-3808


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Property Specification
Data System MDS
Data Specs V1.14.1
Edit Type Format
Severity Warning
Edit Text When this Section S item is required by a State, it should equal one of the valid values indicated in the data specifications for that item. Note that for numeric items, signed numbers (with a leading plus or minus sign) should not be submitted.
Version Notes [V1.14.0]-Added new Section S items to item list.

Item List
Item ID Description
S0101 Admitted from Community
S0102 Admitted from NH or SB
S0111 Lived Alone
S0115 Spouse Location
S0120 Prior Residence ZIP Code
S0122 Prior Residence State
S0123 Prior Residence County
S0125 Prior Residence Town Code
S0130 Highest Education Completed
S0140 Physician License Number
S0141 Physician Name
S0150 State Resident ID
S0160 Specialty unit
S0161A Requires specialized unit: dementia/Alzheimer
S0161B Requires specialized unit: behavioral health
S0161C Requires specialized unit: TBI
S0161D Requires specialized unit: ventilator
S0161Z Requires specialized unit: none of the above
S0165A Specialty services: Dementia/Alzheimers
S0165B Specialty services: Behavioral Health
S0165C Specialty services: Traumatic Brain Injury
S0165D Specialty services: Ventilator
S0165E Specialty services: On-Site Dialysis
S0165Z Specialty services: None of the Above
S0170A Advanced directive: Guardian
S0170B Advanced directive: DPOA-HC
S0170C Advanced directive: Living will
S0170D Advanced directive: Do not resuscitate
S0170E Advanced directive: Do not hospitalize
S0170F Advanced directive: Do not intubate
S0170G Advanced directive: Feeding restrictions
S0170H Advanced directive: Other treatment restrictions
S0170Z Advanced directive: None of the above
S0171A Resident healthcare proxy exists
S0171B Resident healthcare proxy invoked
S0172A Goal discussion: documentation received
S0172B Goal discussion: hospital
S0172C Goal discussion: previous NH
S0172D Goal discussion: Home without home health services
S0172E Goal discussion: Home with home health services
S0172F Goal discussion: PCP office
S0172G Goal discussion: Other
S0172H Goal discussion: Not occur reason
S0173 Documentation of goals of care discussion
S0174 Resident has Advanced Directive
S0175 Resident has POA for Health Care
S0180 Discharged to Community
S0183 Discharged prior to admission assessment
S0500 Level of Care
S0501 CCNH RHNS Level of Care
S0510 PASRR Screening Complete
S0511 PASRR Date
S0512 PASRR Level 1
S0513 PASRR Screening Outcome
S0520 Reason for Admission
S0600A Meets criteria: requires ventilator 10+ hours
S0600B Meets criteria: requires ventilator 16+ hours
S0600C Meets criteria: Traumatic Brain Injury-Tier I
S0600D Meets criteria: Traumatic Brain Injury-Tier II
S0600E Meets criteria: Traumatic Brain Injury-Tier III
S0600Z Meets criteria: none of the above
S1000 Local Health Department Reporting
S1001 State Health Department Reporting
S1100A Disease: Clostridium Difficile
S1100B Disease: MRSA
S1100C Disease: VRE
S1100D Disease: VISA
S1100E Disease: VRSA
S1100F Disease: Other MDRO
S1100F1 Disease: MDRO Name1
S1100F2 Disease: MDRO Name2
S1100G Disease: Tuberculosis
S1100H Disease: Herpes Zoster
S1100I Disease: Scabies
