Variable Format    Q#/Freq            Description/Label
 
BASEID   $BSIDFMT                      Unique SP Identification Number          
                          5,277        LOW-HIGH          BASEID Count                            
 
SURVEYYR SVYRFMT                       Survey Year                              
                          5,277                    2019  2019                                    
 
VERSION  VERSFMT                       Version Number                           
                          5,277                       1  Version 1                               
 
HHASMTID                               HHA Assessment Internal ID               
                          5,277        Range of values   Range of values                         
                 First available in 2018
 
M0010_CM                               CMS Certification Number (CCN)           
                          5,277        Range of values   Range of values                         
 
M0014_BR                               Branch State Code                        
                          4,274                          Missing                                 
                          1,003        Range of values   Range of values                         
 
M0016_BR                               Branch ID                                
                          5,277        Range of values   Range of values                         
 
M0018_NN                               NPI Physician ID                         
                            155                          Missing                                 
                          5,122        Range of values   Range of values                         
 
M0018_NU $INDICOA                      NPI Physician ID Unknown                 
                          5,122        0                 Not indicated                           
                            155        1                 Indicated                               
 
M0030_ST MMDDYYn8                      Start of Care Date                       
                          5,277        MMDDYYYY          Date as MMDDYYYY                        
 
M0032_RO MMDDYYn8                      Resumption of Care Date                  
                          4,892                       .  Inapplicable                            
                            385        MMDDYYYY          Date as MMDDYYYY                        
 
M0032_RN $YESNOOA                      Resumption of Care Date NA               
                            385        0                 No                                      
                          4,892        1                 Yes                                     
 
M0069_GN $SEXFMT                       Patient Sex                           
                          2,099        1                 Male                                    
                          3,178        2                 Female                                  
 
M0080_AS $DISCIOA                      Disc of Person Completing Assess         
                          4,065        01                RN                                      
                          1,063        02                PT                                      
                             43        03                SLP/ST                                  
                            106        04                OT                                      
 
M0090_AS MMDDYYn8                      Date Assessment Completed                
                          5,277        MMDDYYYY          Date as MMDDYYYY                        
 
M0100_RS $ACOMPOA                      Reason for Assessment                    
                          1,803        01                S/R; Start; further visits planned      
                            288        03                S/R; Resumption of care                 
                          1,082        04                Follow-up; Recertification              
                             11        05                Follow-up; Other                        
                            490        06                Transfer to inpat fac; Patient not disch
                             50        07                Transfer to inpat fac; Patient disch    
                              9        08                Disch from agency; Death at home        
                          1,544        09                Disch from agency; Disch from agency    
 
M0102_PD MMDDYYn8                      Phys Ordered SOC or ROC Date             
                          4,552                       .  Inapplicable                            
                            725        MMDDYYYY          Date as MMDDYYYY                        
 
M0102_PN $INDICOA                      Phys Ordered SOC or ROC Date NA          
                          3,213                          Missing                                 
                            698        0                 Not indicated                           
                          1,366        1                 Indicated                               
 
M0104_RF MMDDYYn8                      Date Of Referral                         
                          3,911                       .  Inapplicable                            
                          1,366        MMDDYYYY          Date as MMDDYYYY                        
 
M0110_EP $EPSDFMT                      Episode Timing                           
                          2,093                          Missing                                 
                          2,219        01                Early                                   
                            756        02                Later                                   
                             65        NA                No case mix group defined               
                            144        UK                Unknown                                 
 
M0140_AM $INDICOA                      Race/Eth:Amer Indian/Alaskan Nat         
                          3,169                          Missing                                 
                          2,093        0                 Not indicated                           
                             15        1                 Indicated                               
 
M0140_AS $INDICOA                      Race/Ethnicity: Asian                    
                          3,169                          Missing                                 
                          2,077        0                 Not indicated                           
                             31        1                 Indicated                               
 
M0140_AF $INDICOA                      Race/Eth:Black or African-American       
                          3,169                          Missing                                 
                          1,853        0                 Not indicated                           
                            255        1                 Indicated                               
 
