RIC         1  2  $RIC                                  C Record Identification Code

                                   0                    A Administrative Data
                                   0                   DU Dental Events
                                   0                   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
                               8,792                   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

                               8,792                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                               8,792             LOW-HIGH BASEID Count

TRGT_DT    12  8                                        N Target Date

SUB_DT     20  8                                        N Submission Date

CRCTN_N    28  2                                        N Crctn Num

MCSC       30  1                                        C Crctn Stat

SPEC_VCD   31 10                                        C Data Submission Spec Vers

ITM_SVC    41 10                                        C Item Set Vers

PRCSD_TS   51  8                                        C Processed Timestamp

RES_AGE    59  8                                        N Res Age

RSDT_MCI   67  2                                        N Res Match Criteria ID

CURCD      69  1                                        C CBSA Urban/Rural

A0050      70  1  M3RECTYP                              N Type of Record

                               8,634                    1 Add a new record
                                 158                    2 Modify existing record
                                   0                    3 Inactive existing record

A0200      71  1  M3PROV                                N Type of Provider

                               8,792                    1 Nursing home (SNF/NF)
                                   0                    2 Swing Bed

A0310A     72  2  $M3OBRA                               C Federal OBRA Rsn for Asmt

                                 932                   01 Admission
                               1,765                   02 Quarterly
                                 375                   03 Annual
                                 280                   04 Significant change in status
                                   1                   05 Sig correction - prior comp
                                   1                   06 Sig correction - prior quart
                               5,438                   99 Not OBRA required

A0310B     74  2  $MCASSES                              C PPS Asmt

                               1,114                   01 Sched. 5-day assessment
                                 835                   02 Sched 14-day assessment
                                 457                   03 Sched 30-day assessment
                                 156                   04 Sched 60-day assessment
                                  52                   05 Sched 90-day assessment
                                 141                   06 Sched readmission/return
                                 200                   07 Unsched assessment
                                   0                   08 Not PPS assessment
                               5,837                   99 None of the above

A0310C     76  1  M3PPSOT                               N PPS Oth Mcare Req Asmt (OMRA)

                               8,458                    0 No
                                  46                    1 Start of therapy
                                 115                    2 End of therapy
                                   0                    3 Both start and end of therapy
                                 173                    4 Change of therapy

A0310D     77  1  M3YESNO                               N Swing Bed Clinical Change

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

A0310E     78  1  M3YESNO                               N First Asmt Since Most Rec Admsn

                               7,111                    0 No
                               1,681                    1 Yes

A0310F     79  2  $M3REPO                               C Entry/Dis

                               1,739                   01 Entry
                                 850                   10 Discharge, return not anticipated
                                 792                   11 Discharge, return anticipated
                                 206                   12 Death in facility
                               5,205                   99 None of the above

A0310G     81  1  M3DIS                                 N Planned Dis

                               8,301                    . Missing
                                 179                    1 Planned
                                 312                    2 Unplanned

A0410      82  1  M3SUBREQ                              N Submission Req

                                   0                    1 Neither federal nor state required
                                   0                    2 State but not federal required
                               8,792                    3 Federal required

A0800      83  1  M3GEND                                N Gender

                               3,029                    1 Male
                               5,763                    2 Female

A0900      84  8                                        N Birth Date

                  Note: Not provided in current CAU

A1000A     92  1  M3INDIC                               N R/E: American Indian or Alaskan Native

                                   6                    . Missing
                               8,767                    0 Not indicated
                                  19                    1 Indicated

A1000B     93  1  M3INDIC                               N R/E: Asian

                                   6                    . Missing
                               8,703                    0 Not indicated
                                  83                    1 Indicated

A1000C     94  1  M3INDIC                               N R/E: African American

                                   6                    . Missing
                               7,696                    0 Not indicated
                               1,090                    1 Indicated

A1000D     95  1  M3INDIC                               N R/E: Hispanic

                                   6                    . Missing
                               8,407                    0 Not indicated
                                 379                    1 Indicated

A1000E     96  1  M3INDIC                               N R/E: Native Hawaiian/Pacific Islander

                                   6                    . Missing
                               8,778                    0 Not indicated
                                   8                    1 Indicated

A1000F     97  1  M3INDIC                               N R/E: White

                                   6                    . Missing
                               1,741                    0 Not indicated
                               7,045                    1 Indicated

A1100A     98  1  M3YNDET                               N Res Need Interpreter

                               1,960                    . Missing
                               6,660                    0 No
                                 155                    1 Yes
                                  17                    9 Unable to determine

A1200      99  1  M3MARTL                               N Marital Stat

                                 145                    . Missing
                                 814                    1 Never married
                               2,249                    2 Married
                               4,525                    3 Widowed
                                 180                    4 Separated
                                 879                    5 Divorced

A1300A    100 12                                        C Medical Record Num

                  Note: Not provided in current CAU

A1300D    112 23                                        C Lifetime Occupation(s) Text

A1500     135  1  M3SMI                                 N (PASRR)

                               7,501                    . Missing
                               1,188                    0 No
                                  74                    1 Yes
                                  29                    9 Not a Medicaid-certified unit

A1510A    136  1  M3INDIC                               N Serious Mntl Illness

                               8,764                    . Missing
                                  11                    0 Not indicated
                                  17                    1 Indicated

A1510B    137  1  M3INDIC                               N Intellectual Disability

                               8,764                    . Missing
                                  20                    0 Not indicated
                                   8                    1 Indicated

A1510C    138  1  M3INDIC                               N Oth Related Conds

                               8,764                    . Missing
                                  24                    0 Not indicated
                                   4                    1 Indicated

A1550A    139  1  M3INDIC                               N ID/DD Stat: Down Syndrome

                               7,864                    . Missing
                                 928                    0 Not indicated
                                   0                    1 Indicated

A1550B    140  1  M3INDIC                               N ID/DD Stat: Autism

                               7,864                    . Missing
                                 928                    0 Not indicated
                                   0                    1 Indicated

A1550C    141  1  M3INDIC                               N ID/DD Stat: Epilepsy

                               7,864                    . Missing
                                 927                    0 Not indicated
                                   1                    1 Indicated

A1550D    142  1  M3INDIC                               N ID/DD Stat: Oth Org ID/DD Cond

                               7,864                    . Missing
                                 926                    0 Not indicated
                                   2                    1 Indicated

A1550E    143  1  M3INDIC                               N ID/DD Stat: ID/DD W No Org Cond

                               7,864                    . Missing
                                 924                    0 Not indicated
                                   4                    1 Indicated

A1550Z    144  1  M3INDIC                               N ID/DD Stat: None of the Above

                               7,864                    . Missing
                                   7                    0 Not indicated
                                 921                    1 Indicated

A1600     145  8                                        N Entry Date

A1700     153  1  M3TYP                                 N Type of Entry

                               5,442                    1 Admission
                               3,350                    2 Reentry

A1800     154  2  $M3ADFRM                              C Entered From

                                 563                   01 Community
                                 285                   02 Another nursing home or swing bed
                               7,765                   03 Acute hospital
                                  61                   04 Psychiatric hospital
                                  59                   05 Inpatient rehabilitation facility
                                   2                   06 ID/DD facility
                                  11                   07 Hospice
                                   0                   08 Long Term Care Hospital
                                  38                   99 Other
                                   8                   03 09

A2000     156  8                                        N Dis Date

A2100     164  2  $M3ADFRM                              C Dis Stat

                               6,944                    . Missing
                                 731                   01 Community
                                  65                   02 Another nursing home or swing bed
                                 819                   03 Acute hospital
                                  10                   04 Psychiatric hospital
                                   1                   05 Inpatient rehabilitation facility
                                   0                   06 ID/DD facility
                                   6                   07 Hospice
                                 208                   08 Long Term Care Hospital
                                   8                   99 Other

A2200     166  8                                        N Prev Asmt Ref Date For Significant Crctn

A2300     174  8                                        N Asmt Ref Date

A2400A    182  1  M3YESNO                               N Had a Mcare Stay Since Most Rec Admsn

                               3,524                    0 No
                               5,268                    1 Yes

A2400B    183  8                                        N Start Date of Most Rec Mcare Stay

A2400C    191  8                                        N End Date of Most Rec Mcare Stay

B0100     199  1  M3YESNO                               N Comatose

                               1,974                    . Missing
                               6,815                    0 No
                                   3                    1 Yes

B0200     200  1  M3HEAR                                N Hearing

                               2,655                    . Missing
                               4,345                    0 Adequate
                               1,137                    1 Minimal difficulty
                                 624                    2 Moderate difficulty
                                  31                    3 Highly impaired

B0300     201  1  M3YESNO                               N Hearing Aide

                               2,628                    . Missing
                               5,678                    0 No
                                 486                    1 Yes

B0600     202  1  M3CLEAR                               N Speech Clarity

                               2,626                    . Missing
                               5,346                    0 Clear speech
                                 613                    1 Unclear speech
                                 207                    2 No speech

B0700     203  1  M3UNDER                               N Makes Self Understood

                               2,455                    . Missing
                               4,258                    0 Understood
                               1,142                    1 Usually understood
                                 576                    2 Sometimes understood
                                 361                    3 Rarely/Never understood

B0800     204  1  M3UNDERR                              N Ability to Understand Oth

                               2,641                    . Missing
                               3,818                    0 Understands
                               1,355                    1 Usually understands
                                 719                    2 Sometimes understands
                                 259                    3 Rarely/Never understands

