RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                               5,021             LOW-HIGH BASEID Count

M0010_ME   12  6                                        C Agency Medicare provider number

M0012_ME   18 15                                        C Agency Medicaid provider number

M0014_BR   33  2                                        C Agency branch state

M0016_BR   35 10                                        C Agency branch ID

M0030_ST   45  8                                        N Start of care date

M0032_R0   53  1                                        N Resumption of care date, NA flag

M0032_RO   54  8                                        N Resumption of care date

M0050_PA   62  2                                        C Patient-State

M0060_PA   64 11                                        C Patient-ZIP

M0066_PA   75  8                                        N Patient birth date

M0069_PA   83  1  GEND                                  N Patient gender

                               1,666                    1 Male
                               3,355                    2 Female

M0072_P7   84  1                                        N Primary referring physician, UK flag

M0072_PH   85 10                                        C Primary referring physician UPIN

M0080_AS   95  2  $DISCIOA                              C Discipline of person completing assess

                               4,415                   01 RN
                                 553                   02 PT
                                   9                   03 SLP/ST
                                  44                   04 OT

M0090_AS   97  8                                        N Assessment completion date

M0100_AS  105  2  $ACOMPOA                              C Assessment reason

                               1,354                   01 S/R; Start; further visits planned
                                   0                   02 S/R; Start; no further visits planned
                                 324                   03 S/R; Resumption of care
                               1,471                   04 Follow-up; Recertification
                                  21                   05 Follow-up; Other
                                 502                   06 Transfer to inpat fac; Patient not disch
                                  65                   07 Transfer to inpat fac; Patient disch
                                  27                   08 Disch from agency; Death at home
                               1,257                   09 Disch from agency; Disch from agency
                                   0                   10 Disch from agency; No visits completed

M0140_E0  107  1  INDICOA                               N Ethnicity; Asian

                               3,343                    . Missing
                               1,670                    0 Not indicated
                                   8                    1 Indicated

M0140_E1  108  1  INDICOA                               N Ethnicity; Afr Amer

                               3,343                    . Missing
                               1,470                    0 Not indicated
                                 208                    1 Indicated

M0140_E2  109  1  INDICOA                               N Ethnicity; Hispancic

                               3,343                    . Missing
                               1,601                    0 Not indicated
                                  77                    1 Indicated

M0140_E3  110  1  INDICOA                               N Ethnicity; Hawaii

                               3,343                    . Missing
                               1,674                    0 Not indicated
                                   4                    1 Indicated

M0140_E4  111  1  INDICOA                               N Ethnicity; White

                               3,343                    . Missing
                                 329                    0 Not indicated
                               1,349                    1 Indicated

M0140_E5  112  1  INDICOA                               N Ethnicity; Unknown

                               3,413                    . Missing
                               1,583                    0 Not indicated
                                  25                    1 Indicated

M0140_ET  113  1  INDICOA                               N Ethnicity; Am Indian

                               3,343                    . Missing
                               1,668                    0 Not indicated
                                  10                    1 Indicated

M0150_10  114  1  INDICOA                               N Payment; Workers comp

                               5,021                    0 Not indicated
                                   0                    1 Indicated

M0150_11  115  1  INDICOA                               N Payment; Title programs

                               5,021                    0 Not indicated
                                   0                    1 Indicated

M0150_12  116  1  INDICOA                               N Payment; Other govt

                               5,018                    0 Not indicated
                                   3                    1 Indicated

M0150_13  117  1  INDICOA                               N Payment; Private ins

                               4,879                    0 Not indicated
                                 142                    1 Indicated

M0150_14  118  1  INDICOA                               N Payment; Private HMO

                               5,009                    0 Not indicated
                                  12                    1 Indicated

M0150_15  119  1  INDICOA                               N Payment; Self-pay

                               4,979                    0 Not indicated
                                  42                    1 Indicated

M0150_16  120  1  INDICOA                               N Payment; Other

                               4,981                    0 Not indicated
                                  40                    1 Indicated

M0150_17  121  1  INDICOA                               N Payment; Unknown

                               3,343                    . Missing
                               1,678                    0 Not indicated
                                   0                    1 Indicated

M0150_C6  122  1  INDICOA                               N Payment; Medicare FFS

                                 922                    0 Not indicated
                               4,099                    1 Indicated

M0150_C7  123  1  INDICOA                               N Payment; Medicare HMO

                               4,369                    0 Not indicated
                                 652                    1 Indicated

M0150_C8  124  1  INDICOA                               N Payment; Medicaid FFS

                               4,578                    0 Not indicated
                                 443                    1 Indicated

M0150_C9  125  1  INDICOA                               N Payment; Medicaid HMO

                               4,971                    0 Not indicated
                                  50                    1 Indicated

M0150_CP  126  1  INDICOA                               N Payment; None

                               5,021                    0 Not indicated
                                   0                    1 Indicated

M0160_18  127  1  INDICOA                               N Finance limit; Medicine

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0160_19  128  1  INDICOA                               N Finance limit; Ins copay

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0160_20  129  1  INDICOA                               N Finance limit; Rent

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0160_21  130  1  INDICOA                               N Finance limit; Food

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0160_22  131  1  INDICOA                               N Finance limit; Other

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0160_LT  132  1  INDICOA                               N Finance limit; None

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0175_HS  133  1  INDICOA                               N Disch in past 14 days; Hospital

                               3,413                    . Missing
                                 720                    0 Not indicated
                                 888                    1 Indicated

M0175_NO  134  1  INDICOA                               N Disch in past 14 days; Not disch

                               3,343                    . Missing
                               1,186                    0 Not indicated
                                 492                    1 Indicated

M0175_ON  135  1  INDICOA                               N Disch in past 14 days; Other nursing hom

                               3,413                    . Missing
                               1,594                    0 Not indicated
                                  14                    1 Indicated

M0175_OT  136  1  INDICOA                               N Disch in past 14 days; Other

                               3,413                    . Missing
                               1,603                    0 Not indicated
                                   5                    1 Indicated

M0175_RH  137  1  INDICOA                               N Disch in past 14 days; Rehab

                               3,413                    . Missing
                               1,450                    0 Not indicated
                                 158                    1 Indicated

M0175_SN  138  1  INDICOA                               N Disch in past 14 days; SNF

                               3,343                    . Missing
                               1,555                    0 Not indicated
                                 123                    1 Indicated

M0180_DS  139  1                                        C Disch in past 14 days; UK flag

M0180_IN  140  8                                        N Inpatient discharge date

M0190_14  148  7                                        C Inpatient diag 1 ICD9

M0190_26  155  7                                        C Inpatient diag 2 ICD9

M0200_RE  162  1  YESNOOA                               N Treatment regimen change

                               2,323                    . Missing
                               1,245                    0 No
                               1,453                    1 Yes

M0210_27  163  7                                        C Changed regimen; ICD9 2

