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
                               1,038                   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

                               1,038                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                               1,038             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Event identifier

                                 550            C000-C999 Event created from claim
                                 488            0000-9999 Survey-reported event

OREVTYPE   18  2  $EVN1TYP                              C Original reported event type

                                 550                      Missing
                                   0                   DU Dental
                                   0                   ER Emergency room
                                 106                   IP Inpatient
                                 382                   IU Institutional utilization
                                   0                   MP Medical provider
                                   0                   OM Other medical expense
                                   0                   OP Outpatient
                                   0                   PM Prescribed medicine
                                   0                   SD Separately billing physician
                                   0                   SL Separately billing lab

CLAIMID    20  7                                        N 1st Claim this survey event matched to

CLMCNT     27  2                                        N Number of claims matched to this event

EVBEGYY    29  2  $EVENTYY                              C Event begin year

                                  12                   -8 Don't know
                                   1                   -9 Not ascertained
                               1,025                      Year

EVBEGMM    31  2  $EVENTMM                              C Event begin month

                                  24                   -8 Don't know
                                   1                   -9 Not ascertained
                                   0                   95 Still in progress
                               1,013                      Month

EVBEGDD    33  2  $EVENTDD                              C Event begin day

                                   1                   -7 Refused
                                  53                   -8 Don't know
                                   1                   -9 Not ascertained
                                 983                      Day of month

EVENDYY    35  2  $EVENTYY                              C Event end year

                                  14                   -8 Don't know
                                   1                   -9 Not ascertained
                               1,023                      Year

EVENDMM    37  2  $EVENTMM                              C Event end month

                                  27                   -8 Don't know
                                   1                   -9 Not ascertained
                                   0                   95 Still in progress
                               1,010                      Month

EVENDDD    39  2  $EVENTDD                              C Event end day

                                  57                   -8 Don't know
                                   1                   -9 Not ascertained
                                 980                      Day of month

SOURCE     41  1  $SOURCE                               C Source of event: survey, claim, or both?

                                 244                    1 Survey only
                                 550                    2 Claims only
                                 244                    3 Both survey & claims

SITCODE    42  1  $SITCODE                              C Community or facility setting?

                                   0                    B Both community & facility
                                 231                    C Community
                                   0                    D Deemed community
                                   7                    F Facility
                                   2                    G Deemed facility
                                 798                    S SNF

AMTTOT     43  9                                        N Total payment

IMPATOT    52  1  IMPFLAG                               N AMTTOT imputed in part or in total?

                                 679                    0 Not imputed
                                 359                    1 Imputed

AMTCOV     53  9                                        N Medicare program liability, incl. copays

AMTNCOV    62  9                                        N Total payment not covered by Medicare

AMTCARE    71  9                                        N Amount paid by Medicare

IMPSCARE   79  1  IMPFLAG                               N AMTCARE payment source imputed?

                               1,038                    0 Not imputed
                                   0                    1 Imputed

IMPACARE   81  1  IMPFLAG                               N AMTCARE payment amount imputed?

                               1,028                    0 Not imputed
                                  10                    1 Imputed

AMTCAID    82  9                                        N Amount paid by Medicaid

IMPSCAID   91  1  IMPFLAG                               N AMTCAID payment source imputed?

                                 949                    0 Not imputed
                                  89                    1 Imputed

IMPACAID   92  1  IMPFLAG                               N AMTCAID payment amount imputed?

                                 859                    0 Not imputed
                                 179                    1 Imputed

AMTHMOM    93  9                                        N Amount paid by Medicare HMO

IMPSHMOM  102  1  IMPFLAG                               N AMTHMOM payment source imputed?

                                 983                    0 Not imputed
                                  55                    1 Imputed

IMPAHMOM  103  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                                 965                    0 Not imputed
                                  73                    1 Imputed

AMTHMOP   104  9                                        N Amount paid by private HMO

IMPSHMOP  113  1  IMPFLAG                               N AMTHMOP payment source imputed?

                               1,023                    0 Not imputed
                                  15                    1 Imputed

IMPAHMOP  114  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                               1,024                    0 Not imputed
                                  14                    1 Imputed

AMTVA     115  9                                        N Amount paid by Veterans Administration

IMPSVA    124  1  IMPFLAG                               N AMTVA payment source imputed?

                               1,035                    0 Not imputed
                                   3                    1 Imputed

IMPAVA    125  1  IMPFLAG                               N AMTVA payment amount imputed?