B1000     205  1  M3ADQT                                N Vision

                               2,708                    . Missing
                               4,145                    0 Adequate
                               1,103                    1 Impaired
                                 441                    2 Moderately impaired
                                 316                    3 Highly impaired
                                  79                    4 Severely impaired

B1200     206  1  M3YESNO                               N Corr Lenses

                               2,639                    . Missing
                               2,155                    0 No
                               3,998                    1 Yes

C0100     207  1  M3YESNO                               N Brief Int for Mntl Stat Be Cond

                               2,536                    . Missing
                                 823                    0 No
                               5,433                    1 Yes

C0200     208  1  M3REP3W                               N BIMS: Num of Words Rep After First Att

                               3,473                    . Missing
                                 304                    0 None
                                 238                    1 One
                                 354                    2 Two
                               4,423                    3 Three

C0300A    209  1  M31ORIEN                              N BIMS: Temp Ortn - Able to Rep Corr Yr

                               3,478                    . Missing
                               1,589                    0 Missed by >5 years or no answer
                                 130                    1 Missed by 2-5 years
                                 283                    2 Missed by 1 year
                               3,312                    3 Correct

C0300B    210  1  M32ORIEN                              N BIMS: Temp Ortn - Able to Rep Corr Mon

                               3,487                    . Missing
                               1,356                    0 Missed by >1 month or no answer
                                 405                    1 Missed by 6 days to 1 month
                               3,544                    2 Accurate within 5 days

C0300C    211  1  M33ORIEN                              N BIMS: Temp Ortn - Able to Rep Corr Day

                               3,497                    . Missing
                               2,278                    0 Incorrect or no answer
                               3,017                    1 Correct

C0400A    212  1  M3CUE                                 N BIMS: Rcl - Able to Rcl Sock

                               3,541                    . Missing
                               1,604                    0 No - could not recall
                               1,033                    1 Yes, after cueing
                               2,614                    2 Yes, no cue required

C0400B    213  1  M3CUE                                 N BIMS: Rcl - Able to Rcl Blue

                               3,543                    . Missing
                               1,277                    0 No - could not recall
                               1,201                    1 Yes, after cueing
                               2,771                    2 Yes, no cue required

C0400C    214  1  M3CUE                                 N BIMS: Rcl - Able to Rcl Bed

                               3,546                    . Missing
                               1,778                    0 No - could not recall
                               1,184                    1 Yes, after cueing
                               2,284                    2 Yes, no cue required

C0500     215  2                                        N Brief Int for Mntl Stat (BIMS) Score Num

C0600     217  1  M3YESNO                               N Staff to Cond Brief Int for Mntl Stat

                               3,245                    . Missing
                               5,133                    0 No
                                 414                    1 Yes

C0700     218  1  M3MEMORY                              N SA of Mntl Stat - Short Term Memory

                               7,346                    . Missing
                                 243                    0 Memory OK
                               1,203                    1 Memory problem

C0800     219  1  M3MEMORY                              N SA of Mntl Stat - Long Term Memory

                               7,643                    . Missing
                                 252                    0 Memory OK
                                 897                    1 Memory problem

C0900A    220  1  M3INDIC                               N SA of Mntl Stat - Rcls Cur Season

                               7,614                    . Missing
                                 953                    0 Not indicated
                                 225                    1 Indicated

C0900B    221  1  M3INDIC                               N SA of Mntl Stat - Rcls Loc of Room

                               7,611                    . Missing
                                 846                    0 Not indicated
                                 335                    1 Indicated

C0900C    222  1  M3INDIC                               N SA of Mntl Stat - Rcls Staff Name

                               7,610                    . Missing
                                 698                    0 Not indicated
                                 484                    1 Indicated

C0900D    223  1  M3INDIC                               N SA of Mntl Stat - Rcls Nrs Home

                               7,611                    . Missing
                                 789                    0 Not indicated
                                 392                    1 Indicated

C0900Z    224  1  M3INDIC                               N SA of Mntl Stat - Rcls None of Above

                               7,610                    . Missing
                                 655                    0 Not indicated
                                 527                    1 Indicated

C1000     225  1  M3DECIS                               N Cog Skills for Decision Making

                               7,315                    . Missing
                                 157                    0 Independent
                                 177                    1 Modified independence
                                 559                    2 Moderately impaired
                                 584                    3 Severely impaired

C1300A    226  1  M3BEHFLU                              N S/SDlrm - Inattention

                               2,264                    . Missing
                               5,477                    0 Behavior not present
                                 466                    1 Behavior always present, no fluctuate
                                 585                    2 Behavior present, fluctuates

C1300B    227  1  M3BEHFLU                              N S/SDlrm - Disorganized Thinking

                               2,262                    . Missing
                               5,622                    0 Behavior not present
                                 379                    1 Behavior always present, no fluctuate
                                 529                    2 Behavior present, fluctuates

C1300C    228  1  M3BEHFLU                              N S/SDlrm - Alt Level of Consciousness

                               2,262                    . Missing
                               6,232                    0 Behavior not present
                                 121                    1 Behavior always present, no fluctuate
                                 177                    2 Behavior present, fluctuates

C1300D    229  1  M3BEHFLU                              N S/SDlrm - Psychomotor Retardation

                               2,263                    . Missing
                               6,264                    0 Behavior not present
                                 151                    1 Behavior always present, no fluctuate
                                 114                    2 Behavior present, fluctuates

C1600     230  1  M3YESNO                               N Acute Onset Mntl Stat Change

                               2,282                    . Missing
                               6,315                    0 No
                                 195                    1 Yes

D0100     231  1  M3YESNO                               N Res Mood Int Be Cond

                               2,536                    . Missing
                                 911                    0 No
                               5,345                    1 Yes

D0200A1   232  1  M3YNNORE                              N Res Mood Int - Interest Loss

                               3,543                    . Missing
                               4,362                    0 No
                                 729                    1 Yes
                                 158                    9 No Response

D0200A2   233  1  M3DEPRBO                              N Res Mood Int - Interest Loss Freq

                               3,704                    . Missing
                               4,385                    0 Never or 1 day
                                 282                    1 2 - 6 days
                                 170                    2 7 - 11 days
                                 251                    3 12-14 days

D0200B1   234  1  M3YNNORE                              N Res Mood Int - Feel Down

                               3,542                    . Missing
                               3,455                    0 No
                               1,638                    1 Yes
                                 157                    9 No Response

D0200B2   235  1  M3DEPRBO                              N Res Mood Int - Feel Down Freq

                               3,699                    . Missing
                               3,545                    0 Never or 1 day
                                 761                    1 2 - 6 days
                                 394                    2 7 - 11 days
                                 393                    3 12-14 days

D0200C1   236  1  M3YNNORE                              N Res Mood Int - Trouble Sleep

                               3,542                    . Missing
                               3,785                    0 No
                               1,309                    1 Yes
                                 156                    9 No Response

D0200C2   237  1  M3DEPRBO                              N Res Mood Int - Trouble Sleep Freq

                               3,699                    . Missing
                               3,818                    0 Never or 1 day
                                 571                    1 2 - 6 days
                                 365                    2 7 - 11 days
                                 339                    3 12-14 days

D0200D1   238  1  M3YNNORE                              N Res Mood Int - Little Energy

                               3,550                    . Missing
                               2,990                    0 No
                               2,099                    1 Yes
                                 153                    9 No Response

D0200D2   239  1  M3DEPRBO                              N Res Mood Int - Little Energy Freq

                               3,707                    . Missing
                               3,052                    0 Never or 1 day
                                 788                    1 2 - 6 days
                                 528                    2 7 - 11 days
                                 717                    3 12-14 days

D0200E1   240  1  M3YNNORE                              N Res Mood Int - Poor Appetite

                               3,558                    . Missing
                               4,106                    0 No
                                 978                    1 Yes
                                 150                    9 No Response

D0200E2   241  1  M3DEPRBO                              N Res Mood Int - Poor Appetite Freq

                               3,708                    . Missing
                               4,126                    0 Never or 1 day
                                 407                    1 2 - 6 days
                                 249                    2 7 - 11 days
                                 302                    3 12-14 days

D0200F1   242  1  M3YNNORE                              N Res Mood Int - Self Dprcn

                               3,560                    . Missing
                               4,618                    0 No
                                 451                    1 Yes
                                 163                    9 No Response

D0200F2   243  1  M3DEPRBO                              N Res Mood Int - Self Dprcn Freq

                               3,723                    . Missing
                               4,655                    0 Never or 1 day
                                 196                    1 2 - 6 days
                                  88                    2 7 - 11 days
                                 130                    3 12-14 days

D0200G1   244  1  M3YNNORE                              N Res Mood Int - Lack of Conc

                               3,562                    . Missing
                               4,350                    0 No
                                 730                    1 Yes
                                 150                    9 No Response

D0200G2   245  1  M3DEPRBO                              N Res Mood Int - Lack of Conc Freq

                               3,714                    . Missing
                               4,366                    0 Never or 1 day
                                 316                    1 2 - 6 days
                                 180                    2 7 - 11 days
                                 216                    3 12-14 days

D0200H1   246  1  M3YNNORE                              N Res Mood Int - Movement Diff

                               3,559                    . Missing
                               4,639                    0 No
                                 429                    1 Yes
                                 165                    9 No Response

