Variable Format    Q#/Freq            Description/Label
 
BASEID   $BSIDFMT                      Unique SP Identification Number          
                          3,495        LOW-HIGH          BASEID Count                            
 
SURVEYYR SVYRFMT                       Survey Year                              
                          3,495                    2021  2021                                    
 
VERSION  VERSFMT                       Version Number                           
                          3,495                       1  Version 1                               
 
HHASMTID                               HHA Assessment Internal ID               
                          3,495        Range of values   Range of values                         
                 First available in 2018
 
M0010_CM                               CMS Certification Number (CCN)           
                          3,495        Range of values   Range of values                         
 
M0014_BR                               Branch State Code                        
                          2,857                          Missing                                 
                            638        Range of values   Range of values                         
 
M0016_BR                               Branch ID                                
                          3,495        Range of values   Range of values                         
 
M0018_NN                               NPI Physician ID                         
                            151                          Missing                                 
                          3,344        Range of values   Range of values                         
 
M0018_NU $INDICOA                      NPI Physician ID Unknown                 
                          3,344        0                 Not indicated                           
                            151        1                 Indicated                               
 
M0030_ST MMDDYYn8                      Start of Care Date                       
                          3,495        MMDDYYYY          Date as MMDDYYYY                        
 
M0032_RO MMDDYYn8                      Resumption of Care Date                  
                          3,269                       .  Inapplicable                            
                            226        MMDDYYYY          Date as MMDDYYYY                        
 
M0032_RN $YESNOOA                      Resumption of Care Date NA               
                            226        0                 No                                      
                          3,269        1                 Yes                                     
 
M0069_GN $SEXFMT                       Patient Sex                           
                          1,540        1                 Male                                    
                          1,955        2                 Female                                  
 
M0080_AS $DISCIOA                      Disc of Person Completing Assess         
                          2,595        01                RN                                      
                            791        02                PT                                      
                             21        03                SLP/ST                                  
                             88        04                OT                                      
 
M0090_AS MMDDYYn8                      Date Assessment Completed                
                          3,495        MMDDYYYY          Date as MMDDYYYY                        
 
M0100_RS $ACOMPOA                      Reason for Assessment                    
                          1,227        01                S/R; Start; further visits planned      
                            158        03                S/R; Resumption of care                 
                            720        04                Follow-up; Recertification              
                              9        05                Follow-up; Other                        
                            274        06                Transfer to inpat fac; Patient not disch
                             45        07                Transfer to inpat fac; Patient disch    
                              7        08                Disch from agency; Death at home        
                          1,055        09                Disch from agency; Disch from agency    
 
M0102_PD MMDDYYn8                      Phys Ordered SOC or ROC Date             
                          3,011                       .  Inapplicable                            
                            484        MMDDYYYY          Date as MMDDYYYY                        
 
M0102_PN $INDICOA                      Phys Ordered SOC or ROC Date NA          
                          2,128                          Missing                                 
                            466        0                 Not indicated                           
                            901        1                 Indicated                               
 
M0104_RF MMDDYYn8                      Date Of Referral                         
                          2,594                       .  Inapplicable                            
                            901        MMDDYYYY          Date as MMDDYYYY                        
 
M0110_EP $EPSDFMT                      Episode Timing                           
                          1,381                          Missing                                 
                          1,243        01                Early                                   
                            722        02                Later                                   
                             62        NA                No case mix group defined               
                             87        UK                Unknown                                 
 
M0140_AM $INDICOA                      Race/Eth:Amer Indian/Alaskan Nat         
                          2,110                          Missing                                 
                          1,381        0                 Not indicated                           
                              4        1                 Indicated                               
 
M0140_AS $INDICOA                      Race/Ethnicity: Asian                    
                          2,110                          Missing                                 
                          1,370        0                 Not indicated                           
                             15        1                 Indicated                               
 
M0140_AF $INDICOA                      Race/Eth:Black or African-American       
                          2,110                          Missing                                 
                          1,246        0                 Not indicated                           
                            139        1                 Indicated                               
 
