                    2 Exhibited 6 to 7 days week

E1O       390  2  INDICTH                               N Mood; withdrawal from activ of interest

                               5,412                    . Missing
                              17,098                    0 Not exhibited in last 30 days
                                 585                    1 Exhibited up to 5 days week
                                 244                    2 Exhibited 6 to 7 days week

E1P       392  2  INDICTH                               N Mood; reduced social interaction

                               5,412                    . Missing
                              16,830                    0 Not exhibited in last 30 days
                                 785                    1 Exhibited up to 5 days week
                                 312                    2 Exhibited 6 to 7 days week

E2        394  2  MODINDIC                              N Mood; persistence

                               5,412                    . Missing
                              10,442                    0 No mood indicators
                               4,655                    1 Indicators present, easily altered
                               2,830                    2 Indicators present, not easily altered

E3        396  2  CHANGE                                N Mood; change in last 90 days

                              16,971                    . Missing
                               5,464                    0 No change
                                 345                    1 Improved
                                 559                    2 Deteriorated

E4AA      398  2  BEHAVA                                N Behavior; wandering frequency

                               5,412                    . Missing
                              16,833                    0 Behavior not exhibited
                                 466                    1 1 to 3 days
                                 214                    2 4 to 6 days
                                 414                    3 Behavior exhibited daily

E4AB      400  2  BEHAVB                                N Behavior; wandering alterability

                               5,412                    . Missing
                              17,353                    0 Behavior not present or easily altered
                                 574                    1 Behavior not easily altered

E4BA      402  2  BEHAVA                                N Behavior; verbally abusive frequency

                               5,412                    . Missing
                              16,687                    0 Behavior not exhibited
                                 899                    1 1 to 3 days
                                 219                    2 4 to 6 days
                                 122                    3 Behavior exhibited daily

E4BB      404  2  BEHAVB                                N Behavior; verbally abusive alterability

                               5,412                    . Missing
                              17,193                    0 Behavior not present or easily altered
                                 734                    1 Behavior not easily altered

E4CA      406  2  BEHAVA                                N Behavior; physical abusive frequency

                               5,412                    . Missing
                              17,181                    0 Behavior not exhibited
                                 543                    1 1 to 3 days
                                 119                    2 4 to 6 days
                                  84                    3 Behavior exhibited daily

E4CB      408  2  BEHAVB                                N Behavior; physical abusive alterability

                               5,412                    . Missing
                              17,554                    0 Behavior not present or easily altered
                                 373                    1 Behavior not easily altered

E4DA      410  2  BEHAVA                                N Behavior; soc inappropriate frequency

                               5,412                    . Missing
                              16,184                    0 Behavior not exhibited
                               1,074                    1 1 to 3 days
                                 307                    2 4 to 6 days
                                 362                    3 Behavior exhibited daily

E4DB      412  2  BEHAVB                                N Behavior; soc inappropriate alterability

                               5,412                    . Missing
                              16,871                    0 Behavior not present or easily altered
                               1,056                    1 Behavior not easily altered

E4EA      414  2  BEHAVA                                N Behavior; resists care frequency

                               5,412                    . Missing
                              14,983                    0 Behavior not exhibited
                               1,872                    1 1 to 3 days
                                 572                    2 4 to 6 days
                                 500                    3 Behavior exhibited daily

E4EB      416  2  BEHAVB                                N Behavior; resists care alterability

                               5,412                    . Missing
                              15,918                    0 Behavior not present or easily altered
                               2,009                    1 Behavior not easily altered

E5        418  2  CHANGE                                N Behavior; change in last 90 days

                              16,971                    . Missing
                               5,781                    0 No change
                                 231                    1 Improved
                                 356                    2 Deteriorated

F1A       420  2  INDIC                                 N Social; at ease interacting with others

                              17,036                    . Missing
                               1,205                    0 Not indicated
                               5,098                    1 Indicated

F1B       422  2  INDIC                                 N Social; at ease in structured activities

                              17,038                    . Missing
                               3,195                    0 Not indicated
                               3,106                    1 Indicated

F1C       424  2  INDIC                                 N Social; at ease in self-init activities

                              17,039                    . Missing
                               3,337                    0 Not indicated
                               2,963                    1 Indicated

F1D       426  2  INDIC                                 N Social; establishes own goals

                              17,038                    . Missing
                               4,975                    0 Not indicated
                               1,326                    1 Indicated

F1E       428  2  INDIC                                 N Social; involvement in life of facility

                              17,039                    . Missing
                               5,374                    0 Not indicated
                                 926                    1 Indicated

F1F       430  2  INDIC                                 N Social; accepts invitations group activ

                              17,039                    . Missing
                               4,973                    0 Not indicated
                               1,327                    1 Indicated

F1G       432  2  INDIC                                 N Social; none of above

                              17,036                    . Missing
                               5,510                    0 Not indicated
                                 793                    1 Indicated

F2A       434  2  INDIC                                 N Social; open conflict with staff

                              17,039                    . Missing
                               6,125                    0 Not indicated
                                 175                    1 Indicated

F2B       436  2  INDIC                                 N Social; unhappy with roommate

                              17,039                    . Missing
                               6,179                    0 Not indicated
                                 121                    1 Indicated

F2C       438  2  INDIC                                 N Social; unhappy with other residents

                              17,039                    . Missing
                               6,184                    0 Not indicated
                                 116                    1 Indicated

F2D       440  2  INDIC                                 N Social; open conflict w/ fam/friend

                              17,039                    . Missing
                               6,189                    0 Not indicated
                                 111                    1 Indicated

F2E       442  2  INDIC                                 N Social; absence of contact w/ fam/friend

                              17,039                    . Missing
                               6,184                    0 Not indicated
                                 116                    1 Indicated

F2F       444  2  INDIC                                 N Social; recent loss of close fam/friend

                              17,039                    . Missing
                               6,189                    0 Not indicated
                                 111                    1 Indicated

F2G       446  2  INDIC                                 N Social; does not adjust to routine chang

                              17,039                    . Missing
                               5,824                    0 Not indicated
                                 476                    1 Indicated

F2H       448  2  INDIC                                 N Social; none of above

                              17,038                    . Missing
                                 897                    0 Not indicated
                               5,404                    1 Indicated

F3A       450  2  INDIC                                 N Social; strong identity in past role

                              17,039                    . Missing
                               5,648                    0 Not indicated
                                 652                    1 Indicated

F3B       452  2  INDIC                                 N Social; sadness/anger at loss of role

                              17,039                    . Missing
                               5,995                    0 Not indicated
                                 305                    1 Indicated

F3C       454  2  INDIC                                 N Social; routine diff than prior pattern

                              17,039                    . Missing
                               5,798                    0 Not indicated
                                 502                    1 Indicated

F3D       456  2  INDIC                                 N Social; none of above

                              17,039                    . Missing
                                 997                    0 Not indicated
                               5,303                    1 Indicated

G1AA      458  2  ADLA                                  N ADL; bed mobility, self-perform

                               5,396                    . Missing
                               4,628                    0 Independent
                               1,203                    1 Supervision
                               3,607                    2 Limited assistance
                               5,523                    3 Extensive assistance
                               2,982                    4 Total dependence
                                   0                    8 Activity did not occur

G1AB      460  2  ADLB                                  N ADL; bed mobility, supported

                               7,835                    . Missing
                               3,588                    0 No setup or physical help from staff
                               1,036                    1 Setup help only
                               7,797                    2 One person physical assist
                               3,083                    3 Two+ persons physical assist
                                   0                    8 Activity did not occur

G1BA      462  2  ADLA                                  N ADL; transfer, self-perform

                               5,396                    . Missing
                               3,049                    0 Independent
                               1,145                    1 Supervision
                               3,760                    2 Limited assistance
                               5,647                    3 Extensive assistance
                               4,146                    4 Total dependence
                                 196                    8 Activity did not occur

G1BB      464  2  ADLB                                  N ADL; transfer, supported

                               7,837                    . Missing
                               2,368                    0 No setup or physical help from staff
                                 887                    1 Setup help only
                               7,167                    2 One person physical assist
                               4,900                    3 Two+ persons physical assist
                                 180                    8 Activity did not occur

G1CA      466  2  ADLA                                  N ADL; walk in room, self-perform

                               5,394                    . Missing
                               2,915                    0 Independent
                               1,286                    1 Supervision
                               2,973                    2 Limited assistance
                               2,362                    3 Extensive assistance
                                 222                    4 Total dependence
                               8,187                    8 Activity did not occur

G1CB      468  2  ADLB                                  N ADL; walk in room, supported

                               7,832                    . Missing
                               2,496                    0 No setup or physical help from staff
                                 914                    1 Setup help only
                               4,436                    2 One person physical assist
                                 686                    3 Two+ persons physical assist
                               6,975                    8 Activity did not occur

G1DA      470  2  ADLA                                  N ADL; walk in corridor, self-perform

                               5,396                    . Missing
                               2,347                    0 Independent
                               1,524                    1 Supervision
                               2,982                    2 Limited assistance
                               1,991                    3 Extensive assistance
                                 196                    4 Total dependence
                               8,903                    8 Activity did not occur

G1DB      472  2  ADLB                                  N ADL; walk in corridor, supported

                               7,834                    . Missing
                               2,204                    0 No setup or physical help from staff
                                 888                    1 Setup help only
                               4,256                    2 One person physical assist
                                 556                    3 Two+ persons physical assist
                               7,601                    8 Activity did not occur

G1EA      474  2  ADLA                                  N ADL; locomotion on unit, self-perform

                               5,396                    . Missing
                               4,529                    0 Independent
                               1,917                    1 Supervision
                               2,823                    2 Limited assistance
                               3,063                    3 Extensive assistance
                               5,121                    4 Total dependence
                                 490                    8 Activity did not occur

G1EB      476  2  ADLB                                  N ADL; locomotion on unit, supported

                               7,837                    . Missing
                               3,439                    0 No setup or physical help from staff
                               1,663                    1 Setup help only
                               9,748                    2 One person physical assist
                                 226                    3 Two+ persons physical assist
                                 426                    8 Activity did not occur

G1FA      478  2  ADLA                                  N ADL; locomotion off unit, self-perform

