Variable Format    Q#/Freq            Description/Label
 
BASEID   $BSIDFMT                      Unique SP Identification Number          
                          5,272        LOW-HIGH          BASEID Count                            
 
SURVEYYR SVYRFMT                       Survey Year                              
                          5,272                    2016  2016                                    
 
VERSION  VERSFMT                       Version Number                           
                          5,272                       1  Version 1                               
 
M0010_CM                               M0010 CMS Certification Number (CCN)     
                          5,272        Range of values   Range of Values                         
 
M0014_BR                               M0014 Branch State Code                  
                          5,272                          Range of Values                         
 
M0016_BR                               M0016 Branch ID                          
                          5,272        Range of values   Range of Values                         
 
M0018_NN                               M0018 NPI Physician ID                   
                          5,272                          Range of Values                         
 
M0018_NU $INDICOA                      M0018 NPI Physician ID Unknown           
                          5,169        0                 Not indicated                           
                            103        1                 Indicated                               
 
M0030_ST MMDDYYn8                      M0030 Start of Care Date                 
                          5,272        MMDDYYYY          Date as MMDDYYYY                        
 
M0032_RO MMDDYYn8                      M0032 Resumption of Care Date            
                          4,875                       .  Inapplicable                            
                            397        MMDDYYYY          Date as MMDDYYYY                        
 
M0032_RN $YESNOOA                      M0032 Resumption of Care Date NA         
                            397        0                 No                                      
                          4,875        1                 Yes                                     
 
M0069_GN $SEXFMT                       M0069 Patient Sex                     
                          1,904        1                 Male                                    
                          3,368        2                 Female                                  
 
M0080_AS $DISCIOA                      M0080 Disc of Person Completing Assess   
                          4,343        01                RN                                      
                            841        02                PT                                      
                             18        03                SLP/ST                                  
                             70        04                OT                                      
 
M0090_AS MMDDYYn8                      M0090 Date Assessment Completed          
                          5,272        MMDDYYYY          Date as MMDDYYYY                        
 
M0100_RS $ACOMPOA                      M0100 Reason for Assessment              
                          1,788        01                S/R; Start; further visits planned      
                            263        03                S/R; Resumption of care                 
                          1,233        04                Follow-up; Recertification              
                             10        05                Follow-up; Other                        
                            437        06                Transfer to inpat fac; Patient not disch
                             68        07                Transfer to inpat fac; Patient disch    
                             11        08                Disch from agency; Death at home        
                          1,462        09                Disch from agency; Disch from agency    
 
M0102_PD MMDDYYn8                      M0102 Phys Ordered SOC or ROC Date       
                          4,621                       .  Inapplicable                            
                            651        MMDDYYYY          Date as MMDDYYYY                        
 
M0102_PN $INDICOA                      M0102 Phys Ordered SOC or ROC Date NA    
                          3,233                          Missing                                 
                            639        0                 Not indicated                           
                          1,400        1                 Indicated                               
 
M0104_RF MMDDYYn8                      M0104 Date Of Referral                   
                          3,872                       .  Inapplicable                            
                          1,400        MMDDYYYY          Date as MMDDYYYY                        
 
M0110_EP $EPSDFMT                      M0110 Episode Timing                     
                          1,978                          Missing                                 
                          2,131        01                Early                                   
                            944        02                Later                                   
                            113        NA                No case mix group defined               
                            106        UK                Unknown                                 
 
M0140_AM $INDICOA                      M0140 Race/Eth:Amer Indian/Alaskan Nat   
                          3,221                          Missing                                 
                          2,041        0                 Not indicated                           
                             10        1                 Indicated                               
 
M0140_AS $INDICOA                      M0140 Race/Ethnicity: Asian              
                          3,221                          Missing                                 
                          2,018        0                 Not indicated                           
                             33        1                 Indicated                               
 
M0140_AF $INDICOA                      M0140 Race/Eth:Black or African-American 
                          3,221                          Missing                                 
                          1,797        0                 Not indicated                           
                            254        1                 Indicated                               
 
M0140_HS $INDICOA                      M0140 Race/Ethnicity: Hispanic or Latino 
                          3,221                          Missing                                 
                          1,875        0                 Not indicated                           
                            176        1                 Indicated                               
 
M0140_NT $INDICOA                      M0140 Race/Eth:Nat Hawaii/Oth Pacific Isl
                          3,221                          Missing                                 
                          2,047        0                 Not indicated                           
                              4        1                 Indicated                               
 
M0140_WH $INDICOA                      M0140 Race/Eth:White                     
                          3,221                          Missing                                 
                            468        0                 Not indicated                           
                          1,583        1                 Indicated                               
 
M0150_DF $INDICOA                      M0150 Medicaid Fee For Service Payment   
                          4,983        0                 Not indicated                           
                            289        1                 Indicated                               
 
M0150_DH $INDICOA                      M0150 Medicaid HMO/Managed Care Payment  
                          5,174        0                 Not indicated                           
                             98        1                 Indicated                               
 
M0150_RF $INDICOA                      M0150 Medicare Fee For Service Payment   
                          1,330        0                 Not indicated                           
                          3,942        1                 Indicated                               
 
M0150_RH $INDICOA                      M0150 Medicare HMO/Managed Care Payment  
                          4,136        0                 Not indicated                           
                          1,136        1                 Indicated                               
 
M0150_NO $INDICOA                      M0150 No Payment                         
                          5,272        0                 Not indicated                           
 
M0150_OG $INDICOA                      M0150 Other Government Payment           
                          5,235        0                 Not indicated                           
                             37        1                 Indicated                               
 
M0150_OP $INDICOA                      M0150 Other Payment Source               
                          5,255        0                 Not indicated                           
                             17        1                 Indicated                               
 
M0150_PH $INDICOA                      M0150 Private HMO/Managed Care Payment   
                          5,256        0                 Not indicated                           
                             16        1                 Indicated                               
 
M0150_PI $INDICOA                      M0150 Private Insurance Payment          
                          5,184        0                 Not indicated                           
                             88        1                 Indicated                               
 
M0150_SE $INDICOA                      M0150 Self-Pay Payment                   
                          5,228        0                 Not indicated                           
                             44        1                 Indicated                               
 
