Variable Format    Q#/Freq            Description/Label
 
BASEID   $BSIDFMT                      Unique SP Identification Number          
                          3,206        LOW-HIGH          BASEID Count                            
 
SURVEYYR SVYRFMT                       Survey Year                              
                          3,206                    2022  2022                                    
 
VERSION  VERSFMT                       Version Number                           
                          3,206                       1  Version 1                               
 
HHASMTID                               HHA Assessment Internal ID               
                          3,206        Range of values   Range of values                         
 
M0010_CM                               CMS Certification Number (CCN)           
                          3,206        Range of values   Range of values                         
 
M0014_BR                               Branch State Code                        
                          2,515                          Missing                                 
                            691        Range of values   Range of values                         
 
M0016_BR                               Branch ID                                
                          3,206        Range of values   Range of values                         
 
M0018_NN                               NPI Physician ID                         
                            127                          Missing                                 
                          3,079        Range of values   Range of values                         
 
M0018_NU $INDICOA                      NPI Physician ID Unknown                 
                          3,079        0                 Not indicated                           
                            127        1                 Indicated                               
 
M0030_ST MMDDYYn8                      Start of Care Date                       
                          3,206        MMDDYYYY          Date as MMDDYYYY                        
 
M0032_RO MMDDYYn8                      Resumption of Care Date                  
                          3,013                       .  Inapplicable                            
                            193        MMDDYYYY          Date as MMDDYYYY                        
 
M0032_RN $YESNOOA                      Resumption of Care Date NA               
                            193        0                 No                                      
                          3,013        1                 Yes                                     
 
M0069_GN $SEXFMT                       Patient Sex                           
                          1,317        1                 Male                                    
                          1,889        2                 Female                                  
 
M0080_AS $DISCIOA                      Disc of Person Completing Assess         
                          2,306        01                RN                                      
                            767        02                PT                                      
                             23        03                SLP/ST                                  
                            110        04                OT                                      
 
M0090_AS MMDDYYn8                      Date Assessment Completed                
                          3,206        MMDDYYYY          Date as MMDDYYYY                        
 
M0100_RS $ACOMPOA                      Reason for Assessment                    
                          1,085        01                S/R; Start; further visits planned      
                            138        03                S/R; Resumption of care                 
                            743        04                Follow-up; Recertification              
                             10        05                Follow-up; Other                        
                            236        06                Transfer to inpat fac; Patient not disch
                             39        07                Transfer to inpat fac; Patient disch    
                              6        08                Disch from agency; Death at home        
                            949        09                Disch from agency; Disch from agency    
 
M0102_PD MMDDYYn8                      Phys Ordered SOC or ROC Date             
                          2,747                       .  Inapplicable                            
                            459        MMDDYYYY          Date as MMDDYYYY                        
 
M0102_PN $INDICOA                      Phys Ordered SOC or ROC Date NA          
                          1,998                          Missing                                 
                            444        0                 Not indicated                           
                            764        1                 Indicated                               
 
M0104_RF MMDDYYn8                      Date Of Referral                         
                          2,442                       .  Inapplicable                            
                            764        MMDDYYYY          Date as MMDDYYYY                        
 
M0110_EP $EPSDFMT                      Episode Timing                           
                          1,230                          Missing                                 
                          1,093        01                Early                                   
                            742        02                Later                                   
                             53        NA                No case mix group defined               
                             88        UK                Unknown                                 
 
M0140_AM $INDICOA                      Race/Eth:Amer Indian/Alaskan Nat         
                          1,983                          Missing                                 
                          1,219        0                 Not indicated                           
                              4        1                 Indicated                               
 
M0140_AS $INDICOA                      Race/Ethnicity: Asian                    
                          1,983                          Missing                                 
                          1,205        0                 Not indicated                           
                             18        1                 Indicated                               
 
M0140_AF $INDICOA                      Race/Eth:Black or African-American       
                          1,983                          Missing                                 
                          1,085        0                 Not indicated                           
                            138        1                 Indicated                               
 
M0140_HS $INDICOA                      Race/Ethnicity: Hispanic or Latino       
                          1,983                          Missing                                 
                          1,087        0                 Not indicated                           
                            136        1                 Indicated                               
 
