Variable Format    Q#/Freq            Description/Label
 
BASEID   $BSIDFMT                      Unique SP Identification Number          
                          5,368        LOW-HIGH          BASEID Count                            
 
SURVEYYR SVYRFMT                       Survey Year                              
                          5,368                    2018  2018                                    
 
VERSION  VERSFMT                       Version Number                           
                          5,368                       1  Version 1                               
 
HHASMTID                               HHA Assessment Internal ID               
                          5,368        Range of values   Range of values                         
                 First available in 2018
 
M0010_CM                               CMS Certification Number (CCN)           
                          5,368        Range of values   Range of values                         
 
M0014_BR                               Branch State Code                        
                          4,347                          Missing                                 
                          1,021        Range of values   Range of values                         
 
M0016_BR                               Branch ID                                
                          5,368        Range of values   Range of values                         
 
M0018_NN                               NPI Physician ID                         
                            127                          Missing                                 
                          5,241        Range of values   Range of values                         
 
M0018_NU $INDICOA                      NPI Physician ID Unknown                 
                          5,241        0                 Not indicated                           
                            127        1                 Indicated                               
 
M0030_ST MMDDYYn8                      Start of Care Date                       
                          5,368        MMDDYYYY          Date as MMDDYYYY                        
 
M0032_RO MMDDYYn8                      Resumption of Care Date                  
                          4,937                       .  Inapplicable                            
                            431        MMDDYYYY          Date as MMDDYYYY                        
 
M0032_RN $YESNOOA                      Resumption of Care Date NA               
                            431        0                 No                                      
                          4,937        1                 Yes                                     
 
M0069_GN $SEXFMT                       Patient Sex                           
                          2,094        1                 Male                                    
                          3,274        2                 Female                                  
 
M0080_AS $DISCIOA                      Disc of Person Completing Assess         
                          4,266        01                RN                                      
                            957        02                PT                                      
                             41        03                SLP/ST                                  
                            104        04                OT                                      
 
M0090_AS MMDDYYn8                      Date Assessment Completed                
                          5,368        MMDDYYYY          Date as MMDDYYYY                        
 
M0100_RS $ACOMPOA                      Reason for Assessment                    
                          1,822        01                S/R; Start; further visits planned      
                            313        03                S/R; Resumption of care                 
                          1,105        04                Follow-up; Recertification              
                             11        05                Follow-up; Other                        
                            505        06                Transfer to inpat fac; Patient not disch
                             63        07                Transfer to inpat fac; Patient disch    
                             14        08                Disch from agency; Death at home        
                          1,535        09                Disch from agency; Disch from agency    
 
M0102_PD MMDDYYn8                      Phys Ordered SOC or ROC Date             
                          4,693                       .  Inapplicable                            
                            675        MMDDYYYY          Date as MMDDYYYY                        
 
M0102_PN $INDICOA                      Phys Ordered SOC or ROC Date NA          
                          3,254                          Missing                                 
                            654        0                 Not indicated                           
                          1,460        1                 Indicated                               
 
M0104_RF MMDDYYn8                      Date Of Referral                         
                          3,908                       .  Inapplicable                            
                          1,460        MMDDYYYY          Date as MMDDYYYY                        
 
M0110_EP $EPSDFMT                      Episode Timing                           
                          2,117                          Missing                                 
                          2,211        01                Early                                   
                            855        02                Later                                   
                             68        NA                No case mix group defined               
                            117        UK                Unknown                                 
 
M0140_AM $INDICOA                      Race/Eth:Amer Indian/Alaskan Nat         
                          3,233                          Missing                                 
                          2,118        0                 Not indicated                           
                             17        1                 Indicated                               
 
M0140_AS $INDICOA                      Race/Ethnicity: Asian                    
                          3,233                          Missing                                 
                          2,104        0                 Not indicated                           
                             31        1                 Indicated                               
 
M0140_AF $INDICOA                      Race/Eth:Black or African-American       
                          3,233                          Missing                                 
                          1,912        0                 Not indicated                           
                            223        1                 Indicated                               
 
M0140_HS $INDICOA                      Race/Ethnicity: Hispanic or Latino       
                          3,233                          Missing                                 
                          1,937        0                 Not indicated                           
                            198        1                 Indicated                               
 
M0140_NT $INDICOA                      Race/Eth:Nat Hawaii/Oth Pacific Isl      
                          3,233                          Missing                                 
                          2,134        0                 Not indicated                           
                              1        1                 Indicated                               
 
M0140_WH $INDICOA                      Race/Eth:White                           
                          3,233                          Missing                                 
                            458        0                 Not indicated                           
                          1,677        1                 Indicated                               
 
M0150_DF $INDICOA                      Medicaid Fee For Service Payment         
                          5,166        0                 Not indicated                           
                            202        1                 Indicated                               
 
M0150_DH $INDICOA                      Medicaid HMO/Managed Care Payment        
                          5,261        0                 Not indicated                           
                            107        1                 Indicated                               
 
M0150_RF $INDICOA                      Medicare Fee For Service Payment         
                          1,693        0                 Not indicated                           
                          3,675        1                 Indicated                               
 
M0150_RH $INDICOA                      Medicare HMO/Managed Care Payment        
                          3,791        0                 Not indicated                           
                          1,577        1                 Indicated                               
 
M0150_NO $INDICOA                      No Payment                               
                          5,368        0                 Not indicated                           
 
