RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                                 926             LOW-HIGH BASEID Count

STAYNUM    14  1                                        N Stay number for the year

REFBEGYY   15  2                                        C Reference beginning date year

REFBEGMM   17  2                                        C Reference beginning date month

REFBEGDD   19  2                                        C Reference beginning date day

REFENDYY   21  2                                        C Reference ending date year

REFENDMM   23  2                                        C Reference ending date month

REFENDDD   25  2                                        C Reference ending date day

ADMISYY    27  2                                        C Admission date year

ADMISMM    29  2                                        C Admission date month

ADMISDD    31  2                                        C Admission date day

DISCHYY    33  2                                        C Permanent discharge date year

DISCHMM    35  2                                        C Permanent discharge date month

DISCHDD    37  2                                        C Permanent discharge date day

STAYDAYS   39  3                                        N Number of days in the stay

FACILID    42  6                                        C Facility ID

                  Note: Randomly-assigned number

FACDESC    48  2  FACFMT                                N Facility description

                                   2                    . Inapplicable
                                  15                    1 Hospital
                                 573                    2 Nursing home
                                   5                    3 Retirement home
                                  77                    4 Domiciliary/personal care facility
                                   9                    5 Mental health facility
                                  22                    6 Inst for mentally retarded/devel disab
                                   0                    7 Mental health center
                                  65                    8 Life care/continuing care
                                 122                    9 Assisted living facility
                                   6                   10 Rehabilitation facility
                                  30                   91 Other place, specify

BEGSTAT    50  1  $BEGSTAT                              C Status at the beginning of the stay

                                   3                    - Don't know
                                 680                    0 Continuing SP
                                  89                    1 First time SP from home
                                  71                    2 First time SP from hosp
                                  45                    3 First time SP from nursing home
                                   5                    5 2nd stay 30-day split (in hosp)
                                   3                    6 2nd stay 30-day split (disch)
                                  27                    7 First time SP from other facility
                                   3                    9 Unknown reason

ENDSTAT    51  1  $ENDSTAT                              C Status at the end of the stay

                                   4                    - Don't know
                                 613                    0 SP is still a resident
                                  29                    1 SP was discharged home
                                  33                    2 SP was discharged to hospital
                                  38                    3 SP was discharged to nursing home
                                 173                    4 SP died in the facility
                                   5                    5 Stay split by 30-day hosp
                                   4                    6 Stay split by 30-day disch
                                  23                    7 SP was discharged to other facility
                                   4                    9 Unknown reason for end of stay

AMTTOT     52  9                                        N Total payment

AMTCARE    61  9                                        N Amount paid by Medicare

AMTCAID    70  9                                        N Amount paid by Medicaid

AMTVA      79  9                                        N Amount paid by Veterans Administration

AMTPRVU    88  9                                        N Amt paid by priv ins (unknown purchased)

AMTOOP     97  9                                        N Amount paid out-of-pocket (OOP)

AMTOTH    106  9                                        N Amount paid by other payor(s)

ANCITOT   115  9                                        N Ancillary total payment

ANCICARE  124  9                                        N Ancillary amount paid by Medicare

ANCICAID  133  9                                        N Ancillary amount paid by Medicaid

ANCIVA    142  9                                        N Ancillary amount paid by Veterans Adm.

ANCIPRVU  151  9                                        N Ancillary amount paid by private ins.

ANCIOOP   160  9                                        N Ancillary amount paid by person/family

ANCIOTH   169  9                                        N Ancillary amount paid by other sources

TOTCARE   178  9                                        N Amount paid by Medicare for all services

TOTALL    187  9                                        N Total amt paid (incl. Medicare payments)

DENTNUM   196  3                                        N Number of dental visits

EMNUM     199  3                                        N Number of emergency room visits

OPNUM     202  3                                        N Number of clinic/outpatient visits

MDNUM     205  3                                        N Number of medical doctor visits

MHNUMVIS  208  3                                        N # of mental health professional visits

DIETFLG   211  2  YES2FMT                               N Type of health professional: dietician

                                 388                    1 Yes
                                 538                    2 No

OPTHLFLG  213  2  YES2FMT                               N Type of physician: ophthalmologist

                                 131                    1 Yes
                                 795                    2 No

OPTOMFLG  215  2  YES2FMT                               N Type of health professional: optometrist

                                  96                    1 Yes
                                 830                    2 No

PODIAFLG  217  2  YES2FMT                               N Type of health professional: podiatrist

                                 570                    1 Yes
                                 356                    2 No

EDHABFLG  219  2  YES2FMT                               N Received educational/habitational svcs.