M0140_NT $INDICOA                      Race/Eth:Nat Hawaii/Oth Pacific Isl      
                          1,983                          Missing                                 
                          1,222        0                 Not indicated                           
                              1        1                 Indicated                               
 
M0140_WH $INDICOA                      Race/Eth:White                           
                          1,983                          Missing                                 
                            292        0                 Not indicated                           
                            931        1                 Indicated                               
 
M0150_DF $INDICOA                      Medicaid Fee For Service Payment         
                          3,065        0                 Not indicated                           
                            141        1                 Indicated                               
 
M0150_DH $INDICOA                      Medicaid HMO/Managed Care Payment        
                          3,142        0                 Not indicated                           
                             64        1                 Indicated                               
 
M0150_RF $INDICOA                      Medicare Fee For Service Payment         
                          1,419        0                 Not indicated                           
                          1,787        1                 Indicated                               
 
M0150_RH $INDICOA                      Medicare HMO/Managed Care Payment        
                          1,882        0                 Not indicated                           
                          1,324        1                 Indicated                               
 
M0150_NO $INDICOA                      No Payment                               
                          3,206        0                 Not indicated                           
 
M0150_OG $INDICOA                      Other Government Payment                 
                          3,199        0                 Not indicated                           
                              7        1                 Indicated                               
 
M0150_OP $INDICOA                      Other Payment Source                     
                          3,184        0                 Not indicated                           
                             22        1                 Indicated                               
 
M0150_PH $INDICOA                      Private HMO/Managed Care Payment         
                          3,185        0                 Not indicated                           
                             21        1                 Indicated                               
 
M0150_PI $INDICOA                      Private Insurance Payment                
                          3,164        0                 Not indicated                           
                             42        1                 Indicated                               
 
M0150_SE $INDICOA                      Self-Pay Payment                         
                          3,164        0                 Not indicated                           
                             42        1                 Indicated                               
 
M0150_TI $INDICOA                      Title Programs Payment                   
                          3,206        0                 Not indicated                           
 
M0150_UN $INDICOA                      Unknown Payment Source                   
                          1,983                          Missing                                 
                          1,223        0                 Not indicated                           
 
M0150_WC $INDICOA                      Workers Compensation Payment             
                          3,200        0                 Not indicated                           
                              6        1                 Indicated                               
 
M0906_DS MMDDYYn8                      Discharge/Transfer/Death Date            
                          1,976                       .  Inapplicable                            
                          1,230        MMDDYYYY          Date as MMDDYYYY                        
 
M1000_IP $INDICOA                      Inp Discharg;Short Stay Acut Hosp        
                          1,983                          Missing                                 
                            677        0                 Not indicated                           
                            546        1                 Indicated                               
 
M1000_IR $INDICOA                      Inp Discharg;IRF                         
                          1,983                          Missing                                 
                          1,149        0                 Not indicated                           
                             74        1                 Indicated                               
 
M1000_NF $INDICOA                      Inp Discharg;Nursing Facility            
                          1,983                          Missing                                 
                          1,219        0                 Not indicated                           
                              4        1                 Indicated                               
 
M1000_LT $INDICOA                      Discharged Past 14 Days;LTCH             
                          1,983                          Missing                                 
                          1,218        0                 Not indicated                           
                              5        1                 Indicated                               
 
M1000_NO $INDICOA                      No Inp Discharge                         
                          1,983                          Missing                                 
                            789        0                 Not indicated                           
                            434        1                 Indicated                               
 
M1000_OT $INDICOA                      Inp Discharg;Other                       
                          1,983                          Missing                                 
                          1,220        0                 Not indicated                           
                              3        1                 Indicated                               
 
M1000_PS $INDICOA                      Inp Discharg;Psych Hospital Or Unit      
                          1,983                          Missing                                 
                          1,222        0                 Not indicated                           
                              1        1                 Indicated                               
 
M1000_SN $INDICOA                      Inp Discharg;SNF/TCU Facility            
                          1,983                          Missing                                 
                          1,049        0                 Not indicated                           
                            174        1                 Indicated                               
 