M0150_OG $INDICOA                      Other Government Payment                 
                          5,343        0                 Not indicated                           
                             25        1                 Indicated                               
 
M0150_OP $INDICOA                      Other Payment Source                     
                          5,348        0                 Not indicated                           
                             20        1                 Indicated                               
 
M0150_PH $INDICOA                      Private HMO/Managed Care Payment         
                          5,346        0                 Not indicated                           
                             22        1                 Indicated                               
 
M0150_PI $INDICOA                      Private Insurance Payment                
                          5,279        0                 Not indicated                           
                             89        1                 Indicated                               
 
M0150_SE $INDICOA                      Self-Pay Payment                         
                          5,345        0                 Not indicated                           
                             23        1                 Indicated                               
 
M0150_TI $INDICOA                      Title Programs Payment                   
                          5,367        0                 Not indicated                           
                              1        1                 Indicated                               
 
M0150_UN $INDICOA                      Unknown Payment Source                   
                          3,233                          Missing                                 
                          2,135        0                 Not indicated                           
 
M0150_WC $INDICOA                      Workers Compensation Payment             
                          5,367        0                 Not indicated                           
                              1        1                 Indicated                               
 
M0903_LA MMDDYYn8                      Date of Last Home Visit                  
                          3,251                       .  Inapplicable                            
                          2,117        MMDDYYYY          Date as MMDDYYYY                        
 
M0906_DS MMDDYYn8                      Discharge/Transfer/Death Date            
                          3,251                       .  Inapplicable                            
                          2,117        MMDDYYYY          Date as MMDDYYYY                        
 
M1000_IP $INDICOA                      Inp Discharg;Short Stay Acut Hosp        
                          3,233                          Missing                                 
                          1,136        0                 Not indicated                           
                            999        1                 Indicated                               
 
M1000_IR $INDICOA                      Inp Discharg;IRF                         
                          3,233                          Missing                                 
                          2,005        0                 Not indicated                           
                            130        1                 Indicated                               
 
M1000_NF $INDICOA                      Inp Discharg;Nursing Facility            
                          3,233                          Missing                                 
                          2,126        0                 Not indicated                           
                              9        1                 Indicated                               
 
M1000_LT $INDICOA                      Discharged Past 14 Days;LTCH             
                          3,233                          Missing                                 
                          2,119        0                 Not indicated                           
                             16        1                 Indicated                               
 
M1000_NO $INDICOA                      No Inp Discharge                         
                          3,233                          Missing                                 
                          1,468        0                 Not indicated                           
                            667        1                 Indicated                               
 
M1000_OT $INDICOA                      Inp Discharg;Other                       
                          3,233                          Missing                                 
                          2,131        0                 Not indicated                           
                              4        1                 Indicated                               
 
M1000_PS $INDICOA                      Inp Discharg;Psych Hospital Or Unit      
                          3,233                          Missing                                 
                          2,127        0                 Not indicated                           
                              8        1                 Indicated                               
 
M1000_SN $INDICOA                      Inp Discharg;SNF/TCU Facility            
                          3,233                          Missing                                 
                          1,774        0                 Not indicated                           
                            361        1                 Indicated                               
 
M1005_IU $INDICOA                      Inpat Discharge Date Unknown             
                          3,900                          Missing                                 
                          1,448        0                 Not indicated                           
                             20        1                 Indicated                               
 
M1005_ID MMDDYYn8                      Most Recent Inpat Discharge Date         
                          3,920                       .  Inapplicable                            
                          1,448        MMDDYYYY          Date as MMDDYYYY                        
 
M1018_IC $INDICOA                      Pri Cond;Indwelling/SuprapubicCatheter   
                          3,233                          Missing                                 
                          2,090        0                 Not indicated                           
                             45        1                 Indicated                               
 
M1018_DB $INDICOA                      Pri Cond;Disruptive Behavior             
                          3,233                          Missing                                 
                          2,103        0                 Not indicated                           
                             32        1                 Indicated                               
 
M1018_ID $INDICOA                      Pri Cond;Impaired Decision-Making        
                          3,233                          Missing                                 
                          1,702        0                 Not indicated                           
                            433        1                 Indicated                               
 
M1018_IP $INDICOA                      Pri Cond;Intractable Pain                
                          3,233                          Missing                                 
                          1,836        0                 Not indicated                           
                            299        1                 Indicated                               
 
M1018_ML $INDICOA                      Pri Cond;Memory Loss                     
                          3,233                          Missing                                 
                          1,856        0                 Not indicated                           
                            279        1                 Indicated                               
 
M1018_NA $INDICOA                      Pri Cond;Not Applicable                  
                          3,233                          Missing                                 
                          1,961        0                 Not indicated                           
                            174        1                 Indicated                               
 
M1018_NO $INDICOA                      Pri Cond;None of the Above               
                          3,233                          Missing                                 
                          1,410        0                 Not indicated                           
                            725        1                 Indicated                               
 
M1018_UN $INDICOA                      Pri Cond;Unknown                         
                          3,233                          Missing                                 
                          2,114        0                 Not indicated                           
                             21        1                 Indicated                               
 
M1018_UI $INDICOA                      Pri Cond;Urinary Incontinence            
                          3,233                          Missing                                 
                          1,239        0                 Not indicated                           
                            896        1                 Indicated                               
 
M1030_HE $INDICOA                      Home Thera; Enteral Nutrition            
                          2,117                          Missing                                 
                          3,199        0                 Not indicated                           
                             52        1                 Indicated                               
 