                               5,396                    . Missing
                               3,387                    0 Independent
                               1,764                    1 Supervision
                               2,345                    2 Limited assistance
                               2,742                    3 Extensive assistance
                               6,449                    4 Total dependence
                               1,256                    8 Activity did not occur

G1FB      480  2  ADLB                                  N ADL; locomotion off unit, supported

                               7,837                    . Missing
                               2,639                    0 No setup or physical help from staff
                               1,315                    1 Setup help only
                              10,298                    2 One person physical assist
                                 137                    3 Two+ persons physical assist
                               1,113                    8 Activity did not occur

G1GA      482  2  ADLA                                  N ADL; dressing, self-perform

                               5,396                    . Missing
                               1,372                    0 Independent
                               1,194                    1 Supervision
                               3,649                    2 Limited assistance
                               7,201                    3 Extensive assistance
                               4,482                    4 Total dependence
                                  45                    8 Activity did not occur

G1GB      484  2  ADLB                                  N ADL; dressing, supported

                               7,837                    . Missing
                                 996                    0 No setup or physical help from staff
                                 960                    1 Setup help only
                              13,044                    2 One person physical assist
                                 462                    3 Two+ persons physical assist
                                  40                    8 Activity did not occur

G1HA      486  2  ADLA                                  N ADL; eating, self-perform

                               5,396                    . Missing
                               8,164                    0 Independent
                               3,974                    1 Supervision
                               1,706                    2 Limited assistance
                               1,428                    3 Extensive assistance
                               2,661                    4 Total dependence
                                  10                    8 Activity did not occur

G1HB      488  2  ADLB                                  N ADL; eating, supported

                               7,837                    . Missing
                               2,054                    0 No setup or physical help from staff
                               8,145                    1 Setup help only
                               5,273                    2 One person physical assist
                                  20                    3 Two+ persons physical assist
                                  10                    8 Activity did not occur

G1IA      490  2  ADLA                                  N ADL; toilet use, self-perform

                               5,396                    . Missing
                               2,258                    0 Independent
                               1,015                    1 Supervision
                               2,996                    2 Limited assistance
                               5,893                    3 Extensive assistance
                               5,722                    4 Total dependence
                                  59                    8 Activity did not occur

G1IB      492  2  ADLB                                  N ADL; toilet use, supported

                               7,837                    . Missing
                               1,698                    0 No setup or physical help from staff
                                 785                    1 Setup help only
                              10,072                    2 One person physical assist
                               2,893                    3 Two+ persons physical assist
                                  54                    8 Activity did not occur

G1JA      494  2  ADLA                                  N ADL; personal hygiene, self-perform

                               5,396                    . Missing
                               1,526                    0 Independent
                               1,569                    1 Supervision
                               3,695                    2 Limited assistance
                               6,182                    3 Extensive assistance
                               4,970                    4 Total dependence
                                   1                    8 Activity did not occur

G1JB      496  2  ADLB                                  N ADL; personal hygiene, supported

                               7,837                    . Missing
                                 924                    0 No setup or physical help from staff
                               1,460                    1 Setup help only
                              12,615                    2 One person physical assist
                                 502                    3 Two+ persons physical assist
                                   1                    8 Activity did not occur

G2A       498  2  BATHING                               N ADL; bathing, self perform

                               5,397                    . Missing
                                 266                    0 Independent
                                 795                    1 Supervision
                               1,383                    2 Phys help limited to transfer only
                               8,775                    3 Phys help in part of bathing activity
                               6,612                    4 Total dependence
                                 111                    8 Activity did not occur

G2B       500  2  ADLB                                  N ADL; bathing, supported

                              16,962                    . Missing
                                 114                    0 No setup or physical help from staff
                                 267                    1 Setup help only
                               5,152                    2 One person physical assist
                                 794                    3 Two+ persons physical assist
                                  50                    8 Activity did not occur

G3A       502  2  BALANCE                               N ADL; balance while standing

                               7,920                    . Missing
                               1,041                    0 Maintained position
                               2,081                    1 Unsteady
                               3,271                    2 Partial physical support
                               9,026                    3 Not able to attempt test

G3B       504  2  BALANCE                               N ADL; balance while sitting

                               7,818                    . Missing
                               8,558                    0 Maintained position
                               1,776                    1 Unsteady
                               2,336                    2 Partial physical support
                               2,851                    3 Not able to attempt test

G4AA      506  2  RANGE                                 N ADL; neck, range of motion

                               5,403                    . Missing
                              16,544                    0 No limitation
                                 339                    1 Limitation on one side
                               1,053                    2 Limitation on both sides

G4AB      508  2  VOL                                   N ADL; neck, voluntary motion

                               5,405                    . Missing
                              16,698                    0 No loss
                               1,127                    1 Partial loss
                                 109                    2 Full loss

G4BA      510  2  RANGE                                 N ADL; arm, range of motion

                               5,404                    . Missing
                              12,921                    0 No limitation
                               2,683                    1 Limitation on one side
                               2,331                    2 Limitation on both sides

G4BB      512  2  VOL                                   N ADL; arm, voluntary motion

                               5,406                    . Missing
                              12,924                    0 No loss
                               4,069                    1 Partial loss
                                 940                    2 Full loss

G4CA      514  2  RANGE                                 N ADL; hand, range of motion

                               5,404                    . Missing
                              14,112                    0 No limitation
                               2,267                    1 Limitation on one side
                               1,556                    2 Limitation on both sides

G4CB      516  2  VOL                                   N ADL; hand, voluntary motion

                               5,405                    . Missing
                              13,970                    0 No loss
                               3,035                    1 Partial loss
                                 929                    2 Full loss

G4DA      518  2  RANGE                                 N ADL; leg, range of motion

                               5,402                    . Missing
                              10,882                    0 No limitation
                               3,655                    1 Limitation on one side
                               3,400                    2 Limitation on both sides

G4DB      520  2  VOL                                   N ADL; leg, voluntary motion

                               5,404                    . Missing
                              11,120                    0 No loss
                               5,487                    1 Partial loss
                               1,328                    2 Full loss

G4EA      522  2  RANGE                                 N ADL; foot, range of motion

                               5,402                    . Missing
                              12,994                    0 No limitation
                               2,376                    1 Limitation on one side
                               2,567                    2 Limitation on both sides

G4EB      524  2  VOL                                   N ADL; foot, voluntary motion

                               5,404                    . Missing
                              12,946                    0 No loss
                               3,553                    1 Partial loss
                               1,436                    2 Full loss

G4FA      526  2  RANGE                                 N ADL; other, range of motion

                               5,564                    . Missing
                              16,985                    0 No limitation
                                 257                    1 Limitation on one side
                                 533                    2 Limitation on both sides

G4FB      528  2  VOL                                   N ADL; other, voluntary motion

                               5,574                    . Missing
                              17,069                    0 No loss
                                 611                    1 Partial loss
                                  85                    2 Full loss

G5A       530  2  INDIC                                 N ADL; used cane

                              16,966                    . Missing
                               3,910                    0 Not indicated
                               2,463                    1 Indicated

G5B       532  2  INDIC                                 N ADL; wheeled self

                              12,521                    . Missing
                               6,534                    0 Not indicated
                               4,284                    1 Indicated

G5C       534  2  INDIC                                 N ADL; other person wheeled

                              16,963                    . Missing
                               2,216                    0 Not indicated
                               4,160                    1 Indicated

G5D       536  2  INDIC                                 N ADL; wheelchair primary mode

                              16,964                    . Missing
                               2,222                    0 Not indicated
                               4,153                    1 Indicated

G5E       538  2  INDIC                                 N ADL; none of above

                              16,963                    . Missing
                               5,586                    0 Not indicated
                                 790                    1 Indicated

G6A       540  2  INDIC                                 N ADL; transfer, bedfast

                               5,409                    . Missing
                              17,138                    0 Not indicated
                                 792                    1 Indicated

G6B       542  2  INDIC                                 N ADL; transfer, bed rails used

                               5,409                    . Missing
                               8,559                    0 Not indicated
                               9,371                    1 Indicated

G6C       544  2  INDIC                                 N ADL; transfer, lifted manually

                              16,965                    . Missing
                               5,026                    0 Not indicated
                               1,348                    1 Indicated

G6D       546  2  INDIC                                 N ADL; transfer, lifted mechanically

                              16,963                    . Missing
                               5,650                    0 Not indicated
                                 726                    1 Indicated

G6E       548  2  INDIC                                 N ADL; transfer, transfer aid

                              16,964                    . Missing
                               4,307                    0 Not indicated
                               2,068                    1 Indicated

G6F       550  2  INDIC                                 N ADL; transfer, none of above

                              13,735                    . Missing
                               6,571                    0 Not indicated
                               3,033                    1 Indicated

G7        552  2  YESNO                                 N ADL; task segmentation

                               7,798                    . Missing
                               8,855                    0 No
                               6,686                    1 Yes

G8A       554  2  INDIC                                 N ADL; rehab potential, resident believes

                              16,963                    . Missing
                               4,638                    0 Not indicated
                               1,738                    1 Indicated

G8B       556  2  INDIC                                 N ADL; rehab potential, staff believes

                              16,965                    . Missing
                               4,270                    0 Not indicated
                               2,104                    1 Indicated

G8C       558  2  INDIC                                 N ADL; rehab potential, slow

                              16,965                    . Missing
                               5,627                    0 Not indicated
                                 747                    1 Indicated

G8D       560  2  INDIC                                 N ADL; rehab potential, diff in AM and PM

                              16,965                    . Missing
                               6,061                    0 Not indicated
                                 313                    1 Indicated

G8E       562  2  INDIC                                 N ADL; rehab potential, none of above

                              16,962                    . Missing
                               2,734                    0 Not indicated
                               3,643                    1 Indicated

G9        564  2  CHANGE                                N ADL; change in last 90 days

                              16,967                    . Missing
                               3,822                    0 No change
                                 626                    1 Improved
                               1,924                    2 Deteriorated

H1A       566  2  CONTINEN                              N Continence; bowel

                               5,398                    . Missing
                               8,302                    0 Continent
                               1,208                    1 Usually continent
                               1,245                    2 Occasionally incontinent
                               1,564                    3 Frequently incontinent
                               5,622                    4 Incontinent

