MDS Item Summary

Item

Group

Type

Length

Fixed Start-End

Description

ASMT_SYS_CD Control Code 10 1-10 Assessment system code
ITM_SBST_CD Control Code 3 11-13 Item subset code
ITM_SET_VRSN_CD Control Code 10 14-23 Item set version code
SPEC_VRSN_CD Control Code 10 24-33 Specifications version code
PRODN_TEST_CD Control Code 1 34-34 Production/test indicator
STATE_CD Control Code 2 35-36 Facility"s state postal code
FAC_ID Control Text 16 37-52 Assigned facility/provider submission ID
SFTWR_VNDR_ID Control Text 9 53-61 Software vendor federal employer tax ID
SFTWR_VNDR_NAME Control Text 30 62-91 Software vendor company name
SFTWR_VNDR_EMAIL_ADR Control Text 50 92-141 Software vendor email address
SFTWR_PROD_NAME Control Text 50 142-191 Software product name
SFTWR_PROD_VRSN_CD Control Text 20 192-211 Software product version code
FAC_DOC_ID Control Text 20 212-231 Facility document ID
A0050 Asmt Code 1 1216-1216 Type of transaction (formerly X0100)
A0100A Asmt Text 10 232-241 Facility National Provider Identifier (NPI)
A0100B Asmt Text 12 242-253 Facility CMS Certification Number (CCN)
A0100C Asmt Text 15 254-268 State provider number
A0200 Asmt Code 1 269-269 Type of provider
A0310A Asmt Code 2 270-271 Type of assessment: OBRA
A0310B Asmt Code 2 272-273 Type of assessment: PPS
A0310C Asmt Code 1 274-274 Type of assessment: OMRA
A0310D Asmt Code 1 275-275 Swing bed clinical change assessment
A0310E Asmt Code 1 276-276 First assessment since most recent entry
A0310F Asmt Code 2 277-278 Entry/discharge reporting
A0310G Asmt Code 1 1439-1439 Planned/unplanned discharge
A0410 Asmt Code 1 279-279 Submission requirement
A0500A Asmt Text 12 280-291 Resident first name
A0500B Asmt Text 1 292-292 Resident middle initial
A0500C Asmt Text 18 293-310 Resident last name
A0500D Asmt Text 3 311-313 Resident name suffix
A0600A Asmt Text 9 314-322 Social Security Number
A0600B Asmt Text 12 323-334 Resident Medicare/railroad insurance number
A0700 Asmt Text 14 335-348 Resident Medicaid number
A0800 Asmt Code 1 350-350 Gender
A0900 Asmt Date 8 351-358 Birthdate
A1000A Asmt Checklist 1 359-359 Ethnicity: American Indian or Alaska Native
A1000B Asmt Checklist 1 360-360 Ethnicity: Asian
A1000C Asmt Checklist 1 361-361 Ethnicity: Black or African American
A1000D Asmt Checklist 1 362-362 Ethnicity: Hispanic or Latino
A1000E Asmt Checklist 1 363-363 Ethnicity: Native Hawaiian/Pacific Islander
A1000F Asmt Checklist 1 364-364 Ethnicity: White
A1100A Asmt Code 1 365-365 Does the resident need or want an interpreter
A1100B Asmt Text 15 366-380 Preferred language
A1200 Asmt Code 1 381-381 Marital status
A1300A Asmt Text 12 382-393 Medical record number
A1300B Asmt Text 10 394-403 Room number
A1300C Asmt Text 23 404-426 Name by which resident prefers to be addressed
A1300D Asmt Text 23 427-449 Lifetime occupation(s)
A1500 Asmt Code 1 450-450 Resident evaluated by PASRR
A1510A Asmt Checklist 1 1440-1440 Level II PASRR conditions: Serious Mental Illness
A1510B Asmt Checklist 1 1441-1441 Level II PASRR conditions: Mental Retardation
A1510C Asmt Checklist 1 1442-1442 Level II PASRR conditions: Other related condition
A1550A Asmt Checklist 1 451-451 ID/DD status: Down syndrome
A1550B Asmt Checklist 1 452-452 ID/DD status: Autism
A1550C Asmt Checklist 1 453-453 ID/DD status: Epilepsy
A1550D Asmt Checklist 1 454-454 ID/DD status: other organic ID/DD condition
A1550E Asmt Checklist 1 455-455 ID/DD status: ID/DD with no organic condition
A1550Z Asmt Checklist 1 456-456 ID/DD status: none of the above
A1600 Asmt Date 8 457-464 Entry date (date of admission/reentry in facility)
A1700 Asmt Code 1 465-465 Type of entry
A1800 Asmt Code 2 466-467 Entered from
A2000 Asmt Date 8 468-475 Discharge date
A2100 Asmt Code 2 476-477 Discharge status
A2200 Asmt Date 8 478-485 Previous asmt reference date for signif correction
A2300 Asmt Date 8 486-493 Assessment reference date
A2400A Asmt Code 1 494-494 Has resident had Medicare-covered stay
A2400B Asmt Date 8 495-502 Start date of most recent Medicare stay
A2400C Asmt Date 8 503-510 End date of most recent Medicare stay
B0100 Asmt Code 1 511-511 Comatose
B0200 Asmt Code 1 512-512 Hearing
B0300 Asmt Code 1 513-513 Hearing aid
B0600 Asmt Code 1 514-514 Speech clarity
B0700 Asmt Code 1 515-515 Makes self understood
B0800 Asmt Code 1 516-516 Ability to understand others
B1000 Asmt Code 1 517-517 Vision
B1200 Asmt Code 1 518-518 Corrective lenses
C0100 Asmt Code 1 519-519 BIMS: should resident interview be conducted
C0200 Asmt Code 1 520-520 BIMS res interview: repetition of three words
C0300A Asmt Code 1 521-521 BIMS res interview: able to report correct year
C0300B Asmt Code 1 522-522 BIMS res interview: able to report correct month
C0300C Asmt Code 1 523-523 BIMS res interview: can report correct day of week
C0400A Asmt Code 1 524-524 BIMS res interview: able to recall "sock"
C0400B Asmt Code 1 525-525 BIMS res interview: able to recall "blue"
C0400C Asmt Code 1 526-526 BIMS res interview: able to recall "bed"
C0500 Asmt Number 2 527-528 BIMS res interview: summary score
C0600 Asmt Code 1 529-529 Staff asmt mental status: conduct asmt
C0700 Asmt Code 1 530-530 Staff asmt mental status: short-term memory OK
C0800 Asmt Code 1 531-531 Staff asmt mental status: long-term memory OK
C0900A Asmt Checklist 1 532-532 Staff asmt mental status: recall current season
C0900B Asmt Checklist 1 533-533 Staff asmt mental status: recall location of room
C0900C Asmt Checklist 1 534-534 Staff asmt mental status: recall staff names/faces
C0900D Asmt Checklist 1 535-535 Staff asmt mental status: recall in nursing home
C0900Z Asmt Checklist 1 536-536 Staff asmt mental status: none of above recalled
C1000 Asmt Code 1 537-537 Cognitive skills for daily decision making
C1300A Asmt Code 1 538-538 Signs of delirium: inattention
C1300B Asmt Code 1 539-539 Signs of delirium: disorganized thinking
C1300C Asmt Code 1 540-540 Signs of delirium: altered level of consciousness
C1300D Asmt Code 1 541-541 Signs of delirium: psychomotor retardation
C1600 Asmt Code 1 542-542 Acute onset mental status change
D0100 Asmt Code 1 543-543 PHQ: should resident mood interview be conducted
D0200A1 Asmt Code 1 544-544 PHQ res: little interest or pleasure - presence
D0200A2 Asmt Code 1 545-545 PHQ res: little interest or pleasure - frequency
D0200B1 Asmt Code 1 546-546 PHQ res: feeling down, depressed - presence
D0200B2 Asmt Code 1 547-547 PHQ res: feeling down, depressed - frequency
D0200C1 Asmt Code 1 548-548 PHQ res: trouble with sleep - presence
D0200C2 Asmt Code 1 549-549 PHQ res: trouble with sleep - frequency
D0200D1 Asmt Code 1 550-550 PHQ res: feeling tired/little energy - presence
D0200D2 Asmt Code 1 551-551 PHQ res: feeling tired/little energy - frequency
D0200E1 Asmt Code 1 552-552 PHQ res: poor appetite or overeating - presence
D0200E2 Asmt Code 1 553-553 PHQ res: poor appetite or overeating - frequency
D0200F1 Asmt Code 1 554-554 PHQ res: feeling bad about self - presence
D0200F2 Asmt Code 1 555-555 PHQ res: feeling bad about self - frequency
D0200G1 Asmt Code 1 556-556 PHQ res: trouble concentrating - presence
D0200G2 Asmt Code 1 557-557 PHQ res: trouble concentrating - frequency
D0200H1 Asmt Code 1 558-558 PHQ res: slow, fidgety, restless - presence
D0200H2 Asmt Code 1 559-559 PHQ res: slow, fidgety, restless - frequency
D0200I1 Asmt Code 1 560-560 PHQ res: thoughts better off dead - presence
D0200I2 Asmt Code 1 561-561 PHQ res: thoughts better off dead - frequency
D0300 Asmt Number 2 562-563 PHQ res: total mood severity score
D0350 Asmt Code 1 564-564 PHQ res: safety notification
D0500A1 Asmt Code 1 565-565 PHQ staff: little interest or pleasure - presence
D0500A2 Asmt Code 1 566-566 PHQ staff: little interest or pleasure - frequency
D0500B1 Asmt Code 1 567-567 PHQ staff: feeling down, depressed - presence
D0500B2 Asmt Code 1 568-568 PHQ staff: feeling down, depressed - frequency
