RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                              17,495             LOW-HIGH BASEID Count

AA2        12  2  GEND                                  N ID; gender

                                   4                    . Missing
                               5,067                    1 Male
                              12,424                    2 Female

AA3        14  8                                        N ID; birthdate

AA4        24  2  RACEETH                               N ID; race/ethnicity

                                  67                    . Missing
                                  46                    1 Amer Indian/Alaskan Native
                                 240                    2 Asian/Pacific Islander
                               2,526                    3 Black, not of Hispanic origin
                                 620                    4 Hispanic
                              13,996                    5 White, not of Hispanic origin

AA6A       26 15                                        C ID; facility provider number, state

AA6B       41 12                                        C ID, facility provider number, federal

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

                               3,509                   00 None of above
                               1,767                   01 Admission assessment
                               1,534                   02 Annual assessment
                                 603                   03 Signif change is status assessment
                                   1                   04 Signif correction of prior full
                               6,265                   05 Quarterly review assessment
                               1,233                   06 Discharged; return not anticipated
                               1,198                   07 Discharged; return anticipated
                                 310                   08 Discharged; prior to initial assessment
                               1,071                   09 Re-entry
                                   4                   10 Signif correction of prior quarterly

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

                              12,201                      Missing
                               1,974                    1 Medicare 5 day assessment
                                 879                    2 Medicare 30 day assessment
                                 311                    3 Medicare 60 day assessment
                                 141                    4 Medicare 90 day assessment
                                 259                    5 Medicare readmission/return assessment
                                  51                    6 Other state required assessment
                               1,575                    7 Medicare 14 day assessment
                                 104                    8 Other Medicare required assessment

AB1        56  8                                        N Residential; date of entry

AB2        66  2  ADMITFRM                              N Residential; admitted from

                              12,388                    . Missing
                                 534                    1 Private home w/ no home health services
                                 254                    2 Private home w/ home health services
                                  97                    3 Board and care/assist living/group home
                                 562                    4 Nursing home
                               3,436                    5 Acute care hospital
                                 126                    6 Psychiatric hospital, MR/DD facility
                                  34                    7 Rehabilitation hospital
                                  64                    8 Other

AB3        68  2  YESNOALO                              N Residential; lived alone

                              12,649                    . Missing
                               2,526                    0 No
                               1,699                    1 Yes
                                 621                    2 In other facility

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

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

                               9,968                    . Missing
                               5,892                    0 Not indicated
                               1,635                    1 Indicated

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

                               9,967                    . Missing
                               6,049                    0 Not indicated
                               1,479                    1 Indicated

AB5C       79  2  INDIC                                 N Residential; other residential facility

                               9,967                    . Missing
                               6,621                    0 Not indicated
                                 907                    1 Indicated

AB5D       81  2  INDIC                                 N Residential; MH/psychiatric setting

                               9,967                    . Missing
                               7,359                    0 Not indicated
                                 169                    1 Indicated

AB5E       83  2  INDIC                                 N Residential; MR/DD setting

                               9,967                    . Missing
                               7,484                    0 Not indicated
                                  44                    1 Indicated

AB5F       85  2  INDIC                                 N Residential; none of above

                               9,967                    . Missing
                               3,452                    0 Not indicated
                               4,076                    1 Indicated

AB6        87 21                                        C Demo; lifetime occupation(s)

AB7       108  2  HIEDUCAT                              N Demo; highest of education complete

                              12,733                    . Missing
                                 129                    1 No schooling
                               1,080                    2 8th grade/less
                                 570                    3 9-11 grades
                               1,757                    4 High school
                                 235                    5 Technical or trade school
                                 626                    6 Some college
                                 191                    7 Bachelors degree
                                 174                    8 Graduate degree

AB8A      110  2  PRIMLANG                              N Demo; primary language

                              12,654                    . Missing
                               4,653                    0 English
                                 118                    1 Spanish
                                   2                    2 French
                                  68                    3 Other

AB8B      112  9                                        C Demo; other primary language

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

                              12,654                    . Missing
                               4,207                    0 No
                                 634                    1 Yes

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

                              12,651                    . Missing
                                 152                    0 Not indicated
                               4,692                    1 Indicated

AB10B     125  2  INDIC                                 N Mental; status, downs syndrome

                              17,343                    . Missing
                                 120                    0 Not indicated
                                  32                    1 Indicated

AB10C     127  2  INDIC                                 N Mental; status, autism

                              17,343                    . Missing
                                 152                    0 Not indicated
                                   0                    1 Indicated

AB10D     129  2  INDIC                                 N Mental; status, epilepsy

                              17,343                    . Missing
                                 146                    0 Not indicated
                                   6                    1 Indicated

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

                              17,343                    . Missing
                                 138                    0 Not indicated
                                  14                    1 Indicated

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

                              17,343                    . Missing
                                  80                    0 Not indicated
                                  72                    1 Indicated

AB11      135  8                                        N Date background information completed

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

                              12,738                    . Missing
                               2,769                    0 Not indicated
                               1,988                    1 Indicated

AC1B      147  2  INDIC                                 N Routine; event, naps regularly

                              12,743                    . Missing
                               2,018                    0 Not indicated
                               2,734                    1 Indicated

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

                              12,743                    . Missing
                               2,536                    0 Not indicated
                               2,216                    1 Indicated

AC1D      151  2  INDIC                                 N Routine; event, stays busy

                              12,738                    . Missing
                               2,122                    0 Not indicated
                               2,635                    1 Indicated

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

                              12,738                    . Missing
                               2,768                    0 Not indicated
                               1,989                    1 Indicated

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

                              12,738                    . Missing
                               1,560                    0 Not indicated
                               3,197                    1 Indicated

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

                              12,743                    . Missing
                               4,488                    0 Not indicated
                                 264                    1 Indicated

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

                              12,738                    . Missing
                               4,549                    0 Not indicated
                                 208                    1 Indicated

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

                              12,740                    . Missing
                               3,702                    0 Not indicated
                               1,053                    1 Indicated

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

                              12,741                    . Missing
                               3,154                    0 Not indicated
                               1,600                    1 Indicated

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

                              12,743                    . Missing
                               4,525                    0 Not indicated
                                 227                    1 Indicated

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

                              12,738                    . Missing
                               2,419                    0 Not indicated
                               2,338                    1 Indicated

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

                              12,743                    . Missing
                               4,446                    0 Not indicated
                                 306                    1 Indicated

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

                              12,740                    . Missing
                               2,482                    0 Not indicated
                               2,273                    1 Indicated

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

                              12,743                    . Missing
                               3,969                    0 Not indicated
                                 783                    1 Indicated

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

                              12,742                    . Missing
                               1,217                    0 Not indicated
                               3,536                    1 Indicated

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

                              12,747                    . Missing
                               4,070                    0 Not indicated
                                 678                    1 Indicated

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

                              12,738                    . Missing
                               4,242                    0 Not indicated
                                 515                    1 Indicated

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

                              12,740                    . Missing
                               1,051                    0 Not indicated
                               3,704                    1 Indicated

AC1T      183  2  INDIC                                 N Routine; involve, attends church

                              12,743                    . Missing
                               3,152                    0 Not indicated
                               1,600                    1 Indicated

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

                              12,740                    . Missing
                               2,143                    0 Not indicated
                               2,612                    1 Indicated

AC1V      187  2  INDIC                                 N Routine; involve, animal companion

                              12,745                    . Missing
                               4,272                    0 Not indicated
                                 478                    1 Indicated

AC1W      189  2  INDIC                                 N Routine; involve, group activities

                              12,743                    . Missing
                               3,555                    0 Not indicated
                               1,197                    1 Indicated

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

                              12,740                    . Missing
                               4,254                    0 Not indicated
                                 501                    1 Indicated

AC1Y      193  2  INDIC                                 N Routine; unknown routines

                              12,641                    . Missing
                               4,757                    0 Not indicated
                                  97                    1 Indicated

A2        195  5                                        C Background; room number

A3A       200  8                                        N Background; assessment reference date

A4B       210  2                                        N Background; original or copy number

A4A       212  8                                        N Background; date of reentry

A5        222  2  MARITAL                               N Background; marital status

                               8,713                    . Missing
                               1,196                    1 Never married
                               1,747                    2 Married
                               4,871                    3 Widowed
                                 165                    4 Separated
                                 803                    5 Divorced

A6        224 12                                        C Background; medical record number

A7A       236  2  INDIC                                 N Payment; Medicaid per diem

                              12,954                    . Missing
                               2,355                    0 Not indicated
                               2,186                    1 Indicated

A7B       238  2  INDIC                                 N Payment; Medicare per diem

                              12,951                    . Missing
                               3,065                    0 Not indicated
                               1,479                    1 Indicated

A7C       240  2  INDIC                                 N Payment; Medicare ancillary part A

                              12,951                    . Missing
                               3,720                    0 Not indicated
                                 824                    1 Indicated

A7D       242  2  INDIC                                 N Payment; Medicare ancillary part B

                              12,953                    . Missing
                               4,117                    0 Not indicated
                                 425                    1 Indicated

A7E       244  2  INDIC                                 N Payment; CHAMPUS per diem

                              12,953                    . Missing
                               4,542                    0 Not indicated
                                   0                    1 Indicated

A7F       246  2  INDIC                                 N Payment; VA per diem

                              12,953                    . Missing
                               4,524                    0 Not indicated
                                  18                    1 Indicated

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

                              12,953                    . Missing
                               4,086                    0 Not indicated
                                 456                    1 Indicated

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

                              12,953                    . Missing
                               3,952                    0 Not indicated
                                 590                    1 Indicated

A7I       252  2  INDIC                                 N Payment; private insurance per diem

                              12,953                    . Missing
                               4,065                    0 Not indicated
                                 477                    1 Indicated

A7J       254  2  INDIC                                 N Payment; other per diem

                              12,953                    . Missing
                               4,435                    0 Not indicated
                                 107                    1 Indicated

A9A       256  2  INDIC                                 N Decisions; legal guardian

                              12,951                    . Missing
                               4,377                    0 Not indicated
                                 167                    1 Indicated

A9B       258  2  INDIC                                 N Decisions; other legal oversight

                              12,951                    . Missing
                               4,466                    0 Not indicated
                                  78                    1 Indicated

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

                              12,951                    . Missing
                               2,911                    0 Not indicated
                               1,633                    1 Indicated

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

                              12,952                    . Missing
                               3,631                    0 Not indicated
                                 912                    1 Indicated

A9E       264  2  INDIC                                 N Decisions; family member responsible

                              12,951                    . Missing
                               1,746                    0 Not indicated
                               2,798                    1 Indicated

A9F       266  2  INDIC                                 N Decisions; patient responsible for self

                              12,947                    . Missing
                               2,867                    0 Not indicated
                               1,681                    1 Indicated

A9G       268  2  INDIC                                 N Decisions; none of the above

                              12,947                    . Missing
                               4,382                    0 Not indicated
                                 166                    1 Indicated

A10A      270  2  INDIC                                 N Adv directives; living will

                              12,956                    . Missing
                               3,709                    0 Not indicated
                                 830                    1 Indicated

A10B      272  2  INDIC                                 N Adv directives; do not resuscitate

                               8,921                    . Missing
                               4,850                    0 Not indicated
                               3,724                    1 Indicated

A10C      274  2  INDIC                                 N Adv directives; do not hospitalize

                               8,931                    . Missing
                               8,358                    0 Not indicated
                                 206                    1 Indicated

A10D      276  2  INDIC                                 N Adv directives; organ donation

                              12,956                    . Missing
                               4,511                    0 Not indicated
                                  28                    1 Indicated