M0210_28  170  7                                        C Changed regimen; ICD9 3

M0210_29  177  7                                        C Changed regimen; ICD9 4

M0210_CH  184  7                                        C Changed regimen; ICD9 1

M0220_30  191  1  $INDICOA                              C Prior condition; Catheter

                               3,270                      Missing
                               1,710                    0 Not indicated
                                  41                    1 Indicated

M0220_31  192  1  $INDICOA                              C Prior condition; Intr pain

                               3,270                      Missing
                               1,577                    0 Not indicated
                                 174                    1 Indicated

M0220_32  193  1  $INDICOA                              C Prior condition; Impaired decision

                               3,270                      Missing
                               1,461                    0 Not indicated
                                 290                    1 Indicated

M0220_33  194  1  $INDICOA                              C Prior condition; Disruptive beh

                               3,270                      Missing
                               1,725                    0 Not indicated
                                  26                    1 Indicated

M0220_34  195  1  $INDICOA                              C Prior condition; Memory loss

                               3,270                      Missing
                               1,553                    0 Not indicated
                                 198                    1 Indicated

M0220_35  196  1  $INDICOA                              C Prior condition; None of listed

                               3,270                      Missing
                                 994                    0 Not indicated
                                 757                    1 Indicated

M0220_36  197  1  $INDICOA                              C Prior condition; No change

                               3,343                      Missing
                               1,548                    0 Not indicated
                                 130                    1 Indicated

M0220_37  198  1  $INDICOA                              C Prior condition; Unknown

                               3,343                      Missing
                               1,676                    0 Not indicated
                                   2                    1 Indicated

M0220_PR  199  1  $INDICOA                              C Prior condition; Urinary incont

                               3,270                      Missing
                               1,147                    0 Not indicated
                                 604                    1 Indicated

M0230_38  200  2  $SEVEROA                              C Primary diag; Severity rating

                               1,871                      Missing
                                   0                   00 Asymptomatic, not treatement needed
                                  98                   01 Symptoms contr with current therapy
                               1,390                   02 Symptoms contr with difficulty
                               1,447                   03 Symptoms poorly contr, freq dose adjust
                                 215                   04 Symptoms poorly contr, hist rehospitali

M0230_PR  202  7                                        C Primary diag; ICD9

M0240_39  209  2  $SEVEROA                              C Oth diag 1; Severity rating

                               1,906                      Missing
                                   2                   00 Asymptomatic, not treatement needed
                                 187                   01 Symptoms contr with current therapy
                               1,667                   02 Symptoms contr with difficulty
                               1,117                   03 Symptoms poorly contr, freq dose adjust
                                 142                   04 Symptoms poorly contr, hist rehospitali

M0240_40  211  7                                        C Oth diag 2; ICD9

M0240_41  218  2  $SEVEROA                              C Oth diag 2; Severity rating

                               1,996                      Missing
                                   8                   00 Asymptomatic, not treatement needed
                                 343                   01 Symptoms contr with current therapy
                               1,794                   02 Symptoms contr with difficulty
                                 809                   03 Symptoms poorly contr, freq dose adjust
                                  71                   04 Symptoms poorly contr, hist rehospitali

M0240_42  220  7                                        C Oth diag 3; ICD9

M0240_43  227  2  $SEVEROA                              C Oth diag 3; Severity rating

                               2,151                      Missing
                                  12                   00 Asymptomatic, not treatement needed
                                 457                   01 Symptoms contr with current therapy
                               1,757                   02 Symptoms contr with difficulty
                                 593                   03 Symptoms poorly contr, freq dose adjust
                                  51                   04 Symptoms poorly contr, hist rehospitali

M0240_44  229  7                                        C Oth diag 4; ICD9

M0240_45  236  2  $SEVEROA                              C Oth diag 4; Severity rating

                               2,484                      Missing
                                   3                   00 Asymptomatic, not treatement needed
                                 502                   01 Symptoms contr with current therapy
                               1,558                   02 Symptoms contr with difficulty
                                 446                   03 Symptoms poorly contr, freq dose adjust
                                  28                   04 Symptoms poorly contr, hist rehospitali

M0240_46  238  7                                        C Oth diag 5; ICD9

M0240_47  245  2  $SEVEROA                              C Oth diag 5; Severity rating

                               2,945                      Missing
                                  21                   00 Asymptomatic, not treatement needed
                                 459                   01 Symptoms contr with current therapy
                               1,257                   02 Symptoms contr with difficulty
                                 324                   03 Symptoms poorly contr, freq dose adjust
                                  15                   04 Symptoms poorly contr, hist rehospitali

M0240_OT  247  7                                        C Oth diag 1; ICD9

M0250_48  254  1  INDICOA                               N Home therapies; Par nutr

                                 761                    . Missing
                               4,257                    0 Not indicated
                                   3                    1 Indicated

M0250_49  255  1  INDICOA                               N Home therapies; Ent nutr

                                 761                    . Missing
                               4,189                    0 Not indicated
                                  71                    1 Indicated

M0250_50  256  1  INDICOA                               N Home therapies; None of above

                                 761                    . Missing
                                 152                    0 Not indicated
                               4,108                    1 Indicated

M0250_TH  257  1  INDICOA                               N Home therapies; IV infusion

                                 761                    . Missing
                               4,179                    0 Not indicated
                                  81                    1 Indicated

M0260_OA  258  2  $OVPRGOA                              C Overall prognosis

                               3,413                      Missing
                                  21                   UK Unknown
                                 261                   00 Poor
                               1,326                   01 Good/Fair

M0270_RH  260  2  $REPRGOA                              C Rehab prognosis

                               3,413                      Missing
                                  28                   UK Unknown
                                 543                   00 Guarded
                               1,037                   01 Good

M0280_LI  262  2  $LIFEEOA                              C Life expectancy

                               2,323                      Missing
                               2,119                   00 Life expectancy is greater than 6 months
                                 579                   01 life expectancy is 6 month or fewer

M0290_51  264  1  INDICOA                               N High risk factors; Obesity

                               2,253                    . Missing
                               2,319                    0 Not indicated
                                 449                    1 Indicated

M0290_52  265  1  INDICOA                               N High risk factors; Alcohol

                               2,253                    . Missing
                               2,739                    0 Not indicated
                                  29                    1 Indicated

M0290_53  266  1  INDICOA                               N High risk factors; Drugs

                               2,253                    . Missing
                               2,751                    0 Not indicated
                                  17                    1 Indicated

M0290_54  267  1  INDICOA                               N High risk factors; None

                               2,253                    . Missing
                                 635                    0 Not indicated
                               2,133                    1 Indicated

M0290_55  268  1  INDICOA                               N High risk factors; Unknown

                               3,343                    . Missing
                               1,659                    0 Not indicated
                                  19                    1 Indicated

