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
                                   0                   MP Medical Provider Events
                                   0                    N Non-Respondent
                                   0                   OA OASIS
                              57,647                   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

                              57,647                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                              57,647             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Event identifier

                              23,786            C000-C999 Event created from claim
                              33,861            0000-9999 Survey-reported event

OREVTYPE   18  2  $EVNTTYP                              C Original reported event type

                              23,786                      Missing
                                   0                   DU Dental
                               2,515                   ER Emergency Room
                                 797                   IP Inpatient
                                   0                   IU Institutional utilization
                              10,717                   MP Medical provider
                                 324                   OM Other medical expense
                              18,406                   OP Outpatient
                                   0                   PM Prescribed medicine
                                 439                   SD Separately billing physician
                                 663                   SL Separately billing lab

CLAIMID    20  7                                        N Claim this survey event matched to

FROMDT     27  6                                        C From date on claim

THRUDT     33  6                                        C Thru date on claim

EVBEGYY    39  2  $EVENTYY                              C Event begin year

                                  85                   -8 Don't know
                                   2                   -9 Not ascertained
                              57,560                      Year

EVBEGMM    41  2  $EVENTMM                              C Event begin month

                                 601                   -8 Don't know
                                   2                   -9 Not ascertained
                                   0                   95 Still in progress
                              57,044                      Month

EVBEGDD    43  2  $EVENTDD                              C Event begin day

                                   3                   -7 Refused
                              16,192                   -8 Don't know
                                   2                   -9 Not ascertained
                              41,450                      Day of month

SOURCE     45  1  $SOURCE                               C Source of event: survey, claim, or both?

                              14,215                    1 Survey only
                              23,786                    2 Claims only
                              19,646                    3 Both survey & claims

SITCODE    46  1  $SITCODE                              C Community or facility setting?

                                  13                    B Both community & facility
                              48,725                    C Community
                               3,008                    D Deemed community
                               4,881                    F Facility
                                 237                    G Deemed facility
                                 783                    S SNF

AMTTOT     47  9                                        N Total payment

IMPATOT    56  1  IMPFLAG                               N AMTTOT imputed in part or in total?

                              37,202                    0 Not imputed
                              20,445                    1 Imputed

AMTCOV     57  9                                        N Medicare program liability, incl. copays

AMTNCOV    66  9                                        N Total payment not covered by Medicare

AMTCARE    75  9                                        N Amount paid by Medicare

IMPSCARE   84  1  IMPFLAG                               N AMTCARE payment source imputed?

                              57,647                    0 Not imputed
                                   0                    1 Imputed

IMPACARE   85  1  IMPFLAG                               N AMTCARE payment amount imputed?

                              54,823                    0 Not imputed
                               2,824                    1 Imputed

AMTCAID    86  9                                        N Amount paid by Medicaid

IMPSCAID   95  1  IMPFLAG                               N AMTCAID payment source imputed?

                              52,183                    0 Not imputed
                               5,464                    1 Imputed

IMPACAID   96  1  IMPFLAG                               N AMTCAID payment amount imputed?

                              47,271                    0 Not imputed
                              10,376                    1 Imputed

AMTHMOM    97  9                                        N Amount paid by Medicare HMO

IMPSHMOM  106  1  IMPFLAG                               N AMTHMOM payment source imputed?

                              54,397                    0 Not imputed
                               3,250                    1 Imputed

IMPAHMOM  107  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                              51,696                    0 Not imputed
                               5,951                    1 Imputed

AMTHMOP   108  9                                        N Amount paid by private HMO

IMPSHMOP  117  1  IMPFLAG                               N AMTHMOP payment source imputed?

                              56,309                    0 Not imputed
                               1,338                    1 Imputed

IMPAHMOP  118  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                              55,450                    0 Not imputed
                               2,197                    1 Imputed

AMTVA     119  9                                        N Amount paid by Veterans Administration

IMPSVA    128  1  IMPFLAG                               N AMTVA payment source imputed?

                              57,580                    0 Not imputed
                                  67                    1 Imputed

IMPAVA    129  1  IMPFLAG                               N AMTVA payment amount imputed?

                              56,726                    0 Not imputed
                                 921                    1 Imputed

AMTPRVE   130  9                                        N Amt paid by employer-sponsored priv ins

IMPSPRVE  139  1  IMPFLAG                               N AMTPRVE payment source imputed?

                              55,007                    0 Not imputed
                               2,640                    1 Imputed

IMPAPRVE  140  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                              53,640                    0 Not imputed
                               4,007                    1 Imputed

AMTPRVI   141  9                                        N Amt paid by individually-purch priv ins

IMPSPRVI  150  1  IMPFLAG                               N AMTPRVI payment source imputed?

                              54,344                    0 Not imputed
                               3,303                    1 Imputed

IMPAPRVI  151  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                              53,064                    0 Not imputed
                               4,583                    1 Imputed

AMTPRVU   152  9                                        N Amt paid by priv ins (unknown purchased)

IMPSPRVU  161  1  IMPFLAG                               N AMTPRVU payment source imputed?

                              57,083                    0 Not imputed
                                 564                    1 Imputed

IMPAPRVU  162  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                              57,083                    0 Not imputed
                                 564                    1 Imputed

AMTOOP    163  9                                        N Amount paid out-of-pocket (OOP)

IMPSOOP   172  1  IMPFLAG                               N AMTOOP payment source imputed?

                              50,837                    0 Not imputed
                               6,810                    1 Imputed

IMPAOOP   173  1  IMPFLAG                               N AMTOOP payment amount imputed?

                              49,093                    0 Not imputed
                               8,554                    1 Imputed

AMTDISC   174  9                                        N Amount of uncollected SP liability

IMPSDISC  183  1  IMPFLAG                               N AMTDISC payment source imputed?

                              56,135                    0 Not imputed
                               1,512                    1 Imputed

IMPADISC  184  1  IMPFLAG                               N AMTDISC payment amount imputed?

                              56,280                    0 Not imputed
                               1,367                    1 Imputed

AMTOTH    185  9                                        N Amount paid by other payor(s)

IMPSOTH   194  1  IMPFLAG                               N AMTOTH payment source imputed?

                              57,562                    0 Not imputed
                                  85                    1 Imputed

IMPAOTH   195  1  IMPFLAG                               N AMTOTH payment amount imputed?

                              57,201                    0 Not imputed
                                 446                    1 Imputed

DGNCNT    196  2                                        N Number of diagnostic codes on claim

                  Note: First available in 2011

PRINDIAG  198  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

E1DGNSCD  205  7                                        C First E-CODE from claim

                  Note: First available in 2011

HMO       212  1  $HMO                                  C Event provided by an HMO?

                              42,493                    0 Event not provided by HMO
                              15,154                    1 Event provided by HMO