A10E      278  2  INDIC                                 N Adv directives; autopsy request

                              12,956                    . Missing
                               4,536                    0 Not indicated
                                   3                    1 Indicated

A10F      280  2  INDIC                                 N Adv directives; feeding restrict

                              12,956                    . Missing
                               4,169                    0 Not indicated
                                 370                    1 Indicated

A10G      282  2  INDIC                                 N Adv directives; medication restrict

                              12,956                    . Missing
                               4,409                    0 Not indicated
                                 130                    1 Indicated

A10H      284  2  INDIC                                 N Adv directives; other treatment restrict

                              12,956                    . Missing
                               4,221                    0 Not indicated
                                 318                    1 Indicated

A10I      286  2  INDIC                                 N Adv directives; none of above

                              12,956                    . Missing
                               2,402                    0 Not indicated
                               2,137                    1 Indicated

B1        288  2  YESNO                                 N Cognitive; comatose

                               3,812                    . Missing
                              13,683                    0 No
                                   0                    1 Yes

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

                               3,864                    . Missing
                               4,538                    0 Memory OK
                               9,093                    1 Memory problem

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

                               3,870                    . Missing
                               7,584                    0 Memory OK
                               6,041                    1 Memory problem

B3A       294  2  INDIC                                 N Cognitive; recall; current season

                               5,471                    . Missing
                               5,696                    0 Not indicated
                               6,328                    1 Indicated

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

                               5,459                    . Missing
                               4,147                    0 Not indicated
                               7,889                    1 Indicated

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

                               5,459                    . Missing
                               3,282                    0 Not indicated
                               8,754                    1 Indicated

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

                               5,466                    . Missing
                               3,638                    0 Not indicated
                               8,391                    1 Indicated

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

                               5,459                    . Missing
                              10,184                    0 Not indicated
                               1,852                    1 Indicated

B4        304  2  COGNITIV                              N Cognitive; daily decision making skills

                               3,821                    . Missing
                               3,501                    0 Independent
                               3,298                    1 Modified independence
                               5,332                    2 Moderately impaired
                               1,543                    3 Severely impaired

B5A       306  2  COGNITIV                              N Cognitive; delirium, easily distracted

                               3,813                    . Missing
                              11,580                    0 Independent
                               2,054                    1 Modified independence
                                  48                    2 Moderately impaired
                                   0                    3 Severely impaired

B5B       308  2  COGNITIV                              N Cognitive; delirium, altered perception

                               3,815                    . Missing
                              12,336                    0 Independent
                               1,287                    1 Modified independence
                                  57                    2 Moderately impaired
                                   0                    3 Severely impaired

B5C       310  2  COGNITIV                              N Cognitive; delirium, disorganized speech

                               3,815                    . Missing
                              12,062                    0 Independent
                               1,566                    1 Modified independence
                                  52                    2 Moderately impaired
                                   0                    3 Severely impaired

B5D       312  2  COGNITIV                              N Cognitive; delirium, restlessness

                               3,815                    . Missing
                              11,934                    0 Independent
                               1,658                    1 Modified independence
                                  88                    2 Moderately impaired
                                   0                    3 Severely impaired

B5E       314  2  COGNITIV                              N Cognitive; delirium, lethargy

                               3,815                    . Missing
                              13,008                    0 Independent
                                 588                    1 Modified independence
                                  84                    2 Moderately impaired
                                   0                    3 Severely impaired

B5F       316  2  COGNITIV                              N Cognitive; delirium, varied function

                               3,813                    . Missing
                              10,616                    0 Independent
                               2,960                    1 Modified independence
                                 106                    2 Moderately impaired
                                   0                    3 Severely impaired

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

                              12,955                    . Missing
                               4,086                    0 No change
                                 129                    1 Improved
                                 325                    2 Deteriorated

C1        320  2  HEAR                                  N Comm; hearing ability

                              12,952                    . Missing
                               3,457                    0 Hears adequately
                                 691                    1 Minimal difficulty
                                 352                    2 Hears in special situations only
                                  43                    3 Highly impaired

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

                              12,952                    . Missing
                               4,239                    0 Not indicated
                                 304                    1 Indicated

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

                              12,952                    . Missing
                               4,401                    0 Not indicated
                                 142                    1 Indicated

C2C       326  2  INDIC                                 N Comm; other receptive used

                              12,952                    . Missing
                               4,524                    0 Not indicated
                                  19                    1 Indicated

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

                              12,952                    . Missing
                                 455                    0 Not indicated
                               4,088                    1 Indicated

C3A       330  2  INDIC                                 N Comm; modes, speech

                              12,947                    . Missing
                                 104                    0 Not indicated
                               4,444                    1 Indicated

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

                              12,952                    . Missing
                               4,509                    0 Not indicated
                                  34                    1 Indicated

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

                              12,952                    . Missing
                               4,543                    0 Not indicated
                                   0                    1 Indicated

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

                              12,952                    . Missing
                               4,045                    0 Not indicated
                                 498                    1 Indicated

C3E       338  2  INDIC                                 N Comm; modes, communication board

                              12,951                    . Missing
                               4,489                    0 Not indicated
                                  55                    1 Indicated

C3F       340  2  INDIC                                 N Comm; modes, other

                              12,951                    . Missing
                               4,497                    0 Not indicated
                                  47                    1 Indicated

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

                              12,947                    . Missing
                               4,499                    0 Not indicated
                                  49                    1 Indicated

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

                               3,817                    . Missing
                               8,151                    0 Understood
                               2,979                    1 Usually understood
                               1,857                    2 Sometimes understood
                                 691                    3 Rarely/Never understood

C5        346  2  CLEAR                                 N Comm, speech clarity

                              12,948                    . Missing
                               3,836                    0 clear speech
                                 639                    1 unclear speech
                                  72                    2 no speech

C6        348  2  UNDERSTA                              N Comm; ability to understand others

                               3,815                    . Missing
                               7,591                    0 Understands
                               3,297                    1 Usually understands
                               2,282                    2 Sometimes understands
                                 510                    3 Rarely/Never understands

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

                              12,951                    . Missing
                               4,234                    0 No change
                                  55                    1 Improved
                                 255                    2 Deteriorated

D1        352  2  ADEQUATE                              N Vision

                               9,405                    . Missing
                               5,478                    0 Adequate
                               1,607                    1 Impaired
                                 468                    2 Moderately impaired
                                 465                    3 Highly impaired
                                  72                    4 Severely impaired

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

                              12,967                    . Missing
                               4,428                    0 Not indicated
                                 100                    1 Indicated

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

                              12,967                    . Missing
                               4,508                    0 Not indicated
                                  20                    1 Indicated

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

                              12,970                    . Missing
                                 116                    0 Not indicated
                               4,409                    1 Indicated

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

                              12,969                    . Missing
                               1,578                    0 No
                               2,948                    1 Yes

E1A       362  2  INDICTH                               N Mood; negative statements

                               3,816                    . Missing
                              13,145                    0 Not exhibited in last 30 days
                                 484                    1 Exhibited up to 5 days week
                                  50                    2 Exhibited 6 to 7 days week

E1B       364  2  INDICTH                               N Mood; repetitive questions

                               3,815                    . Missing
                              12,909                    0 Not exhibited in last 30 days
                                 607                    1 Exhibited up to 5 days week
                                 164                    2 Exhibited 6 to 7 days week

E1C       366  2  INDICTH                               N Mood; repetitive verbalizations

                               3,815                    . Missing
                              12,800                    0 Not exhibited in last 30 days
                                 640                    1 Exhibited up to 5 days week
                                 240                    2 Exhibited 6 to 7 days week

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

                               3,813                    . Missing
                              12,041                    0 Not exhibited in last 30 days
                               1,395                    1 Exhibited up to 5 days week
                                 246                    2 Exhibited 6 to 7 days week

E1E       370  2  INDICTH                               N Mood; self deprecation

                               3,815                    . Missing
                              13,499                    0 Not exhibited in last 30 days
                                 148                    1 Exhibited up to 5 days week
                                  33                    2 Exhibited 6 to 7 days week

E1F       372  2  INDICTH                               N Mood; unrealistic fears

                               3,815                    . Missing
                              13,204                    0 Not exhibited in last 30 days
                                 447                    1 Exhibited up to 5 days week
                                  29                    2 Exhibited 6 to 7 days week

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

                               3,815                    . Missing
                              13,464                    0 Not exhibited in last 30 days
                                 205                    1 Exhibited up to 5 days week
                                  11                    2 Exhibited 6 to 7 days week

E1H       376  2  INDICTH                               N Mood; repetitive health complaints

                               3,815                    . Missing
                              12,391                    0 Not exhibited in last 30 days
                               1,048                    1 Exhibited up to 5 days week
                                 241                    2 Exhibited 6 to 7 days week

E1I       378  2  INDICTH                               N Mood; repetitive anxious complaints

                               3,815                    . Missing
                              12,095                    0 Not exhibited in last 30 days
                               1,245                    1 Exhibited up to 5 days week
                                 340                    2 Exhibited 6 to 7 days week

E1J       380  2  INDICTH                               N Mood; unpleasant mood in AM

                               3,813                    . Missing
                              13,137                    0 Not exhibited in last 30 days
                                 441                    1 Exhibited up to 5 days week
                                 104                    2 Exhibited 6 to 7 days week

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

                               3,813                    . Missing
                              12,692                    0 Not exhibited in last 30 days
                                 860                    1 Exhibited up to 5 days week
                                 130                    2 Exhibited 6 to 7 days week

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

                               3,814                    . Missing
                              10,668                    0 Not exhibited in last 30 days
                               2,319                    1 Exhibited up to 5 days week
                                 694                    2 Exhibited 6 to 7 days week

E1M       386  2  INDICTH                               N Mood; crying/tearfulness

                               3,813                    . Missing
                              12,995                    0 Not exhibited in last 30 days
                                 632                    1 Exhibited up to 5 days week
                                  55                    2 Exhibited 6 to 7 days week

E1N       388  2  INDICTH                               N Mood; repetitive physical movements

                               3,813                    . Missing
                              12,224                    0 Not exhibited in last 30 days
                               1,089                    1 Exhibited up to 5 days week
                                 369                    2 Exhibited 6 to 7 days week

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

                               3,813                    . Missing
                              13,076                    0 Not exhibited in last 30 days
                                 460                    1 Exhibited up to 5 days week
                                 146                    2 Exhibited 6 to 7 days week

E1P       392  2  INDICTH                               N Mood; reduced social interaction

                               3,813                    . Missing
                              12,917                    0 Not exhibited in last 30 days
                                 558                    1 Exhibited up to 5 days week
                                 207                    2 Exhibited 6 to 7 days week

E2        394  2  MODINDIC                              N Mood; persistence

                               3,817                    . Missing
                               8,537                    0 No mood indicators
                               3,518                    1 Indicators present, easily altered
                               1,623                    2 Indicators present, not easily altered

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

                              12,955                    . Missing
                               3,999                    0 No change
                                 180                    1 Improved
                                 361                    2 Deteriorated

E4AA      398  2  BEHAVA                                N Behavior; wandering frequency

                               3,813                    . Missing
                              12,821                    0 Behavior not exhibited
                                 398                    1 1 to 3 days
                                 155                    2 4 to 6 days
                                 308                    3 Behavior exhibited daily

E4AB      400  2  BEHAVB                                N Behavior; wandering alterability

                               3,813                    . Missing
                              13,272                    0 Behavior not present or easily altered
                                 410                    1 Behavior not easily altered

E4BA      402  2  BEHAVA                                N Behavior; verbally abusive frequency

