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
                               1,054                   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

                               1,054                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                               1,054             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Event identifier

                                 593            C000-C999 Event created from claim
                                 461            0000-9999 Survey-reported event

OREVTYPE   18  2  $EVN1TYP                              C Original reported event type

                                 593                      Missing
                                   0                   DU Dental
                                   0                   ER Emergency room
                                  91                   IP Inpatient
                                 370                   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
                               1,042                      Year

EVBEGMM    31  2  $EVENTMM                              C Event begin month

                                  18                   -8 Don't know
                                   0                   95 Still in progress
                               1,036                      Month

EVBEGDD    33  2  $EVENTDD                              C Event begin day

                                  74                   -8 Don't know
                                 980                      Day of month

EVENDYY    35  2  $EVENTYY                              C Event end year

                                  15                   -8 Don't know
                               1,039                      Year

EVENDMM    37  2  $EVENTMM                              C Event end month

                                  21                   -8 Don't know
                                   0                   95 Still in progress
                               1,033                      Month

EVENDDD    39  2  $EVENTDD                              C Event end day

                                  76                   -8 Don't know
                                 978                      Day of month

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

                                 220                    1 Survey only
                                 593                    2 Claims only
                                 241                    3 Both survey & claims

SITCODE    42  1  $SITCODE                              C Community or facility setting?

                                   0                    B Both community & facility
                                 206                    C Community
                                   2                    D Deemed community
                                   6                    F Facility
                                   3                    G Deemed facility
                                 837                    S SNF

AMTTOT     43  9                                        N Total payment

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

                                 620                    0 Not imputed
                                 434                    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   80  1  IMPFLAG                               N AMTCARE payment source imputed?

                               1,054                    0 Not imputed
                                   0                    1 Imputed

IMPACARE   81  1  IMPFLAG                               N AMTCARE payment amount imputed?

                               1,039                    0 Not imputed
                                  15                    1 Imputed

AMTCAID    82  9                                        N Amount paid by Medicaid

IMPSCAID   91  1  IMPFLAG                               N AMTCAID payment source imputed?

                                 930                    0 Not imputed
                                 124                    1 Imputed

IMPACAID   92  1  IMPFLAG                               N AMTCAID payment amount imputed?

                                 824                    0 Not imputed
                                 230                    1 Imputed

AMTHMOM    93  9                                        N Amount paid by Medicare HMO

IMPSHMOM  102  1  IMPFLAG                               N AMTHMOM payment source imputed?

                                 988                    0 Not imputed
                                  66                    1 Imputed

IMPAHMOM  103  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                                 973                    0 Not imputed
                                  81                    1 Imputed

AMTHMOP   104  9                                        N Amount paid by private HMO

IMPSHMOP  113  1  IMPFLAG                               N AMTHMOP payment source imputed?

                               1,033                    0 Not imputed
                                  21                    1 Imputed

IMPAHMOP  114  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                               1,033                    0 Not imputed
                                  21                    1 Imputed

AMTVA     115  9                                        N Amount paid by Veterans Administration

IMPSVA    124  1  IMPFLAG                               N AMTVA payment source imputed?

                               1,053                    0 Not imputed
                                   1                    1 Imputed

IMPAVA    125  1  IMPFLAG                               N AMTVA payment amount imputed?

                               1,050                    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?

                                 999                    0 Not imputed
                                  55                    1 Imputed

IMPAPRVE  136  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                                 995                    0 Not imputed
                                  59                    1 Imputed

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

IMPSPRVI  146  1  IMPFLAG                               N AMTPRVI payment source imputed?

                                 992                    0 Not imputed
                                  62                    1 Imputed

IMPAPRVI  147  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                                 991                    0 Not imputed
                                  63                    1 Imputed

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

IMPSPRVU  157  1  IMPFLAG                               N AMTPRVU payment source imputed?

                                 963                    0 Not imputed
                                  91                    1 Imputed

IMPAPRVU  158  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                                 963                    0 Not imputed
                                  91                    1 Imputed

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

IMPSOOP   168  1  IMPFLAG                               N AMTOOP payment source imputed?

                                 815                    0 Not imputed
                                 239                    1 Imputed

IMPAOOP   169  1  IMPFLAG                               N AMTOOP payment amount imputed?

                                 751                    0 Not imputed
                                 303                    1 Imputed

AMTDISC   170  9                                        N Amount of uncollected SP liability

IMPSDISC  179  1  IMPFLAG                               N AMTDISC payment source imputed?

                                 861                    0 Not imputed
                                 193                    1 Imputed

IMPADISC  180  1  IMPFLAG                               N AMTDISC payment amount imputed?

                                 635                    0 Not imputed
                                 419                    1 Imputed

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

IMPSOTH   190  1  IMPFLAG                               N AMTOTH payment source imputed?

                               1,033                    0 Not imputed
                                  21                    1 Imputed

IMPAOTH   191  1  IMPFLAG                               N AMTOTH payment amount imputed?

                               1,009                    0 Not imputed
                                  45                    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

                                 220                      Missing
                                 792                    0 No codes present on admission
                                  42                    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

                                 220                      Missing
                                 255                   01 Discharged to home/self care
                                 162                   02 Discharged to other short-term hospital
                                  21                   03 Discharged to skilled nursing facility
                                  11                   04 Discharged to intermediate care facility
                                   7                   05 Disch to another type of institution
                                  54                   06 Discharged to home care of organized HMO
                                   2                   07 Left against medical advice/stopped care
                                   0                   08 Disch home under care of IV therapy prov
                                  38                   20 Expired (did not recover Christian Sci)
                                 276                   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)
                                   2                   50 Hospice - home (eff. 10/96)
                                   2                   51 Hospice - medical facility (eff. 10/96)
                                   1                   61 Disch w/i facility to swing-bed SNF (99)
                                   0                   62 Disch to inpat rehab facility
                                   1                   63 Disch to long term care hospital
                                   1                   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?

                                 796                    0 Event not provided by HMO
                                 258                    1 Event provided by HMO

