RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                              19,490             LOW-HIGH BASEID Count

AA2        12  2  GEND                                  N ID; sex

                                   4                    . Missing
                               5,068                    1 Male
                              14,418                    2 Female

AA3        14  8                                        N ID; birthdate

AA4        24  2  RACEETH                               N ID; race/ethnicity

                                  50                    . Missing
                                  71                    1 Amer Indian/Alaskan Native
                                 188                    2 Asian/Pacific Islander
                               2,615                    3 Black, not of Hispanic origin
                                 731                    4 Hispanic
                              15,835                    5 White, not of Hispanic origin

AA6A       26 15                                        C ID; facility provider number, state

AA6B       41 12                                        C ID, facility provider number, federal

AA8A       53  2  $PASSESS                              C ID; primary reason for assessment

                               3,671                   00 None of above
                               1,743                   01 Admission assessment
                               1,779                   02 Annual assessment
                                 702                   03 Signif change is status assessment
                                   2                   04 Signif correction of prior full
                               7,193                   05 Quarterly review assessment
                               1,504                   06 Discharged; return not anticipated
                               1,373                   07 Discharged; return anticipated
                                 299                   08 Discharged; prior to initial assessment
                               1,219                   09 Re-entry
                                   5                   10 Signif correction of prior quarterly

AA8B       55  1  $CASSESS                              C ID; codes for assessments required

                              14,102                      Missing
                               2,030                    1 Medicare 5 day assessment
                                 900                    2 Medicare 30 day assessment
                                 313                    3 Medicare 60 day assessment
                                 134                    4 Medicare 90 day assessment
                                 252                    5 Medicare readmission/return assessment
                                  12                    6 Other state required assessment
                               1,627                    7 Medicare 14 day assessment
                                 120                    8 Other Medicare required assessment

AB1        56  8                                        N Residential; date of entry

AB2        66  2  ADMITFRM                              N Residential; admitted from

                              14,114                    . Missing
                                 750                    1 Private home w/ no home health services
                                 282                    2 Private home w/ home health services
                                 175                    3 Board and care/assist living/group home
                                 335                    4 Nursing home
                               3,580                    5 Acute care hospital
                                 103                    6 Psychiatric hospital, MR/DD facility
                                  67                    7 Rehabilitation hospital
                                  84                    8 Other

AB3        68  2  YESNOALO                              N Residential; lived alone

                              14,398                    . Missing
                               2,643                    0 No
                               1,874                    1 Yes
                                 575                    2 In other facility

AB4        70  5                                        C Residential; zip code, prior primary res

AB5A       75  2  INDIC                                 N Residential; prior stay in nursing home

                              11,399                    . Missing
                               6,278                    0 Not indicated
                               1,813                    1 Indicated

AB5B       77  2  INDIC                                 N Residential; stay in other nursing home

                              11,399                    . Missing
                               6,718                    0 Not indicated
                               1,373                    1 Indicated

AB5C       79  2  INDIC                                 N Residential; other residential facility

                              11,399                    . Missing
                               7,160                    0 Not indicated
                                 931                    1 Indicated

AB5D       81  2  INDIC                                 N Residential; MH/psychiatric setting

                              11,399                    . Missing
                               7,931                    0 Not indicated
                                 160                    1 Indicated

AB5E       83  2  INDIC                                 N Residential; MR/DD setting

                              11,399                    . Missing
                               8,071                    0 Not indicated
                                  20                    1 Indicated

AB5F       85  2  INDIC                                 N Residential; none of above

                              11,399                    . Missing
                               3,589                    0 Not indicated
                               4,502                    1 Indicated

AB6        87 21                                        C Demo; lifetime occupation(s)

AB7       108  2  HIEDUCAT                              N Demo; highest of education complete

                              14,477                    . Missing
                                  70                    1 No schooling
                               1,089                    2 8th grade/less
                                 889                    3 9-11 grades
                               1,916                    4 High school
                                 172                    5 Technical or trade school
                                 479                    6 Some college
                                 190                    7 Bachelors degree
                                 208                    8 Graduate degree

AB8A      110  2  PRIMLANG                              N Demo; primary language

                              14,398                    . Missing
                               4,923                    0 English
                                 130                    1 Spanish
                                   1                    2 French
                                  38                    3 Other

AB8B      112  9                                        C Demo; other primary language

AB9       121  2  YESNO                                 N Mental; indication of MR/MI/DD history

                              14,407                    . Missing
                               4,661                    0 No
                                 422                    1 Yes

AB10A     123  2  INDIC                                 N Mental; status, no MR/DD

                              14,397                    . Missing
                                 128                    0 Not indicated
                               4,965                    1 Indicated

AB10B     125  2  INDIC                                 N Mental; status, downs syndrome

                              19,362                    . Missing
                                 105                    0 Not indicated
                                  23                    1 Indicated

AB10C     127  2  INDIC                                 N Mental; status, autism

                              19,362                    . Missing
                                 127                    0 Not indicated
                                   1                    1 Indicated

AB10D     129  2  INDIC                                 N Mental; status, epilepsy

                              19,362                    . Missing
                                 125                    0 Not indicated
                                   3                    1 Indicated

AB10E     131  2  INDIC                                 N Mental; status, other organic condition

                              19,362                    . Missing
                                 114                    0 Not indicated
                                  14                    1 Indicated

AB10F     133  2  INDIC                                 N Mental; status, MR/DD w/ no organic cond

                              19,362                    . Missing
                                 103                    0 Not indicated
                                  25                    1 Indicated

AB11      135  8                                        N Date background information completed

AC1A      145  2  INDIC                                 N Routine; event, stays up late at night

                              14,511                    . Missing
                               2,934                    0 Not indicated
                               2,045                    1 Indicated

AC1B      147  2  INDIC                                 N Routine; event, naps regularly

                              14,513                    . Missing
                               2,062                    0 Not indicated
                               2,915                    1 Indicated

AC1C      149  2  INDIC                                 N Routine; event, goes out 1+ days

                              14,513                    . Missing
                               2,467                    0 Not indicated
                               2,510                    1 Indicated

AC1D      151  2  INDIC                                 N Routine; event, stays busy

                              14,511                    . Missing
                               2,453                    0 Not indicated
                               2,526                    1 Indicated

AC1E      153  2  INDIC                                 N Routine; event, most of time spent alone

                              14,511                    . Missing
                               3,054                    0 Not indicated
                               1,925                    1 Indicated

AC1F      155  2  INDIC                                 N Routine; event, moves independent indoor

                              14,511                    . Missing
                               1,301                    0 Not indicated
                               3,678                    1 Indicated

AC1G      157  2  INDIC                                 N Routine; event, use of tobacco products

                              14,515                    . Missing
                               4,549                    0 Not indicated
                                 426                    1 Indicated

AC1H      159  2  INDIC                                 N Routine; event, none of above

                              14,511                    . Missing
                               4,738                    0 Not indicated
                                 241                    1 Indicated

AC1I      161  2  INDIC                                 N Routine; eating, distinct food pref

                              14,513                    . Missing
                               3,994                    0 Not indicated
                                 983                    1 Indicated

AC1J      163  2  INDIC                                 N Routine; eating, eats between meals

                              14,512                    . Missing
                               3,445                    0 Not indicated
                               1,533                    1 Indicated

AC1K      165  2  INDIC                                 N Routine; eating, use of alcoholic bev

                              14,513                    . Missing
                               4,743                    0 Not indicated
                                 234                    1 Indicated

AC1L      167  2  INDIC                                 N Routine; eating, none of above

                              14,511                    . Missing
                               2,277                    0 Not indicated
                               2,702                    1 Indicated

AC1M      169  2  INDIC                                 N Routine; ADL, bedclothes most of day

                              14,513                    . Missing
                               4,642                    0 Not indicated
                                 335                    1 Indicated

AC1N      171  2  INDIC                                 N Routine; ADL, wakens to toilet

                              14,513                    . Missing
                               2,131                    0 Not indicated
                               2,846                    1 Indicated

AC1O      173  2  INDIC                                 N Routine; ADL, irregular bowel movement

                              14,513                    . Missing
                               4,259                    0 Not indicated
                                 718                    1 Indicated

AC1P      175  2  INDIC                                 N Routine; ADL, showers for bathing

                              14,511                    . Missing
                               1,439                    0 Not indicated
                               3,540                    1 Indicated

AC1Q      177  2  INDIC                                 N Routine; ADL, bathing in PM

                              14,517                    . Missing
                               4,391                    0 Not indicated
                                 582                    1 Indicated

AC1R      179  2  INDIC                                 N Routine; ADL, none of above

                              14,511                    . Missing
                               4,273                    0 Not indicated
                                 706                    1 Indicated

AC1S      181  2  INDIC                                 N Routine; involve, daily contact family

                              14,513                    . Missing
                               1,050                    0 Not indicated
                               3,927                    1 Indicated

AC1T      183  2  INDIC                                 N Routine; involve, attends church

                              14,513                    . Missing
                               3,421                    0 Not indicated
                               1,556                    1 Indicated

AC1U      185  2  INDIC                                 N Routine; involve, strength in faith

                              14,513                    . Missing
                               2,154                    0 Not indicated
                               2,823                    1 Indicated

AC1V      187  2  INDIC                                 N Routine; involve, animal companion

                              14,514                    . Missing
                               4,387                    0 Not indicated
                                 589                    1 Indicated

AC1W      189  2  INDIC                                 N Routine; involve, group activities

                              14,514                    . Missing
                               3,660                    0 Not indicated
                               1,316                    1 Indicated

AC1X      191  2  INDIC                                 N Routine; involve, none of above

                              14,513                    . Missing
                               4,397                    0 Not indicated
                                 580                    1 Indicated

AC1Y      193  2  INDIC                                 N Routine; unknown routines

                              14,391                    . Missing
                               4,979                    0 Not indicated
                                 120                    1 Indicated

A2        195  5                                        C Background; room number

A3A       200  8                                        N Background; assessment reference date

A4B       210  2                                        N Background; original or copy number

A4A       212  8                                        N Background; date of reentry

A5        222  2  MARITAL                               N Background; marital status

                               9,940                    . Missing
                               1,149                    1 Never married
                               2,011                    2 Married
                               5,496                    3 Widowed
                                  76                    4 Separated
                                 818                    5 Divorced

A6        224 12                                        C Background; medical record number

A7A       236  2  INDIC                                 N Payment; Medicaid per diem

                              14,528                    . Missing
                               2,498                    0 Not indicated
                               2,464                    1 Indicated

A7B       238  2  INDIC                                 N Payment; Medicare per diem

                              14,526                    . Missing
                               3,470                    0 Not indicated
                               1,494                    1 Indicated

A7C       240  2  INDIC                                 N Payment; Medicare ancillary part A

                              14,526                    . Missing
                               4,150                    0 Not indicated
                                 814                    1 Indicated

A7D       242  2  INDIC                                 N Payment; Medicare ancillary part B

                              14,528                    . Missing
                               4,465                    0 Not indicated
                                 497                    1 Indicated

A7E       244  2  INDIC                                 N Payment; CHAMPUS per diem

                              14,528                    . Missing
                               4,962                    0 Not indicated
                                   0                    1 Indicated

A7F       246  2  INDIC                                 N Payment; VA per diem

                              14,528                    . Missing
                               4,907                    0 Not indicated
                                  55                    1 Indicated

A7G       248  2  INDIC                                 N Payment; self/family pays full per diem

                              14,528                    . Missing
                               4,359                    0 Not indicated
                                 603                    1 Indicated

A7H       250  2  INDIC                                 N Payment; Mcaid res liab/Mcare co-payment

                              14,528                    . Missing
                               4,385                    0 Not indicated
                                 577                    1 Indicated

A7I       252  2  INDIC                                 N Payment; private insurance per diem

                              14,528                    . Missing
                               4,428                    0 Not indicated
                                 534                    1 Indicated

A7J       254  2  INDIC                                 N Payment; other per diem

                              14,528                    . Missing
                               4,848                    0 Not indicated
                                 114                    1 Indicated

A9A       256  2  INDIC                                 N Decisions; legal guardian

                              14,528                    . Missing
                               4,794                    0 Not indicated
                                 168                    1 Indicated

A9B       258  2  INDIC                                 N Decisions; other legal oversight

                              14,528                    . Missing
                               4,856                    0 Not indicated
                                 106                    1 Indicated

A9C       260  2  INDIC                                 N Decisions; dur power attorney/health

                              14,528                    . Missing
                               3,142                    0 Not indicated
                               1,820                    1 Indicated

A9D       262  2  INDIC                                 N Decisions; dur power attorney/financial

                              14,528                    . Missing
                               3,908                    0 Not indicated
                               1,054                    1 Indicated

A9E       264  2  INDIC                                 N Decisions; family member responsible

                              14,528                    . Missing
                               1,816                    0 Not indicated
                               3,146                    1 Indicated

A9F       266  2  INDIC                                 N Decisions; patient responsible for self

                              14,524                    . Missing
                               3,202                    0 Not indicated
                               1,764                    1 Indicated

A9G       268  2  INDIC                                 N Decisions; none of the above

                              14,524                    . Missing
                               4,790                    0 Not indicated
                                 176                    1 Indicated

A10A      270  2  INDIC                                 N Adv directives; living will

                              14,533                    . Missing
                               3,996                    0 Not indicated
                                 961                    1 Indicated

A10B      272  2  INDIC                                 N Adv directives; do not resuscitate