M1005_IU $INDICOA                      Inpat Discharge Date Unknown             
                          2,417                          Missing                                 
                            775        0                 Not indicated                           
                             14        1                 Indicated                               
 
M1005_ID MMDDYYn8                      Most Recent Inpat Discharge Date         
                          2,431                       .  Inapplicable                            
                            775        MMDDYYYY          Date as MMDDYYYY                        
 
M1030_HE $INDICOA                      Home Thera; Enteral Nutrition            
                          1,252                          Missing                                 
                          1,911        0                 Not indicated                           
                             43        1                 Indicated                               
 
M1030_HI $INDICOA                      Home Thera; Intravenous/Infusion Thera   
                          1,252                          Missing                                 
                          1,895        0                 Not indicated                           
                             59        1                 Indicated                               
 
M1030_HN $INDICOA                      Home Thera; None of the Above            
                          1,251                          Missing                                 
                            103        0                 Not indicated                           
                          1,852        1                 Indicated                               
 
M1030_HP $INDICOA                      Home Thera; Parenteral Nutrition         
                          1,252                          Missing                                 
                          1,952        0                 Not indicated                           
                              2        1                 Indicated                               
 
M1100_PT $PTLVG                        Patient Living Arrangement               
                          1,983                          Missing                                 
                             84        01                Lives alone, 24 hour assistance         
                             47        02                Lives alone, daytime assistance         
                              6        03                Lives alone, nighttime assistance       
                            175        04                Lives alone, occasional/short-term asst 
                             13        05                Lives alone, no assistance              
                            640        06                Lives at home w/others, 24 hr assistance
                             19        07                Lives at home w/others, daytime assist  
                             29        08                Lives at home w/others, nighttime assist
                             51        09                Lives at home w/others, occas/short-term
                              2        10                Lives at home w/others, no assistance av
                            150        11                Lives in congregate situation, 24 hour a
                              1        12                Lives in congregate situation, daytime a
                              6        14                Lives in congregate situation, occasiona
         Notes:  Please see CCW documentation about response option for more information
 
M1200_VS $VISIOOA                      Vision                                   
                          1,329                          Missing                                 
                          1,175        00                Normal vision                           
                            670        01                Partially impaired                      
                             32        02                Severely impaired                       
 
M1242_PA $FREQCOA                      Freq Of Pain Interfere W Activity        
                            295                          Missing                                 
                            678        00                No pain                                 
                            426        01                Pain does not interfere                 
                            381        02                Less often than daily                   
                          1,069        03                Daily, but not constantly               
                            357        04                All of the time                         
 
M1306_PR $YESNOOA                      Unheal Press Ulcers; St II+              
                            281                          Missing                                 
                          2,796        0                 No                                      
                            129        1                 Yes                                     
 
M1307_PD $OLDPUL                       Oldest St II Press Ulcer Onset Date      
                          3,200                          Missing                                 
                              6        01                Was present at the most recent SOC/ROC  
         Notes:  Please see CCW documentation about response option for more information
 
M1322_ST $ULNUMOA                      Curr # Of Stage I Press Ulcers           
                          1,329                          Missing                                 
                          1,853        00                None                                    
                             22        01                One                                     
                              1        02                Two                                     
                              1        04                Four or more                            
 
M1324_PR $ULSTGOA                      Stage, Most Problemat Press Ulcer        
                            382                          Not assessed/no information             
                             19        01                Stage one                               
                             82        02                Stage two                               
                             29        03                Stage three                             
                              8        04                Stage four                              
                          2,686        NA                No observable pressure ulcer            
 
M1330_ST $STASUOA                      Stasis Ulcer Present                     
                            378                          Missing                                 
                          2,773        00                No                                      
                              3        01                Yes, BOTH observable and unobservable   
                             47        02                Yes, Observable only                    
                              5        03                Yes, Unobservable only                  
 
M1332_ST $ULNUMOA                      Curr # Of Stasis Ulcer                   
                          3,162                          Missing                                 
                             30        01                One                                     
                              9        02                Two                                     
                              2        03                Three                                   
                              3        04                Four or more                            
 