                               3,813                    . Missing
                              12,746                    0 Behavior not exhibited
                                 705                    1 1 to 3 days
                                 170                    2 4 to 6 days
                                  61                    3 Behavior exhibited daily

E4BB      404  2  BEHAVB                                N Behavior; verbally abusive alterability

                               3,814                    . Missing
                              13,138                    0 Behavior not present or easily altered
                                 543                    1 Behavior not easily altered

E4CA      406  2  BEHAVA                                N Behavior; physical abusive frequency

                               3,813                    . Missing
                              13,091                    0 Behavior not exhibited
                                 465                    1 1 to 3 days
                                  95                    2 4 to 6 days
                                  31                    3 Behavior exhibited daily

E4CB      408  2  BEHAVB                                N Behavior; physical abusive alterability

                               3,813                    . Missing
                              13,356                    0 Behavior not present or easily altered
                                 326                    1 Behavior not easily altered

E4DA      410  2  BEHAVA                                N Behavior; soc inappropriate frequency

                               3,813                    . Missing
                              12,477                    0 Behavior not exhibited
                                 766                    1 1 to 3 days
                                 226                    2 4 to 6 days
                                 213                    3 Behavior exhibited daily

E4DB      412  2  BEHAVB                                N Behavior; soc inappropriate alterability

                               3,814                    . Missing
                              12,953                    0 Behavior not present or easily altered
                                 728                    1 Behavior not easily altered

E4EA      414  2  BEHAVA                                N Behavior; resists care frequency

                               3,813                    . Missing
                              11,448                    0 Behavior not exhibited
                               1,488                    1 1 to 3 days
                                 461                    2 4 to 6 days
                                 285                    3 Behavior exhibited daily

E4EB      416  2  BEHAVB                                N Behavior; resists care alterability

                               3,815                    . Missing
                              12,218                    0 Behavior not present or easily altered
                               1,462                    1 Behavior not easily altered

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

                              12,961                    . Missing
                               4,146                    0 No change
                                 149                    1 Improved
                                 239                    2 Deteriorated

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

                              12,967                    . Missing
                                 666                    0 Not indicated
                               3,862                    1 Indicated

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

                              12,967                    . Missing
                               1,916                    0 Not indicated
                               2,612                    1 Indicated

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

                              12,967                    . Missing
                               2,026                    0 Not indicated
                               2,502                    1 Indicated

F1D       426  2  INDIC                                 N Social; establishes own goals

                              12,969                    . Missing
                               3,348                    0 Not indicated
                               1,178                    1 Indicated

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

                              12,969                    . Missing
                               3,762                    0 Not indicated
                                 764                    1 Indicated

F1F       430  2  INDIC                                 N Social; accepts invitations group activ

                              12,969                    . Missing
                               3,512                    0 Not indicated
                               1,014                    1 Indicated

F1G       432  2  INDIC                                 N Social; none of above

                              12,967                    . Missing
                               4,092                    0 Not indicated
                                 436                    1 Indicated

F2A       434  2  INDIC                                 N Social; open conflict with staff

                              12,969                    . Missing
                               4,405                    0 Not indicated
                                 121                    1 Indicated

F2B       436  2  INDIC                                 N Social; unhappy with roommate

                              12,969                    . Missing
                               4,476                    0 Not indicated
                                  50                    1 Indicated

F2C       438  2  INDIC                                 N Social; unhappy with other residents

                              12,969                    . Missing
                               4,492                    0 Not indicated
                                  34                    1 Indicated

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

                              12,969                    . Missing
                               4,447                    0 Not indicated
                                  79                    1 Indicated

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

                              12,969                    . Missing
                               4,408                    0 Not indicated
                                 118                    1 Indicated

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

                              12,969                    . Missing
                               4,469                    0 Not indicated
                                  57                    1 Indicated

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

                              12,969                    . Missing
                               4,206                    0 Not indicated
                                 320                    1 Indicated

F2H       448  2  INDIC                                 N Social; none of above

                              12,969                    . Missing
                                 612                    0 Not indicated
                               3,914                    1 Indicated

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

                              12,969                    . Missing
                               4,020                    0 Not indicated
                                 506                    1 Indicated

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

                              12,969                    . Missing
                               4,363                    0 Not indicated
                                 163                    1 Indicated

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

                              12,969                    . Missing
                               4,214                    0 Not indicated
                                 312                    1 Indicated

F3D       456  2  INDIC                                 N Social; none of above

                              12,969                    . Missing
                                 703                    0 Not indicated
                               3,823                    1 Indicated

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

                               3,813                    . Missing
                               2,778                    0 Independent
                                 886                    1 Supervision
                               2,496                    2 Limited assistance
                               5,605                    3 Extensive assistance
                               1,912                    4 Total dependence
                                   5                    8 Activity did not occur

G1AB      460  2  ADLB                                  N ADL; bed mobility, supported

                               5,527                    . Missing
                               2,130                    0 No setup or physical help from staff
                                 800                    1 Setup help only
                               5,503                    2 One person physical assist
                               3,530                    3 Two+ persons physical assist
                                   5                    8 Activity did not occur

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

                               3,813                    . Missing
                               1,942                    0 Independent
                                 881                    1 Supervision
                               2,635                    2 Limited assistance
                               5,383                    3 Extensive assistance
                               2,763                    4 Total dependence
                                  78                    8 Activity did not occur

G1BB      464  2  ADLB                                  N ADL; transfer, supported

                               5,527                    . Missing
                               1,505                    0 No setup or physical help from staff
                                 672                    1 Setup help only
                               5,124                    2 One person physical assist
                               4,600                    3 Two+ persons physical assist
                                  67                    8 Activity did not occur

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

                               3,813                    . Missing
                               1,942                    0 Independent
                               1,107                    1 Supervision
                               2,273                    2 Limited assistance
                               1,868                    3 Extensive assistance
                                  85                    4 Total dependence
                               6,407                    8 Activity did not occur

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

                               5,527                    . Missing
                               1,604                    0 No setup or physical help from staff
                                 803                    1 Setup help only
                               3,361                    2 One person physical assist
                                 572                    3 Two+ persons physical assist
                               5,628                    8 Activity did not occur

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

                               3,813                    . Missing
                               1,566                    0 Independent
                               1,205                    1 Supervision
                               2,145                    2 Limited assistance
                               1,733                    3 Extensive assistance
                                  91                    4 Total dependence
                               6,942                    8 Activity did not occur

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

                               5,527                    . Missing
                               1,408                    0 No setup or physical help from staff
                                 782                    1 Setup help only
                               3,173                    2 One person physical assist
                                 515                    3 Two+ persons physical assist
                               6,090                    8 Activity did not occur

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

                               3,813                    . Missing
                               3,216                    0 Independent
                               1,509                    1 Supervision
                               2,280                    2 Limited assistance
                               2,807                    3 Extensive assistance
                               3,580                    4 Total dependence
                                 290                    8 Activity did not occur

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

                               5,527                    . Missing
                               2,387                    0 No setup or physical help from staff
                               1,312                    1 Setup help only
                               7,749                    2 One person physical assist
                                 244                    3 Two+ persons physical assist
                                 276                    8 Activity did not occur

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

                               3,814                    . Missing
                               2,555                    0 Independent
                               1,221                    1 Supervision
                               1,920                    2 Limited assistance
                               2,774                    3 Extensive assistance
                               4,379                    4 Total dependence
                                 832                    8 Activity did not occur

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

                               5,527                    . Missing
                               1,881                    0 No setup or physical help from staff
                                 985                    1 Setup help only
                               8,146                    2 One person physical assist
                                 188                    3 Two+ persons physical assist
                                 768                    8 Activity did not occur

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

                               3,813                    . Missing
                               1,069                    0 Independent
                                 678                    1 Supervision
                               2,632                    2 Limited assistance
                               6,454                    3 Extensive assistance
                               2,818                    4 Total dependence
                                  31                    8 Activity did not occur

G1GB      484  2  ADLB                                  N ADL; dressing, supported

                               5,527                    . Missing
                                 732                    0 No setup or physical help from staff
                                 628                    1 Setup help only
                               9,796                    2 One person physical assist
                                 781                    3 Two+ persons physical assist
                                  31                    8 Activity did not occur

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

                               3,813                    . Missing
                               6,083                    0 Independent
                               3,599                    1 Supervision
                               1,280                    2 Limited assistance
                               1,327                    3 Extensive assistance
                               1,391                    4 Total dependence
                                   2                    8 Activity did not occur

G1HB      488  2  ADLB                                  N ADL; eating, supported

                               5,527                    . Missing
                               1,172                    0 No setup or physical help from staff
                               6,797                    1 Setup help only
                               3,968                    2 One person physical assist
                                  29                    3 Two+ persons physical assist
                                   2                    8 Activity did not occur

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

                               3,813                    . Missing
                               1,499                    0 Independent
                                 617                    1 Supervision
                               2,216                    2 Limited assistance
                               5,613                    3 Extensive assistance
                               3,726                    4 Total dependence
                                  11                    8 Activity did not occur

G1IB      492  2  ADLB                                  N ADL; toilet use, supported

                               5,527                    . Missing
                               1,133                    0 No setup or physical help from staff
                                 532                    1 Setup help only
                               7,398                    2 One person physical assist
                               2,894                    3 Two+ persons physical assist
                                  11                    8 Activity did not occur

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

                               3,813                    . Missing
                               1,260                    0 Independent
                                 909                    1 Supervision
                               2,721                    2 Limited assistance
                               5,565                    3 Extensive assistance
                               3,224                    4 Total dependence
                                   3                    8 Activity did not occur

G1JB      496  2  ADLB                                  N ADL; personal hygiene, supported

                               5,527                    . Missing
                                 680                    0 No setup or physical help from staff
                               1,091                    1 Setup help only
                               9,498                    2 One person physical assist
                                 696                    3 Two+ persons physical assist
                                   3                    8 Activity did not occur

G2A       498  2  BATHING                               N ADL; bathing, self perform

                               3,817                    . Missing
                                 204                    0 Independent
                                 511                    1 Supervision
                                 815                    2 Phys help limited to transfer only
                               7,365                    3 Phys help in part of bathing activity
                               4,683                    4 Total dependence
                                 100                    8 Activity did not occur

G2B       500  2  ADLB                                  N ADL; bathing, supported

                              12,948                    . Missing
                                  53                    0 No setup or physical help from staff
                                 232                    1 Setup help only
                               3,602                    2 One person physical assist
                                 619                    3 Two+ persons physical assist
                                  41                    8 Activity did not occur

G3A       502  2  BALANCE                               N ADL; balance while standing

                               5,511                    . Missing
                               1,035                    0 Maintained position
                               1,222                    1 Unsteady
                               2,834                    2 Partial physical support
                               6,893                    3 Not able to attempt test

G3B       504  2  BALANCE                               N ADL; balance while sitting

                               5,460                    . Missing
                               6,681                    0 Maintained position
                               1,571                    1 Unsteady
                               1,862                    2 Partial physical support
                               1,921                    3 Not able to attempt test

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

                               3,821                    . Missing
                              12,506                    0 No limitation
                                 322                    1 Limitation on one side
                                 846                    2 Limitation on both sides

G4AB      508  2  VOL                                   N ADL; neck, voluntary motion

                               3,821                    . Missing
                              12,568                    0 No loss
                                 897                    1 Partial loss
                                 209                    2 Full loss

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

                               3,821                    . Missing
                               9,681                    0 No limitation
                               2,424                    1 Limitation on one side
                               1,569                    2 Limitation on both sides

G4BB      512  2  VOL                                   N ADL; arm, voluntary motion

