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
                             313,841                   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

                             313,841                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                             313,841             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Event identifier

                               2,051                      Missing
                             144,652            C000-C999 Event created from claim
                             167,138            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
                             163,894                   MP Medical provider
                              41,842                   OM Other medical expense
                                   0                   OP Outpatient
                                   0                   PM Prescribed medicine
                              62,138                   SD Separately billing physician
                              45,967                   SL Separately billing lab

OREVTYPE   20  2  $EVNTTYP                              C Original reported event type

                             146,703                      Missing
                                   0                   DU Dental
                                 783                   ER Emergency Room
                                 820                   IP Inpatient
                                   0                   IU Institutional utilization
                             117,538                   MP Medical provider
                              23,328                   OM Other medical expense
                               4,373                   OP Outpatient
                                   0                   PM Prescribed medicine
                              15,964                   SD Separately billing physician
                               4,332                   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

                              87,036
                              16,749                    D DME claim
                             208,005                    P Physician claim
                               2,051                    R PDE claim

EVBEGYY    30  2  $EVENTYY                              C Event begin year

                                 247                   -8 Don't know
                                   2                   -9 Not ascertained
                             313,592                      Year

EVBEGMM    32  2  $EVENTMM                              C Event begin month

                                   1                   -7 Refused
                               2,096                   -8 Don't know
                                  23                   -9 Not ascertained
                                   0                   95 Still in progress
                             311,721                      Month

EVBEGDD    34  2  $EVENTDD                              C Event begin day

                                  11                   -7 Refused
                              41,003                   -8 Don't know
                                  23                   -9 Not ascertained
                             272,804                      Day of month

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

                              87,036                    1 Survey only
                             146,703                    2 Claims only
                              80,102                    3 Both survey & claims

SITCODE    37  1  $SITCODE                              C Community or facility setting?

                                 243                    B Both community & facility
                             256,894                    C Community
                              16,978                    D Deemed community
                              32,785                    F Facility
                                 947                    G Deemed facility
                               5,994                    S SNF

AMTTOT     38  9                                        N Total payment

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

                             191,089                    0 Not imputed
                             122,752                    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?

                             313,841                    0 Not imputed
                                   0                    1 Imputed

IMPACARE   76  1  IMPFLAG                               N AMTCARE payment amount imputed?

                             302,302                    0 Not imputed
                              11,539                    1 Imputed

AMTCAID    77  9                                        N Amount paid by Medicaid

IMPSCAID   86  1  IMPFLAG                               N AMTCAID payment source imputed?

                             284,366                    0 Not imputed
                              29,475                    1 Imputed

IMPACAID   87  1  IMPFLAG                               N AMTCAID payment amount imputed?

                             259,580                    0 Not imputed
                              54,261                    1 Imputed

AMTHMOM    88  9                                        N Amount paid by Medicare HMO

IMPSHMOM   97  1  IMPFLAG                               N AMTHMOM payment source imputed?

                             295,354                    0 Not imputed
                              18,487                    1 Imputed

IMPAHMOM   98  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                             282,491                    0 Not imputed
                              31,350                    1 Imputed

AMTHMOP    99  9                                        N Amount paid by private HMO

IMPSHMOP  108  1  IMPFLAG                               N AMTHMOP payment source imputed?

                             303,355                    0 Not imputed
                              10,486                    1 Imputed

IMPAHMOP  109  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                             300,074                    0 Not imputed
                              13,767                    1 Imputed

AMTVA     110  9                                        N Amount paid by Veterans Administration

IMPSVA    119  1  IMPFLAG                               N AMTVA payment source imputed?

                             313,794                    0 Not imputed
                                  47                    1 Imputed

IMPAVA    120  1  IMPFLAG                               N AMTVA payment amount imputed?

                             312,590                    0 Not imputed
                               1,251                    1 Imputed

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

IMPSPRVE  130  1  IMPFLAG                               N AMTPRVE payment source imputed?

                             293,874                    0 Not imputed
                              19,967                    1 Imputed

IMPAPRVE  131  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                             286,139                    0 Not imputed
                              27,702                    1 Imputed

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

IMPSPRVI  141  1  IMPFLAG                               N AMTPRVI payment source imputed?

                             290,406                    0 Not imputed
                              23,435                    1 Imputed

IMPAPRVI  142  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                             283,444                    0 Not imputed
                              30,397                    1 Imputed

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

IMPSPRVU  152  1  IMPFLAG                               N AMTPRVU payment source imputed?

                             309,830                    0 Not imputed
                               4,011                    1 Imputed

IMPAPRVU  153  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                             309,830                    0 Not imputed
                               4,011                    1 Imputed

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

IMPSOOP   163  1  IMPFLAG                               N AMTOOP payment source imputed?