M1334_ST $ULSTAQO                      Status, Most Problemat Stasis Ulcer      
                          3,156                          Missing                                 
                              3        01                Fully granulating                       
                              7        02                Early/Partial granulation               
                             40        03                Not healing                             
 
M1340_SR $SURGWOA                      Surgical Wound Present                   
                            378                          Missing                                 
                          2,348        00                No                                      
                            379        01                Yes, observable                         
                            101        02                Yes, not observable                     
 
M1342_SR $ULSTAQO                      Status, Most Problemat Surg Wound        
                          2,827                          Missing                                 
                            200        00                Newly epithelialized                    
                             25        01                Fully granulating                       
                             34        02                Early/Partial granulation               
                            120        03                Not healing                             
 
M1400_SO $SBREAOA                      When Is Patient Dyspneic or SOB          
                            294                          Missing                                 
                            902        00                Never                                   
                            637        01                When walking more than 20 feet          
                            893        02                With moderate exertion                  
                            409        03                With minimal exertion                   
                             71        04                At rest (day or night)                  
 
M1600_UT $UTINFOA                      UTI Treatment                            
                          1,034                          Missing                                 
                          2,022        00                No                                      
                            138        01                Yes                                     
                             11        NA                Patient on prophylactic treatment       
                              1        UK                Unknown                                 
 
M1610_UR $UIUCPOA                      Urinar Incont Or Catheter Presence       
                          1,247                          Missing                                 
                            669        00                No incontinence or catheter             
                          1,062        01                Patient is incintinent                  
                            228        02                Patient requires a urinary catheter     
 
M1620_BW $BWINCOA                      Bowel Incontinence Frequency             
                            297                          Missing                                 
                          2,323        00                Very rarely or never has bowel incont   
                            166        01                Less than once weekly                   
                            180        02                One to three times weekly               
                             56        03                Four to six times weekly                
                            110        04                On a daily basis                        
                             19        05                More often than once daily              
                             54        NA                Patient has ostomy for bowel elimination
                              1        UK                Unknown                                 
         Notes:  Please see CCW documentation about response option for more information
 
M1630_OS $BWOSTOA                      Ostomy For Bowel Elimination             
                          1,245                          Missing                                 
                          1,918        00                Does not have an ostomy                 
                             33        01                Ostomy was not related to inpatient stay
                             10        02                Ostomy was related to inpatient stay    
 
M1700_CG $COGFUOA                      Cognitive Functioning                    
                          1,034                          Missing                                 
                          1,294        00                Alert/Oriented                          
                            601        01                Req prompting                           
                            181        02                Req assist and some direction           
                             65        03                Req assist in routine situa             
                             31        04                Totally dependent due to disturbances   
         Notes:  Please see CCW documentation about response option for more information
 
M1710_CN $WCONFOA                      When Confused Frequency                  
                          1,034                          Missing                                 
                          1,166        00                Never                                   
                            729        01                In new or complex situations            
                             49        02                On awakening or at night only           
                            157        03                During the day or evening               
                             66        04                Constantly                              
                              5        NA                Patient nonresponsive                   
 
M1720_AN $WANXIOA                      When Anxious Frequency                   
                          1,034                          Missing                                 
                          1,376        00                None of the time                        
                            511        01                Less often than daily                   
                            256        02                Daily, but not constantly               
                             21        03                All of the time                         
                              8        NA                Patient nonresponsive                   
 
M1730_DS $DEPRAOA                      Depression Screening                     
                          2,078                          Missing                                 
                            911        00                No                                      
                            169        01                Yes, PHQ-2 scale                        
                             26        02                Yes, other, further evaluation          
                              5        03                Yes, other, no further evaluation       
                             17        NA                Patient nonresponsive                   
 
M1730_PI $DEPRAOA                      PHQ2 Little Interest/Pleasure            
                          2,078                          Missing                                 
                            926        00                No                                      
                            155        01                Yes, PHQ-2 scale                        
                             23        02                Yes, other, further evaluation          
                              8        03                Yes, other, no further evaluation       
                             16        NA                Patient nonresponsive                   
 