                               3,822                    . Missing
                               9,768                    0 No loss
                               3,208                    1 Partial loss
                                 697                    2 Full loss

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

                               3,821                    . Missing
                              10,572                    0 No limitation
                               2,044                    1 Limitation on one side
                               1,058                    2 Limitation on both sides

G4CB      516  2  VOL                                   N ADL; hand, voluntary motion

                               3,822                    . Missing
                              10,451                    0 No loss
                               2,498                    1 Partial loss
                                 724                    2 Full loss

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

                               3,823                    . Missing
                               8,524                    0 No limitation
                               2,901                    1 Limitation on one side
                               2,247                    2 Limitation on both sides

G4DB      520  2  VOL                                   N ADL; leg, voluntary motion

                               3,821                    . Missing
                               8,769                    0 No loss
                               3,859                    1 Partial loss
                               1,046                    2 Full loss

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

                               3,821                    . Missing
                               9,768                    0 No limitation
                               2,056                    1 Limitation on one side
                               1,850                    2 Limitation on both sides

G4EB      524  2  VOL                                   N ADL; foot, voluntary motion

                               3,821                    . Missing
                               9,630                    0 No loss
                               2,945                    1 Partial loss
                               1,099                    2 Full loss

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

                               3,906                    . Missing
                              12,951                    0 No limitation
                                 260                    1 Limitation on one side
                                 378                    2 Limitation on both sides

G4FB      528  2  VOL                                   N ADL; other, voluntary motion

                               3,904                    . Missing
                              12,963                    0 No loss
                                 466                    1 Partial loss
                                 162                    2 Full loss

G5A       530  2  INDIC                                 N ADL; used cane

                              12,947                    . Missing
                               2,741                    0 Not indicated
                               1,807                    1 Indicated

G5B       532  2  INDIC                                 N ADL; wheeled self

                               8,898                    . Missing
                               4,924                    0 Not indicated
                               3,673                    1 Indicated

G5C       534  2  INDIC                                 N ADL; other person wheeled

                              12,951                    . Missing
                               1,582                    0 Not indicated
                               2,962                    1 Indicated

G5D       536  2  INDIC                                 N ADL; wheelchair primary mode

                              12,951                    . Missing
                               1,550                    0 Not indicated
                               2,994                    1 Indicated

G5E       538  2  INDIC                                 N ADL; none of above

                              12,947                    . Missing
                               3,984                    0 Not indicated
                                 564                    1 Indicated

G6A       540  2  INDIC                                 N ADL; transfer, bedfast

                               3,827                    . Missing
                              13,304                    0 Not indicated
                                 364                    1 Indicated

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

                               3,826                    . Missing
                               6,489                    0 Not indicated
                               7,180                    1 Indicated

G6C       544  2  INDIC                                 N ADL; transfer, lifted manually

                              12,947                    . Missing
                               3,780                    0 Not indicated
                                 768                    1 Indicated

G6D       546  2  INDIC                                 N ADL; transfer, lifted mechanically

                              12,951                    . Missing
                               3,837                    0 Not indicated
                                 707                    1 Indicated

G6E       548  2  INDIC                                 N ADL; transfer, transfer aid

                              12,951                    . Missing
                               2,747                    0 Not indicated
                               1,797                    1 Indicated

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

                              11,031                    . Missing
                               4,565                    0 Not indicated
                               1,899                    1 Indicated

G7        552  2  YESNO                                 N ADL; task segmentation

                               5,437                    . Missing
                               6,847                    0 No
                               5,211                    1 Yes

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

                              12,947                    . Missing
                               3,161                    0 Not indicated
                               1,387                    1 Indicated

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

                              12,947                    . Missing
                               2,894                    0 Not indicated
                               1,654                    1 Indicated

G8C       558  2  INDIC                                 N ADL; rehab potential, slow

                              12,948                    . Missing
                               3,994                    0 Not indicated
                                 553                    1 Indicated

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

                              12,952                    . Missing
                               4,226                    0 Not indicated
                                 317                    1 Indicated

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

                              12,947                    . Missing
                               2,141                    0 Not indicated
                               2,407                    1 Indicated

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

                              12,953                    . Missing
                               2,609                    0 No change
                                 382                    1 Improved
                               1,551                    2 Deteriorated

H1A       566  2  CONTINEN                              N Continence; bowel

                               3,818                    . Missing
                               6,129                    0 Continent
                               1,069                    1 Usually continent
                                 783                    2 Occasionally incontinent
                               1,268                    3 Frequently incontinent
                               4,428                    4 Incontinent

H1B       568  2  CONTINEN                              N Continence; bladder

                               3,816                    . Missing
                               4,635                    0 Continent
                               1,106                    1 Usually continent
                               1,363                    2 Occasionally incontinent
                               2,323                    3 Frequently incontinent
                               4,252                    4 Incontinent

H2A       570  2  INDIC                                 N Continence; bowel regular

                              12,947                    . Missing
                                 979                    0 Not indicated
                               3,569                    1 Indicated

H2B       572  2  INDIC                                 N Continence; bowel constipation

                              12,948                    . Missing
                               4,129                    0 Not indicated
                                 418                    1 Indicated

H2C       574  2  INDIC                                 N Continence; bowel diarrhea

                               5,451                    . Missing
                              11,689                    0 Not indicated
                                 355                    1 Indicated

H2D       576  2  INDIC                                 N Continence; bowel fecal impaction

                               3,832                    . Missing
                              13,640                    0 Not indicated
                                  23                    1 Indicated

H2E       578  2  INDIC                                 N Continence; scheduled plan

                              11,031                    . Missing
                               3,918                    0 Not indicated
                               2,546                    1 Indicated

H3A       580  2  INDIC                                 N Continence; none of above

                               3,830                    . Missing
                               9,849                    0 Not indicated
                               3,816                    1 Indicated

H3B       582  2  INDIC                                 N Continence; bladder retaining plan

                               3,829                    . Missing
                              13,521                    0 Not indicated
                                 145                    1 Indicated

H3C       584  2  INDIC                                 N Continence; external condom catheter

                               3,830                    . Missing
                              13,643                    0 Not indicated
                                  22                    1 Indicated

H3D       586  2  INDIC                                 N Continence; indwelling catheter

                               3,829                    . Missing
                              12,316                    0 Not indicated
                               1,350                    1 Indicated

H3E       588  2  INDIC                                 N Continence; intermittent catheter

                              12,951                    . Missing
                               4,504                    0 Not indicated
                                  40                    1 Indicated

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

                              12,951                    . Missing
                               4,053                    0 Not indicated
                                 491                    1 Indicated

H3G       592  2  INDIC                                 N Continence; pads/briefs used

                              12,951                    . Missing
                               1,747                    0 Not indicated
                               2,797                    1 Indicated

H3H       594  2  INDIC                                 N Continence; enemas/irrigation

                              12,951                    . Missing
                               4,498                    0 Not indicated
                                  46                    1 Indicated

H3I       596  2  INDIC                                 N Continence; ostomy present

                               3,829                    . Missing
                              13,374                    0 Not indicated
                                 292                    1 Indicated

H3J       598  2  INDIC                                 N Continence; none of above

                              10,957                    . Missing
                               4,098                    0 Not indicated
                               2,440                    1 Indicated

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

                              12,953                    . Missing
                               3,906                    0 No change
                                 146                    1 Improved
                                 490                    2 Deteriorated

I1A       602  2  INDIC                                 N Diag; diabetes mellitus

                               5,542                    . Missing
                               8,615                    0 Not indicated
                               3,338                    1 Indicated

I1B       604  2  INDIC                                 N Diag; hyperthyroidism

                              12,951                    . Missing
                               4,496                    0 Not indicated
                                  48                    1 Indicated

I1C       606  2  INDIC                                 N Diag; hypothyroidism

                              12,951                    . Missing
                               3,792                    0 Not indicated
                                 752                    1 Indicated

I1D       608  2  INDIC                                 N Diag; arteriosclerotic heart disease

                               8,693                    . Missing
                               7,807                    0 Not indicated
                                 995                    1 Indicated

I1E       610  2  INDIC                                 N Diag; cardiac dysrhythmias

                              12,951                    . Missing
                               3,837                    0 Not indicated
                                 707                    1 Indicated

I1F       612  2  INDIC                                 N Diag; congestive heart failure

                               8,693                    . Missing
                               7,220                    0 Not indicated
                               1,582                    1 Indicated

I1G       614  2  INDIC                                 N Diag; deep vein thrombosis

                              12,951                    . Missing
                               4,447                    0 Not indicated
                                  97                    1 Indicated

I1H       616  2  INDIC                                 N Diag; hypertension

                              12,947                    . Missing
                               1,535                    0 Not indicated
                               3,013                    1 Indicated

I1I       618  2  INDIC                                 N Diag; hypotension

                              12,951                    . Missing
                               4,485                    0 Not indicated
                                  59                    1 Indicated

I1J       620  2  INDIC                                 N Diag; peripheral vascular disease

                               8,693                    . Missing
                               7,839                    0 Not indicated
                                 963                    1 Indicated

I1K       622  2  INDIC                                 N Diag; other cardiovascular disease

                              12,947                    . Missing
                               3,667                    0 Not indicated
                                 881                    1 Indicated

I1L       624  2  INDIC                                 N Diag; arthritis

                              12,951                    . Missing
                               3,083                    0 Not indicated
                               1,461                    1 Indicated

I1M       626  2  INDIC                                 N Diag; hip fracture

                               5,435                    . Missing
                              11,477                    0 Not indicated
                                 583                    1 Indicated

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

                              12,951                    . Missing
                               4,481                    0 Not indicated
                                  63                    1 Indicated

I1O       630  2  INDIC                                 N Diag; osteoporosis

                              12,951                    . Missing
                               3,660                    0 Not indicated
                                 884                    1 Indicated

I1P       632  2  INDIC                                 N Diag; pathological bone fracture

                              12,951                    . Missing
                               4,511                    0 Not indicated
                                  33                    1 Indicated

I1Q       634  2  INDIC                                 N Diag; alzheimers disease

                              12,948                    . Missing
                               3,903                    0 Not indicated
                                 644                    1 Indicated

I1R       636  2  INDIC                                 N Diag; aphasia

                               5,435                    . Missing
                              11,382                    0 Not indicated
                                 678                    1 Indicated

I1S       638  2  INDIC                                 N Diag; cerebral palsy

                               5,435                    . Missing
                              12,019                    0 Not indicated
                                  41                    1 Indicated

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

                               5,435                    . Missing
                               9,360                    0 Not indicated
                               2,700                    1 Indicated

I1U       642  2  INDIC                                 N Diag; dementia other than alzheimers

                              12,948                    . Missing
                               3,075                    0 Not indicated
                               1,472                    1 Indicated

I1V       644  2  INDIC                                 N Diag; hemiplegia/hemiparesis

                               5,435                    . Missing
                              10,353                    0 Not indicated
                               1,707                    1 Indicated

I1W       646  2  INDIC                                 N Diag; multiple sclerosis

                               5,435                    . Missing
                              11,825                    0 Not indicated
                                 235                    1 Indicated

I1X       648  2  INDIC                                 N Diag; paraplegia

                               8,693                    . Missing
                               8,684                    0 Not indicated
                                 118                    1 Indicated

I1Y       650  2  INDIC                                 N Diag; parkinsons disease

                              12,951                    . Missing
                               4,286                    0 Not indicated
                                 258                    1 Indicated

I1Z       652  2  INDIC                                 N Diag; quadriplegia

                               5,435                    . Missing
                              11,940                    0 Not indicated
                                 120                    1 Indicated

