RIC         1  2  $RIC                                  C Record Identification Code

                                   0                    A Administrative Data
                              12,448                   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
                                   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

                              12,448                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                              12,448             LOW-HIGH BASEID Count

EVNTNUM    14  4                                        C Event identifier

OREVTYPE   18  2  $EVN2TYP                              C Original reported event type

                              12,448                   DU Dental
                                   0                   IP Inpatient
                                   0                   IU Institutional utilization
                                   0                   MP Medical provider
                                   0                   OM Other medical expense
                                   0                   OP Outpatient
                                   0                   PM Prescribed medicine
                                   0                   SD Separate billing doctor
                                   0                   SL Separate billing lab

CLAIMID    20  7                                        N Claim this survey event matched to

EVBEGYY    27  2  $EVENTYY                              C Event begin year

                                  27                   -8 Don't know
                              12,421                      Year

EVBEGMM    29  2  $EVENTMM                              C Event begin month

                                 195                   -8 Don't know
                                   0                   95 Still in progress
                              12,253                      Month

EVBEGDD    31  2  $EVENTDD                              C Event begin day

                                   3                   -7 Refused
                               3,930                   -8 Don't know
                               8,515                      Day of month

SOURCE     33  1  $SOURCE                               C Source of event: survey, claim, or both?

                              12,393                    1 Survey only
                                   0                    2 Claims only
                                  55                    3 Both survey & claims

SITCODE    34  1  $SITCODE                              C Community or facility setting?

                                   2                    B Both community & facility
                              12,418                    C Community
                                  22                    D Deemed community
                                   0                    F Facility
                                   0                    G Deemed facility
                                   6                    S SNF

AMTTOT     35  9                                        N Total payment

IMPATOT    44  1  IMPFLAG                               N AMTTOT imputed in part or in total?

                               6,702                    0 Not imputed
                               5,746                    1 Imputed

AMTCOV     45  9                                        N Medicare program liability, incl. copays

AMTNCOV    54  9                                        N Total payment not covered by Medicare

AMTCARE    63  9                                        N Amount paid by Medicare

IMPSCARE   72  1  IMPFLAG                               N AMTCARE payment source imputed?

                              12,448                    0 Not imputed
                                   0                    1 Imputed

IMPACARE   73  1  IMPFLAG                               N AMTCARE payment amount imputed?

                              12,448                    0 Not imputed
                                   0                    1 Imputed

AMTCAID    74  9                                        N Amount paid by Medicaid

IMPSCAID   83  1  IMPFLAG                               N AMTCAID payment source imputed?

                              12,439                    0 Not imputed
                                   9                    1 Imputed

IMPACAID   84  1  IMPFLAG                               N AMTCAID payment amount imputed?

                              12,186                    0 Not imputed
                                 262                    1 Imputed

AMTHMOM    85  9                                        N Amount paid by Medicare HMO

IMPSHMOM   94  1  IMPFLAG                               N AMTHMOM payment source imputed?

                              11,804                    0 Not imputed
                                 644                    1 Imputed

IMPAHMOM   95  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                              11,496                    0 Not imputed
                                 952                    1 Imputed

AMTHMOP    96  9                                        N Amount paid by private HMO

IMPSHMOP  105  1  IMPFLAG                               N AMTHMOP payment source imputed?

                              12,145                    0 Not imputed
                                 303                    1 Imputed

IMPAHMOP  106  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                              12,005                    0 Not imputed
                                 443                    1 Imputed

AMTVA     107  9                                        N Amount paid by Veterans Administration

IMPSVA    116  1  IMPFLAG                               N AMTVA payment source imputed?

                              12,448                    0 Not imputed
                                   0                    1 Imputed

IMPAVA    117  1  IMPFLAG                               N AMTVA payment amount imputed?

                              12,339                    0 Not imputed
                                 109                    1 Imputed

AMTPRVE   118  9                                        N Amt paid by employer-sponsored priv ins

IMPSPRVE  127  1  IMPFLAG                               N AMTPRVE payment source imputed?

                              12,111                    0 Not imputed
                                 337                    1 Imputed

IMPAPRVE  128  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                              11,286                    0 Not imputed
                               1,162                    1 Imputed

AMTPRVI   129  9                                        N Amt paid by individually-purch priv ins

IMPSPRVI  138  1  IMPFLAG                               N AMTPRVI payment source imputed?

                              12,331                    0 Not imputed
                                 117                    1 Imputed

IMPAPRVI  139  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                              12,101                    0 Not imputed
                                 347                    1 Imputed

AMTPRVU   140  9                                        N Amt paid by priv ins (unknown purchased)

IMPSPRVU  149  1  IMPFLAG                               N AMTPRVU payment source imputed?

                              12,448                    0 Not imputed
                                   0                    1 Imputed

IMPAPRVU  150  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                              12,448                    0 Not imputed
                                   0                    1 Imputed

AMTOOP    151  9                                        N Amount paid out-of-pocket (OOP)

IMPSOOP   160  1  IMPFLAG                               N AMTOOP payment source imputed?

                              10,649                    0 Not imputed
                               1,799                    1 Imputed

IMPAOOP   161  1  IMPFLAG                               N AMTOOP payment amount imputed?

                               9,214                    0 Not imputed
                               3,234                    1 Imputed

AMTDISC   162  9                                        N Amount of uncollected SP liability

IMPSDISC  171  1  IMPFLAG                               N AMTDISC payment source imputed?

                              11,929                    0 Not imputed
                                 519                    1 Imputed

IMPADISC  172  1  IMPFLAG                               N AMTDISC payment amount imputed?

                              11,571                    0 Not imputed
                                 877                    1 Imputed

AMTOTH    173  9                                        N Amount paid by other payor(s)

IMPSOTH   182  1  IMPFLAG                               N AMTOTH payment source imputed?

                              12,446                    0 Not imputed
                                   2                    1 Imputed

IMPAOTH   183  1  IMPFLAG                               N AMTOTH payment amount imputed?

                              12,325                    0 Not imputed
                                 123                    1 Imputed

HMO       210  1  $HMO                                  C Event provided by an HMO?

                               6,363                    0 Event not provided by HMO
                               6,085                    1 Event provided by HMO