D0500C1 Asmt Code 1 569-569 PHQ staff: trouble with sleep - presence
D0500C2 Asmt Code 1 570-570 PHQ staff: trouble with sleep - frequency
D0500D1 Asmt Code 1 571-571 PHQ staff: feeling tired/little energy - presence
D0500D2 Asmt Code 1 572-572 PHQ staff: feeling tired/little energy - frequency
D0500E1 Asmt Code 1 573-573 PHQ staff: poor appetite or overeating - presence
D0500E2 Asmt Code 1 574-574 PHQ staff: poor appetite or overeating - frequency
D0500F1 Asmt Code 1 575-575 PHQ staff: feeling bad about self - presence
D0500F2 Asmt Code 1 576-576 PHQ staff: feeling bad about self - frequency
D0500G1 Asmt Code 1 577-577 PHQ staff: trouble concentrating - presence
D0500G2 Asmt Code 1 578-578 PHQ staff: trouble concentrating - frequency
D0500H1 Asmt Code 1 579-579 PHQ staff: slow, fidgety, restless - presence
D0500H2 Asmt Code 1 580-580 PHQ staff: slow, fidgety, restless - frequency
D0500I1 Asmt Code 1 581-581 PHQ staff: thoughts better off dead - presence
D0500I2 Asmt Code 1 582-582 PHQ staff: thoughts better off dead - frequency
D0500J1 Asmt Code 1 583-583 PHQ staff: short-tempered - presence
D0500J2 Asmt Code 1 584-584 PHQ staff: short-tempered - frequency
D0600 Asmt Number 2 585-586 PHQ staff: total mood score
D0650 Asmt Code 1 587-587 PHQ staff: safety notification
E0100A Asmt Checklist 1 588-588 Psychosis: hallucinations
E0100B Asmt Checklist 1 589-589 Psychosis: delusions
E0100Z Asmt Checklist 1 590-590 Psychosis: none of the above
E0200A Asmt Code 1 591-591 Physical behav symptoms directed toward others
E0200B Asmt Code 1 592-592 Verbal behav symptoms directed toward others
E0200C Asmt Code 1 593-593 Other behav symptoms not directed toward others
E0300 Asmt Code 1 594-594 Overall presence of behavioral symptoms
E0500A Asmt Code 1 595-595 Behav symptoms put res at risk for illness/injury
E0500B Asmt Code 1 596-596 Behav symptoms interfere with resident care
E0500C Asmt Code 1 597-597 Behav symptoms interfere with social activities
E0600A Asmt Code 1 598-598 Behav symptoms put others at risk for injury
E0600B Asmt Code 1 599-599 Behav symptoms intrude on privacy of others
E0600C Asmt Code 1 600-600 Behav symptoms disrupt care or living environment
E0800 Asmt Code 1 601-601 Rejection of care: presence and frequency
E0900 Asmt Code 1 602-602 Wandering: presence and frequency
E1000A Asmt Code 1 603-603 Wandering: risk of getting to dangerous place
E1000B Asmt Code 1 604-604 Wandering: intrude on privacy of others
E1100 Asmt Code 1 605-605 Change in behavioral or other symptoms
F0300 Asmt Code 1 606-606 Conduct res interview for daily/activity prefs
F0400A Asmt Code 1 607-607 Res interview: choose clothes to wear
F0400B Asmt Code 1 608-608 Res interview: take care of personal belongings
F0400C Asmt Code 1 609-609 Res interview: choose tub, bath, shower, sponge
F0400D Asmt Code 1 610-610 Res interview: have snacks between meals
F0400E Asmt Code 1 611-611 Res interview: choose own bedtime
F0400F Asmt Code 1 612-612 Res interview: discuss care with family/friend
F0400G Asmt Code 1 613-613 Res interview: use phone in private
F0400H Asmt Code 1 614-614 Res interview: lock things to keep them safe
F0500A Asmt Code 1 615-615 Res interview: have books, newspaper, mags to read
F0500B Asmt Code 1 616-616 Res interview: listen to music
F0500C Asmt Code 1 617-617 Res interview: be around animals/pets
F0500D Asmt Code 1 618-618 Res interview: keep up with news
F0500E Asmt Code 1 619-619 Res interview: do things with groups of people
F0500F Asmt Code 1 620-620 Res interview: do favorite activities
F0500G Asmt Code 1 621-621 Res interview: go outside when good weather
F0500H Asmt Code 1 622-622 Res interview: participate in religious practices
F0600 Asmt Code 1 623-623 Primary respondent: daily/activities prefs
F0700 Asmt Code 1 624-624 Conduct staff assessment for daily/activity prefs
F0800A Asmt Checklist 1 625-625 Staff assessment: choosing clothes to wear
F0800B Asmt Checklist 1 626-626 Staff assessment: caring for personal belongings
F0800C Asmt Checklist 1 627-627 Staff assessment: receiving tub bath
F0800D Asmt Checklist 1 628-628 Staff assessment: receiving shower
F0800E Asmt Checklist 1 629-629 Staff assessment: receiving bed bath
F0800F Asmt Checklist 1 630-630 Staff assessment: receiving sponge bath
F0800G Asmt Checklist 1 631-631 Staff assessment: snacks between meals
F0800H Asmt Checklist 1 632-632 Staff assessment: staying up past 8PM
F0800I Asmt Checklist 1 633-633 Staff assessment: discuss care with family/other
F0800J Asmt Checklist 1 634-634 Staff assessment: use phone in private
F0800K Asmt Checklist 1 635-635 Staff assessment: place to lock personal things
F0800L Asmt Checklist 1 636-636 Staff assessment: reading books, newspapers, mags
F0800M Asmt Checklist 1 637-637 Staff assessment: listening to music
F0800N Asmt Checklist 1 638-638 Staff assessment: being around animals/pets
F0800O Asmt Checklist 1 639-639 Staff assessment: keeping up with news
F0800P Asmt Checklist 1 640-640 Staff assessment: doing things with groups
F0800Q Asmt Checklist 1 641-641 Staff assessment: participate favorite activities
F0800R Asmt Checklist 1 642-642 Staff assessment: spend time away from nursng home
F0800S Asmt Checklist 1 643-643 Staff assessment: spend time outdoors
F0800T Asmt Checklist 1 644-644 Staff assessment: participate religious activities
F0800Z Asmt Checklist 1 645-645 Staff assessment: none of above activities
G0110A1 Asmt Code 1 646-646 Bed mobility: self-performance
G0110A2 Asmt Code 1 647-647 Bed mobility: support provided
G0110B1 Asmt Code 1 648-648 Transfer: self-performance
G0110B2 Asmt Code 1 649-649 Transfer: support provided
G0110C1 Asmt Code 1 650-650 Walk in room: self-performance
G0110C2 Asmt Code 1 651-651 Walk in room: support provided
G0110D1 Asmt Code 1 652-652 Walk in corridor: self-performance
G0110D2 Asmt Code 1 653-653 Walk in corridor: support provided
G0110E1 Asmt Code 1 654-654 Locomotion on unit: self-performance
G0110E2 Asmt Code 1 655-655 Locomotion on unit: support provided
G0110F1 Asmt Code 1 656-656 Locomotion off unit: self-performance
G0110F2 Asmt Code 1 657-657 Locomotion off unit: support provided
G0110G1 Asmt Code 1 658-658 Dressing: self-performance
G0110G2 Asmt Code 1 659-659 Dressing: support provided
G0110H1 Asmt Code 1 660-660 Eating: self-performance
G0110H2 Asmt Code 1 661-661 Eating: support provided
G0110I1 Asmt Code 1 662-662 Toilet use: self-performance
G0110I2 Asmt Code 1 663-663 Toilet use: support provided
G0110J1 Asmt Code 1 664-664 Personal hygiene: self-performance
G0110J2 Asmt Code 1 665-665 Personal hygiene: support provided
G0120A Asmt Code 1 666-666 Bathing: self-performance
G0120B Asmt Code 1 667-667 Bathing: support provided
G0300A Asmt Code 1 668-668 Balance: moving from seated to standing position
G0300B Asmt Code 1 669-669 Balance: walking (with assistive device if used)
G0300C Asmt Code 1 670-670 Balance: turning around while walking
G0300D Asmt Code 1 671-671 Balance: moving on and off toilet
G0300E Asmt Code 1 672-672 Balance: surface-to-surface transfer
G0400A Asmt Code 1 673-673 ROM limitation: upper extremity
G0400B Asmt Code 1 674-674 ROM limitation: lower extremity
G0600A Asmt Checklist 1 675-675 Mobility devices: cane/crutch
G0600B Asmt Checklist 1 676-676 Mobility devices: walker
G0600C Asmt Checklist 1 677-677 Mobility devices: wheelchair (manual or electric)
G0600D Asmt Checklist 1 678-678 Mobility devices: limb prosthesis
G0600Z Asmt Checklist 1 679-679 Mobility devices: none of the above
G0900A Asmt Code 1 680-680 Resident believes capable of increased independ
G0900B Asmt Code 1 681-681 Staff believes res capable of increased independ
H0100A Asmt Checklist 1 682-682 Appliances: indwelling catheter
H0100B Asmt Checklist 1 683-683 Appliances: external catheter
H0100C Asmt Checklist 1 684-684 Appliances: ostomy
H0100D Asmt Checklist 1 685-685 Appliances: intermittent catheterization