M0150_TI $INDICOA                      M0150 Title Programs Payment             
                          5,270        0                 Not indicated                           
                              2        1                 Indicated                               
 
M0150_UN $INDICOA                      M0150 Unknown Payment Source             
                          3,221                          Missing                                 
                          2,051        0                 Not indicated                           
 
M0150_WC $INDICOA                      M0150 Workers Compensation Payment       
                          5,272        0                 Not indicated                           
 
M0903_LA MMDDYYn8                      M0903 Date of Last Home Visit            
                          3,294                       .  Inapplicable                            
                          1,978        MMDDYYYY          Date as MMDDYYYY                        
 
M0906_DS MMDDYYn8                      M0906 Discharge/Transfer/Death Date      
                          3,294                       .  Inapplicable                            
                          1,978        MMDDYYYY          Date as MMDDYYYY                        
 
M1000_IP $INDICOA                      M1000 Inp Discharg;Short Stay Acut Hosp  
                          3,221                          Missing                                 
                          1,105        0                 Not indicated                           
                            946        1                 Indicated                               
 
M1000_IR $INDICOA                      M1000 Inp Discharg;IRF                   
                          3,221                          Missing                                 
                          1,921        0                 Not indicated                           
                            130        1                 Indicated                               
 
M1000_NF $INDICOA                      M1000 Inp Discharg;Nursing Facility      
                          3,221                          Missing                                 
                          2,042        0                 Not indicated                           
                              9        1                 Indicated                               
 
M1000_LT $INDICOA                      M1000 Discharged Past 14 Days;LTCH       
                          3,221                          Missing                                 
                          2,037        0                 Not indicated                           
                             14        1                 Indicated                               
 
M1000_NO $INDICOA                      M1000 No Inp Discharge                   
                          3,221                          Missing                                 
                          1,341        0                 Not indicated                           
                            710        1                 Indicated                               
 
M1000_OT $INDICOA                      M1000 Inp Discharg;Other                 
                          3,221                          Missing                                 
                          2,042        0                 Not indicated                           
                              9        1                 Indicated                               
 
M1000_PS $INDICOA                      M1000 Inp Discharg;Psych Hospital Or Unit
                          3,221                          Missing                                 
                          2,047        0                 Not indicated                           
                              4        1                 Indicated                               
 
M1000_SN $INDICOA                      M1000 Inp Discharg;SNF/TCU Facility      
                          3,221                          Missing                                 
                          1,766        0                 Not indicated                           
                            285        1                 Indicated                               
 
M1005_IU $INDICOA                      M1005 Inpat Discharge Date Unknown       
                          3,931                          Missing                                 
                          1,307        0                 Not indicated                           
                             34        1                 Indicated                               
 
M1005_ID MMDDYYn8                      M1005 Most Recent Inpat Discharge Date   
                          3,965                       .  Inapplicable                            
                          1,307        MMDDYYYY          Date as MMDDYYYY                        
 
M1016_MN $INDICOA                      M1016 Reg Change;Not Applic ICD-9 Code   
                          5,272                          Missing                                 
 
M1018_IC $INDICOA                      M1018 Pri Cond;Indwelling/SuprapubicCathe
                          3,221                          Missing                                 
                          2,003        0                 Not indicated                           
                             48        1                 Indicated                               
 
M1018_DB $INDICOA                      M1018 Pri Cond;Disruptive Behavior       
                          3,221                          Missing                                 
                          2,021        0                 Not indicated                           
                             30        1                 Indicated                               
 
M1018_ID $INDICOA                      M1018 Pri Cond;Impaired Decision-Making  
                          3,221                          Missing                                 
                          1,626        0                 Not indicated                           
                            425        1                 Indicated                               
 
M1018_IP $INDICOA                      M1018 Pri Cond;Intractable Pain          
                          3,221                          Missing                                 
                          1,768        0                 Not indicated                           
                            283        1                 Indicated                               
 
M1018_ML $INDICOA                      M1018 Pri Cond;Memory Loss               
                          3,221                          Missing                                 
                          1,759        0                 Not indicated                           
                            292        1                 Indicated                               
 
M1018_NA $INDICOA                      M1018 Pri Cond;Not Applicable            
                          3,221                          Missing                                 
                          1,889        0                 Not indicated                           
                            162        1                 Indicated                               
 
M1018_NO $INDICOA                      M1018 Pri Cond;None of the Above         
                          3,221                          Missing                                 
                          1,349        0                 Not indicated                           
                            702        1                 Indicated                               
 
M1018_UN $INDICOA                      M1018 Pri Cond;Unknown                   
                          3,221                          Missing                                 
                          2,032        0                 Not indicated                           
                             19        1                 Indicated                               
 
M1018_UI $INDICOA                      M1018 Pri Cond;Urinary Incontinence      
                          3,221                          Missing                                 
                          1,205        0                 Not indicated                           
                            846        1                 Indicated                               
 
M1030_HE $INDICOA                      M1030 Home Thera; Enteral Nutrition      
                          1,978                          Missing                                 
                          3,264        0                 Not indicated                           
                             30        1                 Indicated                               
 
M1030_HI $INDICOA                      M1030 Home Thera; Intravenous/Infusion Th
                          1,978                          Missing                                 
                          3,223        0                 Not indicated                           
                             71        1                 Indicated                               
 
M1030_HN $INDICOA                      M1030 Home Thera; None of the Above      
                          1,978                          Missing                                 
                            102        0                 Not indicated                           
                          3,192        1                 Indicated                               
 
M1030_HP $INDICOA                      M1030 Home Thera; Parenteral Nutrition   
                          1,978                          Missing                                 
                          3,293        0                 Not indicated                           
                              1        1                 Indicated                               
 
M1034_OV $STATUOA                      M1034 Overall Status                     
                          3,221                          Missing                                 
                            162        00                SP is stable with no heightened risk    
                          1,070        01                SP is temporarily facing high health ris
                            710        02                SP is likely to remain in fragile health
                            109        03                SP has serious progressive conditions   
 
