RIC         1  2  $RIC                                  C Record Identification Code

                                   0                    A Administrative Data
                                   0                   DU Dental Events
                                 956                   FA Facility Events
                                   0                    H HMO Supplement
                                   0                   IA Income and Assets
                                   0                   IP Inpatient Hospital Events
                                   0                   IU Institutional Events
                                   0                    K Key Record
                                   0                   KN Knowledge and Information Needs
                                   0                   MD MDS
                                   0                   MP Medical Provider Events
                                   0                    N Non-Respondent
                                   0                   OA OASIS
                                   0                   OP Outpatient Events
                                   0                   PA Patient Activation
                                   0                   PM Prescribed Medicine Events
                                   0                   PS Person Summary
                                   0                   RX Drug Coverage
                                   0                   SS Service Summary
                                   0                    X Cross Sectional Weights
                                   0                   XE Ever Enrolled Weights
                                   0                   X2 2 year Weights
                                   0                   X3 3 year Weights
                                   0                   X4 4 year Weights
                                   0                    1 Survey Identification (Demographic)
                                   0                   10 MDS/OAS Timeline
                                   0                    2 Health Status/Functioning (Community)
                                   0                   2F Health Status/Functioning (Facility)
                                   0                   2H Health Status/Functioning (Helper)
                                   0                   2P Health Status/Functioning (Prevention)
                                   0                    3 Access to Care
                                   0                    4 Health Insurance
                                   0                    5 Enumeration
                                   0                    6 Facility Residence History
                                   0                    7 Facility Characteristics
                                   0                   7S SNF Characteristics
                                   0                    8 Interview Description
                                   0                    9 Residence Timeline

VERSION     3  1  $VERSION                              C Version Number

                                 956                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                                 956             LOW-HIGH BASEID Count

STAYNUM    14  1                                        N Stay number for the year

REFBEGYY   15  2                                        C Reference beginning date year

REFBEGMM   17  2                                        C Reference beginning date month

REFBEGDD   19  2                                        C Reference beginning date day

REFENDYY   21  2                                        C Reference ending date year

REFENDMM   23  2                                        C Reference ending date month

REFENDDD   25  2                                        C Reference ending date day

ADMISYY    27  2                                        C Admission date year

ADMISMM    29  2                                        C Admission date month

ADMISDD    31  2                                        C Admission date day

DISCHYY    33  2                                        C Permanent discharge date year

DISCHMM    35  2                                        C Permanent discharge date month

DISCHDD    37  2                                        C Permanent discharge date day

STAYDAYS   39  3                                        N Number of days in the stay

FACILID    42  6                                        C Facility ID

                  Note: Randomly-assigned number

FACDESC    48  2  FACFMT                                N Facility description

                                  15                    1 Hospital
                                 551                    2 Nursing home
                                  10                    3 Retirement home
                                  88                    4 Domiciliary/personal care facility
                                  10                    5 Mental health facility
                                  29                    6 Inst for mentally retarded/devel disab
                                   0                    7 Mental health center
                                  80                    8 Life care/continuing care
                                 136                    9 Assisted living facility
                                   8                   10 Rehabilitation facility
                                  29                   91 Other place, specify

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

                                   1                    - Don't know
                                 703                    0 Continuing SP
                                  82                    1 First time SP from home
                                  89                    2 First time SP from hosp
                                  35                    3 First time SP from nursing home
                                  11                    5 2nd stay 30-day split (in hosp)
                                   6                    6 2nd stay 30-day split (disch)
                                  28                    7 First time SP from other facility
                                   1                    9 Unknown reason

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

                                   2                    - Don't know
                                 645                    0 SP is still a resident
                                  41                    1 SP was discharged home
                                  34                    2 SP was discharged to a hospital
                                  53                    3 SP was discharged to another facility
                                 162                    4 SP died in the facility
                                   8                    5 Stay split by 30-day hosp
                                   7                    6 Stay split by 30-day disch
                                   0                    7 SP was discharged to another facility
                                   4                    9 Unknown reason for end of stay

AMTTOT     52  9                                        N Total payment

AMTCARE    61  9                                        N Amount paid by Medicare

AMTCAID    70  9                                        N Amount paid by Medicaid

AMTVA      79  9                                        N Amount paid by Veterans Administration

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

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

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

ANCITOT   115  9                                        N Ancillary total payment

ANCICARE  124  9                                        N Ancillary amount paid by Medicare

ANCICAID  133  9                                        N Ancillary amount paid by Medicaid

ANCIVA    142  9                                        N Ancillary amount paid by Veterans Adm.

ANCIPRVU  151  9                                        N Ancillary amount paid by private ins.

ANCIOOP   160  9                                        N Ancillary amount paid by person/family

ANCIOTH   169  9                                        N Ancillary amount paid by other sources

TOTCARE   178  9                                        N Amount paid by Medicare for all services

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

DENTNUM   196  3                                        N Number of dental visits

EMNUM     199  3                                        N Number of emergency room visits

OPNUM     202  3                                        N Number of clinic/outpatient visits

MDNUM     205  3                                        N Number of medical doctor visits

MHNUMVIS  208  3                                        N # of mental health professional visits

DIETFLG   211  2  YES2FMT                               N Type of health professional: dietician

                                 367                    1 Yes
                                 589                    2 No

OPTHLFLG  213  2  YES2FMT                               N Type of physician: ophthalmologist

                                  99                    1 Yes
                                 857                    2 No

OPTOMFLG  215  2  YES2FMT                               N Type of health professional: optometrist

                                 104                    1 Yes
                                 852                    2 No

PODIAFLG  217  2  YES2FMT                               N Type of health professional: podiatrist

                                 555                    1 Yes
                                 401                    2 No

EDHABFLG  219  2  YES2FMT                               N Received educational/habitational svcs.