                              10,175                    . Missing
                               4,873                    0 Not indicated
                               4,442                    1 Indicated

A10C      274  2  INDIC                                 N Adv directives; do not hospitalize

                              10,186                    . Missing
                               9,122                    0 Not indicated
                                 182                    1 Indicated

A10D      276  2  INDIC                                 N Adv directives; organ donation

                              14,533                    . Missing
                               4,924                    0 Not indicated
                                  33                    1 Indicated

A10E      278  2  INDIC                                 N Adv directives; autopsy request

                              14,533                    . Missing
                               4,953                    0 Not indicated
                                   4                    1 Indicated

A10F      280  2  INDIC                                 N Adv directives; feeding restrict

                              14,533                    . Missing
                               4,472                    0 Not indicated
                                 485                    1 Indicated

A10G      282  2  INDIC                                 N Adv directives; medication restrict

                              14,533                    . Missing
                               4,827                    0 Not indicated
                                 130                    1 Indicated

A10H      284  2  INDIC                                 N Adv directives; other treatment restrict

                              14,534                    . Missing
                               4,547                    0 Not indicated
                                 409                    1 Indicated

A10I      286  2  INDIC                                 N Adv directives; none of above

                              14,533                    . Missing
                               2,771                    0 Not indicated
                               2,186                    1 Indicated

B1        288  2  YESNO                                 N Cognitive; comatose

                               4,395                    . Missing
                              15,093                    0 No
                                   2                    1 Yes

B2A       290  2  MEMORY                                N Cognitive; short-term memory OK

                               4,485                    . Missing
                               4,598                    0 Memory OK
                              10,407                    1 Memory problem

B2B       292  2  MEMORY                                N Cognitive; long-term memory OK

                               4,486                    . Missing
                               8,105                    0 Memory OK
                               6,899                    1 Memory problem

B3A       294  2  INDIC                                 N Cognitive; recall; current season

                               6,409                    . Missing
                               6,233                    0 Not indicated
                               6,848                    1 Indicated

B3B       296  2  INDIC                                 N Cognitive; recall; location of own room

                               6,408                    . Missing
                               4,707                    0 Not indicated
                               8,375                    1 Indicated

B3C       298  2  INDIC                                 N Cognitive; recall; staff names/faces

                               6,408                    . Missing
                               3,886                    0 Not indicated
                               9,196                    1 Indicated

B3D       300  2  INDIC                                 N Cognitive; recall; lives in nursing home

                               6,410                    . Missing
                               4,098                    0 Not indicated
                               8,982                    1 Indicated

B3E       302  2  INDIC                                 N Cognitive; recall; none of the above

                               6,408                    . Missing
                              10,812                    0 Not indicated
                               2,270                    1 Indicated

B4        304  2  COGNITIV                              N Cognitive; daily decision making skills

                               4,402                    . Missing
                               3,561                    0 Independent
                               3,383                    1 Modified independence
                               6,188                    2 Moderately impaired
                               1,956                    3 Severely impaired

B5A       306  2  COGNITIV                              N Cognitive; delirium, easily distracted

                               4,400                    . Missing
                              12,642                    0 Independent
                               2,369                    1 Modified independence
                                  79                    2 Moderately impaired
                                   0                    3 Severely impaired

B5B       308  2  COGNITIV                              N Cognitive; delirium, altered perception

                               4,402                    . Missing
                              13,510                    0 Independent
                               1,500                    1 Modified independence
                                  78                    2 Moderately impaired
                                   0                    3 Severely impaired

B5C       310  2  COGNITIV                              N Cognitive; delirium, disorganized speech

                               4,402                    . Missing
                              13,285                    0 Independent
                               1,741                    1 Modified independence
                                  62                    2 Moderately impaired
                                   0                    3 Severely impaired

B5D       312  2  COGNITIV                              N Cognitive; delirium, restlessness

                               4,402                    . Missing
                              12,992                    0 Independent
                               1,958                    1 Modified independence
                                 138                    2 Moderately impaired
                                   0                    3 Severely impaired

B5E       314  2  COGNITIV                              N Cognitive; delirium, lethargy

                               4,402                    . Missing
                              14,388                    0 Independent
                                 630                    1 Modified independence
                                  70                    2 Moderately impaired
                                   0                    3 Severely impaired

B5F       316  2  COGNITIV                              N Cognitive; delirium, varied function

                               4,400                    . Missing
                              11,536                    0 Independent
                               3,448                    1 Modified independence
                                 106                    2 Moderately impaired
                                   0                    3 Severely impaired

B6        318  2  CHANGE                                N Cognitive; change in last 90 days

                              14,528                    . Missing
                               4,473                    0 No change
                                 122                    1 Improved
                                 367                    2 Deteriorated

C1        320  2  HEAR                                  N Comm; hearing ability

                              14,525                    . Missing
                               3,659                    0 Hears adequately
                                 860                    1 Minimal difficulty
                                 413                    2 Hears in special situations only
                                  33                    3 Highly impaired

C2A       322  2  INDIC                                 N Comm; hearing aid, present and used

                              14,528                    . Missing
                               4,620                    0 Not indicated
                                 342                    1 Indicated

C2B       324  2  INDIC                                 N Comm; hearing aid, present and not used

                              14,528                    . Missing
                               4,848                    0 Not indicated
                                 114                    1 Indicated

C2C       326  2  INDIC                                 N Comm; other receptive used

                              14,528                    . Missing
                               4,918                    0 Not indicated
                                  44                    1 Indicated

C2D       328  2  INDIC                                 N Comm; none of above comm methods used

                              14,528                    . Missing
                                 494                    0 Not indicated
                               4,468                    1 Indicated

C3A       330  2  INDIC                                 N Comm; modes, speech

                              14,524                    . Missing
                                 139                    0 Not indicated
                               4,827                    1 Indicated

C3B       332  2  INDIC                                 N Comm; modes, writing messages to clarify

                              14,528                    . Missing
                               4,924                    0 Not indicated
                                  38                    1 Indicated

C3C       334  2  INDIC                                 N Comm; modes, ASL or braille

                              14,528                    . Missing
                               4,962                    0 Not indicated
                                   0                    1 Indicated

C3D       336  2  INDIC                                 N Comm; modes, signs, gestures, or sounds

                              14,528                    . Missing
                               4,470                    0 Not indicated
                                 492                    1 Indicated

C3E       338  2  INDIC                                 N Comm; modes, communication board

                              14,528                    . Missing
                               4,902                    0 Not indicated
                                  60                    1 Indicated

C3F       340  2  INDIC                                 N Comm; modes, other

                              14,528                    . Missing
                               4,910                    0 Not indicated
                                  52                    1 Indicated

C3G       342  2  INDIC                                 N Comm; modes, none of above

                              14,524                    . Missing
                               4,898                    0 Not indicated
                                  68                    1 Indicated

C4        344  2  UNDERSTO                              N Comm; ability to make self understood

                               4,406                    . Missing
                               8,956                    0 Understood
                               3,425                    1 Usually understood
                               1,894                    2 Sometimes understood
                                 809                    3 Rarely/Never understood

C5        346  2  CLEAR                                 N Comm, speech clarity

                              14,524                    . Missing
                               4,179                    0 clear speech
                                 681                    1 unclear speech
                                 106                    2 no speech

C6        348  2  UNDERSTA                              N Comm; ability to understand others

                               4,404                    . Missing
                               7,888                    0 Understands
                               4,064                    1 Usually understands
                               2,479                    2 Sometimes understands
                                 655                    3 Rarely/Never understands

C7        350  2  CHANGE                                N Comm; change in last 90 days

                              14,528                    . Missing
                               4,638                    0 No change
                                  51                    1 Improved
                                 273                    2 Deteriorated

D1        352  2  ADEQUATE                              N Vision

                              10,853                    . Missing
                               5,857                    0 Adequate
                               1,756                    1 Impaired
                                 511                    2 Moderately impaired
                                 420                    3 Highly impaired
                                  93                    4 Severely impaired

D2A       354  2  INDIC                                 N Vision; limitation, side vision problems

                              14,561                    . Missing
                               4,836                    0 Not indicated
                                  93                    1 Indicated

D2B       356  2  INDIC                                 N Vision; limitation, halos/rings/flashes

                              14,561                    . Missing
                               4,901                    0 Not indicated
                                  28                    1 Indicated

D2C       358  2  INDIC                                 N Vision; limitation, none of above

                              14,562                    . Missing
                                 119                    0 Not indicated
                               4,809                    1 Indicated

D3        360  2  YESNO                                 N Vision; corrective eyewear, etc.

                              14,553                    . Missing
                               1,612                    0 No
                               3,325                    1 Yes

E1A       362  2  INDICTH                               N Mood; negative statements

                               4,404                    . Missing
                              14,445                    0 Not exhibited in last 30 days
                                 581                    1 Exhibited up to 5 days week
                                  60                    2 Exhibited 6 to 7 days week

E1B       364  2  INDICTH                               N Mood; repetitive questions

                               4,403                    . Missing
                              14,267                    0 Not exhibited in last 30 days
                                 617                    1 Exhibited up to 5 days week
                                 203                    2 Exhibited 6 to 7 days week

E1C       366  2  INDICTH                               N Mood; repetitive verbalizations

                               4,403                    . Missing
                              14,083                    0 Not exhibited in last 30 days
                                 725                    1 Exhibited up to 5 days week
                                 279                    2 Exhibited 6 to 7 days week

E1D       368  2  INDICTH                               N Mood; persistent anger w/ self or others

                               4,401                    . Missing
                              13,127                    0 Not exhibited in last 30 days
                               1,680                    1 Exhibited up to 5 days week
                                 282                    2 Exhibited 6 to 7 days week

E1E       370  2  INDICTH                               N Mood; self deprecation

                               4,403                    . Missing
                              14,829                    0 Not exhibited in last 30 days
                                 234                    1 Exhibited up to 5 days week
                                  24                    2 Exhibited 6 to 7 days week

E1F       372  2  INDICTH                               N Mood; unrealistic fears

                               4,403                    . Missing
                              14,525                    0 Not exhibited in last 30 days
                                 493                    1 Exhibited up to 5 days week
                                  69                    2 Exhibited 6 to 7 days week

E1G       374  2  INDICTH                               N Mood; belief terrible going to happen

                               4,403                    . Missing
                              14,860                    0 Not exhibited in last 30 days
                                 214                    1 Exhibited up to 5 days week
                                  13                    2 Exhibited 6 to 7 days week

E1H       376  2  INDICTH                               N Mood; repetitive health complaints

                               4,403                    . Missing
                              13,654                    0 Not exhibited in last 30 days
                               1,184                    1 Exhibited up to 5 days week
                                 249                    2 Exhibited 6 to 7 days week

E1I       378  2  INDICTH                               N Mood; repetitive anxious complaints

                               4,403                    . Missing
                              13,341                    0 Not exhibited in last 30 days
                               1,355                    1 Exhibited up to 5 days week
                                 391                    2 Exhibited 6 to 7 days week

E1J       380  2  INDICTH                               N Mood; unpleasant mood in AM

                               4,401                    . Missing
                              14,466                    0 Not exhibited in last 30 days
                                 502                    1 Exhibited up to 5 days week
                                 121                    2 Exhibited 6 to 7 days week

E1K       382  2  INDICTH                               N Mood; insomnia/change in sleep pattern

                               4,401                    . Missing
                              13,694                    0 Not exhibited in last 30 days
                               1,255                    1 Exhibited up to 5 days week
                                 140                    2 Exhibited 6 to 7 days week

E1L       384  2  INDICTH                               N Mood; sad/worried facial expressions

                               4,404                    . Missing
                              11,736                    0 Not exhibited in last 30 days
                               2,575                    1 Exhibited up to 5 days week
                                 775                    2 Exhibited 6 to 7 days week

E1M       386  2  INDICTH                               N Mood; crying/tearfulness

                               4,402                    . Missing
                              14,211                    0 Not exhibited in last 30 days
                                 796                    1 Exhibited up to 5 days week
                                  81                    2 Exhibited 6 to 7 days week

E1N       388  2  INDICTH                               N Mood; repetitive physical movements

                               4,402                    . Missing
                              13,139                    0 Not exhibited in last 30 days
                               1,365                    1 Exhibited up to 5 days week
                                 584                    2 Exhibited 6 to 7 days week

E1O       390  2  INDICTH                               N Mood; withdrawal from activ of interest

                               4,402                    . Missing
                              14,512                    0 Not exhibited in last 30 days
                                 424                    1 Exhibited up to 5 days week
                                 152                    2 Exhibited 6 to 7 days week

E1P       392  2  INDICTH                               N Mood; reduced social interaction

                               4,402                    . Missing
                              14,208                    0 Not exhibited in last 30 days
                                 636                    1 Exhibited up to 5 days week
                                 244                    2 Exhibited 6 to 7 days week

E2        394  2  MODINDIC                              N Mood; persistence

                               4,402                    . Missing
                               9,242                    0 No mood indicators
                               3,625                    1 Indicators present, easily altered
                               2,221                    2 Indicators present, not easily altered

E3        396  2  CHANGE                                N Mood; change in last 90 days

                              14,529                    . Missing
                               4,314                    0 No change
                                 201                    1 Improved
                                 446                    2 Deteriorated

E4AA      398  2  BEHAVA                                N Behavior; wandering frequency