I1AA      654  2  INDIC                                 N Diag; seizure disorder

                              12,948                    . Missing
                               4,156                    0 Not indicated
                                 391                    1 Indicated

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

                              12,951                    . Missing
                               4,376                    0 Not indicated
                                 168                    1 Indicated

I1CC      658  2  INDIC                                 N Diag; traumatic brain injury

                              12,948                    . Missing
                               4,453                    0 Not indicated
                                  94                    1 Indicated

I1DD      660  2  INDIC                                 N Diag; anxiety disorder

                              12,951                    . Missing
                               3,746                    0 Not indicated
                                 798                    1 Indicated

I1EE      662  2  INDIC                                 N Diag; depression

                               5,435                    . Missing
                               6,595                    0 Not indicated
                               5,465                    1 Indicated

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

                               5,436                    . Missing
                              11,683                    0 Not indicated
                                 376                    1 Indicated

I1GG      666  2  INDIC                                 N Diag; schizophrenia

                               8,693                    . Missing
                               8,491                    0 Not indicated
                                 311                    1 Indicated

I1HH      668  2  INDIC                                 N Diag; asthma

                               8,693                    . Missing
                               8,548                    0 Not indicated
                                 254                    1 Indicated

I1II      670  2  INDIC                                 N Diag; emphysema/COPD

                               8,693                    . Missing
                               7,369                    0 Not indicated
                               1,433                    1 Indicated

I1JJ      672  2  INDIC                                 N Diag; cataracts

                              12,951                    . Missing
                               4,192                    0 Not indicated
                                 352                    1 Indicated

I1KK      674  2  INDIC                                 N Diag; diabetic retinopathy

                              12,951                    . Missing
                               4,504                    0 Not indicated
                                  40                    1 Indicated

I1LL      676  2  INDIC                                 N Diag; glaucoma

                              12,951                    . Missing
                               4,115                    0 Not indicated
                                 429                    1 Indicated

I1MM      678  2  INDIC                                 N Diag; macular degeneration

                              12,951                    . Missing
                               4,389                    0 Not indicated
                                 155                    1 Indicated

I1NN      680  2  INDIC                                 N Diag; allergies

                              12,951                    . Missing
                               3,132                    0 Not indicated
                               1,412                    1 Indicated

I1OO      682  2  INDIC                                 N Diag; anemia

                              12,951                    . Missing
                               3,505                    0 Not indicated
                               1,039                    1 Indicated

I1PP      684  2  INDIC                                 N Diag; cancer

                              12,951                    . Missing
                               4,252                    0 Not indicated
                                 292                    1 Indicated

I1QQ      686  2  INDIC                                 N Diag; renal failure

                              12,948                    . Missing
                               4,309                    0 Not indicated
                                 238                    1 Indicated

I1RR      688  2  INDIC                                 N Diag; none of above

                               9,783                    . Missing
                               6,840                    0 Not indicated
                                 872                    1 Indicated

I2A       690  2  INDIC                                 N Diag; antibiotic resistant infection

                               5,436                    . Missing
                              11,853                    0 Not indicated
                                 206                    1 Indicated

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

                               5,436                    . Missing
                              11,927                    0 Not indicated
                                 132                    1 Indicated

I2C       694  2  INDIC                                 N Diag; conjunctivitis

                               5,436                    . Missing
                              12,003                    0 Not indicated
                                  56                    1 Indicated

I2D       696  2  INDIC                                 N Diag; HIV infection

                               9,782                    . Missing
                               7,713                    0 Not indicated
                                   0                    1 Indicated

I2E       698  2  INDIC                                 N Diag; pneumonia

                               5,436                    . Missing
                              11,569                    0 Not indicated
                                 490                    1 Indicated

I2F       700  2  INDIC                                 N Diag; respiratory infection

                               5,436                    . Missing
                              11,789                    0 Not indicated
                                 270                    1 Indicated

I2G       702  2  INDIC                                 N Diag; septicemia

                               5,436                    . Missing
                              11,958                    0 Not indicated
                                 101                    1 Indicated

I2H       704  2  INDIC                                 N Diag; sexually transmitted diseases

                               9,769                    . Missing
                               7,726                    0 Not indicated
                                   0                    1 Indicated

I2I       706  2  INDIC                                 N Diag; tuberculosis

                               5,436                    . Missing
                              12,053                    0 Not indicated
                                   6                    1 Indicated

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

                               3,819                    . Missing
                              11,863                    0 Not indicated
                               1,813                    1 Indicated

I2K       710  2  INDIC                                 N Diag; viral hepatitus

                               5,436                    . Missing
                              12,054                    0 Not indicated
                                   5                    1 Indicated

I2L       712  2  INDIC                                 N Diag; wound infection

                               5,436                    . Missing
                              11,791                    0 Not indicated
                                 268                    1 Indicated

I2M       714  2  INDIC                                 N Diag; none of above

                               8,085                    . Missing
                               2,643                    0 Not indicated
                               6,767                    1 Indicated

I3A       716  7                                        C Diag; other diagnosis A

I3B       723  7                                        C Diag; other diagnosis B

I3C       730  7                                        C Diag; other diagnosis C

I3D       737  7                                        C Diag; other diagnosis D

I3E       744  7                                        C Diag; other diagnosis E

J1A       751  2  INDIC                                 N Health; weight gain/loss

                               5,443                    . Missing
                              11,814                    0 Not indicated
                                 238                    1 Indicated

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

                               5,436                    . Missing
                              11,714                    0 Not indicated
                                 345                    1 Indicated

J1C       755  2  INDIC                                 N Health; dehydrated

                               3,817                    . Missing
                              13,662                    0 Not indicated
                                  16                    1 Indicated

J1D       757  2  INDIC                                 N Health; insufficient fluid

                               5,440                    . Missing
                              11,801                    0 Not indicated
                                 254                    1 Indicated

J1E       759  2  INDIC                                 N Health; delusions

                               5,436                    . Missing
                              11,845                    0 Not indicated
                                 214                    1 Indicated

J1F       761  2  INDIC                                 N Health; dizziness/vertigo

                              12,948                    . Missing
                               4,453                    0 Not indicated
                                  94                    1 Indicated

J1G       763  2  INDIC                                 N Health; edema

                               5,434                    . Missing
                               9,509                    0 Not indicated
                               2,552                    1 Indicated

J1H       765  2  INDIC                                 N Health; fever

                               5,436                    . Missing
                              11,890                    0 Not indicated
                                 169                    1 Indicated

J1I       767  2  INDIC                                 N Health; hallucinations

                               3,817                    . Missing
                              13,497                    0 Not indicated
                                 181                    1 Indicated

J1J       769  2  INDIC                                 N Health; internal bleeding

                               5,436                    . Missing
                              11,971                    0 Not indicated
                                  88                    1 Indicated

J1K       771  2  INDIC                                 N Health; recurrent lung aspirations

                               5,436                    . Missing
                              12,020                    0 Not indicated
                                  39                    1 Indicated

J1L       773  2  INDIC                                 N Health; shortness of breath

                               5,436                    . Missing
                              11,215                    0 Not indicated
                                 844                    1 Indicated

J1M       775  2  INDIC                                 N Health; syncope (fainting)

                              12,951                    . Missing
                               4,526                    0 Not indicated
                                  18                    1 Indicated

J1N       777  2  INDIC                                 N Health; unsteady gate

                               5,432                    . Missing
                               7,391                    0 Not indicated
                               4,672                    1 Indicated

J1O       779  2  INDIC                                 N Health; vomiting

                               5,436                    . Missing
                              11,825                    0 Not indicated
                                 234                    1 Indicated

J1P       781  2  INDIC                                 N Health; none of above

                              11,033                    . Missing
                               3,253                    0 Not indicated
                               3,209                    1 Indicated

J2A       783  2  PAINA                                 N Health; pain symptoms, frequency

                               3,814                    . Missing
                               8,518                    0 No pain
                               3,508                    1 Pain less than daily
                               1,655                    2 Pain daily

J2B       785  2  PAINB                                 N Health; pain symptoms, intensity

                              12,344                    . Missing
                               1,983                    1 Mild pain
                               2,777                    2 Moderate pain
                                 391                    3 Horrible/Excruciating pain

J3A       787  2  INDIC                                 N Health; pain site, back

                              15,644                    . Missing
                               1,377                    0 Not indicated
                                 474                    1 Indicated

J3B       789  2  INDIC                                 N Health; pain site, bone

                              15,644                    . Missing
                               1,733                    0 Not indicated
                                 118                    1 Indicated

J3C       791  2  INDIC                                 N Health; pain site, chest

                              15,644                    . Missing
                               1,829                    0 Not indicated
                                  22                    1 Indicated

J3D       793  2  INDIC                                 N Health; pain site, headache

                              15,644                    . Missing
                               1,670                    0 Not indicated
                                 181                    1 Indicated

J3E       795  2  INDIC                                 N Health; pain site, hip

                              15,644                    . Missing
                               1,602                    0 Not indicated
                                 249                    1 Indicated

J3F       797  2  INDIC                                 N Health; pain site, incisional

                              15,644                    . Missing
                               1,664                    0 Not indicated
                                 187                    1 Indicated

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

                              15,644                    . Missing
                               1,338                    0 Not indicated
                                 513                    1 Indicated

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

                              15,644                    . Missing
                               1,572                    0 Not indicated
                                 279                    1 Indicated

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

                              15,644                    . Missing
                               1,778                    0 Not indicated
                                  73                    1 Indicated

J3J       805  2  INDIC                                 N Health; pain site, other

                              15,643                    . Missing
                               1,100                    0 Not indicated
                                 752                    1 Indicated

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

                               3,818                    . Missing
                              11,055                    0 Not indicated
                               2,622                    1 Indicated

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

                               3,817                    . Missing
                              10,209                    0 Not indicated
                               3,469                    1 Indicated

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

                               3,819                    . Missing
                              13,104                    0 Not indicated
                                 572                    1 Indicated

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

                               3,817                    . Missing
                              13,060                    0 Not indicated
                                 618                    1 Indicated

J4E       815  2  INDIC                                 N Health; none of above

                               3,817                    . Missing
                               5,308                    0 Not indicated
                               8,370                    1 Indicated

J5A       817  2  INDIC                                 N Health; diseases make patterns unstable

                               3,817                    . Missing
                               7,928                    0 Not indicated
                               5,750                    1 Indicated

J5B       819  2  INDIC                                 N Health; episode of recurrent problem

                               3,821                    . Missing
                              10,854                    0 Not indicated
                               2,820                    1 Indicated

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

                               3,821                    . Missing
                              13,527                    0 Not indicated
                                 147                    1 Indicated

J5D       823  2  INDIC                                 N Health; none of above

                               3,817                    . Missing
                               6,905                    0 Not indicated
                               6,773                    1 Indicated

K1A       825  2  INDIC                                 N Nutri; chewing problem

                               5,444                    . Missing
                               8,773                    0 Not indicated
                               3,278                    1 Indicated

K1B       827  2  INDIC                                 N Nutri; swallowing problem

                               5,441                    . Missing
                               9,798                    0 Not indicated
                               2,256                    1 Indicated

K1C       829  2  INDIC                                 N Nutri; mouth pain

                              12,951                    . Missing
                               4,519                    0 Not indicated
                                  25                    1 Indicated

K1D       831  2  INDIC                                 N Nutri; none of above

                               9,787                    . Missing
                               2,719                    0 Not indicated
                               4,989                    1 Indicated

K2A       833  2                                        N Nutri; height

K2B       835  3                                        N Nutri; weight

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

                               3,934                    . Missing
                              12,469                    0 No
                               1,092                    1 Yes