M0140_HS $INDICOA                      Race/Ethnicity: Hispanic or Latino       
                          2,110                          Missing                                 
                          1,251        0                 Not indicated                           
                            134        1                 Indicated                               
 
M0140_NT $INDICOA                      Race/Eth:Nat Hawaii/Oth Pacific Isl      
                          2,110                          Missing                                 
                          1,385        0                 Not indicated                           
 
M0140_WH $INDICOA                      Race/Eth:White                           
                          2,110                          Missing                                 
                            285        0                 Not indicated                           
                          1,100        1                 Indicated                               
 
M0150_DF $INDICOA                      Medicaid Fee For Service Payment         
                          3,368        0                 Not indicated                           
                            127        1                 Indicated                               
 
M0150_DH $INDICOA                      Medicaid HMO/Managed Care Payment        
                          3,415        0                 Not indicated                           
                             80        1                 Indicated                               
 
M0150_RF $INDICOA                      Medicare Fee For Service Payment         
                          1,444        0                 Not indicated                           
                          2,051        1                 Indicated                               
 
M0150_RH $INDICOA                      Medicare HMO/Managed Care Payment        
                          2,115        0                 Not indicated                           
                          1,380        1                 Indicated                               
 
M0150_NO $INDICOA                      No Payment                               
                          3,495        0                 Not indicated                           
 
M0150_OG $INDICOA                      Other Government Payment                 
                          3,481        0                 Not indicated                           
                             14        1                 Indicated                               
 
M0150_OP $INDICOA                      Other Payment Source                     
                          3,479        0                 Not indicated                           
                             16        1                 Indicated                               
 
M0150_PH $INDICOA                      Private HMO/Managed Care Payment         
                          3,477        0                 Not indicated                           
                             18        1                 Indicated                               
 
M0150_PI $INDICOA                      Private Insurance Payment                
                          3,444        0                 Not indicated                           
                             51        1                 Indicated                               
 
M0150_SE $INDICOA                      Self-Pay Payment                         
                          3,472        0                 Not indicated                           
                             23        1                 Indicated                               
 
M0150_TI $INDICOA                      Title Programs Payment                   
                          3,495        0                 Not indicated                           
 
M0150_UN $INDICOA                      Unknown Payment Source                   
                          2,110                          Missing                                 
                          1,385        0                 Not indicated                           
 
M0150_WC $INDICOA                      Workers Compensation Payment             
                          3,495        0                 Not indicated                           
 
M0906_DS MMDDYYn8                      Discharge/Transfer/Death Date            
                          2,114                       .  Inapplicable                            
                          1,381        MMDDYYYY          Date as MMDDYYYY                        
 
M1000_IP $INDICOA                      Inp Discharg;Short Stay Acut Hosp        
                          2,110                          Missing                                 
                            740        0                 Not indicated                           
                            645        1                 Indicated                               
 
M1000_IR $INDICOA                      Inp Discharg;IRF                         
                          2,110                          Missing                                 
                          1,323        0                 Not indicated                           
                             62        1                 Indicated                               
 
M1000_NF $INDICOA                      Inp Discharg;Nursing Facility            
                          2,110                          Missing                                 
                          1,381        0                 Not indicated                           
                              4        1                 Indicated                               
 
M1000_LT $INDICOA                      Discharged Past 14 Days;LTCH             
                          2,110                          Missing                                 
                          1,380        0                 Not indicated                           
                              5        1                 Indicated                               
 
M1000_NO $INDICOA                      No Inp Discharge                         
                          2,110                          Missing                                 
                            886        0                 Not indicated                           
                            499        1                 Indicated                               
 
M1000_OT $INDICOA                      Inp Discharg;Other                       
                          2,110                          Missing                                 
                          1,380        0                 Not indicated                           
                              5        1                 Indicated                               
 
M1000_PS $INDICOA                      Inp Discharg;Psych Hospital Or Unit      
                          2,110                          Missing                                 
                          1,383        0                 Not indicated                           
                              2        1                 Indicated                               
 
M1000_SN $INDICOA                      Inp Discharg;SNF/TCU Facility            
                          2,110                          Missing                                 
                          1,192        0                 Not indicated                           
                            193        1                 Indicated                               
 