D0200H2   247  1  M3DEPRBO                              N Res Mood Int - Movement Diff Freq

                               3,727                    . Missing
                               4,654                    0 Never or 1 day
                                 186                    1 2 - 6 days
                                  91                    2 7 - 11 days
                                 134                    3 12-14 days

D0200I1   248  1  M3YNNORE                              N Res Mood Int - Neg Stmnt

                               3,560                    . Missing
                               4,980                    0 No
                                 103                    1 Yes
                                 149                    9 No Response

D0200I2   249  1  M3DEPRBO                              N Res Mood Int - Neg Stmnt Freq

                               3,709                    . Missing
                               5,006                    0 Never or 1 day
                                  35                    1 2 - 6 days
                                  20                    2 7 - 11 days
                                  22                    3 12-14 days

D0300     250  2                                        N Res Mood Int - Tot Svrty Mood Score

D0350     252  1  M3YESNO                               N Res Mood Int - Neg Stmnts Notify Staff

                               8,689                    . Missing
                                   5                    0 No
                                  98                    1 Yes

D0500A1   253  1  M3YESNO                               N SA of Res Mood - Interest Loss

                               7,502                    . Missing
                                 914                    0 No
                                 376                    1 Yes

D0500A2   254  1  M3DEPRBO                              N SA of Res Mood - Interest Loss Freq

                               7,502                    . Missing
                                 925                    0 Never or 1 day
                                  77                    1 2 - 6 days
                                 100                    2 7 - 11 days
                                 188                    3 12-14 days

D0500B1   255  1  M3YESNO                               N SA of Res Mood - Feel Down

                               7,502                    . Missing
                               1,004                    0 No
                                 286                    1 Yes

D0500B2   256  1  M3DEPRBO                              N SA of Res Mood - Feel Down Freq

                               7,502                    . Missing
                               1,005                    0 Never or 1 day
                                 140                    1 2 - 6 days
                                  76                    2 7 - 11 days
                                  69                    3 12-14 days

D0500C1   257  1  M3YESNO                               N SA of Res Mood - Trouble Sleep

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

D0500C2   258  1  M3DEPRBO                              N SA of Res Mood - Trouble Sleep Freq

                               8,792                    . Missing
                                   0                    0 Never or 1 day
                                   0                    1 2 - 6 days
                                   0                    2 7 - 11 days
                                   0                    3 12-14 days

D0500D1   259  1  M3YESNO                               N SA of Res Mood - Little Energy

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

D0500D2   260  1  M3DEPRBO                              N SA of Res Mood - Little Energy Freq

                               8,792                    . Missing
                                   0                    0 Never or 1 day
                                   0                    1 2 - 6 days
                                   0                    2 7 - 11 days
                                   0                    3 12-14 days

D0500E1   261  1  M3YESNO                               N SA of Res Mood - Poor Appetite

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

D0500E2   262  1  M3DEPRBO                              N SA of Res Mood - Poor Appetite Freq

                               8,792                    . Missing
                                   0                    0 Never or 1 day
                                   0                    1 2 - 6 days
                                   0                    2 7 - 11 days
                                   0                    3 12-14 days

D0500F1   263  1  M3YESNO                               N SA of Res Mood - Self Dprcn

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

D0500F2   264  1  M3DEPRBO                              N SA of Res Mood - Self Dprcn Freq

                               8,792                    . Missing
                                   0                    0 Never or 1 day
                                   0                    1 2 - 6 days
                                   0                    2 7 - 11 days
                                   0                    3 12-14 days

D0500G1   265  1  M3YESNO                               N SA of Res Mood - Conc

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

D0500G2   266  1  M3DEPRBO                              N SA of Res Mood - Conc Freq

                               8,792                    . Missing
                                   0                    0 Never or 1 day
                                   0                    1 2 - 6 days
                                   0                    2 7 - 11 days
                                   0                    3 12-14 days

D0500H1   267  1  M3YESNO                               N SA of Res Mood - Movement Diff

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

D0500H2   268  1  M3DEPRBO                              N SA of Res Mood - Movement Diff Freq

                               8,792                    . Missing
                                   0                    0 Never or 1 day
                                   0                    1 2 - 6 days
                                   0                    2 7 - 11 days
                                   0                    3 12-14 days

D0500I1   269  1  M3YESNO                               N SA of Res Mood - Neg Stmnt

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

D0500I2   270  1  M3DEPRBO                              N SA of Res Mood - Neg Stmnt Freq

                               8,792                    . Missing
                                   0                    0 Never or 1 day
                                   0                    1 2 - 6 days
                                   0                    2 7 - 11 days
                                   0                    3 12-14 days

D0500J1   271  1  M3YESNO                               N SA of Res Mood - Short Temper

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

D0500J2   272  1  M3DEPRBO                              N SA of Res Mood - Short Temper Freq

                               8,792                    . Missing
                                   0                    0 Never or 1 day
                                   0                    1 2 - 6 days
                                   0                    2 7 - 11 days
                                   0                    3 12-14 days

D0600     273  2                                        N SA Tot Svrty Mood Score

D0650     275  1  M3YESNO                               N SA of Res Mood - Neg Stmnt Notify

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

E0100A    276  1  M3INDIC                               N Bhvr: Hallucinations

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

E0100B    277  1  M3INDIC                               N Bhvr: Delusion

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

E0100Z    278  1  M3INDIC                               N Bhvr: No Psychosis

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

E0200A    279  1  M3BEHAVA                              N Bhvr: Phys Bhvral

                               8,792                    . Missing
                                   0                    0 Behavior not exhibited
                                   0                    1 1 to 3 days
                                   0                    2 4 to 6 days
                                   0                    3 Behavior exhibited daily

E0200B    280  1  M3BEHAVA                              N Bhvr: Verbal Bhvral

                               8,792                    . Missing
                                   0                    0 Behavior not exhibited
                                   0                    1 1 to 3 days
                                   0                    2 4 to 6 days
                                   0                    3 Behavior exhibited daily

E0200C    281  1  M3BEHAVA                              N Bhvr: Oth Bhvral

                               8,792                    . Missing
                                   0                    0 Behavior not exhibited
                                   0                    1 1 to 3 days
                                   0                    2 4 to 6 days
                                   0                    3 Behavior exhibited daily

E0300     282  1  M3YESNO                               N Overall Pres of Bhvral Sympt

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

E0500A    283  1  M3YESNO                               N Bhvr Imp on Res: Risk to Inj Self

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

E0500B    284  1  M3YESNO                               N Bhvr Imp on Res: Int W Care

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

E0500C    285  1  M3YESNO                               N Bhvr Imp on Res: Int W Part

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

E0600A    286  1  M3YESNO                               N Bhvr Imp on Oth: Risk to Inj Oth

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

E0600B    287  1  M3YESNO                               N Bhvr Imp on Oth: Intrude On Priv of Oth

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

E0600C    288  1  M3YESNO                               N Bhvr Imp on Oth: Dis Care or Living Env

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

E0800     289  1  M3BEHAVA                              N Rejection of Care: Pres and Freq

                               8,792                    . Missing
                                   0                    0 Behavior not exhibited
                                   0                    1 1 to 3 days
                                   0                    2 4 to 6 days
                                   0                    3 Behavior exhibited daily

E0900     290  1  M3BEHAVA                              N Wandering: Pres and Freq

                               8,792                    . Missing
                                   0                    0 Behavior not exhibited
                                   0                    1 1 to 3 days
                                   0                    2 4 to 6 days
                                   0                    3 Behavior exhibited daily

E1000A    291  1  M3YESNO                               N Wander Risk Imp

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

E1000B    292  1  M3YESNO                               N Wandering Intrudes on Priv of Oth

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

E1100     293  1  M3CHANGE                              N Change in Bhvr or Oth Sympt

                               8,792                    . Missing
                                   0                    0 Same
                                   0                    1 Improved
                                   0                    2 Worse
                                   0                    3 N/A

F0300     294  1  M3YESNO                               N Should Dly and Act Pref Int Be Cond

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

F0400A    295  1  M3IMPORT                              N Int for Dly Pref: Chooses Clothes

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0400B    296  1  M3IMPORT                              N Int for Dly Pref: Care Personal Items

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0400C    297  1  M3IMPORT                              N Int for Dly Pref: Bathing Option

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0400D    298  1  M3IMPORT                              N Int for Dly Pref: Snack Between Meals

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0400E    299  1  M3IMPORT                              N Int for Dly Pref: Choose Bed Time

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0400F    300  1  M3IMPORT                              N Int for Dly Pref: Fam Involvement

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0400G    301  1  M3IMPORT                              N Int for Dly Pref: Priv Phone Time

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0400H    302  1  M3IMPORT                              N Int for Dly Pref: Lock Item

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0500A    303  1  M3IMPORT                              N Int for Act Pref: Reading Mat Available

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0500B    304  1  M3IMPORT                              N Int for Act Pref: Music

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0500C    305  1  M3IMPORT                              N Int for Act Pref: Animal Pres

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0500D    306  1  M3IMPORT                              N Int for Act Pref: News

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0500E    307  1  M3IMPORT                              N Int for Act Pref: Group Act

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0500F    308  1  M3IMPORT                              N Int for Act Pref: Favorite Act

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0500G    309  1  M3IMPORT                              N Int for Act Pref: Time Outdoors

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0500H    310  1  M3IMPORT                              N Int for Act Pref: Religion