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

                               3,930                    . Missing
                              12,792                    0 No
                                 773                    1 Yes

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

                              12,954                    . Missing
                               4,516                    0 Not indicated
                                  25                    1 Indicated

K4B       844  2  INDIC                                 N Nutri; regular complaints of hunger

                              12,954                    . Missing
                               4,534                    0 Not indicated
                                   7                    1 Indicated

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

                              12,954                    . Missing
                               3,020                    0 Not indicated
                               1,521                    1 Indicated

K4D       848  2  INDIC                                 N Nutri; none of above

                              12,954                    . Missing
                               1,531                    0 Not indicated
                               3,010                    1 Indicated

K5A       850  2  INDIC                                 N Nutri; parenteral/IV

                               5,448                    . Missing
                              11,669                    0 Not indicated
                                 378                    1 Indicated

K5B       852  2  INDIC                                 N Nutri; feeding tube

                               3,825                    . Missing
                              13,057                    0 Not indicated
                                 613                    1 Indicated

K5C       854  2  INDIC                                 N Nutri; mechanically altered diet

                              12,956                    . Missing
                               3,215                    0 Not indicated
                               1,324                    1 Indicated

K5D       856  2  INDIC                                 N Nutri; syringe, oral feeding

                              12,954                    . Missing
                               4,539                    0 Not indicated
                                   2                    1 Indicated

K5E       858  2  INDIC                                 N Nutri; therapeutic diet

                              12,947                    . Missing
                               2,160                    0 Not indicated
                               2,388                    1 Indicated

K5F       860  2  INDIC                                 N Nutri; dietary supplement before meals

                              12,950                    . Missing
                               3,545                    0 Not indicated
                               1,000                    1 Indicated

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

                              12,953                    . Missing
                               4,340                    0 Not indicated
                                 202                    1 Indicated

K5H       864  2  INDIC                                 N Nutri; planned weight change program

                               3,831                    . Missing
                              11,603                    0 Not indicated
                               2,061                    1 Indicated

K5I       866  2  INDIC                                 N Nutri; none of above

                              10,953                    . Missing
                               4,060                    0 Not indicated
                               2,482                    1 Indicated

K6A       868  2  CALORIES                              N Nutri; parenteral, total calories

                              16,553                    . Missing
                                 331                    0 None
                                  69                    1 1% - 25%
                                  35                    2 26% - 50%
                                  60                    3 51% - 75%
                                 447                    4 76% - 100%

K6B       870  2  FLUID                                 N Nutri; parenteral, fluid intake

                              16,555                    . Missing
                                   9                    0 None
                                 213                    1 1 to 500cc/day
                                 124                    2 501 to 1000cc/day
                                 101                    3 1001 to 1500cc/day
                                 237                    4 1501 to 2000cc/day
                                 256                    5 2001 or more cc/day

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

                              12,969                    . Missing
                               4,501                    0 Not indicated
                                  25                    1 Indicated

L1B       874  2  INDIC                                 N Dental; dentures or removable bridge

                              12,965                    . Missing
                               2,727                    0 Not indicated
                               1,803                    1 Indicated

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

                              12,969                    . Missing
                               3,328                    0 Not indicated
                               1,198                    1 Indicated

L1D       878  2  INDIC                                 N Dental; broken or loose teeth

                              12,969                    . Missing
                               4,311                    0 Not indicated
                                 215                    1 Indicated

L1E       880  2  INDIC                                 N Dental; inflamed gums

                              12,969                    . Missing
                               4,510                    0 Not indicated
                                  16                    1 Indicated

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

                              12,965                    . Missing
                                  29                    0 Not indicated
                               4,501                    1 Indicated

L1G       884  2  INDIC                                 N Dental; none of above

                              12,965                    . Missing
                               4,525                    0 Not indicated
                                   5                    1 Indicated

M1A       886  2                                        N Skin; number of stage 1 ulcers

M1B       888  2                                        N Skin; number of stage 2 ulcers

M1C       890  2                                        N Skin; number of stage 3 ulcers

M1D       892  2                                        N Skin; number of stage 4 ulcers

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

                               3,813                    . Missing
                              12,353                    0 None
                                 348                    1 Stage one
                                 606                    2 Stage two
                                 100                    3 Stage three
                                 275                    4 Stage four

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

                               3,813                    . Missing
                              13,430                    0 None
                                  11                    1 Stage one
                                 122                    2 Stage two
                                  52                    3 Stage three
                                  67                    4 Stage four

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

                               8,702                    . Missing
                               8,085                    0 No
                                 708                    1 Yes

M4A       900  2  INDIC                                 N Skin; abrasions, bruises

                               5,432                    . Missing
                               8,781                    0 Not indicated
                               3,282                    1 Indicated

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

                               5,435                    . Missing
                              12,055                    0 Not indicated
                                   5                    1 Indicated

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

                               5,435                    . Missing
                              11,776                    0 Not indicated
                                 284                    1 Indicated

M4D       906  2  INDIC                                 N Skin; rashes

                               5,437                    . Missing
                              10,569                    0 Not indicated
                               1,489                    1 Indicated

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

                               5,435                    . Missing
                              11,257                    0 Not indicated
                                 803                    1 Indicated

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

                               5,435                    . Missing
                              11,373                    0 Not indicated
                                 687                    1 Indicated

M4G       912  2  INDIC                                 N Skin; surgical wounds

                               5,435                    . Missing
                              10,827                    0 Not indicated
                               1,233                    1 Indicated

M4H       914  2  INDIC                                 N Skin; none of above

                               5,431                    . Missing
                               5,564                    0 Not indicated
                               6,500                    1 Indicated

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

                               5,435                    . Missing
                               6,244                    0 Not indicated
                               5,816                    1 Indicated

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

                               5,435                    . Missing
                               3,058                    0 Not indicated
                               9,002                    1 Indicated

M5C       920  2  INDIC                                 N Skin; turning/repositioning program

                               5,435                    . Missing
                               7,412                    0 Not indicated
                               4,648                    1 Indicated

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

                               5,435                    . Missing
                              10,278                    0 Not indicated
                               1,782                    1 Indicated

M5E       924  2  INDIC                                 N Skin; ulcer care

                               5,431                    . Missing
                              10,805                    0 Not indicated
                               1,259                    1 Indicated

M5F       926  2  INDIC                                 N Skin; surgical wound care

                               5,435                    . Missing
                              11,006                    0 Not indicated
                               1,054                    1 Indicated

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

                               5,431                    . Missing
                               9,814                    0 Not indicated
                               2,250                    1 Indicated

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

                               5,431                    . Missing
                               8,169                    0 Not indicated
                               3,895                    1 Indicated

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

                               5,435                    . Missing
                               5,296                    0 Not indicated
                               6,764                    1 Indicated

M5J       934  2  INDIC                                 N Skin; none of above

                               5,431                    . Missing
                              11,122                    0 Not indicated
                                 942                    1 Indicated

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

                               5,435                    . Missing
                               9,771                    0 Not indicated
                               2,289                    1 Indicated

M6B       938  2  INDIC                                 N Skin; foot, infections

                               5,435                    . Missing
                              11,979                    0 Not indicated
                                  81                    1 Indicated

M6C       940  2  INDIC                                 N Skin; foot, open lesions

                               5,435                    . Missing
                              11,851                    0 Not indicated
                                 209                    1 Indicated

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

                               5,440                    . Missing
                               6,662                    0 Not indicated
                               5,393                    1 Indicated

M6E       944  2  INDIC                                 N Skin; foot, preventative care

                               5,435                    . Missing
                               8,847                    0 Not indicated
                               3,213                    1 Indicated

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

                               5,435                    . Missing
                              11,468                    0 Not indicated
                                 592                    1 Indicated

M6G       948  2  INDIC                                 N Skin; none of above

                               5,435                    . Missing
                               7,841                    0 Not indicated
                               4,219                    1 Indicated

N1A       950  2  INDIC                                 N Act; awake in morning

                               3,822                    . Missing
                                 901                    0 Not indicated
                              12,772                    1 Indicated

N1B       952  2  INDIC                                 N Act; awake in afternoon

                               3,820                    . Missing
                               1,595                    0 Not indicated
                              12,080                    1 Indicated

N1C       954  2  INDIC                                 N Act; awake in evening

                               3,822                    . Missing
                               4,350                    0 Not indicated
                               9,323                    1 Indicated

N1D       956  2  INDIC                                 N Act; none of above

                               3,818                    . Missing
                              13,467                    0 Not indicated
                                 210                    1 Indicated

N2        958  2  AVRGTIME                              N Act; average time involved

                               3,819                    . Missing
                                 892                    0 Most - more than 2/3 time
                              12,334                    1 Some - from 1/3 to 2/3 time
                                 426                    2 Little - less than 1/3 time
                                  24                    3 None

N3A       960  2  INDIC                                 N Act; settings, own room

                              12,950                    . Missing
                                 420                    0 Not indicated
                               4,125                    1 Indicated

N3B       962  2  INDIC                                 N Act; settings, day room

                              12,949                    . Missing
                               1,011                    0 Not indicated
                               3,535                    1 Indicated

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

                              12,952                    . Missing
                               2,048                    0 Not indicated
                               2,495                    1 Indicated

N3D       966  2  INDIC                                 N Act; settings, outside facility

                              12,950                    . Missing
                               3,255                    0 Not indicated
                               1,290                    1 Indicated

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

                              12,950                    . Missing
                               4,532                    0 Not indicated
                                  13                    1 Indicated

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

                              12,949                    . Missing
                               2,320                    0 Not indicated
                               2,226                    1 Indicated

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

                              12,954                    . Missing
                               3,185                    0 Not indicated
                               1,356                    1 Indicated

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

                              12,949                    . Missing
                               2,243                    0 Not indicated
                               2,303                    1 Indicated

N4D       976  2  INDIC                                 N Act; pref, music

                              12,948                    . Missing
                                 452                    0 Not indicated
                               4,095                    1 Indicated

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

                              12,948                    . Missing
                               2,189                    0 Not indicated
                               2,358                    1 Indicated

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

                              12,948                    . Missing
                               1,544                    0 Not indicated
                               3,003                    1 Indicated

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

                              12,952                    . Missing
                               3,360                    0 Not indicated
                               1,183                    1 Indicated

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

                              12,949                    . Missing
                               2,305                    0 Not indicated
                               2,241                    1 Indicated

N4I       986  2  INDIC                                 N Act; pref, watching TV

                              12,948                    . Missing
                                 521                    0 Not indicated
                               4,026                    1 Indicated

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

                              12,953                    . Missing
                               3,696                    0 Not indicated
                                 846                    1 Indicated

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

                              12,949                    . Missing
                                 573                    0 Not indicated
                               3,973                    1 Indicated

N4L       992  2  INDIC                                 N Act; pref, helping others

                              12,955                    . Missing
                               3,767                    0 Not indicated
                                 773                    1 Indicated

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

                              12,949                    . Missing
                               4,532                    0 Not indicated
                                  14                    1 Indicated

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

                              12,950                    . Missing
                               4,414                    0 No change
                                 105                    1 Slight change
                                  26                    2 Major change

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

                              12,949                    . Missing
                               4,403                    0 No change
                                 121                    1 Slight change
                                  22                    2 Major change

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

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

                              12,953                    . Missing
                               1,699                    0 No
                               2,843                    1 Yes

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

                               5,517                    . Missing
                              11,978                  0-7 Number of days

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

                               3,813                    . Missing
                              13,682                  0-7 Number of days

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

                               3,813                    . Missing
                              13,682                  0-7 Number of days

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

                               3,813                    . Missing
                              13,682                  0-7 Number of days

