IRF-PAI Item Summary

Item

XML Tag

Group

Type

Length

Fixed Start-End

Description

ASMT_SYS_CD ASMT_SYS_CD Control Code 10 1-10 Assessment System Code
REC_ID REC_ID Control Code 1 11-11 Record ID
FAC_ID FAC_ID Control Text 16 12-27 Facility ID
STATE_CD STATE_CD Control Code 2 28-29 State Code
FAC_ADDR_1 FAC_ADDR_1 Control Text 30 30-59 Facility Address Line 1
FAC_ADDR_2 FAC_ADDR_2 Control Text 30 60-89 Facility Address Line 2
FAC_CITY FAC_CITY Control Text 20 90-109 Facility City
FAC_ZIP FAC_ZIP Control Text 5 110-114 Facility ZIP Code
FAC_CNTCT FAC_CNTCT Control Text 30 115-144 Facility Contact Person Name
FAC_PHONE FAC_PHONE Control Text 10 145-154 Facility Contact Person Phone
FAC_EXTEN FAC_EXTEN Control Text 5 155-159 Facility Contact Person Phone Extension
FAC_DOC_CD FAC_DOC_CD Control Text 8 160-167 Facility Document ID
VERSION_CD1 VERSION_CD1 Control Code 5 168-172 IRF-PAI Assessment Version
VERSION_CD2 VERSION_CD2 Control Code 5 173-177 IRF-PAI Specifications Version
SFTWR_VNDR_ID SFTWR_VNDR_ID Control Text 9 178-186 Software Vendor EIN
SFTWR_VNDR_NAME SFTWR_VNDR_NAME Control Text 30 187-216 Software Vendor Name
SFTWR_VNDR_EMAIL_ADR SFTWR_VNDR_EMAIL_ADR Control Text 50 217-266 Software Vendor Email Address
SFTWR_PROD_NAME SFTWR_PROD_NAME Control Text 50 267-316 Software Product Name
SFTWR_PROD_VRSN_CD SFTWR_PROD_VRSN_CD Control Text 20 317-336 Software Product Version Code
CORRECTION_NUM CORRECTION_NUM Control Number 2 337-338 Correction Number
CONTROL_FILLER CNRTL_FLR Control Text 200 339-538 Control items filler
1A R1A Asmt Text 50 539-588 Facility Name
1B R1B Asmt Text 12 589-600 CMS Certification Number (CCN) (Medicare Prov Num)
2 R2 Asmt Text 12 601-612 Patient Medicare Number
3 R3 Asmt Text 14 613-626 Patient Medicaid Number
4 R4 Asmt Text 12 627-638 Patient First Name
5A R5A Asmt Text 18 639-656 Patient Last Name
6 R6 Asmt Date 8 657-664 Birth Date
7 R7 Asmt Text 9 665-673 Social Security Number (SSN)
8 R8 Asmt Code 1 674-674 Gender
9A R9A Asmt Checklist 1 675-675 Race: American Indian/Alaskan Native
9B R9B Asmt Checklist 1 676-676 Race: Asian
9C R9C Asmt Checklist 1 677-677 Race: Black or African American
9D R9D Asmt Checklist 1 678-678 Ethnicity: Hispanic or Latino
9E R9E Asmt Checklist 1 679-679 Race: Native Hawaiian or other Pacific Islander
9F R9F Asmt Checklist 1 680-680 Race: White
10 R10 Asmt Code 2 681-682 Marital Status
11 R11 Asmt Text 5 683-687 ZIP Code of Patient"s Pre-hospital Residence
12 R12 Asmt Date 8 688-695 Admission Date
13 R13 Asmt Date 8 696-703 Assessment Reference Date
14 R14 Asmt Code 2 704-705 Admission Class
15 R15 Asmt Code 2 706-707 Admit From
16 R16 Asmt Code 2 708-709 Pre-Hospital Living Setting
17 R17 Asmt Code 2 710-711 Pre-Hospital Living With
18 R18 Asmt Code 2 712-713 Pre-Hospital Vocational Category
19 R19 Asmt Code 2 714-715 Pre-Hospital Vocational Effort
20A R20A Asmt Code 2 716-717 Primary Payment Source
20B R20B Asmt Code 2 718-719 Secondary Payment Source
21A R21A Asmt Code 9 720-728 Impairment Group: Admission
21D R21D Asmt Code 9 729-737 Impairment Group: Discharge
22 R22 Asmt ICD 8 738-745 Etiologic Diagnosis Code (ICD-9 Code)
23 R23 Asmt Date 8 746-753 Date of Onset
24A R24A Asmt ICD 8 754-761 Comorbid Condition 1 (ICD-9 Code)
24B R24B Asmt ICD 8 762-769 Comorbid Condition 2 (ICD-9 Code)