                                   7                   -8 Don't know
                                   1                   -7 Refused
                                 196                    1 Yes
                                 722                    2 No

HABFLG    221  2  YES2FMT                               N Received habitational services

                                   8                   -8 Don't know
                                   1                   -7 Refused
                                 186                    1 Yes
                                 731                    2 No

EDUCFLG   223  2  YES2FMT                               N Received educational services

                                   8                   -8 Don't know
                                   1                   -7 Refused
                                 115                    1 Yes
                                 802                    2 No

AMBUSERV  225  2  YES2FMT                               N Used ambulance service

                                 318                    1 Yes
                                 608                    2 No

BEDPADS   227  2  YES2FMT                               N Received bed pads

                                 551                    1 Yes
                                 375                    2 No

CATHETER  229  2  YES2FMT                               N Received catheter or catheter supplies

                                  94                    1 Yes
                                 832                    2 No

CATHIRRI  231  2  YES2FMT                               N Catheterization and irrigation

                                  89                    1 Yes
                                 837                    2 No

CHNGBAND  233  2  YES2FMT                               N Apply or change dressing

                                 382                    1 Yes
                                 544                    2 No

CLOTHDPR  235  2  YES2FMT                               N Received cloth diapers

                                  25                    1 Yes
                                 901                    2 No

COMMODE   237  2  YES2FMT                               N Received bedside commode

                                  71                    1 Yes
                                 855                    2 No

DIABSUPP  239  2  YES2FMT                               N Used diabetic supplies

                                 199                    1 Yes
                                 727                    2 No

DIAPRSUP  241  2  YES2FMT                               N Used disposable diapers

                                 640                    1 Yes
                                 286                    2 No

EQUIPSUP  243  2  YES2FMT                               N Used equipment or supplies

                                  13                    1 Yes
                                 913                    2 No

EYEGLASS  245  2  YES2FMT                               N Used eyeglasses

                                 223                    1 Yes
                                 703                    2 No

FEEDSERV  247  2  YES2FMT                               N Received feeding services

                                 230                    1 Yes
                                 696                    2 No

FEEDSUPP  249  2  YES2FMT                               N Received feeding supplies

                                  48                    1 Yes
                                 878                    2 No

GERCHAIR  251  2  YES2FMT                               N Received geri-chair

                                  66                    1 Yes
                                 860                    2 No

GTUBESUP  253  2  YES2FMT                               N Received gastrointestinal tube & suppl.

                                  39                    1 Yes
                                 887                    2 No

GTUBEUSE  255  2  YES2FMT                               N Received gastrointestinal tube serivces

                                  40                    1 Yes
                                 886                    2 No

HEARAID   257  2  YES2FMT                               N Used hearing aid

                                  57                    1 Yes
                                 869                    2 No

HOSPBED   259  2  YES2FMT                               N Received hospital bed

                                 334                    1 Yes
                                 592                    2 No

HOTPACKS  261  2  YES2FMT                               N Received hot pack & hot pack services

                                  32                    1 Yes
                                 894                    2 No

INCNCARE  263  2  YES2FMT                               N Received incontinence care

                                 657                    1 Yes
                                 269                    2 No

INJCTION  265  2  YES2FMT                               N Received injections

                                 314                    1 Yes
                                 612                    2 No

IVSUPP    267  2  YES2FMT                               N Received IV therapy supplies

                                  37                    1 Yes
                                 889                    2 No

IVUSE     269  2  YES2FMT                               N Received IV therapy services

                                  39                    1 Yes
                                 887                    2 No

MATTRESS  271  2  YES2FMT                               N Received special mattress

                                 366                    1 Yes
                                 560                    2 No

NEBULIZR  273  2  YES2FMT                               N Received nebulizer

                                  95                    1 Yes
                                 831                    2 No

ORTHITEM  275  2  YES2FMT                               N Used orthopedic items

                                 137                    1 Yes
                                 789                    2 No

OSTOMSUP  277  2  YES2FMT                               N Used ostomy supplies

                                  28                    1 Yes
                                 898                    2 No

OXYGEN    279  2  YES2FMT                               N Used oxygen

                                 189                    1 Yes
                                 737                    2 No

PACEMCHK  281  2  YES2FMT                               N Pacemaker check/monitoring services

                                  36                    1 Yes
                                 890                    2 No

PROSTHES  283  2  YES2FMT                               N Used prosthesis

                                  12                    1 Yes
                                 914                    2 No

RESTRAIN  285  2  YES2FMT                               N Received restraints

                                  62                    1 Yes
                                 864                    2 No

SKINSERV  287  2  YES2FMT                               N Rec'd skin ulcer prevention/care svcs.

                                 577                    1 Yes
                                 349                    2 No

SUCTSERV  289  2  YES2FMT                               N Received respiratory tract suctioning

                                  21                    1 Yes
                                 905                    2 No

SUCTSUPP  291  2  YES2FMT                               N Received suction machine and supplies

                                  22                    1 Yes
                                 904                    2 No

TEDHOSE   293  2  YES2FMT                               N Received support (ted) hose and supplies

                                  91                    1 Yes
                                 835                    2 No

TUBEFEED  295  2  YES2FMT                               N Received tube feeding

                                  52                    1 Yes
                                 874                    2 No

TURNPOS   299  2  YES2FMT                               N Received turning and positioning

                                 487                    1 Yes
                                 439                    2 No

WHEEWALK  301  2  YES2FMT                               N Received wheel chair or walker

                                 418                    1 Yes
                                 508                    2 No