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

                               3,813                    . Missing
                              13,682                  0-7 Number of days

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

                               3,813                    . Missing
                              13,682                  0-7 Number of days

P1AA     1016  2  INDIC                                 N Special; chemotherapy

                               5,441                    . Missing
                              11,950                    0 Not indicated
                                 104                    1 Indicated

P1AB     1018  2  INDIC                                 N Special; dialysis

                               5,434                    . Missing
                              11,936                    0 Not indicated
                                 125                    1 Indicated

P1AC     1020  2  INDIC                                 N Special; IV medication

                               5,430                    . Missing
                               9,761                    0 Not indicated
                               2,304                    1 Indicated

P1AD     1022  2  INDIC                                 N Special; intake/output

                               5,434                    . Missing
                               9,259                    0 Not indicated
                               2,802                    1 Indicated

P1AE     1024  2  INDIC                                 N Special; monitoring acute med condition

                               5,437                    . Missing
                               7,551                    0 Not indicated
                               4,507                    1 Indicated

P1AF     1026  2  INDIC                                 N Special; ostomy care

                               5,434                    . Missing
                              11,517                    0 Not indicated
                                 544                    1 Indicated

P1AG     1028  2  INDIC                                 N Special; oxygen therapy

                               5,434                    . Missing
                              10,362                    0 Not indicated
                               1,699                    1 Indicated

P1AH     1030  2  INDIC                                 N Special; radiation

                               5,434                    . Missing
                              12,049                    0 Not indicated
                                  12                    1 Indicated

P1AI     1032  2  INDIC                                 N Special; suctioning

                               5,434                    . Missing
                              12,006                    0 Not indicated
                                  55                    1 Indicated

P1AJ     1034  2  INDIC                                 N Special; tracheostomy

                               5,434                    . Missing
                              11,986                    0 Not indicated
                                  75                    1 Indicated

P1AK     1036  2  INDIC                                 N Special; transfusions

                               5,434                    . Missing
                              11,855                    0 Not indicated
                                 206                    1 Indicated

P1AL     1038  2  INDIC                                 N Special; ventilator or respirator

                               5,434                    . Missing
                              12,039                    0 Not indicated
                                  22                    1 Indicated

P1AM     1040  2  INDIC                                 N Special; alcoholic/drug treatment

                               5,434                    . Missing
                              12,054                    0 Not indicated
                                   7                    1 Indicated

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

                               5,434                    . Missing
                              11,238                    0 Not indicated
                                 823                    1 Indicated

P1AO     1044  2  INDIC                                 N Special; hospice care

                               5,434                    . Missing
                              11,825                    0 Not indicated
                                 236                    1 Indicated

P1AP     1046  2  INDIC                                 N Special; pediatric unite

                               5,434                    . Missing
                              12,061                    0 Not indicated
                                   0                    1 Indicated

P1AQ     1048  2  INDIC                                 N Special; respite care

                               5,434                    . Missing
                              12,054                    0 Not indicated
                                   7                    1 Indicated

P1AR     1050  2  INDIC                                 N Special; community skill training

                               5,430                    . Missing
                               9,427                    0 Not indicated
                               2,638                    1 Indicated

P1AS     1052  2  INDIC                                 N Special; none of above

                               5,430                    . Missing
                               7,508                    0 Not indicated
                               4,557                    1 Indicated

P1BAA    1054  2  NUMDAY                                N Special; speech therapy days

                               5,443                    . Missing
                              12,052                  0-7 Number of days

P1BAB    1056  4  NUMMINS                               N Special; speech therapy minutes

                               5,438                    . Missing
                              12,057               0-9999 Number of minutes

P1BBA    1060  2  NUMDAY                                N Special; occupational therapy days

                               5,434                    . Missing
                              12,061                  0-7 Number of days

P1BBB    1062  4  NUMMINS                               N Special; occupational therapy minutes

                               5,436                    . Missing
                              12,059               0-9999 Number of minutes

P1BCA    1066  2  NUMDAY                                N Special; physical therapy days

                               5,434                    . Missing
                              12,061                  0-7 Number of days

P1BCB    1068  4  NUMMINS                               N Special; physical therapy minutes

                               5,436                    . Missing
                              12,059               0-9999 Number of minutes

P1BDA    1072  2  NUMDAY                                N Special; respiratory therapy days

                               5,438                    . Missing
                              12,057                  0-7 Number of days

P1BDB    1074  4  NUMMINS                               N Special; respiratory therapy minutes

                               5,438                    . Missing
                              12,057               0-9999 Number of minutes

P1BEA    1078  2  NUMDAY                                N Special; psychological therapy days

                               5,438                    . Missing
                              12,057                  0-7 Number of days

P1BEB    1080  4  NUMMINS                               N Special; psychological therapy minutes

                               5,438                    . Missing
                              12,057               0-9999 Number of minutes

P2A      1084  2  INDIC                                 N Special; behavior symptom eval program

                              12,948                    . Missing
                               4,249                    0 Not indicated
                                 298                    1 Indicated

P2B      1086  2  INDIC                                 N Special; mental health specialist eval

                              12,948                    . Missing
                               3,782                    0 Not indicated
                                 765                    1 Indicated

P2C      1088  2  INDIC                                 N Special; group therapy

                              12,948                    . Missing
                               4,512                    0 Not indicated
                                  35                    1 Indicated

P2D      1090  2  INDIC                                 N Special; deliberate environment changes

                              12,951                    . Missing
                               4,484                    0 Not indicated
                                  60                    1 Indicated

P2E      1092  2  INDIC                                 N Special; reorientation

                              12,951                    . Missing
                               2,763                    0 Not indicated
                               1,781                    1 Indicated

P2F      1094  2  INDIC                                 N Special; none of above

                              12,951                    . Missing
                               2,236                    0 Not indicated
                               2,308                    1 Indicated

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

                               5,440                    . Missing
                              12,055                  0-7 Number of days

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

                               5,440                    . Missing
                              12,055                  0-7 Number of days

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

                               5,440                    . Missing
                              12,055                  0-7 Number of days

P3D      1102  2  NUMDAY                                N Special; practice, bed mobility

                               5,440                    . Missing
                              12,055                  0-7 Number of days

P3E      1104  2  NUMDAY                                N Special; practice, transfer

                               5,440                    . Missing
                              12,055                  0-7 Number of days

P3F      1106  2  NUMDAY                                N Special; practice, walking

                               5,441                    . Missing
                              12,054                  0-7 Number of days

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

                               5,440                    . Missing
                              12,055                  0-7 Number of days

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

                               5,440                    . Missing
                              12,055                  0-7 Number of days

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

                               5,440                    . Missing
                              12,055                  0-7 Number of days

P3J      1114  2  NUMDAY                                N Special; practice, communication

                               5,440                    . Missing
                              12,055                  0-7 Number of days

P3K      1116  2  NUMDAY                                N Special; practice, other

                               5,440                    . Missing
                              12,055                  0-7 Number of days

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

                               3,813                    . Missing
                              12,507                    0 Not used
                                  40                    1 Used less than daily
                               1,135                    2 Used daily

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

                               3,816                    . Missing
                              11,084                    0 Not used
                                 129                    1 Used less than daily
                               2,466                    2 Used daily

P4C      1122  2  USED                                  N Special; devices, trunk restraint

                               3,814                    . Missing
                              13,525                    0 Not used
                                  15                    1 Used less than daily
                                 141                    2 Used daily

P4D      1124  2  USED                                  N Special; devices, limb restraint

                               3,813                    . Missing
                              13,664                    0 Not used
                                   4                    1 Used less than daily
                                  14                    2 Used daily

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

                               3,813                    . Missing
                              13,493                    0 Not used
                                  15                    1 Used less than daily
                                 174                    2 Used daily

P5       1128  2  NUMDAY2X                              N Special; # overnight hospital stays

                              12,947                    . Missing
                               4,548                 0-99 Number of days

P6       1130  2  NUMDAY2X                              N Special; # emergency room visits

                              12,945                    . Missing
                               4,550                 0-99 Number of days

P7       1132  2  NUMDAY2X                              N Special; # days physician examined

                               5,431                    . Missing
                              12,064                 0-99 Number of days

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

                               5,430                    . Missing
                              12,065                 0-99 Number of days

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

                              12,950                    . Missing
                               1,096                    0 No
                               3,449                    1 Yes

Q1A      1138  2  YESNO                                 N Status; expresses pref of discharge

                               8,716                    . Missing
                               5,161                    0 No
                               3,618                    1 Yes

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

                              12,956                    . Missing
                               3,126                    0 No
                               1,413                    1 Yes

Q1C      1142  2  DISCHARG                              N Status; discharge projected

                               8,695                    . Missing
                               4,960                    0 No
                               1,301                    1 Within 30 days
                                 830                    2 Within 31-90 days
                               1,709                    3 Discharge status uncertain

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

                               3,820                    . Missing
                              10,408                    0 No change
                                 956                    1 Improved
                               2,311                    2 Deteriorated

R1A      1146  2  YESNO                                 N Discharge; assess resident particip

                              12,950                    . Missing
                                 395                    0 No
                               4,150                    1 Yes

R1B      1148  2  YESNOFAM                              N Discharge; assess, family particip

                              12,949                    . Missing
                               2,388                    0 No
                               2,106                    1 Yes
                                  52                    2 No family

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

                              12,965                    . Missing
                               2,845                    0 No
                                 305                    1 Yes
                               1,380                    2 None

R2B      1152  8                                        N Discharge; date RN assess complete

R3A      1162  2                                        N Discharge; code for resident disposition

R3B      1164  2                                        N Discharge; optional state code

R4       1166  8                                        N Discharge; date of discharge

T1AA     1176  2  NUMDAY                                N Supp; recreation therapy days

                              15,171                    . Missing
                               2,324                  0-7 Number of days

T1AB     1178  4  NUMMINS                               N Supp; recreation therapy minutes

                              15,165                    . Missing
                               2,330               0-9999 Number of minutes

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

                              15,263                    . Missing
                                 221                    0 No
                               2,011                    1 Yes

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

                              15,487                    . Missing
                               2,008                 0-99 Number of days

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

                              15,487                    . Missing
                               2,008               0-9999 Number of minutes

T2A      1190  2  WALKDIST                              N Supp; furthest distance walked

                              15,824                    . Missing
                                 811                    0 150+ feet
                                 378                    1 51-149 feet
                                 155                    2 26-50 feet
                                 186                    3 10-25 feet
                                 141                    4 Less than 25 feet

T2B      1192  2  WALKTIME                              N Supp; time walked without sitting

                              15,821                    . Missing
                                 727                    0 1-2 minutes
                                 488                    1 3-4 minutes
                                 337                    2 5-10 minutes
                                 107                    3 11-15 minutes
                                   9                    4 16-30 minutes
                                   6                    5 31+ minutes

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

                              15,825                    . Missing
                                 526                    0 Independent
                                 283                    1 Supervision
                                 574                    2 Limited assistance
                                 287                    3 Extensive assistance

T2D      1196  2  WALKSUPP                              N Supp; walking support provided

                              15,825                    . Missing
                                 569                    0 No setup or physical help from staff
                                 224                    1 Setup help only
                                 757                    2 One person physical assist
                                 120                    3 Two+ persons physical assist

T2E      1198  2  YESNO                                 N Supp; parallel bars used

                              15,793                    . Missing
                               1,596                    0 No
                                 106                    1 Yes

T3MDCR   1200  5                                        C Case mix group Medicare