M1030_HI $INDICOA                      Home Thera; Intravenous/Infusion Thera   
                          2,117                          Missing                                 
                          3,192        0                 Not indicated                           
                             59        1                 Indicated                               
 
M1030_HN $INDICOA                      Home Thera; None of the Above            
                          2,117                          Missing                                 
                            112        0                 Not indicated                           
                          3,139        1                 Indicated                               
 
M1030_HP $INDICOA                      Home Thera; Parenteral Nutrition         
                          2,117                          Missing                                 
                          3,248        0                 Not indicated                           
                              3        1                 Indicated                               
 
M1034_OV $STATUOA                      Overall Status                           
                          3,233                          Missing                                 
                            127        00                SP is stable with no heightened risk    
                          1,058        01                SP temporarily faces high health risk   
                            822        02                SP is likely to remain in fragile health
                            128        03                SP has serious progressive conditions   
         Notes:  Please see CCW documentation about response option for more information
 
M1036_RA $INDICOA                      Risk Factor - Alcohol Dependency         
                          3,233                          Missing                                 
                          2,077        0                 Not indicated                           
                             58        1                 Indicated                               
 
M1036_RD $INDICOA                      Risk Factor - Drug Dependency            
                          3,233                          Missing                                 
                          2,116        0                 Not indicated                           
                             19        1                 Indicated                               
 
M1036_RN $INDICOA                      Risk Factor - None of the Above          
                          3,233                          Missing                                 
                            952        0                 Not indicated                           
                          1,183        1                 Indicated                               
 
M1036_RO $INDICOA                      Risk Factor - Obesity                    
                          3,233                          Missing                                 
                          1,553        0                 Not indicated                           
                            582        1                 Indicated                               
 
M1036_RS $INDICOA                      Risk Factor - Smoking                    
                          3,233                          Missing                                 
                          1,684        0                 Not indicated                           
                            451        1                 Indicated                               
 
M1036_RU $INDICOA                      Risk Factor - Unknown                    
                          3,233                          Missing                                 
                          2,110        0                 Not indicated                           
                             25        1                 Indicated                               
 
M1100_PT $PTLVG                        Patient Living Arrangement               
                          3,233                          Missing                                 
                            146        01                Lives alone, 24 hour assistance         
                             69        02                Lives alone, daytime assistance         
                              9        03                Lives alone, nighttime assistance       
                            288        04                Lives alone, occasional/short-term asst 
                             16        05                Lives alone, no assistance              
                          1,083        06                Lives at home w/others, 24 hr assistance
                             30        07                Lives at home w/others, daytime assist  
                             90        08                Lives at home w/others, nighttime assist
                             78        09                Lives at home w/others, occas/short-term
                              3        10                Lives at home w/others, no assistance av
                            308        11                Lives in congregate situation, 24 hour a
                              5        12                Lives in congregate situation, daytime a
                             10        14                Lives in congregate situation, occasiona
         Notes:  Please see CCW documentation about response option for more information
 
M1200_VS $VISIOOA                      Vision                                   
                          2,117                          Missing                                 
                          2,025        00                Normal vision                           
                          1,164        01                Partially impaired                      
                             62        02                Severely impaired                       
 
M1210_HE $HEARCOA                      Hearing                                  
                          3,233                          Missing                                 
                          1,178        00                Adequate                                
                            908        01                Mildly to moderately impaired           
                             41        02                Severely impaired                       
                              8        UK                Unable to assess hearing                
 
M1220_UN $VERBAOA                      Understand Verbal Content                
                          3,233                          Missing                                 
                          1,075        00                Understands                             
                            855        01                Usually understands                     
                            178        02                Sometimes understands                   
                             19        03                Never understands                       
                              8        UK                Unable to assess hearing                
 
M1230_VR $SPEECOA                      Verbal Expression                        
                          1,698                          Missing                                 
                          2,144        00                No observable impairement               
                          1,135        01                Minimal difficulty                      
                            258        02                Moderate difficulty                     
                             94        03                Severe difficulty                       
                             30        04                Unable to express basic needs           
                              9        05                Nonresponsive or unable to speak        
 
M1240_PA $PAINAOA                      Formal Pain Assess                       
                          3,233                          Missing                                 
                             19        00                No standardized assessment              
                          1,653        01                Yes, severe pain not indicated          
                            463        02                Yes, severe pain indicated              
 
M1242_PA $FREQCOA                      Freq Of Pain Interfere W Activity        
                            582                          Missing                                 
                          1,277        00                No pain                                 
                            592        01                Pain does not interfere                 
                            669        02                Less often than daily                   
                          1,757        03                Daily, but not constantly               
                            491        04                All of the time                         
 
M1300_PR $ULASSOA                      Pressure Ulcer Assess                    
                          3,233                          Missing                                 
                             16        00                No assessment conducted                 
                            113        01                Yes, based on eval of clinical factors  
                          2,006        02                Yes, using a standardized tool          
 
M1302_PR $YESNOOA                      Risk Of Devel Press Ulcers               
                          3,249                          Missing                                 
                            959        0                 No                                      
                          1,160        1                 Yes                                     
 
M1306_PR $YESNOOA                      Unheal Press Ulcers; St II+              
                            582                          Missing                                 
                          4,633        0                 No                                      
                            153        1                 Yes                                     
 