H1B       568  2  CONTINEN                              N Continence; bladder

                               5,396                    . Missing
                               6,343                    0 Continent
                               1,329                    1 Usually continent
                               1,313                    2 Occasionally incontinent
                               3,091                    3 Frequently incontinent
                               5,867                    4 Incontinent

H2A       570  2  INDIC                                 N Continence; bowel regular

                              16,963                    . Missing
                               1,428                    0 Not indicated
                               4,948                    1 Indicated

H2B       572  2  INDIC                                 N Continence; bowel constipation

                              16,966                    . Missing
                               5,589                    0 Not indicated
                                 784                    1 Indicated

H2C       574  2  INDIC                                 N Continence; bowel diarrhea

                               7,840                    . Missing
                              15,007                    0 Not indicated
                                 492                    1 Indicated

H2D       576  2  INDIC                                 N Continence; bowel fecal impaction

                               5,449                    . Missing
                              17,873                    0 Not indicated
                                  17                    1 Indicated

H2E       578  2  INDIC                                 N Continence; scheduled plan

                              13,746                    . Missing
                               5,541                    0 Not indicated
                               4,052                    1 Indicated

H3A       580  2  INDIC                                 N Continence; none of above

                               5,438                    . Missing
                              12,469                    0 Not indicated
                               5,432                    1 Indicated

H3B       582  2  INDIC                                 N Continence; bladder retaining plan

                               5,438                    . Missing
                              17,763                    0 Not indicated
                                 138                    1 Indicated

H3C       584  2  INDIC                                 N Continence; external condom catheter

                               5,438                    . Missing
                              17,800                    0 Not indicated
                                 101                    1 Indicated

H3D       586  2  INDIC                                 N Continence; indwelling catheter

                               5,436                    . Missing
                              16,304                    0 Not indicated
                               1,599                    1 Indicated

H3E       588  2  INDIC                                 N Continence; intermittent catheter

                              16,966                    . Missing
                               6,327                    0 Not indicated
                                  46                    1 Indicated

H3F       590  2  INDIC                                 N Continence; did not use commode/urinal

                              16,965                    . Missing
                               5,625                    0 Not indicated
                                 749                    1 Indicated

H3G       592  2  INDIC                                 N Continence; pads/briefs used

                              16,965                    . Missing
                               2,412                    0 Not indicated
                               3,962                    1 Indicated

H3H       594  2  INDIC                                 N Continence; enemas/irrigation

                              16,967                    . Missing
                               6,261                    0 Not indicated
                                 111                    1 Indicated

H3I       596  2  INDIC                                 N Continence; ostomy present

                               5,437                    . Missing
                              17,431                    0 Not indicated
                                 471                    1 Indicated

H3J       598  2  INDIC                                 N Continence; none of above

                              13,694                    . Missing
                               5,951                    0 Not indicated
                               3,694                    1 Indicated

H4        600  2  CHANGE                                N Continence; change in last 90 days

                              16,967                    . Missing
                               5,489                    0 No change
                                 203                    1 Improved
                                 680                    2 Deteriorated

I1A       602  2  INDIC                                 N Diag; diabetes mellitus

                               7,890                    . Missing
                              11,282                    0 Not indicated
                               4,167                    1 Indicated

I1B       604  2  INDIC                                 N Diag; hyperthyroidism

                              16,965                    . Missing
                               6,331                    0 Not indicated
                                  43                    1 Indicated

I1C       606  2  INDIC                                 N Diag; hypothyroidism

                              16,966                    . Missing
                               5,165                    0 Not indicated
                               1,208                    1 Indicated

I1D       608  2  INDIC                                 N Diag; arteriosclerotic heart disease

                              12,370                    . Missing
                               9,778                    0 Not indicated
                               1,191                    1 Indicated

I1E       610  2  INDIC                                 N Diag; cardiac dysrhythmias

                              16,963                    . Missing
                               5,475                    0 Not indicated
                                 901                    1 Indicated

I1F       612  2  INDIC                                 N Diag; congestive heart failure

                              12,370                    . Missing
                               8,336                    0 Not indicated
                               2,633                    1 Indicated

I1G       614  2  INDIC                                 N Diag; deep vein thrombosis

                              16,965                    . Missing
                               6,203                    0 Not indicated
                                 171                    1 Indicated

I1H       616  2  INDIC                                 N Diag; hypertension

                              16,965                    . Missing
                               2,381                    0 Not indicated
                               3,993                    1 Indicated

I1I       618  2  INDIC                                 N Diag; hypotension

                              16,965                    . Missing
                               6,303                    0 Not indicated
                                  71                    1 Indicated

I1J       620  2  INDIC                                 N Diag; peripheral vascular disease

                              12,370                    . Missing
                               9,596                    0 Not indicated
                               1,373                    1 Indicated

I1K       622  2  INDIC                                 N Diag; other cardiovascular disease

                              16,965                    . Missing
                               4,977                    0 Not indicated
                               1,397                    1 Indicated

I1L       624  2  INDIC                                 N Diag; arthritis

                              16,965                    . Missing
                               4,137                    0 Not indicated
                               2,237                    1 Indicated

I1M       626  2  INDIC                                 N Diag; hip fracture

                               7,791                    . Missing
                              14,506                    0 Not indicated
                               1,042                    1 Indicated

I1N       628  2  INDIC                                 N Diag; missing limb (e.g., amputation)

                              16,965                    . Missing
                               6,223                    0 Not indicated
                                 151                    1 Indicated

I1O       630  2  INDIC                                 N Diag; osteoporosis

                              16,965                    . Missing
                               5,004                    0 Not indicated
                               1,370                    1 Indicated

I1P       632  2  INDIC                                 N Diag; pathological bone fracture

                              16,965                    . Missing
                               6,345                    0 Not indicated
                                  29                    1 Indicated

I1Q       634  2  INDIC                                 N Diag; alzheimers disease

                              16,965                    . Missing
                               5,458                    0 Not indicated
                                 916                    1 Indicated

I1R       636  2  INDIC                                 N Diag; aphasia

                               7,793                    . Missing
                              14,808                    0 Not indicated
                                 738                    1 Indicated

I1S       638  2  INDIC                                 N Diag; cerebral palsy

                               7,793                    . Missing
                              15,304                    0 Not indicated
                                 242                    1 Indicated

I1T       640  2  INDIC                                 N Diag; cerebrovascular accident (stroke)

                               7,793                    . Missing
                              12,284                    0 Not indicated
                               3,262                    1 Indicated

I1U       642  2  INDIC                                 N Diag; dementia other than alzheimers

                              16,965                    . Missing
                               4,040                    0 Not indicated
                               2,334                    1 Indicated

I1V       644  2  INDIC                                 N Diag; hemiplegia/hemiparesis

                               7,793                    . Missing
                              13,975                    0 Not indicated
                               1,571                    1 Indicated

I1W       646  2  INDIC                                 N Diag; multiple sclerosis

                               7,793                    . Missing
                              15,353                    0 Not indicated
                                 193                    1 Indicated

I1X       648  2  INDIC                                 N Diag; paraplegia

                              12,370                    . Missing
                              10,928                    0 Not indicated
                                  41                    1 Indicated

I1Y       650  2  INDIC                                 N Diag; parkinsons disease

                              16,965                    . Missing
                               5,889                    0 Not indicated
                                 485                    1 Indicated

I1Z       652  2  INDIC                                 N Diag; quadriplegia

                               7,794                    . Missing
                              15,336                    0 Not indicated
                                 209                    1 Indicated

I1AA      654  2  INDIC                                 N Diag; seizure disorder

                              16,964                    . Missing
                               5,644                    0 Not indicated
                                 731                    1 Indicated

I1BB      656  2  INDIC                                 N Diag; transient ischemic attack (TIA)

                              16,965                    . Missing
                               6,175                    0 Not indicated
                                 199                    1 Indicated

I1CC      658  2  INDIC                                 N Diag; traumatic brain injury

                              16,965                    . Missing
                               6,309                    0 Not indicated
                                  65                    1 Indicated

I1DD      660  2  INDIC                                 N Diag; anxiety disorder

                              16,965                    . Missing
                               5,343                    0 Not indicated
                               1,031                    1 Indicated

I1EE      662  2  INDIC                                 N Diag; depression

                               7,793                    . Missing
                               8,558                    0 Not indicated
                               6,988                    1 Indicated

I1FF      664  2  INDIC                                 N Diag; manic depression (bipolar disease)

                               7,793                    . Missing
                              15,065                    0 Not indicated
                                 481                    1 Indicated

I1GG      666  2  INDIC                                 N Diag; schizophrenia

                              12,370                    . Missing
                              10,490                    0 Not indicated
                                 479                    1 Indicated

I1HH      668  2  INDIC                                 N Diag; asthma

                              12,370                    . Missing
                              10,669                    0 Not indicated
                                 300                    1 Indicated

I1II      670  2  INDIC                                 N Diag; emphysema/COPD

                              12,370                    . Missing
                               9,225                    0 Not indicated
                               1,744                    1 Indicated

I1JJ      672  2  INDIC                                 N Diag; cataracts

                              16,965                    . Missing
                               5,887                    0 Not indicated
                                 487                    1 Indicated

I1KK      674  2  INDIC                                 N Diag; diabetic retinopathy

                              16,965                    . Missing
                               6,319                    0 Not indicated
                                  55                    1 Indicated

I1LL      676  2  INDIC                                 N Diag; glaucoma

                              16,965                    . Missing
                               5,869                    0 Not indicated
                                 505                    1 Indicated

I1MM      678  2  INDIC                                 N Diag; macular degeneration

                              16,965                    . Missing
                               6,067                    0 Not indicated
                                 307                    1 Indicated

I1NN      680  2  INDIC                                 N Diag; allergies

                              16,964                    . Missing
                               4,538                    0 Not indicated
                               1,837                    1 Indicated

I1OO      682  2  INDIC                                 N Diag; anemia

                              16,964                    . Missing
                               4,948                    0 Not indicated
                               1,427                    1 Indicated

I1PP      684  2  INDIC                                 N Diag; cancer

                              16,965                    . Missing
                               5,917                    0 Not indicated
                                 457                    1 Indicated

I1QQ      686  2  INDIC                                 N Diag; renal failure

                              16,965                    . Missing
                               6,083                    0 Not indicated
                                 291                    1 Indicated

I1RR      688  2  INDIC                                 N Diag; none of above

                              12,453                    . Missing
                               9,727                    0 Not indicated
                               1,159                    1 Indicated

I2A       690  2  INDIC                                 N Diag; antibiotic resistant infection

                               7,788                    . Missing
                              15,267                    0 Not indicated
                                 284                    1 Indicated

I2B       692  2  INDIC                                 N Diag; clostridium difficile (c. diff.)