                               4,401                    . Missing
                              14,025                    0 Behavior not exhibited
                                 526                    1 1 to 3 days
                                 170                    2 4 to 6 days
                                 368                    3 Behavior exhibited daily

E4AB      400  2  BEHAVB                                N Behavior; wandering alterability

                               4,401                    . Missing
                              14,531                    0 Behavior not present or easily altered
                                 558                    1 Behavior not easily altered

E4BA      402  2  BEHAVA                                N Behavior; verbally abusive frequency

                               4,401                    . Missing
                              13,939                    0 Behavior not exhibited
                                 864                    1 1 to 3 days
                                 172                    2 4 to 6 days
                                 114                    3 Behavior exhibited daily

E4BB      404  2  BEHAVB                                N Behavior; verbally abusive alterability

                               4,401                    . Missing
                              14,384                    0 Behavior not present or easily altered
                                 705                    1 Behavior not easily altered

E4CA      406  2  BEHAVA                                N Behavior; physical abusive frequency

                               4,401                    . Missing
                              14,342                    0 Behavior not exhibited
                                 561                    1 1 to 3 days
                                 105                    2 4 to 6 days
                                  81                    3 Behavior exhibited daily

E4CB      408  2  BEHAVB                                N Behavior; physical abusive alterability

                               4,401                    . Missing
                              14,626                    0 Behavior not present or easily altered
                                 463                    1 Behavior not easily altered

E4DA      410  2  BEHAVA                                N Behavior; soc inappropriate frequency

                               4,401                    . Missing
                              13,714                    0 Behavior not exhibited
                                 842                    1 1 to 3 days
                                 278                    2 4 to 6 days
                                 255                    3 Behavior exhibited daily

E4DB      412  2  BEHAVB                                N Behavior; soc inappropriate alterability

                               4,401                    . Missing
                              14,207                    0 Behavior not present or easily altered
                                 882                    1 Behavior not easily altered

E4EA      414  2  BEHAVA                                N Behavior; resists care frequency

                               4,401                    . Missing
                              12,592                    0 Behavior not exhibited
                               1,761                    1 1 to 3 days
                                 394                    2 4 to 6 days
                                 342                    3 Behavior exhibited daily

E4EB      416  2  BEHAVB                                N Behavior; resists care alterability

                               4,401                    . Missing
                              13,387                    0 Behavior not present or easily altered
                               1,702                    1 Behavior not easily altered

E5        418  2  CHANGE                                N Behavior; change in last 90 days

                              14,528                    . Missing
                               4,534                    0 No change
                                 147                    1 Improved
                                 281                    2 Deteriorated

F1A       420  2  INDIC                                 N Social; at ease interacting with others

                              14,552                    . Missing
                                 826                    0 Not indicated
                               4,112                    1 Indicated

F1B       422  2  INDIC                                 N Social; at ease in structured activities

                              14,552                    . Missing
                               2,240                    0 Not indicated
                               2,698                    1 Indicated

F1C       424  2  INDIC                                 N Social; at ease in self-init activities

                              14,552                    . Missing
                               2,304                    0 Not indicated
                               2,634                    1 Indicated

F1D       426  2  INDIC                                 N Social; establishes own goals

                              14,554                    . Missing
                               3,777                    0 Not indicated
                               1,159                    1 Indicated

F1E       428  2  INDIC                                 N Social; involvement in life of facility

                              14,554                    . Missing
                               4,102                    0 Not indicated
                                 834                    1 Indicated

F1F       430  2  INDIC                                 N Social; accepts invitations group activ

                              14,554                    . Missing
                               3,815                    0 Not indicated
                               1,121                    1 Indicated

F1G       432  2  INDIC                                 N Social; none of above

                              14,552                    . Missing
                               4,377                    0 Not indicated
                                 561                    1 Indicated

F2A       434  2  INDIC                                 N Social; open conflict with staff

                              14,554                    . Missing
                               4,807                    0 Not indicated
                                 129                    1 Indicated

F2B       436  2  INDIC                                 N Social; unhappy with roommate

                              14,554                    . Missing
                               4,886                    0 Not indicated
                                  50                    1 Indicated

F2C       438  2  INDIC                                 N Social; unhappy with other residents

                              14,554                    . Missing
                               4,903                    0 Not indicated
                                  33                    1 Indicated

F2D       440  2  INDIC                                 N Social; open conflict w/ fam/friend

                              14,554                    . Missing
                               4,846                    0 Not indicated
                                  90                    1 Indicated

F2E       442  2  INDIC                                 N Social; absence of contact w/ fam/friend

                              14,554                    . Missing
                               4,830                    0 Not indicated
                                 106                    1 Indicated

F2F       444  2  INDIC                                 N Social; recent loss of close fam/friend

                              14,554                    . Missing
                               4,855                    0 Not indicated
                                  81                    1 Indicated

F2G       446  2  INDIC                                 N Social; does not adjust to routine chang

                              14,554                    . Missing
                               4,506                    0 Not indicated
                                 430                    1 Indicated

F2H       448  2  INDIC                                 N Social; none of above

                              14,554                    . Missing
                                 735                    0 Not indicated
                               4,201                    1 Indicated

F3A       450  2  INDIC                                 N Social; strong identity in past role

                              14,554                    . Missing
                               4,378                    0 Not indicated
                                 558                    1 Indicated

F3B       452  2  INDIC                                 N Social; sadness/anger at loss of role

                              14,554                    . Missing
                               4,737                    0 Not indicated
                                 199                    1 Indicated

F3C       454  2  INDIC                                 N Social; routine diff than prior pattern

                              14,554                    . Missing
                               4,629                    0 Not indicated
                                 307                    1 Indicated

F3D       456  2  INDIC                                 N Social; none of above

                              14,554                    . Missing
                                 783                    0 Not indicated
                               4,153                    1 Indicated

G1AA      458  2  ADLA                                  N ADL; bed mobility, self-perform

                               4,396                    . Missing
                               3,314                    0 Independent
                                 973                    1 Supervision
                               2,712                    2 Limited assistance
                               6,054                    3 Extensive assistance
                               2,035                    4 Total dependence
                                   6                    8 Activity did not occur

G1AB      460  2  ADLB                                  N ADL; bed mobility, supported

                               6,461                    . Missing
                               2,554                    0 No setup or physical help from staff
                                 858                    1 Setup help only
                               5,980                    2 One person physical assist
                               3,631                    3 Two+ persons physical assist
                                   6                    8 Activity did not occur

G1BA      462  2  ADLA                                  N ADL; transfer, self-perform

                               4,396                    . Missing
                               2,325                    0 Independent
                                 892                    1 Supervision
                               2,861                    2 Limited assistance
                               6,149                    3 Extensive assistance
                               2,767                    4 Total dependence
                                 100                    8 Activity did not occur

G1BB      464  2  ADLB                                  N ADL; transfer, supported

                               6,461                    . Missing
                               1,768                    0 No setup or physical help from staff
                                 721                    1 Setup help only
                               5,878                    2 One person physical assist
                               4,568                    3 Two+ persons physical assist
                                  94                    8 Activity did not occur

G1CA      466  2  ADLA                                  N ADL; walk in room, self-perform

                               4,397                    . Missing
                               2,278                    0 Independent
                               1,226                    1 Supervision
                               2,473                    2 Limited assistance
                               2,414                    3 Extensive assistance
                                  81                    4 Total dependence
                               6,621                    8 Activity did not occur

G1CB      468  2  ADLB                                  N ADL; walk in room, supported

                               6,463                    . Missing
                               1,832                    0 No setup or physical help from staff
                                 896                    1 Setup help only
                               3,936                    2 One person physical assist
                                 688                    3 Two+ persons physical assist
                               5,675                    8 Activity did not occur

G1DA      470  2  ADLA                                  N ADL; walk in corridor, self-perform

                               4,397                    . Missing
                               1,905                    0 Independent
                               1,345                    1 Supervision
                               2,460                    2 Limited assistance
                               2,130                    3 Extensive assistance
                                  80                    4 Total dependence
                               7,173                    8 Activity did not occur

G1DB      472  2  ADLB                                  N ADL; walk in corridor, supported

                               6,463                    . Missing
                               1,578                    0 No setup or physical help from staff
                                 932                    1 Setup help only
                               3,790                    2 One person physical assist
                                 561                    3 Two+ persons physical assist
                               6,166                    8 Activity did not occur

G1EA      474  2  ADLA                                  N ADL; locomotion on unit, self-perform

                               4,397                    . Missing
                               3,690                    0 Independent
                               1,629                    1 Supervision
                               2,497                    2 Limited assistance
                               3,162                    3 Extensive assistance
                               3,851                    4 Total dependence
                                 264                    8 Activity did not occur

G1EB      476  2  ADLB                                  N ADL; locomotion on unit, supported

                               6,462                    . Missing
                               2,664                    0 No setup or physical help from staff
                               1,483                    1 Setup help only
                               8,376                    2 One person physical assist
                                 253                    3 Two+ persons physical assist
                                 252                    8 Activity did not occur

G1FA      478  2  ADLA                                  N ADL; locomotion off unit, self-perform

                               4,400                    . Missing
                               3,027                    0 Independent
                               1,308                    1 Supervision
                               2,078                    2 Limited assistance
                               3,038                    3 Extensive assistance
                               4,743                    4 Total dependence
                                 896                    8 Activity did not occur

G1FB      480  2  ADLB                                  N ADL; locomotion off unit, supported

                               6,464                    . Missing
                               2,206                    0 No setup or physical help from staff
                               1,072                    1 Setup help only
                               8,772                    2 One person physical assist
                                 174                    3 Two+ persons physical assist
                                 802                    8 Activity did not occur

G1GA      482  2  ADLA                                  N ADL; dressing, self-perform

                               4,397                    . Missing
                               1,221                    0 Independent
                                 722                    1 Supervision
                               2,922                    2 Limited assistance
                               7,148                    3 Extensive assistance
                               3,017                    4 Total dependence
                                  63                    8 Activity did not occur

G1GB      484  2  ADLB                                  N ADL; dressing, supported

                               6,462                    . Missing
                                 876                    0 No setup or physical help from staff
                                 735                    1 Setup help only
                              10,572                    2 One person physical assist
                                 783                    3 Two+ persons physical assist
                                  62                    8 Activity did not occur

G1HA      486  2  ADLA                                  N ADL; eating, self-perform

                               4,396                    . Missing
                               6,530                    0 Independent
                               4,009                    1 Supervision
                               1,381                    2 Limited assistance
                               1,365                    3 Extensive assistance
                               1,805                    4 Total dependence
                                   4                    8 Activity did not occur

G1HB      488  2  ADLB                                  N ADL; eating, supported

                               6,461                    . Missing
                               1,356                    0 No setup or physical help from staff
                               7,249                    1 Setup help only
                               4,398                    2 One person physical assist
                                  22                    3 Two+ persons physical assist
                                   4                    8 Activity did not occur

G1IA      490  2  ADLA                                  N ADL; toilet use, self-perform

                               4,396                    . Missing
                               1,771                    0 Independent
                                 673                    1 Supervision
                               2,460                    2 Limited assistance
                               6,276                    3 Extensive assistance
                               3,905                    4 Total dependence
                                   9                    8 Activity did not occur

G1IB      492  2  ADLB                                  N ADL; toilet use, supported

                               6,461                    . Missing
                               1,427                    0 No setup or physical help from staff
                                 514                    1 Setup help only
                               8,029                    2 One person physical assist
                               3,050                    3 Two+ persons physical assist
                                   9                    8 Activity did not occur

G1JA      494  2  ADLA                                  N ADL; personal hygiene, self-perform

                               4,397                    . Missing
                               1,320                    0 Independent
                                 979                    1 Supervision
                               3,089                    2 Limited assistance
                               6,073                    3 Extensive assistance
                               3,630                    4 Total dependence
                                   2                    8 Activity did not occur

G1JB      496  2  ADLB                                  N ADL; personal hygiene, supported

                               6,462                    . Missing
                                 760                    0 No setup or physical help from staff
                               1,133                    1 Setup help only
                              10,479                    2 One person physical assist
                                 654                    3 Two+ persons physical assist
                                   2                    8 Activity did not occur

G2A       498  2  BATHING                               N ADL; bathing, self perform

                               4,400                    . Missing
                                 203                    0 Independent
                                 640                    1 Supervision
                                 952                    2 Phys help limited to transfer only
                               7,808                    3 Phys help in part of bathing activity
                               5,389                    4 Total dependence
                                  98                    8 Activity did not occur

G2B       500  2  ADLB                                  N ADL; bathing, supported

                              14,527                    . Missing
                                  98                    0 No setup or physical help from staff
                                 246                    1 Setup help only
                               4,074                    2 One person physical assist
                                 505                    3 Two+ persons physical assist
                                  40                    8 Activity did not occur

G3A       502  2  BALANCE                               N ADL; balance while standing

                               6,438                    . Missing
                               1,137                    0 Maintained position
                               1,414                    1 Unsteady
                               3,104                    2 Partial physical support
                               7,397                    3 Not able to attempt test

G3B       504  2  BALANCE                               N ADL; balance while sitting

                               6,401                    . Missing
                               7,353                    0 Maintained position
                               1,530                    1 Unsteady
                               2,212                    2 Partial physical support
                               1,994                    3 Not able to attempt test

G4AA      506  2  RANGE                                 N ADL; neck, range of motion

                               4,398                    . Missing
                              14,020                    0 No limitation
                                 273                    1 Limitation on one side
                                 799                    2 Limitation on both sides