M1307_PD $OLDPUL                       Oldest St II Press Ulcer Onset Date      
                          5,360                          Missing                                 
                              5        01                Was present at the most recent SOC/ROC  
                              2        02                Developed since the most recent SOC/ROC 
                              1        NA                No non-epithelialized/pressure/ulc dis  
         Notes:  Please see CCW documentation about response option for more information
 
M1307_PS MMDDYYn8                      Oldest St II Press Ulcer Since SOC/ROC   
                          5,366                       .  Inapplicable                            
                              2        MMDDYYYY          Date as MMDDYYYY                        
 
M1320_PR $ULSTAPO                      Status, Most Problemat Press Ulcer       
                          5,273                          Missing                                 
                              5        02                Early/Partial granulation               
                             90        03                Not healing                             
 
M1322_ST $ULNUMOA                      Curr # Of Stage I Press Ulcers           
                            582                          Missing                                 
                          4,716        00                None                                    
                             55        01                One                                     
                              8        02                Two                                     
                              2        03                Three                                   
                              5        04                Four or more                            
 
M1324_PR $ULSTGOA                      Stage, Most Problemat Press Ulcer        
                            582                          Not assessed/no information             
                             58        01                Stage one                               
                             88        02                Stage two                               
                             23        03                Stage three                             
                             23        04                Stage four                              
                          4,594        NA                No observable pressure ulcer            
 
M1330_ST $STASUOA                      Stasis Ulcer Present                     
                            582                          Missing                                 
                          4,698        00                No                                      
                              6        01                Yes, BOTH observable and unobservable   
                             72        02                Yes, Observable only                    
                             10        03                Yes, Unobservable only                  
 
M1332_ST $ULNUMOA                      Curr # Of Stasis Ulcer                   
                          5,290                          Missing                                 
                             41        01                One                                     
                             16        02                Two                                     
                              7        03                Three                                   
                             14        04                Four or more                            
 
M1334_ST $ULSTAQO                      Status, Most Problemat Stasis Ulcer      
                          5,290                          Missing                                 
                             13        01                Fully granulating                       
                             16        02                Early/Partial granulation               
                             49        03                Not healing                             
 
M1340_SR $SURGWOA                      Surgical Wound Present                   
                            582                          Missing                                 
                          4,065        00                No                                      
                            606        01                Yes, observable                         
                            115        02                Yes, not observable                     
 
M1342_SR $ULSTAQO                      Status, Most Problemat Surg Wound        
                          4,762                          Missing                                 
                            303        00                Newly epithelialized                    
                             39        01                Fully granulating                       
                             44        02                Early/Partial granulation               
                            220        03                Not healing                             
 
M1350_OP $YESNOOA                      Skin Lesion Or Open Wound                
                          3,233                          Missing                                 
                          1,626        0                 No                                      
                            509        1                 Yes                                     
 
M1400_SO $SBREAOA                      When Is Patient Dyspneic or SOB          
                            582                          Missing                                 
                          1,415        00                Never                                   
                          1,242        01                When walking more than 20 feet          
                          1,424        02                With moderate exertion                  
                            561        03                With minimal exertion                   
                            144        04                At rest (day or night)                  
 
M1410_CP $INDICOA                      Resp Treat @ Home;CPAP/BPAP              
                          3,233                          Missing                                 
                          2,057        0                 Not indicated                           
                             78        1                 Indicated                               
 
M1410_RS $INDICOA                      Resp Treat @ Home;None of the Above      
                          3,233                          Missing                                 
                            389        0                 Not indicated                           
                          1,746        1                 Indicated                               
 
M1410_OX $INDICOA                      Resp Treat @ Home;Oxygen                 
                          3,233                          Missing                                 
                          1,798        0                 Not indicated                           
                            337        1                 Indicated                               
 
M1410_VN $INDICOA                      Resp Treat @ Home;Ventilator             
                          3,233                          Missing                                 
                          2,133        0                 Not indicated                           
                              2        1                 Indicated                               
 
M1600_UT $UTINFOA                      UTI Treatment                            
                          1,698                          Missing                                 
                          3,393        00                No                                      
                            246        01                Yes                                     
                             15        NA                Patient on prophylactic treatment       
                             16        UK                Unknown                                 
 
M1610_UR $UIUCPOA                      Urinar Incont Or Catheter Presence       
                            582                          Missing                                 
                          1,863        00                No incontinence or catheter             
                          2,695        01                Patient is incintinent                  
                            228        02                Patient requires a urinary catheter     
 
M1615_UR $URINCOO                      Urinar Incont Timing                     
                          3,389                          Missing                                 
                            150        00                Timed-voiding deters incontinence       
                            784        01                Occasional stress incontinence          
                             86        02                During the night only                   
                             24        03                During the day only                     
                            935        04                During the day and night                
 
M1620_BW $BWINCOA                      Bowel Incontinence Frequency             
                            582                          Missing                                 
                          3,834        00                Very rarely or never has bowel incont   
                            296        01                Less than once weekly                   
                            260        02                One to three times weekly               
                            121        03                Four to six times weekly                
                            153        04                On a daily basis                        
                             22        05                More often than once daily              
                             97        NA                Patient has ostomy for bowel elimination
                              3        UK                Unknown                                 
         Notes:  Please see CCW documentation about response option for more information
 
M1630_OS $BWOSTOA                      Ostomy For Bowel Elimination             
                          2,117                          Missing                                 
                          3,170        00                Does not have an ostomy                 
                             63        01                Ostomy was not related to inpatient stay
                             18        02                Ostomy was related to inpatient stay    
 