M1036_RA $INDICOA                      M1036 Risk Factor - Alcohol Dependency   
                          3,221                          Missing                                 
                          2,008        0                 Not indicated                           
                             43        1                 Indicated                               
 
M1036_RD $INDICOA                      M1036 Risk Factor - Drug Dependency      
                          3,221                          Missing                                 
                          2,033        0                 Not indicated                           
                             18        1                 Indicated                               
 
M1036_RN $INDICOA                      M1036 Risk Factor - None of the Above    
                          3,221                          Missing                                 
                            790        0                 Not indicated                           
                          1,261        1                 Indicated                               
 
M1036_RO $INDICOA                      M1036 Risk Factor - Obesity              
                          3,221                          Missing                                 
                          1,625        0                 Not indicated                           
                            426        1                 Indicated                               
 
M1036_RS $INDICOA                      M1036 Risk Factor - Smoking              
                          3,221                          Missing                                 
                          1,657        0                 Not indicated                           
                            394        1                 Indicated                               
 
M1036_RU $INDICOA                      M1036 Risk Factor - Unknown              
                          3,221                          Missing                                 
                          2,016        0                 Not indicated                           
                             35        1                 Indicated                               
 
M1100_PT $PTLVG                        M1100 Patient Living Arrangement         
                          3,221                          Missing                                 
                            213        01                Lives alone, 24 hour assistance         
                             41        02                Lives alone, daytime assistance         
                             12        03                Lives alone, nighttime assistance       
                            279        04                Lives alone, occasional/short-term asst 
                             14        05                Lives alone, no assistance              
                          1,070        06                Lives at home w/others, 24 hr assistance
                             18        07                Lives at home w/others, daytime assist  
                             63        08                Lives at home w/others, nighttime assist
                             60        09                Lives at home w/others, occas/short-term
                              5        10                Lives at home w/others, no assistance av
                            265        11                Lives in congregate situation, 24 hour a
                              1        12                Lives in congregate situation, daytime a
                             10        14                Lives in congregate situation, occasiona
 
M1200_VS $VISIOOA                      M1200 Vision                             
                          1,978                          Missing                                 
                          2,156        00                Normal vision                           
                          1,077        01                Partially impaired                      
                             61        02                Severely impaired                       
 
M1210_HE $HEARCOA                      M1210 Hearing                            
                          3,221                          Missing                                 
                          1,125        00                Adequate                                
                            896        01                Mildly to moderately impaired           
                             28        02                Severely impaired                       
                              2        UK                Unable to assess hearing                
 
M1220_UN $VERBAOA                      M1220 Understand Verbal Content          
                          3,221                          Missing                                 
                          1,077        00                Understands                             
                            763        01                Usually understands                     
                            192        02                Sometimes understands                   
                             12        03                Never understands                       
                              7        UK                Unable to assess hearing                
 
M1230_VR $SPEECOA                      M1230 Verbal Expression                  
                          1,759                          Missing                                 
                          2,159        00                No observable impairement               
                          1,011        01                Minimal difficulty                      
                            242        02                Moderate difficulty                     
                             65        03                Severe difficulty                       
                             30        04                Unable to express basic needs           
                              6        05                Nonresponsive or unable to speak        
 
M1240_PA $PAINAOA                      M1240 Formal Pain Assess                 
                          3,221                          Missing                                 
                             16        00                No standardized assessment              
                          1,558        01                Yes, severe pain not indicated          
                            477        02                Yes, severe pain indicated              
 
M1242_PA $FREQCOA                      M1242 Freq Of Pain Interfere W Activity  
                            516                          Missing                                 
                          1,239        00                No pain                                 
                            542        01                Pain does not interfere                 
                            645        02                Less often than daily                   
                          1,846        03                Daily, but not constantly               
                            484        04                All of the time                         
 
M1300_PR $ULASSOA                      M1300 Pressure Ulcer Assess              
                          3,221                          Missing                                 
                             13        00                No assessment conducted                 
                            108        01                Yes, based on eval of clinical factors  
                          1,930        02                Yes, using a standardized tool          
 
M1302_PR $YESNOOA                      M1302 Risk Of Devel Press Ulcers         
                          3,234                          Missing                                 
                          1,089        0                 No                                      
                            949        1                 Yes                                     
 
M1306_PR $YESNOOA                      M1306 Unheal Press Ulcers; St II+        
                            516                          Missing                                 
                          4,570        0                 No                                      
                            186        1                 Yes                                     
 
M1307_PD $OLDPUL                       M1307 Oldest St II Press Ulcer Onset Date
                          5,258                          Missing                                 
                             12        01                Was present at most recent SOC/ROC asses
                              1        02                Developed since most recent SOC/ROC asse
                              1        NA                None present at discharge               
 
M1307_PS MMDDYYn8                      M1307 Oldest St II Press Ulcer Since SOC/
                          5,271                       .  Inapplicable                            
                              1        MMDDYYYY          Date as MMDDYYYY                        
 
M1308_2N                               M1308 # Curr Press Ulcers, St II         
                          5,272                          Range of Values                         
 
M1308_3N                               M1308 # Curr Press Ulcers, St III        
                          5,272                          Range of Values                         
 
M1308_4N                               M1308 # Current Press Ulcers, St IV      
                          5,272                          Range of Values                         
 
M1308_ES                               M1308 # Unstag PresUlc;Eschar            
                          5,272                          Range of Values                         
 
M1308_DE                               M1308 # Unstag PresUlc;DeepTissue        
                          5,272                          Range of Values                         
 
M1308_UN                               M1308 # Unstag PresUlc;NonRemovDsg       
                          5,272                          Range of Values                         
 
M1320_PR $ULSTAPO                      M1320 Status, Most Problemat Press Ulcer 
                          5,178                          Missing                                 
                              2        00                Newly epithelialized                    
                              3        01                Fully granulating                       
                              2        02                Early/Partial granulation               
                             87        03                Not healing                             
 
M1322_ST $ULNUMOA                      M1322 Curr # Of Stage I Press Ulcers     
                            516                          Missing                                 
                          4,688        00                None                                    
                             52        01                One                                     
                             13        02                Two                                     
                              3        04                Four or more                            
 