M0140_HS $INDICOA                      Race/Ethnicity: Hispanic or Latino       
                          3,169                          Missing                                 
                          1,904        0                 Not indicated                           
                            204        1                 Indicated                               
 
M0140_NT $INDICOA                      Race/Eth:Nat Hawaii/Oth Pacific Isl      
                          3,169                          Missing                                 
                          2,108        0                 Not indicated                           
 
M0140_WH $INDICOA                      Race/Eth:White                           
                          3,169                          Missing                                 
                            493        0                 Not indicated                           
                          1,615        1                 Indicated                               
 
M0150_DF $INDICOA                      Medicaid Fee For Service Payment         
                          5,064        0                 Not indicated                           
                            213        1                 Indicated                               
 
M0150_DH $INDICOA                      Medicaid HMO/Managed Care Payment        
                          5,191        0                 Not indicated                           
                             86        1                 Indicated                               
 
M0150_RF $INDICOA                      Medicare Fee For Service Payment         
                          1,889        0                 Not indicated                           
                          3,388        1                 Indicated                               
 
M0150_RH $INDICOA                      Medicare HMO/Managed Care Payment        
                          3,489        0                 Not indicated                           
                          1,788        1                 Indicated                               
 
M0150_NO $INDICOA                      No Payment                               
                          5,275        0                 Not indicated                           
                              2        1                 Indicated                               
 
M0150_OG $INDICOA                      Other Government Payment                 
                          5,250        0                 Not indicated                           
                             27        1                 Indicated                               
 
M0150_OP $INDICOA                      Other Payment Source                     
                          5,241        0                 Not indicated                           
                             36        1                 Indicated                               
 
M0150_PH $INDICOA                      Private HMO/Managed Care Payment         
                          5,236        0                 Not indicated                           
                             41        1                 Indicated                               
 
M0150_PI $INDICOA                      Private Insurance Payment                
                          5,200        0                 Not indicated                           
                             77        1                 Indicated                               
 
M0150_SE $INDICOA                      Self-Pay Payment                         
                          5,252        0                 Not indicated                           
                             25        1                 Indicated                               
 
M0150_TI $INDICOA                      Title Programs Payment                   
                          5,277        0                 Not indicated                           
 
M0150_UN $INDICOA                      Unknown Payment Source                   
                          3,157                          Missing                                 
                          2,120        0                 Not indicated                           
 
M0150_WC $INDICOA                      Workers Compensation Payment             
                          5,277        0                 Not indicated                           
 
M0906_DS MMDDYYn8                      Discharge/Transfer/Death Date            
                          3,184                       .  Inapplicable                            
                          2,093        MMDDYYYY          Date as MMDDYYYY                        
 
M1000_IP $INDICOA                      Inp Discharg;Short Stay Acut Hosp        
                          3,184                          Missing                                 
                          1,102        0                 Not indicated                           
                            991        1                 Indicated                               
 
M1000_IR $INDICOA                      Inp Discharg;IRF                         
                          3,184                          Missing                                 
                          1,972        0                 Not indicated                           
                            121        1                 Indicated                               
 
M1000_NF $INDICOA                      Inp Discharg;Nursing Facility            
                          3,184                          Missing                                 
                          2,087        0                 Not indicated                           
                              6        1                 Indicated                               
 
M1000_LT $INDICOA                      Discharged Past 14 Days;LTCH             
                          3,184                          Missing                                 
                          2,082        0                 Not indicated                           
                             11        1                 Indicated                               
 
M1000_NO $INDICOA                      No Inp Discharge                         
                          3,184                          Missing                                 
                          1,387        0                 Not indicated                           
                            706        1                 Indicated                               
 
M1000_OT $INDICOA                      Inp Discharg;Other                       
                          3,184                          Missing                                 
                          2,091        0                 Not indicated                           
                              2        1                 Indicated                               
 
M1000_PS $INDICOA                      Inp Discharg;Psych Hospital Or Unit      
                          3,184                          Missing                                 
                          2,089        0                 Not indicated                           
                              4        1                 Indicated                               
 
M1000_SN $INDICOA                      Inp Discharg;SNF/TCU Facility            
                          3,184                          Missing                                 
                          1,779        0                 Not indicated                           
                            314        1                 Indicated                               
 
