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
                                   0                   MD MDS
                             311,243                   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

                             311,243                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                             311,243             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Unique event identifier

                               1,420                      Missing
                             152,648            C000-C999 Event created from claim
                             157,175            0000-9999 Survey-reported event

EVNTTYPE   18  2  $EVNTTYP                              C Event type

                                   0                   DU Dental
                                   0                   ER Emergency Room
                                   0                   IP Inpatient
                                   0                   IU Institutional utilization
                             167,357                   MP Medical provider
                              38,908                   OM Other medical expense
                                   0                   OP Outpatient
                                   0                   PM Prescribed medicine
                              60,893                   SD Separately billing physician
                              44,085                   SL Separately billing lab

OREVTYPE   20  2  $EVNTTYP                              C Original reported event type

                             154,068                      Missing
                                   0                   DU Dental
                                 902                   ER Emergency Room
                                 429                   IP Inpatient
                                   0                   IU Institutional utilization
                             112,388                   MP Medical provider
                              19,730                   OM Other medical expense
                               3,407                   OP Outpatient
                                   0                   PM Prescribed medicine
                              16,471                   SD Separately billing physician
                               3,848                   SL Separately billing lab

CLAIMID    22  7                                        N Claim this survey event matched to

CLAIMTYP   29  1  $CLAIMTP                              C Claim type that event matched to

                              83,029
                              18,092                    D DME claim
                             208,702                    P Physician claim
                               1,420                    R PDE claim

EVBEGYY    30  2  $EVENTYY                              C Event begin year

                                 121                   -8 Don't know
                                   9                   -9 Not ascertained
                             311,113                      Year

EVBEGMM    32  2  $EVENTMM                              C Event begin month

                               2,797                   -8 Don't know
                                  10                   -9 Not ascertained
                                   0                   95 Still in progress
                             308,436                      Month

EVBEGDD    34  2  $EVENTDD                              C Event begin day

                                  15                   -7 Refused
                              41,792                   -8 Don't know
                                  10                   -9 Not ascertained
                             269,426                      Day of month

SOURCE     36  1  $SOURCE                               C Source of event: survey, claim, or both?

                              83,029                    1 Survey only
                             154,068                    2 Claims only
                              74,146                    3 Both survey & claims

SITCODE    37  1  $SITCODE                              C Community or facility setting?

                                 391                    B Both community & facility
                             257,493                    C Community
                              15,712                    D Deemed community
                              30,033                    F Facility
                               1,477                    G Deemed facility
                               6,137                    S SNF

AMTTOT     38  9                                        N Total payment

IMPATOT    47  1  IMPFLAG                               N AMTTOT imputed in part or in total?

                             204,518                    0 Not imputed
                             106,725                    1 Imputed

AMTCOV     48  9                                        N Medicare program liability, incl. copays

AMTNCOV    57  9                                        N Total payment not covered by Medicare

AMTCARE    66  9                                        N Amount paid by Medicare

IMPSCARE   75  1  IMPFLAG                               N AMTCARE payment source imputed?

                             309,653                    0 Not imputed
                               1,590                    1 Imputed

IMPACARE   76  1  IMPFLAG                               N AMTCARE payment amount imputed?

                             293,964                    0 Not imputed
                              17,279                    1 Imputed

AMTCAID    77  9                                        N Amount paid by Medicaid

IMPSCAID   86  1  IMPFLAG                               N AMTCAID payment source imputed?

                             283,074                    0 Not imputed
                              28,169                    1 Imputed

IMPACAID   87  1  IMPFLAG                               N AMTCAID payment amount imputed?

                             259,753                    0 Not imputed
                              51,490                    1 Imputed

AMTHMOM    88  9                                        N Amount paid by Medicare HMO

IMPSHMOM   97  1  IMPFLAG                               N AMTHMOM payment source imputed?

                             295,150                    0 Not imputed
                              16,093                    1 Imputed

IMPAHMOM   98  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                             283,823                    0 Not imputed
                              27,420                    1 Imputed

AMTHMOP    99  9                                        N Amount paid by private HMO

IMPSHMOP  108  1  IMPFLAG                               N AMTHMOP payment source imputed?

                             303,059                    0 Not imputed
                               8,184                    1 Imputed

IMPAHMOP  109  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                             300,386                    0 Not imputed
                              10,857                    1 Imputed

AMTVA     110  9                                        N Amount paid by Veterans Administration

IMPSVA    119  1  IMPFLAG                               N AMTVA payment source imputed?

                             311,094                    0 Not imputed
                                 149                    1 Imputed

IMPAVA    120  1  IMPFLAG                               N AMTVA payment amount imputed?

                             309,957                    0 Not imputed
                               1,286                    1 Imputed

AMTPRVE   121  9                                        N Amt paid by employer-sponsored priv ins

IMPSPRVE  130  1  IMPFLAG                               N AMTPRVE payment source imputed?

                             283,293                    0 Not imputed
                              27,950                    1 Imputed

IMPAPRVE  131  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                             275,758                    0 Not imputed
                              35,485                    1 Imputed

AMTPRVI   132  9                                        N Amt paid by individually-purch priv ins

IMPSPRVI  141  1  IMPFLAG                               N AMTPRVI payment source imputed?

                             284,069                    0 Not imputed
                              27,174                    1 Imputed

IMPAPRVI  142  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                             276,136                    0 Not imputed
                              35,107                    1 Imputed

AMTPRVU   143  9                                        N Amt paid by priv ins (unknown purchased)

IMPSPRVU  152  1  IMPFLAG                               N AMTPRVU payment source imputed?