                               8,792                    . Missing
                                   0                    1 Very important
                                   0                    2 Somewhat important
                                   0                    3 Not very important
                                   0                    4 Not important at all
                                   0                    5 Important, but cannot do or no choice
                                   0                    9 No response or non-responsive

F0600     311  1  M3PRIRES                              N Dly and Act Pref Primary Respondent

                               8,792                    . Missing
                                   0                    1 Resident
                                   0                    2 Family or significant other
                                   0                    9 Interview could not be completed

F0700     312  1  M3YESNO                               N Cond SA of Dly and Act Pref

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

F0800A    313  1  M3INDIC                               N SA: Chooses Clothes

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800B    314  1  M3INDIC                               N SA: Care Personal Item

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800C    315  1  M3INDIC                               N SA: Tub Bath

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800D    316  1  M3INDIC                               N SA: Shower

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800E    317  1  M3INDIC                               N SA: Bed Bath

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800F    318  1  M3INDIC                               N SA: Sponge Bath

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800G    319  1  M3INDIC                               N SA: Snacks Between

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800H    320  1  M3INDIC                               N SA: Bed Time

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800I    321  1  M3INDIC                               N SA: Fam Involvement

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800J    322  1  M3INDIC                               N SA: Priv Phone

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800K    323  1  M3INDIC                               N SA: Lock Item

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800L    324  1  M3INDIC                               N SA: Reading Mat Available

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800M    325  1  M3INDIC                               N SA: Music

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800N    326  1  M3INDIC                               N SA: Animal Pres

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800O    327  1  M3INDIC                               N SA: News

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800P    328  1  M3INDIC                               N SA: Group Act

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800Q    329  1  M3INDIC                               N SA: Favorite Act

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800R    330  1  M3INDIC                               N SA: Time Away Nrs Home

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800S    331  1  M3INDIC                               N SA: Time Outdoors

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800T    332  1  M3INDIC                               N SA: Part in Rel Act

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

F0800Z    333  1  M3INDIC                               N SA: None of Above Act

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

G0110A1   334  1  M3ADLACT                              N ADL Ass: Bed Mob Self Perf

                               8,792                    . Missing
                                   0                    0 Independent
                                   0                    1 Supervision
                                   0                    2 Limited assistance
                                   0                    3 Extensive assistance
                                   0                    4 Total dependence
                                   0                    7 Activity occurred only once or twice
                                   0                    8 Activity did not occur

G0110A2   335  1  M3ADLSUP                              N ADL Ass: Bed Mob Supp Prov

                               8,792                    . Missing
                                   0                    0 No setup or physical help from staff
                                   0                    1 Setup help only
                                   0                    2 One person physical assist
                                   0                    3 Two+ persons physical assist
                                   0                    8 ADL activity did not occur

G0110B1   336  1  M3ADLACT                              N ADL Ass: Trans Self Perf

                               8,792                    . Missing
                                   0                    0 Independent
                                   0                    1 Supervision
                                   0                    2 Limited assistance
                                   0                    3 Extensive assistance
                                   0                    4 Total dependence
                                   0                    7 Activity occurred only once or twice
                                   0                    8 Activity did not occur

G0110B2   337  1  M3ADLSUP                              N ADL Ass: Trans Self Supp Prov

                               8,792                    . Missing
                                   0                    0 No setup or physical help from staff
                                   0                    1 Setup help only
                                   0                    2 One person physical assist
                                   0                    3 Two+ persons physical assist
                                   0                    8 ADL activity did not occur

G0110C1   338  1  M3ADLACT                              N ADL Ass: Wlk In Room Self Perf

                               8,792                    . Missing
                                   0                    0 Independent
                                   0                    1 Supervision
                                   0                    2 Limited assistance
                                   0                    3 Extensive assistance
                                   0                    4 Total dependence
                                   0                    7 Activity occurred only once or twice
                                   0                    8 Activity did not occur

G0110C2   339  1  M3ADLSUP                              N ADL Ass: Wlk In Room Supp Prov

                               8,792                    . Missing
                                   0                    0 No setup or physical help from staff
                                   0                    1 Setup help only
                                   0                    2 One person physical assist
                                   0                    3 Two+ persons physical assist
                                   0                    8 ADL activity did not occur

G0110D1   340  1  M3ADLACT                              N ADL Ass: Wlk In Corr Self Perf

                               8,792                    . Missing
                                   0                    0 Independent
                                   0                    1 Supervision
                                   0                    2 Limited assistance
                                   0                    3 Extensive assistance
                                   0                    4 Total dependence
                                   0                    7 Activity occurred only once or twice
                                   0                    8 Activity did not occur

G0110D2   341  1  M3ADLSUP                              N ADL Ass: Wlk In Corr Self Supp Prov

                               8,792                    . Missing
                                   0                    0 No setup or physical help from staff
                                   0                    1 Setup help only
                                   0                    2 One person physical assist
                                   0                    3 Two+ persons physical assist
                                   0                    8 ADL activity did not occur

G0110E1   342  1  M3ADLACT                              N ADL Ass: Loc On Self Perf

                               8,792                    . Missing
                                   0                    0 Independent
                                   0                    1 Supervision
                                   0                    2 Limited assistance
                                   0                    3 Extensive assistance
                                   0                    4 Total dependence
                                   0                    7 Activity occurred only once or twice
                                   0                    8 Activity did not occur

G0110E2   343  1  M3ADLSUP                              N ADL Ass: Loc On Supp Prov

                               8,792                    . Missing
                                   0                    0 No setup or physical help from staff
                                   0                    1 Setup help only
                                   0                    2 One person physical assist
                                   0                    3 Two+ persons physical assist
                                   0                    8 ADL activity did not occur

G0110F1   344  1  M3ADLACT                              N ADL Ass: Loc Off Self Perf

                               8,792                    . Missing
                                   0                    0 Independent
                                   0                    1 Supervision
                                   0                    2 Limited assistance
                                   0                    3 Extensive assistance
                                   0                    4 Total dependence
                                   0                    7 Activity occurred only once or twice
                                   0                    8 Activity did not occur

G0110F2   345  1  M3ADLSUP                              N ADL Ass: Loc Off Supp Prov

                               8,792                    . Missing
                                   0                    0 No setup or physical help from staff
                                   0                    1 Setup help only
                                   0                    2 One person physical assist
                                   0                    3 Two+ persons physical assist
                                   0                    8 ADL activity did not occur

G0110G1   346  1  M3ADLACT                              N ADL Ass: Dress Self Perf

                               8,792                    . Missing
                                   0                    0 Independent
                                   0                    1 Supervision
                                   0                    2 Limited assistance
                                   0                    3 Extensive assistance
                                   0                    4 Total dependence
                                   0                    7 Activity occurred only once or twice
                                   0                    8 Activity did not occur

G0110G2   347  1  M3ADLSUP                              N ADL Ass: Dress Supp Prov

                               8,792                    . Missing
                                   0                    0 No setup or physical help from staff
                                   0                    1 Setup help only
                                   0                    2 One person physical assist
                                   0                    3 Two+ persons physical assist
                                   0                    8 ADL activity did not occur

G0110H1   348  1  M3ADLACT                              N ADL Ass: Eating Self Perf

                               8,792                    . Missing
                                   0                    0 Independent
                                   0                    1 Supervision
                                   0                    2 Limited assistance
                                   0                    3 Extensive assistance
                                   0                    4 Total dependence
                                   0                    7 Activity occurred only once or twice
                                   0                    8 Activity did not occur

G0110H2   349  1  M3ADLSUP                              N ADL Ass: Eating Supp Prov

                               8,792                    . Missing
                                   0                    0 No setup or physical help from staff
                                   0                    1 Setup help only
                                   0                    2 One person physical assist
                                   0                    3 Two+ persons physical assist
                                   0                    8 ADL activity did not occur

G0110I1   350  1  M3ADLACT                              N ADL Ass: Toileting Self Perf

                               8,792                    . Missing
                                   0                    0 Independent
                                   0                    1 Supervision
                                   0                    2 Limited assistance
                                   0                    3 Extensive assistance
                                   0                    4 Total dependence
                                   0                    7 Activity occurred only once or twice
                                   0                    8 Activity did not occur

G0110I2   351  1  M3ADLSUP                              N ADL Ass: Toileting Supp Prov

                               8,792                    . Missing
                                   0                    0 No setup or physical help from staff
                                   0                    1 Setup help only
                                   0                    2 One person physical assist
                                   0                    3 Two+ persons physical assist
                                   0                    8 ADL activity did not occur

G0110J1   352  1  M3ADLACT                              N ADL Ass: Personal Hygiene Self Perf

                               8,792                    . Missing
                                   0                    0 Independent
                                   0                    1 Supervision
                                   0                    2 Limited assistance
                                   0                    3 Extensive assistance
                                   0                    4 Total dependence
                                   0                    7 Activity occurred only once or twice
                                   0                    8 Activity did not occur

G0110J2   353  1  M3ADLSUP                              N ADL Ass: Personal Hygiene Supp Prov

                               8,792                    . Missing
                                   0                    0 No setup or physical help from staff
                                   0                    1 Setup help only
                                   0                    2 One person physical assist
                                   0                    3 Two+ persons physical assist
                                   0                    8 ADL activity did not occur

G0120A    354  1  M3ADLACT                              N ADL Ass: Bathing Self Perf