M1005_IU $INDICOA                      Inpat Discharge Date Unknown             
                          3,892                          Missing                                 
                          1,356        0                 Not indicated                           
                             29        1                 Indicated                               
 
M1005_ID MMDDYYn8                      Most Recent Inpat Discharge Date         
                          3,921                       .  Inapplicable                            
                          1,356        MMDDYYYY          Date as MMDDYYYY                        
 
M1030_HE $INDICOA                      Home Thera; Enteral Nutrition            
                          2,091                          Missing                                 
                          3,133        0                 Not indicated                           
                             53        1                 Indicated                               
 
M1030_HI $INDICOA                      Home Thera; Intravenous/Infusion Thera   
                          2,091                          Missing                                 
                          3,104        0                 Not indicated                           
                             82        1                 Indicated                               
 
M1030_HN $INDICOA                      Home Thera; None of the Above            
                          2,091                          Missing                                 
                            137        0                 Not indicated                           
                          3,049        1                 Indicated                               
 
M1030_HP $INDICOA                      Home Thera; Parenteral Nutrition         
                          2,091                          Missing                                 
                          3,186        0                 Not indicated                           
 
M1100_PT $PTLVG                        Patient Living Arrangement               
                          3,186                          Missing                                 
                            169        01                Lives alone, 24 hour assistance         
                             40        02                Lives alone, daytime assistance         
                             13        03                Lives alone, nighttime assistance       
                            279        04                Lives alone, occasional/short-term asst 
                             16        05                Lives alone, no assistance              
                          1,032        06                Lives at home w/others, 24 hr assistance
                             30        07                Lives at home w/others, daytime assist  
                             77        08                Lives at home w/others, nighttime assist
                             96        09                Lives at home w/others, occas/short-term
                              3        10                Lives at home w/others, no assistance av
                            322        11                Lives in congregate situation, 24 hour a
                              3        12                Lives in congregate situation, daytime a
                             11        14                Lives in congregate situation, occasiona
         Notes:  Please see CCW documentation about response option for more information
 
M1200_VS $VISIOOA                      Vision                                   
                          2,093                          Missing                                 
                          2,055        00                Normal vision                           
                          1,082        01                Partially impaired                      
                             47        02                Severely impaired                       
 
M1242_PA $FREQCOA                      Freq Of Pain Interfere W Activity        
                            549                          Missing                                 
                          1,220        00                No pain                                 
                            628        01                Pain does not interfere                 
                            678        02                Less often than daily                   
                          1,730        03                Daily, but not constantly               
                            472        04                All of the time                         
 
M1306_PR $YESNOOA                      Unheal Press Ulcers; St II+              
                            548                          Missing                                 
                          4,527        0                 No                                      
                            202        1                 Yes                                     
 
M1307_PD $OLDPUL                       Oldest St II Press Ulcer Onset Date      
                          5,249                          Missing                                 
                             15        01                Was present at the most recent SOC/ROC  
                              4        02                Developed since the most recent SOC/ROC 
                              9        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   
                          5,273                       .  Inapplicable                            
                              4        MMDDYYYY          Date as MMDDYYYY                        
 
M1322_ST $ULNUMOA                      Curr # Of Stage I Press Ulcers           
                          2,092                          Missing                                 
                          3,149        00                None                                    
                             28        01                One                                     
                              3        02                Two                                     
                              4        03                Three                                   
                              1        04                Four or more                            
 
M1324_PR $ULSTGOA                      Stage, Most Problemat Press Ulcer        
                            549                          Not assessed/no information             
                             33        01                Stage one                               
                            110        02                Stage two                               
                             50        03                Stage three                             
                             15        04                Stage four                              
                          4,520        NA                No observable pressure ulcer            
 
M1330_ST $STASUOA                      Stasis Ulcer Present                     
                            549                          Missing                                 
                          4,658        00                No                                      
                              5        01                Yes, BOTH observable and unobservable   
                             55        02                Yes, Observable only                    
                             10        03                Yes, Unobservable only                  
 
M1332_ST $ULNUMOA                      Curr # Of Stasis Ulcer                   
                          5,226                          Missing                                 
                             29        01                One                                     
                             16        02                Two                                     
                              3        03                Three                                   
                              3        04                Four or more                            
 
