Variable Format    Q#/Freq            Description/Label
 
BASEID   $BSIDFMT                      Unique SP Identification Number          
                          3,937        LOW-HIGH          BASEID Count                            
 
SURVEYYR SVYRFMT                       Survey Year                              
                          3,937                    2020  2020                                    
 
VERSION  VERSFMT                       Version Number                           
                          3,937                       1  Version 1                               
 
HHASMTID                               HHA Assessment Internal ID               
                          3,937        Range of values   Range of values                         
                 First available in 2018
 
M0010_CM                               CMS Certification Number (CCN)           
                          3,937        Range of values   Range of values                         
 
M0014_BR                               Branch State Code                        
                          3,094                          Missing                                 
                            843        Range of values   Range of values                         
 
M0016_BR                               Branch ID                                
                          3,937        Range of values   Range of values                         
 
M0018_NN                               NPI Physician ID                         
                            125                          Missing                                 
                          3,812        Range of values   Range of values                         
 
M0018_NU $INDICOA                      NPI Physician ID Unknown                 
                          3,812        0                 Not indicated                           
                            125        1                 Indicated                               
 
M0030_ST MMDDYYn8                      Start of Care Date                       
                          3,937        MMDDYYYY          Date as MMDDYYYY                        
 
M0032_RO MMDDYYn8                      Resumption of Care Date                  
                          3,679                       .  Inapplicable                            
                            258        MMDDYYYY          Date as MMDDYYYY                        
 
M0032_RN $YESNOOA                      Resumption of Care Date NA               
                            258        0                 No                                      
                          3,679        1                 Yes                                     
 
M0069_GN $SEXFMT                       Patient Sex                           
                          1,576        1                 Male                                    
                          2,361        2                 Female                                  
 
M0080_AS $DISCIOA                      Disc of Person Completing Assess         
                          3,093        01                RN                                      
                            723        02                PT                                      
                             38        03                SLP/ST                                  
                             83        04                OT                                      
 
M0090_AS MMDDYYn8                      Date Assessment Completed                
                          3,937        MMDDYYYY          Date as MMDDYYYY                        
 
M0100_RS $ACOMPOA                      Reason for Assessment                    
                          1,354        01                S/R; Start; further visits planned      
                            182        03                S/R; Resumption of care                 
                            879        04                Follow-up; Recertification              
                             13        05                Follow-up; Other                        
                            296        06                Transfer to inpat fac; Patient not disch
                             67        07                Transfer to inpat fac; Patient disch    
                              8        08                Disch from agency; Death at home        
                          1,138        09                Disch from agency; Disch from agency    
 
M0102_PD MMDDYYn8                      Phys Ordered SOC or ROC Date             
                          3,410                       .  Inapplicable                            
                            527        MMDDYYYY          Date as MMDDYYYY                        
 
M0102_PN $INDICOA                      Phys Ordered SOC or ROC Date NA          
                          2,411                          Missing                                 
                            516        0                 Not indicated                           
                          1,010        1                 Indicated                               
 
M0104_RF MMDDYYn8                      Date Of Referral                         
                          2,927                       .  Inapplicable                            
                          1,010        MMDDYYYY          Date as MMDDYYYY                        
 
M0110_EP $EPSDFMT                      Episode Timing                           
                          1,509                          Missing                                 
                          1,395        01                Early                                   
                            867        02                Later                                   
                             58        NA                No case mix group defined               
                            108        UK                Unknown                                 
 
M0140_AM $INDICOA                      Race/Eth:Amer Indian/Alaskan Nat         
                          2,382                          Missing                                 
                          1,549        0                 Not indicated                           
                              6        1                 Indicated                               
 
M0140_AS $INDICOA                      Race/Ethnicity: Asian                    
                          2,382                          Missing                                 
                          1,530        0                 Not indicated                           
                             25        1                 Indicated                               
 
M0140_AF $INDICOA                      Race/Eth:Black or African-American       
                          2,382                          Missing                                 
                          1,339        0                 Not indicated                           
                            216        1                 Indicated                               
 