                               7,788                    . Missing
                              15,413                    0 Not indicated
                                 138                    1 Indicated

I2C       694  2  INDIC                                 N Diag; conjunctivitis

                               7,788                    . Missing
                              15,475                    0 Not indicated
                                  76                    1 Indicated

I2D       696  2  INDIC                                 N Diag; HIV infection

                              12,279                    . Missing
                              11,059                    0 Not indicated
                                   1                    1 Indicated

I2E       698  2  INDIC                                 N Diag; pneumonia

                               7,788                    . Missing
                              14,873                    0 Not indicated
                                 678                    1 Indicated

I2F       700  2  INDIC                                 N Diag; respiratory infection

                               7,788                    . Missing
                              15,077                    0 Not indicated
                                 474                    1 Indicated

I2G       702  2  INDIC                                 N Diag; septicemia

                               7,788                    . Missing
                              15,411                    0 Not indicated
                                 140                    1 Indicated

I2H       704  2  INDIC                                 N Diag; sexually transmitted diseases

                              12,162                    . Missing
                              11,173                    0 Not indicated
                                   4                    1 Indicated

I2I       706  2  INDIC                                 N Diag; tuberculosis

                               7,788                    . Missing
                              15,543                    0 Not indicated
                                   8                    1 Indicated

I2J       708  2  INDIC                                 N Diag; urinary tract infection, 30 days

                               5,398                    . Missing
                              15,652                    0 Not indicated
                               2,289                    1 Indicated

I2K       710  2  INDIC                                 N Diag; viral hepatitus

                               7,788                    . Missing
                              15,535                    0 Not indicated
                                  16                    1 Indicated

I2L       712  2  INDIC                                 N Diag; wound infection

                               7,788                    . Missing
                              15,197                    0 Not indicated
                                 354                    1 Indicated

I2M       714  2  INDIC                                 N Diag; none of above

                              10,026                    . Missing
                               3,521                    0 Not indicated
                               9,792                    1 Indicated

I3A       716  7                                        C Diag; other diagnosis A

I3B       723  7                                        C Diag; other diagnosis B

I3C       730  7                                        C Diag; other diagnosis C

I3D       737  7                                        C Diag; other diagnosis D

I3E       744  7                                        C Diag; other diagnosis E

J1A       751  2  INDIC                                 N Health; weight gain/loss

                               7,798                    . Missing
                              15,145                    0 Not indicated
                                 396                    1 Indicated

J1B       753  2  INDIC                                 N Health; not able lie flat, short breath

                               7,794                    . Missing
                              14,987                    0 Not indicated
                                 558                    1 Indicated

J1C       755  2  INDIC                                 N Health; dehydrated

                               5,402                    . Missing
                              17,894                    0 Not indicated
                                  43                    1 Indicated

J1D       757  2  INDIC                                 N Health; insufficient fluid

                               7,794                    . Missing
                              15,053                    0 Not indicated
                                 492                    1 Indicated

J1E       759  2  INDIC                                 N Health; delusions

                               7,794                    . Missing
                              15,063                    0 Not indicated
                                 482                    1 Indicated

J1F       761  2  INDIC                                 N Health; dizziness/vertigo

                              16,965                    . Missing
                               6,248                    0 Not indicated
                                 126                    1 Indicated

J1G       763  2  INDIC                                 N Health; edema

                               7,794                    . Missing
                              12,149                    0 Not indicated
                               3,396                    1 Indicated

J1H       765  2  INDIC                                 N Health; fever

                               7,794                    . Missing
                              15,193                    0 Not indicated
                                 352                    1 Indicated

J1I       767  2  INDIC                                 N Health; hallucinations

                               5,403                    . Missing
                              17,736                    0 Not indicated
                                 200                    1 Indicated

J1J       769  2  INDIC                                 N Health; internal bleeding

                               7,794                    . Missing
                              15,395                    0 Not indicated
                                 150                    1 Indicated

J1K       771  2  INDIC                                 N Health; recurrent lung aspirations

                               7,794                    . Missing
                              15,479                    0 Not indicated
                                  66                    1 Indicated

J1L       773  2  INDIC                                 N Health; shortness of breath

                               7,794                    . Missing
                              14,254                    0 Not indicated
                               1,291                    1 Indicated

J1M       775  2  INDIC                                 N Health; syncope (fainting)

                              16,965                    . Missing
                               6,350                    0 Not indicated
                                  24                    1 Indicated

J1N       777  2  INDIC                                 N Health; unsteady gate

                               7,793                    . Missing
                               9,562                    0 Not indicated
                               5,984                    1 Indicated

J1O       779  2  INDIC                                 N Health; vomiting

                               7,794                    . Missing
                              15,286                    0 Not indicated
                                 259                    1 Indicated

J1P       781  2  INDIC                                 N Health; none of above

                              13,737                    . Missing
                               4,817                    0 Not indicated
                               4,785                    1 Indicated

J2A       783  2  PAINA                                 N Health; pain symptoms, frequency

                               5,396                    . Missing
                              10,949                    0 No pain
                               4,308                    1 Pain less than daily
                               2,686                    2 Pain daily

J2B       785  2  PAINB                                 N Health; pain symptoms, intensity

                              16,352                    . Missing
                               2,684                    1 Mild pain
                               3,806                    2 Moderate pain
                                 497                    3 Horrible/Excruciating pain

J3A       787  2  INDIC                                 N Health; pain site, back

                              20,572                    . Missing
                               2,104                    0 Not indicated
                                 663                    1 Indicated

J3B       789  2  INDIC                                 N Health; pain site, bone

                              20,573                    . Missing
                               2,521                    0 Not indicated
                                 245                    1 Indicated

J3C       791  2  INDIC                                 N Health; pain site, chest

                              20,574                    . Missing
                               2,720                    0 Not indicated
                                  45                    1 Indicated

J3D       793  2  INDIC                                 N Health; pain site, headache

                              20,574                    . Missing
                               2,512                    0 Not indicated
                                 253                    1 Indicated

J3E       795  2  INDIC                                 N Health; pain site, hip

                              20,571                    . Missing
                               2,257                    0 Not indicated
                                 511                    1 Indicated

J3F       797  2  INDIC                                 N Health; pain site, incisional

                              20,573                    . Missing
                               2,501                    0 Not indicated
                                 265                    1 Indicated

J3G       799  2  INDIC                                 N Health; pain site, joint, other than hip

                              20,574                    . Missing
                               1,885                    0 Not indicated
                                 880                    1 Indicated

J3H       801  2  INDIC                                 N Health; pain site, soft tissue

                              20,576                    . Missing
                               2,304                    0 Not indicated
                                 459                    1 Indicated

J3I       803  2  INDIC                                 N Health; pain site, stomach pain

                              20,574                    . Missing
                               2,654                    0 Not indicated
                                 111                    1 Indicated

J3J       805  2  INDIC                                 N Health; pain site, other

                              20,573                    . Missing
                               1,750                    0 Not indicated
                               1,016                    1 Indicated

J4A       807  2  INDIC                                 N Health; fell in last 30 days

                               5,396                    . Missing
                              14,573                    0 Not indicated
                               3,370                    1 Indicated

J4B       809  2  INDIC                                 N Health; fell in last 31-180 days

                               5,396                    . Missing
                              13,380                    0 Not indicated
                               4,563                    1 Indicated

J4C       811  2  INDIC                                 N Health; hip fracture in last 180 days

                               5,397                    . Missing
                              17,029                    0 Not indicated
                                 913                    1 Indicated

J4D       813  2  INDIC                                 N Health; other fracture in last 180 days

                               5,400                    . Missing
                              17,096                    0 Not indicated
                                 843                    1 Indicated

J4E       815  2  INDIC                                 N Health; none of above

                               5,396                    . Missing
                               7,063                    0 Not indicated
                              10,880                    1 Indicated

J5A       817  2  INDIC                                 N Health; diseases make patterns unstable

                               5,397                    . Missing
                              10,760                    0 Not indicated
                               7,182                    1 Indicated

J5B       819  2  INDIC                                 N Health; episode of recurrent problem

                               5,395                    . Missing
                              14,807                    0 Not indicated
                               3,137                    1 Indicated

J5C       821  2  INDIC                                 N Health; end-stage disease, 6 mo. to live

                               5,397                    . Missing
                              17,683                    0 Not indicated
                                 259                    1 Indicated

J5D       823  2  INDIC                                 N Health; none of above

                               5,395                    . Missing
                               8,494                    0 Not indicated
                               9,450                    1 Indicated

K1A       825  2  INDIC                                 N Nutri; chewing problem

                               7,840                    . Missing
                              11,450                    0 Not indicated
                               4,049                    1 Indicated

K1B       827  2  INDIC                                 N Nutri; swallowing problem

                               7,834                    . Missing
                              12,533                    0 Not indicated
                               2,972                    1 Indicated

K1C       829  2  INDIC                                 N Nutri; mouth pain

                              16,966                    . Missing
                               6,349                    0 Not indicated
                                  24                    1 Indicated

K1D       831  2  INDIC                                 N Nutri; none of above

                              12,453                    . Missing
                               3,752                    0 Not indicated
                               7,134                    1 Indicated

K2A       833  2                                        N Nutri; height

K2B       835  3                                        N Nutri; weight

K3A       838  2  YESNO                                 N Nutri; weight loss, 5% in last 30

                               5,570                    . Missing
                              15,855                    0 No
                               1,914                    1 Yes

K3B       840  2  YESNO                                 N Nutri; weight gain, 5% in last 30

                               5,564                    . Missing
                              16,665                    0 No
                               1,110                    1 Yes

K4A       842  2  INDIC                                 N Nutri; complains about taste of food

                              16,966                    . Missing
                               6,306                    0 Not indicated
                                  67                    1 Indicated

K4B       844  2  INDIC                                 N Nutri; regular complaints of hunger

                              16,966                    . Missing
                               6,343                    0 Not indicated
                                  30                    1 Indicated

K4C       846  2  INDIC                                 N Nutri; leaves 25% food left uneaten

                              16,964                    . Missing
                               3,939                    0 Not indicated
                               2,436                    1 Indicated

K4D       848  2  INDIC                                 N Nutri; none of above

                              16,964                    . Missing
                               2,481                    0 Not indicated
                               3,894                    1 Indicated

K5A       850  2  INDIC                                 N Nutri; parenteral/IV

                               7,815                    . Missing
                              15,071                    0 Not indicated
                                 453                    1 Indicated

K5B       852  2  INDIC                                 N Nutri; feeding tube

                               5,415                    . Missing
                              16,983                    0 Not indicated
                                 941                    1 Indicated

K5C       854  2  INDIC                                 N Nutri; mechanically altered diet

                              16,964                    . Missing
                               4,275                    0 Not indicated
                               2,100                    1 Indicated

K5D       856  2  INDIC                                 N Nutri; syringe, oral feeding

                              16,964                    . Missing
                               6,373                    0 Not indicated
                                   2                    1 Indicated

K5E       858  2  INDIC                                 N Nutri; therapeutic diet

                              16,962                    . Missing
                               3,268                    0 Not indicated
                               3,109                    1 Indicated

K5F       860  2  INDIC                                 N Nutri; dietary supplement before meals

                              16,965                    . Missing
                               4,733                    0 Not indicated
                               1,641                    1 Indicated

K5G       862  2  INDIC                                 N Nutri; plate guard, built-up utensil,...