M1334_ST $ULSTAQO                      Status, Most Problemat Stasis Ulcer      
                          5,217                          Missing                                 
                              3        01                Fully granulating                       
                             23        02                Early/Partial granulation               
                             34        03                Not healing                             
 
M1340_SR $SURGWOA                      Surgical Wound Present                   
                            549                          Missing                                 
                          3,975        00                No                                      
                            603        01                Yes, observable                         
                            150        02                Yes, not observable                     
 
M1342_SR $ULSTAQO                      Status, Most Problemat Surg Wound        
                          4,674                          Missing                                 
                            303        00                Newly epithelialized                    
                             41        01                Fully granulating                       
                             58        02                Early/Partial granulation               
                            201        03                Not healing                             
 
M1400_SO $SBREAOA                      When Is Patient Dyspneic or SOB          
                            549                          Missing                                 
                          1,533        00                Never                                   
                          1,165        01                When walking more than 20 feet          
                          1,330        02                With moderate exertion                  
                            563        03                With minimal exertion                   
                            137        04                At rest (day or night)                  
 
M1600_UT $UTINFOA                      UTI Treatment                            
                          1,642                          Missing                                 
                          3,352        00                No                                      
                            257        01                Yes                                     
                             23        NA                Patient on prophylactic treatment       
                              3        UK                Unknown                                 
 
M1620_BW $BWINCOA                      Bowel Incontinence Frequency             
                            549                          Missing                                 
                          3,769        00                Very rarely or never has bowel incont   
                            293        01                Less than once weekly                   
                            279        02                One to three times weekly               
                            101        03                Four to six times weekly                
                            163        04                On a daily basis                        
                             35        05                More often than once daily              
                             86        NA                Patient has ostomy for bowel elimination
                              2        UK                Unknown                                 
         Notes:  Please see CCW documentation about response option for more information
 
M1630_OS $BWOSTOA                      Ostomy For Bowel Elimination             
                          2,093                          Missing                                 
                          3,118        00                Does not have an ostomy                 
                             58        01                Ostomy was not related to inpatient stay
                              8        02                Ostomy was related to inpatient stay    
 
M1700_CG $COGFUOA                      Cognitive Functioning                    
                          1,642                          Missing                                 
                          2,020        00                Alert/Oriented                          
                          1,041        01                Req prompting                           
                            379        02                Req assist and some direction           
                            153        03                Req assist in routine situa             
                             42        04                Totally dependent due to disturbances   
         Notes:  Please see CCW documentation about response option for more information
 
M1710_CN $WCONFOA                      When Confused Frequency                  
                          1,642                          Missing                                 
                          1,859        00                Never                                   
                          1,152        01                In new or complex situations            
                             80        02                On awakening or at night only           
                            394        03                During the day or evening               
                            140        04                Constantly                              
                             10        NA                Patient nonresponsive                   
 
M1720_AN $WANXIOA                      When Anxious Frequency                   
                          1,642                          Missing                                 
                          2,252        00                None of the time                        
                            851        01                Less often than daily                   
                            483        02                Daily, but not constantly               
                             38        03                All of the time                         
                             11        NA                Patient nonresponsive                   
 
M1730_DS $DEPRAOA                      Depression Screening                     
                          3,381                          Missing                                 
                          1,558        00                No                                      
                            254        01                Yes, PHQ-2 scale                        
                             30        02                Yes, other, further evaluation          
                             23        03                Yes, other, no further evaluation       
                             31        NA                Patient nonresponsive                   
 
M1730_PI $DEPRAOA                      PHQ2 Little Interest/Pleasure            
                          3,381                          Missing                                 
                          1,574        00                No                                      
                            234        01                Yes, PHQ-2 scale                        
                             33        02                Yes, other, further evaluation          
                             23        03                Yes, other, no further evaluation       
                             32        NA                Patient nonresponsive                   
 
M1730_PD $DEPRAOA                      PHQ2 Down/Depressed/Hopeless             
                          3,186                          Missing                                 
                             78        00                No                                      
                          1,896        01                Yes, PHQ-2 scale                        
                             31        02                Yes, other, further evaluation          
                             86        03                Yes, other, no further evaluation       
 