M1005_IU $INDICOA                      Inpat Discharge Date Unknown             
                          2,609                          Missing                                 
                            866        0                 Not indicated                           
                             20        1                 Indicated                               
 
M1005_ID MMDDYYn8                      Most Recent Inpat Discharge Date         
                          2,629                       .  Inapplicable                            
                            866        MMDDYYYY          Date as MMDDYYYY                        
 
M1030_HE $INDICOA                      Home Thera; Enteral Nutrition            
                          1,404                          Missing                                 
                          2,042        0                 Not indicated                           
                             49        1                 Indicated                               
 
M1030_HI $INDICOA                      Home Thera; Intravenous/Infusion Thera   
                          1,405                          Missing                                 
                          2,022        0                 Not indicated                           
                             68        1                 Indicated                               
 
M1030_HN $INDICOA                      Home Thera; None of the Above            
                          1,402                          Missing                                 
                            118        0                 Not indicated                           
                          1,975        1                 Indicated                               
 
M1030_HP $INDICOA                      Home Thera; Parenteral Nutrition         
                          1,405                          Missing                                 
                          2,088        0                 Not indicated                           
                              2        1                 Indicated                               
 
M1100_PT $PTLVG                        Patient Living Arrangement               
                          2,110                          Missing                                 
                            110        01                Lives alone, 24 hour assistance         
                             56        02                Lives alone, daytime assistance         
                              4        03                Lives alone, nighttime assistance       
                            190        04                Lives alone, occasional/short-term asst 
                             12        05                Lives alone, no assistance              
                            702        06                Lives at home w/others, 24 hr assistance
                             21        07                Lives at home w/others, daytime assist  
                             37        08                Lives at home w/others, nighttime assist
                             60        09                Lives at home w/others, occas/short-term
                              1        10                Lives at home w/others, no assistance av
                            178        11                Lives in congregate situation, 24 hour a
                              4        12                Lives in congregate situation, daytime a
                              8        14                Lives in congregate situation, occasiona
                              2        15                Lives in congregate situation, no assist
         Notes:  Please see CCW documentation about response option for more information
 
M1200_VS $VISIOOA                      Vision                                   
                          1,437                          Missing                                 
                          1,315        00                Normal vision                           
                            703        01                Partially impaired                      
                             40        02                Severely impaired                       
 
M1242_PA $FREQCOA                      Freq Of Pain Interfere W Activity        
                            346                          Missing                                 
                            765        00                No pain                                 
                            456        01                Pain does not interfere                 
                            444        02                Less often than daily                   
                          1,104        03                Daily, but not constantly               
                            380        04                All of the time                         
 
M1306_PR $YESNOOA                      Unheal Press Ulcers; St II+              
                            326                          Missing                                 
                          3,012        0                 No                                      
                            157        1                 Yes                                     
 
M1307_PD $OLDPUL                       Oldest St II Press Ulcer Onset Date      
                          3,474                          Missing                                 
                             16        01                Was present at the most recent SOC/ROC  
                              1        02                Developed since the most recent SOC/ROC 
                              4        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   
                          3,494                       .  Inapplicable                            
                              1        MMDDYYYY          Date as MMDDYYYY                        
 
M1322_ST $ULNUMOA                      Curr # Of Stage I Press Ulcers           
                          1,435                          Missing                                 
                          2,019        00                None                                    
                             30        01                One                                     
                              8        02                Two                                     
                              1        03                Three                                   
                              2        04                Four or more                            
 
M1324_PR $ULSTGOA                      Stage, Most Problemat Press Ulcer        
                            380                          Not assessed/no information             
                             34        01                Stage one                               
                             85        02                Stage two                               
                             19        03                Stage three                             
                             28        04                Stage four                              
                          2,949        NA                No observable pressure ulcer            
 
M1330_ST $STASUOA                      Stasis Ulcer Present                     
                            378                          Missing                                 
                          3,035        00                No                                      
                              5        01                Yes, BOTH observable and unobservable   
                             72        02                Yes, Observable only                    
                              5        03                Yes, Unobservable only                  
 