T3STATE  1205  5                                        C Case mix group State

U01RA    1210  2  ROUTE                                 N Drug 1; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U01FR    1212  2  $FREQU                                C Drug 1; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U01AA    1214  5  $AMOUNT                               C Drug 1; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U02RA    1230  2  ROUTE                                 N Drug 2; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U02FR    1232  2  $FREQU                                C Drug 2; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U02AA    1234  5  $AMOUNT                               C Drug 2; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U03RA    1250  2  ROUTE                                 N Drug 3; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U03FR    1252  2  $FREQU                                C Drug 3; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U03AA    1254  5  $AMOUNT                               C Drug 3; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U04RA    1270  2  ROUTE                                 N Drug 4; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U04FR    1272  2  $FREQU                                C Drug 4; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U04AA    1274  5  $AMOUNT                               C Drug 4; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U05RA    1290  2  ROUTE                                 N Drug 5; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U05FR    1292  2  $FREQU                                C Drug 5; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U05AA    1294  5  $AMOUNT                               C Drug 5; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U06RA    1310  2  ROUTE                                 N Drug 6; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U06FR    1312  2  $FREQU                                C Drug 6; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U06AA    1314  5  $AMOUNT                               C Drug 6; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U07RA    1330  2  ROUTE                                 N Drug 7; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U07FR    1332  2  $FREQU                                C Drug 7; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U07AA    1334  5  $AMOUNT                               C Drug 7; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U08RA    1350  2  ROUTE                                 N Drug 8; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U08FR    1352  2  $FREQU                                C Drug 8; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U08AA    1354  5  $AMOUNT                               C Drug 8; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U09RA    1370  2  ROUTE                                 N Drug 9; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U09FR    1372  2  $FREQU                                C Drug 9; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U09AA    1374  5  $AMOUNT                               C Drug 9; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U10RA    1390  2  ROUTE                                 N Drug 10; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U10FR    1392  2  $FREQU                                C Drug 10; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U10AA    1394  5  $AMOUNT                               C Drug 10; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U11RA    1410  2  ROUTE                                 N Drug 11; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U11FR    1412  2  $FREQU                                C Drug 11; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U11AA    1414  5  $AMOUNT                               C Drug 11; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U12RA    1430  2  ROUTE                                 N Drug 12; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U12FR    1432  2  $FREQU                                C Drug 12; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U12AA    1434  5  $AMOUNT                               C Drug 12; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U13RA    1450  2  ROUTE                                 N Drug 13; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U13FR    1452  2  $FREQU                                C Drug 13; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U13AA    1454  5  $AMOUNT                               C Drug 13; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U14RA    1470  2  ROUTE                                 N Drug 14; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U14FR    1472  2  $FREQU                                C Drug 14; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U14AA    1474  5  $AMOUNT                               C Drug 14; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U15RA    1490  2  ROUTE                                 N Drug 15; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U15FR    1492  2  $FREQU                                C Drug 15; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U15AA    1494  5  $AMOUNT                               C Drug 15; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U16RA    1510  2  ROUTE                                 N Drug 16; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U16FR    1512  2  $FREQU                                C Drug 16; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U16AA    1514  5  $AMOUNT                               C Drug 16; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U17RA    1530  2  ROUTE                                 N Drug 17; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U17FR    1532  2  $FREQU                                C Drug 17; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U17AA    1534  5  $AMOUNT                               C Drug 17; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

U18RA    1550  2  ROUTE                                 N Drug 18; route of administration

                              17,495                    . Missing
                                   0                    1 By mouth (PO)
                                   0                    2 Sub lingual (SL)
                                   0                    3 Intramuscular (IM)
                                   0                    4 Intravenous (IV)
                                   0                    5 Subcutaneous (SQ)
                                   0                    6 Rectal (R)
                                   0                    7 Topical
                                   0                    8 Inhalation
                                   0                    9 Enteral tube
                                   0                   10 Other

U18FR    1552  2  $FREQU                                C Drug 18; frequency

                              17,495                      Missing
                                   0                   && Invalid entry, &&
                                   0                   -- Invalid entry, --
                                   0                    C Continuous
                                   0                    O Other
                                   0                   PR (PRN) As necessary
                                   0                   QO Every other day
                                   0                   Q0 Invalid entry, Q0
                                   0                   Q4 Invalid entry, Q4
                                   0                   0O Invalid entry, 0O
                                   0                   00 Invalid entry, 00
                                   0                    1 Invalid entry, One
                                   0                   1D (QD or HS) Once daily
                                   0                   1H (QH) Every hour
                                   0                   1M (Q mo) Once each month
                                   0                   1W (Q week) Once each week
                                   0                   1X Invalid entry, 1X
                                   0                   12 Invalid entry, 12
                                   0                   2D (BID) Two times daily
                                   0                   2H (Q2H) Every 2 hours
                                   0                   2M Twice each month
                                   0                   2W Two times each week
                                   0                   21 Invalid entry, 21
                                   0                   3D (TID) Three times daily
                                   0                   3H (Q3H) Every 3 hours
                                   0                   3P Invalid entry, 3P
                                   0                   3W Three times each week
                                   0                   4D (QID) Four times daily
                                   0                   4H (Q4H) Every 4 hours
                                   0                   4W Four times each week
                                   0                   5D Five times daily
                                   0                   5W Five times each week
                                   0                   6D Invalid entry, 6D
                                   0                   6H (Q6H) Every 6 hours
                                   0                   6W Six times each week
                                   0                   8H (Q8H) Every 8 hours

U18AA    1554  5  $AMOUNT                               C Drug 18; amount administered

                              17,495             LOW-HIGH Amount administered

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

                              17,495                    . Missing
                                   0                 0-99 Number of doses

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

                              17,495             LOW-HIGH National Drug Code

VA01A    1570  2  INDIC                                 N Delirium, triggered

                              13,592                    . Missing
                               3,322                    0 Not indicated
                                 581                    1 Indicated

VA01B    1572  2  INDIC                                 N Delirium, care planning

                              13,975                    . Missing
                               3,237                    0 Not indicated
                                 283                    1 Indicated

VA02A    1574  2  INDIC                                 N Cognitive loss, triggered

                              13,577                    . Missing
                                 932                    0 Not indicated
                               2,986                    1 Indicated

VA02B    1576  2  INDIC                                 N Cognitive loss, care planning

                              13,709                    . Missing
                               1,313                    0 Not indicated
                               2,473                    1 Indicated

VA03A    1578  2  INDIC                                 N Visual function, triggered

                              13,587                    . Missing
                               2,373                    0 Not indicated
                               1,535                    1 Indicated

VA03B    1580  2  INDIC                                 N Visual function, care planning

                              13,851                    . Missing
                               2,507                    0 Not indicated
                               1,137                    1 Indicated

VA04A    1582  2  INDIC                                 N Communication, triggered

                              13,579                    . Missing
                               1,747                    0 Not indicated
                               2,169                    1 Indicated

VA04B    1584  2  INDIC                                 N Communication, care planning

                              13,815                    . Missing
                               1,952                    0 Not indicated
                               1,728                    1 Indicated

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

                              13,577                    . Missing
                                  46                    0 Not indicated
                               3,872                    1 Indicated

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

                              13,602                    . Missing
                                 460                    0 Not indicated
                               3,433                    1 Indicated

VA06A    1590  2  INDIC                                 N Urinary incontinence, triggered

                              13,579                    . Missing
                               1,113                    0 Not indicated
                               2,803                    1 Indicated

VA06B    1592  2  INDIC                                 N Urinary incontinence, care planning

                              13,736                    . Missing
                               1,333                    0 Not indicated
                               2,426                    1 Indicated

VA07A    1594  2  INDIC                                 N Psychosocial well-being, triggered

                              13,579                    . Missing
                               2,561                    0 Not indicated
                               1,355                    1 Indicated

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

                              13,922                    . Missing
                               2,601                    0 Not indicated
                                 972                    1 Indicated

VA08A    1598  2  INDIC                                 N Mood state, triggered

                              13,577                    . Missing
                               2,240                    0 Not indicated
                               1,678                    1 Indicated

VA08B    1600  2  INDIC                                 N Mood state, care planning

                              13,855                    . Missing
                               2,220                    0 Not indicated
                               1,420                    1 Indicated

VA09A    1602  2  INDIC                                 N Behavioral symptoms, triggered

                              13,582                    . Missing
                               2,895                    0 Not indicated
                               1,018                    1 Indicated

VA09B    1604  2  INDIC                                 N Behavioral symptoms, care planning

                              13,928                    . Missing
                               2,692                    0 Not indicated
                                 875                    1 Indicated

VA10A    1606  2  INDIC                                 N Activities, triggered

                              13,579                    . Missing
                               3,429                    0 Not indicated
                                 487                    1 Indicated

VA10B    1608  2  INDIC                                 N Activities, care planning

                              13,973                    . Missing
                               3,088                    0 Not indicated
                                 434                    1 Indicated

VA11A    1610  2  INDIC                                 N Falls, triggered

                              13,579                    . Missing
                               1,135                    0 Not indicated
                               2,781                    1 Indicated

VA11B    1612  2  INDIC                                 N Falls, care planning

                              13,743                    . Missing
                               1,259                    0 Not indicated
                               2,493                    1 Indicated

VA12A    1614  2  INDIC                                 N Nutritional status, triggered

                              13,590                    . Missing
                                 777                    0 Not indicated
                               3,128                    1 Indicated

VA12B    1616  2  INDIC                                 N Nutritional status, care planning

                              13,685                    . Missing
                               1,118                    0 Not indicated
                               2,692                    1 Indicated

VA13A    1618  2  INDIC                                 N Feeding tubes, triggered

                              13,580                    . Missing
                               3,742                    0 Not indicated
                                 173                    1 Indicated

VA13B    1620  2  INDIC                                 N Feeding tubes, care planning

                              13,992                    . Missing
                               3,346                    0 Not indicated
                                 157                    1 Indicated

VA14A    1622  2  INDIC                                 N Dehydration/Fluid mainten, triggered

                              13,577                    . Missing
                               1,983                    0 Not indicated
                               1,935                    1 Indicated

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

                              13,801                    . Missing
                               2,095                    0 Not indicated
                               1,599                    1 Indicated

VA15A    1626  2  INDIC                                 N Dental care, triggered

                              13,579                    . Missing
                               2,765                    0 Not indicated
                               1,151                    1 Indicated

VA15B    1628  2  INDIC                                 N Dental care, care planning

                              13,918                    . Missing
                               2,736                    0 Not indicated
                                 841                    1 Indicated

VA16A    1630  2  INDIC                                 N Pressure ulcers, triggered

                              13,581                    . Missing
                                 678                    0 Not indicated
                               3,236                    1 Indicated

VA16B    1632  2  INDIC                                 N Pressure ulcers, care planning

                              13,670                    . Missing
                               1,000                    0 Not indicated
                               2,825                    1 Indicated

VA17A    1634  2  INDIC                                 N Psychotropic drug use, triggered

                              13,577                    . Missing
                               1,685                    0 Not indicated
                               2,233                    1 Indicated

VA17B    1636  2  INDIC                                 N Psychotropic drug use, care planning

                              13,786                    . Missing
                               1,897                    0 Not indicated
                               1,812                    1 Indicated

VA18A    1638  2  INDIC                                 N Physical restraints, triggered

                              13,577                    . Missing
                               3,812                    0 Not indicated
                                 106                    1 Indicated

VA18B    1640  2  INDIC                                 N Physical restraints, care planning

                              14,025                    . Missing
                               3,377                    0 Not indicated
                                  93                    1 Indicated

VB2      1642  8                                        N Signature date, RAP assessment

VB4      1652  8                                        N Signature date, care planning

DEATH_DA 1662  8                                        N FU-DEATH-DA