G4AB      508  2  VOL                                   N ADL; neck, voluntary motion

                               4,398                    . Missing
                              14,034                    0 No loss
                                 942                    1 Partial loss
                                 116                    2 Full loss

G4BA      510  2  RANGE                                 N ADL; arm, range of motion

                               4,398                    . Missing
                              11,291                    0 No limitation
                               2,145                    1 Limitation on one side
                               1,656                    2 Limitation on both sides

G4BB      512  2  VOL                                   N ADL; arm, voluntary motion

                               4,404                    . Missing
                              11,567                    0 No loss
                               2,960                    1 Partial loss
                                 559                    2 Full loss

G4CA      514  2  RANGE                                 N ADL; hand, range of motion

                               4,398                    . Missing
                              12,430                    0 No limitation
                               1,823                    1 Limitation on one side
                                 839                    2 Limitation on both sides

G4CB      516  2  VOL                                   N ADL; hand, voluntary motion

                               4,404                    . Missing
                              12,218                    0 No loss
                               2,320                    1 Partial loss
                                 548                    2 Full loss

G4DA      518  2  RANGE                                 N ADL; leg, range of motion

                               4,398                    . Missing
                              10,147                    0 No limitation
                               2,868                    1 Limitation on one side
                               2,077                    2 Limitation on both sides

G4DB      520  2  VOL                                   N ADL; leg, voluntary motion

                               4,404                    . Missing
                              10,248                    0 No loss
                               4,106                    1 Partial loss
                                 732                    2 Full loss

G4EA      522  2  RANGE                                 N ADL; foot, range of motion

                               4,398                    . Missing
                              11,648                    0 No limitation
                               1,926                    1 Limitation on one side
                               1,518                    2 Limitation on both sides

G4EB      524  2  VOL                                   N ADL; foot, voluntary motion

                               4,404                    . Missing
                              11,364                    0 No loss
                               2,872                    1 Partial loss
                                 850                    2 Full loss

G4FA      526  2  RANGE                                 N ADL; other, range of motion

                               4,449                    . Missing
                              14,468                    0 No limitation
                                 176                    1 Limitation on one side
                                 397                    2 Limitation on both sides

G4FB      528  2  VOL                                   N ADL; other, voluntary motion

                               4,455                    . Missing
                              14,446                    0 No loss
                                 473                    1 Partial loss
                                 116                    2 Full loss

G5A       530  2  INDIC                                 N ADL; used cane

                              14,524                    . Missing
                               2,864                    0 Not indicated
                               2,102                    1 Indicated

G5B       532  2  INDIC                                 N ADL; wheeled self

                              10,151                    . Missing
                               5,332                    0 Not indicated
                               4,007                    1 Indicated

G5C       534  2  INDIC                                 N ADL; other person wheeled

                              14,528                    . Missing
                               1,864                    0 Not indicated
                               3,098                    1 Indicated

G5D       536  2  INDIC                                 N ADL; wheelchair primary mode

                              14,528                    . Missing
                               1,817                    0 Not indicated
                               3,145                    1 Indicated

G5E       538  2  INDIC                                 N ADL; none of above

                              14,524                    . Missing
                               4,246                    0 Not indicated
                                 720                    1 Indicated

G6A       540  2  INDIC                                 N ADL; transfer, bedfast

                               4,409                    . Missing
                              14,619                    0 Not indicated
                                 462                    1 Indicated

G6B       542  2  INDIC                                 N ADL; transfer, bed rails used

                               4,410                    . Missing
                               7,277                    0 Not indicated
                               7,803                    1 Indicated

G6C       544  2  INDIC                                 N ADL; transfer, lifted manually

                              14,524                    . Missing
                               4,166                    0 Not indicated
                                 800                    1 Indicated

G6D       546  2  INDIC                                 N ADL; transfer, lifted mechanically

                              14,528                    . Missing
                               4,374                    0 Not indicated
                                 588                    1 Indicated

G6E       548  2  INDIC                                 N ADL; transfer, transfer aid

                              14,528                    . Missing
                               3,003                    0 Not indicated
                               1,959                    1 Indicated

G6F       550  2  INDIC                                 N ADL; transfer, none of above

                              12,161                    . Missing
                               4,958                    0 Not indicated
                               2,371                    1 Indicated

G7        552  2  YESNO                                 N ADL; task segmentation

                               6,387                    . Missing
                               7,493                    0 No
                               5,610                    1 Yes

G8A       554  2  INDIC                                 N ADL; rehab potential, resident believes

                              14,524                    . Missing
                               3,499                    0 Not indicated
                               1,467                    1 Indicated

G8B       556  2  INDIC                                 N ADL; rehab potential, staff believes

                              14,524                    . Missing
                               3,255                    0 Not indicated
                               1,711                    1 Indicated

G8C       558  2  INDIC                                 N ADL; rehab potential, slow

                              14,524                    . Missing
                               4,400                    0 Not indicated
                                 566                    1 Indicated

G8D       560  2  INDIC                                 N ADL; rehab potential, diff in AM and PM

                              14,528                    . Missing
                               4,587                    0 Not indicated
                                 375                    1 Indicated

G8E       562  2  INDIC                                 N ADL; rehab potential, none of above

                              14,524                    . Missing
                               2,203                    0 Not indicated
                               2,763                    1 Indicated

G9        564  2  CHANGE                                N ADL; change in last 90 days

                              14,529                    . Missing
                               2,947                    0 No change
                                 420                    1 Improved
                               1,594                    2 Deteriorated

H1A       566  2  CONTINEN                              N Continence; bowel

                               4,398                    . Missing
                               7,070                    0 Continent
                               1,186                    1 Usually continent
                                 924                    2 Occasionally incontinent
                               1,442                    3 Frequently incontinent
                               4,470                    4 Incontinent

H1B       568  2  CONTINEN                              N Continence; bladder

                               4,397                    . Missing
                               4,935                    0 Continent
                               1,409                    1 Usually continent
                               1,501                    2 Occasionally incontinent
                               2,593                    3 Frequently incontinent
                               4,655                    4 Incontinent

H2A       570  2  INDIC                                 N Continence; bowel regular

                              14,524                    . Missing
                               1,014                    0 Not indicated
                               3,952                    1 Indicated

H2B       572  2  INDIC                                 N Continence; bowel constipation

                              14,527                    . Missing
                               4,472                    0 Not indicated
                                 491                    1 Indicated

H2C       574  2  INDIC                                 N Continence; bowel diarrhea

                               6,415                    . Missing
                              12,736                    0 Not indicated
                                 339                    1 Indicated

H2D       576  2  INDIC                                 N Continence; bowel fecal impaction

                               4,430                    . Missing
                              15,051                    0 Not indicated
                                   9                    1 Indicated

H2E       578  2  INDIC                                 N Continence; scheduled plan

                              12,162                    . Missing
                               4,247                    0 Not indicated
                               3,081                    1 Indicated

H3A       580  2  INDIC                                 N Continence; none of above

                               4,418                    . Missing
                              10,733                    0 Not indicated
                               4,339                    1 Indicated

H3B       582  2  INDIC                                 N Continence; bladder retaining plan

                               4,418                    . Missing
                              14,897                    0 Not indicated
                                 175                    1 Indicated

H3C       584  2  INDIC                                 N Continence; external condom catheter

                               4,418                    . Missing
                              15,052                    0 Not indicated
                                  20                    1 Indicated

H3D       586  2  INDIC                                 N Continence; indwelling catheter

                               4,418                    . Missing
                              13,840                    0 Not indicated
                               1,232                    1 Indicated

H3E       588  2  INDIC                                 N Continence; intermittent catheter

                              14,528                    . Missing
                               4,934                    0 Not indicated
                                  28                    1 Indicated

H3F       590  2  INDIC                                 N Continence; did not use commode/urinal

                              14,528                    . Missing
                               4,403                    0 Not indicated
                                 559                    1 Indicated

H3G       592  2  INDIC                                 N Continence; pads/briefs used

                              14,528                    . Missing
                               1,976                    0 Not indicated
                               2,986                    1 Indicated

H3H       594  2  INDIC                                 N Continence; enemas/irrigation

                              14,528                    . Missing
                               4,932                    0 Not indicated
                                  30                    1 Indicated

H3I       596  2  INDIC                                 N Continence; ostomy present

                               4,418                    . Missing
                              14,867                    0 Not indicated
                                 205                    1 Indicated

H3J       598  2  INDIC                                 N Continence; none of above

                              12,100                    . Missing
                               4,430                    0 Not indicated
                               2,960                    1 Indicated

H4        600  2  CHANGE                                N Continence; change in last 90 days

                              14,529                    . Missing
                               4,286                    0 No change
                                 160                    1 Improved
                                 515                    2 Deteriorated

I1A       602  2  INDIC                                 N Diag; diabetes mellitus

                               6,427                    . Missing
                               9,226                    0 Not indicated
                               3,837                    1 Indicated

I1B       604  2  INDIC                                 N Diag; hyperthyroidism

                              14,528                    . Missing
                               4,914                    0 Not indicated
                                  48                    1 Indicated

I1C       606  2  INDIC                                 N Diag; hypothyroidism

                              14,528                    . Missing
                               4,020                    0 Not indicated
                                 942                    1 Indicated

I1D       608  2  INDIC                                 N Diag; arteriosclerotic heart disease

                               9,902                    . Missing
                               8,266                    0 Not indicated
                               1,322                    1 Indicated

I1E       610  2  INDIC                                 N Diag; cardiac dysrhythmias

                              14,528                    . Missing
                               4,248                    0 Not indicated
                                 714                    1 Indicated

I1F       612  2  INDIC                                 N Diag; congestive heart failure

                               9,902                    . Missing
                               7,647                    0 Not indicated
                               1,941                    1 Indicated

I1G       614  2  INDIC                                 N Diag; deep vein thrombosis

                              14,528                    . Missing
                               4,894                    0 Not indicated
                                  68                    1 Indicated

I1H       616  2  INDIC                                 N Diag; hypertension

                              14,524                    . Missing
                               1,677                    0 Not indicated
                               3,289                    1 Indicated

I1I       618  2  INDIC                                 N Diag; hypotension

                              14,528                    . Missing
                               4,917                    0 Not indicated
                                  45                    1 Indicated

I1J       620  2  INDIC                                 N Diag; peripheral vascular disease

                               9,902                    . Missing
                               8,536                    0 Not indicated
                               1,052                    1 Indicated

I1K       622  2  INDIC                                 N Diag; other cardiovascular disease

                              14,524                    . Missing
                               3,955                    0 Not indicated
                               1,011                    1 Indicated

I1L       624  2  INDIC                                 N Diag; arthritis

                              14,528                    . Missing
                               3,232                    0 Not indicated
                               1,730                    1 Indicated

I1M       626  2  INDIC                                 N Diag; hip fracture

                               6,386                    . Missing
                              12,310                    0 Not indicated
                                 794                    1 Indicated

I1N       628  2  INDIC                                 N Diag; missing limb (e.g., amputation)

                              14,528                    . Missing
                               4,898                    0 Not indicated
                                  64                    1 Indicated

I1O       630  2  INDIC                                 N Diag; osteoporosis

                              14,528                    . Missing
                               3,937                    0 Not indicated
                               1,025                    1 Indicated

I1P       632  2  INDIC                                 N Diag; pathological bone fracture

                              14,528                    . Missing
                               4,913                    0 Not indicated
                                  49                    1 Indicated

I1Q       634  2  INDIC                                 N Diag; alzheimers disease

                              14,527                    . Missing
                               4,036                    0 Not indicated
                                 927                    1 Indicated

I1R       636  2  INDIC                                 N Diag; aphasia

                               6,386                    . Missing
                              12,452                    0 Not indicated
                                 652                    1 Indicated

I1S       638  2  INDIC                                 N Diag; cerebral palsy

                               6,386                    . Missing
                              13,039                    0 Not indicated
                                  65                    1 Indicated

I1T       640  2  INDIC                                 N Diag; cerebrovascular accident (stroke)

                               6,386                    . Missing
                              10,189                    0 Not indicated
                               2,915                    1 Indicated

I1U       642  2  INDIC                                 N Diag; dementia other than alzheimers

                              14,527                    . Missing
                               3,358                    0 Not indicated
                               1,605                    1 Indicated

I1V       644  2  INDIC                                 N Diag; hemiplegia/hemiparesis

                               6,386                    . Missing
                              11,632                    0 Not indicated
                               1,472                    1 Indicated

I1W       646  2  INDIC                                 N Diag; multiple sclerosis

                               6,386                    . Missing
                              12,911                    0 Not indicated
                                 193                    1 Indicated

I1X       648  2  INDIC                                 N Diag; paraplegia

                               9,902                    . Missing
                               9,526                    0 Not indicated
                                  62                    1 Indicated

I1Y       650  2  INDIC                                 N Diag; parkinsons disease

                              14,528                    . Missing
                               4,657                    0 Not indicated
                                 305                    1 Indicated

I1Z       652  2  INDIC                                 N Diag; quadriplegia

                               6,386                    . Missing
                              13,079                    0 Not indicated
                                  25                    1 Indicated

I1AA      654  2  INDIC                                 N Diag; seizure disorder

                              14,527                    . Missing
                               4,557                    0 Not indicated
                                 406                    1 Indicated

I1BB      656  2  INDIC                                 N Diag; transient ischemic attack (TIA)