                              16,964                    . Missing
                               6,071                    0 Not indicated
                                 304                    1 Indicated

K5H       864  2  INDIC                                 N Nutri; planned weight change program

                               5,415                    . Missing
                              15,142                    0 Not indicated
                               2,782                    1 Indicated

K5I       866  2  INDIC                                 N Nutri; none of above

                              13,702                    . Missing
                               5,763                    0 Not indicated
                               3,874                    1 Indicated

K6A       868  2  CALORIES                              N Nutri; parenteral, total calories

                              22,020                    . Missing
                                 363                    0 None
                                 114                    1 1% - 25%
                                  26                    2 26% - 50%
                                  67                    3 51% - 75%
                                 749                    4 76% - 100%

K6B       870  2  FLUID                                 N Nutri; parenteral, fluid intake

                              22,019                    . Missing
                                  32                    0 None
                                 282                    1 1 to 500cc/day
                                  81                    2 501 to 1000cc/day
                                 181                    3 1001 to 1500cc/day
                                 340                    4 1501 to 2000cc/day
                                 404                    5 2001 or more cc/day

L1A       872  2  INDIC                                 N Dental; debris present prior to bed

                              17,033                    . Missing
                               6,293                    0 Not indicated
                                  13                    1 Indicated

L1B       874  2  INDIC                                 N Dental; dentures or removable bridge

                              17,033                    . Missing
                               3,425                    0 Not indicated
                               2,881                    1 Indicated

L1C       876  2  INDIC                                 N Dental; some/all natural teeth lost

                              17,033                    . Missing
                               4,635                    0 Not indicated
                               1,671                    1 Indicated

L1D       878  2  INDIC                                 N Dental; broken or loose teeth

                              17,033                    . Missing
                               6,025                    0 Not indicated
                                 281                    1 Indicated

L1E       880  2  INDIC                                 N Dental; inflamed gums

                              17,033                    . Missing
                               6,284                    0 Not indicated
                                  22                    1 Indicated

L1F       882  2  INDIC                                 N Dental; daily cleaning of teeth/dentures

                              17,030                    . Missing
                                  69                    0 Not indicated
                               6,240                    1 Indicated

L1G       884  2  INDIC                                 N Dental; none of above

                              17,030                    . Missing
                               6,291                    0 Not indicated
                                  18                    1 Indicated

M1A       886  2                                        N Skin; number of stage 1 ulcers

M1B       888  2                                        N Skin; number of stage 2 ulcers

M1C       890  2                                        N Skin; number of stage 3 ulcers

M1D       892  2                                        N Skin; number of stage 4 ulcers

M2A       894  2  ULCERSTA                              N Skin; highest stage, pressure ulcer

                               5,396                    . Missing
                              15,915                    0 None
                                 440                    1 Stage one
                               1,007                    2 Stage two
                                 212                    3 Stage three
                                 369                    4 Stage four

M2B       896  2  ULCERSTA                              N Skin; highest stage, stasis ulcer

                               5,396                    . Missing
                              17,639                    0 None
                                  15                    1 Stage one
                                 188                    2 Stage two
                                  36                    3 Stage three
                                  65                    4 Stage four

M3        898  2  YESNO                                 N Skin; ulcer resolved in last 90 days

                              12,391                    . Missing
                               9,812                    0 No
                               1,136                    1 Yes

M4A       900  2  INDIC                                 N Skin; abrasions, bruises

                               7,790                    . Missing
                              11,535                    0 Not indicated
                               4,014                    1 Indicated

M4B       902  2  INDIC                                 N Skin; burns, 2nd or 3rd degree

                               7,790                    . Missing
                              15,527                    0 Not indicated
                                  22                    1 Indicated

M4C       904  2  INDIC                                 N Skin; open lesions, not ulcer/rash/cut

                               7,790                    . Missing
                              15,264                    0 Not indicated
                                 285                    1 Indicated

M4D       906  2  INDIC                                 N Skin; rashes

                               7,790                    . Missing
                              14,041                    0 Not indicated
                               1,508                    1 Indicated

M4E       908  2  INDIC                                 N Skin; desensitized to pain or pressure

                               7,790                    . Missing
                              14,335                    0 Not indicated
                               1,214                    1 Indicated

M4F       910  2  INDIC                                 N Skin; tears or cuts, other than surgery

                               7,790                    . Missing
                              14,510                    0 Not indicated
                               1,039                    1 Indicated

M4G       912  2  INDIC                                 N Skin; surgical wounds

                               7,790                    . Missing
                              14,129                    0 Not indicated
                               1,420                    1 Indicated

M4H       914  2  INDIC                                 N Skin; none of above

                               7,790                    . Missing
                               7,020                    0 Not indicated
                               8,529                    1 Indicated

M5A       916  2  INDIC                                 N Skin; pressure rel device for chair

                               7,790                    . Missing
                               8,344                    0 Not indicated
                               7,205                    1 Indicated

M5B       918  2  INDIC                                 N Skin; pressure rel device for bed

                               7,789                    . Missing
                               4,801                    0 Not indicated
                              10,749                    1 Indicated

M5C       920  2  INDIC                                 N Skin; turning/repositioning program

                               7,789                    . Missing
                               8,876                    0 Not indicated
                               6,674                    1 Indicated

M5D       922  2  INDIC                                 N Skin; nutrition to manage skin prob

                               7,789                    . Missing
                              12,970                    0 Not indicated
                               2,580                    1 Indicated

M5E       924  2  INDIC                                 N Skin; ulcer care

                               7,789                    . Missing
                              13,693                    0 Not indicated
                               1,857                    1 Indicated

M5F       926  2  INDIC                                 N Skin; surgical wound care

                               7,791                    . Missing
                              14,331                    0 Not indicated
                               1,217                    1 Indicated

M5G       928  2  INDIC                                 N Skin; applic. of dressings, not feet

                               7,791                    . Missing
                              12,742                    0 Not indicated
                               2,806                    1 Indicated

M5H       930  2  INDIC                                 N Skin; applic. of ointment/med, not feet

                               7,790                    . Missing
                              11,025                    0 Not indicated
                               4,524                    1 Indicated

M5I       932  2  INDIC                                 N Skin; other preventative care, not feet

                               7,789                    . Missing
                               6,755                    0 Not indicated
                               8,795                    1 Indicated

M5J       934  2  INDIC                                 N Skin; none of above

                               7,789                    . Missing
                              14,174                    0 Not indicated
                               1,376                    1 Indicated

M6A       936  2  INDIC                                 N Skin; foot, one or more problems

                               7,790                    . Missing
                              12,384                    0 Not indicated
                               3,165                    1 Indicated

M6B       938  2  INDIC                                 N Skin; foot, infections

                               7,789                    . Missing
                              15,379                    0 Not indicated
                                 171                    1 Indicated

M6C       940  2  INDIC                                 N Skin; foot, open lesions

                               7,793                    . Missing
                              15,244                    0 Not indicated
                                 302                    1 Indicated

M6D       942  2  INDIC                                 N Skin; foot, nails/calluses trimmed

                               7,794                    . Missing
                               8,294                    0 Not indicated
                               7,251                    1 Indicated

M6E       944  2  INDIC                                 N Skin; foot, preventative care

                               7,789                    . Missing
                              12,146                    0 Not indicated
                               3,404                    1 Indicated

M6F       946  2  INDIC                                 N Skin; foot, application of dressings

                               7,789                    . Missing
                              14,866                    0 Not indicated
                                 684                    1 Indicated

M6G       948  2  INDIC                                 N Skin; none of above

                               7,789                    . Missing
                              10,248                    0 Not indicated
                               5,302                    1 Indicated

N1A       950  2  INDIC                                 N Act; awake in morning

                               5,399                    . Missing
                               1,470                    0 Not indicated
                              16,470                    1 Indicated

N1B       952  2  INDIC                                 N Act; awake in afternoon

                               5,403                    . Missing
                               2,464                    0 Not indicated
                              15,472                    1 Indicated

N1C       954  2  INDIC                                 N Act; awake in evening

                               5,400                    . Missing
                               6,225                    0 Not indicated
                              11,714                    1 Indicated

N1D       956  2  INDIC                                 N Act; none of above

                               5,399                    . Missing
                              17,478                    0 Not indicated
                                 462                    1 Indicated

N2        958  2  AVRGTIME                              N Act; average time involved

                               5,417                    . Missing
                                 899                    0 Most - more than 2/3 time
                              15,690                    1 Some - from 1/3 to 2/3 time
                               1,272                    2 Little - less than 1/3 time
                                  61                    3 None

N3A       960  2  INDIC                                 N Act; settings, own room

                              16,969                    . Missing
                                 637                    0 Not indicated
                               5,733                    1 Indicated

N3B       962  2  INDIC                                 N Act; settings, day room