M0290_RS  269  1  INDICOA                               N High risk factors; Smoking

                               2,253                    . Missing
                               2,595                    0 Not indicated
                                 173                    1 Indicated

M0300_CU  270  2  $CURREOA                              C Current residence

                               2,323                      Missing
                               2,095                   01 Patient owned or rented residence
                                 269                   02 Family member residence
                                  15                   03 Boarding home or rented room
                                 289                   04 Board and care or assisted living facili
                                  30                   05 Other

M0310_S0  272  1  INDICOA                               N Struct barriers; Stairs must

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0310_S1  273  1  INDICOA                               N Struct barriers; Stairs opt

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0310_S2  274  1  INDICOA                               N Struct barriers; Stairs outside

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0310_S3  275  1  INDICOA                               N Struct barriers; Doorways

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0310_ST  276  1  INDICOA                               N Struct barriers; None

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0320_10  277  1  INDICOA                               N Safety haz; Floor covering

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0320_11  278  1  INDICOA                               N Safety haz; Railings

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0320_12  279  1  INDICOA                               N Safety haz; Haz Materials

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0320_13  280  1  INDICOA                               N Safety haz; Lead paint

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0320_14  281  1  INDICOA                               N Safety haz; Other

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0320_S4  282  1  INDICOA                               N Safety haz; Floor,roof,windows

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0320_S5  283  1  INDICOA                               N Safety haz; Lighting

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0320_S6  284  1  INDICOA                               N Safety haz; Appliances

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0320_S7  285  1  INDICOA                               N Safety haz; Heating

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0320_S8  286  1  INDICOA                               N Safety haz; Cooling

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0320_S9  287  1  INDICOA                               N Safety haz; Lack of fire devices

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0320_SA  288  1  INDICOA                               N Safety haz; None

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_15  289  1  INDICOA                               N Sanitation haz; No running water

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_16  290  1  INDICOA                               N Sanitation haz; Contaminated water

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_17  291  1  INDICOA                               N Sanitation haz; No toilet fac

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_18  292  1  INDICOA                               N Sanitation haz; Outdoor toilet fac

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_19  293  1  INDICOA                               N Sanitation haz; Inadequate sewer disp

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_20  294  1  INDICOA                               N Sanitation haz; Inadequate food stor

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_21  295  1  INDICOA                               N Sanitation haz; No food refridge

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_22  296  1  INDICOA                               N Sanitation haz; No cooking fac

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_23  297  1  INDICOA                               N Sanitation haz; Insects/rodents present

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_24  298  1  INDICOA                               N Sanitation haz; No trash pickup

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_25  299  1  INDICOA                               N Sanitation haz; Cluttered/Soiled living

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_26  300  1  INDICOA                               N Sanitation haz; Other

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0330_SA  301  1  INDICOA                               N Sanitation haz; None

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0340_27  302  1  INDICOA                               N Patient lives w/ spouse

                               2,323                    . Missing
                               1,835                    0 Not indicated
                                 863                    1 Indicated

M0340_28  303  1  INDICOA                               N Patient lives w/ oth fam

                               2,323                    . Missing
                               1,989                    0 Not indicated
                                 709                    1 Indicated

M0340_29  304  1  INDICOA                               N Patient lives w/ friend

                               2,323                    . Missing
                               2,662                    0 Not indicated
                                  36                    1 Indicated

M0340_30  305  1  INDICOA                               N Patient lives w/ paid help

                               2,323                    . Missing
                               2,462                    0 Not indicated
                                 236                    1 Indicated

M0340_31  306  1  INDICOA                               N Patient lives w/ other

                               2,323                    . Missing
                               2,669                    0 Not indicated
                                  29                    1 Indicated

M0340_LI  307  1  INDICOA                               N Patient lives w/ alone

                               2,323                    . Missing
                               1,766                    0 Not indicated
                                 932                    1 Indicated

M0350_A0  308  1  INDICOA                               N Assist person; Home resident

                               2,323                    . Missing
                               1,365                    0 Not indicated
                               1,333                    1 Indicated

M0350_A1  309  1  INDICOA                               N Assist person; Paid help

                               2,323                    . Missing
                               2,035                    0 Not indicated
                                 663                    1 Indicated

M0350_A2  310  1  INDICOA                               N Assist person; None

                               2,323                    . Missing
                               2,611                    0 Not indicated
                                  87                    1 Indicated

M0350_A3  311  1  INDICOA                               N Assist person; Unknown

                               3,413                    . Missing
                               1,607                    0 Not indicated
                                   1                    1 Indicated

M0350_AP  312  1  INDICOA                               N Assist person; Relative/Friend

                               2,323                    . Missing
                               1,205                    0 Not indicated
                               1,493                    1 Indicated

M0360_PR  313  2  $PRICAOA                              C Primary caregiver

                               2,411                      Missing
                                   0                   UK Unknown
                                 434                   00 No one person
                                 650                   01 Spouse of significant other
                                 869                   02 Daughter or son
                                 248                   03 Other family member
                                  77                   04 Friend, neighbor, community, church memb
                                 332                   05 Paid help

M0370_FR  315  2  $OFTASOA                              C Primary caregiver; How often

                               2,845                      Missing
                                   1                   UK Unknown
                                 876                   01 Several times during day or night
                                 725                   02 Several times during day
                                 214                   03 Once daily
                                 190                   04 Three or more times per week
                                 126                   05 One to two times per week
                                  44                   06 Less often than weekly

M0380_10  317  1  $INDICOA                              C Caregiver assist; Unknown

                               3,670                      Missing
                               1,349                    0 Not indicated
                                   2                    1 Indicated

M0380_C4  318  1  $INDICOA                              C Caregiver assist; IADL

                               2,845                      Missing
                                 230                    0 Not indicated
                               1,946                    1 Indicated

M0380_C5  319  1  $INDICOA                              C Caregiver assist; Environmental

                               2,845                      Missing
                                 243                    0 Not indicated
                               1,933                    1 Indicated

M0380_C6  320  1  $INDICOA                              C Caregiver assist; Psychosocial

                               2,845                      Missing
                                 182                    0 Not indicated
                               1,994                    1 Indicated

M0380_C7  321  1  $INDICOA                              C Caregiver assist; Medical care

                               2,845                      Missing
                                 505                    0 Not indicated
                               1,671                    1 Indicated

M0380_C8  322  1  $INDICOA                              C Caregiver assist; Financial/Legal

                               2,845                      Missing
                               1,605                    0 Not indicated
                                 571                    1 Indicated

M0380_C9  323  1  $INDICOA                              C Caregiver assist; Health care agent

                               2,845                      Missing
                               1,741                    0 Not indicated
                                 435                    1 Indicated

M0380_CA  324  1  $INDICOA                              C Caregiver assist; ADL

                               2,845                      Missing
                                 932                    0 Not indicated
                               1,244                    1 Indicated