                              14,528                    . Missing
                               4,751                    0 Not indicated
                                 211                    1 Indicated

I1CC      658  2  INDIC                                 N Diag; traumatic brain injury

                              14,527                    . Missing
                               4,905                    0 Not indicated
                                  58                    1 Indicated

I1DD      660  2  INDIC                                 N Diag; anxiety disorder

                              14,528                    . Missing
                               4,042                    0 Not indicated
                                 920                    1 Indicated

I1EE      662  2  INDIC                                 N Diag; depression

                               6,386                    . Missing
                               7,008                    0 Not indicated
                               6,096                    1 Indicated

I1FF      664  2  INDIC                                 N Diag; manic depression (bipolar disease)

                               6,387                    . Missing
                              12,761                    0 Not indicated
                                 342                    1 Indicated

I1GG      666  2  INDIC                                 N Diag; schizophrenia

                               9,902                    . Missing
                               9,145                    0 Not indicated
                                 443                    1 Indicated

I1HH      668  2  INDIC                                 N Diag; asthma

                               9,902                    . Missing
                               9,310                    0 Not indicated
                                 278                    1 Indicated

I1II      670  2  INDIC                                 N Diag; emphysema/COPD

                               9,902                    . Missing
                               8,023                    0 Not indicated
                               1,565                    1 Indicated

I1JJ      672  2  INDIC                                 N Diag; cataracts

                              14,528                    . Missing
                               4,516                    0 Not indicated
                                 446                    1 Indicated

I1KK      674  2  INDIC                                 N Diag; diabetic retinopathy

                              14,528                    . Missing
                               4,922                    0 Not indicated
                                  40                    1 Indicated

I1LL      676  2  INDIC                                 N Diag; glaucoma

                              14,528                    . Missing
                               4,506                    0 Not indicated
                                 456                    1 Indicated

I1MM      678  2  INDIC                                 N Diag; macular degeneration

                              14,528                    . Missing
                               4,754                    0 Not indicated
                                 208                    1 Indicated

I1NN      680  2  INDIC                                 N Diag; allergies

                              14,528                    . Missing
                               3,506                    0 Not indicated
                               1,456                    1 Indicated

I1OO      682  2  INDIC                                 N Diag; anemia

                              14,528                    . Missing
                               3,802                    0 Not indicated
                               1,160                    1 Indicated

I1PP      684  2  INDIC                                 N Diag; cancer

                              14,528                    . Missing
                               4,630                    0 Not indicated
                                 332                    1 Indicated

I1QQ      686  2  INDIC                                 N Diag; renal failure

                              14,527                    . Missing
                               4,707                    0 Not indicated
                                 256                    1 Indicated

I1RR      688  2  INDIC                                 N Diag; none of above

                              11,096                    . Missing
                               7,389                    0 Not indicated
                               1,005                    1 Indicated

I2A       690  2  INDIC                                 N Diag; antibiotic resistant infection

                               6,385                    . Missing
                              12,827                    0 Not indicated
                                 278                    1 Indicated

I2B       692  2  INDIC                                 N Diag; clostridium difficile (c. diff.)

                               6,385                    . Missing
                              12,965                    0 Not indicated
                                 140                    1 Indicated

I2C       694  2  INDIC                                 N Diag; conjunctivitis

                               6,385                    . Missing
                              13,025                    0 Not indicated
                                  80                    1 Indicated

I2D       696  2  INDIC                                 N Diag; HIV infection

                              10,780                    . Missing
                               8,709                    0 Not indicated
                                   1                    1 Indicated

I2E       698  2  INDIC                                 N Diag; pneumonia

                               6,385                    . Missing
                              12,567                    0 Not indicated
                                 538                    1 Indicated

I2F       700  2  INDIC                                 N Diag; respiratory infection

                               6,385                    . Missing
                              12,792                    0 Not indicated
                                 313                    1 Indicated

I2G       702  2  INDIC                                 N Diag; septicemia

                               6,385                    . Missing
                              12,987                    0 Not indicated
                                 118                    1 Indicated

I2H       704  2  INDIC                                 N Diag; sexually transmitted diseases

                              10,765                    . Missing
                               8,725                    0 Not indicated
                                   0                    1 Indicated

I2I       706  2  INDIC                                 N Diag; tuberculosis

                               6,385                    . Missing
                              13,098                    0 Not indicated
                                   7                    1 Indicated

I2J       708  2  INDIC                                 N Diag; urinary tract infection, 30 days

                               4,402                    . Missing
                              13,129                    0 Not indicated
                               1,959                    1 Indicated

I2K       710  2  INDIC                                 N Diag; viral hepatitus

                               6,385                    . Missing
                              13,095                    0 Not indicated
                                  10                    1 Indicated

I2L       712  2  INDIC                                 N Diag; wound infection

                               6,385                    . Missing
                              12,798                    0 Not indicated
                                 307                    1 Indicated

I2M       714  2  INDIC                                 N Diag; none of above

                               8,771                    . Missing
                               2,937                    0 Not indicated
                               7,782                    1 Indicated

I3A       716  7                                        C Diag; other diagnosis A

I3B       723  7                                        C Diag; other diagnosis B

I3C       730  7                                        C Diag; other diagnosis C

I3D       737  7                                        C Diag; other diagnosis D

I3E       744  7                                        C Diag; other diagnosis E

J1A       751  2  INDIC                                 N Health; weight gain/loss

                               6,391                    . Missing
                              12,863                    0 Not indicated
                                 236                    1 Indicated

J1B       753  2  INDIC                                 N Health; not able lie flat, short breath

                               6,386                    . Missing
                              12,700                    0 Not indicated
                                 404                    1 Indicated

J1C       755  2  INDIC                                 N Health; dehydrated

                               4,400                    . Missing
                              15,084                    0 Not indicated
                                   6                    1 Indicated

J1D       757  2  INDIC                                 N Health; insufficient fluid

                               6,385                    . Missing
                              12,842                    0 Not indicated
                                 263                    1 Indicated

J1E       759  2  INDIC                                 N Health; delusions

                               6,386                    . Missing
                              12,788                    0 Not indicated
                                 316                    1 Indicated

J1F       761  2  INDIC                                 N Health; dizziness/vertigo

                              14,526                    . Missing
                               4,878                    0 Not indicated
                                  86                    1 Indicated

J1G       763  2  INDIC                                 N Health; edema

                               6,385                    . Missing
                              10,106                    0 Not indicated
                               2,999                    1 Indicated

J1H       765  2  INDIC                                 N Health; fever

                               6,386                    . Missing
                              12,876                    0 Not indicated
                                 228                    1 Indicated

J1I       767  2  INDIC                                 N Health; hallucinations

                               4,400                    . Missing
                              14,875                    0 Not indicated
                                 215                    1 Indicated

J1J       769  2  INDIC                                 N Health; internal bleeding

                               6,385                    . Missing
                              12,972                    0 Not indicated
                                 133                    1 Indicated

J1K       771  2  INDIC                                 N Health; recurrent lung aspirations

                               6,385                    . Missing
                              13,042                    0 Not indicated
                                  63                    1 Indicated

J1L       773  2  INDIC                                 N Health; shortness of breath

                               6,386                    . Missing
                              12,157                    0 Not indicated
                                 947                    1 Indicated

J1M       775  2  INDIC                                 N Health; syncope (fainting)

                              14,527                    . Missing
                               4,949                    0 Not indicated
                                  14                    1 Indicated

J1N       777  2  INDIC                                 N Health; unsteady gate

                               6,381                    . Missing
                               7,843                    0 Not indicated
                               5,266                    1 Indicated

J1O       779  2  INDIC                                 N Health; vomiting

                               6,386                    . Missing
                              12,898                    0 Not indicated
                                 206                    1 Indicated

J1P       781  2  INDIC                                 N Health; none of above

                              12,165                    . Missing
                               3,643                    0 Not indicated
                               3,682                    1 Indicated

J2A       783  2  PAINA                                 N Health; pain symptoms, frequency

                               4,398                    . Missing
                               9,453                    0 No pain
                               3,794                    1 Pain less than daily
                               1,845                    2 Pain daily

J2B       785  2  PAINB                                 N Health; pain symptoms, intensity

                              13,858                    . Missing
                               2,297                    1 Mild pain
                               3,018                    2 Moderate pain
                                 317                    3 Horrible/Excruciating pain

J3A       787  2  INDIC                                 N Health; pain site, back

                              17,526                    . Missing
                               1,479                    0 Not indicated
                                 485                    1 Indicated

J3B       789  2  INDIC                                 N Health; pain site, bone

                              17,526                    . Missing
                               1,827                    0 Not indicated
                                 137                    1 Indicated

J3C       791  2  INDIC                                 N Health; pain site, chest

                              17,526                    . Missing
                               1,943                    0 Not indicated
                                  21                    1 Indicated

J3D       793  2  INDIC                                 N Health; pain site, headache

                              17,526                    . Missing
                               1,794                    0 Not indicated
                                 170                    1 Indicated

J3E       795  2  INDIC                                 N Health; pain site, hip

                              17,526                    . Missing
                               1,658                    0 Not indicated
                                 306                    1 Indicated

J3F       797  2  INDIC                                 N Health; pain site, incisional

                              17,526                    . Missing
                               1,761                    0 Not indicated
                                 203                    1 Indicated

J3G       799  2  INDIC                                 N Health; pain site, joint, other than hip

                              17,526                    . Missing
                               1,393                    0 Not indicated
                                 571                    1 Indicated

J3H       801  2  INDIC                                 N Health; pain site, soft tissue

                              17,526                    . Missing
                               1,679                    0 Not indicated
                                 285                    1 Indicated

J3I       803  2  INDIC                                 N Health; pain site, stomach pain

                              17,526                    . Missing
                               1,883                    0 Not indicated
                                  81                    1 Indicated

J3J       805  2  INDIC                                 N Health; pain site, other

                              17,526                    . Missing
                               1,157                    0 Not indicated
                                 807                    1 Indicated

J4A       807  2  INDIC                                 N Health; fell in last 30 days

                               4,402                    . Missing
                              12,176                    0 Not indicated
                               2,912                    1 Indicated

J4B       809  2  INDIC                                 N Health; fell in last 31-180 days

                               4,400                    . Missing
                              10,959                    0 Not indicated
                               4,131                    1 Indicated

J4C       811  2  INDIC                                 N Health; hip fracture in last 180 days

                               4,400                    . Missing
                              14,450                    0 Not indicated
                                 640                    1 Indicated

J4D       813  2  INDIC                                 N Health; other fracture in last 180 days

                               4,400                    . Missing
                              14,408                    0 Not indicated
                                 682                    1 Indicated

J4E       815  2  INDIC                                 N Health; none of above

                               4,400                    . Missing
                               6,157                    0 Not indicated
                               8,933                    1 Indicated

J5A       817  2  INDIC                                 N Health; diseases make patterns unstable

                               4,400                    . Missing
                               8,935                    0 Not indicated
                               6,155                    1 Indicated

J5B       819  2  INDIC                                 N Health; episode of recurrent problem

                               4,400                    . Missing
                              12,277                    0 Not indicated
                               2,813                    1 Indicated

J5C       821  2  INDIC                                 N Health; end-stage disease, 6 mo. to live

                               4,400                    . Missing
                              14,853                    0 Not indicated
                                 237                    1 Indicated

J5D       823  2  INDIC                                 N Health; none of above

                               4,400                    . Missing
                               7,343                    0 Not indicated
                               7,747                    1 Indicated

K1A       825  2  INDIC                                 N Nutri; chewing problem

                               6,404                    . Missing
                               9,441                    0 Not indicated
                               3,645                    1 Indicated

K1B       827  2  INDIC                                 N Nutri; swallowing problem

                               6,402                    . Missing
                              10,790                    0 Not indicated
                               2,298                    1 Indicated

K1C       829  2  INDIC                                 N Nutri; mouth pain

                              14,528                    . Missing
                               4,942                    0 Not indicated
                                  20                    1 Indicated

K1D       831  2  INDIC                                 N Nutri; none of above

                              11,099                    . Missing
                               2,948                    0 Not indicated
                               5,443                    1 Indicated

K2A       833  2                                        N Nutri; height

K2B       835  3                                        N Nutri; weight

K3A       838  2  YESNO                                 N Nutri; weight loss, 5% in last 30

                               4,527                    . Missing
                              13,682                    0 No
                               1,281                    1 Yes

K3B       840  2  YESNO                                 N Nutri; weight gain, 5% in last 30

                               4,523                    . Missing
                              14,159                    0 No
                                 808                    1 Yes

K4A       842  2  INDIC                                 N Nutri; complains about taste of food

                              14,528                    . Missing
                               4,928                    0 Not indicated
                                  34                    1 Indicated

K4B       844  2  INDIC                                 N Nutri; regular complaints of hunger

                              14,528                    . Missing
                               4,954                    0 Not indicated
                                   8                    1 Indicated

K4C       846  2  INDIC                                 N Nutri; leaves 25% food left uneaten

                              14,528                    . Missing
                               3,215                    0 Not indicated
                               1,747                    1 Indicated

K4D       848  2  INDIC                                 N Nutri; none of above

                              14,528                    . Missing
                               1,764                    0 Not indicated
                               3,198                    1 Indicated

K5A       850  2  INDIC                                 N Nutri; parenteral/IV

                               6,401                    . Missing
                              12,726                    0 Not indicated
                                 363                    1 Indicated

K5B       852  2  INDIC                                 N Nutri; feeding tube

                               4,414                    . Missing
                              14,399                    0 Not indicated
                                 677                    1 Indicated

K5C       854  2  INDIC                                 N Nutri; mechanically altered diet

                              14,529                    . Missing
                               3,429                    0 Not indicated
                               1,532                    1 Indicated

K5D       856  2  INDIC                                 N Nutri; syringe, oral feeding

                              14,529                    . Missing
                               4,955                    0 Not indicated
                                   6                    1 Indicated

K5E       858  2  INDIC                                 N Nutri; therapeutic diet

                              14,524                    . Missing
                               2,361                    0 Not indicated
                               2,605                    1 Indicated

K5F       860  2  INDIC                                 N Nutri; dietary supplement before meals

                              14,528                    . Missing
                               3,646                    0 Not indicated
                               1,316                    1 Indicated

K5G       862  2  INDIC                                 N Nutri; plate guard, built-up utensil,...