                              16,974                    . Missing
                               1,503                    0 Not indicated
                               4,862                    1 Indicated

N3C       964  2  INDIC                                 N Act; settings, inside NH, off unit

                              16,971                    . Missing
                               3,034                    0 Not indicated
                               3,334                    1 Indicated

N3D       966  2  INDIC                                 N Act; settings, outside facility

                              16,972                    . Missing
                               4,594                    0 Not indicated
                               1,773                    1 Indicated

N3E       968  2  INDIC                                 N Act; settings, none of above

                              16,969                    . Missing
                               6,335                    0 Not indicated
                                  35                    1 Indicated

N4A       970  2  INDIC                                 N Act; pref, cards, other games

                              16,971                    . Missing
                               3,389                    0 Not indicated
                               2,979                    1 Indicated

N4B       972  2  INDIC                                 N Act; pref, crafts/arts

                              16,972                    . Missing
                               4,496                    0 Not indicated
                               1,871                    1 Indicated

N4C       974  2  INDIC                                 N Act; pref, exercise/sports

                              16,972                    . Missing
                               3,400                    0 Not indicated
                               2,967                    1 Indicated

N4D       976  2  INDIC                                 N Act; pref, music

                              16,971                    . Missing
                                 610                    0 Not indicated
                               5,758                    1 Indicated

N4E       978  2  INDIC                                 N Act; pref, reading/writing

                              16,970                    . Missing
                               2,936                    0 Not indicated
                               3,433                    1 Indicated

N4F       980  2  INDIC                                 N Act; pref, spiritual/religious activitie

                              16,972                    . Missing
                               1,927                    0 Not indicated
                               4,440                    1 Indicated

N4G       982  2  INDIC                                 N Act; pref, trips/shopping

                              16,971                    . Missing
                               4,803                    0 Not indicated
                               1,565                    1 Indicated

N4H       984  2  INDIC                                 N Act; pref, walking/wheelchair outdoors

                              16,972                    . Missing
                               3,446                    0 Not indicated
                               2,921                    1 Indicated

N4I       986  2  INDIC                                 N Act; pref, watching TV

                              16,970                    . Missing
                                 948                    0 Not indicated
                               5,421                    1 Indicated

N4J       988  2  INDIC                                 N Act; pref, gardening or plants

                              16,971                    . Missing
                               5,223                    0 Not indicated
                               1,145                    1 Indicated

N4K       990  2  INDIC                                 N Act; pref, talking or conversing

                              16,969                    . Missing
                                 977                    0 Not indicated
                               5,393                    1 Indicated

N4L       992  2  INDIC                                 N Act; pref, helping others

                              16,973                    . Missing
                               5,483                    0 Not indicated
                                 883                    1 Indicated

N4M       994  2  INDIC                                 N Act; pref, none of above

                              16,969                    . Missing
                               6,344                    0 Not indicated
                                  26                    1 Indicated

N5A       996  2  ROUTINCH                              N Act; pref, change in type activities

                              16,977                    . Missing
                               6,043                    0 No change
                                 251                    1 Slight change
                                  68                    2 Major change

N5B       998  2  ROUTINCH                              N Act; pref, change in extent involvement

                              16,977                    . Missing
                               6,043                    0 No change
                                 247                    1 Slight change
                                  72                    2 Major change

O1       1000  2                                        N Rx; # of different med rec last 7

O2       1002  2  YESNO                                 N Rx; receiving med initiated, last 90

                              16,964                    . Missing
                               2,359                    0 No
                               4,016                    1 Yes

O3       1004  2  NUMDAY                                N Rx; # of days injections rec, last 7

                               7,868                    . Missing
                              15,471                  0-7 Number of days

O4A      1006  2  NUMDAY                                N Rx; # of days antipsychotic rec, last 7

                               5,395                    . Missing
                              17,944                  0-7 Number of days

O4B      1008  2  NUMDAY                                N Rx; # of days antianxiety rec, last 7

                               5,395                    . Missing
                              17,944                  0-7 Number of days

O4C      1010  2  NUMDAY                                N Rx; # of days antidepressant rec, last 7

                               5,395                    . Missing
                              17,944                  0-7 Number of days

O4D      1012  2  NUMDAY                                N Rx; # of days hypnotic rec, last 7

                               5,395                    . Missing
                              17,944                  0-7 Number of days

O4E      1014  2  NUMDAY                                N Rx; # of days diuretic rec, last 7

                               5,395                    . Missing
                              17,944                  0-7 Number of days

P1AA     1016  2  INDIC                                 N Special; chemotherapy

                               7,814                    . Missing
                              15,480                    0 Not indicated
                                  45                    1 Indicated

P1AB     1018  2  INDIC                                 N Special; dialysis

                               7,788                    . Missing
                              15,361                    0 Not indicated
                                 190                    1 Indicated

P1AC     1020  2  INDIC                                 N Special; IV medication

                               7,792                    . Missing
                              13,304                    0 Not indicated
                               2,243                    1 Indicated

P1AD     1022  2  INDIC                                 N Special; intake/output

                               7,788                    . Missing
                              11,267                    0 Not indicated
                               4,284                    1 Indicated

P1AE     1024  2  INDIC                                 N Special; monitoring acute med condition

                               7,786                    . Missing
                              10,264                    0 Not indicated
                               5,289                    1 Indicated

P1AF     1026  2  INDIC                                 N Special; ostomy care

                               7,788                    . Missing
                              14,665                    0 Not indicated
                                 886                    1 Indicated

P1AG     1028  2  INDIC                                 N Special; oxygen therapy

                               7,788                    . Missing
                              13,340                    0 Not indicated
                               2,211                    1 Indicated

P1AH     1030  2  INDIC                                 N Special; radiation

                               7,788                    . Missing
                              15,533                    0 Not indicated
                                  18                    1 Indicated

P1AI     1032  2  INDIC                                 N Special; suctioning

                               7,788                    . Missing
                              15,446                    0 Not indicated
                                 105                    1 Indicated

P1AJ     1034  2  INDIC                                 N Special; tracheostomy

                               7,788                    . Missing
                              15,490                    0 Not indicated
                                  61                    1 Indicated

P1AK     1036  2  INDIC                                 N Special; transfusions

                               7,788                    . Missing
                              15,277                    0 Not indicated
                                 274                    1 Indicated

P1AL     1038  2  INDIC                                 N Special; ventilator or respirator

                               7,788                    . Missing
                              15,510                    0 Not indicated
                                  41                    1 Indicated

P1AM     1040  2  INDIC                                 N Special; alcoholic/drug treatment

                               7,788                    . Missing
                              15,551                    0 Not indicated
                                   0                    1 Indicated

P1AN     1042  2  INDIC                                 N Special; alzheimers/dementia spec care

                               7,788                    . Missing
                              14,873                    0 Not indicated
                                 678                    1 Indicated

P1AO     1044  2  INDIC                                 N Special; hospice care

                               7,788                    . Missing
                              15,306                    0 Not indicated
                                 245                    1 Indicated

P1AP     1046  2  INDIC                                 N Special; pediatric unite

                               7,788                    . Missing
                              15,549                    0 Not indicated
                                   2                    1 Indicated

P1AQ     1048  2  INDIC                                 N Special; respite care

                               7,788                    . Missing
                              15,543                    0 Not indicated
                                   8                    1 Indicated

P1AR     1050  2  INDIC                                 N Special; community skill training

                               7,786                    . Missing
                              12,903                    0 Not indicated
                               2,650                    1 Indicated

P1AS     1052  2  INDIC                                 N Special; none of above

                               7,786                    . Missing
                               9,218                    0 Not indicated
                               6,335                    1 Indicated

P1BAA    1054  2  NUMDAY                                N Special; speech therapy days

                               7,844                    . Missing
                              15,495                  0-7 Number of days

P1BAB    1056  4  NUMMINS                               N Special; speech therapy minutes

                               7,813                    . Missing
                              15,526               0-9999 Number of minutes

P1BBA    1060  2  NUMDAY                                N Special; occupational therapy days

                               7,796                    . Missing
                              15,543                  0-7 Number of days

P1BBB    1062  4  NUMMINS                               N Special; occupational therapy minutes

                               7,812                    . Missing
                              15,527               0-9999 Number of minutes

P1BCA    1066  2  NUMDAY                                N Special; physical therapy days

                               7,795                    . Missing
                              15,544                  0-7 Number of days

P1BCB    1068  4  NUMMINS                               N Special; physical therapy minutes

                               7,811                    . Missing
                              15,528               0-9999 Number of minutes

P1BDA    1072  2  NUMDAY                                N Special; respiratory therapy days

                               7,795                    . Missing
                              15,544                  0-7 Number of days

P1BDB    1074  4  NUMMINS                               N Special; respiratory therapy minutes

                               7,812                    . Missing
                              15,527               0-9999 Number of minutes

P1BEA    1078  2  NUMDAY                                N Special; psychological therapy days

                               7,796                    . Missing
                              15,543                  0-7 Number of days

P1BEB    1080  4  NUMMINS                               N Special; psychological therapy minutes

                               7,813                    . Missing
                              15,526               0-9999 Number of minutes

P2A      1084  2  INDIC                                 N Special; behavior symptom eval program

                              16,965                    . Missing
                               6,001                    0 Not indicated
                                 373                    1 Indicated

P2B      1086  2  INDIC                                 N Special; mental health specialist eval

                              16,964                    . Missing
                               5,383                    0 Not indicated
                                 992                    1 Indicated

P2C      1088  2  INDIC                                 N Special; group therapy

                              16,965                    . Missing
                               6,296                    0 Not indicated
                                  78                    1 Indicated

P2D      1090  2  INDIC                                 N Special; deliberate environment changes

                              16,965                    . Missing
                               6,258                    0 Not indicated
                                 116                    1 Indicated

P2E      1092  2  INDIC                                 N Special; reorientation

                              16,964                    . Missing
                               3,682                    0 Not indicated
                               2,693                    1 Indicated

P2F      1094  2  INDIC                                 N Special; none of above

                              16,964                    . Missing
                               3,273                    0 Not indicated
                               3,102                    1 Indicated

P3A      1096  2  NUMDAY                                N Special; rehab, passive range of motion

                               7,794                    . Missing
                              15,545                  0-7 Number of days

