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
                               3,458                   IP Inpatient Hospital Events
                                   0                   IU Institutional Events
                                   0                    K Key Record
                                   0                   KN Knowledge and Information Needs
                                   0                   MD MDS
                                   0                   MP Medical Provider Events
                                   0                    N Non-Respondent
                                   0                   OA OASIS
                                   0                   OP Outpatient Events
                                   0                   PA Patient Activation
                                   0                   PM Prescribed Medicine Events
                                   0                   PS Person Summary
                                   0                   RX Drug Coverage
                                   0                   SS Service Summary
                                   0                    X Cross Sectional Weights
                                   0                   XE Ever Enrolled Weights
                                   0                   X2 2 year Weights
                                   0                   X3 3 year Weights
                                   0                   X4 4 year Weights
                                   0                    1 Survey Identification (Demographic)
                                   0                   10 MDS/OAS Timeline
                                   0                    2 Health Status/Functioning (Community)
                                   0                   2F Health Status/Functioning (Facility)
                                   0                   2H Health Status/Functioning (Helper)
                                   0                   2P Health Status/Functioning (Prevention)
                                   0                    3 Access to Care
                                   0                    4 Health Insurance
                                   0                    5 Enumeration
                                   0                    6 Facility Residence History
                                   0                    7 Facility Characteristics
                                   0                   7S SNF Characteristics
                                   0                    8 Interview Description
                                   0                    9 Residence Timeline

VERSION     3  1  $VERSION                              C Version number

                               3,458                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                               3,458             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Event identifier

                               1,051            C000-C999 Event created from claim
                               2,407            0000-9999 Survey-reported event

OREVTYPE   18  2  $EVNTTYP                              C Original reported event type

                               1,051                      Missing
                                   0                   DU Dental
                                  67                   ER Emergency Room
                               2,253                   IP Inpatient
                                  48                   IU Institutional utilization
                                   0                   MP Medical provider
                                   0                   OM Other medical expense
                                  39                   OP Outpatient
                                   0                   PM Prescribed medicine
                                   0                   SD Separately billing physician
                                   0                   SL Separately billing lab

CLAIMID    20  7                                        N Claim this survey event matched to

EVBEGYY    27  2  $EVENTYY                              C Event begin year

                                   5                   -8 Don't know
                                   1                   -9 Not ascertained
                               3,452                      Year

EVBEGMM    29  2  $EVENTMM                              C Event begin month

                                  18                   -8 Don't know
                                   1                   -9 Not ascertained
                                   0                   95 Still in progress
                               3,439                      Month

EVBEGDD    31  2  $EVENTDD                              C Event begin day

                                 131                   -8 Don't know
                                   1                   -9 Not ascertained
                               3,326                      Day of month

EVENDYY    33  2  $EVENTYY                              C Event end year

                                   7                   -8 Don't know
                                   1                   -9 Not ascertained
                               3,450                      Year

EVENDMM    35  2  $EVENTMM                              C Event end month

                                  19                   -8 Don't know
                                   1                   -9 Not ascertained
                                   0                   95 Still in progress
                               3,438                      Month

EVENDDD    37  2  $EVENTDD                              C Event end day

                                 103                   -8 Don't know
                                   1                   -9 Not ascertained
                               3,354                      Day of month

SOURCE     39  1  $SOURCE                               C Source of event: survey, claim, or both?

                                 645                    1 Survey only
                               1,051                    2 Claims only
                               1,762                    3 Both survey & claims

SITCODE    40  1  $SITCODE                              C Community or facility setting?

                                  11                    B Both community & facility
                               2,585                    C Community
                                 212                    D Deemed community
                                 451                    F Facility
                                  39                    G Deemed facility
                                 160                    S SNF

AMTTOT     41  9                                        N Total payment

IMPATOT    50  1  IMPFLAG                               N AMTTOT imputed in part or in total?

                               2,450                    0 Not imputed
                               1,008                    1 Imputed

AMTCOV     51  9                                        N Medicare program liability, incl. copays

AMTNCOV    60  9                                        N Total payment not covered by Medicare

AMTCARE    69  9                                        N Amount paid by Medicare

IMPSCARE   78  1  IMPFLAG                               N AMTCARE payment source imputed?

                               3,458                    0 Not imputed
                                   0                    1 Imputed

IMPACARE   79  1  IMPFLAG                               N AMTCARE payment amount imputed?

                               3,375                    0 Not imputed
                                  83                    1 Imputed

AMTCAID    80  9                                        N Amount paid by Medicaid

IMPSCAID   89  1  IMPFLAG                               N AMTCAID payment source imputed?

                               3,205                    0 Not imputed
                                 253                    1 Imputed

IMPACAID   90  1  IMPFLAG                               N AMTCAID payment amount imputed?

                               2,925                    0 Not imputed
                                 533                    1 Imputed

AMTHMOM    91  9                                        N Amount paid by Medicare HMO

IMPSHMOM  100  1  IMPFLAG                               N AMTHMOM payment source imputed?

                               3,189                    0 Not imputed
                                 269                    1 Imputed

IMPAHMOM  101  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                               3,006                    0 Not imputed
                                 452                    1 Imputed

AMTHMOP   102  9                                        N Amount paid by private HMO

IMPSHMOP  111  1  IMPFLAG                               N AMTHMOP payment source imputed?