                              14,528                    . Missing
                               4,732                    0 Not indicated
                                 230                    1 Indicated

K5H       864  2  INDIC                                 N Nutri; planned weight change program

                               4,416                    . Missing
                              12,861                    0 Not indicated
                               2,213                    1 Indicated

K5I       866  2  INDIC                                 N Nutri; none of above

                              12,096                    . Missing
                               4,412                    0 Not indicated
                               2,982                    1 Indicated

K6A       868  2  CALORIES                              N Nutri; parenteral, total calories

                              18,523                    . Missing
                                 293                    0 None
                                  58                    1 1% - 25%
                                  32                    2 26% - 50%
                                  38                    3 51% - 75%
                                 546                    4 76% - 100%

K6B       870  2  FLUID                                 N Nutri; parenteral, fluid intake

                              18,523                    . Missing
                                  19                    0 None
                                 167                    1 1 to 500cc/day
                                 110                    2 501 to 1000cc/day
                                 161                    3 1001 to 1500cc/day
                                 284                    4 1501 to 2000cc/day
                                 226                    5 2001 or more cc/day

L1A       872  2  INDIC                                 N Dental; debris present prior to bed

                              14,554                    . Missing
                               4,922                    0 Not indicated
                                  14                    1 Indicated

L1B       874  2  INDIC                                 N Dental; dentures or removable bridge

                              14,550                    . Missing
                               2,800                    0 Not indicated
                               2,140                    1 Indicated

L1C       876  2  INDIC                                 N Dental; some/all natural teeth lost

                              14,554                    . Missing
                               3,569                    0 Not indicated
                               1,367                    1 Indicated

L1D       878  2  INDIC                                 N Dental; broken or loose teeth

                              14,554                    . Missing
                               4,702                    0 Not indicated
                                 234                    1 Indicated

L1E       880  2  INDIC                                 N Dental; inflamed gums

                              14,554                    . Missing
                               4,914                    0 Not indicated
                                  22                    1 Indicated

L1F       882  2  INDIC                                 N Dental; daily cleaning of teeth/dentures

                              14,550                    . Missing
                                  39                    0 Not indicated
                               4,901                    1 Indicated

L1G       884  2  INDIC                                 N Dental; none of above

                              14,550                    . Missing
                               4,932                    0 Not indicated
                                   8                    1 Indicated

M1A       886  2                                        N Skin; number of stage 1 ulcers

M1B       888  2                                        N Skin; number of stage 2 ulcers

M1C       890  2                                        N Skin; number of stage 3 ulcers

M1D       892  2                                        N Skin; number of stage 4 ulcers

M2A       894  2  ULCERSTA                              N Skin; highest stage, pressure ulcer

                               4,396                    . Missing
                              13,608                    0 None
                                 390                    1 Stage one
                                 734                    2 Stage two
                                 125                    3 Stage three
                                 237                    4 Stage four

M2B       896  2  ULCERSTA                              N Skin; highest stage, stasis ulcer

                               4,396                    . Missing
                              14,799                    0 None
                                  16                    1 Stage one
                                 126                    2 Stage two
                                  73                    3 Stage three
                                  80                    4 Stage four

M3        898  2  YESNO                                 N Skin; ulcer resolved in last 90 days

                               9,914                    . Missing
                               8,806                    0 No
                                 770                    1 Yes

M4A       900  2  INDIC                                 N Skin; abrasions, bruises

                               6,382                    . Missing
                               9,606                    0 Not indicated
                               3,502                    1 Indicated

M4B       902  2  INDIC                                 N Skin; burns, 2nd or 3rd degree

                               6,385                    . Missing
                              13,095                    0 Not indicated
                                  10                    1 Indicated

M4C       904  2  INDIC                                 N Skin; open lesions, not ulcer/rash/cut

                               6,385                    . Missing
                              12,876                    0 Not indicated
                                 229                    1 Indicated

M4D       906  2  INDIC                                 N Skin; rashes

                               6,386                    . Missing
                              11,809                    0 Not indicated
                               1,295                    1 Indicated

M4E       908  2  INDIC                                 N Skin; desensitized to pain or pressure

                               6,385                    . Missing
                              12,195                    0 Not indicated
                                 910                    1 Indicated

M4F       910  2  INDIC                                 N Skin; tears or cuts, other than surgery

                               6,385                    . Missing
                              12,301                    0 Not indicated
                                 804                    1 Indicated

M4G       912  2  INDIC                                 N Skin; surgical wounds

                               6,385                    . Missing
                              11,830                    0 Not indicated
                               1,275                    1 Indicated

M4H       914  2  INDIC                                 N Skin; none of above

                               6,384                    . Missing
                               5,778                    0 Not indicated
                               7,328                    1 Indicated

M5A       916  2  INDIC                                 N Skin; pressure rel device for chair

                               6,385                    . Missing
                               7,163                    0 Not indicated
                               5,942                    1 Indicated

M5B       918  2  INDIC                                 N Skin; pressure rel device for bed

                               6,385                    . Missing
                               3,418                    0 Not indicated
                               9,687                    1 Indicated

M5C       920  2  INDIC                                 N Skin; turning/repositioning program

                               6,385                    . Missing
                               8,294                    0 Not indicated
                               4,811                    1 Indicated

M5D       922  2  INDIC                                 N Skin; nutrition to manage skin prob

                               6,386                    . Missing
                              11,184                    0 Not indicated
                               1,920                    1 Indicated

M5E       924  2  INDIC                                 N Skin; ulcer care

                               6,382                    . Missing
                              11,729                    0 Not indicated
                               1,379                    1 Indicated

M5F       926  2  INDIC                                 N Skin; surgical wound care

                               6,385                    . Missing
                              11,998                    0 Not indicated
                               1,107                    1 Indicated

M5G       928  2  INDIC                                 N Skin; applic. of dressings, not feet

                               6,381                    . Missing
                              10,811                    0 Not indicated
                               2,298                    1 Indicated

M5H       930  2  INDIC                                 N Skin; applic. of ointment/med, not feet

                               6,381                    . Missing
                               9,246                    0 Not indicated
                               3,863                    1 Indicated

M5I       932  2  INDIC                                 N Skin; other preventative care, not feet

                               6,385                    . Missing
                               5,588                    0 Not indicated
                               7,517                    1 Indicated

M5J       934  2  INDIC                                 N Skin; none of above

                               6,384                    . Missing
                              12,091                    0 Not indicated
                               1,015                    1 Indicated

M6A       936  2  INDIC                                 N Skin; foot, one or more problems

                               6,386                    . Missing
                              10,852                    0 Not indicated
                               2,252                    1 Indicated

M6B       938  2  INDIC                                 N Skin; foot, infections

                               6,386                    . Missing
                              12,998                    0 Not indicated
                                 106                    1 Indicated

M6C       940  2  INDIC                                 N Skin; foot, open lesions

                               6,386                    . Missing
                              12,866                    0 Not indicated
                                 238                    1 Indicated

M6D       942  2  INDIC                                 N Skin; foot, nails/calluses trimmed

                               6,386                    . Missing
                               7,150                    0 Not indicated
                               5,954                    1 Indicated

M6E       944  2  INDIC                                 N Skin; foot, preventative care

                               6,385                    . Missing
                               9,682                    0 Not indicated
                               3,423                    1 Indicated

M6F       946  2  INDIC                                 N Skin; foot, application of dressings

                               6,385                    . Missing
                              12,419                    0 Not indicated
                                 686                    1 Indicated

M6G       948  2  INDIC                                 N Skin; none of above

                               6,388                    . Missing
                               8,635                    0 Not indicated
                               4,467                    1 Indicated

N1A       950  2  INDIC                                 N Act; awake in morning

                               4,401                    . Missing
                               1,027                    0 Not indicated
                              14,062                    1 Indicated

N1B       952  2  INDIC                                 N Act; awake in afternoon

                               4,402                    . Missing
                               1,872                    0 Not indicated
                              13,216                    1 Indicated

N1C       954  2  INDIC                                 N Act; awake in evening

                               4,401                    . Missing
                               4,809                    0 Not indicated
                              10,280                    1 Indicated

N1D       956  2  INDIC                                 N Act; none of above

                               4,401                    . Missing
                              14,750                    0 Not indicated
                                 339                    1 Indicated

N2        958  2  AVRGTIME                              N Act; average time involved

                               4,408                    . Missing
                                 856                    0 Most - more than 2/3 time
                              13,531                    1 Some - from 1/3 to 2/3 time
                                 671                    2 Little - less than 1/3 time
                                  24                    3 None

N3A       960  2  INDIC                                 N Act; settings, own room

                              14,526                    . Missing
                                 411                    0 Not indicated
                               4,553                    1 Indicated

N3B       962  2  INDIC                                 N Act; settings, day room

                              14,526                    . Missing
                               1,050                    0 Not indicated
                               3,914                    1 Indicated

N3C       964  2  INDIC                                 N Act; settings, inside NH, off unit

                              14,534                    . Missing
                               2,256                    0 Not indicated
                               2,700                    1 Indicated

N3D       966  2  INDIC                                 N Act; settings, outside facility

                              14,529                    . Missing
                               3,482                    0 Not indicated
                               1,479                    1 Indicated

N3E       968  2  INDIC                                 N Act; settings, none of above

                              14,526                    . Missing
                               4,953                    0 Not indicated
                                  11                    1 Indicated

N4A       970  2  INDIC                                 N Act; pref, cards, other games

                              14,525                    . Missing
                               2,472                    0 Not indicated
                               2,493                    1 Indicated

N4B       972  2  INDIC                                 N Act; pref, crafts/arts

                              14,530                    . Missing
                               3,485                    0 Not indicated
                               1,475                    1 Indicated

N4C       974  2  INDIC                                 N Act; pref, exercise/sports

                              14,524                    . Missing
                               2,336                    0 Not indicated
                               2,630                    1 Indicated

N4D       976  2  INDIC                                 N Act; pref, music

                              14,524                    . Missing
                                 462                    0 Not indicated
                               4,504                    1 Indicated

N4E       978  2  INDIC                                 N Act; pref, reading/writing

                              14,524                    . Missing
                               2,272                    0 Not indicated
                               2,694                    1 Indicated

N4F       980  2  INDIC                                 N Act; pref, spiritual/religious activitie

                              14,524                    . Missing
                               1,375                    0 Not indicated
                               3,591                    1 Indicated

N4G       982  2  INDIC                                 N Act; pref, trips/shopping

                              14,528                    . Missing
                               3,560                    0 Not indicated
                               1,402                    1 Indicated

N4H       984  2  INDIC                                 N Act; pref, walking/wheelchair outdoors

                              14,526                    . Missing
                               2,514                    0 Not indicated
                               2,450                    1 Indicated

N4I       986  2  INDIC                                 N Act; pref, watching TV

                              14,524                    . Missing
                                 611                    0 Not indicated
                               4,355                    1 Indicated

N4J       988  2  INDIC                                 N Act; pref, gardening or plants

                              14,528                    . Missing
                               3,992                    0 Not indicated
                                 970                    1 Indicated

N4K       990  2  INDIC                                 N Act; pref, talking or conversing

                              14,524                    . Missing
                                 683                    0 Not indicated
                               4,283                    1 Indicated

N4L       992  2  INDIC                                 N Act; pref, helping others

                              14,529                    . Missing
                               4,038                    0 Not indicated
                                 923                    1 Indicated

N4M       994  2  INDIC                                 N Act; pref, none of above

                              14,524                    . Missing
                               4,956                    0 Not indicated
                                  10                    1 Indicated

N5A       996  2  ROUTINCH                              N Act; pref, change in type activities

                              14,526                    . Missing
                               4,815                    0 No change
                                 127                    1 Slight change
                                  22                    2 Major change

N5B       998  2  ROUTINCH                              N Act; pref, change in extent involvement

                              14,526                    . Missing
                               4,782                    0 No change
                                 158                    1 Slight change
                                  24                    2 Major change

O1       1000  2                                        N Rx; # of different med rec last 7

O2       1002  2  YESNO                                 N Rx; receiving med initiated, last 90

                              14,527                    . Missing
                               1,984                    0 No
                               2,979                    1 Yes

O3       1004  2  NUMDAY                                N Rx; # of days injections rec, last 7

                               6,431                    . Missing
                              13,059                  0-7 Number of days

O4A      1006  2  NUMDAY                                N Rx; # of days antipsychotic rec, last 7

                               4,396                    . Missing
                              15,094                  0-7 Number of days