S1100J Disease: CRE
S1100Z Disease: None of the Above
S1200A Primary/secondary SMI dx: schizophrenia
S1200B Primary/secondary SMI dx: delusional disorder
S1200C Primary/secondary SMI dx: schizoaffective disorder
S1200D Primary/secondary SMI dx: psychotic disorder NOS
S1200E Primary/secondary SMI dx: bipolar disorder I
S1200F Primary/secondary SMI dx: bipolar disorder II
S1200G Primary/secondary SMI dx: cyclothymic disorder
S1200H Primary/secondary SMI dx: bipolar disorder NOS
S1200I Primary/secondary SMI dx: major depress recurrent
S2000 Capable of self-administration of medications
S2001 Wishes to self-medicate
S2010 Refused meds 3 days
S2011 Staff support for meds 3 days
S2015 Refused meds occasionally 30 days
S2016 Refused meds frequently 30 days
S2040 Behavior Management Program
S2050 Resists grooming/hygiene
S2060A Resident centered care: Oasis
S2060B Resident centered care: habilitation therapy
S2060C Resident centered care: hand in hand
S2060D Resident centered care: consistent assignment
S2060E Resident centered care: other
S2060Z Resident centered care: none of the above
S3100A Contractures: Hand
S3100B Contractures: Wrist
S3100C Contractures: Elbow
S3100D Contractures: Shoulder
S3100E Contractures: Neck
S3100F Contractures: Ankle
S3100G Contractures: Knee
S3100H Contractures: Hip
S3100Z Contractures: Other
S3200A Dominant Side
S3200B Use of dominant hand/arm
S3300 Weight-based Equipment Need
S3305A Lifting device for weight
S3305B Wheelchair or mobility device for weight
S3305C Bed for weight
S3305D Seating for weight
S3305E More than 2 staff for weight
S3305Y Other for weight
S4000A Harm: Self Injury/Self-injurious attempt
S4000B Harm: Attempt was to kill self
S4000C Harm: Considered injuring self
S4000D Harm: Self-injury caregiver concern
S4010A Hourly Interval Observation
S4010B 15- Min. Interval Observation
S4010C 5- Min. Interval Observation
S4010D Constant Observation for < 1 hr
S4010E Constant Observation for > 1 hr
S4500 Substance Abuse: Alcoholic Drinks
S4510A Substance Abuse: Inhalants
S4510B Substance Abuse: Hallucinogens
S4510C Substance Abuse: Cocaine and Crack
S4510D Substance Abuse: Stimulants
S4510E Substance Abuse: Opiates
S4510F Substance Abuse: Cannabis
S5000 Number of New Pressure Ulcers
S5005 New Pressure Ulcer setting
S5010A1 Pressure ulcer 1 location
S5010A2 Pressure ulcer 1 status
S5010B1 Pressure ulcer 2 location
S5010B2 Pressure ulcer 2 status
S5010C1 Pressure ulcer 3 location
S5010C2 Pressure ulcer 3 status
S5010D1 Pressure ulcer 4 location
S5010D2 Pressure ulcer 4 status
S5010E1 Pressure ulcer 5 location
S5010E2 Pressure ulcer 5 status
S5010F1 Pressure ulcer 6 location
S5010F2 Pressure ulcer 6 status
S5010G1 Pressure ulcer 7 location
S5010G2 Pressure ulcer 7 status
S5010H1 Pressure ulcer 8 location
S5010H2 Pressure ulcer 8 status
S5010I1 Pressure ulcer 9 location
S5010I2 Pressure ulcer 9 status
S6000 Parenteral/IV feeding in NH
S6005 IV meds in NH
S6010 Oxygen Therapy in NH
S6020A Vent/resp specialized RN expertise
S6020B Vent/resp specialized CNA training needed
S6020C Vent/resp specialized therapy (PT,OT,RT) expertise
S6020D Vent/resp specialized equipment
S6020Y Vent/resp Other
S6020Z Vent/resp None of the Above