M0390_VI  325  2  $VISIOOA                              C Physical assesment; Vision

                               1,851                      Missing
                               2,059                   00 Normal vision
                               1,033                   01 Partially impaired
                                  78                   02 Severely impaired

M0400_HE  327  2  $HEARIOA                              C Physical assesment; Hearing

                               3,413                      Missing
                                 905                   00 No observable impairement
                                 535                   01 Minimal difficulty
                                 132                   02 Moderate difficulty
                                  29                   03 Severe difficulty
                                   7                   04 Unable to hear or nonresponsive

M0410_SP  329  2  $SPEECOA                              C Physical assesment; Speech

                               2,086                      Missing
                               1,998                   00 No observable impairement
                                 669                   01 Minimal difficulty
                                 166                   02 Moderate difficulty
                                  62                   03 Severe difficulty
                                  21                   04 Unable to express basic needs
                                  19                   05 Nonresponsive or unable to speak

M0420_FR  331  2  $FREQPOA                              C Frequency of pain

                               1,305                      Missing
                               1,412                   00 No pain or pain does not interfere
                                 537                   01 Less often than daily
                               1,463                   02 Daily, but not constantly
                                 304                   03 All of the time

M0430_IN  333  1  YESNOOA                               N Intractable pain

                               2,323                    . Missing
                               2,355                    0 No
                                 343                    1 Yes

M0440_LE  334  1  YESNOOA                               N Skin lesion/Open wound

                               1,305                    . Missing
                               1,127                    0 No
                               2,589                    1 Yes

M0445_PR  335  1  $YESNOOA                              C Pressure ulcer

                               3,084                      Missing
                               1,801                    0 No
                                 136                    1 Yes

M0450_N0  336  2  $ULNUMOA                              C No. of press ulcers Stage 2

                               4,439                      Missing
                                 472                   00 None
                                  75                   01 One
                                  28                   02 Two
                                   5                   03 Three
                                   2                   04 Four or more

M0450_N1  338  2  $ULNUMOA                              C No. of press ulcers Stage 3

                               4,440                      Missing
                                 534                   00 None
                                  33                   01 One
                                  13                   02 Two
                                   0                   03 Three
                                   1                   04 Four or more

M0450_N2  340  2  $ULNUMOA                              C No. of press ulcers Stage 4

                               4,439                      Missing
                                 559                   00 None
                                  16                   01 One
                                   3                   02 Two
                                   3                   03 Three
                                   1                   04 Four or more

M0450_NB  342  2  $ULNUMOA                              C No. of Press ulcers Stage 1

                               3,728                      Missing
                               1,212                   00 None
                                  61                   01 One
                                  15                   02 Two
                                   3                   03 Three
                                   2                   04 Four or more

M0450_UN  344  1  $YESNOOA                              C Press ulcer cannot be observed

                               4,442                      Missing
                                 550                    0 No
                                  29                    1 Yes

M0460_ST  345  2  $ULSTGOA                              C Stage of most prob press ulcer

                               4,084                      Missing
                                 653                   NA No observable pressure ulcer
                                  58                   01 Stage one
                                 110                   02 Stage two
                                  74                   03 Stage three
                                  42                   04 Stage four

M0464_ST  347  2  $ULSTAOA                              C Status of most prob press ulcer

                               4,885                      Missing
                                   3                   NA No observable pressure ulcer
                                  15                   01 Fully granulating
                                  66                   02 Early/Partial granulation
                                  52                   03 Not healing

M0468_ST  349  1  $YESNOOA                              C Stasis ulcer

                               3,084                      Missing
                               1,901                    0 No
                                  36                    1 Yes

M0470_NB  350  2  $ULNUMOA                              C No. of statis ulcers

                               4,491                      Missing
                                 472                   00 None
                                  36                   01 One
                                  14                   02 Two
                                   4                   03 Three
                                   4                   04 Four or more

M0474_UN  352  1  $YESNOOA                              C Stasis ulcer that cannot be observed

                               4,505                      Missing
                                 512                    0 No
                                   4                    1 Yes

M0476_ST  353  2  $ULSTAOA                              C Status of most problemat stasis ulcer

                               4,799                      Missing
                                 162                   NA No observable pressure ulcer
                                   5                   01 Fully granulating
                                  21                   02 Early/Partial granulation
                                  34                   03 Not healing

M0482_SU  355  1  $YESNOOA                              C Surgical wound

                               3,084                      Missing
                               1,423                    0 No
                                 514                    1 Yes

M0484_NB  356  2  $ULNUMOA                              C No. of surgical wounds

                               4,507                      Missing
                                  13                   00 None
                                 360                   01 One
                                  63                   02 Two
                                  37                   03 Three
                                  41                   04 Four or more

M0486_UN  358  1  $YESNOOA                              C Surgical wound that cannot be observed

                               4,507                      Missing
                                 480                    0 No
                                  34                    1 Yes

M0488_ST  359  2  $ULSTAOA                              C Status of most problemat surgical wound

                               4,296                      Missing
                                 165                   NA No observable pressure ulcer
                                 226                   01 Fully granulating
                                 273                   02 Early/Partial granulation
                                  61                   03 Not healing

M0490_WH  361  2  $SBREAOA                              C When is patient dyspneic

                                 594                      Missing
                               1,266                   00 Never
                               1,169                   01 When walking more than 20 feet
                               1,245                   02 With moderate exertion
                                 653                   03 With minimal exertion
                                  94                   04 At rest (day or night)

M0500_R0  363  1  INDICOA                               N Respir treatment; Ventilator

                               2,086                    . Missing
                               2,934                    0 Not indicated
                                   1                    1 Indicated

M0500_R1  364  1  INDICOA                               N Respir treatment; Airway pressure

                               2,086                    . Missing
                               2,899                    0 Not indicated
                                  36                    1 Indicated

M0500_R2  365  1  INDICOA                               N Respir treatment; None

                               2,086                    . Missing
                                 528                    0 Not indicated
                               2,407                    1 Indicated

M0500_RE  366  1  INDICOA                               N Respir treatment; Oxygen

                               2,086                    . Missing
                               2,426                    0 Not indicated
                                 509                    1 Indicated

M0510_UT  367  2  $UTINFOA                              C Urinary tract infection

                               2,086                      Missing
                                  15                   NA Patient on prophylactic treatment
                                   9                   UK Unknown
                               2,706                   00 No
                                 205                   01 Yes

M0520_UR  369  2  $UIUCPOA                              C Urinary incontinence

                                 594                      Missing
                               2,047                   00 No incontinence or catheter
                               2,190                   01 Patient is incintinent
                                 190                   02 Patient requires a urinary catheter

M0530_UR  371  2  $URINCOA                              C Urinary incontinence occurs

                               3,260                      Missing
                                 343                   00 Timed-voiding deters incontinence
                                 113                   01 During the night only
                               1,305                   02 During the day and night

