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
                             330,623                   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

                             330,623                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                             330,623             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Event identifier

                               1,607                      Missing
                             148,279            C000-C999 Event created from claim
                             180,737            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
                             176,117                   MP Medical provider
                              44,726                   OM Other medical expense
                                   0                   OP Outpatient
                                   0                   PM Prescribed medicine
                              65,310                   SD Separately billing physician
                              44,470                   SL Separately billing lab

OREVTYPE   20  2  $EVNTTYP                              C Original reported event type

                             149,886                      Missing
                                   0                   DU Dental
                                 995                   ER Emergency Room
                                 607                   IP Inpatient
                                   0                   IU Institutional utilization
                             125,173                   MP Medical provider
                              25,224                   OM Other medical expense
                               4,343                   OP Outpatient
                                   0                   PM Prescribed medicine
                              20,006                   SD Separately billing physician
                               4,389                   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

                             100,985
                              18,358                    D DME claim
                             209,673                    P Physician claim
                               1,607                    R PDE claim

EVBEGYY    30  2  $EVENTYY                              C Event begin year

                                 389                   -8 Don't know
                                   4                   -9 Not ascertained
                             330,230                      Year

EVBEGMM    32  2  $EVENTMM                              C Event begin month

                               2,248                   -8 Don't know
                                   8                   -9 Not ascertained
                                   0                   95 Still in progress
                             328,367                      Month

EVBEGDD    34  2  $EVENTDD                              C Event begin day

                                  16                   -7 Refused
                              49,226                   -8 Don't know
                                   8                   -9 Not ascertained
                             281,373                      Day of month

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

                             100,985                    1 Survey only
                             149,886                    2 Claims only
                              79,752                    3 Both survey & claims

SITCODE    37  1  $SITCODE                              C Community or facility setting?

                                 433                    B Both community & facility
                             273,275                    C Community
                              17,145                    D Deemed community
                              31,355                    F Facility
                               2,209                    G Deemed facility
                               6,206                    S SNF

AMTTOT     38  9                                        N Total payment

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

                             208,350                    0 Not imputed
                             122,273                    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?

                             330,623                    0 Not imputed
                                   0                    1 Imputed

IMPACARE   76  1  IMPFLAG                               N AMTCARE payment amount imputed?

                             312,686                    0 Not imputed
                              17,937                    1 Imputed

AMTCAID    77  9                                        N Amount paid by Medicaid

IMPSCAID   86  1  IMPFLAG                               N AMTCAID payment source imputed?

                             301,574                    0 Not imputed
                              29,049                    1 Imputed

IMPACAID   87  1  IMPFLAG                               N AMTCAID payment amount imputed?

                             275,844                    0 Not imputed
                              54,779                    1 Imputed

AMTHMOM    88  9                                        N Amount paid by Medicare HMO

IMPSHMOM   97  1  IMPFLAG                               N AMTHMOM payment source imputed?

                             312,059                    0 Not imputed
                              18,564                    1 Imputed

IMPAHMOM   98  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                             297,809                    0 Not imputed
                              32,814                    1 Imputed

AMTHMOP    99  9                                        N Amount paid by private HMO

IMPSHMOP  108  1  IMPFLAG                               N AMTHMOP payment source imputed?

                             320,777                    0 Not imputed
                               9,846                    1 Imputed

IMPAHMOP  109  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                             318,115                    0 Not imputed
                              12,508                    1 Imputed

AMTVA     110  9                                        N Amount paid by Veterans Administration

IMPSVA    119  1  IMPFLAG                               N AMTVA payment source imputed?

                             330,511                    0 Not imputed
                                 112                    1 Imputed

IMPAVA    120  1  IMPFLAG                               N AMTVA payment amount imputed?

                             329,023                    0 Not imputed
                               1,600                    1 Imputed

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

IMPSPRVE  130  1  IMPFLAG                               N AMTPRVE payment source imputed?

                             306,744                    0 Not imputed
                              23,879                    1 Imputed

IMPAPRVE  131  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                             301,400                    0 Not imputed
                              29,223                    1 Imputed

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

IMPSPRVI  141  1  IMPFLAG                               N AMTPRVI payment source imputed?

                             305,427                    0 Not imputed
                              25,196                    1 Imputed

IMPAPRVI  142  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                             299,879                    0 Not imputed
                              30,744                    1 Imputed

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

IMPSPRVU  152  1  IMPFLAG                               N AMTPRVU payment source imputed?

                             326,689                    0 Not imputed
                               3,934                    1 Imputed

IMPAPRVU  153  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                             326,689                    0 Not imputed
                               3,934                    1 Imputed

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

IMPSOOP   163  1  IMPFLAG                               N AMTOOP payment source imputed?