                               8,792                    . Missing
                                   0                    0 Independent
                                   0                    1 Supervision
                                   0                    2 Limited assistance
                                   0                    3 Extensive assistance
                                   0                    4 Total dependence
                                   0                    7 Activity occurred only once or twice
                                   0                    8 Activity did not occur

G0120B    355  1  M3ADLSUP                              N ADL Ass: Bathing Supp Prov

                               8,792                    . Missing
                                   0                    0 No setup or physical help from staff
                                   0                    1 Setup help only
                                   0                    2 One person physical assist
                                   0                    3 Two+ persons physical assist
                                   0                    8 ADL activity did not occur

G0300A    356  1  M3BAL                                 N Blnce Dur Seated to Standing Pos

                               8,792                    . Missing
                                   0                    0 Steady at all times
                                   0                    1 Not steady, but able to stabilize w/o as
                                   0                    2 Not steady, only able to stabilize w/ as
                                   0                    8 Activity did not occur

G0300B    357  1  M3BAL                                 N Blnce Dur Wlking

                               8,792                    . Missing
                                   0                    0 Steady at all times
                                   0                    1 Not steady, but able to stabilize w/o as
                                   0                    2 Not steady, only able to stabilize w/ as
                                   0                    8 Activity did not occur

G0300C    358  1  M3BAL                                 N Blnce When Turning Around

                               8,792                    . Missing
                                   0                    0 Steady at all times
                                   0                    1 Not steady, but able to stabilize w/o as
                                   0                    2 Not steady, only able to stabilize w/ as
                                   0                    8 Activity did not occur

G0300D    359  1  M3BAL                                 N Blnce Moving On and Off Toilet

                               8,792                    . Missing
                                   0                    0 Steady at all times
                                   0                    1 Not steady, but able to stabilize w/o as
                                   0                    2 Not steady, only able to stabilize w/ as
                                   0                    8 Activity did not occur

G0300E    360  1  M3BAL                                 N Blnce W Surface to Surface Trans

                               8,792                    . Missing
                                   0                    0 Steady at all times
                                   0                    1 Not steady, but able to stabilize w/o as
                                   0                    2 Not steady, only able to stabilize w/ as
                                   0                    8 Activity did not occur

G0400A    361  1  M3RANGE                               N Func Lim in ROM: Upper Ext Mtn

                               8,792                    . Missing
                                   0                    0 No impairment
                                   0                    1 Impairment on one side
                                   0                    2 Impairment on both sides

G0400B    362  1  M3RANGE                               N Func Lim in ROM: Lower Ext Mtn

                               8,792                    . Missing
                                   0                    0 No impairment
                                   0                    1 Impairment on one side
                                   0                    2 Impairment on both sides

G0600A    363  1  M3INDIC                               N Mob Devices: Cane

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

G0600B    364  1  M3INDIC                               N Mob Devices: Wlker

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

G0600C    365  1  M3INDIC                               N Mob Devices: Wheelchair

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

G0600D    366  1  M3INDIC                               N Mob Devices: Limb Prosthesis

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

G0600Z    367  1  M3INDIC                               N Mob Devices: None of Above

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

G0900A    368  1  M3YNDET                               N Func Rehab Pot: Res Increased Ind

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    9 Unable to determine

G0900B    369  1  M3YESNO                               N Func Rehab Pot: Staff Increased Ind

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

H0100A    370  1  M3INDIC                               N Bldr and Bwl App: Indwelling Cath

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

H0100B    371  1  M3INDIC                               N Bldr and Bwl App: Ext Cath

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

H0100C    372  1  M3INDIC                               N Bldr and Bwl App: Ostomy

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

H0100D    373  1  M3INDIC                               N Bldr and Bwl App: Imt Cath

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

H0100Z    374  1  M3INDIC                               N Bldr and Bwl App: No Urny App

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

H0200A    375  1  M3YNDET                               N Urny Toil Prog: Trial Toileting Prog

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    9 Unable to determine

H0200B    376  1  M3TOILET                              N Urny Toil Prog: Resp To Toileting Prog

                               8,792                    . Missing
                                   0                    0 No improvement
                                   0                    1 Decreased wetness
                                   0                    2 Completely dry
                                   0                    9 Unable to determine

H0200C    377  1  M3YESNO                               N Urny Toil Prog: Cur Toileting Prog

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

H0300     378  1  M3CONT                                N Urny Continence

                               8,792                    . Missing
                                   0                    0 Always continent
                                   0                    1 Occasionally incontinent
                                   0                    2 Frequently incontinent
                                   0                    3 Always incontinent
                                   0                    9 Not rated

H0400     379  1  M3CONT                                N Bwl Continence

                               8,792                    . Missing
                                   0                    0 Always continent
                                   0                    1 Occasionally incontinent
                                   0                    2 Frequently incontinent
                                   0                    3 Always incontinent
                                   0                    9 Not rated

H0500     380  1  M3YESNO                               N Bwl Toileting Prog

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

H0600     381  1  M3YESNO                               N Constipation

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

I0100     382  1  M3INDIC                               N Actv Diag: Cancer

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I0200     383  1  M3INDIC                               N Actv Diag: Anemia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I0300     384  1  M3INDIC                               N Actv Diag: Dysrhythmia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I0400     385  1  M3INDIC                               N Actv Diag: Coronary Artery Dis (CAD)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I0500     386  1  M3INDIC                               N Actv Diag: Deep Vein Thrombosis (DVT)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I0600     387  1  M3INDIC                               N Actv Diag: Heart Failure (CHF)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I0700     388  1  M3INDIC                               N Actv Diag: Hypertension

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I0800     389  1  M3INDIC                               N Actv Diag: Hypotension

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I0900     390  1  M3INDIC                               N Actv Diag: (PVD)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I1100     391  1  M3INDIC                               N Actv Diag: Cirrhosis

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I1200     392  1  M3INDIC                               N Actv Diag:  (GERD)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I1300     393  1  M3INDIC                               N Actv Diag: Ulcrative Colitis

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I1400     394  1  M3INDIC                               N Actv Diag: (BPH)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I1500     395  1  M3INDIC                               N Actv Diag: (ESRD)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I1550     396  1  M3INDIC                               N Actv Diag: Neurogenic Bldr

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I1650     397  1  M3INDIC                               N Actv Diag: Obstructive Uropathy

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I1700     398  1  M3INDIC                               N Actv Diag: (MDRO)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I2000     399  1  M3INDIC                               N Actv Diag: Pneumonia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I2100     400  1  M3INDIC                               N Actv Diag: Septicemia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I2200     401  1  M3INDIC                               N Actv Diag: Tuberculosis

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I2300     402  1  M3INDIC                               N Actv Diag: Urny Tract Infn (UTI)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I2400     403  1  M3INDIC                               N Actv Diag: Viral Hepatitis

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I2500     404  1  M3INDIC                               N Wound Infn

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I2900     405  1  M3INDIC                               N Actv Diag: Diabetes Mellitus (DM)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I3100     406  1  M3INDIC                               N Actv Diag: Hyponatremia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I3200     407  1  M3INDIC                               N Actv Diag: Hyperkalemia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I3300     408  1  M3INDIC                               N Actv Diag: Hyperlipidemia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I3400     409  1  M3INDIC                               N Actv Diag: Thyroid

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I3700     410  1  M3INDIC                               N Actv Diag: Arthritis

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I3800     411  1  M3INDIC                               N Actv Diag: Osteoporosis

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I3900     412  1  M3INDIC                               N Actv Diag: Hip Fracture

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I4000     413  1  M3INDIC                               N Actv Diag: Oth Fracture

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I4200     414  1  M3INDIC                               N Actv Diag: Alzheimers Disease

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I4300     415  1  M3INDIC                               N Actv Diag: Aphasia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I4400     416  1  M3INDIC                               N Actv Diag: Cerebral Palsy

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I4500     417  1  M3INDIC                               N Actv Diag: (CVA or TIA or Stroke)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I4800     418  1  M3INDIC                               N Actv Diag: Dementia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I4900     419  1  M3INDIC                               N Actv Diag: Hemiplegia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5000     420  1  M3INDIC                               N Actv Diag: Paraplegia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5100     421  1  M3INDIC                               N Actv Diag: Quadriplegia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5200     422  1  M3INDIC                               N Actv Diag: Multiple Sclerosis

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5250     423  1  M3INDIC                               N Actv Diag: Huntingtons

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5300     424  1  M3INDIC                               N Actv Diag: Parkinsons

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5350     425  1  M3INDIC                               N Tourettes

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5400     426  1  M3INDIC                               N Actv Diag: Seizure

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5500     427  1  M3INDIC                               N Actv Diag: Traumatic Brain Inj (TBI)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5600     428  1  M3INDIC                               N Actv Diag: Malnutrition

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5700     429  1  M3INDIC                               N Actv Diag: Anxiety Disorder

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5800     430  1  M3INDIC                               N Actv Diag: Depression

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5900     431  1  M3INDIC                               N Actv Diag: Manic Depression

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I5950     432  1  M3INDIC                               N Actv Diag: Psychotic

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I6000     433  1  M3INDIC                               N Actv Diag: Schizophrenia

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I6100     434  1  M3INDIC                               N Actv Diag:  (PTSD)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I6200     435  1  M3INDIC                               N Actv Diag: Asth, COPD, Chron Lung Dis

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I6300     436  1  M3INDIC                               N Actv Diag: Resp Failure

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I6500     437  1  M3INDIC                               N Actv Diag: Cataracts, Glauc or Mac Deg