H0100Z Asmt Checklist 1 686-686 Appliances: none of the above
H0200A Asmt Code 1 687-687 Urinary toileting program: has been attempted
H0200B Asmt Code 1 688-688 Urinary toileting program: response
H0200C Asmt Code 1 689-689 Urinary toileting program: current program/trial
H0300 Asmt Code 1 690-690 Urinary continence
H0400 Asmt Code 1 691-691 Bowel continence
H0500 Asmt Code 1 692-692 Bowel toileting program being used
H0600 Asmt Code 1 693-693 Constipation
I0100 Asmt Checklist 1 694-694 Cancer (with or without metastasis)
I0200 Asmt Checklist 1 695-695 Anemia
I0300 Asmt Checklist 1 696-696 Atrial fibrillation and other dysrhythmias
I0400 Asmt Checklist 1 697-697 Coronary artery disease (CAD)
I0500 Asmt Checklist 1 698-698 Deep venous thrombosis (DVT), PE, or PTE
I0600 Asmt Checklist 1 699-699 Heart failure
I0700 Asmt Checklist 1 700-700 Hypertension
I0800 Asmt Checklist 1 701-701 Orthostatic hypotension
I0900 Asmt Checklist 1 702-702 Peripheral vascular disease (PVD) or PAD
I1100 Asmt Checklist 1 703-703 Cirrhosis
I1200 Asmt Checklist 1 704-704 Gastroesophageal reflux disease (GERD) or ulcer
I1300 Asmt Checklist 1 705-705 Ulcerative colitis, Chrohn"s, inflam bowel disease
I1400 Asmt Checklist 1 706-706 Benign prostatic hyperplasia (BPH)
I1500 Asmt Checklist 1 707-707 Renal insufficiency, renal failure, ESRD
I1550 Asmt Checklist 1 708-708 Neurogenic bladder
I1650 Asmt Checklist 1 709-709 Obstructive uropathy
I1700 Asmt Checklist 1 710-710 Multidrug resistant organism (MDRO)
I2000 Asmt Checklist 1 711-711 Pneumonia
I2100 Asmt Checklist 1 712-712 Septicemia
I2200 Asmt Checklist 1 713-713 Tuberculosis
I2300 Asmt Checklist 1 714-714 Urinary tract infection (UTI) (LAST 30 DAYS)
I2400 Asmt Checklist 1 715-715 Viral hepatitis (includes type A, B, C, D, and E)
I2500 Asmt Checklist 1 716-716 Wound infection (other than foot)
I2900 Asmt Checklist 1 717-717 Diabetes mellitus (DM)
I3100 Asmt Checklist 1 718-718 Hyponatremia
I3200 Asmt Checklist 1 719-719 Hyperkalemia
I3300 Asmt Checklist 1 720-720 Hyperlipidemia (e.g., hypercholesterolemia)
I3400 Asmt Checklist 1 721-721 Thyroid disorder
I3700 Asmt Checklist 1 722-722 Arthritis
I3800 Asmt Checklist 1 723-723 Osteoporosis
I3900 Asmt Checklist 1 724-724 Hip fracture
I4000 Asmt Checklist 1 725-725 Other fracture
I4200 Asmt Checklist 1 726-726 Alzheimer"s disease
I4300 Asmt Checklist 1 727-727 Aphasia
I4400 Asmt Checklist 1 728-728 Cerebral palsy
I4500 Asmt Checklist 1 729-729 Cerebrovascular accident (CVA), TIA, or stroke
I4800 Asmt Checklist 1 730-730 Non-Alzheimer"s dementia
I4900 Asmt Checklist 1 731-731 Hemiplegia or hemiparesis
I5000 Asmt Checklist 1 732-732 Paraplegia
I5100 Asmt Checklist 1 733-733 Quadriplegia
I5200 Asmt Checklist 1 734-734 Multiple sclerosis
I5250 Asmt Checklist 1 735-735 Huntington"s disease
I5300 Asmt Checklist 1 736-736 Parkinson"s disease
I5350 Asmt Checklist 1 737-737 Tourette"s syndrome
I5400 Asmt Checklist 1 738-738 Seizure disorder or epilepsy
I5500 Asmt Checklist 1 739-739 Traumatic brain injury (TBI)
I5600 Asmt Checklist 1 740-740 Malnutrition (protein, calorie), risk of malnutrit
I5700 Asmt Checklist 1 741-741 Anxiety disorder
I5800 Asmt Checklist 1 742-742 Depression (other than bipolar)
I5900 Asmt Checklist 1 743-743 Manic depression (bipolar disease)
I5950 Asmt Checklist 1 744-744 Psychotic disorder (other than schizophrenia)
I6000 Asmt Checklist 1 745-745 Schizophrenia
I6100 Asmt Checklist 1 746-746 Post-traumatic stress disorder (PTSD)
I6200 Asmt Checklist 1 747-747 Asthma (COPD) or chronic lung disease
I6300 Asmt Checklist 1 748-748 Respiratory failure
I6500 Asmt Checklist 1 749-749 Cataracts, glaucoma, or macular degeneration
I7900 Asmt Checklist 1 750-750 None of above active diseases within last 7 days
I8000A Asmt ICD 8 751-758 Additional active ICD diagnosis 1
I8000B Asmt ICD 8 759-766 Additional active ICD diagnosis 2
I8000C Asmt ICD 8 767-774 Additional active ICD diagnosis 3
I8000D Asmt ICD 8 775-782 Additional active ICD diagnosis 4
I8000E Asmt ICD 8 783-790 Additional active ICD diagnosis 5
I8000F Asmt ICD 8 791-798 Additional active ICD diagnosis 6
I8000G Asmt ICD 8 799-806 Additional active ICD diagnosis 7
I8000H Asmt ICD 8 807-814 Additional active ICD diagnosis 8
I8000I Asmt ICD 8 815-822 Additional active ICD diagnosis 9
I8000J Asmt ICD 8 823-830 Additional active ICD diagnosis 10
J0100A Asmt Code 1 831-831 Pain: received scheduled pain med regimen
J0100B Asmt Code 1 832-832 Pain: received PRN pain medications
J0100C Asmt Code 1 833-833 Pain: received non-medication intervention
J0200 Asmt Code 1 834-834 Should pain assessment interview be conducted
J0300 Asmt Code 1 835-835 Res pain interview: presence
J0400 Asmt Code 1 836-836 Res pain interview: frequency
J0500A Asmt Code 1 837-837 Res pain interview: made it hard to sleep
J0500B Asmt Code 1 838-838 Res pain interview: limited daily activities
J0600A Asmt Number 2 839-840 Res pain interview: intensity rating scale
J0600B Asmt Code 1 841-841 Res pain interview: verbal descriptor scale
J0700 Asmt Code 1 842-842 Should staff assessment for pain be conducted
J0800A Asmt Checklist 1 843-843 Staff pain asmt: non-verbal sounds
J0800B Asmt Checklist 1 844-844 Staff pain asmt: vocal complaints of pain
J0800C Asmt Checklist 1 845-845 Staff pain asmt: facial expressions
J0800D Asmt Checklist 1 846-846 Staff pain asmt: protective movements/postures
J0800Z Asmt Checklist 1 847-847 Staff pain asmt: none of these signs observed
J0850 Asmt Code 1 848-848 Staff pain asmt: frequency of pain
J1100A Asmt Checklist 1 849-849 Short breath/trouble breathing: with exertion
J1100B Asmt Checklist 1 850-850 Short breath/trouble breathing: sitting at rest
J1100C Asmt Checklist 1 851-851 Short breath/trouble breathing: lying flat
J1100Z Asmt Checklist 1 852-852 Short breath/trouble breathing: none of above
J1300 Asmt Code 1 853-853 Current tobacco use
J1400 Asmt Code 1 854-854 Prognosis: life expectancy of less than 6 months
J1550A Asmt Checklist 1 855-855 Problem conditions: fever
J1550B Asmt Checklist 1 856-856 Problem conditions: vomiting
J1550C Asmt Checklist 1 857-857 Problem conditions: dehydrated
J1550D Asmt Checklist 1 858-858 Problem conditions: internal bleeding
J1550Z Asmt Checklist 1 859-859 Problem conditions: none of the above
J1700A Asmt Code 1 860-860 Fall history: fall during month before admission
J1700B Asmt Code 1 861-861 Fall history: fall 2-6 months before admission
J1700C Asmt Code 1 862-862 Fall history: fracture from fall 6 month pre admit
J1800 Asmt Code 1 863-863 Falls since admit/prior asmt: any falls
J1900A Asmt Code 1 864-864 Falls since admit/prior asmt: no injury
J1900B Asmt Code 1 865-865 Falls since admit/prior asmt: injury (not major)
J1900C Asmt Code 1 866-866 Falls since admit/prior asmt: major injury
K0100A Asmt Checklist 1 867-867 Swallow disorder: loss liquids/solids from mouth
K0100B Asmt Checklist 1 868-868 Swallow disorder: holds food in mouth/cheeks
K0100C Asmt Checklist 1 869-869 Swallow disorder: cough/choke with meals/meds
K0100D Asmt Checklist 1 870-870 Swallow disorder: difficulty or pain swallowing
K0100Z Asmt Checklist 1 871-871 Swallow disorder: none of the above
K0200A Asmt Number 2 872-873 Height (in inches)
K0200B Asmt Number 3 874-876 Weight (in pounds)
K0300 Asmt Code 1 877-877 Weight loss
K0310 Asmt Code 1 1443-1443 Weight Gain
K0510A1 Asmt Checklist 1 1444-1444 Nutrition approach: Not Res: parenteral/IV feeding
K0510A2 Asmt Checklist 1 1445-1445 Nutrition approach: Res: parenteral /IV feeding
K0510B1 Asmt Checklist 1 1446-1446 Nutrition approach: Not Res: feeding tube
K0510B2 Asmt Checklist 1 1447-1447 Nutrition approach: Res: feeding tube
K0510C1 Asmt Checklist 1 1448-1448 Nutrition approach: Not Res: mechanic altered diet
K0510C2 Asmt Checklist 1 1449-1449 Nutrition approach: Res: mechanic altered diet