M1332_ST $ULNUMOA                      Curr # Of Stasis Ulcer                   
                          3,424                          Missing                                 
                             41        01                One                                     
                             17        02                Two                                     
                             11        03                Three                                   
                              2        04                Four or more                            
 
M1334_ST $ULSTAQO                      Status, Most Problemat Stasis Ulcer      
                          3,419                          Missing                                 
                              9        01                Fully granulating                       
                             24        02                Early/Partial granulation               
                             43        03                Not healing                             
 
M1340_SR $SURGWOA                      Surgical Wound Present                   
                            378                          Missing                                 
                          2,601        00                No                                      
                            406        01                Yes, observable                         
                            110        02                Yes, not observable                     
 
M1342_SR $ULSTAQO                      Status, Most Problemat Surg Wound        
                          3,088                          Missing                                 
                            213        00                Newly epithelialized                    
                             19        01                Fully granulating                       
                             41        02                Early/Partial granulation               
                            134        03                Not healing                             
 
M1400_SO $SBREAOA                      When Is Patient Dyspneic or SOB          
                            344                          Missing                                 
                            951        00                Never                                   
                            713        01                When walking more than 20 feet          
                            937        02                With moderate exertion                  
                            457        03                With minimal exertion                   
                             93        04                At rest (day or night)                  
 
M1600_UT $UTINFOA                      UTI Treatment                            
                          1,055                          Missing                                 
                          2,264        00                No                                      
                            152        01                Yes                                     
                             18        NA                Patient on prophylactic treatment       
                              6        UK                Unknown                                 
 
M1610_UR $UIUCPOA                      Urinar Incont Or Catheter Presence       
                          1,417                          Missing                                 
                            743        00                No incontinence or catheter             
                          1,197        01                Patient is incintinent                  
                            138        02                Patient requires a urinary catheter     
 
M1620_BW $BWINCOA                      Bowel Incontinence Frequency             
                            346                          Missing                                 
                          2,496        00                Very rarely or never has bowel incont   
                            157        01                Less than once weekly                   
                            176        02                One to three times weekly               
                             86        03                Four to six times weekly                
                            149        04                On a daily basis                        
                             19        05                More often than once daily              
                             66        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             
                          1,402                          Missing                                 
                          2,047        00                Does not have an ostomy                 
                             34        01                Ostomy was not related to inpatient stay
                             12        02                Ostomy was related to inpatient stay    
 
M1700_CG $COGFUOA                      Cognitive Functioning                    
                          1,055                          Missing                                 
                          1,438        00                Alert/Oriented                          
                            665        01                Req prompting                           
                            220        02                Req assist and some direction           
                             81        03                Req assist in routine situa             
                             36        04                Totally dependent due to disturbances   
         Notes:  Please see CCW documentation about response option for more information
 
M1710_CN $WCONFOA                      When Confused Frequency                  
                          1,055                          Missing                                 
                          1,321        00                Never                                   
                            781        01                In new or complex situations            
                             57        02                On awakening or at night only           
                            186        03                During the day or evening               
                             90        04                Constantly                              
                              5        NA                Patient nonresponsive                   
 
M1720_AN $WANXIOA                      When Anxious Frequency                   
                          1,055                          Missing                                 
                          1,544        00                None of the time                        
                            577        01                Less often than daily                   
                            284        02                Daily, but not constantly               
                             29        03                All of the time                         
                              6        NA                Patient nonresponsive                   
 
M1730_DS $DEPRAOA                      Depression Screening                     
                          2,235                          Missing                                 
                          1,039        00                No                                      
                            164        01                Yes, PHQ-2 scale                        
                             28        02                Yes, other, further evaluation          
                              8        03                Yes, other, no further evaluation       
                             21        NA                Patient nonresponsive                   
 
M1730_PI $DEPRAOA                      PHQ2 Little Interest/Pleasure            
                          2,235                          Missing                                 
                          1,050        00                No                                      
                            156        01                Yes, PHQ-2 scale                        
                             27        02                Yes, other, further evaluation          
                              8        03                Yes, other, no further evaluation       
                             19        NA                Patient nonresponsive                   
 