M0540_BW  373  2  $BWINCOA                              C Bowel incontinence frequency

                                 594                      Missing
                                  91                   NA Patient has ostomy for bowel elimination
                                   1                   UK Unknown
                               3,584                   00 Very rarely or never has bowel incont
                                 188                   01 Less than once weekly
                                 268                   02 One to three times weekly
                                  97                   03 Four to six times weekly
                                 161                   04 On a daily basis
                                  37                   05 More often than once daily

M0550_OS  375  2  $BWOSTOA                              C Ostomy

                                 761                      Missing
                               4,171                   00 Does not have an ostomy
                                  71                   01 Ostomy was not related to inpatient stay
                                  18                   02 Ostomy was related to inpatient stay

M0560_CO  377  2  $COGFUOA                              C Cognitive functioning

                               2,086                      Missing
                               1,861                   00 Alert/Oriented
                                 710                   01 Req prompting
                                 265                   02 Req assist and some direction
                                  71                   03 Req conciderable assist in routine situa
                                  28                   04 Totally dependent due to disturbances

M0570_WH  379  2  $WCONFOA                              C When confused (reported or observed)

                               2,086                      Missing
                                  10                   NA Patient nonresponsive
                               1,557                   00 Never
                                 973                   01 In new or complex situations
                                  45                   02 On awakening or at night only
                                 266                   03 During the day or evening
                                  84                   04 Constantly

M0580_WH  381  2  $WANXIOA                              C When anxious (reported or observed)

                               2,086                      Missing
                                   7                   NA Patient nonresponsive
                               1,770                   00 None of the time
                                 719                   01 Less often than daily
                                 408                   02 Daily, but not constantly
                                  31                   03 All of the time

M0590_D0  383  1  INDICOA                               N Sense of failure or self reproach

                               2,323                    . Missing
                               2,673                    0 Not indicated
                                  25                    1 Indicated

M0590_D1  384  1  INDICOA                               N Hopelessness

                               2,323                    . Missing
                               2,675                    0 Not indicated
                                  23                    1 Indicated

M0590_D2  385  1  INDICOA                               N Recurrent thoughts of death

                               2,323                    . Missing
                               2,692                    0 Not indicated
                                   6                    1 Indicated

M0590_D3  386  1  INDICOA                               N Thoughts of suicide

                               2,323                    . Missing
                               2,692                    0 Not indicated
                                   6                    1 Indicated

M0590_D4  387  1  INDICOA                               N None of the above feelings

                               2,323                    . Missing
                                 532                    0 Not indicated
                               2,166                    1 Indicated

M0590_DP  388  1  INDICOA                               N Depressed mood

                               2,323                    . Missing
                               2,176                    0 Not indicated
                                 522                    1 Indicated

M0600_10  389  1  INDICOA                               N None of the above behaviors

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0600_B5  390  1  INDICOA                               N Diminished interest in most activities

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0600_B6  391  1  INDICOA                               N Sleep disturbances

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0600_B7  392  1  INDICOA                               N Recent change in appetite or weight

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0600_B8  393  1  INDICOA                               N Agitation

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0600_B9  394  1  INDICOA                               N A suicide attempt

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0600_BE  395  1  INDICOA                               N Indecisiveness, lack of concentration

                               5,021                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0610_11  396  1  INDICOA                               N Impaired decision-making

                               2,086                    . Missing
                               2,400                    0 Not indicated
                                 535                    1 Indicated

M0610_12  397  1  INDICOA                               N Verbal disruption

                               2,086                    . Missing
                               2,902                    0 Not indicated
                                  33                    1 Indicated

M0610_13  398  1  INDICOA                               N Physical aggression

                               2,086                    . Missing
                               2,915                    0 Not indicated
                                  20                    1 Indicated

M0610_14  399  1  INDICOA                               N Disruptive, infantile, or socially inapp

                               2,086                    . Missing
                               2,916                    0 Not indicated
                                  19                    1 Indicated

M0610_15  400  1  INDICOA                               N Delusional, hallucinatory, or paranoid

                               2,086                    . Missing
                               2,892                    0 Not indicated
                                  43                    1 Indicated

M0610_16  401  1  INDICOA                               N None of the above behaivors demonstrated

                               2,086                    . Missing
                                 757                    0 Not indicated
                               2,178                    1 Indicated

M0610_BD  402  1  INDICOA                               N Memory deficit

                               2,086                    . Missing
                               2,491                    0 Not indicated
                                 444                    1 Indicated

M0620_BE  403  2  $FREQBOA                              C Frequency of behavior problems

                               2,086                      Missing
                                   0                    0 As reported
                               2,419                   00 Never
                                  45                   01 Less than once a month
                                  15                   02 One a month
                                  88                   03 Several times each month
                                 115                   04 Several times a week
                                 253                   05 At least daily

M0630_RE  405  1  YESNOOA                               N Receiving psychiatric nursing services

                               2,253                    . Missing
                               2,726                    0 No
                                  42                    1 Yes

M0640_CU  406  2  $GROOMOA                              C Grooming, current

                               2,086                      Missing
                                   0                   UK Unknown
                               1,502                   00 Able to groom self unaided
                                 798                   01 Utensils must be placed within reach
                                 477                   02 Someone must assis patient to groom self
                                 158                   03 Depends entirely upon another person

M0640_PR  408  2  $GROOMOA                              C Grooming, prior

                               3,413                      Missing
                                   6                   UK Unknown
                                 826                   00 Able to groom self unaided
                                 426                   01 Utensils must be placed within reach
                                 249                   02 Someone must assis patient to groom self
                                 101                   03 Depends entirely upon another person

M0650_CU  410  2  $DRESSOA                              C Ability to dress upper body, current

                                 594                      Missing
                                   0                   UK Unknown
                               1,716                   00 No assist needed
                               1,406                   01 No assist needed if clothing laid out
                                 951                   02 Assist from another person
                                 354                   03 Depends entirely upon another person

M0650_PR  412  2  $DRESSOA                              C Ability to dress upper body, prior

                               3,413                      Missing
                                   7                   UK Unknown
                                 744                   00 No assist needed
                                 425                   01 No assist needed if clothing laid out
                                 324                   02 Assist from another person
                                 108                   03 Depends entirely upon another person

M0660_CU  414  2  $DRESSOA                              C Ability to dress lower body, current

                                 594                      Missing
                                   0                   UK Unknown
                               1,465                   00 No assist needed
                                 950                   01 No assist needed if clothing laid out
                               1,503                   02 Assist from another person
                                 509                   03 Depends entirely upon another person

M0660_PR  416  2  $DRESSOA                              C Ability to dress lower body, prior

                               3,413                      Missing
                                   6                   UK Unknown
                                 674                   00 No assist needed
                                 293                   01 No assist needed if clothing laid out
                                 464                   02 Assist from another person
                                 171                   03 Depends entirely upon another person