M1740_DL $INDICOA                      Cog/Behav/Psych; Delusional              
                          1,640                          Missing                                 
                          3,589        0                 Not indicated                           
                             48        1                 Indicated                               
 
M1740_IM $INDICOA                      Cog/Behav/Psych;Impaired Decision_making 
                          1,640                          Missing                                 
                          2,858        0                 Not indicated                           
                            779        1                 Indicated                               
 
M1740_ME $INDICOA                      Cog/Behav/Psych;Memory Deficit           
                          1,640                          Missing                                 
                          2,960        0                 Not indicated                           
                            677        1                 Indicated                               
 
M1740_CG $INDICOA                      Cog/Behav/Psych;None of the Above        
                          1,640                          Missing                                 
                          1,045        0                 Not indicated                           
                          2,592        1                 Indicated                               
 
M1740_PH $INDICOA                      Cog/Behav/Psych;Physical Aggression      
                          1,640                          Missing                                 
                          3,611        0                 Not indicated                           
                             26        1                 Indicated                               
 
M1740_DS $INDICOA                      Cog/Behav/Psych;Disruptive/Inappropriate 
                          1,640                          Missing                                 
                          3,610        0                 Not indicated                           
                             27        1                 Indicated                               
 
M1740_VR $INDICOA                      Cog/Behav/Psych;Verbal Disruption        
                          1,640                          Missing                                 
                          3,597        0                 Not indicated                           
                             40        1                 Indicated                               
 
M1745_DS $FREQBOA                      Freq Of Disruptive Behav Symptoms        
                          1,642                          Missing                                 
                          2,847        00                Never                                   
                            129        01                Less than once a month                  
                             32        02                One a month                             
                            136        03                Several times each month                
                            158        04                Several times a week                    
                            333        05                At least daily                          
 
M1800_GR $GROOMOA                      Current Grooming                         
                          1,642                          Missing                                 
                          1,018        00                Able to groom self unaided              
                          1,186        01                Utensils must be placed within reach    
                          1,149        02                Someone must assis patient to groom self
                            282        03                Depends entirely upon another person    
 
M1810_DR $DRESSOA                      Current Dress Upper Body                 
                            549                          Missing                                 
                          1,067        00                No assist needed                        
                          1,403        01                No assist needed if clothing laid out   
                          1,820        02                Assist from another person              
                            438        03                Depends entirely upon another person    
 
M1820_DR $DRESSOA                      Current Dress Lower Body                 
                            549                          Missing                                 
                            969        00                No assist needed                        
                            809        01                No assist needed if clothing laid out   
                          2,201        02                Assist from another person              
                            749        03                Depends entirely upon another person    
 
M1830_BA $BATHCOA                      Ability To Wash Body                     
                            549                          Missing                                 
                            406        00                Bathes self independently               
                            579        01                Bathes self with use of devices         
                            874        02                Bathes with intermittent assist         
                          1,740        03                Bathes with complete assist/supervision 
                            137        04                Unable, bed/sink/chair, independent     
                            617        05                Unable, bed/sing/chair, assisted        
                            375        06                Unable, totally bathed by another person
 
M1840_TO $TOILEOA                      Current Toilet Transferring              
                            549                          Missing                                 
                          1,285        00                Toilet, to and from independently       
                          2,283        01                Toilet, when reminded/assist/supervised 
                            611        02                Unable toil, able to bedside commode    
                             60        03                Unable toil/bedside commode, able bedpan
                            489        04                Depends entirely upon another person    
 
M1845_TO $TOILEOA                      Current Toileting Hygiene                
                          1,642                          Missing                                 
                          1,024        00                Toilet, to and from independently       
                            924        01                Toilet, when reminded/assist/supervised 
                          1,313        02                Unable toil, able to bedside commode    
                            374        03                Unable toil/bedside commode, able bedpan
 