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I7900     438  1  M3INDIC                               N Actv Diag: No Actv Disease

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

I8000A    439  8                                        C Addl Actv Diag: ICD 1

I8000B    447  8                                        C Addl Actv Diag: ICD 2

I8000C    455  8                                        C Addl Actv Diag: ICD 3

I8000D    463  8                                        C Addl Actv Diag: ICD 4

I8000E    471  8                                        C Addl Actv Diag: ICD 5

I8000F    479  8                                        C Addl Actv Diag: ICD 6

I8000G    487  8                                        C Addl Actv Diag: ICD 7

I8000H    495  8                                        C Addl Actv Diag: ICD 8

I8000I    503  8                                        C Addl Actv Diag: ICD 9

I8000J    511  8                                        C  Addl Actv Diag: ICD 10

J0100A    519  1  M3YESNO                               N Pain management: Scheduled Pain Med

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

J0100B    520  1  M3YESNO                               N Pain management: PRN Pain Med

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

J0100C    521  1  M3YESNO                               N Pain management: Oth Pain Intervention

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

J0200     522  1  M3YESNO                               N Should Pain Asmt be Cond

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

J0300     523  1  M3YNANS                               N Pain Asmt Int: Pain Pres

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    9 Unable to answer

J0400     524  1  M31PAIN                               N Pain Asmt Int: Pain Freq

                               8,792                    . Missing
                                   0                    1 Almost constantly
                                   0                    2 Frequently
                                   0                    3 Occasionally
                                   0                    4 Rarely
                                   0                    9 Unable to answer

J0500A    525  1  M3YNANS                               N Pain Asmt Int: Pain Effect Sleep

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    9 Unable to answer

J0500B    526  1  M3YNANS                               N Pain Asmt Int: Pain Effect Act

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    9 Unable to answer

J0600A    527  2                                        C Pain Intensity Numeric Rating Scale Num

J0600B    529  1  M32PAIN                               N Pain Intensity Verbal Descr Scale Num

                               8,792                    . Missing
                                   0                    1 Mild
                                   0                    2 Moderate
                                   0                    3 Severe
                                   0                    4 Very severe, horrible
                                   0                    9 Unable to answer

J0700     530  1  M3YESNO                               N Staff Cond Pain Asmt

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

J0800A    531  1  M3INDIC                               N SA for Pain: Nonverbal Sound

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J0800B    532  1  M3INDIC                               N SA for Pain: Vocal Complaint

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J0800C    533  1  M3INDIC                               N SA for Pain: Facial Expression

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J0800D    534  1  M3INDIC                               N SA for Pain: Protective Movement

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J0800Z    535  1  M3INDIC                               N SA for Pain: None Above Signs of Pain

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J0850     536  1  M3PAINI                               N Staff Freq of Ind of Pain or Poss Pain

                               8,792                    . Missing
                                   0                    1 Indicators of pain 1-2 days
                                   0                    2 Indicators of pain 3-4 days
                                   0                    3 Indicators of pain daily

J1100A    537  1  M3INDIC                               N Shortness of Breath W Exertion

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J1100B    538  1  M3INDIC                               N Shortness of Breath When Sitting

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J1100C    539  1  M3INDIC                               N Shortness of Breath When Lying Flat

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J1100Z    540  1  M3INDIC                               N None of Above Shortness of Breath

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J1300     541  1  M3YESNO                               N Tobacco Use

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

J1400     542  1  M3YESNO                               N Life Prognosis Less Than Six Mons

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

J1550A    543  1  M3INDIC                               N Prob Conds: Fever

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J1550B    544  1  M3INDIC                               N Prob Conds: Vomiting

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J1550C    545  1  M3INDIC                               N Prob Conds: Dehydration

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J1550D    546  1  M3INDIC                               N Prob Conds: Internal Bleeding

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J1550Z    547  1  M3INDIC                               N Prob Conds: None of Above

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

J1700A    548  1  M3YNDET                               N Fall History on Admsn: Fall 30 Day

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    9 Unable to determine

J1700B    549  1  M3YNDET                               N Fall History on Admsn: Fall 31-180 Day

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    9 Unable to determine

J1700C    550  1  M3YNDET                               N Fall History on Admsn: Fall Six Mon

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    9 Unable to determine

J1800     551  1  M3YESNO                               N Falls Since Admsn or Prior Asmt

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

J1900A    552  1  M3FALLS                               N Falls Since Adm/Prior Asmt W No Inj

                               8,792                    . Missing
                                   0                    0 None
                                   0                    1 One
                                   0                    2 Two or more

J1900B    553  1  M3FALLS                               N Falls Since Adm/Prior Asmt W Inj Ex Maj

                               8,792                    . Missing
                                   0                    0 None
                                   0                    1 One
                                   0                    2 Two or more

J1900C    554  1  M3FALLS                               N Falls Since Adm/Prior Asmt W Maj Inj

                               8,792                    . Missing
                                   0                    0 None
                                   0                    1 One
                                   0                    2 Two or more

K0100A    555  1  M3INDIC                               N Swall Disorder: Loss Mouth Eating

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0100B    556  1  M3INDIC                               N Swall Disorder: Hold Food Mouth

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0100C    557  1  M3INDIC                               N Swall Disorder: Choke Drinking Meal

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0100D    558  1  M3INDIC                               N Swall Disorder: Complaint Swall

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0100Z    559  1  M3INDIC                               N Swall Disorder: None of Above

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0200A    560  2                                        N Height Num

K0200B    562  3                                        N Weight Num

K0300     565  1  M3WEIGHT                              N Weight Loss

                               8,792                    . Missing
                                   0                    0 No or unknown
                                   0                    1 Yes, on physician-prescribed regimen
                                   0                    2 Yes, not on physician-prescribed regimen

K0310     566  1  M3WEIGHT                              N Weight Gain

                               8,792                    . Missing
                                   0                    0 No or unknown
                                   0                    1 Yes, on physician-prescribed regimen
                                   0                    2 Yes, not on physician-prescribed regimen

K0500A    567  1  M3INDIC                               N Nutr App: Par/IV Feeding

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0500B    568  1  M3INDIC                               N Nutr App: Feeding Tube

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0500C    569  1  M3INDIC                               N Nutr App: Mech Alt Diet

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0500D    570  1  M3INDIC                               N Nutr App: Ther Diet

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0500Z    571  1  M3INDIC                               N Nutr App: None of Above

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0510A1   572  1  M3INDIC                               N Nutr App: Prior Par/IV Feeding

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0510A2   573  1  M3INDIC                               N Nutr App: Post Par/IV Feeding

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0510B1   574  1  M3INDIC                               N Nutr App: Prior Feeding Tube

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0510B2   575  1  M3INDIC                               N Nutr App: Post Feeding Tube

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0510C1   576  1  M3INDIC                               N Nutr App: Prior Mech Alt Diet

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0510C2   577  1  M3INDIC                               N Nutr App: Post Mech Alt Diet

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0510D1   578  1  M3INDIC                               N Nutr App: Prior Ther Diet

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0510D2   579  1  M3INDIC                               N Nutr App: Post Ther Diet

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0510Z1   580  1  M3INDIC                               N Nutr App: Prior None of Above

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0510Z2   581  1  M3INDIC                               N Nutr App: Post None of Above

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

K0700A    582  1  M3ARTCAL                              N Pct Cal Intake Through Par/Tube Feeding

                               8,792                    . Missing
                                   0                    1 25% or less
                                   0                    2 26%-50%
                                   0                    3 51% or more

K0700B    583  1  M3IVFLU                               N Avg Fluid Intake by IV Or Tube Feeding

                               8,792                    . Missing
                                   0                    1 500 cc/day or less
                                   0                    2 501 cc/day or more

L0200A    584  1  M3INDIC                               N Dental Stat: Broken Denture

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

L0200B    585  1  M3INDIC                               N Dental Stat: No Teeth

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

L0200C    586  1  M3INDIC                               N Dental Stat: Abnormal Mouth Tiss

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

L0200D    587  1  M3INDIC                               N Dental Stat: Cavity

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

L0200E    588  1  M3INDIC                               N Dental Stat: Inflamed Gum

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

L0200F    589  1  M3INDIC                               N Dental Stat: Mouth or Facial Pain

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

L0200G    590  1  M3INDIC                               N Dental Stat: Unable to Examine

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

L0200Z    591  1  M3INDIC                               N Dental Stat: None of Above

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0100A    592  1  M3INDIC                               N Det of Press Ulcr Risk: Ulcr Visible

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0100B    593  1  M3INDIC                               N Det of Press Ulcr Risk: Frml Asmt/Instr

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0100C    594  1  M3INDIC                               N Det of Press Ulcr Risk: Clinical Asmt

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0100Z    595  1  M3INDIC                               N Det of Press Ulcr Risk: None of Above

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M0150     596  1  M3YESNO                               N Press Ulcr Risk

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

M0210     597  1  M3YESNO                               N One or More S1 or Higher UPU

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

M0300A    598  1                                        N Stage 1 Press Ulcr Num

M0300B1   599  1                                        N Stage 2 Press Ulcr Num

M0300B2   600  1                                        N Stage 2 Press Ulcr Present on Admsn Num

M0300B3   601  8                                        N Date of Oldest Stage 2 Press Ulcr

M0300C1   609  1                                        N Stage 3 Press Ulcr Num

M0300C2   610  1                                        N Stage 3 Press Ulcr Present on Admsn Num