M0140_HS $INDICOA                      Race/Ethnicity: Hispanic or Latino       
                          2,382                          Missing                                 
                          1,437        0                 Not indicated                           
                            118        1                 Indicated                               
 
M0140_NT $INDICOA                      Race/Eth:Nat Hawaii/Oth Pacific Isl      
                          2,382                          Missing                                 
                          1,555        0                 Not indicated                           
 
M0140_WH $INDICOA                      Race/Eth:White                           
                          2,382                          Missing                                 
                            363        0                 Not indicated                           
                          1,192        1                 Indicated                               
 
M0150_DF $INDICOA                      Medicaid Fee For Service Payment         
                          3,767        0                 Not indicated                           
                            170        1                 Indicated                               
 
M0150_DH $INDICOA                      Medicaid HMO/Managed Care Payment        
                          3,868        0                 Not indicated                           
                             69        1                 Indicated                               
 
M0150_RF $INDICOA                      Medicare Fee For Service Payment         
                          1,552        0                 Not indicated                           
                          2,385        1                 Indicated                               
 
M0150_RH $INDICOA                      Medicare HMO/Managed Care Payment        
                          2,474        0                 Not indicated                           
                          1,463        1                 Indicated                               
 
M0150_NO $INDICOA                      No Payment                               
                          3,937        0                 Not indicated                           
 
M0150_OG $INDICOA                      Other Government Payment                 
                          3,904        0                 Not indicated                           
                             33        1                 Indicated                               
 
M0150_OP $INDICOA                      Other Payment Source                     
                          3,908        0                 Not indicated                           
                             29        1                 Indicated                               
 
M0150_PH $INDICOA                      Private HMO/Managed Care Payment         
                          3,918        0                 Not indicated                           
                             19        1                 Indicated                               
 
M0150_PI $INDICOA                      Private Insurance Payment                
                          3,881        0                 Not indicated                           
                             56        1                 Indicated                               
 
M0150_SE $INDICOA                      Self-Pay Payment                         
                          3,917        0                 Not indicated                           
                             20        1                 Indicated                               
 
M0150_TI $INDICOA                      Title Programs Payment                   
                          3,935        0                 Not indicated                           
                              2        1                 Indicated                               
 
M0150_UN $INDICOA                      Unknown Payment Source                   
                          2,383                          Missing                                 
                          1,554        0                 Not indicated                           
 
M0150_WC $INDICOA                      Workers Compensation Payment             
                          3,935        0                 Not indicated                           
                              2        1                 Indicated                               
 
M0906_DS MMDDYYn8                      Discharge/Transfer/Death Date            
                          2,428                       .  Inapplicable                            
                          1,509        MMDDYYYY          Date as MMDDYYYY                        
 
M1000_IP $INDICOA                      Inp Discharg;Short Stay Acut Hosp        
                          2,398                          Missing                                 
                            811        0                 Not indicated                           
                            728        1                 Indicated                               
 
M1000_IR $INDICOA                      Inp Discharg;IRF                         
                          2,398                          Missing                                 
                          1,446        0                 Not indicated                           
                             93        1                 Indicated                               
 
M1000_NF $INDICOA                      Inp Discharg;Nursing Facility            
                          2,398                          Missing                                 
                          1,534        0                 Not indicated                           
                              5        1                 Indicated                               
 
M1000_LT $INDICOA                      Discharged Past 14 Days;LTCH             
                          2,398                          Missing                                 
                          1,532        0                 Not indicated                           
                              7        1                 Indicated                               
 
M1000_NO $INDICOA                      No Inp Discharge                         
                          2,398                          Missing                                 
                          1,021        0                 Not indicated                           
                            518        1                 Indicated                               
 
M1000_OT $INDICOA                      Inp Discharg;Other                       
                          2,398                          Missing                                 
                          1,531        0                 Not indicated                           
                              8        1                 Indicated                               
 
M1000_PS $INDICOA                      Inp Discharg;Psych Hospital Or Unit      
                          2,398                          Missing                                 
                          1,537        0                 Not indicated                           
                              2        1                 Indicated                               
 
M1000_SN $INDICOA                      Inp Discharg;SNF/TCU Facility            
                          2,398                          Missing                                 
                          1,331        0                 Not indicated                           
                            208        1                 Indicated                               
 