M0670_CU  418  2  $BATHIOA                              C Bathing, current

                               1,305                      Missing
                                   0                   UK Unknown
                                 432                   00 Bathes self independently
                                 688                   01 Bathes self with use of devices
                               1,049                   02 Bathes with intermittent assist
                                 931                   03 Bathes with complete assist/supervision
                                 429                   04 Unable, bed/bedside chair
                                 187                   05 Unable, totally bathed by another person

M0670_PR  420  2  $BATHIOA                              C Bathing, prior

                               3,413                      Missing
                                   6                   UK Unknown
                                 352                   00 Bathes self independently
                                 312                   01 Bathes self with use of devices
                                 315                   02 Bathes with intermittent assist
                                 379                   03 Bathes with complete assist/supervision
                                 167                   04 Unable, bed/bedside chair
                                  77                   05 Unable, totally bathed by another person

M0680_CU  422  2  $TOILEOA                              C Toileting, current

                               1,305                      Missing
                                   0                   UK Unknown
                               2,211                   00 Toilet, to and from independently
                               1,031                   01 Toilet, when reminded/assist/supervised
                                 223                   02 Unable toil, able to bedside commode
                                  26                   03 Unable toil/bedside commode, able bedpan
                                 225                   04 Depends entirely upon another person

M0680_PR  424  2  $TOILEOA                              C Toileting, prior

                               3,413                      Missing
                                   8                   UK Unknown
                                 990                   00 Toilet, to and from independently
                                 414                   01 Toilet, when reminded/assist/supervised
                                  93                   02 Unable toil, able to bedside commode
                                  14                   03 Unable toil/bedside commode, able bedpan
                                  89                   04 Depends entirely upon another person

M0690_CU  426  2  $TRANSOA                              C Transferring, current

                               1,305                      Missing
                                   0                   UK Unknown
                               1,045                   00 Able to independently transfer
                               2,133                   01 Transfers with minimal assist or device
                                 345                   02 Unable transfer self, able to pivot
                                 112                   03 Unable transfer self, unable to pivot
                                  15                   04 Bedfast, unable trans, able to positio
                                  66                   05 Bedfast, unable trans, unable to positio

M0690_PR  428  2  $TRANSOA                              C Transferring, prior

                               3,413                      Missing
                                   8                   UK Unknown
                                 565                   00 Able to independently transfer
                                 824                   01 Transfers with minimal assist or device
                                 130                   02 Unable transfer self, able to pivot
                                  45                   03 Unable transfer self, unable to pivot
                                   6                   04 Bedfast, unable trans, able to positio
                                  30                   05 Bedfast, unable trans, unable to positio

M0700_CU  430  2  $AMBULOA                              C Ambulation/Locomotion, current

                               1,305                      Missing
                                   0                   UK Unknown
                                 484                   00 Able to independently walk/stairs
                               2,238                   01 Able to walk w/ device, assist w/ stairs
                                 615                   02 Able to walk w/ constant assist/supervis
                                 190                   03 Chairfast, able to wheel self independ
                                 151                   04 Chairfast, unable to wheel self independ
                                  38                   05 Bedfast, unable to ambulate/or chair

M0700_PR  432  2  $AMBULOA                              C Ambulation/Locomotion, prior

                               3,413                      Missing
                                   9                   UK Unknown
                                 395                   00 Able to independently walk/stairs
                                 801                   01 Able to walk w/ device, assist w/ stairs
                                 250                   02 Able to walk w/ constant assist/supervis
                                  77                   03 Chairfast, able to wheel self independ
                                  61                   04 Chairfast, unable to wheel self independ
                                  15                   05 Bedfast, unable to ambulate/or chair

M0710_CU  434  2  $FEEDIOA                              C Feeding or eating, current

                               2,086                      Missing
                                   0                   UK Unknown
                               1,941                   00 Able independently feed self
                                 869                   01 Able feed self with intermittent assist
                                  93                   02 Unable feed self, complete assist/superv
                                   8                   03 Able take nutri oral, rec tube feedi
                                  21                   04 Unable take nutri oral, rec tube feedi
                                   3                   05 Unable take nutri oral or tube feedi

M0710_PR  436  2  $FEEDIOA                              C Feeding or eating, prior

                               3,413                      Missing
                                   7                   UK Unknown
                               1,059                   00 Able independently feed self
                                 473                   01 Able feed self with intermittent assist
                                  53                   02 Unable feed self, complete assist/superv
                                   4                   03 Able take nutri oral, rec tube feedi
                                  10                   04 Unable take nutri oral, rec tube feedi
                                   2                   05 Unable take nutri oral or tube feedi

M0720_CU  438  2  $MEALSOA                              C Planning/Preparing light meals, current

                               2,086                      Missing
                                   0                   UK Unknown
                               1,092                   00 Able to independently prepare all meals
                                 928                   01 Unable to prepare meals on regular basis
                                 915                   02 Unable to prepare any meals

M0720_PR  440  2  $MEALSOA                              C Planning/Preparing light meals, prior

                               3,413                      Missing
                                   6                   UK Unknown
                                 611                   00 Able to independently prepare all meals
                                 467                   01 Unable to prepare meals on regular basis
                                 524                   02 Unable to prepare any meals

M0730_CU  442  2  $TRANPOA                              C Transportation, current

                               2,323                      Missing
                                   0                   UK Unknown
                                 188                   00 Able to independently drive car
                               2,436                   01 Able to ride when car driven by another
                                  74                   02 Unable to ride in car, trans by ambulanc

M0730_PR  444  2  $TRANPOA                              C Transportation, prior

                               3,413                      Missing
                                  10                   UK Unknown
                                 277                   00 Able to independently drive car
                               1,258                   01 Able to ride when car driven by another
                                  63                   02 Unable to ride in car, trans by ambulanc

M0740_CU  446  2  $LAUNDOA                              C Laundry, current

                               2,323                      Missing
                                   0                   UK Unknown
                                 260                   00 Able to independently do laundry
                                 802                   01 Able to do only lt laundry, assist heavy
                               1,636                   02 Unable to do any laundry

M0740_PR  448  2  $LAUNDOA                              C Laundry, prior

                               3,413                      Missing
                                   8                   UK Unknown
                                 308                   00 Able to independently do laundry
                                 396                   01 Able to do only lt laundry, assist heavy
                                 896                   02 Unable to do any laundry

M0750_CU  450  2  $HOUSEOA                              C Housekeeping, current

                               2,323                      Missing
                                   0                   UK Unknown
                                 174                   00 Able independently perform houskeep
                                 793                   01 Able perform only light houskeep
                                 176                   02 Able perform houskeep w/ intermit assist
                                 412                   03 Unable perform houskeep w/o compl assist
                               1,143                   04 Unable particip in any houskeep tasks