24C R24C Asmt ICD 8 770-777 Comorbid Condition 3 (ICD-9 Code)
24D R24D Asmt ICD 8 778-785 Comorbid Condition 4 (ICD-9 Code)
24E R24E Asmt ICD 8 786-793 Comorbid Condition 5 (ICD-9 Code)
24F R24F Asmt ICD 8 794-801 Comorbid Condition 6 (ICD-9 Code)
24G R24G Asmt ICD 8 802-809 Comorbid Condition 7 (ICD-9 Code)
24H R24H Asmt ICD 8 810-817 Comorbid Condition 8 (ICD-9 Code)
24I R24I Asmt ICD 8 818-825 Comorbid Condition 9 (ICD-9 Code)
24J R24J Asmt ICD 8 826-833 Comorbid Condition 10 (ICD-9 Code)
25 R25 Asmt Code 1 834-834 Comatose: Admission
26 R26 Asmt Code 1 835-835 Delirious: Admission
27A R27A Asmt Code 2 836-837 Swallowing Status: Admission
27D R27D Asmt Code 2 838-839 Swallowing Status: Discharge
28A R28A Asmt Code 1 840-840 Clinical Signs of Dehydration: Admission
28D R28D Asmt Code 1 841-841 Clinical Signs of Dehydration: Discharge
29A R29A Asmt Code 2 842-843 Bladder Level of Assistance: Admission
29D R29D Asmt Code 2 844-845 Bladder Level of Assistance: Discharge
30A R30A Asmt Code 2 846-847 Bladder Frequency of Accidents: Admission
30D R30D Asmt Code 2 848-849 Bladder Frequency of Accidents: Discharge
31A R31A Asmt Code 2 850-851 Bowel Level of Assistance: Admission
31D R31D Asmt Code 2 852-853 Bowel Level of Assistance: Discharge
32A R32A Asmt Code 2 854-855 Bowel Frequency of Accidents: Admission
32D R32D Asmt Code 2 856-857 Bowel Frequency of Accidents: Discharge
33A R33A Asmt Code 2 858-859 Tub Transfer: Admission
33D R33D Asmt Code 2 860-861 Tub Transfer: Discharge
34A R34A Asmt Code 2 862-863 Shower Transfer: Admission
34D R34D Asmt Code 2 864-865 Shower Transfer: Discharge
35A R35A Asmt Code 2 866-867 Distance Walked: Admission
35D R35D Asmt Code 2 868-869 Distance Walked: Discharge
36A R36A Asmt Code 2 870-871 Distance Traveled in Wheelchair: Admission
36D R36D Asmt Code 2 872-873 Distance Traveled in Wheelchair: Discharge
37A R37A Asmt Code 2 874-875 Walk: Admission
37D R37D Asmt Code 2 876-877 Walk: Discharge
38A R38A Asmt Code 2 878-879 Wheelchair: Admission
38D R38D Asmt Code 2 880-881 Wheelchair: Discharge
39AA R39AA Asmt Code 2 882-883 Self-Care -Eating: Admission
39AD R39AD Asmt Code 2 884-885 Self-Care -Eating: Discharge
39AG R39AG Asmt Code 2 886-887 Self-Care -Eating: Goal
39BA R39BA Asmt Code 2 888-889 Self-Care -Grooming: Admission
39BD R39BD Asmt Code 2 890-891 Self-Care -Grooming: Discharge
39BG R39BG Asmt Code 2 892-893 Self-Care -Grooming: Goal
39CA R39CA Asmt Code 2 894-895 Self-Care -Bathing: Admission
39CD R39CD Asmt Code 2 896-897 Self-Care -Bathing: Discharge
39CG R39CG Asmt Code 2 898-899 Self-Care -Bathing: Goal
39DA R39DA Asmt Code 2 900-901 Self-Care -Dressing - Upper: Admission
39DD R39DD Asmt Code 2 902-903 Self-Care -Dressing - Upper: Discharge
39DG R39DG Asmt Code 2 904-905 Self-Care -Dressing - Upper: Goal
39EA R39EA Asmt Code 2 906-907 Self-Care -Dressing - Lower: Admission
39ED R39ED Asmt Code 2 908-909 Self-Care -Dressing - Lower: Discharge
39EG R39EG Asmt Code 2 910-911 Self-Care -Dressing - Lower: Goal
39FA R39FA Asmt Code 2 912-913 Self-Care -Toileting: Admission
39FD R39FD Asmt Code 2 914-915 Self-Care -Toileting: Discharge
39FG R39FG Asmt Code 2 916-917 Self-Care -Toileting: Goal
39GA R39GA Asmt Code 2 918-919 Sphincter Control -Bladder: Admission
39GD R39GD Asmt Code 2 920-921 Sphincter Control -Bladder: Discharge