S6022A Vent/resp days licensed nurse: hourly intervals
S6022B Vent/resp days licensed nurse: 15-minute intervals
S6022C Vent/resp days licensed nurse: 5-minute intervals
S6023A Vent/resp days CNA: hourly intervals
S6023B Vent/resp days CNA: 15-minute intervals
S6023C Vent/resp days CNA: 5-minute intervals
S6024A Vent/resp days RT: hourly intervals
S6024B Vent/resp days RT: 15-minute intervals
S6024C Vent/resp days RT: 5-minute intervals
S6050 Isolation precautions needed
S6051A Isolation Precaution: Airborne
S6051B Isolation Precaution: Contact
S6051C Isolation Precaution: Droplet
S6051D Isolation Precaution: Protective
S6100A Vaccination: Varicella
S6100B Vaccination: Tetanus, diphtheria (Td)
S6100C Vaccination: Tetanus, diphtheria, pertussis (Tdap)
S6100D Vaccination: Measles, Mumps, Rubella (MMR)
S6100E Vaccination: Other
S6100F1 Vaccination: Other Name 1
S6100F2 Vaccination: Other Name 2
S6100F3 Vaccination: Other Name 3
S6100Z Vaccination: None of the above
S6200 Number of Hospital Stays
S6205 Number of Observation Stays
S6210 Number of ER visits
S6220 Alzheimer"s/Dementia Special Care Unit
S6230 Has resident received antipsychotic
S6232 Is resident currently receiving antipsychotic
S6234 Attempt to reduce amount of antipsychotic
S6236 Was reduction in antipsychotic maintained
S7000 Dental Care
S8000A1 Medicare - Primary Payor
S8000A2 Medicare - Secondary Payor
S8000A3 Medicare Payor
S8000B1 Medicare Part A - Primary Payor
S8000B2 Medicare Part A - Secondary Payor
S8000B3 Medicare Part A Payor
S8000C1 Medicare Part B - Primary Payor
S8000C2 Medicare Part B - Secondary Payor
S8000C3 Medicare Part B Payor
S8000D1 Medicare Part C - Primary Payor
S8000D2 Medicare Part C - Secondary Payor
S8000D3 Medicare Part C Payor
S8000E1 Medicare per diem - Primary Payor
S8000E2 Medicare per diem - Secondary Payor
S8000E3 Medicare per diem Payor
S8000Z Medicare not a payment source
S8010A1 In-state Medicaid - Primary Payor
S8010A2 In-state Medicaid - Secondary Payor
S8010A3 In-state Medicaid payor
S8010B1 Out-of-state Medicaid - Primary Payor
S8010B2 Out-of-state Medicaid - Secondary Payor
S8010B3 Out-of-state Medicaid Payor
S8010C1 Medicaid per diem - Primary Payor
S8010C2 Medicaid per diem - Secondary Payor
S8010C3 Medicaid per diem Payor
S8010D1 Medicaid managed care per diem - Primary Payor
S8010D2 Medicaid managed care per diem - Secondary Payor
S8010D3 Medicaid managed care per diem Payor
S8010E1 Medicaid per diem (not MC) - Primary Payor
S8010E2 Medicaid per diem (not MC) - Secondary Payor
S8010E3 Medicaid per diem (not MC) Payor
S8010F Medicaid per diem type
S8010F1 Medicaid Resident Liability - Primary Payor
S8010F2 Medicaid Resident Liability - Secondary Payor
S8010F3 Medicaid Resident Liability Payor
S8010G Medicaid state source
S8010G1 Medicare Co-Pay - Primary Payor
S8010G2 Medicare Co-pay - Secondary Payor
S8010G3 Medicare Co-pay Payor
S8010H1 Picture Date reporting
S8010H2 Medicaid Other - Secondary Payor
S8010H3 Medicaid Other Payor
S8010I1 Medicaid Pending - Primary Payor
S8010I2 Medicaid Pending - Secondary Payor
S8010I3 Medicaid Pending Payor
S8010Z Medicaid not a payment source
S8020A1 Private - Primary Payor
S8020A2 Private - Secondary Payor
S8020A3 Private Payor