M1700_CG $COGFUOA                      Cognitive Functioning                    
                          1,698                          Missing                                 
                          1,984        00                Alert/Oriented                          
                          1,134        01                Req prompting                           
                            400        02                Req assist and some direction           
                            125        03                Req assist in routine situa             
                             27        04                Totally dependent due to disturbances   
         Notes:  Please see CCW documentation about response option for more information
 
M1710_CN $WCONFOA                      When Confused Frequency                  
                          1,698                          Missing                                 
                          1,806        00                Never                                   
                          1,234        01                In new or complex situations            
                             90        02                On awakening or at night only           
                            414        03                During the day or evening               
                            112        04                Constantly                              
                             14        NA                Patient nonresponsive                   
 
M1720_AN $WANXIOA                      When Anxious Frequency                   
                          1,698                          Missing                                 
                          2,197        00                None of the time                        
                            929        01                Less often than daily                   
                            493        02                Daily, but not constantly               
                             36        03                All of the time                         
                             15        NA                Patient nonresponsive                   
 
M1730_DS $DEPRAOA                      Depression Screening                     
                          3,384                          Missing                                 
                          1,572        00                No                                      
                            321        01                Yes, PHQ-2 scale                        
                             37        02                Yes, other, further evaluation          
                             23        03                Yes, other, no further evaluation       
                             31        NA                Patient nonresponsive                   
 
M1730_PI $DEPRAOA                      PHQ2 Little Interest/Pleasure            
                          3,384                          Missing                                 
                          1,612        00                No                                      
                            290        01                Yes, PHQ-2 scale                        
                             31        02                Yes, other, further evaluation          
                             20        03                Yes, other, no further evaluation       
                             31        NA                Patient nonresponsive                   
 
M1730_PD $DEPRAOA                      PHQ2 Down/Depressed/Hopeless             
                          3,233                          Missing                                 
                             58        00                No                                      
                          1,984        01                Yes, PHQ-2 scale                        
                             16        02                Yes, other, further evaluation          
                             77        03                Yes, other, no further evaluation       
 
M1740_DL $INDICOA                      Cog/Behav/Psych; Delusional              
                          1,698                          Missing                                 
                          3,632        0                 Not indicated                           
                             38        1                 Indicated                               
 
M1740_IM $INDICOA                      Cog/Behav/Psych;Impaired Decision_making 
                          1,698                          Missing                                 
                          2,839        0                 Not indicated                           
                            831        1                 Indicated                               
 
M1740_ME $INDICOA                      Cog/Behav/Psych;Memory Deficit           
                          1,698                          Missing                                 
                          2,967        0                 Not indicated                           
                            703        1                 Indicated                               
 
M1740_CG $INDICOA                      Cog/Behav/Psych;None of the Above        
                          1,698                          Missing                                 
                          1,098        0                 Not indicated                           
                          2,572        1                 Indicated                               
 
M1740_PH $INDICOA                      Cog/Behav/Psych;Physical Aggression      
                          1,698                          Missing                                 
                          3,638        0                 Not indicated                           
                             32        1                 Indicated                               
 
M1740_DS $INDICOA                      Cog/Behav/Psych;Disruptive/Inappropriate 
                          1,698                          Missing                                 
                          3,633        0                 Not indicated                           
                             37        1                 Indicated                               
 
M1740_VR $INDICOA                      Cog/Behav/Psych;Verbal Disruption        
                          1,698                          Missing                                 
                          3,630        0                 Not indicated                           
                             40        1                 Indicated                               
 
M1745_DS $FREQBOA                      Freq Of Disruptive Behav Symptoms        
                          1,698                          Missing                                 
                          2,853        00                Never                                   
                            136        01                Less than once a month                  
                             46        02                One a month                             
                            101        03                Several times each month                
                            169        04                Several times a week                    
                            365        05                At least daily                          
 
M1750_PH $YESNOOA                      Receives Psych Nursing Services          
                          3,233                          Missing                                 
                          2,107        0                 No                                      
                             28        1                 Yes                                     
 
M1800_GR $GROOMOA                      Current Grooming                         
                          1,698                          Missing                                 
                            924        00                Able to groom self unaided              
                          1,293        01                Utensils must be placed within reach    
                          1,190        02                Someone must assis patient to groom self
                            263        03                Depends entirely upon another person    
 
M1810_DR $DRESSOA                      Current Dress Upper Body                 
                            582                          Missing                                 
                            981        00                No assist needed                        
                          1,592        01                No assist needed if clothing laid out   
                          1,848        02                Assist from another person              
                            365        03                Depends entirely upon another person    
 
M1820_DR $DRESSOA                      Current Dress Lower Body                 
                            582                          Missing                                 
                            888        00                No assist needed                        
                            930        01                No assist needed if clothing laid out   
                          2,259        02                Assist from another person              
                            709        03                Depends entirely upon another person    
 
M1830_BA $BATHCOA                      Ability To Wash Body                     
                            582                          Missing                                 
                            356        00                Bathes self independently               
                            577        01                Bathes self with use of devices         
                            924        02                Bathes with intermittent assist         
                          1,857        03                Bathes with complete assist/supervision 
                            242        04                Unable, bed/sink/chair, independent     
                            543        05                Unable, bed/sing/chair, assisted        
                            287        06                Unable, totally bathed by another person
 