M1730_PD $DEPRAOA                      PHQ2 Down/Depressed/Hopeless             
                          1,983                          Missing                                 
                             31        00                No                                      
                          1,128        01                Yes, PHQ-2 scale                        
                              7        02                Yes, other, further evaluation          
                             57        03                Yes, other, no further evaluation       
 
M1740_DL $INDICOA                      Cog/Behav/Psych; Delusional              
                          1,034                          Missing                                 
                          2,153        0                 Not indicated                           
                             19        1                 Indicated                               
 
M1740_IM $INDICOA                      Cog/Behav/Psych;Impaired Decision_making 
                          1,034                          Missing                                 
                          1,791        0                 Not indicated                           
                            381        1                 Indicated                               
 
M1740_ME $INDICOA                      Cog/Behav/Psych;Memory Deficit           
                          1,034                          Missing                                 
                          1,834        0                 Not indicated                           
                            338        1                 Indicated                               
 
M1740_CG $INDICOA                      Cog/Behav/Psych;None of the Above        
                          1,034                          Missing                                 
                            533        0                 Not indicated                           
                          1,639        1                 Indicated                               
 
M1740_PH $INDICOA                      Cog/Behav/Psych;Physical Aggression      
                          1,034                          Missing                                 
                          2,159        0                 Not indicated                           
                             13        1                 Indicated                               
 
M1740_DS $INDICOA                      Cog/Behav/Psych;Disruptive/Inappropriate 
                          1,034                          Missing                                 
                          2,163        0                 Not indicated                           
                              9        1                 Indicated                               
 
M1740_VR $INDICOA                      Cog/Behav/Psych;Verbal Disruption        
                          1,034                          Missing                                 
                          2,154        0                 Not indicated                           
                             18        1                 Indicated                               
 
M1745_DS $FREQBOA                      Freq Of Disruptive Behav Symptoms        
                          1,034                          Missing                                 
                          1,757        00                Never                                   
                             66        01                Less than once a month                  
                             19        02                One a month                             
                             64        03                Several times each month                
                             83        04                Several times a week                    
                            183        05                At least daily                          
 
M1800_GR $GROOMOA                      Current Grooming                         
                            281                          Missing                                 
                            653        00                Able to groom self unaided              
                            753        01                Utensils must be placed within reach    
                          1,246        02                Someone must assis patient to groom self
                            273        03                Depends entirely upon another person    
 
M1810_DR $DRESSOA                      Current Dress Upper Body                 
                            281                          Missing                                 
                            626        00                No assist needed                        
                            677        01                No assist needed if clothing laid out   
                          1,323        02                Assist from another person              
                            299        03                Depends entirely upon another person    
 
M1820_DR $DRESSOA                      Current Dress Lower Body                 
                            281                          Missing                                 
                            570        00                No assist needed                        
                            440        01                No assist needed if clothing laid out   
                          1,405        02                Assist from another person              
                            510        03                Depends entirely upon another person    
 
M1830_BA $BATHCOA                      Ability To Wash Body                     
                            281                          Missing                                 
                            257        00                Bathes self independently               
                            322        01                Bathes self with use of devices         
                            450        02                Bathes with intermittent assist         
                          1,026        03                Bathes with complete assist/supervision 
                             68        04                Unable, bed/sink/chair, independent     
                            500        05                Unable, bed/sing/chair, assisted        
                            302        06                Unable, totally bathed by another person
 
M1840_TO $TOILEOA                      Current Toilet Transferring              
                            281                          Missing                                 
                            726        00                Toilet, to and from independently       
                          1,361        01                Toilet, when reminded/assist/supervised 
                            378        02                Unable toil, able to bedside commode    
                             59        03                Unable toil/bedside commode, able bedpan
                            401        04                Depends entirely upon another person    
 
M1845_TO $TOILEOA                      Current Toileting Hygiene                
                          1,034                          Missing                                 
                            585        00                Toilet, to and from independently       
                            461        01                Toilet, when reminded/assist/supervised 
                            897        02                Unable toil, able to bedside commode    
                            229        03                Unable toil/bedside commode, able bedpan
 