M1850_TR $TRANSOA                      Current Transferring                     
                            549                          Missing                                 
                            825        00                Able to independently transfer          
                          1,582        01                Transfers with minimal assist or device 
                          1,833        02                Unable transfer self, able to pivot     
                            405        03                Unable transfer self, unable to pivot   
                             16        04                Bedfast, unable trans, able to positio  
                             67        05                Bedfast, unable trans, unable to positio
 
M1860_AM $AMBUCOA                      Current Ambulation/Locomotion            
                            549                          Missing                                 
                            438        00                Able to independently walk/stairs       
                            481        01                Able to walk w/1 handed device          
                          1,251        02                Able to walk w/2 handed device          
                          1,965        03                Able to walk w/constant assist/supervis 
                            217        04                Chairfast,able to wheel self independ   
                            323        05                Chairfast,unable to wheel self independ 
                             53        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                
                          1,642                          Missing                                 
                          1,639        00                Able independently feed self            
                          1,745        01                Able feed self with intermittent assist 
                            213        02                Unable feed self, complete assist/superv
                             15        03                Able take nutri oral, rec tube feedi    
                             20        04                Unable take nutri oral, rec tube feedi  
                              3        05                Unable take nutri oral or tube feedi    
         Notes:  Please see CCW documentation about response option for more information
 
M1910_FA $FALLMOA                      Multi-Factor Fall Risk Assessment        
                          3,186                          Missing                                 
                              8        00                No multi-factor fall risk assessment    
                             73        01                Yes, does not indicated a risk for fall 
                          2,010        02                Yes, indicates a risk for falls fall    
 
M2010_DR $YESNAOA                      Patient/Caregiv High Risk Drug Educ      
                          3,192                          Missing                                 
                             44        00                No                                      
                          1,711        01                Yes                                     
                            330        NA                Not applicable                          
 
M2020_OR $MGMRXOA                      Curr Manag Of Oral Medications           
                          1,648                          Missing                                 
                            783        00                Able to independently take correct med  
                            653        01                Able to take med corect time w/prepared 
                            503        02                Able to take med corect time w/ assist  
                          1,673        03                Unable to take med unless administered  
                             17        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     
                          2,098                          Missing                                 
                             60        00                Able to independently take correct med  
                             92        01                Able to take med corect time w/prepared 
                             78        02                Able to take med corect time w/ assist  
                            426        03                Unable to take med unless administered  
                          2,523        NA                No med of this type prescribed          
         Notes:  Please see CCW documentation about response option for more information
 
M2200_NA $INDICOA                      Therapy Need; Not Applicable             
                          2,090                          Missing                                 
                          3,107        0                 Not indicated                           
                             80        1                 Indicated                               
 
M2200_VI                               Therapy Need; Number Of Visits           
                          2,172                          Missing                                 
                          3,105        Range of values   Range of values                         
 
M2310_DB $INDICOA                      EmergCare;Hypo/Hyperglycemia/Diabetes    
                          4,795                          Missing                                 
                            479        0                 Not indicated                           
                              3        1                 Indicated                               
 
M2310_MD $INDICOA                      EmergCare;Improper Medication Admin      
                          4,795                          Missing                                 
                            478        0                 Not indicated                           
                              4        1                 Indicated                               
 
M2310_OT $INDICOA                      EmergCare;Other                          
                          4,795                          Missing                                 
                             43        0                 Not indicated                           
                            439        1                 Indicated                               
 
M2310_UN $INDICOA                      EmergCare;Unknown                        
                          4,795                          Missing                                 
                            445        0                 Not indicated                           
                             37        1                 Indicated                               
 
M2410_AD $INFACOA                      Admit Inpatient Facility Type            
                          3,193                          Missing                                 
                            517        01                Hospital                                
                             12        02                Rehabilitation facility                 
                              9        03                Nursing home                            
                              2        04                Hospice                                 
                          1,544        NA                No inpatient facility admission         
 
M2420_DS $DISPOCA                      Discharge Location                       
                          3,733                          Missing                                 
                          1,118        01                Patient remained in commun, no assistive
                            383        02                Patient remained in commun, assistive   
                             31        03                Patient transferred to a noninsti hospic
                              9        04                Unknown, location not served by agency  
                              3        UK                Unknown, other                          
         Notes:  Please see CCW documentation about response option for more information
 