M1840_TO $TOILEOA                      Current Toilet Transferring              
                            582                          Missing                                 
                          1,344        00                Toilet, to and from independently       
                          2,297        01                Toilet, when reminded/assist/supervised 
                            684        02                Unable toil, able to bedside commode    
                             76        03                Unable toil/bedside commode, able bedpan
                            385        04                Depends entirely upon another person    
 
M1845_TO $TOILEOA                      Current Toileting Hygiene                
                          1,698                          Missing                                 
                          1,008        00                Toilet, to and from independently       
                          1,008        01                Toilet, when reminded/assist/supervised 
                          1,327        02                Unable toil, able to bedside commode    
                            327        03                Unable toil/bedside commode, able bedpan
 
M1850_TR $TRANSOA                      Current Transferring                     
                            582                          Missing                                 
                            759        00                Able to independently transfer          
                          1,809        01                Transfers with minimal assist or device 
                          1,703        02                Unable transfer self, able to pivot     
                            452        03                Unable transfer self, unable to pivot   
                             18        04                Bedfast, unable trans, able to positio  
                             45        05                Bedfast, unable trans, unable to positio
 
M1860_AM $AMBUCOA                      Current Ambulation/Locomotion            
                            582                          Missing                                 
                            393        00                Able to independently walk/stairs       
                            544        01                Able to walk w/1 handed device          
                          1,353        02                Able to walk w/2 handed device          
                          1,870        03                Able to walk w/constant assist/supervis 
                            289        04                Chairfast,able to wheel self independ   
                            297        05                Chairfast,unable to wheel self independ 
                             40        06                Bedfast,unable to ambulate/or chair     
         Notes:  Please see CCW documentation about response option for more information
 
M1870_EA $FEEDIOA                      Current Feeding or Eating                
                          1,698                          Missing                                 
                          1,729        00                Able independently feed self            
                          1,707        01                Able feed self with intermittent assist 
                            187        02                Unable feed self, complete assist/superv
                             21        03                Able take nutri oral, rec tube feedi    
                             21        04                Unable take nutri oral, rec tube feedi  
                              5        05                Unable take nutri oral or tube feedi    
         Notes:  Please see CCW documentation about response option for more information
 
M1880_PR $MEALSOA                      Current Plan/Prepare Light Meal          
                          1,698                          Missing                                 
                            940        00                Able to independently prepare all meals 
                          1,384        01                Unable to prepare meals on regular basis
                          1,346        02                Unable to prepare any meals             
 
M1890_TE $TELEPOA                      Current Telephone Use                    
                          1,698                          Missing                                 
                          2,193        00                Able independently dial/answer calls    
                            357        01                Able use a specif adapted phone and call
                            388        02                Able answer calls, diff placing calls   
                            295        03                Able answer calls only some of the time 
                            136        04                Unable answer phone at all, can listen  
                            168        05                Totaly unable to use the telephone      
                            133        NA                Patient does not have a telephone       
 
M1900_PA $PRADLOA                      Pri Funct ADL/IADL; Ambulation           
                          3,233                          Missing                                 
                            872        00                Independent                             
                          1,108        01                Needed some help                        
                            155        02                Dependent                               
 
M1900_PH $PRADLOA                      Pri Funct ADL/IADL; Household Tasks      
                          3,233                          Missing                                 
                            459        00                Independent                             
                          1,049        01                Needed some help                        
                            627        02                Dependent                               
 
M1900_PS $PRADLOA                      Pri Funct ADL/IADL; Self Care            
                          3,233                          Missing                                 
                            774        00                Independent                             
                          1,190        01                Needed some help                        
                            171        02                Dependent                               
 
M1900_PT $PRADLOA                      Pri Funct ADL/IADL; Transfer             
                          3,233                          Missing                                 
                            943        00                Independent                             
                          1,053        01                Needed some help                        
                            139        02                Dependent                               
 
M1910_FA $FALLMOA                      Multi-Factor Fall Risk Assessment        
                          3,233                          Missing                                 
                             10        00                No multi-factor fall risk assessment    
                             62        01                Yes, does not indicated a risk for fall 
                          2,063        02                Yes, indicates a risk for falls fall    
 
M2010_DR $YESNAOA                      Patient/Caregiv High Risk Drug Educ      
                          3,235                          Missing                                 
                             41        00                No                                      
                          1,684        01                Yes                                     
                            408        NA                Not applicable                          
 
M2020_OR $MGMRXOA                      Curr Manag Of Oral Medications           
                          1,703                          Missing                                 
                            764        00                Able to independently take correct med  
                            787        01                Able to take med corect time w/prepared 
                            565        02                Able to take med corect time w/ assist  
                          1,533        03                Unable to take med unless administered  
                             16        NA                No med of this type prescribed          
         Notes:  Please see CCW documentation about response option for more information
 
M2030_IN $MGMRXOA                      Curr Manag Of Injectable Medications     
                            588                          Missing                                 
                            216        00                Able to independently take correct med  
                            179        01                Able to take med corect time w/prepared 
                            126        02                Able to take med corect time w/ assist  
                            421        03                Unable to take med unless administered  
                          3,838        NA                No med of this type prescribed          
         Notes:  Please see CCW documentation about response option for more information
 
M2040_PR $PRADLOA                      Prior Medication Manag Injectable Meds   
                          3,233                          Missing                                 
                            127        00                Independent                             
                            172        01                Needed some help                        
                            109        02                Dependent                               
                          1,727        NA                NA                                      
 