K0510D1 Asmt Checklist 1 1450-1450 Nutrition approach: Not Res: therapeutic diet
K0510D2 Asmt Checklist 1 1451-1451 Nutrition approach: Res: therapeutic diet
K0510Z1 Asmt Checklist 1 1452-1452 Nutrition approach: Not Res: none of the above
K0510Z2 Asmt Checklist 1 1453-1453 Nutrition approach: Res: none of the above
K0710A1 Asmt Code 1 1466-1466 Prop calories parenteral/tube feed: not resident
K0710A2 Asmt Code 1 1467-1467 Prop calories parenteral/tube feed: while resident
K0710A3 Asmt Code 1 1468-1468 Prop calories parenteral/tube feed: 7 days
K0710B1 Asmt Code 1 1469-1469 Avg fluid intake per day IV/tube: not resident
K0710B2 Asmt Code 1 1470-1470 Avg fluid intake per day IV/ tube: while resident
K0710B3 Asmt Code 1 1471-1471 Avg fluid intake per day IV/tube: 7 days
L0200A Asmt Checklist 1 885-885 Dental: broken or loosely fitting denture
L0200B Asmt Checklist 1 886-886 Dental: no natural teeth or tooth fragment(s)
L0200C Asmt Checklist 1 887-887 Dental: abnormal mouth tissue
L0200D Asmt Checklist 1 888-888 Dental: cavity or broken natural teeth
L0200E Asmt Checklist 1 889-889 Dental: inflamed/bleeding gums or loose teeth
L0200F Asmt Checklist 1 890-890 Dental: pain, discomfort, difficulty chewing
L0200G Asmt Checklist 1 891-891 Dental: unable to examine
L0200Z Asmt Checklist 1 892-892 Dental: none of the above
M0100A Asmt Checklist 1 893-893 Risk determination: has ulcer, scar, or dressing
M0100B Asmt Checklist 1 894-894 Risk determination: formal assessment
M0100C Asmt Checklist 1 895-895 Risk determination: clinical assessment
M0100Z Asmt Checklist 1 896-896 Risk determination: none of the above
M0150 Asmt Code 1 897-897 Is resident at risk of developing pressure ulcer
M0210 Asmt Code 1 898-898 Resident has Stage 1 or higher pressure ulcers
M0300A Asmt Number 1 899-899 Stage 1 pressure ulcers: number present
M0300B1 Asmt Number 1 900-900 Stage 2 pressure ulcers: number present
M0300B2 Asmt Number 1 901-901 Stage 2 pressure ulcers: number at admit/reentry
M0300B3 Asmt Date 8 902-909 Stage 2 pressure ulcers: date of oldest
M0300C1 Asmt Number 1 910-910 Stage 3 pressure ulcers: number present
M0300C2 Asmt Number 1 911-911 Stage 3 pressure ulcers: number at admit/reentry
M0300D1 Asmt Number 1 912-912 Stage 4 pressure ulcers: number present
M0300D2 Asmt Number 1 913-913 Stage 4 pressure ulcers: number at admit/reentry
M0300E1 Asmt Number 1 914-914 Unstaged due to dressing: number present
M0300E2 Asmt Number 1 915-915 Unstaged due to dressing: number at admit/reentry
M0300F1 Asmt Number 1 916-916 Unstaged slough/eschar: number present
M0300F2 Asmt Number 1 917-917 Unstaged slough/eschar: number at admit/reentry
M0300G1 Asmt Number 1 918-918 Unstageable - deep tissue: number present
M0300G2 Asmt Number 1 919-919 Unstageable - deep tissue: number at admit/reentry
M0610A Asmt Number 4 920-923 Stage 3 or 4 pressure ulcer longest length
M0610B Asmt Number 4 924-927 Stage 3 or 4 pressure ulcer width (same ulcer)
M0610C Asmt Number 4 928-931 Stage 3 or 4 pressure ulcer depth (same ulcer)
M0700 Asmt Code 1 932-932 Tissue type for ulcer at most advanced stage
M0800A Asmt Number 1 933-933 Worsened since prior asmt: Stage 2 pressure ulcers
M0800B Asmt Number 1 934-934 Worsened since prior asmt: Stage 3 pressure ulcers
M0800C Asmt Number 1 935-935 Worsened since prior asmt: Stage 4 pressure ulcers
M0900A Asmt Code 1 936-936 Pressure ulcers on prior assessment
M0900B Asmt Number 1 937-937 Healed pressure ulcers: Stage 2
M0900C Asmt Number 1 938-938 Healed pressure ulcers: Stage 3
M0900D Asmt Number 1 939-939 Healed pressure ulcers: Stage 4
M1030 Asmt Number 1 940-940 Number of venous and arterial ulcers
M1040A Asmt Checklist 1 941-941 Other skin probs: infection of the foot
M1040B Asmt Checklist 1 942-942 Other skin probs: diabetic foot ulcer(s)
M1040C Asmt Checklist 1 943-943 Other skin probs: other open lesion(s) on the foot
M1040D Asmt Checklist 1 944-944 Other skin probs: lesions not ulcers, rashes, cuts
M1040E Asmt Checklist 1 945-945 Other skin probs: surgical wound(s)
M1040F Asmt Checklist 1 946-946 Other skin probs: burns (second or third degree)
M1040G Asmt Checklist 1 1454-1454 Skin Tear(s)
M1040H Asmt Checklist 1 1455-1455 Moisture Associated Skin Damage (MASD)
M1040Z Asmt Checklist 1 947-947 Other skin probs: none of the above
M1200A Asmt Checklist 1 948-948 Skin/ulcer treat: pressure reduce device for chair
M1200B Asmt Checklist 1 949-949 Skin/ulcer treat: pressure reducing device for bed
M1200C Asmt Checklist 1 950-950 Skin/ulcer treat: turning/repositioning
M1200D Asmt Checklist 1 951-951 Skin/ulcer treat: nutrition/hydration
M1200E Asmt Checklist 1 952-952 Skin/ulcer treat: pressure ulcer care
M1200F Asmt Checklist 1 953-953 Skin/ulcer treat: surgical wound care
M1200G Asmt Checklist 1 954-954 Skin/ulcer treat: application of dressings
M1200H Asmt Checklist 1 955-955 Skin/ulcer treat: apply ointments/medications
M1200I Asmt Checklist 1 956-956 Skin/ulcer treat: apply dressings to feet
M1200Z Asmt Checklist 1 957-957 Skin/ulcer treat: none of the above
N0300 Asmt Number 1 958-958 Number of days injectable medications received
N0350A Asmt Number 1 959-959 Insulin: insulin injections
N0350B Asmt Number 1 960-960 Insulin: orders for insulin
N0410A Asmt Number 1 1456-1456 Medication received: Days: antipsychotic
N0410B Asmt Number 1 1457-1457 Medication received: Days: antianxiety
N0410C Asmt Number 1 1458-1458 Medication received: Days: antidepressant
N0410D Asmt Number 1 1459-1459 Medication received: Days: hypnotic
N0410E Asmt Number 1 1460-1460 Medication received: Days: anticoagulant
N0410F Asmt Number 1 1461-1461 Medication received: Days: antibiotic
N0410G Asmt Number 1 1462-1462 Medication received: Days: diuretic
O0100A1 Asmt Checklist 1 969-969 Treatment: chemotherapy - while not resident
O0100A2 Asmt Checklist 1 970-970 Treatment: chemotherapy - while resident
O0100B1 Asmt Checklist 1 971-971 Treatment: radiation - while not resident
O0100B2 Asmt Checklist 1 972-972 Treatment: radiation - while resident
O0100C1 Asmt Checklist 1 973-973 Treatment: oxygen therapy - while not resident
O0100C2 Asmt Checklist 1 974-974 Treatment: oxygen therapy - while resident
O0100D1 Asmt Checklist 1 975-975 Treatment: suctioning - while not resident
O0100D2 Asmt Checklist 1 976-976 Treatment: suctioning - while resident
O0100E1 Asmt Checklist 1 977-977 Treatment: tracheostomy care - while not resident
O0100E2 Asmt Checklist 1 978-978 Treatment: tracheostomy care - while resident
O0100F1 Asmt Checklist 1 979-979 Treatment: vent/respirator - while not resident
O0100F2 Asmt Checklist 1 980-980 Treatment: vent/respirator - while resident
O0100G1 Asmt Checklist 1 981-981 Treatment: BiPAP/CPAP - while not resident
O0100G2 Asmt Checklist 1 982-982 Treatment: BIPAP/CPAP - while resident
O0100H1 Asmt Checklist 1 983-983 Treatment: IV medications - while not resident
O0100H2 Asmt Checklist 1 984-984 Treatment: IV medications - while resident
O0100I1 Asmt Checklist 1 985-985 Treatment: transfusions - while not resident
O0100I2 Asmt Checklist 1 986-986 Treatment: transfusions - while resident
O0100J1 Asmt Checklist 1 987-987 Treatment: dialysis - while not resident
O0100J2 Asmt Checklist 1 988-988 Treatment: dialysis - while resident
O0100K1 Asmt Checklist 1 989-989 Treatment: hospice care - while not resident
O0100K2 Asmt Checklist 1 990-990 Treatment: hospice care - while resident
O0100L2 Asmt Checklist 1 991-991 Treatment: respite care - while resident
O0100M1 Asmt Checklist 1 992-992 Treatment: isolate/quarantine - while not resident
O0100M2 Asmt Checklist 1 993-993 Treatment: isolate/quarantine - while resident
O0100Z1 Asmt Checklist 1 994-994 Treatment: none of above - while not resident
O0100Z2 Asmt Checklist 1 995-995 Treatment: none of above - while resident
O0250A Asmt Code 1 996-996 Was influenza vaccine received
O0250B Asmt Date 8 997-1004 Date influenza vaccine received.