                             282,922                    0 Not imputed
                              47,701                    1 Imputed

IMPAOOP   164  1  IMPFLAG                               N AMTOOP payment amount imputed?

                             262,119                    0 Not imputed
                              68,504                    1 Imputed

AMTDISC   165  9                                        N Amount of uncollected SP liability

IMPSDISC  174  1  IMPFLAG                               N AMTDISC payment source imputed?

                             320,856                    0 Not imputed
                               9,767                    1 Imputed

IMPADISC  175  1  IMPFLAG                               N AMTDISC payment amount imputed?

                             321,950                    0 Not imputed
                               8,673                    1 Imputed

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

IMPSOTH   185  1  IMPFLAG                               N AMTOTH payment source imputed?

                             330,500                    0 Not imputed
                                 123                    1 Imputed

IMPAOTH   186  1  IMPFLAG                               N AMTOTH payment amount imputed?

                             329,045                    0 Not imputed
                               1,578                    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

                             150,103                    . Missing
                                 355                   -9 Not ascertained
                               1,017                   -8 Don't know
                                   1                   -7 Refused
                              47,406                   -1 Inapplicable
                                  47                    1 Dentist or dental provider
                              91,174                    2 Medical doctor
                                 700                    3 Audiologist
                               5,863                    4 Chiropractor
                                 465                    5 Clinical Social Worker
                                  69                    6 Dietician or nutritionist
                                  14                    7 Hearing therapist
                                 183                    8 Home health/health aide
                                   2                    9 Homemaker
                                 201                   10 Hospice worker
                                 211                   11 I.V. Therapist
                               1,548                   12 Nurse (RN)
                               1,510                   13 Nurse Practitioner
                                  81                   14 Nurse's aide
                                 461                   15 Occupational Therapist (OT)
                               2,540                   16 Optometrist
                                 224                   17 Osteopath (DO)
                                 108                   18 Paramedic
                              12,074                   19 Physical Therapist (PT)
                                 519                   20 Physician's Assistant
                               2,880                   21 Podiatrist (foot doctor)
                               1,670                   22 Psychologist
                                 172                   23 Respiratory Therapist
                                 483                   24 Social/case worker
                                 217                   25 Speech Therapist
                                 936                   26 Therapist (mental health)
                               1,017                   27 X-Ray Technician
                                  56                   28 Licensed Practical Nurse (LPN)
                                 485                   29 Acupuncturist
                                  24                   30 Homeopath
                               1,108                   31 Massage therapist
                                  58                   32 Naturopath
                                 541                   33 Licensed Professional Counselor (LPC)
                               1,604                   34 Lab Technician
                               2,496                   91 Other medical provider

OMETYPE   234  2  OMETYPE                               N Type of other medical event

                             134,570                    . Missing
                             155,513                   -1 Inapplicable
                               2,804                    1 Eyeglasses
                                 709                    2 Hearing or speech device
                               2,909                    3 Orthopedic
                               8,443                    4 Diabetic
                               5,186                    5 Ambulance
                                 162                    6 Prosthesis
                                 586                    7 Alteration
                               5,874                    8 Oxygen
                                  69                    9 Kidney dialysis
                              13,798                   10 Other

ORTHTYPE  236  2  ORTHTYPE                              N Type of orthopedic item

                             149,482                    . Missing
                             178,232                   -1 Inapplicable
                                 730                    1 Braces or supports
                                 311                    2 Cane
                                 444                    3 Corrective shoes or inserts
                                  52                    4 Crutches
                                 505                    5 Walker
                                 466                    6 Wheelchair
                                 325                    7 Stockings
                                  76                   91 Other

ALTRTYPE  238  2  ALTRTYPE                              N Type of alteration

                             150,051                    . Missing
                             179,986                   -1 Inapplicable
                                  23                    1 Elevator or incline chair
                                 154                    2 Handrails (other than tub)
                                  99                    3 Ramps
                                 111                    4 Tub handrails
                                  43                    5 Tub seat
                                  20                    6 Any car alteration
                                 136                   91 Other

OTHRTYPE  240  2  OTHRTYPE                              N Type of durable medical event

                             146,950                    . Missing
                             169,875                   -1 Inapplicable
                                 266                    1 Portable or raised toilet
                                 121                    2 Portable tub seat
                                  98                    3 Special chair or cushion
                                 682                    4 Hospital bed
                                 515                    5 Ostomy supplies
                               7,516                    6 Depends (diapers)
                                 961                    7 Bandages, dressings, tape supplies
                                 701                    8 Pulmonary equipment
                                 219                    9 Blood pressure equipment
                               2,719                   91 Other

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

                             236,640                    0 Event not provided by HMO
                              92,376                    1 Event provided by HMO
                               1,607                    3 Event provided by PDP/MAPD