                                   9                   -8 Don't know
                                   1                   -7 Refused
                                 223                    1 Yes
                                 723                    2 No

HABFLG    221  2  YES2FMT                               N Received habitational services

                                   9                   -8 Don't know
                                   1                   -7 Refused
                                 212                    1 Yes
                                 734                    2 No

EDUCFLG   223  2  YES2FMT                               N Received educational services

                                   9                   -8 Don't know
                                   1                   -7 Refused
                                 145                    1 Yes
                                 801                    2 No

AMBUSERV  225  2  YES2FMT                               N Used ambulance service

                                 296                    1 Yes
                                 660                    2 No

BEDPADS   227  2  YES2FMT                               N Received bed pads

                                 489                    1 Yes
                                 467                    2 No

CATHETER  229  2  YES2FMT                               N Received catheter or catheter supplies

                                  86                    1 Yes
                                 870                    2 No

CATHIRRI  231  2  YES2FMT                               N Catheterization and irrigation

                                  89                    1 Yes
                                 867                    2 No

CHNGBAND  233  2  YES2FMT                               N Apply or change dressing

                                 404                    1 Yes
                                 552                    2 No

CLOTHDPR  235  2  YES2FMT                               N Received cloth diapers

                                  20                    1 Yes
                                 936                    2 No

COMMODE   237  2  YES2FMT                               N Received bedside commode

                                  68                    1 Yes
                                 888                    2 No

DIABSUPP  239  2  YES2FMT                               N Used diabetic supplies

                                 195                    1 Yes
                                 761                    2 No

DIAPRSUP  241  2  YES2FMT                               N Used disposable diapers

                                 637                    1 Yes
                                 319                    2 No

EQUIPSUP  243  2  YES2FMT                               N Used equipment or supplies

                                  13                    1 Yes
                                 943                    2 No

EYEGLASS  245  2  YES2FMT                               N Used eyeglasses

                                 201                    1 Yes
                                 755                    2 No

FEEDSERV  247  2  YES2FMT                               N Received feeding services

                                 203                    1 Yes
                                 753                    2 No

FEEDSUPP  249  2  YES2FMT                               N Received feeding supplies

                                  47                    1 Yes
                                 909                    2 No

GERCHAIR  251  2  YES2FMT                               N Received geri-chair

                                  62                    1 Yes
                                 894                    2 No

GTUBESUP  253  2  YES2FMT                               N Received gastrointestinal tube & suppl.

                                  40                    1 Yes
                                 916                    2 No

GTUBEUSE  255  2  YES2FMT                               N Received gastrointestinal tube serivces

                                  47                    1 Yes
                                 909                    2 No

HEARAID   257  2  YES2FMT                               N Used hearing aid

                                  44                    1 Yes
                                 912                    2 No

HOSPBED   259  2  YES2FMT                               N Received hospital bed

                                 342                    1 Yes
                                 614                    2 No

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

                                  37                    1 Yes
                                 919                    2 No

INCNCARE  263  2  YES2FMT                               N Received incontinence care

                                 665                    1 Yes
                                 291                    2 No

INJCTION  265  2  YES2FMT                               N Received injections

                                 292                    1 Yes
                                 664                    2 No

IVSUPP    267  2  YES2FMT                               N Received IV therapy supplies

                                  38                    1 Yes
                                 918                    2 No

IVUSE     269  2  YES2FMT                               N Received IV therapy services

                                  39                    1 Yes
                                 917                    2 No

MATTRESS  271  2  YES2FMT                               N Received special mattress

                                 330                    1 Yes
                                 626                    2 No

NEBULIZR  273  2  YES2FMT                               N Received nebulizer

                                 116                    1 Yes
                                 840                    2 No

ORTHITEM  275  2  YES2FMT                               N Used orthopedic items

                                 119                    1 Yes
                                 837                    2 No

OSTOMSUP  277  2  YES2FMT                               N Used ostomy supplies

                                  21                    1 Yes
                                 935                    2 No

OXYGEN    279  2  YES2FMT                               N Used oxygen

                                 191                    1 Yes
                                 765                    2 No

PACEMCHK  281  2  YES2FMT                               N Pacemaker check/monitoring services

                                  48                    1 Yes
                                 908                    2 No

PROSTHES  283  2  YES2FMT                               N Used prosthesis

                                   3                    1 Yes
                                 953                    2 No

RESTRAIN  285  2  YES2FMT                               N Received restraints

                                  52                    1 Yes
                                 904                    2 No

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

                                 565                    1 Yes
                                 391                    2 No

SUCTSERV  289  2  YES2FMT                               N Received respiratory tract suctioning

                                  19                    1 Yes
                                 937                    2 No

SUCTSUPP  291  2  YES2FMT                               N Received suction machine and supplies

                                  20                    1 Yes
                                 936                    2 No

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

                                  93                    1 Yes
                                 863                    2 No

TUBEFEED  295  2  YES2FMT                               N Received tube feeding

                                  53                    1 Yes
                                 903                    2 No

TURNPOS   299  2  YES2FMT                               N Received turning and positioning

                                 486                    1 Yes
                                 470                    2 No

WHEEWALK  301  2  YES2FMT                               N Received wheel chair or walker

                                 421                    1 Yes
                                 535                    2 No