M0300D1   611  1                                        N Stage 4 Press Ulcr Num

M0300D2   612  1                                        N Stage 4 Press Ulcr Present on Admsn Num

M0300E1   613  1                                        N UPU Due To Drsng Num

M0300E2   614  1                                        N UPU Due To Drsng on Admsn Num

M0300F1   615  1                                        N UPU W Slough or Eschar Num

M0300F2   616  1                                        N UPU W Slough or Eschar on Admsn Num

M0300G1   617  1                                        N UPU W Deep Tiss Inj Num

M0300G2   618  1                                        N UPU W Deep Tiss Inj on Admsn Num

M0610A    619  4                                        N Unhealed Stage 3-4 Press Ulcr Length Num

M0610B    623  4                                        N Unhealed Stage 3-4 Press Ulcr Width Num

M0610C    627  4                                        N Unhealed Stage 3-4 Press Ulcr Depth Num

M0700     631  1  M3TISSUE                              N Most Severe Press Ulcr Tiss Type

                               8,792                    . Missing
                                   0                    1 Epithelial tissue
                                   0                    2 Granulation tissue
                                   0                    3 Slough
                                   0                    4 Necrotic tissue (Eschar)
                                   0                    9 None of the above

M0800A    632  1                                        N Wrsng S2 Press Ulcr Since Prior Asmt Num

M0800B    633  1                                        N Wrsng S3 Press Ulcr Since Prior Asmt Num

M0800C    634  1                                        N Wrsng S4 Press Ulcr Since Prior Asmt Num

M0900A    635  1  M3YESNO                               N Healed Press Ulcr Present on Prior Asmt

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

M0900B    636  1                                        N Healed Stage 2 Press Ulcr Num

M0900C    637  1                                        N Healed Stage 3 Press Ulcr Num

M0900D    638  1                                        N Healed Stage 4 Press Ulcr Num

M1030     639  1                                        N Venous and Arterial Ulcr Num

M1040A    640  1  M3INDIC                               N Oth Foot Skin Probs: Foot Infn

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1040B    641  1  M3INDIC                               N Oth Foot Skin Probs: Diab Foot Ulcr

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1040C    642  1  M3INDIC                               N Oth Foot Skin Probs: Oth Open Les Foot

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1040D    643  1  M3INDIC                               N O/S/P: Oth Than Ulcrs, Rashes, Cuts

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1040E    644  1  M3INDIC                               N O/S/P: Surgical Wound(s)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1040F    645  1  M3INDIC                               N O/S/P: Burn(s)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1040G    646  1  M3INDIC                               N O/S/P: Skin Tear(s)

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1040H    647  1  M3INDIC                               N O/S/P: Moisture Assoc Skin Dmge

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1040Z    648  1  M3INDIC                               N O/S/P: None of Above

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1200A    649  1  M3INDIC                               N S/U Trtmts: Press Reducng Device in Chr

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1200B    650  1  M3INDIC                               N S/U Trtmts: Press Reducng Device in Bed

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1200C    651  1  M3INDIC                               N S/U Trtmts: Turning/RePosing Prog

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1200D    652  1  M3INDIC                               N S/U Trtmts: Nutrition/Hydration

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1200E    653  1  M3INDIC                               N S/U Trtmts: Ulcr Care

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1200F    654  1  M3INDIC                               N S/U Trtmts: Surgical Wound Care

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1200G    655  1  M3INDIC                               N S/U Trtmts: App Nonsurgical Drsng

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1200H    656  1  M3INDIC                               N S/U Trtmts: App Ointments/Meds

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1200I    657  1  M3INDIC                               N S/U Trtmts: App Drsngs to Foot

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

M1200Z    658  1  M3INDIC                               N S/U Trtmts: None of Above

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

N0300     659  1                                        N Num of Days Injections of Any Type

N0350A    660  1                                        N Num of Days Insulin Injections

N0350B    661  1                                        N Num of Days Insulin Orders Changed

N0400A    662  1  M3INDIC                               N Meds Rcd: Antipsychotic

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

N0400B    663  1  M3INDIC                               N Meds Rcd: Antianxiety

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

N0400C    664  1  M3INDIC                               N Meds Rcd: Antidepressant

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

N0400D    665  1  M3INDIC                               N Meds Rcd: Hypnotic

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

N0400E    666  1  M3INDIC                               N Meds Rcd: Anticoagulant

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

N0400F    667  1  M3INDIC                               N Meds Rcd: Antibiotic

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

N0400G    668  1  M3INDIC                               N Meds Rcd: Diuretic

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

N0400Z    669  1  M3INDIC                               N Meds Rcd: None of Above

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

N0410A    670  1                                        N Meds Rcd: Antipsychotic Num Days

N0410B    671  1                                        N Meds Rcd: Antianxiety Num Days

N0410C    672  1                                        N Meds Rcd: Antidepressant Num Days

N0410D    673  1                                        N Meds Rcd: Hypnotic Num Days

N0410E    674  1                                        N Meds Rcd: Anticoagulant Num Days

N0410F    675  1                                        N Meds Rcd: Antibiotic Num Days

N0410G    676  1                                        N Meds Rcd: Diuretic Num Days

O0100A1   677  1  M3INDIC                               N Spcl T/P: ChemOthapy Pre-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100A2   678  1  M3INDIC                               N Spcl T/P: ChemOthapy Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100B1   679  1  M3INDIC                               N Spcl T/P: Radiation Pre-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100B2   680  1  M3INDIC                               N Spcl T/P: Radiation Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100C1   681  1  M3INDIC                               N Spcl T/P: Oxygen Pre-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100C2   682  1  M3INDIC                               N Spcl T/P: Oxygen Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100D1   683  1  M3INDIC                               N Spcl T/P: Suctioning Pre-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100D2   684  1  M3INDIC                               N Spcl T/P: Suctioning Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100E1   685  1  M3INDIC                               N Spcl T/P: Tracheostomy Pre-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100E2   686  1  M3INDIC                               N Spcl T/P: Tracheostomy Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100F1   687  1  M3INDIC                               N Spcl T/P: Ventilator Pre-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100F2   688  1  M3INDIC                               N Spcl T/P: Ventilator Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100G1   689  1  M3INDIC                               N Spcl T/P: Cont Pos Arwy Press Pre-A

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100G2   690  1  M3INDIC                               N Spcl T/P: Cont Pos Arwy Press Post-A

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100H1   691  1  M3INDIC                               N Spcl T/P: Intravenous Med Pre-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100H2   692  1  M3INDIC                               N Spcl T/P: Intravenous Med Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100I1   693  1  M3INDIC                               N Spcl T/P: Transfusion Pre-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100I2   694  1  M3INDIC                               N Spcl T/P: Transfusion Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100J1   695  1  M3INDIC                               N Spcl T/P: Dialysis Pre-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100J2   696  1  M3INDIC                               N Spcl T/P: Dialysis Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100K1   697  1  M3INDIC                               N Spcl T/P: Hospice Pre-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100K2   698  1  M3INDIC                               N Spcl T/P: Hospice Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100L2   699  1  M3INDIC                               N Spcl T/P: Respite Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100M1   700  1  M3INDIC                               N Spcl T/P: Isolation Pre-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100M2   701  1  M3INDIC                               N Spcl T/P: Isolation Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100Z1   702  1  M3INDIC                               N Spcl T/P: None Above Pre-A Trtmt Prior

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0100Z2   703  1  M3INDIC                               N Spcl T/P: None Above Trtmt Post-admit

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

O0250A    704  1  M3YESNO                               N Influenza Rcd

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

O0250B    705  8                                        N Influenza Rcd Date

O0250C    713  1  M3FLRSN                               N Rsn Influenza Not Rcd

                               8,792                    . Missing
                                   0                    1 Resident not in facility
                                   0                    2 Received outside the facility
                                   0                    3 Not eligible
                                   0                    4 Offered and declined
                                   0                    5 Not offered
                                   0                    6 Inability to obtain vaccine
                                   0                    9 None of the above

O0300A    714  1  M3YESNO                               N Pneumococcal Vaccination

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

O0300B    715  1  M3PNRSN                               N Rsn Pneumococcal Vaccination Not Rcd

                               8,792                    . Missing
                                   0                    1 Not eligible
                                   0                    2 Offered and declined
                                   0                    3 Not offered

O0400A1   716  4                                        N Speech Ther/Aud Individual Minutes Num

O0400A2   720  4                                        N Speech Ther/Aud ConCur Minutes Num

O0400A3   724  4                                        N Speech Ther/Aud Group Minutes Num

O0400A4   728  1                                        N Num of Days Speech Ther/Aud Admin

O0400A5   729  8                                        N Speech Ther/Audiology Start Date

O0400A6   737  8                                        N Speech Ther/Audiology End Date

O0400B1   745  4                                        N Occupational Ther Individual Minutes Num

O0400B2   749  4                                        N Occupational Ther ConCur Minutes Num

O0400B3   753  4                                        N Occupational Ther Group Minutes Num

O0400B4   757  1                                        N Num of Days Occ Ther Administered

O0400B5   758  8                                        N Occupational Ther Start Date

O0400B6   766  8                                        N Occupational Ther End Date

O0400C1   774  4                                        N Phys Ther Individual Minutes Num

O0400C2   778  4                                        N Phys Ther ConCur Minutes Num

O0400C3   782  4                                        N Phys Ther Group Minutes Num

