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