M1850_TR $TRANSOA                      Current Transferring                     
                            281                          Missing                                 
                            498        00                Able to independently transfer          
                            756        01                Transfers with minimal assist or device 
                          1,222        02                Unable transfer self, able to pivot     
                            343        03                Unable transfer self, unable to pivot   
                             27        04                Bedfast, unable trans, able to positio  
                             79        05                Bedfast, unable trans, unable to positio
 
M1860_AM $AMBUCOA                      Current Ambulation/Locomotion            
                            281                          Missing                                 
                            262        00                Able to independently walk/stairs       
                            243        01                Able to walk w/1 handed device          
                            604        02                Able to walk w/2 handed device          
                          1,295        03                Able to walk w/constant assist/supervis 
                            185        04                Chairfast,able to wheel self independ   
                            260        05                Chairfast,unable to wheel self independ 
                             76        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                
                          1,034                          Missing                                 
                            950        00                Able independently feed self            
                          1,032        01                Able feed self with intermittent assist 
                            157        02                Unable feed self, complete assist/superv
                              5        03                Able take nutri oral, rec tube feedi    
                             28        04                Unable take nutri oral, rec tube feedi  
         Notes:  Please see CCW documentation about response option for more information
 
M1910_FA $FALLMOA                      Multi-Factor Fall Risk Assessment        
                          2,060                          Missing                                 
                              6        00                No multi-factor fall risk assessment    
                             34        01                Yes, does not indicated a risk for fall 
                          1,106        02                Yes, indicates a risk for falls fall    
 
M2010_DR $YESNAOA                      Patient/Caregiv High Risk Drug Educ      
                          1,988                          Missing                                 
                             28        00                No                                      
                          1,039        01                Yes                                     
                            151        NA                Not applicable                          
 
M2020_OR $MGMRXOA                      Curr Manag Of Oral Medications           
                          1,039                          Missing                                 
                            479        00                Able to independently take correct med  
                            331        01                Able to take med corect time w/prepared 
                            282        02                Able to take med corect time w/ assist  
                          1,058        03                Unable to take med unless administered  
                             17        NA                No med of this type prescribed          
         Notes:  Please see CCW documentation about response option for more information
 
M2030_IN $MGMRXOA                      Curr Manag Of Injectable Medications     
                          1,255                          Missing                                 
                             33        00                Able to independently take correct med  
                             33        01                Able to take med corect time w/prepared 
                             32        02                Able to take med corect time w/ assist  
                            277        03                Unable to take med unless administered  
                          1,576        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             
                          1,248                          Missing                                 
                          1,854        0                 Not indicated                           
                            104        1                 Indicated                               
 
M2200_VI                               Therapy Need; Number Of Visits           
                          1,365                          Missing                                 
                          1,841        Range of values   Range of values                         
 
M2310_DB $INDICOA                      EmergCare;Hypo/Hyperglycemia/Diabetes    
                          2,953                          Missing                                 
                            252        0                 Not indicated                           
                              1        1                 Indicated                               
 
M2310_MD $INDICOA                      EmergCare;Improper Medication Admin      
                          2,953                          Missing                                 
                            252        0                 Not indicated                           
                              1        1                 Indicated                               
 
M2310_OT $INDICOA                      EmergCare;Other                          
                          2,953                          Missing                                 
                             23        0                 Not indicated                           
                            230        1                 Indicated                               
 
M2310_UN $INDICOA                      EmergCare;Unknown                        
                          2,953                          Missing                                 
                            232        0                 Not indicated                           
                             21        1                 Indicated                               
 
M2410_AD $INFACOA                      Admit Inpatient Facility Type            
                          1,982                          Missing                                 
                            257        01                Hospital                                
                             10        02                Rehabilitation facility                 
                              7        03                Nursing home                            
                              1        04                Hospice                                 
                            949        NA                No inpatient facility admission         
 
M2420_DS $DISPOCA                      Discharge Location                       
                          2,257                          Missing                                 
                            733        01                Patient remained in commun, no assistive
                            192        02                Patient remained in commun, assistive   
                             14        03                Patient transferred to a noninsti hospic
                              3        04                Unknown, location not served by agency  
                              7        UK                Unknown, other                          
         Notes:  Please see CCW documentation about response option for more information
 