M0750_PR  452  2  $HOUSEOA                              C Housekeeping, prior

                               3,413                      Missing
                                   7                   UK Unknown
                                 266                   00 Able independently perform houskeep
                                 348                   01 Able perform only light houskeep
                                  98                   02 Able perform houskeep w/ intermit assist
                                 222                   03 Unable perform houskeep w/o compl assist
                                 667                   04 Unable particip in any houskeep tasks

M0760_CU  454  2  $SHOPPOA                              C Shopping, current

                               2,323                      Missing
                                   0                   UK Unknown
                                 133                   00 Able to independently shop
                                 776                   01 Able to shop, but needs some assistance
                               1,074                   02 Unable to shop, but can arrange delivery
                                 715                   03 Needs someone to do all shop and errands

M0760_PR  456  2  $SHOPPOA                              C Shopping, prior

                               3,413                      Missing
                                   8                   UK Unknown
                                 246                   00 Able to independently shop
                                 428                   01 Able to shop, but needs some assistance
                                 486                   02 Unable to shop, but can arrange delivery
                                 440                   03 Needs someone to do all shop and errands

M0770_CU  458  2  $TELEPOA                              C Ability to use telephone, current

                               2,086                      Missing
                                  37                   NA Patient does not have a telephone
                                   0                   UK Unknown
                               2,145                   00 Able independently dial/answer calls
                                 198                   01 Able use a specif adapted phone and call
                                 210                   02 Able answer calls, diff placing calls
                                 140                   03 Able answer calls only some of the time
                                  82                   04 Unable answer phone at all, can listen
                                 123                   05 Totaly unable to use the telephone

M0770_PR  460  2  $TELEPOA                              C Ability to use telephone, prior

                               3,413                      Missing
                                  21                   NA Patient does not have a telephone
                                  13                   UK Unknown
                               1,148                   00 Able independently dial/answer calls
                                 112                   01 Able use a specif adapted phone and call
                                 113                   02 Able answer calls, diff placing calls
                                  85                   03 Able answer calls only some of the time
                                  51                   04 Unable answer phone at all, can listen
                                  65                   05 Totaly unable to use the telephone

M0780_CU  462  2  $MANRXOA                              C Manage oral medica, current

                               2,323                      Missing
                                  14                   NA No med of this type prescribed
                                   0                   UK Unknown
                               1,043                   00 Able to independently take correct med
                                 991                   01 Able to take med corect times w/ assist
                                 650                   02 Unable to take med unless administered

M0780_PR  464  2  $MANRXOA                              C Manage oral medica, prior

                               3,413                      Missing
                                  13                   NA No med of this type prescribed
                                   7                   UK Unknown
                                 609                   00 Able to independently take correct med
                                 532                   01 Able to take med corect times w/ assist
                                 447                   02 Unable to take med unless administered

M0790_CU  466  2  $MANRXOA                              C Manage inhalation/mist medica, current

                               2,323                      Missing
                               1,965                   NA No med of this type prescribed
                                   0                   UK Unknown
                                 343                   00 Able to independently take correct med
                                 241                   01 Able to take med corect times w/ assist
                                 149                   02 Unable to take med unless administered

M0790_PR  468  2  $MANRXOA                              C Manage inhalation/mist medica, prior

                               3,413                      Missing
                               1,133                   NA No med of this type prescribed
                                  16                   UK Unknown
                                 199                   00 Able to independently take correct med
                                 163                   01 Able to take med corect times w/ assist
                                  97                   02 Unable to take med unless administered

M0800_CU  470  2  $MANRXOA                              C Manage injectable medica, current

                               1,305                      Missing
                               2,836                   NA No med of this type prescribed
                                   0                   UK Unknown
                                 227                   00 Able to independently take correct med
                                 155                   01 Able to take med corect times w/ assist
                                 498                   02 Unable to take med unless administered

M0800_PR  472  2  $MANRXOA                              C Manage injectable medica, prior

                               3,413                      Missing
                               1,251                   NA No med of this type prescribed
                                  20                   UK Unknown
                                 105                   00 Able to independently take correct med
                                  51                   01 Able to take med corect times w/ assist
                                 181                   02 Unable to take med unless administered

M0810_PA  474  2  $PQUIPOA                              C Patient management of equipment

                               2,323                      Missing
                               2,185                   NA No equipment used in this type of care
                                 134                   00 Able to independently manage all equip
                                 138                   01 Able to manage equip if someone sets up
                                  45                   02 Req considerable assist managing equip
                                  41                   03 Only able to monitor equipment
                                 155                   04 Depends entirely upon another person

M0820_CG  476  2  $CQUIPOA                              C Caregiver management of equipment

                               4,508                      Missing
                                  52                   NA No caregiver
                                   5                   UK Unknown
                                 282                   00 Able to independently manage all equip
                                 105                   01 Able to manage equip if someone sets up
                                  17                   02 Req considerable assist managing equip
                                  23                   03 Only able to monitor equipment
                                  29                   04 Depends entirely upon another person

M0825_TH  478  2  $YESNAOA                              C Indication of therapy need

                               5,021                      Missing
                                   0                   NA Inapplicable
                                   0                   00 No
                                   0                   01 Yes

M0830_E0  480  1  INDICOA                               N Emerg; Hospital emergency room

                               3,481                    . Missing
                               1,243                    0 Not indicated
                                 297                    1 Indicated

M0830_E1  481  1  INDICOA                               N Emerg; Doctors office emerg visit

                               3,481                    . Missing
                               1,509                    0 Not indicated
                                  31                    1 Indicated

M0830_E2  482  1  INDICOA                               N Emerg; Outpatient depart/clinic emerg

                               3,481                    . Missing
                               1,536                    0 Not indicated
                                   4                    1 Indicated

M0830_E3  483  1  INDICOA                               N Emerg; Unknown emergent care

                               3,481                    . Missing
                               1,516                    0 Not indicated
                                  24                    1 Indicated

M0830_EC  484  1  INDICOA                               N Emerg; No emergent care services

                               3,481                    . Missing
                                 352                    0 Not indicated
                               1,188                    1 Indicated

M0840_10  485  1  $INDICOA                              C Reas; GI bleeding, obstruction

                               4,693                      Missing
                                 318                    0 Not indicated
                                  10                    1 Indicated

M0840_11  486  1  $INDICOA                              C Reas; Other emergent care reason

                               4,693                      Missing
                                 188                    0 Not indicated
                                 140                    1 Indicated

M0840_12  487  1  $INDICOA                              C Reas; Unknown emergent care reason

                               4,612                      Missing
                                 378                    0 Not indicated
                                  31                    1 Indicated

M0840_E4  488  1  $INDICOA                              C Reas; Nausia, dehydration, malnutrition

                               4,693                      Missing
                                 305                    0 Not indicated
                                  23                    1 Indicated