39GG R39GG Asmt Code 2 922-923 Sphincter Control -Bladder: Goal
39HA R39HA Asmt Code 2 924-925 Sphincter Control -Bowel: Admission
39HD R39HD Asmt Code 2 926-927 Sphincter Control -Bowel: Discharge
39HG R39HG Asmt Code 2 928-929 Sphincter Control -Bowel: Goal
39IA R39IA Asmt Code 2 930-931 Transfers -Bed, Chair, Wheelchair: Admission
39ID R39ID Asmt Code 2 932-933 Transfers -Bed, Chair, Wheelchair: Discharge
39IG R39IG Asmt Code 2 934-935 Transfers -Bed, Chair, Wheelchair: Goal
39JA R39JA Asmt Code 2 936-937 Transfers -Toilet: Admission
39JD R39JD Asmt Code 2 938-939 Transfers -Toilet: Discharge
39JG R39JG Asmt Code 2 940-941 Transfers -Toilet: Goal
39KA R39KA Asmt Code 2 942-943 Transfers -Tub, Shower: Admission
39KD R39KD Asmt Code 2 944-945 Transfers - Tub, Shower: Discharge
39KG R39KG Asmt Code 2 946-947 Transfers -Tub, Shower: Goal
39LA R39LA Asmt Code 2 948-949 Locomotion -Walk/Wheelchair: Admission
39LAA R39LAA Asmt Code 1 950-950 Locomotion -Walk/Wheelchair/both: Admission
39LD R39LD Asmt Code 2 951-952 Locomotion -Walk/Wheelchair: Discharge
39LDD R39LDD Asmt Code 1 953-953 Locomotion -Walk/Wheelchair/both: Discharge
39LG R39LG Asmt Code 2 954-955 Locomotion -Walk/Wheelchair: Goal
39MA R39MA Asmt Code 2 956-957 Locomotion -Stairs: Admission
39MD R39MD Asmt Code 2 958-959 Locomotion -Stairs: Discharge
39MG R39MG Asmt Code 2 960-961 Locomotion -Stairs: Goal
39NA R39NA Asmt Code 2 962-963 Communication -Comprehension: Admission
39NAA R39NAA Asmt Code 1 964-964 Communication -Comp Auditory/Visual/Both:Admission
39ND R39ND Asmt Code 2 965-966 Communication -Comprehension: Discharge
39NDD R39NDD Asmt Code 1 967-967 Communication -Comp Auditory/Visual/Both:Discharge
39NG R39NG Asmt Code 2 968-969 Communication -Comprehension: Goal
39OA R39OA Asmt Code 2 970-971 Communication -Expression: Admission
39OAA R39OAA Asmt Code 1 972-972 Communication -Expr Vocal/Nonvocal/Both: Admission
39OD R39OD Asmt Code 2 973-974 Communication -Expression: Discharge
39ODD R39ODD Asmt Code 1 975-975 Communication -Expr Vocal/Nonvocal/Both: Discharge
39OG R39OG Asmt Code 2 976-977 Communication -Expression: Goal
39PA R39PA Asmt Code 2 978-979 Social Cognition -Social Interaction: Admission
39PD R39PD Asmt Code 2 980-981 Social Cognition -Social Interaction: Discharge
39PG R39PG Asmt Code 2 982-983 Social Cognition -Social Interaction: Goal
39QA R39QA Asmt Code 2 984-985 Social Cognition -Problem Solving: Admission
39QD R39QD Asmt Code 2 986-987 Social Cognition -Problem Solving: Discharge
39QG R39QG Asmt Code 2 988-989 Social Cognition -Problem Solving: Goal
39RA R39RA Asmt Code 2 990-991 Social Cognition -Memory: Admission
39RD R39RD Asmt Code 2 992-993 Social Cognition -Memory: Discharge
39RG R39RG Asmt Code 2 994-995 Social Cognition -Memory: Goal
40 R40 Asmt Date 8 996-1003 Discharge Date
41 R41 Asmt Code 1 1004-1004 Patient Discharged Against Medical Advice
42 R42 Asmt Code 1 1005-1005 Program Interruption(s) Indicator
43A R43A Asmt Date 8 1006-1013 1st Interruption Date
43B R43B Asmt Date 8 1014-1021 1st Return Date
43C R43C Asmt Date 8 1022-1029 2nd Interruption Date
43D R43D Asmt Date 8 1030-1037 2nd Return Date
43E R43E Asmt Date 8 1038-1045 3rd Interruption Date
43F R43F Asmt Date 8 1046-1053 3rd Return Date
44A R44A Asmt Code 2 1054-1055 Discharge to Living Setting