P3B      1098  2  NUMDAY                                N Special; rehab, active range of motion

                               7,794                    . Missing
                              15,545                  0-7 Number of days

P3C      1100  2  NUMDAY                                N Special; rehab, splint or brace

                               7,794                    . Missing
                              15,545                  0-7 Number of days

P3D      1102  2  NUMDAY                                N Special; practice, bed mobility

                               7,794                    . Missing
                              15,545                  0-7 Number of days

P3E      1104  2  NUMDAY                                N Special; practice, transfer

                               7,794                    . Missing
                              15,545                  0-7 Number of days

P3F      1106  2  NUMDAY                                N Special; practice, walking

                               7,794                    . Missing
                              15,545                  0-7 Number of days

P3G      1108  2  NUMDAY                                N Special; practice, dressing or grooming

                               7,794                    . Missing
                              15,545                  0-7 Number of days

P3H      1110  2  NUMDAY                                N Special; practice, eating or swallowing

                               7,794                    . Missing
                              15,545                  0-7 Number of days

P3I      1112  2  NUMDAY                                N Special; practice, ampu/prosthesis care

                               7,794                    . Missing
                              15,545                  0-7 Number of days

P3J      1114  2  NUMDAY                                N Special; practice, communication

                               7,794                    . Missing
                              15,545                  0-7 Number of days

P3K      1116  2  NUMDAY                                N Special; practice, other

                               7,804                    . Missing
                              15,535                  0-7 Number of days

P4A      1118  2  USED                                  N Special; devices, full bed rails

                               5,396                    . Missing
                              15,280                    0 Not used
                                  80                    1 Used less than daily
                               2,583                    2 Used daily

P4B      1120  2  USED                                  N Special; devices, other types of rails

                               5,403                    . Missing
                              13,259                    0 Not used
                                 165                    1 Used less than daily
                               4,512                    2 Used daily

P4C      1122  2  USED                                  N Special; devices, trunk restraint

                               5,397                    . Missing
                              17,126                    0 Not used
                                  62                    1 Used less than daily
                                 754                    2 Used daily

P4D      1124  2  USED                                  N Special; devices, limb restraint

                               5,397                    . Missing
                              17,919                    0 Not used
                                   3                    1 Used less than daily
                                  20                    2 Used daily

P4E      1126  2  USED                                  N Special; devices, chair prevents rising

                               5,397                    . Missing
                              17,415                    0 Not used
                                  45                    1 Used less than daily
                                 482                    2 Used daily

P5       1128  2  NUMDAY2X                              N Special; # overnight hospital stays

                              16,963                    . Missing
                               6,374                 0-15 Number of days
                                   2                   -3                                90

P6       1130  2  NUMDAY2X                              N Special; # emergency room visits

                              16,919                    . Missing
                               6,420                 0-15 Number of days

P7       1132  2  NUMDAY2X                              N Special; # days physician examined

                               7,787                    . Missing
                              15,552                 0-15 Number of days

P8       1134  2  NUMDAY2X                              N Special; # days physician changed orders

                               7,787                    . Missing
                              15,552                 0-15 Number of days

P9       1136  2  YESNO                                 N Special; abnormal lab value last 90 days

                              16,963                    . Missing
                               1,861                    0 No
                               4,515                    1 Yes

Q1A      1138  2  YESNO                                 N Status; expresses pref of discharge

                              12,394                    . Missing
                               6,967                    0 No
                               3,978                    1 Yes

Q1B      1140  2  YESNO                                 N Status; support person pos to discharge

                              16,982                    . Missing
                               4,606                    0 No
                               1,751                    1 Yes

Q1C      1142  2  DISCHARG                              N Status; discharge projected

                              12,371                    . Missing
                               6,788                    0 No
                               1,381                    1 Within 30 days
                                 858                    2 Within 31-90 days
                               1,941                    3 Discharge status uncertain

Q2       1144  2  CHANGE                                N Status; overall care change last 90 days

                               5,406                    . Missing
                              13,883                    0 No change
                               1,133                    1 Improved
                               2,917                    2 Deteriorated

R1A      1146  2  YESNO                                 N Discharge; assess resident particip

                              16,962                    . Missing
                                 670                    0 No
                               5,707                    1 Yes

R1B      1148  2  YESNOFAM                              N Discharge; assess, family particip

                              16,962                    . Missing
                               3,253                    0 No
                               3,075                    1 Yes
                                  49                    2 No family

R1C      1150  2  YESNONON                              N Discharge; assess, signif other particip

                              16,978                    . Missing
                               4,033                    0 No
                                 489                    1 Yes
                               1,839                    2 None

R2B      1152  8                                        N Discharge; date RN assess complete

R3A      1162  2                                        N Discharge; code for resident disposition

R3B      1164  2                                        N Discharge; optional state code

R4       1166  8                                        N Discharge; date of discharge

T1AA     1176  2  NUMDAY                                N Supp; recreation therapy days

                              19,741                    . Missing
                               3,598                  0-7 Number of days

T1AB     1178  4  NUMMINS                               N Supp; recreation therapy minutes

                              19,742                    . Missing
                               3,597               0-9999 Number of minutes

T1B      1182  2  YESNO                                 N Supp; PT, OT, ST ordered first 14 days

                              20,701                    . Missing
                                 447                    0 No
                               2,191                    1 Yes

T1C      1184  2  NUMDAY2X                              N Supp; therapy days through day 15

                              21,145                    . Missing
                               2,194                 0-15 Number of days

T1D      1186  4  NUMMINS                               N Supp; total min therapy through day 15

                              21,145                    . Missing
                               2,194               0-9999 Number of minutes

T2A      1190  2  WALKDIST                              N Supp; furthest distance walked

                              21,489                    . Missing
                                 738                    0 150+ feet
                                 472                    1 51-149 feet
                                 289                    2 26-50 feet
                                 186                    3 10-25 feet
                                 165                    4 Less than 25 feet

T2B      1192  2  WALKTIME                              N Supp; time walked without sitting

                              21,499                    . Missing
                                 640                    0 1-2 minutes
                                 538                    1 3-4 minutes
                                 504                    2 5-10 minutes
                                 134                    3 11-15 minutes
                                  18                    4 16-30 minutes
                                   6                    5 31+ minutes

T2C      1194  2  WALKASSI                              N Supp; self-performance in walking

                              21,496                    . Missing
                                 497                    0 Independent
                                 318                    1 Supervision
                                 744                    2 Limited assistance
                                 284                    3 Extensive assistance

T2D      1196  2  WALKSUPP                              N Supp; walking support provided

                              21,494                    . Missing
                                 546                    0 No setup or physical help from staff
                                 245                    1 Setup help only
                                 937                    2 One person physical assist
                                 117                    3 Two+ persons physical assist

T2E      1198  2  YESNO                                 N Supp; parallel bars used

                              21,427                    . Missing
                               1,794                    0 No
                                 118                    1 Yes

T3MDCR   1200  5                                        C Case mix group Medicare

T3STATE  1205  5                                        C Case mix group State

U01RA    1210  2  ROUTE                                 N Drug 1; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U01FR    1212  2  $FREQU                                C Drug 1; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U01AA    1214  5  $AMOUNT                               C Drug 1; amount administered

                              23,339             LOW-HIGH Amount administered

U01PR    1219  2  PRNN                                  N Drug 1; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U01NDC   1221  9  $NDCDRUG                              C Drug 1; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U02RA    1230  2  ROUTE                                 N Drug 2; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U02FR    1232  2  $FREQU                                C Drug 2; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U02AA    1234  5  $AMOUNT                               C Drug 2; amount administered

                              23,339             LOW-HIGH Amount administered

U02PR    1239  2  PRNN                                  N Drug 2; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U02NDC   1241  9  $NDCDRUG                              C Drug 2; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U03RA    1250  2  ROUTE                                 N Drug 3; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U03FR    1252  2  $FREQU                                C Drug 3; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U03AA    1254  5  $AMOUNT                               C Drug 3; amount administered

                              23,339             LOW-HIGH Amount administered

U03PR    1259  2  PRNN                                  N Drug 3; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U03NDC   1261  9  $NDCDRUG                              C Drug 3; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U04RA    1270  2  ROUTE                                 N Drug 4; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U04FR    1272  2  $FREQU                                C Drug 4; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U04AA    1274  5  $AMOUNT                               C Drug 4; amount administered

                              23,339             LOW-HIGH Amount administered

U04PR    1279  2  PRNN                                  N Drug 4; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U04NDC   1281  9  $NDCDRUG                              C Drug 4; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U05RA    1290  2  ROUTE                                 N Drug 5; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U05FR    1292  2  $FREQU                                C Drug 5; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U05AA    1294  5  $AMOUNT                               C Drug 5; amount administered

                              23,339             LOW-HIGH Amount administered

U05PR    1299  2  PRNN                                  N Drug 5; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U05NDC   1301  9  $NDCDRUG                              C Drug 5; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U06RA    1310  2  ROUTE                                 N Drug 6; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U06FR    1312  2  $FREQU                                C Drug 6; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U06AA    1314  5  $AMOUNT                               C Drug 6; amount administered

                              23,339             LOW-HIGH Amount administered

U06PR    1319  2  PRNN                                  N Drug 6; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U06NDC   1321  9  $NDCDRUG                              C Drug 7; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U07RA    1330  2  ROUTE                                 N Drug 7; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U07FR    1332  2  $FREQU                                C Drug 7; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U07AA    1334  5  $AMOUNT                               C Drug 7; amount administered

                              23,339             LOW-HIGH Amount administered

U07PR    1339  2  PRNN                                  N Drug 7; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U07NDC   1341  9  $NDCDRUG                              C Drug 7; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U08RA    1350  2  ROUTE                                 N Drug 8; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U08FR    1352  2  $FREQU                                C Drug 8; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U08AA    1354  5  $AMOUNT                               C Drug 8; amount administered

                              23,339             LOW-HIGH Amount administered

U08PR    1359  2  PRNN                                  N Drug 8; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U08NDC   1361  9  $NDCDRUG                              C Drug 8; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U09RA    1370  2  ROUTE                                 N Drug 9; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U09FR    1372  2  $FREQU                                C Drug 9; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U09AA    1374  5  $AMOUNT                               C Drug 9; amount administered