M0840_E5  489  1  $INDICOA                              C Reas; Injury from fall or home accident

                               4,693                      Missing
                                 296                    0 Not indicated
                                  32                    1 Indicated

M0840_E6  490  1  $INDICOA                              C Reas; Respiratory problems

                               4,693                      Missing
                                 273                    0 Not indicated
                                  55                    1 Indicated

M0840_E7  491  1  $INDICOA                              C Reas; Wound infection, new lesion/ulcer

                               4,693                      Missing
                                 317                    0 Not indicated
                                  11                    1 Indicated

M0840_E8  492  1  $INDICOA                              C Reas; Cardiac problems

                               4,693                      Missing
                                 283                    0 Not indicated
                                  45                    1 Indicated

M0840_E9  493  1  $INDICOA                              C Reas; Hypo/Hyperglycemia, diabetes

                               4,612                      Missing
                                 396                    0 Not indicated
                                  13                    1 Indicated

M0840_EC  494  1  $INDICOA                              C Reas; Improper medication administration

                               4,612                      Missing
                                 401                    0 Not indicated
                                   8                    1 Indicated

M0855_IN  495  2  $INFACOA                              C Inpatient facility admitted to

                               3,197                      Missing
                               1,257                   NA No inpatient facility admission
                                 551                   01 Hospital
                                   4                   02 Rehabilitation facility
                                  11                   03 Nursing home
                                   1                   04 Hospice

M0870_DS  497  2  $DISPOOA                              C Discharge disposition

                               3,932                      Missing
                                  12                   UK Unknown, other
                               1,054                   01 Patient remained in the community
                                  15                   02 Patient transferred to a noninsti hospic
                                   8                   03 Unknown, location not served by agency

M0880_A0  499  1  $INDICOA                              C Svcs after disch; Family/Friends

                               3,966                      Missing
                                 277                    0 Not indicated
                                 778                    1 Indicated

M0880_A1  500  1  $INDICOA                              C Svcs after disch; Other comm resources

                               3,966                      Missing
                                 763                    0 Not indicated
                                 292                    1 Indicated

M0880_AF  501  1  $INDICOA                              C Svcs after disch; No services

                               3,966                      Missing
                                 919                    0 Not indicated
                                 136                    1 Indicated

M0890_HO  502  2  $RHOSPOA                              C Reason admitted to acute care hospital

                               4,586                      Missing
                                   8                   UK Unknown
                                 368                   01 Hospitalization; Emergent care
                                  30                   02 Hospitalization; Urgent care
                                  29                   03 Hospitalization; Elective care

M0895_10  504  1  $INDICOA                              C ReasHosp; Scheduled surgical procedure

                               4,586                      Missing
                                 418                    0 Not indicated
                                  17                    1 Indicated

M0895_11  505  1  $INDICOA                              C ReasHosp; Urinary tract infection

                               4,470                      Missing
                                 531                    0 Not indicated
                                  20                    1 Indicated

M0895_12  506  1  $INDICOA                              C ReasHosp; IV catheter-related infection

                               4,586                      Missing
                                 435                    0 Not indicated
                                   0                    1 Indicated

M0895_13  507  1  $INDICOA                              C ReasHosp; Pulminary embolus

                               4,470                      Missing
                                 547                    0 Not indicated
                                   4                    1 Indicated

M0895_14  508  1  $INDICOA                              C ReasHosp; Uncontrolled pain

                               4,470                      Missing
                                 533                    0 Not indicated
                                  18                    1 Indicated

M0895_15  509  1  $INDICOA                              C ReasHosp; Psychotic episode

                               4,586                      Missing
                                 431                    0 Not indicated
                                   4                    1 Indicated

M0895_16  510  1  $INDICOA                              C ReasHosp; Other reason

                               4,586                      Missing
                                 201                    0 Not indicated
                                 234                    1 Indicated

M0895_H2  511  1  $INDICOA                              C ReasHosp; Injury from fall or home accid

                               4,586                      Missing
                                 408                    0 Not indicated
                                  27                    1 Indicated

M0895_H3  512  1  $INDICOA                              C ReasHosp; Respiratory problems

                               4,586                      Missing
                                 363                    0 Not indicated
                                  72                    1 Indicated

M0895_H4  513  1  $INDICOA                              C ReasHosp; Wound infection, new lesion/ul

                               4,586                      Missing
                                 417                    0 Not indicated
                                  18                    1 Indicated

M0895_H5  514  1  $INDICOA                              C ReasHosp; Hypo/Hyperglycemia, diabetes

                               4,470                      Missing
                                 537                    0 Not indicated
                                  14                    1 Indicated

M0895_H6  515  1  $INDICOA                              C ReasHosp; GI bleeding, obstruction

                               4,586                      Missing
                                 420                    0 Not indicated
                                  15                    1 Indicated

M0895_H7  516  1  $INDICOA                              C ReasHosp; Exac of CHF, heart failure

                               4,586                      Missing
                                 400                    0 Not indicated
                                  35                    1 Indicated

M0895_H8  517  1  $INDICOA                              C ReasHosp; Myocardial infarction, stroke

                               4,586                      Missing
                                 429                    0 Not indicated
                                   6                    1 Indicated

M0895_H9  518  1  $INDICOA                              C ReasHosp; Chemotherapy

                               4,586                      Missing
                                 433                    0 Not indicated
                                   2                    1 Indicated

M0895_HO  519  1  $INDICOA                              C ReasHosp; Improper medical administratio

                               4,470                      Missing
                                 543                    0 Not indicated
                                   8                    1 Indicated

M0900_17  520  1  $INDICOA                              C Reason admitted to nursing home

                               5,010                      Missing
                                   8                    0 Not indicated
                                   3                    1 Indicated

M0900_18  521  1  $INDICOA                              C ReasHome; Hospice care

                               5,010                      Missing
                                  11                    0 Not indicated
                                   0                    1 Indicated

M0900_19  522  1  $INDICOA                              C ReasHome; Permanent Placement

                               5,010                      Missing
                                   6                    0 Not indicated
                                   5                    1 Indicated

M0900_20  523  1  $INDICOA                              C ReasHome; Unsafe for care at home

                               5,010                      Missing
                                  10                    0 Not indicated
                                   1                    1 Indicated

M0900_21  524  1  $INDICOA                              C ReasHome; Other reason

                               5,010                      Missing
                                   9                    0 Not indicated
                                   2                    1 Indicated

M0900_22  525  1  $INDICOA                              C ReasHome; Unknown reason

                               5,010                      Missing
                                  10                    0 Not indicated
                                   1                    1 Indicated

M0900_NH  526  1  $INDICOA                              C ReasHome; Therapy Services

                               5,010                      Missing
                                  11                    0 Not indicated
                                   0                    1 Indicated

M0903_LA  527  8                                        N Date of last home visit

M0906_DC  535  8                                        N Discharge/Transfer/Death date