S8020B1 Private per diem - Primary Payor
S8020B2 Private per diem - Secondary Payor
S8020B3 Private per diem Payor
S8020C1 Private LTC insurance policy - Primary Payor
S8020C2 Private LTC insurance policy - Secondary Payor
S8020C3 Private LTC insurance policy
S8020Z Private insurance not a payment source
S8030A1 Self-pay - Primary Payor
S8030A2 Self-pay - Secondary Payor
S8030A3 Self-pay Payor
S8030B1 Family pay - Primary Payor
S8030B2 Family pay - Secondary Payor
S8030B3 Family pay Payor
S8030C Self or Family pay for full per diem
S8030Z Self or Family not a payment source
S8040A1 State Run Medical Assistance - Primary Payor
S8040A2 State Run Medical Assistance - Secondary Payor
S8040A3 State Run Medical Assistance Payor
S8040B1 Tricare per diem - Primary Payor
S8040B2 Tricare per diem - Secondary Payor
S8040B3 Tricare per diem Payor
S8040C1 VA per diem - Primary Payor
S8040C2 VA per diem - Secondary Payor
S8040C3 VA per diem Payor
S8040D1 Other Public - Primary Payor
S8040D2 Other Public - Secondary Payor
S8040D3 Other Public Payor
S8040Z Other government not a payment source
S8050A1 Other - Primary Payor
S8050A2 Other - Secondary Payor
S8050A3 Other Payor
S8050B Other Payor Name 1
S8050C Other Payor Name 2
S8050D Other Payor Name 3
S8055 Primary payor
S8099 Payor: None of the Above
S8500 Medicaid begin date
S8510A Medicaid Therapeutic bed-hold days since last asmt
S8510B Medicaid Therapeutic bed-hold days - YTD
S8512A Medicaid hospital bed-hold days since last asmt
S8512B Medicaid hospital bed-hold days - YTD
S8520A Medicaid Leave Days Type 1
S8520B Leave Days for Medicaid begin date 1
S8520C Leave Days for Medicaid end date 1
S8521A Medicaid Leave Days Type 2
S8521B Leave Days for Medicaid begin date 2
S8521C Leave Days for Medicaid end date 2
S9000 IL Skills Training
S9001 IL IDPH Subpart S criteria
S9002A IL IDPH Subpart S: Schizophrenia
S9002B IL IDPH Subpart S: Delusional disorder
S9002C IL IDPH Subpart S: Schizoaffective disorder
S9002D IL IDPH Subpart S:Psychotic disorder not specified
S9002E IL IDPH Subpart S: Bipolar I mixed, manic, & depr
S9002F IL IDPH Subpart S: Bipolar disorder II
S9002G IL IDPH Subpart S: Cyclothymic disorder
S9002H IL IDPH Subpart S: Bipolar disorder not specified
S9002I IL IDPH Subpart S: Major depression, recurrent
S9003 IL IDPH Subpart S: Ancillary
S9020 FL FRAES number
S9040A CA POLST
S9040B CA POLST Section A
S9040C CA POLST Section B
S9040C1 CA POLST Section B (revised)
S9040D CA POLST Section C
S9040D1 CA POLST Section C (revised)
S9040E CA POLST D physician signature
S9040F CA POLST D resident signature
S9040G CA POLST D discussed with patient or decisionmaker
S9040H CA POLST advanced directive
S9060 NY Medicaid add-on eligibility
S9080A PA MA CASE-MIX
S9080B PA MA CASE-MIX Date
S9080C PA MA CASE-MIX Access Card Number
S9080D PA MA CASE-MIX MA NF Effective Date
S9080E PA MA CASE-MIX Day One MA
S9100A VA Room & Board Payment Assessment Reference Date
S9100B VA Room & Board Payment Entry Date
S9100C VA Medicaid Room & Board initial date
S9120 CT Approved LTC
S9140 Completed LAPOST

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NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 05/08/2014
MDS 3.0 dataspecs V1.14.1 | http://www.careplans.com