M1005_IU $INDICOA                      Inpat Discharge Date Unknown             
                          2,918                          Missing                                 
                          1,001        0                 Not indicated                           
                             18        1                 Indicated                               
 
M1005_ID MMDDYYn8                      Most Recent Inpat Discharge Date         
                          2,936                       .  Inapplicable                            
                          1,001        MMDDYYYY          Date as MMDDYYYY                        
 
M1030_HE $INDICOA                      Home Thera; Enteral Nutrition            
                          1,540                          Missing                                 
                          2,353        0                 Not indicated                           
                             44        1                 Indicated                               
 
M1030_HI $INDICOA                      Home Thera; Intravenous/Infusion Thera   
                          1,540                          Missing                                 
                          2,334        0                 Not indicated                           
                             63        1                 Indicated                               
 
M1030_HN $INDICOA                      Home Thera; None of the Above            
                          1,532                          Missing                                 
                            107        0                 Not indicated                           
                          2,298        1                 Indicated                               
 
M1030_HP $INDICOA                      Home Thera; Parenteral Nutrition         
                          1,540                          Missing                                 
                          2,397        0                 Not indicated                           
 
M1100_PT $PTLVG                        Patient Living Arrangement               
                          2,400                          Missing                                 
                            122        01                Lives alone, 24 hour assistance         
                             32        02                Lives alone, daytime assistance         
                              4        03                Lives alone, nighttime assistance       
                            194        04                Lives alone, occasional/short-term asst 
                             19        05                Lives alone, no assistance              
                            784        06                Lives at home w/others, 24 hr assistance
                             29        07                Lives at home w/others, daytime assist  
                             44        08                Lives at home w/others, nighttime assist
                             79        09                Lives at home w/others, occas/short-term
                              5        10                Lives at home w/others, no assistance av
                            210        11                Lives in congregate situation, 24 hour a
                              3        12                Lives in congregate situation, daytime a
                             12        14                Lives in congregate situation, occasiona
         Notes:  Please see CCW documentation about response option for more information
 
M1200_VS $VISIOOA                      Vision                                   
                          1,529                          Missing                                 
                          1,556        00                Normal vision                           
                            807        01                Partially impaired                      
                             45        02                Severely impaired                       
 
M1242_PA $FREQCOA                      Freq Of Pain Interfere W Activity        
                            392                          Missing                                 
                            818        00                No pain                                 
                            433        01                Pain does not interfere                 
                            538        02                Less often than daily                   
                          1,302        03                Daily, but not constantly               
                            454        04                All of the time                         
 
M1306_PR $YESNOOA                      Unheal Press Ulcers; St II+              
                            371                          Missing                                 
                          3,364        0                 No                                      
                            202        1                 Yes                                     
 
M1307_PD $OLDPUL                       Oldest St II Press Ulcer Onset Date      
                          3,921                          Missing                                 
                             12        01                Was present at the most recent SOC/ROC  
                              1        02                Developed since the most recent SOC/ROC 
                              3        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   
                          3,936                       .  Inapplicable                            
                              1        MMDDYYYY          Date as MMDDYYYY                        
 
M1322_ST $ULNUMOA                      Curr # Of Stage I Press Ulcers           
                          1,530                          Missing                                 
                          2,355        00                None                                    
                             38        01                One                                     
                             10        02                Two                                     
                              1        03                Three                                   
                              3        04                Four or more                            
 
M1324_PR $ULSTGOA                      Stage, Most Problemat Press Ulcer        
                            394                          Not assessed/no information             
                             44        01                Stage one                               
                            112        02                Stage two                               
                             42        03                Stage three                             
                             24        04                Stage four                              
                          3,321        NA                No observable pressure ulcer            
 
M1330_ST $STASUOA                      Stasis Ulcer Present                     
                            393                          Missing                                 
                          3,467        00                No                                      
                              7        01                Yes, BOTH observable and unobservable   
                             68        02                Yes, Observable only                    
                              2        03                Yes, Unobservable only                  
 