M2110_AD $FREQAOA                      Freq Of ADL/IADL Assist From Caregiver   
                          3,233                          Missing                                 
                          1,829        01                Daily                                   
                            156        02                Three or more times per week            
                             79        03                One to two times per week               
                             39        04                Received, but less often than weekly    
                             29        05                No assistance received                  
                              3        UK                Unknown                                 
 
M2200_NA $INDICOA                      Therapy Need; Not Applicable             
                          2,117                          Missing                                 
                          3,201        0                 Not indicated                           
                             50        1                 Indicated                               
 
M2200_VI                               Therapy Need; Number Of Visits           
                          2,167                          Missing                                 
                          3,201        Range of values   Range of values                         
 
M2250_DB $YESNAOA                      POC Synop; Diabetic Foot Care            
                          3,233                          Missing                                 
                             17        00                No                                      
                            779        01                Yes                                     
                          1,339        NA                Not applicable                          
 
M2250_DT $ASSISOA                      POC Synop; Depression Intervention       
                          3,233                          Missing                                 
                             23        00                No assistance needed                    
                            640        01                Currently provide assistance            
                          1,472        NA                Not applicable                          
 
M2250_FA $ASSISOA                      POC Synop; Fall Prevention               
                          3,233                          Missing                                 
                              8        00                No assistance needed                    
                          2,099        01                Currently provide assistance            
                             28        NA                Not applicable                          
 
M2250_PI $YESNAOA                      POC Synop; Pain Intervention             
                          3,233                          Missing                                 
                             17        00                No                                      
                          1,850        01                Yes                                     
                            268        NA                Not applicable                          
 
M2250_PR $YESNAOA                      POC Synop; Press Ulcer Prevention        
                          3,233                          Missing                                 
                             13        00                No                                      
                          1,251        01                Yes                                     
                            871        NA                Not applicable                          
 
M2250_PU $YESNAOA                      POC Synop; Press Ulcer Moist Treatment   
                          3,233                          Missing                                 
                              9        00                No                                      
                             90        01                Yes                                     
                          2,036        NA                Not applicable                          
 
M2250_PN $YESNAOA                      POC Synop; Parameter Phys Notif          
                          3,233                          Missing                                 
                             46        00                No                                      
                          1,010        01                Yes                                     
                          1,079        NA                Not applicable                          
 
M2310_CR $INDICOA                      EmergCare;Cardiac Dysrhythmia            
                          4,860                          Missing                                 
                            494        0                 Not indicated                           
                             14        1                 Indicated                               
 
M2310_IV $INDICOA                      EmergCare;IV Catheter Infection          
                          4,860                          Missing                                 
                            504        0                 Not indicated                           
                              4        1                 Indicated                               
 
M2310_DE $INDICOA                      EmergCare;Dehydration/Malnutrition       
                          4,860                          Missing                                 
                            484        0                 Not indicated                           
                             24        1                 Indicated                               
 
M2310_PL $INDICOA                      EmergCare;DVT,Pulmonary Embolus          
                          4,860                          Missing                                 
                            503        0                 Not indicated                           
                              5        1                 Indicated                               
 
M2310_GI $INDICOA                      EmergCare;GI Issues                      
                          4,860                          Missing                                 
                            494        0                 Not indicated                           
                             14        1                 Indicated                               
 
M2310_HR $INDICOA                      EmergCare;Heart Failure                  
                          4,860                          Missing                                 
                            477        0                 Not indicated                           
                             31        1                 Indicated                               
 
M2310_DB $INDICOA                      EmergCare;Hypo/Hyperglycemia/Diabetes    
                          4,860                          Missing                                 
                            502        0                 Not indicated                           
                              6        1                 Indicated                               
 
M2310_FA $INDICOA                      EmergCare;Injury From Fall               
                          4,860                          Missing                                 
                            454        0                 Not indicated                           
                             54        1                 Indicated                               
 
M2310_MD $INDICOA                      EmergCare;Improper Medication Admin      
                          4,860                          Missing                                 
                            505        0                 Not indicated                           
                              3        1                 Indicated                               
 
M2310_MN $INDICOA                      EmergCare;Acute Mental/Behavioral        
                          4,860                          Missing                                 
                            497        0                 Not indicated                           
                             11        1                 Indicated                               
 
M2310_CH $INDICOA                      EmergCare;Myocardial Infarc/Chest Pain   
                          4,860                          Missing                                 
                            490        0                 Not indicated                           
                             18        1                 Indicated                               
 
M2310_OT $INDICOA                      EmergCare;Other                          
                          4,860                          Missing                                 
                            332        0                 Not indicated                           
                            176        1                 Indicated                               
 
M2310_OH $INDICOA                      EmergCare;Other Heart Disease            
                          4,860                          Missing                                 
                            496        0                 Not indicated                           
                             12        1                 Indicated                               
 
M2310_RS $INDICOA                      EmergCare;Respir Infection               
                          4,860                          Missing                                 
                            471        0                 Not indicated                           
                             37        1                 Indicated                               
 
M2310_OR $INDICOA                      EmergCare;Other Respir Problem           
                          4,860                          Missing                                 
                            455        0                 Not indicated                           
                             53        1                 Indicated                               
 
M2310_ST $INDICOA                      EmergCare;Stroke (CVA) or TIA            
                          4,860                          Missing                                 
                            499        0                 Not indicated                           
                              9        1                 Indicated                               
 
M2310_UN $INDICOA                      EmergCare;Unknown                        
                          4,860                          Missing                                 
                            473        0                 Not indicated                           
                             35        1                 Indicated                               
 