                             306,248                    0 Not imputed
                               4,995                    1 Imputed

IMPAPRVU  153  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                             306,248                    0 Not imputed
                               4,995                    1 Imputed

AMTOOP    154  9                                        N Amount paid out-of-pocket (OOP)

IMPSOOP   163  1  IMPFLAG                               N AMTOOP payment source imputed?

                             263,381                    0 Not imputed
                              47,862                    1 Imputed

IMPAOOP   164  1  IMPFLAG                               N AMTOOP payment amount imputed?

                             241,688                    0 Not imputed
                              69,555                    1 Imputed

AMTDISC   165  9                                        N Amount of uncollected SP liability

IMPSDISC  174  1  IMPFLAG                               N AMTDISC payment source imputed?

                             302,488                    0 Not imputed
                               8,755                    1 Imputed

IMPADISC  175  1  IMPFLAG                               N AMTDISC payment amount imputed?

                             300,793                    0 Not imputed
                              10,450                    1 Imputed

AMTOTH    176  9                                        N Amount paid by other payor(s)

IMPSOTH   185  1  IMPFLAG                               N AMTOTH payment source imputed?

                             311,000                    0 Not imputed
                                 243                    1 Imputed

IMPAOTH   186  1  IMPFLAG                               N AMTOTH payment amount imputed?

                             309,655                    0 Not imputed
                               1,588                    1 Imputed

PAMTMED   187  9                                        N Total amount paid for medical services

PAMTSURG  196  9                                        N Total amount paid for surgical services

PAMTLABX  205  9                                        N Total amount paid for lab/X-Ray

PAMTOM    214  9                                        N Total payment for other medical services

PAMTPM    223  9                                        N Total payment for prescribed medicines

PROVSPEC  232  2  PROVSPEC                              N Medical provider specialty

                             154,355                    . Missing
                                 354                   -9 Not ascertained
                                 597                   -8 Don't know
                                   1                   -7 Refused
                              38,659                   -1 Inapplicable
                                  17                    1 Dentist or dental provider
                              84,907                    2 Medical doctor
                                 500                    3 Audiologist
                               5,320                    4 Chiropractor
                                 359                    5 Clinical Social Worker
                                  55                    6 Dietician or nutritionist
                                  18                    7 Hearing therapist
                                 425                    8 Home health/health aide
                                   7                    9 Homemaker
                                 106                   10 Hospice worker
                                  81                   11 I.V. Therapist
                                 936                   12 Nurse (RN)
                                 752                   13 Nurse Practitioner
                                  46                   14 Nurse's aide
                                 162                   15 Occupational Therapist (OT)
                               2,245                   16 Optometrist
                                 267                   17 Osteopath (DO)
                                  75                   18 Paramedic
                               9,395                   19 Physical Therapist (PT)
                                 343                   20 Physician's Assistant
                               2,507                   21 Podiatrist (foot doctor)
                               1,262                   22 Psychologist
                                 282                   23 Respiratory Therapist
                                 508                   24 Social/case worker
                                  75                   25 Speech Therapist
                                 676                   26 Therapist (mental health)
                                 799                   27 X-Ray Technician
                                  36                   28 Licensed Practical Nurse (LPN)
                                 319                   29 Acupuncturist
                                  79                   30 Homeopath
                                 805                   31 Massage therapist
                                  70                   32 Naturopath
                                 505                   33 Licensed Professional Counselor (LPC)
                               1,440                   34 Lab Technician
                               1,898                   91 Other medical provider

OMETYPE   234  2  OMETYPE                               N Type of other medical event

                             138,971                    . Missing
                             137,445                   -1 Inapplicable
                               2,280                    1 Eyeglasses
                                 576                    2 Hearing or speech device
                               2,215                    3 Orthopedic
                               7,788                    4 Diabetic
                               4,869                    5 Ambulance
                                 179                    6 Prosthesis
                                 351                    7 Alteration
                               6,052                    8 Oxygen
                                  42                    9 Kidney dialysis
                              10,475                   10 Other

ORTHTYPE  236  2  ORTHTYPE                              N Type of orthopedic item

                             153,751                    . Missing
                             155,277                   -1 Inapplicable
                                 625                    1 Braces or supports
                                 194                    2 Cane
                                 347                    3 Corrective shoes or inserts
                                  29                    4 Crutches
                                 446                    5 Walker
                                 342                    6 Wheelchair
                                 153                    7 Stockings
                                  79                   91 Other

ALTRTYPE  238  2  ALTRTYPE                              N Type of alteration

                             154,305                    . Missing
                             156,587                   -1 Inapplicable
                                  20                    1 Elevator or incline chair
                                  83                    2 Handrails (other than tub)
                                  50                    3 Ramps
                                  75                    4 Tub handrails
                                  26                    5 Tub seat
                                   7                    6 Any car alteration
                                  90                   91 Other

OTHRTYPE  240  2  OTHRTYPE                              N Type of other medical event

                             151,426                    . Missing
                             149,342                   -1 Inapplicable
                                 288                    1 Portable or raised toilet
                                  86                    2 Portable tub seat
                                  83                    3 Special chair or cushion
                                 628                    4 Hospital bed
                                 522                    5 Ostomy supplies
                               5,391                    6 Depends (diapers)
                                 434                    7 Bandages, dressings, tape supplies
                                 559                    8 Pulmonary equipment
                                 118                    9 Blood pressure equipment
                               2,366                   91 Other

HMO       242  1  $HMO                                  C Event provided by an HMO?

                             234,476                    0 Event not provided by HMO
                              75,347                    1 Event provided by HMO
                               1,420                    3 Event provided by PDP/MAPD