O0250C Asmt Code 1 1005-1005 If influenza vaccine not received, state reason
O0300A Asmt Code 1 1006-1006 Is pneumococcal vaccination up to date
O0300B Asmt Code 1 1007-1007 If pneumococcal vacc not received, state reason
O0400A1 Asmt Number 4 1008-1011 Speech-language/audiology: individ minutes
O0400A2 Asmt Number 4 1012-1015 Speech-language/audiology: concur minutes
O0400A3 Asmt Number 4 1016-1019 Speech-language/audiology: group minutes
O0400A3A Asmt Number 4 1472-1475 Speech-language/audiology: co-treatment minutes
O0400A4 Asmt Number 1 1020-1020 Speech-language/audiology: number of days
O0400A5 Asmt Date 8 1021-1028 Speech-language/audiology: start date
O0400A6 Asmt Date 8 1029-1036 Speech-language/audiology: end date
O0400B1 Asmt Number 4 1037-1040 Occupational therapy: individ minutes
O0400B2 Asmt Number 4 1041-1044 Occupational therapy: concur minutes
O0400B3 Asmt Number 4 1045-1048 Occupational therapy: group minutes
O0400B3A Asmt Number 4 1476-1479 Occupational therapy: co-treatment minutes
O0400B4 Asmt Number 1 1049-1049 Occupational therapy: number of days
O0400B5 Asmt Date 8 1050-1057 Occupational therapy: start date
O0400B6 Asmt Date 8 1058-1065 Occupational therapy: end date
O0400C1 Asmt Number 4 1066-1069 Physical therapy: individ minutes
O0400C2 Asmt Number 4 1070-1073 Physical therapy: concur minutes
O0400C3 Asmt Number 4 1074-1077 Physical therapy: group minutes
O0400C3A Asmt Number 4 1480-1483 Physical therapy: co-treatment minutes
O0400C4 Asmt Number 1 1078-1078 Physical therapy: number of days
O0400C5 Asmt Date 8 1079-1086 Physical therapy: start date
O0400C6 Asmt Date 8 1087-1094 Physical therapy: end date
O0400D1 Asmt Number 4 1095-1098 Respiratory therapy: number of minutes
O0400D2 Asmt Number 1 1099-1099 Respiratory therapy: number of days
O0400E1 Asmt Number 4 1100-1103 Psychological therapy: number of minutes
O0400E2 Asmt Number 1 1104-1104 Psychological therapy: number of days
O0400F1 Asmt Number 4 1105-1108 Recreational therapy: number of minutes
O0400F2 Asmt Number 1 1109-1109 Recreational therapy: number of days
O0420 Asmt Number 1 1484-1484 Distinct calendar days of therapy
O0450A Asmt Code 1 1429-1429 Has therapy resumed
O0450B Asmt Date 8 1430-1437 Therapy resumption date
O0500A Asmt Number 1 1110-1110 Range of motion (passive): number of days
O0500B Asmt Number 1 1111-1111 Range of motion (active): number of days
O0500C Asmt Number 1 1112-1112 Splint or brace assistance: number of days
O0500D Asmt Number 1 1113-1113 Bed mobility training: number of days
O0500E Asmt Number 1 1114-1114 Transfer training: number of days
O0500F Asmt Number 1 1115-1115 Walking training: number of days
O0500G Asmt Number 1 1116-1116 Dressing and/or grooming training: number of days
O0500H Asmt Number 1 1117-1117 Eating and/or swallowing training: number of days
O0500I Asmt Number 1 1118-1118 Amputation/prosthesis training: number of days
O0500J Asmt Number 1 1119-1119 Communication training: number of days
O0600 Asmt Number 2 1120-1121 Physician examinations: number of days
O0700 Asmt Number 2 1122-1123 Physician orders: number of days
P0100A Asmt Code 1 1124-1124 Restraints used in bed: bed rail
P0100B Asmt Code 1 1125-1125 Restraints used in bed: trunk restraint
P0100C Asmt Code 1 1126-1126 Restraints used in bed: limb restraint
P0100D Asmt Code 1 1127-1127 Restraints used in bed: other
P0100E Asmt Code 1 1128-1128 Restraints in chair/out of bed: trunk restraint
P0100F Asmt Code 1 1129-1129 Restraints in chair/out of bed: limb restraint
P0100G Asmt Code 1 1130-1130 Restraints in chair/out of bed: chair stops rising
P0100H Asmt Code 1 1131-1131 Restraints in chair/out of bed: other
Q0100A Asmt Code 1 1132-1132 Resident participated in assessment
Q0100B Asmt Code 1 1133-1133 Family/signif other participated in assessment
Q0100C Asmt Code 1 1134-1134 Guardian/legal rep participated in assessment
Q0300A Asmt Code 1 1135-1135 Resident"s overall goal
Q0300B Asmt Code 1 1136-1136 Information source for resident"s goal
Q0400A Asmt Code 1 1137-1137 Active discharge planning for return to community
Q0490 Asmt Code 1 1463-1463 Resident"s preference to avoid being asked
Q0500B Asmt Code 1 1140-1140 Do you want to talk about returning to community
Q0550A Asmt Code 1 1464-1464 Reasking resident preference
Q0550B Asmt Code 1 1465-1465 Reasking resident preference source
Q0600 Asmt Code 1 1141-1141 Referral been made to Local Contact Agency
V0100A Asmt Code 2 1142-1143 Prior OBRA reason for assessment
V0100B Asmt Code 2 1144-1145 Prior PPS reason for assessment
V0100C Asmt Date 8 1146-1153 Prior assessment reference date
V0100D Asmt Number 2 1154-1155 Prior assessment BIMS summary score
V0100E Asmt Number 2 1156-1157 Prior asmt PHQ res: total mood severity score
V0100F Asmt Number 2 1158-1159 Prior asmt PHQ staff: total mood score
V0200A01A Asmt Checklist 1 1160-1160 CAA-Delirium: triggered
V0200A01B Asmt Checklist 1 1161-1161 CAA-Delirium: plan
V0200A02A Asmt Checklist 1 1162-1162 CAA-Cognitive loss/dementia: triggered
V0200A02B Asmt Checklist 1 1163-1163 CAA-Cognitive loss/dementia: plan
V0200A03A Asmt Checklist 1 1164-1164 CAA-Visual function: triggered
V0200A03B Asmt Checklist 1 1165-1165 CAA-Visual function: plan
V0200A04A Asmt Checklist 1 1166-1166 CAA-Communication: triggered
V0200A04B Asmt Checklist 1 1167-1167 CAA-Communication: plan
V0200A05A Asmt Checklist 1 1168-1168 CAA-ADL functional/rehab potential: triggered
V0200A05B Asmt Checklist 1 1169-1169 CAA-ADL functional/rehab potential: plan
V0200A06A Asmt Checklist 1 1170-1170 CAA-Urinary incont/indwell catheter: triggered
V0200A06B Asmt Checklist 1 1171-1171 CAA-Urinary incont/indwell catheter: plan
V0200A07A Asmt Checklist 1 1172-1172 CAA-Psychosocial well-being: triggered
V0200A07B Asmt Checklist 1 1173-1173 CAA-Psychosocial well-being: plan
V0200A08A Asmt Checklist 1 1174-1174 CAA-Mood state: triggered
V0200A08B Asmt Checklist 1 1175-1175 CAA-Mood state: plan
V0200A09A Asmt Checklist 1 1176-1176 CAA-Behavioral symptoms: triggered
V0200A09B Asmt Checklist 1 1177-1177 CAA-Behavioral symptoms: plan
V0200A10A Asmt Checklist 1 1178-1178 CAA-Activities: triggered
V0200A10B Asmt Checklist 1 1179-1179 CAA-Activities: plan
V0200A11A Asmt Checklist 1 1180-1180 CAA-Falls: triggered
V0200A11B Asmt Checklist 1 1181-1181 CAA-Falls: plan
V0200A12A Asmt Checklist 1 1182-1182 CAA-Nutritional status: triggered
V0200A12B Asmt Checklist 1 1183-1183 CAA-Nutritional status: plan
V0200A13A Asmt Checklist 1 1184-1184 CAA-Feeding tubes: triggered