M1324_PR $ULSTGOA                      M1324 Stage, Most Problemat Press Ulcer  
                            516                          Not assessed/no information             
                             53        01                Stage one                               
                            113        02                Stage two                               
                             35        03                Stage three                             
                             27        04                Stage four                              
                          4,528        NA                No observable pressure ulcer            
 
M1330_ST $STASUOA                      M1330 Stasis Ulcer Present               
                            516                          Missing                                 
                          4,668        00                No                                      
                              9        01                Yes, BOTH observable and unobservable   
                             69        02                Yes, Observable only                    
                             10        03                Yes, Unobservable only                  
 
M1332_ST $ULNUMOA                      M1332 Curr # Of Stasis Ulcer             
                          5,194                          Missing                                 
                             41        01                One                                     
                             23        02                Two                                     
                              3        03                Three                                   
                             11        04                Four or more                            
 
M1334_ST $ULSTAQO                      M1334 Status, Most Problemat Stasis Ulcer
                          5,194                          Missing                                 
                              5        01                Fully granulating                       
                             22        02                Early/Partial granulation               
                             51        03                Not healing                             
 
M1340_SR $SURGWOA                      M1340 Surgical Wound Present             
                            516                          Missing                                 
                          4,102        00                No                                      
                            568        01                Yes, observable                         
                             86        02                Yes, not observable                     
 
M1342_SR $ULSTAQO                      M1342 Status, Most Problemat Surg Wound  
                          4,704                          Missing                                 
                            264        00                Newly epithelialized                    
                             37        01                Fully granulating                       
                             61        02                Early/Partial granulation               
                            206        03                Not healing                             
 
M1350_OP $YESNOOA                      M1350 Skin Lesion Or Open Wound          
                          3,221                          Missing                                 
                          1,550        0                 No                                      
                            501        1                 Yes                                     
 
M1400_SO $SBREAOA                      M1400 When Is Patient Dyspneic or SOB    
                            516                          Missing                                 
                          1,511        00                Never                                   
                          1,231        01                When walking more than 20 feet          
                          1,383        02                With moderate exertion                  
                            504        03                With minimal exertion                   
                            127        04                At rest (day or night)                  
 
M1410_CP $INDICOA                      M1410 Resp Treat @ Home;CPAP/BPAP        
                          3,221                          Missing                                 
                          1,983        0                 Not indicated                           
                             68        1                 Indicated                               
 
M1410_RS $INDICOA                      M1410 Resp Treat @ Home;None of the Above
                          3,221                          Missing                                 
                            361        0                 Not indicated                           
                          1,690        1                 Indicated                               
 
M1410_OX $INDICOA                      M1410 Resp Treat @ Home;Oxygen           
                          3,221                          Missing                                 
                          1,728        0                 Not indicated                           
                            323        1                 Indicated                               
 
M1410_VN $INDICOA                      M1410 Resp Treat @ Home;Ventilator       
                          3,221                          Missing                                 
                          2,047        0                 Not indicated                           
                              4        1                 Indicated                               
 
M1500_HR $SYMHFOA                      M1500 Heart Fail Present                 
                          3,766                          Missing                                 
                            348        00                No                                      
                            135        01                Yes                                     
                              2        02                Not assessed                            
                          1,021        NA                NA                                      
 
M1510_CA $INDICOA                      M1510 Heart Fail FollUp;Chg In Care Plan 
                          5,137                          Missing                                 
                            113        0                 Not indicated                           
                             22        1                 Indicated                               
 
M1510_CL $INDICOA                      M1510 Heart Fail FollUp;Pt Educ/Clinic In
                          5,137                          Missing                                 
                             33        0                 Not indicated                           
                            102        1                 Indicated                               
 
M1510_ER $INDICOA                      M1510 Heart Fail FollUp;Emerg Trea Advise
                          5,137                          Missing                                 
                            102        0                 Not indicated                           
                             33        1                 Indicated                               
 
M1510_NO $INDICOA                      M1510 Heart Fail FollUp;No Action Taken  
                          5,137                          Missing                                 
                            135        0                 Not indicated                           
 
M1510_CN $INDICOA                      M1510 Heart Fail FollUp;Phys Contacted   
                          5,137                          Missing                                 
                             80        0                 Not indicated                           
                             55        1                 Indicated                               
 
M1510_TR $INDICOA                      M1510 Heart Fail FollUp;Phys Ordered Trea
                          5,137                          Missing                                 
                             85        0                 Not indicated                           
                             50        1                 Indicated                               
 
M1600_UT $UTINFOA                      M1600 UTI Treatment                      
                          1,759                          Missing                                 
                          3,216        00                No                                      
                            262        01                Yes                                     
                             23        NA                Patient on prophylactic treatment       
                             12        UK                Unknown                                 
 
M1610_UR $UIUCPOA                      M1610 Urinar Incont Or Catheter Presence 
                            516                          Missing                                 
                          1,884        00                No incontinence or catheter             
                          2,623        01                Patient is incintinent                  
                            249        02                Patient requires a urinary catheter     
 
M1615_UR $URINCOO                      M1615 Urinar Incont Timing               
                          3,425                          Missing                                 
                            154        00                Timed-voiding deters incontinence       
                            707        01                Occasional stress incontinence          
                             74        02                During the night only                   
                             20        03                During the day only                     
                            892        04                During the day and night                
 
M1620_BW $BWINCOA                      M1620 Bowel Incontinence Frequency       
                            516                          Missing                                 
                          3,864        00                Very rarely or never has bowel incont   
                            254        01                Less than once weekly                   
                            292        02                One to three times weekly               
                            100        03                Four to six times weekly                
                            150        04                On a daily basis                        
                             35        05                More often than once daily              
                             61        NA                Patient has ostomy for bowel elimination
 
M1630_OS $BWOSTOA                      M1630 Ostomy For Bowel Elimination       
                          1,978                          Missing                                 
                          3,242        00                Does not have an ostomy                 
                             44        01                Ostomy was not related to inpatient stay
                              8        02                Ostomy was related to inpatient stay    
 