                              23,339             LOW-HIGH Amount administered

U09PR    1379  2  PRNN                                  N Drug 9; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U09NDC   1381  9  $NDCDRUG                              C Drug 9; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U10RA    1390  2  ROUTE                                 N Drug 10; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U10FR    1392  2  $FREQU                                C Drug 10; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U10AA    1394  5  $AMOUNT                               C Drug 10; amount administered

                              23,339             LOW-HIGH Amount administered

U10PR    1399  2  PRNN                                  N Drug 10; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U10NDC   1401  9  $NDCDRUG                              C Drug 10; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U11RA    1410  2  ROUTE                                 N Drug 11; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U11FR    1412  2  $FREQU                                C Drug 11; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U11AA    1414  5  $AMOUNT                               C Drug 11; amount administered

                              23,339             LOW-HIGH Amount administered

U11PR    1419  2  PRNN                                  N Drug 11; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U11NDC   1421  9  $NDCDRUG                              C Drug 11; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U12RA    1430  2  ROUTE                                 N Drug 12; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U12FR    1432  2  $FREQU                                C Drug 12; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U12AA    1434  5  $AMOUNT                               C Drug 12; amount administered

                              23,339             LOW-HIGH Amount administered

U12PR    1439  2  PRNN                                  N Drug 12; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U12NDC   1441  9  $NDCDRUG                              C Drug 12; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U13RA    1450  2  ROUTE                                 N Drug 13; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U13FR    1452  2  $FREQU                                C Drug 13; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U13AA    1454  5  $AMOUNT                               C Drug 13; amount administered

                              23,339             LOW-HIGH Amount administered

U13PR    1459  2  PRNN                                  N Drug 13; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U13NDC   1461  9  $NDCDRUG                              C Drug 13; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U14RA    1470  2  ROUTE                                 N Drug 14; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U14FR    1472  2  $FREQU                                C Drug 14; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U14AA    1474  5  $AMOUNT                               C Drug 14; amount administered

                              23,339             LOW-HIGH Amount administered

U14PR    1479  2  PRNN                                  N Drug 14; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U14NDC   1481  9  $NDCDRUG                              C Drug 14; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U15RA    1490  2  ROUTE                                 N Drug 15; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U15FR    1492  2  $FREQU                                C Drug 15; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U15AA    1494  5  $AMOUNT                               C Drug 15; amount administered

                              23,339             LOW-HIGH Amount administered

U15PR    1499  2  PRNN                                  N Drug 15; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U15NDC   1501  9  $NDCDRUG                              C Drug 15; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U16RA    1510  2  ROUTE                                 N Drug 16; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U16FR    1512  2  $FREQU                                C Drug 16; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U16AA    1514  5  $AMOUNT                               C Drug 16; amount administered

                              23,339             LOW-HIGH Amount administered

U16PR    1519  2  PRNN                                  N Drug 16; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U16NDC   1521  9  $NDCDRUG                              C Drug 16; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U17RA    1530  2  ROUTE                                 N Drug 17; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U17FR    1532  2  $FREQU                                C Drug 17; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U17AA    1534  5  $AMOUNT                               C Drug 17; amount administered

                              23,339             LOW-HIGH Amount administered

U17PR    1539  2  PRNN                                  N Drug 17; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U17NDC   1541  9  $NDCDRUG                              C Drug 17; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

U18RA    1550  2  ROUTE                                 N Drug 18; route of administration

                              23,339                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U18FR    1552  2  $FREQU                                C Drug 18; frequency

                              23,339                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U18AA    1554  5  $AMOUNT                               C Drug 18; amount administered

                              23,339             LOW-HIGH Amount administered

U18PR    1559  2  PRNN                                  N Drug 18; PRN-number of doses

                              23,339                    . Missing
                                   0                 0-99 Number of doses

U18NDC   1561  9  $NDCDRUG                              C Drug 18; National Drug Code (NDC)

                              23,339             LOW-HIGH National Drug Code

VA01A    1570  2  INDIC                                 N Delirium, triggered

                              18,216                    . Missing
                               4,174                    0 Not indicated
                                 949                    1 Indicated

VA01B    1572  2  INDIC                                 N Delirium, care planning

                              18,728                    . Missing
                               4,204                    0 Not indicated
                                 407                    1 Indicated

VA02A    1574  2  INDIC                                 N Cognitive loss, triggered

                              18,211                    . Missing
                               1,025                    0 Not indicated
                               4,103                    1 Indicated

VA02B    1576  2  INDIC                                 N Cognitive loss, care planning

                              18,340                    . Missing
                               1,715                    0 Not indicated
                               3,284                    1 Indicated

VA03A    1578  2  INDIC                                 N Visual function, triggered

                              18,217                    . Missing
                               3,136                    0 Not indicated
                               1,986                    1 Indicated

VA03B    1580  2  INDIC                                 N Visual function, care planning

                              18,590                    . Missing
                               3,404                    0 Not indicated
                               1,345                    1 Indicated

VA04A    1582  2  INDIC                                 N Communication, triggered

                              18,210                    . Missing
                               2,061                    0 Not indicated
                               3,068                    1 Indicated

VA04B    1584  2  INDIC                                 N Communication, care planning

                              18,505                    . Missing
                               2,490                    0 Not indicated
                               2,344                    1 Indicated

VA05A    1586  2  INDIC                                 N ADL funct/Rehab potential, triggered

                              18,210                    . Missing
                                  62                    0 Not indicated
                               5,067                    1 Indicated

VA05B    1588  2  INDIC                                 N ADL funct/Rehab potential, care planning

                              18,255                    . Missing
                                 708                    0 Not indicated
                               4,376                    1 Indicated

VA06A    1590  2  INDIC                                 N Urinary incontinence, triggered

                              18,210                    . Missing
                               1,490                    0 Not indicated
                               3,639                    1 Indicated

VA06B    1592  2  INDIC                                 N Urinary incontinence, care planning

                              18,395                    . Missing
                               1,907                    0 Not indicated
                               3,037                    1 Indicated

VA07A    1594  2  INDIC                                 N Psychosocial well-being, triggered

                              18,211                    . Missing
                               3,470                    0 Not indicated
                               1,658                    1 Indicated

VA07B    1596  2  INDIC                                 N Psychosocial well-being, care planning

                              18,631                    . Missing
                               3,482                    0 Not indicated
                               1,226                    1 Indicated

VA08A    1598  2  INDIC                                 N Mood state, triggered

                              18,210                    . Missing
                               2,775                    0 Not indicated
                               2,354                    1 Indicated

VA08B    1600  2  INDIC                                 N Mood state, care planning

                              18,560                    . Missing
                               2,828                    0 Not indicated
                               1,951                    1 Indicated

VA09A    1602  2  INDIC                                 N Behavioral symptoms, triggered

                              18,213                    . Missing
                               3,668                    0 Not indicated
                               1,458                    1 Indicated

VA09B    1604  2  INDIC                                 N Behavioral symptoms, care planning

                              18,623                    . Missing
                               3,508                    0 Not indicated
                               1,208                    1 Indicated

VA10A    1606  2  INDIC                                 N Activities, triggered

                              18,214                    . Missing
                               4,274                    0 Not indicated
                                 851                    1 Indicated

VA10B    1608  2  INDIC                                 N Activities, care planning

                              18,674                    . Missing
                               3,922                    0 Not indicated
                                 743                    1 Indicated

VA11A    1610  2  INDIC                                 N Falls, triggered

                              18,211                    . Missing
                               1,453                    0 Not indicated
                               3,675                    1 Indicated

VA11B    1612  2  INDIC                                 N Falls, care planning

                              18,412                    . Missing
                               1,711                    0 Not indicated
                               3,216                    1 Indicated

VA12A    1614  2  INDIC                                 N Nutritional status, triggered

                              18,223                    . Missing
                                 946                    0 Not indicated
                               4,170                    1 Indicated

VA12B    1616  2  INDIC                                 N Nutritional status, care planning

                              18,338                    . Missing
                               1,499                    0 Not indicated
                               3,502                    1 Indicated

VA13A    1618  2  INDIC                                 N Feeding tubes, triggered

                              18,211                    . Missing
                               4,876                    0 Not indicated
                                 252                    1 Indicated

VA13B    1620  2  INDIC                                 N Feeding tubes, care planning

                              18,779                    . Missing
                               4,348                    0 Not indicated
                                 212                    1 Indicated

VA14A    1622  2  INDIC                                 N Dehydration/Fluid mainten, triggered

                              18,213                    . Missing
                               2,448                    0 Not indicated
                               2,678                    1 Indicated

VA14B    1624  2  INDIC                                 N Dehydration/Fluid mainten, care planning

                              18,520                    . Missing
                               2,677                    0 Not indicated
                               2,142                    1 Indicated

VA15A    1626  2  INDIC                                 N Dental care, triggered

                              18,212                    . Missing
                               3,643                    0 Not indicated
                               1,484                    1 Indicated

VA15B    1628  2  INDIC                                 N Dental care, care planning

                              18,625                    . Missing
                               3,770                    0 Not indicated
                                 944                    1 Indicated

VA16A    1630  2  INDIC                                 N Pressure ulcers, triggered

                              18,212                    . Missing
                               1,043                    0 Not indicated
                               4,084                    1 Indicated

VA16B    1632  2  INDIC                                 N Pressure ulcers, care planning

                              18,348                    . Missing
                               1,558                    0 Not indicated
                               3,433                    1 Indicated

VA17A    1634  2  INDIC                                 N Psychotropic drug use, triggered

                              18,211                    . Missing
                               2,206                    0 Not indicated
                               2,922                    1 Indicated

VA17B    1636  2  INDIC                                 N Psychotropic drug use, care planning

                              18,509                    . Missing
                               2,387                    0 Not indicated
                               2,443                    1 Indicated

VA18A    1638  2  INDIC                                 N Physical restraints, triggered

                              18,210                    . Missing
                               4,779                    0 Not indicated
                                 350                    1 Indicated

VA18B    1640  2  INDIC                                 N Physical restraints, care planning

                              18,768                    . Missing
                               4,257                    0 Not indicated
                                 314                    1 Indicated

VB2      1642 10                                        N Signature date, RAP assessment

VB4      1652 10                                        N Signature date, care planning

DEATH_DA 1662 10                                        N FU-DEATH-DA