V0200A13B Asmt Checklist 1 1185-1185 CAA-Feeding tubes: plan
V0200A14A Asmt Checklist 1 1186-1186 CAA-Dehydration/fluid maintenance: triggered
V0200A14B Asmt Checklist 1 1187-1187 CAA-Dehydration/fluid maintenance: plan
V0200A15A Asmt Checklist 1 1188-1188 CAA-Dental care: triggered
V0200A15B Asmt Checklist 1 1189-1189 CAA-Dental care: plan
V0200A16A Asmt Checklist 1 1190-1190 CAA-Pressure ulcer: triggered
V0200A16B Asmt Checklist 1 1191-1191 CAA-Pressure ulcer: plan
V0200A17A Asmt Checklist 1 1192-1192 CAA-Psychotropic drug use: triggered
V0200A17B Asmt Checklist 1 1193-1193 CAA-Psychotropic drug use: plan
V0200A18A Asmt Checklist 1 1194-1194 CAA-Physical restraints: triggered
V0200A18B Asmt Checklist 1 1195-1195 CAA-Physical restraints: plan
V0200A19A Asmt Checklist 1 1196-1196 CAA-Pain: triggered
V0200A19B Asmt Checklist 1 1197-1197 CAA-Pain: plan
V0200A20A Asmt Checklist 1 1198-1198 CAA-Return to community referral: triggered
V0200A20B Asmt Checklist 1 1199-1199 CAA-Return to community referral: plan
V0200B2 Asmt Date 8 1200-1207 CAA-Assessment process signature date
V0200C2 Asmt Date 8 1208-1215 CAA-Care planning signature date
X0150 Asmt Code 1 1217-1217 Correction: type of provider
X0200A Asmt Text 12 1218-1229 Correction: resident first name
X0200C Asmt Text 18 1230-1247 Correction: resident last name
X0300 Asmt Code 1 1248-1248 Correction: resident gender
X0400 Asmt Date 8 1249-1256 Correction: resident birth date
X0500 Asmt Text 9 1257-1265 Correction: resident social security number
X0600A Asmt Code 2 1266-1267 Correction: OBRA reason for assessment
X0600B Asmt Code 2 1268-1269 Correction: PPS reason for assessment
X0600C Asmt Code 1 1270-1270 Correction: OMRA assessment
X0600D Asmt Code 1 1271-1271 Correction: Swing bed clinical change asmt
X0600F Asmt Code 2 1427-1428 Correction: entry/discharge reporting
X0700A Asmt Date 8 1273-1280 Correction: assessment reference date
X0700B Asmt Date 8 1281-1288 Correction: discharge date
X0700C Asmt Date 8 1289-1296 Correction: entry date
X0800 Asmt Number 2 1297-1298 Correction: correction number
X0900A Asmt Checklist 1 1299-1299 Correction: modif reasons - transcription error
X0900B Asmt Checklist 1 1300-1300 Correction: modif reasons - data entry error
X0900C Asmt Checklist 1 1301-1301 Correction: modif reasons - software error
X0900D Asmt Checklist 1 1302-1302 Correction: modif reasons - item coding error
X0900E Asmt Checklist 1 1438-1438 Correction: modif reasons - resume therapy date
X0900Z Asmt Checklist 1 1303-1303 Correction: modif reasons - other error
X1050A Asmt Checklist 1 1304-1304 Correction: inact reasons - event did not occur
X1050Z Asmt Checklist 1 1305-1305 Correction: inact reasons - other reason
X1100A Asmt Text 12 1306-1317 Correction: attestor first name
X1100B Asmt Text 18 1318-1335 Correction: attestor last name
X1100E Asmt Date 8 1336-1343 Correction: attestation date
Z0100A Asmt Text 7 1344-1350 Medicare Part A: HIPPS code
Z0100B Asmt Text 10 1351-1360 Medicare Part A: RUG version code
Z0100C Asmt Code 1 1361-1361 Medicare Part A: Medicare short stay asmt
Z0150A Asmt Text 7 1362-1368 Medicare Part A: non-therapy HIPPS code
Z0150B Asmt Text 10 1369-1378 Medicare Part A: non-therapy RUG version code
Z0200A Asmt Text 10 1379-1388 State case mix: RUG group
Z0200B Asmt Text 10 1389-1398 State case mix: RUG version code
Z0250A Asmt Text 10 1399-1408 State case mix: Alternate RUG group
Z0250B Asmt Text 10 1409-1418 State case mix: Alternate RUG version code
Z0500B Asmt Date 8 1419-1426 Date RN signed assessment as complete
ITEM_FILLER_001 Filler Text 1 349-349 Item filler: replaces byte 15 of A0700
ITEM_FILLER_002 Filler Text 1 1272-1272 Item filler: replaces old X0600F
ITEM_FILLER_003 Filler Text 8 2943-2950 Item filler: replaces old EFFECTIVE_DATE
ITEM_FILLER_004 Filler Text 1 878-878 Item filler: replaces old K0500A
ITEM_FILLER_005 Filler Text 1 879-879 Item filler: replaces old K0500B
ITEM_FILLER_006 Filler Text 1 880-880 Item filler: replaces old K0500C
ITEM_FILLER_007 Filler Text 1 881-881 Item filler: replaces old K0500D
ITEM_FILLER_008 Filler Text 1 882-882 Item filler: replaces old K0500Z
ITEM_FILLER_009 Filler Text 1 961-961 Item filler: replaces old N0400A
ITEM_FILLER_010 Filler Text 1 962-962 Item filler: replaces old N0400B
ITEM_FILLER_011 Filler Text 1 963-963 Item filler: replaces old N0400C
ITEM_FILLER_012 Filler Text 1 964-964 Item filler: replaces old N0400D
ITEM_FILLER_013 Filler Text 1 965-965 Item filler: replaces old N0400E
ITEM_FILLER_014 Filler Text 1 966-966 Item filler: replaces old N0400F
ITEM_FILLER_015 Filler Text 1 967-967 Item filler: replaces old N0400G
ITEM_FILLER_016 Filler Text 1 968-968 Item filler: replaces old N0400Z
ITEM_FILLER_017 Filler Text 1 1138-1138 Item filler: replaces old Q0400B
ITEM_FILLER_018 Filler Text 1 1139-1139 Item filler: replaces old Q0500A
ITEM_FILLER_019 Filler Text 1 883-883 Item filler: replaces old K0700A
ITEM_FILLER_020 Filler Text 1 884-884 Item filler: replaces old K0700B
ITEM_FILLER_021 Filler Text 1 2082-2082 Item filler: replaces old S1200Z
ASMT_ITEMS_FILLER Filler Text 442 1485-1926 Assessment items filler
S0101 Asmt Code 1 1927-1927 Admitted from Community
S0102 Asmt Code 1 1928-1928 Admitted from NH or SB
S0111 Asmt Code 1 1929-1929 Lived Alone
S0115 Asmt Code 1 1930-1930 Spouse Location
S0120 Asmt Text 5 1931-1935 Prior Residence ZIP Code
S0122 Asmt Code 2 1936-1937 Prior Residence State
S0123 Asmt Text 3 1938-1940 Prior Residence County
S0125 Asmt Text 5 1941-1945 Prior Residence Town Code
S0130 Asmt Code 1 1946-1946 Highest Education Completed
S0140 Asmt Text 11 1947-1957 Physician License Number
S0141 Asmt Text 18 1958-1975 Physician Name
S0150 Asmt Text 9 1976-1984 State Resident ID
S0160 Asmt Code 2 2509-2510 Specialty unit
S0161A Asmt Checklist 1 2536-2536 Requires specialized unit: dementia/Alzheimer
S0161B Asmt Checklist 1 2537-2537 Requires specialized unit: behavioral health
S0161C Asmt Checklist 1 2538-2538 Requires specialized unit: TBI
S0161D Asmt Checklist 1 2539-2539 Requires specialized unit: ventilator
S0161Z Asmt Checklist 1 2540-2540 Requires specialized unit: none of the above
S0170A Asmt Code 1 2511-2511 Advanced directive: Guardian
S0170B Asmt Code 1 2512-2512 Advanced directive: DPOA-HC
S0170C Asmt Code 1 2513-2513 Advanced directive: Living will
S0170D Asmt Code 1 2514-2514 Advanced directive: Do not resuscitate
S0170E Asmt Code 1 2515-2515 Advanced directive: Do not hospitalize
S0170F Asmt Code 1 2516-2516 Advanced directive: Do not intubate