O4B      1008  2  NUMDAY                                N Rx; # of days antianxiety rec, last 7

                               4,396                    . Missing
                              15,094                  0-7 Number of days

O4C      1010  2  NUMDAY                                N Rx; # of days antidepressant rec, last 7

                               4,396                    . Missing
                              15,094                  0-7 Number of days

O4D      1012  2  NUMDAY                                N Rx; # of days hypnotic rec, last 7

                               4,396                    . Missing
                              15,094                  0-7 Number of days

O4E      1014  2  NUMDAY                                N Rx; # of days diuretic rec, last 7

                               4,396                    . Missing
                              15,094                  0-7 Number of days

P1AA     1016  2  INDIC                                 N Special; chemotherapy

                               6,392                    . Missing
                              13,043                    0 Not indicated
                                  55                    1 Indicated

P1AB     1018  2  INDIC                                 N Special; dialysis

                               6,384                    . Missing
                              12,978                    0 Not indicated
                                 128                    1 Indicated

P1AC     1020  2  INDIC                                 N Special; IV medication

                               6,380                    . Missing
                              10,763                    0 Not indicated
                               2,347                    1 Indicated

P1AD     1022  2  INDIC                                 N Special; intake/output

                               6,385                    . Missing
                              10,123                    0 Not indicated
                               2,982                    1 Indicated

P1AE     1024  2  INDIC                                 N Special; monitoring acute med condition

                               6,384                    . Missing
                               8,261                    0 Not indicated
                               4,845                    1 Indicated

P1AF     1026  2  INDIC                                 N Special; ostomy care

                               6,384                    . Missing
                              12,575                    0 Not indicated
                                 531                    1 Indicated

P1AG     1028  2  INDIC                                 N Special; oxygen therapy

                               6,386                    . Missing
                              11,197                    0 Not indicated
                               1,907                    1 Indicated

P1AH     1030  2  INDIC                                 N Special; radiation

                               6,384                    . Missing
                              13,103                    0 Not indicated
                                   3                    1 Indicated

P1AI     1032  2  INDIC                                 N Special; suctioning

                               6,384                    . Missing
                              13,014                    0 Not indicated
                                  92                    1 Indicated

P1AJ     1034  2  INDIC                                 N Special; tracheostomy

                               6,384                    . Missing
                              13,013                    0 Not indicated
                                  93                    1 Indicated

P1AK     1036  2  INDIC                                 N Special; transfusions

                               6,384                    . Missing
                              12,899                    0 Not indicated
                                 207                    1 Indicated

P1AL     1038  2  INDIC                                 N Special; ventilator or respirator

                               6,384                    . Missing
                              13,074                    0 Not indicated
                                  32                    1 Indicated

P1AM     1040  2  INDIC                                 N Special; alcoholic/drug treatment

                               6,384                    . Missing
                              13,103                    0 Not indicated
                                   3                    1 Indicated

P1AN     1042  2  INDIC                                 N Special; alzheimers/dementia spec care

                               6,384                    . Missing
                              12,320                    0 Not indicated
                                 786                    1 Indicated

P1AO     1044  2  INDIC                                 N Special; hospice care

                               6,384                    . Missing
                              12,805                    0 Not indicated
                                 301                    1 Indicated

P1AP     1046  2  INDIC                                 N Special; pediatric unite

                               6,384                    . Missing
                              13,105                    0 Not indicated
                                   1                    1 Indicated

P1AQ     1048  2  INDIC                                 N Special; respite care

                               6,384                    . Missing
                              13,088                    0 Not indicated
                                  18                    1 Indicated

P1AR     1050  2  INDIC                                 N Special; community skill training

                               6,380                    . Missing
                              10,450                    0 Not indicated
                               2,660                    1 Indicated

P1AS     1052  2  INDIC                                 N Special; none of above

                               6,383                    . Missing
                               7,822                    0 Not indicated
                               5,285                    1 Indicated

P1BAA    1054  2  NUMDAY                                N Special; speech therapy days

                               6,392                    . Missing
                              13,098                  0-7 Number of days

P1BAB    1056  4  NUMMINS                               N Special; speech therapy minutes

                               6,387                    . Missing
                              13,103               0-9999 Number of minutes

P1BBA    1060  2  NUMDAY                                N Special; occupational therapy days

                               6,385                    . Missing
                              13,105                  0-7 Number of days

P1BBB    1062  4  NUMMINS                               N Special; occupational therapy minutes

                               6,386                    . Missing
                              13,104               0-9999 Number of minutes

P1BCA    1066  2  NUMDAY                                N Special; physical therapy days

                               6,385                    . Missing
                              13,105                  0-7 Number of days

P1BCB    1068  4  NUMMINS                               N Special; physical therapy minutes

                               6,386                    . Missing
                              13,104               0-9999 Number of minutes

P1BDA    1072  2  NUMDAY                                N Special; respiratory therapy days

                               6,386                    . Missing
                              13,104                  0-7 Number of days

P1BDB    1074  4  NUMMINS                               N Special; respiratory therapy minutes

                               6,387                    . Missing
                              13,103               0-9999 Number of minutes

P1BEA    1078  2  NUMDAY                                N Special; psychological therapy days

                               6,386                    . Missing
                              13,104                  0-7 Number of days

P1BEB    1080  4  NUMMINS                               N Special; psychological therapy minutes

                               6,387                    . Missing
                              13,103               0-9999 Number of minutes

P2A      1084  2  INDIC                                 N Special; behavior symptom eval program

                              14,527                    . Missing
                               4,608                    0 Not indicated
                                 355                    1 Indicated

P2B      1086  2  INDIC                                 N Special; mental health specialist eval

                              14,527                    . Missing
                               4,050                    0 Not indicated
                                 913                    1 Indicated

P2C      1088  2  INDIC                                 N Special; group therapy

                              14,527                    . Missing
                               4,889                    0 Not indicated
                                  74                    1 Indicated

P2D      1090  2  INDIC                                 N Special; deliberate environment changes

                              14,528                    . Missing
                               4,896                    0 Not indicated
                                  66                    1 Indicated

P2E      1092  2  INDIC                                 N Special; reorientation

                              14,528                    . Missing
                               2,818                    0 Not indicated
                               2,144                    1 Indicated

P2F      1094  2  INDIC                                 N Special; none of above

                              14,528                    . Missing
                               2,619                    0 Not indicated
                               2,343                    1 Indicated

P3A      1096  2  NUMDAY                                N Special; rehab, passive range of motion

                               6,383                    . Missing
                              13,107                  0-7 Number of days

P3B      1098  2  NUMDAY                                N Special; rehab, active range of motion

                               6,383                    . Missing
                              13,107                  0-7 Number of days

P3C      1100  2  NUMDAY                                N Special; rehab, splint or brace

                               6,383                    . Missing
                              13,107                  0-7 Number of days

P3D      1102  2  NUMDAY                                N Special; practice, bed mobility

                               6,383                    . Missing
                              13,107                  0-7 Number of days

P3E      1104  2  NUMDAY                                N Special; practice, transfer

                               6,383                    . Missing
                              13,107                  0-7 Number of days

P3F      1106  2  NUMDAY                                N Special; practice, walking

                               6,384                    . Missing
                              13,106                  0-7 Number of days

P3G      1108  2  NUMDAY                                N Special; practice, dressing or grooming

                               6,383                    . Missing
                              13,107                  0-7 Number of days

P3H      1110  2  NUMDAY                                N Special; practice, eating or swallowing

                               6,383                    . Missing
                              13,107                  0-7 Number of days

P3I      1112  2  NUMDAY                                N Special; practice, ampu/prosthesis care

                               6,384                    . Missing
                              13,106                  0-7 Number of days

P3J      1114  2  NUMDAY                                N Special; practice, communication

                               6,384                    . Missing
                              13,106                  0-7 Number of days

P3K      1116  2  NUMDAY                                N Special; practice, other

                               6,384                    . Missing
                              13,106                  0-7 Number of days

P4A      1118  2  USED                                  N Special; devices, full bed rails

                               4,396                    . Missing
                              13,638                    0 Not used
                                  60                    1 Used less than daily
                               1,396                    2 Used daily

P4B      1120  2  USED                                  N Special; devices, other types of rails

                               4,396                    . Missing
                              11,926                    0 Not used
                                 149                    1 Used less than daily
                               3,019                    2 Used daily

P4C      1122  2  USED                                  N Special; devices, trunk restraint

                               4,397                    . Missing
                              14,818                    0 Not used
                                  21                    1 Used less than daily
                                 254                    2 Used daily

P4D      1124  2  USED                                  N Special; devices, limb restraint

                               4,396                    . Missing
                              15,079                    0 Not used
                                   7                    1 Used less than daily
                                   8                    2 Used daily

P4E      1126  2  USED                                  N Special; devices, chair prevents rising

                               4,396                    . Missing
                              14,873                    0 Not used
                                  30                    1 Used less than daily
                                 191                    2 Used daily

P5       1128  2  NUMDAY2X                              N Special; # overnight hospital stays

                              14,524                    . Missing
                               4,966                 0-99 Number of days

P6       1130  2  NUMDAY2X                              N Special; # emergency room visits

                              14,514                    . Missing
                               4,976                 0-99 Number of days

P7       1132  2  NUMDAY2X                              N Special; # days physician examined

                               6,381                    . Missing
                              13,109                 0-99 Number of days

P8       1134  2  NUMDAY2X                              N Special; # days physician changed orders

                               6,381                    . Missing
                              13,109                 0-99 Number of days

P9       1136  2  YESNO                                 N Special; abnormal lab value last 90 days

                              14,529                    . Missing
                               1,254                    0 No
                               3,707                    1 Yes

Q1A      1138  2  YESNO                                 N Status; expresses pref of discharge

                               9,909                    . Missing
                               5,890                    0 No
                               3,691                    1 Yes

Q1B      1140  2  YESNO                                 N Status; support person pos to discharge

                              14,535                    . Missing
                               3,544                    0 No
                               1,411                    1 Yes

Q1C      1142  2  DISCHARG                              N Status; discharge projected

                               9,912                    . Missing
                               5,732                    0 No
                               1,259                    1 Within 30 days
                                 871                    2 Within 31-90 days
                               1,716                    3 Discharge status uncertain

Q2       1144  2  CHANGE                                N Status; overall care change last 90 days

                               4,399                    . Missing
                              11,611                    0 No change
                               1,023                    1 Improved
                               2,457                    2 Deteriorated

R1A      1146  2  YESNO                                 N Discharge; assess resident particip

                              14,529                    . Missing
                                 407                    0 No
                               4,554                    1 Yes

R1B      1148  2  YESNOFAM                              N Discharge; assess, family particip

                              14,529                    . Missing
                               2,482                    0 No
                               2,432                    1 Yes
                                  47                    2 No family

R1C      1150  2  YESNONON                              N Discharge; assess, signif other particip

                              14,546                    . Missing
                               3,089                    0 No
                                 321                    1 Yes
                               1,534                    2 None

R2B      1152  8                                        N Discharge; date RN assess complete

R3A      1162  2                                        N Discharge; code for resident disposition

R3B      1164  2                                        N Discharge; optional state code

R4       1166  8                                        N Discharge; date of discharge

T1AA     1176  2  NUMDAY                                N Supp; recreation therapy days

                              17,075                    . Missing
                               2,415                  0-7 Number of days

T1AB     1178  4  NUMMINS                               N Supp; recreation therapy minutes

                              17,062                    . Missing
                               2,428               0-9999 Number of minutes

T1B      1182  2  YESNO                                 N Supp; PT, OT, ST ordered first 14 days

                              17,207                    . Missing
                                 284                    0 No
                               1,999                    1 Yes

T1C      1184  2  NUMDAY2X                              N Supp; therapy days through day 15

                              17,492                    . Missing
                               1,998                 0-99 Number of days

T1D      1186  4  NUMMINS                               N Supp; total min therapy through day 15

                              17,491                    . Missing
                               1,999               0-9999 Number of minutes

T2A      1190  2  WALKDIST                              N Supp; furthest distance walked

                              17,922                    . Missing
                                 662                    0 150+ feet
                                 409                    1 51-149 feet
                                 165                    2 26-50 feet
                                 172                    3 10-25 feet
                                 160                    4 Less than 25 feet

T2B      1192  2  WALKTIME                              N Supp; time walked without sitting

                              17,922                    . Missing
                                 540                    0 1-2 minutes
                                 508                    1 3-4 minutes
                                 344                    2 5-10 minutes
                                 120                    3 11-15 minutes
                                  19                    4 16-30 minutes
                                  37                    5 31+ minutes

T2C      1194  2  WALKASSI                              N Supp; self-performance in walking

                              17,922                    . Missing
                                 379                    0 Independent
                                 270                    1 Supervision
                                 622                    2 Limited assistance
                                 297                    3 Extensive assistance

T2D      1196  2  WALKSUPP                              N Supp; walking support provided

                              17,922                    . Missing
                                 413                    0 No setup or physical help from staff
                                 228                    1 Setup help only
                                 795                    2 One person physical assist
                                 132                    3 Two+ persons physical assist

T2E      1198  2  YESNO                                 N Supp; parallel bars used

                              17,914                    . Missing
                               1,495                    0 No
                                  81                    1 Yes

T3MDCR   1200  5                                        C Case mix group Medicare

T3STATE  1205  5                                        C Case mix group State

U01RA    1210  2  ROUTE                                 N Drug 1; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U01FR    1212  2  $FREQU                                C Drug 1; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U01AA    1214  5  $AMOUNT                               C Drug 1; amount administered