M1700_CG $COGFUOA                      M1700 Cognitive Functioning              
                          1,759                          Missing                                 
                          1,969        00                Alert/Oriented                          
                          1,033        01                Req prompting                           
                            358        02                Req assist and some direction           
                            127        03                Req conciderable assist in routine situa
                             26        04                Totally dependent due to disturbances   
 
M1710_CN $WCONFOA                      M1710 When Confused Frequency            
                          1,759                          Missing                                 
                          1,707        00                Never                                   
                          1,250        01                In new or complex situations            
                             66        02                On awakening or at night only           
                            363        03                During the day or evening               
                            121        04                Constantly                              
                              6        NA                Patient nonresponsive                   
 
M1720_AN $WANXIOA                      M1720 When Anxious Frequency             
                          1,759                          Missing                                 
                          2,061        00                None of the time                        
                            903        01                Less often than daily                   
                            519        02                Daily, but not constantly               
                             24        03                All of the time                         
                              6        NA                Patient nonresponsive                   
 
M1730_DS $DEPRAOA                      M1730 Depression Screening               
                          3,221                          Missing                                 
                             46        00                No                                      
                          1,934        01                Yes, PHQ-2 scale                        
                             14        02                Yes, other, further evaluation          
                             57        03                Yes, other, no further evaluation       
 
M1730_PD $DEPRBOA                      M1730 PHQ2 Down/Depressed/Hopeless       
                          3,338                          Missing                                 
                          1,536        00                Not at all (0-1)                        
                            293        01                Several days (2-6)                      
                             47        02                More than half of the days (7-11)       
                             22        03                Nearly every day (12-14)                
                             36        NA                Patient nonresponsive                   
 
M1730_PI $DEPRBOA                      M1730 PHQ2 Little Interest/Pleasure      
                          3,338                          Missing                                 
                          1,570        00                Not at all (0-1)                        
                            260        01                Several days (2-6)                      
                             42        02                More than half of the days (7-11)       
                             26        03                Nearly every day (12-14)                
                             36        NA                Patient nonresponsive                   
 
M1740_DL $INDICOA                      M1740 Cog/Behav/Psych; Delusional        
                          1,759                          Missing                                 
                          3,476        0                 Not indicated                           
                             37        1                 Indicated                               
 
M1740_IM $INDICOA                      M1740 Cog/Behav/Psych;Impaired Decision_m
                          1,759                          Missing                                 
                          2,805        0                 Not indicated                           
                            708        1                 Indicated                               
 
M1740_ME $INDICOA                      M1740 Cog/Behav/Psych;Memory Deficit     
                          1,759                          Missing                                 
                          2,882        0                 Not indicated                           
                            631        1                 Indicated                               
 
M1740_CG $INDICOA                      M1740 Cog/Behav/Psych;None of the Above  
                          1,759                          Missing                                 
                            987        0                 Not indicated                           
                          2,526        1                 Indicated                               
 
M1740_PH $INDICOA                      M1740 Cog/Behav/Psych;Physical Aggression
                          1,759                          Missing                                 
                          3,495        0                 Not indicated                           
                             18        1                 Indicated                               
 
M1740_DS $INDICOA                      M1740 Cog/Behav/Psych;Disruptive/Inapprop
                          1,759                          Missing                                 
                          3,490        0                 Not indicated                           
                             23        1                 Indicated                               
 
M1740_VR $INDICOA                      M1740 Cog/Behav/Psych;Verbal Disruption  
                          1,759                          Missing                                 
                          3,474        0                 Not indicated                           
                             39        1                 Indicated                               
 
M1745_DS $FREQBOA                      M1745 Freq Of Disruptive Behav Symptoms  
                          1,759                          Missing                                 
                          2,833        00                Never                                   
                            124        01                Less than once a month                  
                             28        02                One a month                             
                            106        03                Several times each month                
                            147        04                Several times a week                    
                            275        05                At least daily                          
 
M1750_PH $YESNOOA                      M1750 Receives Psych Nursing Services    
                          3,221                          Missing                                 
                          2,025        0                 No                                      
                             26        1                 Yes                                     
 
M1800_GR $GROOMOA                      M1800 Current Grooming                   
                          1,759                          Missing                                 
                            989        00                Able to groom self unaided              
                          1,303        01                Utensils must be placed within reach    
                            956        02                Someone must assis patient to groom self
                            265        03                Depends entirely upon another person    
 
M1810_DR $DRESSOA                      M1810 Current Dress Upper Body           
                            516                          Missing                                 
                          1,139        00                No assist needed                        
                          1,678        01                No assist needed if clothing laid out   
                          1,522        02                Assist from another person              
                            417        03                Depends entirely upon another person    
 
M1820_DR $DRESSOA                      M1820 Current Dress Lower Body           
                            516                          Missing                                 
                            974        00                No assist needed                        
                          1,003        01                No assist needed if clothing laid out   
                          2,107        02                Assist from another person              
                            672        03                Depends entirely upon another person    
 
M1830_BA $BATHCOA                      M1830 Ability To Wash Body               
                            516                          Missing                                 
                            373        00                Bathes self independently               
                            638        01                Bathes self with use of devices         
                          1,071        02                Bathes with intermittent assist         
                          1,662        03                Bathes with complete assist/supervision 
                            209        04                Unable, bed/sink/chair, independent     
                            470        05                Unable, bed/sing/chair, assisted        
                            333        06                Unable, totally bathed by another person
 
M1840_TO $TOILEOA                      M1840 Current Toilet Transferring        
                            516                          Missing                                 
                          1,570        00                Toilet, to and from independently       
                          2,197        01                Toilet, when reminded/assist/supervised 
                            529        02                Unable toil, able to bedside commode    
                             85        03                Unable toil/bedside commode, able bedpan
                            375        04                Depends entirely upon another person    
 
M1845_TO $TOILEOA                      M1845 Current Toileting Hygiene          
                          1,759                          Missing                                 
                          1,096        00                Toilet, to and from independently       
                          1,064        01                Toilet, when reminded/assist/supervised 
                          1,042        02                Unable toil, able to bedside commode    
                            311        03                Unable toil/bedside commode, able bedpan
 