O0400C4   786  1                                        N Num of Days Phys Ther Administered

O0400C5   787  8                                        N Phys Ther Start Date

O0400C6   795  8                                        N Phys Ther End Date

O0400D1   803  4                                        N Resp Ther Minutes Num

O0400D2   807  1                                        N Num of Days Resp Ther Administered

O0400E1   808  4                                        N Psych Ther Minutes Num

O0400E2   812  1                                        N Num of Days Psych Ther Administered

O0400F1   813  4                                        N Rec Ther Minutes Num

O0400F2   817  1                                        N Num of Days Rec Ther Administered

O0450A    818  1  M3YESNO                               N Has Ther Resumed

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

O0450B    819  8                                        N Date Ther Resumed

O0500A    827  1                                        N Rest Nrs: Passive Range of Mtn Num

O0500B    828  1                                        N Rest Nrs: Actv Range of Mtn Num

O0500C    829  1                                        N Rest Nrs: Splint/Brace Ass Num

O0500D    830  1                                        N Rest Nrs: Bed Mob Training Num

O0500E    831  1                                        N Rest Nrs: Trans Training Num

O0500F    832  1                                        N Rest Nrs: Wlking Training Num

O0500G    833  1                                        N Rest Nrs: Drsng/Grooming Training Num

O0500H    834  1                                        N Rest Nrs: Eating/Swall Training Num

O0500I    835  1                                        N Rest Nrs: Amp/Prosthes Care Training Num

O0500J    836  1                                        N Rest Nrs: Communication Training Num

O0600     837  2                                        N  Physician Exam Day Num

O0700     839  2                                        N Physician Order Day Num

P0100A    841  1  M3USED                                N Phys Rstrnts in Bed: Bed Rail

                               8,792                    . Missing
                                   0                    0 Not used
                                   0                    1 Used less than daily
                                   0                    2 Used daily

P0100B    842  1  M3USED                                N Phys Rstrnts in Bed: Trunk Rstrnt Bed

                               8,792                    . Missing
                                   0                    0 Not used
                                   0                    1 Used less than daily
                                   0                    2 Used daily

P0100C    843  1  M3USED                                N Phys Rstrnts in Bed: Limb Rstrnt Bed

                               8,792                    . Missing
                                   0                    0 Not used
                                   0                    1 Used less than daily
                                   0                    2 Used daily

P0100D    844  1  M3USED                                N Phys Rstrnts in Bed: Oth Rstrnt Bed

                               8,792                    . Missing
                                   0                    0 Not used
                                   0                    1 Used less than daily
                                   0                    2 Used daily

P0100E    845  1  M3USED                                N Phys Rstrnts Chair: Trunk Rstrnt Chair

                               8,792                    . Missing
                                   0                    0 Not used
                                   0                    1 Used less than daily
                                   0                    2 Used daily

P0100F    846  1  M3USED                                N Phys Rstrnts Chair: Limb Rstrnt Chair

                               8,792                    . Missing
                                   0                    0 Not used
                                   0                    1 Used less than daily
                                   0                    2 Used daily

P0100G    847  1  M3USED                                N Phys Rstrnts Chair: Chair Prevent Rise

                               8,792                    . Missing
                                   0                    0 Not used
                                   0                    1 Used less than daily
                                   0                    2 Used daily

P0100H    848  1  M3USED                                N Phys Rstrnts Chair: Oth Rstrnt Chair

                               8,792                    . Missing
                                   0                    0 Not used
                                   0                    1 Used less than daily
                                   0                    2 Used daily

Q0100A    849  1  M3YESNO                               N Res Part in Asmt

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

Q0100B    850  1  M3FAMPAR                              N Fam Part in Asmt

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    9 No family or significant other available

Q0100C    851  1  M3GUAPAR                              N Guardian Part in Asmt

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    9 No guardian or legally auth rep availabl

Q0300A    852  1  M3OVGOAL                              N Res Overall Goal

                               8,792                    . Missing
                                   0                    1 Discharged to the community
                                   0                    2 Remain in this facility
                                   0                    3 Discharged to another facility
                                   0                    9 Unknown or uncertain

Q0300B    853  1  M3SOURCE                              N Overall Goal Source

                               8,792                    . Missing
                                   0                    1 Resident
                                   0                    2 Family or sig other
                                   0                    3 Guardian or legally auth rep
                                   0                    9 Unknown or uncertain

Q0400A    854  1  M3YESNO                               N Dis Plan

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes

Q0400B    855  1  M3DSCHRG                              N Dis Det

                               8,792                    . Missing
                                   0                    0 Determination not made
                                   0                    1 Discharge feasible
                                   0                    2 Discharge not feasible

Q0490     856  1  M3NOINFO                              N Ress Pref Answering Q0500B

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    8 Information not available

Q0500A    857  1  M3RESASK                              N Has Res Been Asked About Rtn To Comm

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Previous response was no
                                   0                    2 Previous response was yes
                                   0                    3 Previous response was uknown

Q0500B    858  1  M3WNTTLK                              N Staff Asked Res or Fam Abt Rtn To Comm

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    9 Unknown or uncertain

Q0550A    859  1  M3NOINFO                              N Pref In Answering Q0550B

                               8,792                    . Missing
                                   0                    0 No
                                   0                    1 Yes
                                   0                    8 Information not available

Q0550B    860  1  M3SOURC                               N Source Answering Q0550A

                               8,792                    . Missing
                                   0                    1 Resident
                                   0                    2 Family or sig other
                                   0                    3 Guardian or legally auth rep
                                   0                    8 No information source available

Q0600     861  1  M3REFER                               N Local Contact Agency Referral

                               8,792                    . Missing
                                   0                    0 No - referral not needed
                                   0                    1 No - referral may be needed
                                   0                    2 Yes

V0100A    862  2  $M3PASSE                              C Prior Asmt Federal OBRA Rsn for Asmt

                                   0                   01 Admission assessment
                                   0                   02 Quarterly review assessment
                                   0                   03 Annual assessment
                                   0                   04 Signif change in status assessment
                                   0                   05 Signif correction of prior full
                                   0                   06 Signif correction of prior quarterly
                                   0                   99 None of above
                               8,792                   01

V0100B    864  2  $M3CASSE                              C Prior Asmt PPS Rsn for Asmt

                                   0                   01 5 day sched assessment
                                   0                   02 14 day sched assessment
                                   0                   03 30 day sched assessment
                                   0                   04 60 day sched assessment
                                   0                   05 90 day sched assessment
                                   0                   06 Readmission/return assessment
                                   0                   07 Unsched assessment for PPS
                                   0                   99 None of above
                               8,792                    .

V0100C    866  8                                        N Prior Asmt Ref Date

V0100D    874  2                                        N Prior Asmt (BIMS) Summary Score Num

V0100E    876  2                                        N Prior Asmt  (PHQ-9) Tot Svrty Score Num

V0100F    878  2                                        N Prior Asmt  (PHQ-9) Tot Svrty Score Num

V200A01A  880  1  M3INDIC                               N Dlrm Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A01B  881  1  M3INDIC                               N Dlrm Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A02A  882  1  M3INDIC                               N Dementia Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A02B  883  1  M3INDIC                               N Dementia Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A03A  884  1  M3INDIC                               N Visual Func Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A03B  885  1  M3INDIC                               N Visual Func Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A04A  886  1  M3INDIC                               N Communication Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A04B  887  1  M3INDIC                               N Communication Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A05A  888  1  M3INDIC                               N ADL Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A05B  889  1  M3INDIC                               N ADL Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A06A  890  1  M3INDIC                               N Urny Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A06B  891  1  M3INDIC                               N Urny Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A07A  892  1  M3INDIC                               N Psychosocial Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A07B  893  1  M3INDIC                               N Psychosocial Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A08A  894  1  M3INDIC                               N Mood Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A08B  895  1  M3INDIC                               N Mood Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A09A  896  1  M3INDIC                               N Bhvral Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A09B  897  1  M3INDIC                               N Bhvral Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A10A  898  1  M3INDIC                               N Act Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A10B  899  1  M3INDIC                               N Act Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A11A  900  1  M3INDIC                               N Fall Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A11B  901  1  M3INDIC                               N Fall Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A12A  902  1  M3INDIC                               N Nutr Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A12B  903  1  M3INDIC                               N Nutr Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A13A  904  1  M3INDIC                               N Feeding Tube Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A13B  905  1  M3INDIC                               N Feeding Tube Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A14A  906  1  M3INDIC                               N Dehydration Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A14B  907  1  M3INDIC                               N Dehydration Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A15A  908  1  M3INDIC                               N Dental Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A15B  909  1  M3INDIC                               N Dental Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A16A  910  1  M3INDIC                               N Press Ulcr Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A16B  911  1  M3INDIC                               N Press Ulcr Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A17A  912  1  M3INDIC                               N Psychotropic Drug Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A17B  913  1  M3INDIC                               N Psychotropic Drug Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A18A  914  1  M3INDIC                               N Rstrnt Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A18B  915  1  M3INDIC                               N Rstrnt Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A19A  916  1  M3INDIC                               N Pain Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A19B  917  1  M3INDIC                               N Pain Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A20A  918  1  M3INDIC                               N Rtn to Comm Care Area Trigger

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

V200A20B  919  1  M3INDIC                               N Rtn to Comm Adrsd in Care Plan

                               8,792                    . Missing
                                   0                    0 Not indicated
                                   0                    1 Indicated

DEATH_DA  920  8                                        N Resident Date of Death