S0170G Asmt Code 1 2517-2517 Advanced directive: Feeding restrictions
S0170H Asmt Code 1 2518-2518 Advanced directive: Other treatment restrictions
S0170Z Asmt Code 1 2519-2519 Advanced directive: None of the above
S0171A Asmt Code 1 2520-2520 Resident healthcare proxy exists
S0171B Asmt Code 1 2521-2521 Resident healthcare proxy invoked
S0172A Asmt Code 1 2522-2522 Goal discussion: documentation received
S0172B Asmt Code 1 2523-2523 Goal discussion: hospital
S0172C Asmt Code 1 2524-2524 Goal discussion: previous NH
S0172D Asmt Code 1 2525-2525 Goal discussion: Home without home health services
S0172E Asmt Code 1 2526-2526 Goal discussion: Home with home health services
S0172F Asmt Code 1 2527-2527 Goal discussion: PCP office
S0172G Asmt Code 1 2528-2528 Goal discussion: Other
S0172H Asmt Code 1 2529-2529 Goal discussion: Not occur reason
S0173 Asmt Code 1 2535-2535 Documentation of goals of care discussion
S0180 Asmt Code 1 1985-1985 Discharged to Community
S0183 Asmt Code 1 2530-2530 Discharged prior to admission assessment
S0500 Asmt Code 2 1986-1987 Level of Care
S0501 Asmt Code 1 1988-1988 CCNH RHNS Level of Care
S0510 Asmt Code 1 1989-1989 PASRR Screening Complete
S0511 Asmt Date 8 1990-1997 PASRR Date
S0512 Asmt Code 1 1998-1998 PASRR Level 1
S0520 Asmt Code 2 1999-2000 Reason for Admission
S0600A Asmt Checklist 1 2541-2541 Meets criteria: requires ventilator 10+ hours
S0600B Asmt Checklist 1 2542-2542 Meets criteria: requires ventilator 16+ hours
S0600C Asmt Checklist 1 2543-2543 Meets criteria: Traumatic Brain Injury-Tier I
S0600D Asmt Checklist 1 2544-2544 Meets criteria: Traumatic Brain Injury-Tier II
S0600E Asmt Checklist 1 2545-2545 Meets criteria: Traumatic Brain Injury-Tier III
S0600Z Asmt Checklist 1 2546-2546 Meets criteria: none of the above
S1000 Asmt Code 1 2001-2001 Local Health Department Reporting
S1001 Asmt Code 1 2002-2002 State Health Department Reporting
S1100A Asmt Checklist 1 2003-2003 Disease: Clostridium Difficile
S1100B Asmt Checklist 1 2004-2004 Disease: MRSA
S1100C Asmt Checklist 1 2005-2005 Disease: VRE
S1100D Asmt Checklist 1 2006-2006 Disease: VISA
S1100E Asmt Checklist 1 2007-2007 Disease: VRSA
S1100F Asmt Checklist 1 2008-2008 Disease: Other MDRO
S1100F1 Asmt Text 30 2009-2038 Disease: MDRO Name1
S1100F2 Asmt Text 30 2039-2068 Disease: MDRO Name2
S1100G Asmt Checklist 1 2069-2069 Disease: Tuberculosis
S1100H Asmt Checklist 1 2070-2070 Disease: Herpes Zoster
S1100I Asmt Checklist 1 2071-2071 Disease: Scabies
S1100Z Asmt Checklist 1 2072-2072 Disease: None of the Above
S1200A Asmt Code 1 2073-2073 Primary/secondary SMI dx: schizophrenia
S1200B Asmt Code 1 2074-2074 Primary/secondary SMI dx: delusional disorder
S1200C Asmt Code 1 2075-2075 Primary/secondary SMI dx: schizoaffective disorder
S1200D Asmt Code 1 2076-2076 Primary/secondary SMI dx: psychotic disorder NOS
S1200E Asmt Code 1 2077-2077 Primary/secondary SMI dx: bipolar disorder I
S1200F Asmt Code 1 2078-2078 Primary/secondary SMI dx: bipolar disorder II
S1200G Asmt Code 1 2079-2079 Primary/secondary SMI dx: cyclothymic disorder
S1200H Asmt Code 1 2080-2080 Primary/secondary SMI dx: bipolar disorder NOS
S1200I Asmt Code 1 2081-2081 Primary/secondary SMI dx: major depress recurrent
S2000 Asmt Code 1 2083-2083 Capable of self-administration of medications
S2001 Asmt Code 1 2084-2084 Wishes to self-medicate
S2010 Asmt Code 1 2085-2085 Refused meds 3 days
S2011 Asmt Code 1 2086-2086 Staff support for meds 3 days
S2015 Asmt Code 1 2087-2087 Refused meds occasionally 30 days
S2016 Asmt Code 1 2088-2088 Refused meds frequently 30 days
S2040 Asmt Code 1 2089-2089 Behavior Management Program
S2050 Asmt Code 1 2090-2090 Resists grooming/hygiene
S2060A Asmt Code 1 2547-2547 Resident centered care: Oasis
S2060B Asmt Code 1 2548-2548 Resident centered care: habilitation therapy
S2060C Asmt Code 1 2549-2549 Resident centered care: hand in hand
S2060D Asmt Code 1 2550-2550 Resident centered care: consistent assignment
S2060E Asmt Code 1 2551-2551 Resident centered care: other
S2060Z Asmt Code 1 2552-2552 Resident centered care: none of the above
S3100A Asmt Code 1 2091-2091 Contractures: Hand
S3100B Asmt Code 1 2092-2092 Contractures: Wrist
S3100C Asmt Code 1 2093-2093 Contractures: Elbow
S3100D Asmt Code 1 2094-2094 Contractures: Shoulder
S3100E Asmt Code 1 2095-2095 Contractures: Neck
S3100F Asmt Code 1 2096-2096 Contractures: Ankle
S3100G Asmt Code 1 2097-2097 Contractures: Knee
S3100H Asmt Code 1 2098-2098 Contractures: Hip
S3100Z Asmt Code 1 2099-2099 Contractures: Other
S3200A Asmt Code 1 2100-2100 Dominant Side
S3200B Asmt Code 1 2101-2101 Use of dominant hand/arm
S4000A Asmt Code 1 2102-2102 Harm: Self Injury/Self-injurious attempt
S4000B Asmt Code 1 2103-2103 Harm: Attempt was to kill self
S4000C Asmt Code 1 2104-2104 Harm: Considered injuring self
S4000D Asmt Code 1 2105-2105 Harm: Self-injury caregiver concern
S4010A Asmt Number 1 2106-2106 Hourly Interval Observation
S4010B Asmt Number 1 2107-2107 15- Min. Interval Observation
S4010C Asmt Number 1 2108-2108 5- Min. Interval Observation
S4010D Asmt Number 1 2109-2109 Constant Observation for < 1 hr
S4010E Asmt Number 1 2110-2110 Constant Observation for > 1 hr
S4500 Asmt Code 1 2111-2111 Substance Abuse: Alcoholic Drinks
S4510A Asmt Code 1 2112-2112 Substance Abuse: Inhalants
S4510B Asmt Code 1 2113-2113 Substance Abuse: Hallucinogens
S4510C Asmt Code 1 2114-2114 Substance Abuse: Cocaine and Crack
S4510D Asmt Code 1 2115-2115 Substance Abuse: Stimulants
S4510E Asmt Code 1 2116-2116 Substance Abuse: Opiates
S4510F Asmt Code 1 2117-2117 Substance Abuse: Cannabis
S5000 Asmt Number 1 2118-2118 Number of New Pressure Ulcers
S5005 Asmt Code 1 2119-2119 New Pressure Ulcer setting
S5010A1 Asmt Code 2 2120-2121 Pressure ulcer 1 location
S5010A2 Asmt Code 1 2122-2122 Pressure ulcer 1 status
S5010B1 Asmt Code 2 2123-2124 Pressure ulcer 2 location
S5010B2 Asmt Code 1 2125-2125 Pressure ulcer 2 status
S5010C1 Asmt Code 2 2126-2127 Pressure ulcer 3 location
S5010C2 Asmt Code 1 2128-2128 Pressure ulcer 3 status
S5010D1 Asmt Code 2 2129-2130 Pressure ulcer 4 location
S5010D2 Asmt Code 1 2131-2131 Pressure ulcer 4 status
S5010E1 Asmt Code 2 2132-2133 Pressure ulcer 5 location
S5010E2 Asmt Code 1 2134-2134 Pressure ulcer 5 status
S5010F1 Asmt Code 2 2135-2136 Pressure ulcer 6 location
S5010F2 Asmt Code 1 2137-2137 Pressure ulcer 6 status
S5010G1 Asmt Code 2 2138-2139 Pressure ulcer 7 location
S5010G2 Asmt Code 1 2140-2140 Pressure ulcer 7 status
S5010H1 Asmt Code 2 2141-2142 Pressure ulcer 8 location