M1850_TR $TRANSOA                      M1850 Current Transferring               
                            516                          Missing                                 
                            831        00                Able to independently transfer          
                          2,281        01                Transfers with minimal assist or device 
                          1,196        02                Unable transfer self, able to pivot     
                            328        03                Unable transfer self, unable to pivot   
                             45        04                Bedfast, unable trans, able to positio  
                             75        05                Bedfast, unable trans, unable to positio
 
M1860_AM $AMBUCOA                      M1860 Current Ambulation/Locomotion      
                            516                          Missing                                 
                            429        00                Able to independently walk/stairs       
                            597        01                Able to walk w/ 1 handed device         
                          1,570        02                Able to walk w/ 2 handed device         
                          1,600        03                Able to walk w/ constant assist/supervis
                            242        04                Chairfast, able to wheel self independ  
                            256        05                Chairfast, unable to wheel self independ
                             62        06                Bedfast, unable to ambulate/or chair    
 
M1870_EA $FEEDIOA                      M1870 Current Feeding or Eating          
                          1,759                          Missing                                 
                          1,699        00                Able independently feed self            
                          1,620        01                Able feed self with intermittent assist 
                            160        02                Unable feed self, complete assist/superv
                              9        03                Able take nutri oral, rec tube feedi    
                             18        04                Unable take nutri oral, rec tube feedi  
                              7        05                Unable take nutri oral or tube feedi    
 
M1880_PR $MEALSOA                      M1880 Current Plan/Prepare Light Meal    
                          1,759                          Missing                                 
                            983        00                Able to independently prepare all meals 
                          1,299        01                Unable to prepare meals on regular basis
                          1,231        02                Unable to prepare any meals             
 
M1890_TE $TELEPOA                      M1890 Current Telephone Use              
                          1,759                          Missing                                 
                          2,239        00                Able independently dial/answer calls    
                            293        01                Able use a specif adapted phone and call
                            357        02                Able answer calls, diff placing calls   
                            233        03                Able answer calls only some of the time 
                            131        04                Unable answer phone at all, can listen  
                            144        05                Totaly unable to use the telephone      
                            116        NA                Patient does not have a telephone       
 
M1900_PA $PRADLOA                      M1900 Pri Funct ADL/IADL; Ambulation     
                          3,221                          Missing                                 
                            850        00                Independent                             
                          1,017        01                Needed some help                        
                            184        02                Dependent                               
 
M1900_PH $PRADLOA                      M1900 Pri Funct ADL/IADL; Household Tasks
                          3,221                          Missing                                 
                            416        00                Independent                             
                            945        01                Needed some help                        
                            690        02                Dependent                               
 
M1900_PS $PRADLOA                      M1900 Pri Funct ADL/IADL; Self Care      
                          3,221                          Missing                                 
                            746        00                Independent                             
                          1,106        01                Needed some help                        
                            199        02                Dependent                               
 
M1900_PT $PRADLOA                      M1900 Pri Funct ADL/IADL; Transfer       
                          3,221                          Missing                                 
                            941        00                Independent                             
                            954        01                Needed some help                        
                            156        02                Dependent                               
 
M1910_FA $FALLMOA                      M1910 Multi-Factor Fall Risk Assessment  
                          3,221                          Missing                                 
                             11        00                No multi-factor fall risk assessment    
                             86        01                Yes, does not indicated a risk for fall 
                          1,954        02                Yes, indicates a risk for falls fall    
 
M2000_DR $DRUGROA                      M2000 Drug Regimen Review                
                          3,686                          Missing                                 
                              9        00                Not assessed                            
                          1,196        01                No problems found during review         
                            381        02                Problems found during review            
 
M2002_MD $YESNOOA                      M2002 Medication Follow-Up               
                          4,891                          Missing                                 
                             75        0                 No                                      
                            306        1                 Yes                                     
 
M2004_MD $YESNAOA                      M2004 Medication Intervention            
                          3,766                          Missing                                 
                            118        00                No                                      
                            349        01                Yes                                     
                          1,039        NA                Not applicable                          
 
M2010_DR $YESNAOA                      M2010 Patient/Caregiv High Risk Drug Educ
                          3,221                          Missing                                 
                             31        00                No                                      
                          1,630        01                Yes                                     
                            390        NA                Not applicable                          
 
M2015_DR $YESNAOA                      M2015 Patient/Caregiv Drug Educ Intervent
                          3,766                          Missing                                 
                             34        00                No                                      
                          1,468        01                Yes                                     
                              4        NA                Not applicable                          
 
M2020_OR $MGMRXOA                      M2020 Curr Manag Of Oral Medications     
                          1,759                          Missing                                 
                            918        00                Able to independently take correct med  
                            874        01                Able to take med corect times w/ prepare
                            532        02                Able to take med corect times w/ assist 
                          1,182        03                Unable to take med unless administered  
                              7        NA                No med of this type prescribed          
 
M2030_IN $MGMRXOA                      M2030 Curr Manag Of Injectable Medication
                            516                          Missing                                 
                            223        00                Able to independently take correct med  
                            168        01                Able to take med corect times w/ prepare
                             83        02                Able to take med corect times w/ assist 
                            428        03                Unable to take med unless administered  
                          3,854        NA                No med of this type prescribed          
 
M2040_PR $PRADLOA                      M2040 Prior Medication Manag; Injectable 
                          3,221                          Missing                                 
                            113        00                Independent                             
                            145        01                Needed some help                        
                            125        02                Dependent                               
                          1,668        NA                NA                                      
 
M2110_AD $FREQAOA                      M2110 Freq Of ADL/IADL Assist From Caregi
                          3,221                          Missing                                 
                          1,726        01                Daily                                   
                            161        02                Three or more times per week            
                             95        03                One to two times per week               
                             29        04                Received, but less often than weekly    
                             35        05                No assistance received                  
                              5        UK                Unknown                                 
 
M2200_NA $INDICOA                      M2200 Therapy Need; Not Applicable       
                          1,978                          Missing                                 
                          3,181        0                 Not indicated                           
                            113        1                 Indicated                               
 
M2200_VI                               M2200 Therapy Need; Number Of Visits     
                          5,272                          Range of Values                         
 