M1332_ST $ULNUMOA                      Curr # Of Stasis Ulcer                   
                          3,870                          Missing                                 
                             29        01                One                                     
                             21        02                Two                                     
                             14        03                Three                                   
                              3        04                Four or more                            
 
M1334_ST $ULSTAQO                      Status, Most Problemat Stasis Ulcer      
                          3,862                          Missing                                 
                              4        01                Fully granulating                       
                             23        02                Early/Partial granulation               
                             48        03                Not healing                             
 
M1340_SR $SURGWOA                      Surgical Wound Present                   
                            390                          Missing                                 
                          3,047        00                No                                      
                            396        01                Yes, observable                         
                            104        02                Yes, not observable                     
 
M1342_SR $ULSTAQO                      Status, Most Problemat Surg Wound        
                          3,542                          Missing                                 
                            209        00                Newly epithelialized                    
                             25        01                Fully granulating                       
                             38        02                Early/Partial granulation               
                            123        03                Not healing                             
 
M1400_SO $SBREAOA                      When Is Patient Dyspneic or SOB          
                            390                          Missing                                 
                          1,046        00                Never                                   
                            820        01                When walking more than 20 feet          
                          1,045        02                With moderate exertion                  
                            549        03                With minimal exertion                   
                             87        04                At rest (day or night)                  
 
M1600_UT $UTINFOA                      UTI Treatment                            
                          1,262                          Missing                                 
                          2,452        00                No                                      
                            210        01                Yes                                     
                              8        NA                Patient on prophylactic treatment       
                              5        UK                Unknown                                 
 
M1610_UR $UIUCPOA                      Urinar Incont Or Catheter Presence       
                          1,536                          Missing                                 
                            796        00                No incontinence or catheter             
                          1,414        01                Patient is incintinent                  
                            191        02                Patient requires a urinary catheter     
 
M1620_BW $BWINCOA                      Bowel Incontinence Frequency             
                            392                          Missing                                 
                          2,778        00                Very rarely or never has bowel incont   
                            199        01                Less than once weekly                   
                            199        02                One to three times weekly               
                             90        03                Four to six times weekly                
                            176        04                On a daily basis                        
                             20        05                More often than once daily              
                             83        NA                Patient has ostomy for bowel elimination
         Notes:  Please see CCW documentation about response option for more information
 
M1630_OS $BWOSTOA                      Ostomy For Bowel Elimination             
                          1,533                          Missing                                 
                          2,346        00                Does not have an ostomy                 
                             48        01                Ostomy was not related to inpatient stay
                             10        02                Ostomy was related to inpatient stay    
 
M1700_CG $COGFUOA                      Cognitive Functioning                    
                          1,262                          Missing                                 
                          1,468        00                Alert/Oriented                          
                            808        01                Req prompting                           
                            278        02                Req assist and some direction           
                             95        03                Req assist in routine situa             
                             26        04                Totally dependent due to disturbances   
         Notes:  Please see CCW documentation about response option for more information
 
M1710_CN $WCONFOA                      When Confused Frequency                  
                          1,262                          Missing                                 
                          1,364        00                Never                                   
                            887        01                In new or complex situations            
                             63        02                On awakening or at night only           
                            261        03                During the day or evening               
                             99        04                Constantly                              
                              1        NA                Patient nonresponsive                   
 
M1720_AN $WANXIOA                      When Anxious Frequency                   
                          1,262                          Missing                                 
                          1,628        00                None of the time                        
                            663        01                Less often than daily                   
                            361        02                Daily, but not constantly               
                             21        03                All of the time                         
                              2        NA                Patient nonresponsive                   
 
M1730_DS $DEPRAOA                      Depression Screening                     
                          2,545                          Missing                                 
                          1,138        00                No                                      
                            197        01                Yes, PHQ-2 scale                        
                             24        02                Yes, other, further evaluation          
                             16        03                Yes, other, no further evaluation       
                             17        NA                Patient nonresponsive                   
 
M1730_PI $DEPRAOA                      PHQ2 Little Interest/Pleasure            
                          2,545                          Missing                                 
                          1,158        00                No                                      
                            178        01                Yes, PHQ-2 scale                        
                             25        02                Yes, other, further evaluation          
                             14        03                Yes, other, no further evaluation       
                             17        NA                Patient nonresponsive                   
 