                              19,490             LOW-HIGH Amount administered

U01PR    1219  2  PRNN                                  N Drug 1; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U01NDC   1221  9  $NDCDRUG                              C Drug 1; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U02RA    1230  2  ROUTE                                 N Drug 2; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U02FR    1232  2  $FREQU                                C Drug 2; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U02AA    1234  5  $AMOUNT                               C Drug 2; amount administered

                              19,490             LOW-HIGH Amount administered

U02PR    1239  2  PRNN                                  N Drug 2; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U02NDC   1241  9  $NDCDRUG                              C Drug 2; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U03RA    1250  2  ROUTE                                 N Drug 3; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U03FR    1252  2  $FREQU                                C Drug 3; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U03AA    1254  5  $AMOUNT                               C Drug 3; amount administered

                              19,490             LOW-HIGH Amount administered

U03PR    1259  2  PRNN                                  N Drug 3; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U03NDC   1261  9  $NDCDRUG                              C Drug 3; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U04RA    1270  2  ROUTE                                 N Drug 4; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U04FR    1272  2  $FREQU                                C Drug 4; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U04AA    1274  5  $AMOUNT                               C Drug 4; amount administered

                              19,490             LOW-HIGH Amount administered

U04PR    1279  2  PRNN                                  N Drug 4; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U04NDC   1281  9  $NDCDRUG                              C Drug 4; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U05RA    1290  2  ROUTE                                 N Drug 5; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U05FR    1292  2  $FREQU                                C Drug 5; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U05AA    1294  5  $AMOUNT                               C Drug 5; amount administered

                              19,490             LOW-HIGH Amount administered

U05PR    1299  2  PRNN                                  N Drug 5; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U05NDC   1301  9  $NDCDRUG                              C Drug 5; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U06RA    1310  2  ROUTE                                 N Drug 6; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U06FR    1312  2  $FREQU                                C Drug 6; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U06AA    1314  5  $AMOUNT                               C Drug 6; amount administered

                              19,490             LOW-HIGH Amount administered

U06PR    1319  2  PRNN                                  N Drug 6; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U06NDC   1321  9  $NDCDRUG                              C Drug 7; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U07RA    1330  2  ROUTE                                 N Drug 7; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U07FR    1332  2  $FREQU                                C Drug 7; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U07AA    1334  5  $AMOUNT                               C Drug 7; amount administered

                              19,490             LOW-HIGH Amount administered

U07PR    1339  2  PRNN                                  N Drug 7; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U07NDC   1341  9  $NDCDRUG                              C Drug 7; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U08RA    1350  2  ROUTE                                 N Drug 8; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U08FR    1352  2  $FREQU                                C Drug 8; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U08AA    1354  5  $AMOUNT                               C Drug 8; amount administered

                              19,490             LOW-HIGH Amount administered

U08PR    1359  2  PRNN                                  N Drug 8; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U08NDC   1361  9  $NDCDRUG                              C Drug 8; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U09RA    1370  2  ROUTE                                 N Drug 9; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U09FR    1372  2  $FREQU                                C Drug 9; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U09AA    1374  5  $AMOUNT                               C Drug 9; amount administered

                              19,490             LOW-HIGH Amount administered

U09PR    1379  2  PRNN                                  N Drug 9; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U09NDC   1381  9  $NDCDRUG                              C Drug 9; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U10RA    1390  2  ROUTE                                 N Drug 10; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U10FR    1392  2  $FREQU                                C Drug 10; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U10AA    1394  5  $AMOUNT                               C Drug 10; amount administered

                              19,490             LOW-HIGH Amount administered

U10PR    1399  2  PRNN                                  N Drug 10; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U10NDC   1401  9  $NDCDRUG                              C Drug 10; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U11RA    1410  2  ROUTE                                 N Drug 11; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U11FR    1412  2  $FREQU                                C Drug 11; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U11AA    1414  5  $AMOUNT                               C Drug 11; amount administered

                              19,490             LOW-HIGH Amount administered

U11PR    1419  2  PRNN                                  N Drug 11; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U11NDC   1421  9  $NDCDRUG                              C Drug 11; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U12RA    1430  2  ROUTE                                 N Drug 12; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U12FR    1432  2  $FREQU                                C Drug 12; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U12AA    1434  5  $AMOUNT                               C Drug 12; amount administered

                              19,490             LOW-HIGH Amount administered

U12PR    1439  2  PRNN                                  N Drug 12; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U12NDC   1441  9  $NDCDRUG                              C Drug 12; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U13RA    1450  2  ROUTE                                 N Drug 13; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U13FR    1452  2  $FREQU                                C Drug 13; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U13AA    1454  5  $AMOUNT                               C Drug 13; amount administered

                              19,490             LOW-HIGH Amount administered

U13PR    1459  2  PRNN                                  N Drug 13; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U13NDC   1461  9  $NDCDRUG                              C Drug 13; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U14RA    1470  2  ROUTE                                 N Drug 14; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U14FR    1472  2  $FREQU                                C Drug 14; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U14AA    1474  5  $AMOUNT                               C Drug 14; amount administered

                              19,490             LOW-HIGH Amount administered

U14PR    1479  2  PRNN                                  N Drug 14; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U14NDC   1481  9  $NDCDRUG                              C Drug 14; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U15RA    1490  2  ROUTE                                 N Drug 15; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U15FR    1492  2  $FREQU                                C Drug 15; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U15AA    1494  5  $AMOUNT                               C Drug 15; amount administered

                              19,490             LOW-HIGH Amount administered

U15PR    1499  2  PRNN                                  N Drug 15; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U15NDC   1501  9  $NDCDRUG                              C Drug 15; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U16RA    1510  2  ROUTE                                 N Drug 16; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U16FR    1512  2  $FREQU                                C Drug 16; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U16AA    1514  5  $AMOUNT                               C Drug 16; amount administered

                              19,490             LOW-HIGH Amount administered

U16PR    1519  2  PRNN                                  N Drug 16; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U16NDC   1521  9  $NDCDRUG                              C Drug 16; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U17RA    1530  2  ROUTE                                 N Drug 17; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U17FR    1532  2  $FREQU                                C Drug 17; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U17AA    1534  5  $AMOUNT                               C Drug 17; amount administered

                              19,490             LOW-HIGH Amount administered

U17PR    1539  2  PRNN                                  N Drug 17; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U17NDC   1541  9  $NDCDRUG                              C Drug 17; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

U18RA    1550  2  ROUTE                                 N Drug 18; route of administration

                              19,490                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U18FR    1552  2  $FREQU                                C Drug 18; frequency

                              19,490                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U18AA    1554  5  $AMOUNT                               C Drug 18; amount administered

                              19,490             LOW-HIGH Amount administered

U18PR    1559  2  PRNN                                  N Drug 18; PRN-number of doses

                              19,490                    . Missing
                                   0                 0-99 Number of doses

U18NDC   1561  9  $NDCDRUG                              C Drug 18; National Drug Code (NDC)

                              19,490             LOW-HIGH National Drug Code

VA01A    1570  2  INDIC                                 N Delirium, triggered

                              15,267                    . Missing
                               3,551                    0 Not indicated
                                 672                    1 Indicated

VA01B    1572  2  INDIC                                 N Delirium, care planning

                              15,696                    . Missing
                               3,515                    0 Not indicated
                                 279                    1 Indicated

VA02A    1574  2  INDIC                                 N Cognitive loss, triggered

                              15,259                    . Missing
                                 897                    0 Not indicated
                               3,334                    1 Indicated

VA02B    1576  2  INDIC                                 N Cognitive loss, care planning

                              15,376                    . Missing
                               1,406                    0 Not indicated
                               2,708                    1 Indicated

VA03A    1578  2  INDIC                                 N Visual function, triggered

                              15,272                    . Missing
                               2,553                    0 Not indicated
                               1,665                    1 Indicated

VA03B    1580  2  INDIC                                 N Visual function, care planning

                              15,577                    . Missing
                               2,770                    0 Not indicated
                               1,143                    1 Indicated

VA04A    1582  2  INDIC                                 N Communication, triggered

                              15,261                    . Missing
                               1,793                    0 Not indicated
                               2,436                    1 Indicated

VA04B    1584  2  INDIC                                 N Communication, care planning

                              15,514                    . Missing
                               2,094                    0 Not indicated
                               1,882                    1 Indicated

VA05A    1586  2  INDIC                                 N ADL funct/Rehab potential, triggered

                              15,259                    . Missing
                                  36                    0 Not indicated
                               4,195                    1 Indicated

VA05B    1588  2  INDIC                                 N ADL funct/Rehab potential, care planning

                              15,290                    . Missing
                                 546                    0 Not indicated
                               3,654                    1 Indicated

VA06A    1590  2  INDIC                                 N Urinary incontinence, triggered

                              15,261                    . Missing
                               1,241                    0 Not indicated
                               2,988                    1 Indicated

VA06B    1592  2  INDIC                                 N Urinary incontinence, care planning

                              15,406                    . Missing
                               1,525                    0 Not indicated
                               2,559                    1 Indicated

VA07A    1594  2  INDIC                                 N Psychosocial well-being, triggered

                              15,261                    . Missing
                               2,871                    0 Not indicated
                               1,358                    1 Indicated

VA07B    1596  2  INDIC                                 N Psychosocial well-being, care planning

                              15,613                    . Missing
                               2,904                    0 Not indicated
                                 973                    1 Indicated

VA08A    1598  2  INDIC                                 N Mood state, triggered

                              15,259                    . Missing
                               2,385                    0 Not indicated
                               1,846                    1 Indicated

VA08B    1600  2  INDIC                                 N Mood state, care planning

                              15,583                    . Missing
                               2,382                    0 Not indicated
                               1,525                    1 Indicated

VA09A    1602  2  INDIC                                 N Behavioral symptoms, triggered

                              15,261                    . Missing
                               3,103                    0 Not indicated
                               1,126                    1 Indicated

VA09B    1604  2  INDIC                                 N Behavioral symptoms, care planning

                              15,629                    . Missing
                               2,923                    0 Not indicated
                                 938                    1 Indicated

VA10A    1606  2  INDIC                                 N Activities, triggered

                              15,262                    . Missing
                               3,657                    0 Not indicated
                                 571                    1 Indicated

VA10B    1608  2  INDIC                                 N Activities, care planning

                              15,682                    . Missing
                               3,318                    0 Not indicated
                                 490                    1 Indicated

VA11A    1610  2  INDIC                                 N Falls, triggered

                              15,261                    . Missing
                               1,162                    0 Not indicated
                               3,067                    1 Indicated

VA11B    1612  2  INDIC                                 N Falls, care planning

                              15,418                    . Missing
                               1,342                    0 Not indicated
                               2,730                    1 Indicated

VA12A    1614  2  INDIC                                 N Nutritional status, triggered

                              15,272                    . Missing
                                 755                    0 Not indicated
                               3,463                    1 Indicated

VA12B    1616  2  INDIC                                 N Nutritional status, care planning

                              15,363                    . Missing
                               1,183                    0 Not indicated
                               2,944                    1 Indicated

VA13A    1618  2  INDIC                                 N Feeding tubes, triggered

                              15,262                    . Missing
                               4,059                    0 Not indicated
                                 169                    1 Indicated

VA13B    1620  2  INDIC                                 N Feeding tubes, care planning

                              15,738                    . Missing
                               3,589                    0 Not indicated
                                 163                    1 Indicated

VA14A    1622  2  INDIC                                 N Dehydration/Fluid mainten, triggered

                              15,259                    . Missing
                               2,109                    0 Not indicated
                               2,122                    1 Indicated

VA14B    1624  2  INDIC                                 N Dehydration/Fluid mainten, care planning

                              15,514                    . Missing
                               2,246                    0 Not indicated
                               1,730                    1 Indicated

VA15A    1626  2  INDIC                                 N Dental care, triggered

                              15,261                    . Missing
                               2,971                    0 Not indicated
                               1,258                    1 Indicated

VA15B    1628  2  INDIC                                 N Dental care, care planning

                              15,599                    . Missing
                               3,045                    0 Not indicated
                                 846                    1 Indicated

VA16A    1630  2  INDIC                                 N Pressure ulcers, triggered

                              15,263                    . Missing
                                 771                    0 Not indicated
                               3,456                    1 Indicated

VA16B    1632  2  INDIC                                 N Pressure ulcers, care planning

                              15,366                    . Missing
                               1,113                    0 Not indicated
                               3,011                    1 Indicated

VA17A    1634  2  INDIC                                 N Psychotropic drug use, triggered

                              15,259                    . Missing
                               1,740                    0 Not indicated
                               2,491                    1 Indicated

VA17B    1636  2  INDIC                                 N Psychotropic drug use, care planning

                              15,487                    . Missing
                               1,915                    0 Not indicated
                               2,088                    1 Indicated

VA18A    1638  2  INDIC                                 N Physical restraints, triggered

                              15,259                    . Missing
                               4,102                    0 Not indicated
                                 129                    1 Indicated

VA18B    1640  2  INDIC                                 N Physical restraints, care planning

                              15,749                    . Missing
                               3,629                    0 Not indicated
                                 112                    1 Indicated

VB2      1642 10                                        N Signature date, RAP assessment

VB4      1652 10                                        N Signature date, care planning

DEATH_DA 1662 10                                        N FU-DEATH-DA