M1730_PD $DEPRAOA                      PHQ2 Down/Depressed/Hopeless             
                          2,110                          Missing                                 
                             51        00                No                                      
                          1,260        01                Yes, PHQ-2 scale                        
                             10        02                Yes, other, further evaluation          
                             64        03                Yes, other, no further evaluation       
 
M1740_DL $INDICOA                      Cog/Behav/Psych; Delusional              
                          1,055                          Missing                                 
                          2,416        0                 Not indicated                           
                             24        1                 Indicated                               
 
M1740_IM $INDICOA                      Cog/Behav/Psych;Impaired Decision_making 
                          1,055                          Missing                                 
                          1,969        0                 Not indicated                           
                            471        1                 Indicated                               
 
M1740_ME $INDICOA                      Cog/Behav/Psych;Memory Deficit           
                          1,055                          Missing                                 
                          2,031        0                 Not indicated                           
                            409        1                 Indicated                               
 
M1740_CG $INDICOA                      Cog/Behav/Psych;None of the Above        
                          1,055                          Missing                                 
                            640        0                 Not indicated                           
                          1,800        1                 Indicated                               
 
M1740_PH $INDICOA                      Cog/Behav/Psych;Physical Aggression      
                          1,055                          Missing                                 
                          2,431        0                 Not indicated                           
                              9        1                 Indicated                               
 
M1740_DS $INDICOA                      Cog/Behav/Psych;Disruptive/Inappropriate 
                          1,055                          Missing                                 
                          2,433        0                 Not indicated                           
                              7        1                 Indicated                               
 
M1740_VR $INDICOA                      Cog/Behav/Psych;Verbal Disruption        
                          1,055                          Missing                                 
                          2,413        0                 Not indicated                           
                             27        1                 Indicated                               
 
M1745_DS $FREQBOA                      Freq Of Disruptive Behav Symptoms        
                          1,055                          Missing                                 
                          1,942        00                Never                                   
                             79        01                Less than once a month                  
                             28        02                One a month                             
                             87        03                Several times each month                
                             94        04                Several times a week                    
                            210        05                At least daily                          
 
M1800_GR $GROOMOA                      Current Grooming                         
                            326                          Missing                                 
                            708        00                Able to groom self unaided              
                            885        01                Utensils must be placed within reach    
                          1,268        02                Someone must assis patient to groom self
                            308        03                Depends entirely upon another person    
 
M1810_DR $DRESSOA                      Current Dress Upper Body                 
                            326                          Missing                                 
                            691        00                No assist needed                        
                            782        01                No assist needed if clothing laid out   
                          1,361        02                Assist from another person              
                            335        03                Depends entirely upon another person    
 
M1820_DR $DRESSOA                      Current Dress Lower Body                 
                            326                          Missing                                 
                            626        00                No assist needed                        
                            509        01                No assist needed if clothing laid out   
                          1,438        02                Assist from another person              
                            596        03                Depends entirely upon another person    
 
M1830_BA $BATHCOA                      Ability To Wash Body                     
                            326                          Missing                                 
                            317        00                Bathes self independently               
                            343        01                Bathes self with use of devices         
                            485        02                Bathes with intermittent assist         
                          1,113        03                Bathes with complete assist/supervision 
                             94        04                Unable, bed/sink/chair, independent     
                            493        05                Unable, bed/sing/chair, assisted        
                            324        06                Unable, totally bathed by another person
 
M1840_TO $TOILEOA                      Current Toilet Transferring              
                            326                          Missing                                 
                            815        00                Toilet, to and from independently       
                          1,515        01                Toilet, when reminded/assist/supervised 
                            385        02                Unable toil, able to bedside commode    
                             62        03                Unable toil/bedside commode, able bedpan
                            392        04                Depends entirely upon another person    
 