                             270,444                    0 Not imputed
                              43,397                    1 Imputed

IMPAOOP   164  1  IMPFLAG                               N AMTOOP payment amount imputed?

                             244,532                    0 Not imputed
                              69,309                    1 Imputed

AMTDISC   165  9                                        N Amount of uncollected SP liability

IMPSDISC  174  1  IMPFLAG                               N AMTDISC payment source imputed?

                             206,224                    0 Not imputed
                             107,617                    1 Imputed

IMPADISC  175  1  IMPFLAG                               N AMTDISC payment amount imputed?

                             175,632                    0 Not imputed
                             138,209                    1 Imputed

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

IMPSOTH   185  1  IMPFLAG                               N AMTOTH payment source imputed?

                             313,721                    0 Not imputed
                                 120                    1 Imputed

IMPAOTH   186  1  IMPFLAG                               N AMTOTH payment amount imputed?

                             312,177                    0 Not imputed
                               1,664                    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

                             147,026                    . Missing
                                 339                   -9 Not ascertained
                                 600                   -8 Don't know
                                   6                   -7 Refused
                              43,042                   -1 Inapplicable
                                  57                    1 Dentist or dental provider
                              84,649                    2 Medical doctor
                                 586                    3 Audiologist
                               6,201                    4 Chiropractor
                                 401                    5 Clinical Social Worker
                                  68                    6 Dietician or nutritionist
                                  22                    7 Hearing therapist
                                 322                    8 Home health/health aide
                                   3                    9 Homemaker
                                 126                   10 Hospice worker
                                 149                   11 I.V. Therapist
                               1,801                   12 Nurse (RN)
                               1,088                   13 Nurse Practitioner
                                  34                   14 Nurse's aide
                                 270                   15 Occupational Therapist (OT)
                               2,313                   16 Optometrist
                                  95                   17 Osteopath (DO)
                                 115                   18 Paramedic
                              11,712                   19 Physical Therapist (PT)
                                 608                   20 Physician's Assistant
                               2,568                   21 Podiatrist (foot doctor)
                               1,475                   22 Psychologist
                                  55                   23 Respiratory Therapist
                                 364                   24 Social/case worker
                                 140                   25 Speech Therapist
                                 710                   26 Therapist (mental health)
                                 793                   27 X-Ray Technician
                                  39                   28 Licensed Practical Nurse (LPN)
                                 619                   29 Acupuncturist
                                  51                   30 Homeopath
                               1,034                   31 Massage therapist
                                 134                   32 Naturopath
                                 599                   33 Licensed Professional Counselor (LPC)
                               1,529                   34 Lab Technician
                               2,098                   91 Other medical provider

OMETYPE   234  2  OMETYPE                               N Type of other medical event

                             131,900                    . Missing
                             143,810                   -1 Inapplicable
                               2,597                    1 Eyeglasses
                                 665                    2 Hearing or speech device
                               2,837                    3 Orthopedic
                               8,561                    4 Diabetic
                               5,056                    5 Ambulance
                                 161                    6 Prosthesis
                                 524                    7 Alteration
                               5,534                    8 Oxygen
                                  91                    9 Kidney dialysis
                              12,105                   10 Other

ORTHTYPE  236  2  ORTHTYPE                              N Type of orthopedic item

                             146,364                    . Missing
                             164,640                   -1 Inapplicable
                                 731                    1 Braces or supports
                                 313                    2 Cane
                                 410                    3 Corrective shoes or inserts
                                  39                    4 Crutches
                                 479                    5 Walker
                                 451                    6 Wheelchair
                                 335                    7 Stockings
                                  79                   91 Other

ALTRTYPE  238  2  ALTRTYPE                              N Type of alteration

                             147,007                    . Missing
                             166,310                   -1 Inapplicable
                                  24                    1 Elevator or incline chair
                                 150                    2 Handrails (other than tub)
                                  85                    3 Ramps
                                 125                    4 Tub handrails
                                  33                    5 Tub seat
                                  24                    6 Any car alteration
                                  83                   91 Other

OTHRTYPE  240  2  OTHRTYPE                              N Type of durable medical event

                             144,209                    . Missing
                             157,527                   -1 Inapplicable
                                 279                    1 Portable or raised toilet
                                 110                    2 Portable tub seat
                                 104                    3 Special chair or cushion
                                 481                    4 Hospital bed
                                 379                    5 Ostomy supplies
                               6,405                    6 Depends (diapers)
                                 879                    7 Bandages, dressings, tape supplies
                                 657                    8 Pulmonary equipment
                                 191                    9 Blood pressure equipment
                               2,620                   91 Other

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

                             220,442                    0 Event not provided by HMO
                              91,348                    1 Event provided by HMO
                               2,051                    3 Event provided by PDP/MAPD