M1730_PD $DEPRAOA                      PHQ2 Down/Depressed/Hopeless             
                          2,400                          Missing                                 
                             59        00                No                                      
                          1,392        01                Yes, PHQ-2 scale                        
                             22        02                Yes, other, further evaluation          
                             64        03                Yes, other, no further evaluation       
 
M1740_DL $INDICOA                      Cog/Behav/Psych; Delusional              
                          1,261                          Missing                                 
                          2,650        0                 Not indicated                           
                             26        1                 Indicated                               
 
M1740_IM $INDICOA                      Cog/Behav/Psych;Impaired Decision_making 
                          1,261                          Missing                                 
                          2,114        0                 Not indicated                           
                            562        1                 Indicated                               
 
M1740_ME $INDICOA                      Cog/Behav/Psych;Memory Deficit           
                          1,261                          Missing                                 
                          2,184        0                 Not indicated                           
                            492        1                 Indicated                               
 
M1740_CG $INDICOA                      Cog/Behav/Psych;None of the Above        
                          1,261                          Missing                                 
                            757        0                 Not indicated                           
                          1,919        1                 Indicated                               
 
M1740_PH $INDICOA                      Cog/Behav/Psych;Physical Aggression      
                          1,261                          Missing                                 
                          2,663        0                 Not indicated                           
                             13        1                 Indicated                               
 
M1740_DS $INDICOA                      Cog/Behav/Psych;Disruptive/Inappropriate 
                          1,261                          Missing                                 
                          2,660        0                 Not indicated                           
                             16        1                 Indicated                               
 
M1740_VR $INDICOA                      Cog/Behav/Psych;Verbal Disruption        
                          1,261                          Missing                                 
                          2,650        0                 Not indicated                           
                             26        1                 Indicated                               
 
M1745_DS $FREQBOA                      Freq Of Disruptive Behav Symptoms        
                          1,262                          Missing                                 
                          2,109        00                Never                                   
                             93        01                Less than once a month                  
                             36        02                One a month                             
                             79        03                Several times each month                
                            124        04                Several times a week                    
                            234        05                At least daily                          
 
M1800_GR $GROOMOA                      Current Grooming                         
                            371                          Missing                                 
                            795        00                Able to groom self unaided              
                            960        01                Utensils must be placed within reach    
                          1,447        02                Someone must assis patient to groom self
                            364        03                Depends entirely upon another person    
 
M1810_DR $DRESSOA                      Current Dress Upper Body                 
                            371                          Missing                                 
                            760        00                No assist needed                        
                            876        01                No assist needed if clothing laid out   
                          1,527        02                Assist from another person              
                            403        03                Depends entirely upon another person    
 
M1820_DR $DRESSOA                      Current Dress Lower Body                 
                            371                          Missing                                 
                            695        00                No assist needed                        
                            558        01                No assist needed if clothing laid out   
                          1,620        02                Assist from another person              
                            693        03                Depends entirely upon another person    
 
M1830_BA $BATHCOA                      Ability To Wash Body                     
                            371                          Missing                                 
                            308        00                Bathes self independently               
                            395        01                Bathes self with use of devices         
                            556        02                Bathes with intermittent assist         
                          1,269        03                Bathes with complete assist/supervision 
                            108        04                Unable, bed/sink/chair, independent     
                            560        05                Unable, bed/sing/chair, assisted        
                            370        06                Unable, totally bathed by another person
 
M1840_TO $TOILEOA                      Current Toilet Transferring              
                            371                          Missing                                 
                            892        00                Toilet, to and from independently       
                          1,664        01                Toilet, when reminded/assist/supervised 
                            470        02                Unable toil, able to bedside commode    
                             72        03                Unable toil/bedside commode, able bedpan
                            468        04                Depends entirely upon another person    
 
M1845_TO $TOILEOA                      Current Toileting Hygiene                
                          1,262                          Missing                                 
                            694        00                Toilet, to and from independently       
                            602        01                Toilet, when reminded/assist/supervised 
                          1,048        02                Unable toil, able to bedside commode    
                            331        03                Unable toil/bedside commode, able bedpan
 