44B R44B Asmt Code 1 1056-1056 Patient Discharged with Home Health Services
45 R45 Asmt Code 2 1057-1058 Discharge to Living With
46 R46 Asmt ICD 8 1059-1066 Diagnosis for Interruption or Death (ICD-9 Code)
47A R47A Asmt ICD 8 1067-1074 Complication during rehab stay 1 (ICD-9 Code)
47B R47B Asmt ICD 8 1075-1082 Complication during rehab stay 2 (ICD-9 Code)
47C R47C Asmt ICD 8 1083-1090 Complication during rehab stay 3 (ICD-9 Code)
47D R47D Asmt ICD 8 1091-1098 Complication during rehab stay 4 (ICD-9 Code)
47E R47E Asmt ICD 8 1099-1106 Complication during rehab stay 5 (ICD-9 Code)
47F R47F Asmt ICD 8 1107-1114 Complication during rehab stay 6 (ICD-9 Code)
48AA R48AA Asmt Number 1 1115-1115 Number of Stage 2 pressure ulcers: Admission
48AD R48AD Asmt Number 1 1116-1116 Number of Stage 2 pressure ulcers: Discharge
48BA R48BA Asmt Number 1 1117-1117 Number of Stage 3 pressure ulcers: Admission
48BD R48BD Asmt Number 1 1118-1118 Number of Stage 3 pressure ulcers: Discharge
48CA R48CA Asmt Number 1 1119-1119 Number of Stage 4 pressure ulcers: Admission
48CD R48CD Asmt Number 1 1120-1120 Number of Stage 4 pressure ulcers: Discharge
49A R49A Asmt Number 1 1121-1121 Number of Stage 2 worsening pressure ulcers
49B R49B Asmt Number 1 1122-1122 Number of Stage 3 worsening pressure ulcers
49C R49C Asmt Number 1 1123-1123 Number of Stage 4 worsening pressure ulcers
50A R50A Asmt Code 1 1124-1124 Pressure Ulcers Present on Admission
50B R50B Asmt Number 1 1125-1125 Number of Stage 2 Healed Pressure Ulcers
50C R50C Asmt Number 1 1126-1126 Number of Stage 3 Healed Pressure Ulcers
50D R50D Asmt Number 1 1127-1127 Number of Stage 4 Healed Pressure Ulcers
ASMT_FILLER ASMT_FILLER Filler Text 1000 1128-2127 Assessment items filler
SBMTD_CMG_TXT SBMTD_CMG_TXT Control Text 10 2128-2137 Submitted CMG Code
RCALC_CMG_TXT RCALC_CMG_TXT Calc Text 10 2138-2147 Recalculated CMG Code
SBMTD_CMG_VRSN_TXT SBMTD_CMG_VRSN_TXT Control Text 10 2148-2157 Submitted CMG Version Code
RCALC_CMG_VRSN_TXT RCALC_CMG_VRSN_TXT Calc Text 10 2158-2167 Recalculated CMG Version Code
ASSESSMENT_ID ASSESSMENT_ID Calc Number 15 2168-2182 Assessment ID
ORIGINAL_ASSESSMENT_ID ORIGINAL_ASSESSMENT_ID Calc Number 15 2183-2197 Original Assessment ID
RESIDENT_INTERNAL_ID RESIDENT_INTERNAL_ID Calc Number 10 2198-2207 Resident ID
PROVIDER_INTERNAL_ID PROVIDER_INTERNAL_ID Calc Number 10 2208-2217 Provider Internal Number
SUBMISSION_ID SUBMISSION_ID Calc Number 15 2218-2232 Submission ID
SUBMISSION_DATE SUBMISSION_DATE Calc Date 8 2233-2240 Submission Date
SUBMISSION_COMPLETE_DATE SUBMISSION_COMPLETE_DATE Calc Date 8 2241-2248 Submission Complete Date
SUBMITTING_USER_ID SUBMITTING_USER_ID Calc Text 30 2249-2278 Submitting User ID
BIRTHDATE_SUBMIT_CODE BIRTHDATE_SUBMIT_CODE Calc Code 1 2279-2279 Birthdate Submit Code
RESIDENT_MATCH_CRITERIA RESIDENT_MATCH_CRITERIA Calc Number 2 2280-2281 Resident Matching Criteria
RESIDENT_AGE RESIDENT_AGE Calc Number 3 2282-2284 Resident Age
DATA_END_INDICATOR DATA_END_INDICATOR Calc Text 1 2285-2285 End of Data Terminator Code
CALC_FILLER CALC_FILLER Calc Text 500 2286-2785 Calculated items filler
CR CR Calc Text 1 2786-2786 Carriage Return
LF LF Calc Text 1 2787-2787 Line Feed

NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 12/02/2011 02:56:12 PM