                               3,359                    0 Not imputed
                                  99                    1 Imputed

IMPAHMOP  112  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                               3,329                    0 Not imputed
                                 129                    1 Imputed

AMTVA     113  9                                        N Amount paid by Veterans Administration

IMPSVA    122  1  IMPFLAG                               N AMTVA payment source imputed?

                               3,458                    0 Not imputed
                                   0                    1 Imputed

IMPAVA    123  1  IMPFLAG                               N AMTVA payment amount imputed?

                               3,457                    0 Not imputed
                                   1                    1 Imputed

AMTPRVE   124  9                                        N Amt paid by employer-sponsored priv ins

IMPSPRVE  133  1  IMPFLAG                               N AMTPRVE payment source imputed?

                               3,300                    0 Not imputed
                                 158                    1 Imputed

IMPAPRVE  134  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                               3,244                    0 Not imputed
                                 214                    1 Imputed

AMTPRVI   135  9                                        N Amt paid by individually-purch priv ins

IMPSPRVI  144  1  IMPFLAG                               N AMTPRVI payment source imputed?

                               3,290                    0 Not imputed
                                 168                    1 Imputed

IMPAPRVI  145  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                               3,233                    0 Not imputed
                                 225                    1 Imputed

AMTPRVU   146  9                                        N Amt paid by priv ins (unknown purchased)

IMPSPRVU  155  1  IMPFLAG                               N AMTPRVU payment source imputed?

                               3,418                    0 Not imputed
                                  40                    1 Imputed

IMPAPRVU  156  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                               3,418                    0 Not imputed
                                  40                    1 Imputed

AMTOOP    157  9                                        N Amount paid out-of-pocket (OOP)

IMPSOOP   166  1  IMPFLAG                               N AMTOOP payment source imputed?

                               3,085                    0 Not imputed
                                 373                    1 Imputed

IMPAOOP   167  1  IMPFLAG                               N AMTOOP payment amount imputed?

                               3,031                    0 Not imputed
                                 427                    1 Imputed

AMTDISC   168  9                                        N Amount of uncollected SP liability

IMPSDISC  177  1  IMPFLAG                               N AMTDISC payment source imputed?

                               3,321                    0 Not imputed
                                 137                    1 Imputed

IMPADISC  178  1  IMPFLAG                               N AMTDISC payment amount imputed?

                               3,356                    0 Not imputed
                                 102                    1 Imputed

AMTOTH    179  9                                        N Amount paid by other payor(s)

IMPSOTH   188  1  IMPFLAG                               N AMTOTH payment source imputed?

                               3,456                    0 Not imputed
                                   2                    1 Imputed

IMPAOTH   189  1  IMPFLAG                               N AMTOTH payment amount imputed?

                               3,450                    0 Not imputed
                                   8                    1 Imputed

DGNCNT    190  2                                        N Number of diagnostic codes on claim

                  Note: First available in 2011

PRINDIAG  192  7                                        C Primary ICD-9 diagnosis code

                 Notes: If DGNCNT > 1 then additional codes can be found on assoc claims records
                        First available in 2011

POAIND    199  1  $POA                                  C Present on admission indicator

                                 645                      Missing
                                 163                    0 No codes present on admission
                               2,650                    1 At least 1 code present on admis

                  Note: First available in 2011

E1DGNSCD  200  7                                        C First E-CODE from claim

                  Note: First available in 2011

DRG       207  3                                        C Diagnosis related group from claim

IPPRJCNT  210  2                                        N Number of procedure codes on claim

PRCDRCD1  212  4                                        C First procedure code from claims

PROV      216  6                                        C Medicare provider number from claim

STATUS    222  2  $STATUS                               C Beneficiary status as of claim thru date

                                 645                      Missing
                               1,295                   01 Discharged to home/self care
                                  72                   02 Discharged to other short-term hospital
                                 589                   03 Discharged to skilled nursing facility
                                  67                   04 Discharged to intermediate care facility
                                   1                   05 Disch to another type of institution
                                 445                   06 Discharged to home care of organized HMO
                                  15                   07 Left against medical advice/stopped care
                                   0                   08 Disch home under care of IV therapy prov
                                  93                   20 Expired (did not recover - Christian Sci
                                   0                   30 Still patient
                                   0                   40 Expired at home (hospice claims only)
                                   0                   41 Expired in hospital, SNF, ICF or hospice
                                   0                   42 Expired in unknown place (hospice only)
                                  32                   50 Hospice - home (eff. 10/96)
                                  40                   51 Hospice - medical facility (eff. 10/96)
                                  29                   61 Disch w/i facility to swing-bed SNF (99)
                                   0                   71 Disch to other facility for O/P svcs(99)
                                   0                   72 Disch to this facility for O/P svcs (99)
                                 135                      Other destination

UTLZNDAY  224  3                                        N Number of covered days of care

COINDAY   227  2                                        N Total number of coinsurance days

LRDAYS    229  2                                        N Number of lifetime reserve days used

HMO       231  1  $HMO                                  C Event provided by an HMO?

                               2,511                    0 Event not provided by HMO
                                 947                    1 Event provided by HMO