M1845_TO $TOILEOA                      Current Toileting Hygiene                
                          1,055                          Missing                                 
                            654        00                Toilet, to and from independently       
                            559        01                Toilet, when reminded/assist/supervised 
                            940        02                Unable toil, able to bedside commode    
                            287        03                Unable toil/bedside commode, able bedpan
 
M1850_TR $TRANSOA                      Current Transferring                     
                            326                          Missing                                 
                            525        00                Able to independently transfer          
                            920        01                Transfers with minimal assist or device 
                          1,288        02                Unable transfer self, able to pivot     
                            348        03                Unable transfer self, unable to pivot   
                             23        04                Bedfast, unable trans, able to positio  
                             65        05                Bedfast, unable trans, unable to positio
 
M1860_AM $AMBUCOA                      Current Ambulation/Locomotion            
                            326                          Missing                                 
                            286        00                Able to independently walk/stairs       
                            298        01                Able to walk w/1 handed device          
                            640        02                Able to walk w/2 handed device          
                          1,442        03                Able to walk w/constant assist/supervis 
                            170        04                Chairfast,able to wheel self independ   
                            262        05                Chairfast,unable to wheel self independ 
                             71        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                
                          1,055                          Missing                                 
                          1,075        00                Able independently feed self            
                          1,140        01                Able feed self with intermittent assist 
                            188        02                Unable feed self, complete assist/superv
                              7        03                Able take nutri oral, rec tube feedi    
                             29        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        
                          2,209                          Missing                                 
                              5        00                No multi-factor fall risk assessment    
                             41        01                Yes, does not indicated a risk for fall 
                          1,240        02                Yes, indicates a risk for falls fall    
 
M2010_DR $YESNAOA                      Patient/Caregiv High Risk Drug Educ      
                          2,113                          Missing                                 
                             39        00                No                                      
                          1,169        01                Yes                                     
                            174        NA                Not applicable                          
 
M2020_OR $MGMRXOA                      Curr Manag Of Oral Medications           
                          1,058                          Missing                                 
                            560        00                Able to independently take correct med  
                            384        01                Able to take med corect time w/prepared 
                            292        02                Able to take med corect time w/ assist  
                          1,182        03                Unable to take med unless administered  
                             19        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     
                          1,421                          Missing                                 
                             39        00                Able to independently take correct med  
                             55        01                Able to take med corect time w/prepared 
                             53        02                Able to take med corect time w/ assist  
                            315        03                Unable to take med unless administered  
                          1,612        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             
                          1,403                          Missing                                 
                          2,011        0                 Not indicated                           
                             81        1                 Indicated                               
 
M2200_VI                               Therapy Need; Number Of Visits           
                          1,503                          Missing                                 
                          1,992        Range of values   Range of values                         
 
M2310_DB $INDICOA                      EmergCare;Hypo/Hyperglycemia/Diabetes    
                          3,198                          Missing                                 
                            294        0                 Not indicated                           
                              3        1                 Indicated                               
 
M2310_MD $INDICOA                      EmergCare;Improper Medication Admin      
                          3,198                          Missing                                 
                            295        0                 Not indicated                           
                              2        1                 Indicated                               
 
M2310_OT $INDICOA                      EmergCare;Other                          
                          3,198                          Missing                                 
                             26        0                 Not indicated                           
                            271        1                 Indicated                               
 
M2310_UN $INDICOA                      EmergCare;Unknown                        
                          3,198                          Missing                                 
                            274        0                 Not indicated                           
                             23        1                 Indicated                               
 
M2410_AD $INFACOA                      Admit Inpatient Facility Type            
                          2,121                          Missing                                 
                            299        01                Hospital                                
                              9        02                Rehabilitation facility                 
                             10        03                Nursing home                            
                              1        04                Hospice                                 
                          1,055        NA                No inpatient facility admission         
 
M2420_DS $DISPOCA                      Discharge Location                       
                          2,440                          Missing                                 
                            815        01                Patient remained in commun, no assistive
                            208        02                Patient remained in commun, assistive   
                             23        03                Patient transferred to a noninsti hospic
                              5        04                Unknown, location not served by agency  
                              4        UK                Unknown, other                          
         Notes:  Please see CCW documentation about response option for more information
 