M2250_DB $YESNAOA                      M2250 POC Synop; Diabetic Foot Care      
                          3,221                          Missing                                 
                             13        00                No                                      
                            665        01                Yes                                     
                          1,373        NA                Not applicable                          
 
M2250_DT $ASSISOA                      M2250 POC Synop; Depression Intervention 
                          3,221                          Missing                                 
                             23        00                No assistance needed                    
                            566        01                Currently provide assistance            
                          1,462        NA                Not applicable                          
 
M2250_FA $ASSISOA                      M2250 POC Synop; Fall Prevention         
                          3,221                          Missing                                 
                              9        00                No assistance needed                    
                          1,999        01                Currently provide assistance            
                             43        NA                Not applicable                          
 
M2250_PI $YESNAOA                      M2250 POC Synop; Pain Intervention       
                          3,221                          Missing                                 
                             23        00                No                                      
                          1,709        01                Yes                                     
                            319        NA                Not applicable                          
 
M2250_PR $YESNAOA                      M2250 POC Synop; Press Ulcer Prevention  
                          3,221                          Missing                                 
                             19        00                No                                      
                          1,034        01                Yes                                     
                            998        NA                Not applicable                          
 
M2250_PU $YESNAOA                      M2250 POC Synop; Press Ulcer Moist Treatm
                          3,221                          Missing                                 
                              6        00                No                                      
                             91        01                Yes                                     
                          1,954        NA                Not applicable                          
 
M2250_PN $YESNAOA                      M2250 POC Synop; Parameter Phys Notif    
                          3,221                          Missing                                 
                             49        00                No                                      
                            912        01                Yes                                     
                          1,090        NA                Not applicable                          
 
M2300_EM $EMERCOA                      M2300 EmergCare Since Last OASIS         
                          3,766                          Missing                                 
                          1,166        00                No                                      
                             60        01                Yes, without hospital admission         
                            265        02                Yes, with hospital admission            
                             15        UK                Unknown                                 
 
M2310_CR $INDICOA                      M2310 EmergCare;Cardiac Dysrhythmia      
                          4,847                          Missing                                 
                            415        0                 Not indicated                           
                             10        1                 Indicated                               
 
M2310_IV $INDICOA                      M2310 EmergCare;IV Catheter Infection    
                          4,847                          Missing                                 
                            424        0                 Not indicated                           
                              1        1                 Indicated                               
 
M2310_DE $INDICOA                      M2310 EmergCare;Dehydration/Malnutrition 
                          4,847                          Missing                                 
                            410        0                 Not indicated                           
                             15        1                 Indicated                               
 
M2310_PL $INDICOA                      M2310 EmergCare;DVT, Pulmonary Embolus   
                          4,847                          Missing                                 
                            423        0                 Not indicated                           
                              2        1                 Indicated                               
 
M2310_GI $INDICOA                      M2310 EmergCare;GI Issues                
                          4,847                          Missing                                 
                            405        0                 Not indicated                           
                             20        1                 Indicated                               
 
M2310_HR $INDICOA                      M2310 EmergCare;Heart Failure            
                          4,847                          Missing                                 
                            394        0                 Not indicated                           
                             31        1                 Indicated                               
 
M2310_DB $INDICOA                      M2310 EmergCare;Hypo/Hyperglycemia/Diabet
                          4,847                          Missing                                 
                            421        0                 Not indicated                           
                              4        1                 Indicated                               
 
M2310_FA $INDICOA                      M2310 EmergCare;Injury From Fall         
                          4,847                          Missing                                 
                            386        0                 Not indicated                           
                             39        1                 Indicated                               
 
M2310_MD $INDICOA                      M2310 EmergCare;Improper Medication Admin
                          4,847                          Missing                                 
                            421        0                 Not indicated                           
                              4        1                 Indicated                               
 
M2310_MN $INDICOA                      M2310 EmergCare;Acute Mental/Behavioral  
                          4,847                          Missing                                 
                            413        0                 Not indicated                           
                             12        1                 Indicated                               
 
M2310_CH $INDICOA                      M2310 EmergCare;Myocardial Infarc/Chest P
                          4,847                          Missing                                 
                            414        0                 Not indicated                           
                             11        1                 Indicated                               
 
M2310_OT $INDICOA                      M2310 EmergCare;Other                    
                          4,847                          Missing                                 
                            274        0                 Not indicated                           
                            151        1                 Indicated                               
 
M2310_OH $INDICOA                      M2310 EmergCare;Other Heart Disease      
                          4,847                          Missing                                 
                            413        0                 Not indicated                           
                             12        1                 Indicated                               
 
M2310_RS $INDICOA                      M2310 EmergCare;Respir Infection         
                          4,847                          Missing                                 
                            402        0                 Not indicated                           
                             23        1                 Indicated                               
 
M2310_OR $INDICOA                      M2310 EmergCare;Other Respir Problem     
                          4,847                          Missing                                 
                            386        0                 Not indicated                           
                             39        1                 Indicated                               
 
M2310_ST $INDICOA                      M2310 EmergCare;Stroke (CVA) or TIA      
                          4,847                          Missing                                 
                            414        0                 Not indicated                           
                             11        1                 Indicated                               
 
M2310_UN $INDICOA                      M2310 EmergCare;Unknown                  
                          4,847                          Missing                                 
                            400        0                 Not indicated                           
                             25        1                 Indicated                               
 
M2310_PA $INDICOA                      M2310 EmergCare;Uncontrolled Pain        
                          4,847                          Missing                                 
                            398        0                 Not indicated                           
                             27        1                 Indicated                               
 
M2310_UT $INDICOA                      M2310 EmergCare;Urinary Tract Infection  
                          4,847                          Missing                                 
                            395        0                 Not indicated                           
                             30        1                 Indicated                               
 
M2310_WN $INDICOA                      M2310 EmergCare;Wound Infection/Deteriora
                          4,847                          Missing                                 
                            411        0                 Not indicated                           
                             14        1                 Indicated                               
 
M2400_DB $YESNAOA                      M2400 Synopsis; Diabetic Foot Care       
                          3,766                          Missing                                 
                             10        00                No                                      
                            483        01                Yes                                     
                          1,013        NA                Not applicable                          
 