M2310_PA $INDICOA                      EmergCare;Uncontrolled Pain              
                          4,860                          Missing                                 
                            484        0                 Not indicated                           
                             24        1                 Indicated                               
 
M2310_UT $INDICOA                      EmergCare;Urinary Tract Infection        
                          4,860                          Missing                                 
                            480        0                 Not indicated                           
                             28        1                 Indicated                               
 
M2310_WN $INDICOA                      EmergCare;Wound Infection/Deterioration  
                          4,860                          Missing                                 
                            498        0                 Not indicated                           
                             10        1                 Indicated                               
 
M2410_AD $INFACOA                      Admit Inpatient Facility Type            
                          3,265                          Missing                                 
                            537        01                Hospital                                
                             14        02                Rehabilitation facility                 
                             15        03                Nursing home                            
                              2        04                Hospice                                 
                          1,535        NA                No inpatient facility admission         
 
M2420_DS $DISPOCA                      Discharge Location                       
                          3,833                          Missing                                 
                          1,100        01                Patient remained in commun, no assistive
                            390        02                Patient remained in commun, assistive   
                             28        03                Patient transferred to a noninsti hospic
                              9        04                Unknown, location not served by agency  
                              8        UK                Unknown, other                          
         Notes:  Please see CCW documentation about response option for more information
 
M2430_CR $INDICOA                      Hosp Reas;Cardiac Dysrhythmia            
                          4,831                          Missing                                 
                            522        0                 Not indicated                           
                             15        1                 Indicated                               
 
M2430_IV $INDICOA                      Hosp Reas IV Catheter Infection          
                          4,831                          Missing                                 
                            534        0                 Not indicated                           
                              3        1                 Indicated                               
 
M2430_DE $INDICOA                      Hosp Reas;Dehydration/Malnutrition       
                          4,831                          Missing                                 
                            514        0                 Not indicated                           
                             23        1                 Indicated                               
 
M2430_GI $INDICOA                      Hosp Reas;GI Issues                      
                          4,831                          Missing                                 
                            522        0                 Not indicated                           
                             15        1                 Indicated                               
 
M2430_HR $INDICOA                      Hosp Reas;Heart Failure                  
                          4,831                          Missing                                 
                            497        0                 Not indicated                           
                             40        1                 Indicated                               
 
M2430_FA $INDICOA                      Hosp Reas;Injury Caused by Fall          
                          4,831                          Missing                                 
                            490        0                 Not indicated                           
                             47        1                 Indicated                               
 
M2430_MD $INDICOA                      Hosp Reas;Improper Medication Admin      
                          4,831                          Missing                                 
                            534        0                 Not indicated                           
                              3        1                 Indicated                               
 
M2430_MN $INDICOA                      Hosp Reas;Acute Mental/Behavioral        
                          4,831                          Missing                                 
                            522        0                 Not indicated                           
                             15        1                 Indicated                               
 
M2430_CH $INDICOA                      Hosp Reas Myocardial Infarc/Chest Pain   
                          4,831                          Missing                                 
                            520        0                 Not indicated                           
                             17        1                 Indicated                               
 
M2430_OC $INDICOA                      Hosp Reas Other                          
                          4,831                          Missing                                 
                            369        0                 Not indicated                           
                            168        1                 Indicated                               
 
M2430_OH $INDICOA                      Hosp Reas Other Heart Disease            
                          4,831                          Missing                                 
                            525        0                 Not indicated                           
                             12        1                 Indicated                               
 
M2430_PA $INDICOA                      Hosp Reas Uncontrolled Pain              
                          4,831                          Missing                                 
                            516        0                 Not indicated                           
                             21        1                 Indicated                               
 
M2430_RS $INDICOA                      Hosp Reas Respiratory Infection          
                          4,831                          Missing                                 
                            489        0                 Not indicated                           
                             48        1                 Indicated                               
 
M2430_OR $INDICOA                      Hosp Reas Other Respiratory Problem      
                          4,831                          Missing                                 
                            489        0                 Not indicated                           
                             48        1                 Indicated                               
 
M2430_SC $INDICOA                      Hosp Reas Sched Treatment/Procedure      
                          4,831                          Missing                                 
                            527        0                 Not indicated                           
                             10        1                 Indicated                               
 
M2430_ST $INDICOA                      Hosp Reas Stroke (CVA) Or TIA            
                          4,831                          Missing                                 
                            527        0                 Not indicated                           
                             10        1                 Indicated                               
 
M2430_UN $INDICOA                      Hosp Reas Unknown                        
                          4,831                          Missing                                 
                            491        0                 Not indicated                           
                             46        1                 Indicated                               
 
M2430_UT $INDICOA                      Hosp Reas Urinary Tract Infect           
                          4,831                          Missing                                 
                            506        0                 Not indicated                           
                             31        1                 Indicated                               
 
M2430_PL $INDICOA                      Hosp Reas;DVT, Pulmonary Embolus         
                          4,831                          Missing                                 
                            533        0                 Not indicated                           
                              4        1                 Indicated                               
 
M2430_WN $INDICOA                      Hosp Reas Wound Infection/Deterioration  
                          4,831                          Missing                                 
                            520        0                 Not indicated                           
                             17        1                 Indicated                               
 
M2430_DB $INDICOA                      Hosp Reas;Hypo/Hyperglycemia/Diabetes    
                          4,831                          Missing                                 
                            533        0                 Not indicated                           
                              4        1                 Indicated                               
 