                               1,034                    0 Not imputed
                                   4                    1 Imputed

AMTPRVE   126  9                                        N Amt paid by employer-sponsored priv ins

IMPSPRVE  135  1  IMPFLAG                               N AMTPRVE payment source imputed?

                                 976                    0 Not imputed
                                  62                    1 Imputed

IMPAPRVE  136  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                                 973                    0 Not imputed
                                  65                    1 Imputed

AMTPRVI   137  9                                        N Amt paid by individually-purch priv ins

IMPSPRVI  146  1  IMPFLAG                               N AMTPRVI payment source imputed?

                                 982                    0 Not imputed
                                  56                    1 Imputed

IMPAPRVI  147  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                                 984                    0 Not imputed
                                  54                    1 Imputed

AMTPRVU   148  9                                        N Amt paid by priv ins (unknown purchased)

IMPSPRVU  157  1  IMPFLAG                               N AMTPRVU payment source imputed?

                                 929                    0 Not imputed
                                 109                    1 Imputed

IMPAPRVU  158  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                                 929                    0 Not imputed
                                 109                    1 Imputed

AMTOOP    159  9                                        N Amount paid out-of-pocket (OOP)

IMPSOOP   168  1  IMPFLAG                               N AMTOOP payment source imputed?

                                 811                    0 Not imputed
                                 227                    1 Imputed

IMPAOOP   169  1  IMPFLAG                               N AMTOOP payment amount imputed?

                                 766                    0 Not imputed
                                 272                    1 Imputed

AMTDISC   170  9                                        N Amount of uncollected SP liability

IMPSDISC  179  1  IMPFLAG                               N AMTDISC payment source imputed?

                                 987                    0 Not imputed
                                  51                    1 Imputed

IMPADISC  180  1  IMPFLAG                               N AMTDISC payment amount imputed?

                                 995                    0 Not imputed
                                  43                    1 Imputed

AMTOTH    181  9                                        N Amount paid by other payor(s)

IMPSOTH   190  1  IMPFLAG                               N AMTOTH payment source imputed?

                               1,027                    0 Not imputed
                                  11                    1 Imputed

IMPAOTH   191  1  IMPFLAG                               N AMTOTH payment amount imputed?

                               1,027                    0 Not imputed
                                  11                    1 Imputed

DGNCNT    192  2                                        N UNIQUE diagnosis codes for event

                  Note: First available in 2011

PRINDIAG  194  7                                        C Primary ICD-9 diag code from 1st claim

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

POAIND    201  1  $POA                                  C Present on admission indicator

                                 244                      Missing
                                 746                    0 No codes present on admission
                                  48                    1 At least 1 code present on admis

                  Note: First available in 2011

E1DGNSCD  202  7                                        C First E-CODE from claim

                  Note: First available in 2011

PROV      209  6                                        C Medicare provider number from claim

STATUS    215  2  $STATUS                               C Beneficiary status as of claim thru date

                                 244                      Missing
                                 237                   01 Discharged to home/self care
                                 163                   02 Discharged to other short-term hospital
                                  21                   03 Discharged to skilled nursing facility
                                  17                   04 Discharged to intermediate care facility
                                  10                   05 Disch to another type of institution
                                  57                   06 Discharged to home care of organized HMO
                                   3                   07 Left against medical advice/stopped care
                                   0                   08 Disch home under care of IV therapy prov
                                  33                   20 Expired (did not recover Christian Sci)
                                 241                   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)
                                   1                   50 Hospice - home (eff. 10/96)
                                   6                   51 Hospice - medical facility (eff. 10/96)
                                   0                   61 Disch w/i facility to swing-bed SNF (99)
                                   1                   62 Disch to inpat rehab facility
                                   1                   63 Disch to long term care hospital
                                   2                   64 Disch to Medicaid cert nursing facility
                                   0                   70 Disch to other type of hlth care facilit
                                   0                   71 Disch to other facility for O/P svcs(99)
                                   0                   72 Disch to this facility for O/P svcs (99)
                                   1                      Other destination

UTLZNDAY  217  3                                        N Number of covered days of care

COINDAY   220  2                                        N Total number of coinsurance days

HMO       222  1  $HMO                                  C Event provided by an HMO?

                                 800                    0 Event not provided by HMO
                                 238                    1 Event provided by HMO