M1850_TR $TRANSOA                      Current Transferring                     
                            371                          Missing                                 
                            575        00                Able to independently transfer          
                          1,024        01                Transfers with minimal assist or device 
                          1,495        02                Unable transfer self, able to pivot     
                            385        03                Unable transfer self, unable to pivot   
                             26        04                Bedfast, unable trans, able to positio  
                             61        05                Bedfast, unable trans, unable to positio
 
M1860_AM $AMBUCOA                      Current Ambulation/Locomotion            
                            371                          Missing                                 
                            300        00                Able to independently walk/stairs       
                            296        01                Able to walk w/1 handed device          
                            799        02                Able to walk w/2 handed device          
                          1,641        03                Able to walk w/constant assist/supervis 
                            179        04                Chairfast,able to wheel self independ   
                            289        05                Chairfast,unable to wheel self independ 
                             62        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                
                          1,262                          Missing                                 
                          1,136        00                Able independently feed self            
                          1,324        01                Able feed self with intermittent assist 
                            187        02                Unable feed self, complete assist/superv
                             13        03                Able take nutri oral, rec tube feedi    
                             14        04                Unable take nutri oral, rec tube feedi  
                              1        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        
                          2,543                          Missing                                 
                              5        00                No multi-factor fall risk assessment    
                             48        01                Yes, does not indicated a risk for fall 
                          1,341        02                Yes, indicates a risk for falls fall    
 
M2010_DR $YESNAOA                      Patient/Caregiv High Risk Drug Educ      
                          2,403                          Missing                                 
                             33        00                No                                      
                          1,282        01                Yes                                     
                            219        NA                Not applicable                          
 
M2020_OR $MGMRXOA                      Curr Manag Of Oral Medications           
                          1,265                          Missing                                 
                            540        00                Able to independently take correct med  
                            478        01                Able to take med corect time w/prepared 
                            351        02                Able to take med corect time w/ assist  
                          1,294        03                Unable to take med unless administered  
                              9        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     
                          1,547                          Missing                                 
                             38        00                Able to independently take correct med  
                             46        01                Able to take med corect time w/prepared 
                             57        02                Able to take med corect time w/ assist  
                            376        03                Unable to take med unless administered  
                          1,873        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             
                          1,525                          Missing                                 
                          2,307        0                 Not indicated                           
                            105        1                 Indicated                               
 
M2200_VI                               Therapy Need; Number Of Visits           
                          1,651                          Missing                                 
                          2,286        Range of values   Range of values                         
 
M2310_DB $INDICOA                      EmergCare;Hypo/Hyperglycemia/Diabetes    
                          3,592                          Missing                                 
                            336        0                 Not indicated                           
                              9        1                 Indicated                               
 
M2310_MD $INDICOA                      EmergCare;Improper Medication Admin      
                          3,592                          Missing                                 
                            342        0                 Not indicated                           
                              3        1                 Indicated                               
 
M2310_OT $INDICOA                      EmergCare;Other                          
                          3,592                          Missing                                 
                             41        0                 Not indicated                           
                            304        1                 Indicated                               
 
M2310_UN $INDICOA                      EmergCare;Unknown                        
                          3,592                          Missing                                 
                            313        0                 Not indicated                           
                             32        1                 Indicated                               
 
M2410_AD $INFACOA                      Admit Inpatient Facility Type            
                          2,436                          Missing                                 
                            343        01                Hospital                                
                             11        02                Rehabilitation facility                 
                              7        03                Nursing home                            
                              2        04                Hospice                                 
                          1,138        NA                No inpatient facility admission         
 
M2420_DS $DISPOCA                      Discharge Location                       
                          2,799                          Missing                                 
                            820        01                Patient remained in commun, no assistive
                            277        02                Patient remained in commun, assistive   
                             33        03                Patient transferred to a noninsti hospic
                              4        04                Unknown, location not served by agency  
                              4        UK                Unknown, other                          
         Notes:  Please see CCW documentation about response option for more information
 