M2400_DP $YESNAOA                      M2400 Synopsis; Depression Prevention    
                          3,766                          Missing                                 
                             23        00                No                                      
                            433        01                Yes                                     
                          1,050        NA                Not applicable                          
 
M2400_FA $YESNAOA                      M2400 Synopsis; Falls Prevention         
                          3,766                          Missing                                 
                              6        00                No                                      
                          1,467        01                Yes                                     
                             33        NA                Not applicable                          
 
M2400_PI $YESNAOA                      M2400 Synopsis; Pain Intervention        
                          3,766                          Missing                                 
                              8        00                No                                      
                          1,290        01                Yes                                     
                            208        NA                Not applicable                          
 
M2400_PV $YESNAOA                      M2400 Synopsis; Press Ulcer Prevention   
                          3,766                          Missing                                 
                              9        00                No                                      
                            738        01                Yes                                     
                            759        NA                Not applicable                          
 
M2400_PS $YESNAOA                      M2400 Synopsis; Press Ulcer Moist Treatme
                          3,766                          Missing                                 
                              7        00                No                                      
                             83        01                Yes                                     
                          1,416        NA                Not applicable                          
 
M2410_AD $INFACOA                      M2410 Admit Inpatient Facility Type      
                          3,305                          Missing                                 
                            467        01                Hospital                                
                             16        02                Rehabilitation facility                 
                             19        03                Nursing home                            
                              3        04                Hospice                                 
                          1,462        NA                No inpatient facility admission         
 
M2420_DS $DISPOCA                      M2420 Discharge Location                 
                          3,810                          Missing                                 
                          1,054        01                Patient remained in commun, no assistive
                            368        02                Patient remained in commun, assistive   
                             23        03                Patient transferred to a noninsti hospic
                              6        04                Unknown, location not served by agency  
                             11        UK                Unknown, other                          
 
M2430_CR $INDICOA                      M2430 Hosp Reas;Cardiac Dysrhythmia      
                          4,805                          Missing                                 
                            457        0                 Not indicated                           
                             10        1                 Indicated                               
 
M2430_IV $INDICOA                      M2430 Hosp Reas IV Catheter Infection    
                          4,805                          Missing                                 
                            467        0                 Not indicated                           
 
M2430_DE $INDICOA                      M2430 Hosp Reas;Dehydration/Malnutrition 
                          4,805                          Missing                                 
                            457        0                 Not indicated                           
                             10        1                 Indicated                               
 
M2430_GI $INDICOA                      M2430 Hosp Reas;GI Issues                
                          4,805                          Missing                                 
                            447        0                 Not indicated                           
                             20        1                 Indicated                               
 
M2430_HR $INDICOA                      M2430 Hosp Reas;Heart Failure            
                          4,805                          Missing                                 
                            434        0                 Not indicated                           
                             33        1                 Indicated                               
 
M2430_FA $INDICOA                      M2430 Hosp Reas;Injury Caused by Fall    
                          4,805                          Missing                                 
                            438        0                 Not indicated                           
                             29        1                 Indicated                               
 
M2430_MD $INDICOA                      M2430 Hosp Reas;Improper Medication Admin
                          4,805                          Missing                                 
                            463        0                 Not indicated                           
                              4        1                 Indicated                               
 
M2430_MN $INDICOA                      M2430 Hosp Reas;Acute Mental/Behavioral  
                          4,805                          Missing                                 
                            453        0                 Not indicated                           
                             14        1                 Indicated                               
 
M2430_CH $INDICOA                      M2430 Hosp Reas Myocardial Infarc/Chest P
                          4,805                          Missing                                 
                            459        0                 Not indicated                           
                              8        1                 Indicated                               
 
M2430_OC $INDICOA                      M2430 Hosp Reas Other                    
                          4,805                          Missing                                 
                            304        0                 Not indicated                           
                            163        1                 Indicated                               
 
M2430_OH $INDICOA                      M2430 Hosp Reas Other Heart Disease      
                          4,805                          Missing                                 
                            457        0                 Not indicated                           
                             10        1                 Indicated                               
 
M2430_PA $INDICOA                      M2430 Hosp Reas Uncontrolled Pain        
                          4,805                          Missing                                 
                            445        0                 Not indicated                           
                             22        1                 Indicated                               
 
M2430_RS $INDICOA                      M2430 Hosp Reas Respiratory Infection    
                          4,805                          Missing                                 
                            432        0                 Not indicated                           
                             35        1                 Indicated                               
 
M2430_OR $INDICOA                      M2430 Hosp Reas Other Respiratory Problem
                          4,805                          Missing                                 
                            418        0                 Not indicated                           
                             49        1                 Indicated                               
 
M2430_SC $INDICOA                      M2430 Hosp Reas Sched Treatment/Procedure
                          4,805                          Missing                                 
                            445        0                 Not indicated                           
                             22        1                 Indicated                               
 
M2430_ST $INDICOA                      M2430 Hosp Reas Stroke (CVA) Or TIA      
                          4,805                          Missing                                 
                            455        0                 Not indicated                           
                             12        1                 Indicated                               
 
M2430_UN $INDICOA                      M2430 Hosp Reas Unknown                  
                          4,805                          Missing                                 
                            436        0                 Not indicated                           
                             31        1                 Indicated                               
 
M2430_UT $INDICOA                      M2430 Hosp Reas Urinary Tract Infect     
                          4,805                          Missing                                 
                            437        0                 Not indicated                           
                             30        1                 Indicated                               
 
M2430_PL $INDICOA                      M2430 Hosp Reas;DVT, Pulmonary Embolus   
                          4,805                          Missing                                 
                            461        0                 Not indicated                           
                              6        1                 Indicated                               
 
M2430_WN $INDICOA                      M2430 Hosp Reas Wound Infection/Deteriora
                          4,805                          Missing                                 
                            448        0                 Not indicated                           
                             19        1                 Indicated                               
 
M2430_DB $INDICOA                      M2430 Hosp Reas;Hypo/Hyperglycemia/Diabet
                          4,805                          Missing                                 
                            465        0                 Not indicated                           
                              2        1                 Indicated                               
 