S5010H2 Asmt Code 1 2143-2143 Pressure ulcer 8 status
S5010I1 Asmt Code 2 2144-2145 Pressure ulcer 9 location
S5010I2 Asmt Code 1 2146-2146 Pressure ulcer 9 status
S6000 Asmt Code 1 2147-2147 Parenteral/IV feeding in NH
S6005 Asmt Code 1 2148-2148 IV meds in NH
S6010 Asmt Code 1 2149-2149 Oxygen Therapy in NH
S6050 Asmt Code 1 2150-2150 Isolation precautions needed
S6051A Asmt Checklist 1 2151-2151 Isolation Precaution: Airborne
S6051B Asmt Checklist 1 2152-2152 Isolation Precaution: Contact
S6051C Asmt Checklist 1 2153-2153 Isolation Precaution: Droplet
S6051D Asmt Checklist 1 2154-2154 Isolation Precaution: Protective
S6100A Asmt Checklist 1 2155-2155 Vaccination: Varicella
S6100B Asmt Checklist 1 2156-2156 Vaccination: Tetanus, diphtheria (Td)
S6100C Asmt Checklist 1 2157-2157 Vaccination: Tetanus, diphtheria, pertussis (Tdap)
S6100D Asmt Checklist 1 2158-2158 Vaccination: Measles, Mumps, Rubella (MMR)
S6100E Asmt Checklist 1 2159-2159 Vaccination: Other
S6100F1 Asmt Text 20 2160-2179 Vaccination: Other Name 1
S6100F2 Asmt Text 20 2180-2199 Vaccination: Other Name 2
S6100F3 Asmt Text 20 2200-2219 Vaccination: Other Name 3
S6100Z Asmt Checklist 1 2220-2220 Vaccination: None of the above
S6200 Asmt Number 2 2221-2222 Number of Hospital Stays
S6210 Asmt Number 3 2223-2225 Number of ER visits
S6220 Asmt Code 1 2226-2226 Alzheimer"s/Dementia Special Care Unit
S6230 Asmt Code 1 2553-2553 Has resident received antipsychotic
S6232 Asmt Code 1 2554-2554 Is resident currently receiving antipsychotic
S6234 Asmt Code 1 2555-2555 Attempt to reduce amount of antipsychotic
S6236 Asmt Code 1 2556-2556 Was reduction in antipsychotic maintained
S8000A1 Asmt Checklist 1 2227-2227 Medicare - Primary Payor
S8000A2 Asmt Checklist 1 2228-2228 Medicare - Secondary Payor
S8000A3 Asmt Checklist 1 2229-2229 Medicare Payor
S8000B1 Asmt Checklist 1 2230-2230 Medicare Part A - Primary Payor
S8000B2 Asmt Checklist 1 2231-2231 Medicare Part A - Secondary Payor
S8000B3 Asmt Checklist 1 2232-2232 Medicare Part A Payor
S8000C1 Asmt Checklist 1 2233-2233 Medicare Part B - Primary Payor
S8000C2 Asmt Checklist 1 2234-2234 Medicare Part B - Secondary Payor
S8000C3 Asmt Checklist 1 2235-2235 Medicare Part B Payor
S8000D1 Asmt Checklist 1 2236-2236 Medicare Part C - Primary Payor
S8000D2 Asmt Checklist 1 2237-2237 Medicare Part C - Secondary Payor
S8000D3 Asmt Checklist 1 2238-2238 Medicare Part C Payor
S8000E1 Asmt Checklist 1 2239-2239 Medicare per diem - Primary Payor
S8000E2 Asmt Checklist 1 2240-2240 Medicare per diem - Secondary Payor
S8000E3 Asmt Checklist 1 2241-2241 Medicare per diem Payor
S8000Z Asmt Checklist 1 2242-2242 Medicare not a payment source
S8010A1 Asmt Checklist 1 2243-2243 In-state Medicaid - Primary Payor
S8010A2 Asmt Checklist 1 2244-2244 In-state Medicaid - Secondary Payor
S8010A3 Asmt Checklist 1 2245-2245 In-state Medicaid payor
S8010B1 Asmt Checklist 1 2246-2246 Out-of-state Medicaid - Primary Payor
S8010B2 Asmt Checklist 1 2247-2247 Out-of-state Medicaid - Secondary Payor
S8010B3 Asmt Checklist 1 2248-2248 Out-of-state Medicaid Payor
S8010C1 Asmt Checklist 1 2249-2249 Medicaid per diem - Primary Payor
S8010C2 Asmt Checklist 1 2250-2250 Medicaid per diem - Secondary Payor
S8010C3 Asmt Checklist 1 2251-2251 Medicaid per diem Payor
S8010D1 Asmt Checklist 1 2252-2252 Medicaid managed care per diem - Primary Payor
S8010D2 Asmt Checklist 1 2253-2253 Medicaid managed care per diem - Secondary Payor
S8010D3 Asmt Checklist 1 2254-2254 Medicaid managed care per diem Payor
S8010E1 Asmt Checklist 1 2255-2255 Medicaid per diem (not MC) - Primary Payor
S8010E2 Asmt Checklist 1 2256-2256 Medicaid per diem (not MC) - Secondary Payor
S8010E3 Asmt Checklist 1 2257-2257 Medicaid per diem (not MC) Payor
S8010F Asmt Code 1 2531-2531 Medicaid per diem type
S8010F1 Asmt Checklist 1 2258-2258 Medicaid Resident Liability - Primary Payor
S8010F2 Asmt Checklist 1 2259-2259 Medicaid Resident Liability - Secondary Payor
S8010F3 Asmt Checklist 1 2260-2260 Medicaid Resident Liability Payor
S8010G Asmt Code 1 2532-2532 Medicaid state source
S8010G1 Asmt Checklist 1 2261-2261 Medicare Co-Pay - Primary Payor
S8010G2 Asmt Checklist 1 2262-2262 Medicare Co-pay - Secondary Payor
S8010G3 Asmt Checklist 1 2263-2263 Medicare Co-pay Payor
S8010H1 Asmt Checklist 1 2264-2264 Picture Date reporting
S8010H2 Asmt Checklist 1 2265-2265 Medicaid Other - Secondary Payor
S8010H3 Asmt Checklist 1 2266-2266 Medicaid Other Payor
S8010I1 Asmt Checklist 1 2267-2267 Medicaid Pending - Primary Payor
S8010I2 Asmt Checklist 1 2268-2268 Medicaid Pending - Secondary Payor
S8010I3 Asmt Checklist 1 2269-2269 Medicaid Pending Payor
S8010Z Asmt Checklist 1 2270-2270 Medicaid not a payment source
S8020A1 Asmt Checklist 1 2271-2271 Private - Primary Payor
S8020A2 Asmt Checklist 1 2272-2272 Private - Secondary Payor
S8020A3 Asmt Checklist 1 2273-2273 Private Payor
S8020B1 Asmt Checklist 1 2274-2274 Private per diem - Primary Payor
S8020B2 Asmt Checklist 1 2275-2275 Private per diem - Secondary Payor
S8020B3 Asmt Checklist 1 2276-2276 Private per diem Payor
S8020C1 Asmt Checklist 1 2277-2277 Private LTC insurance policy - Primary Payor
S8020C2 Asmt Checklist 1 2278-2278 Private LTC insurance policy - Secondary Payor
S8020C3 Asmt Checklist 1 2279-2279 Private LTC insurance policy
S8020Z Asmt Checklist 1 2280-2280 Private insurance not a payment source
S8030A1 Asmt Checklist 1 2281-2281 Self-pay - Primary Payor
S8030A2 Asmt Checklist 1 2282-2282 Self-pay - Secondary Payor
S8030A3 Asmt Checklist 1 2283-2283 Self-pay Payor
S8030B1 Asmt Checklist 1 2284-2284 Family pay - Primary Payor
S8030B2 Asmt Checklist 1 2285-2285 Family pay - Secondary Payor
S8030B3 Asmt Checklist 1 2286-2286 Family pay Payor
S8030C Asmt Checklist 1 2287-2287 Self or Family pay for full per diem
S8030Z Asmt Checklist 1 2288-2288 Self or Family not a payment source
S8040A1 Asmt Checklist 1 2289-2289 State Run Medical Assistance - Primary Payor
S8040A2 Asmt Checklist 1 2290-2290 State Run Medical Assistance - Secondary Payor
S8040A3 Asmt Checklist 1 2291-2291 State Run Medical Assistance Payor
S8040B1 Asmt Checklist 1 2292-2292 Tricare per diem - Primary Payor
S8040B2 Asmt Checklist 1 2293-2293 Tricare per diem - Secondary Payor
S8040B3 Asmt Checklist 1 2294-2294 Tricare per diem Payor
S8040C1 Asmt Checklist 1 2295-2295 VA per diem - Primary Payor
S8040C2 Asmt Checklist 1 2296-2296 VA per diem - Secondary Payor
S8040C3 Asmt Checklist 1 2297-2297 VA per diem Payor
S8040D1 Asmt Checklist 1 2298-2298 Other Public - Primary Payor
S8040D2 Asmt Checklist 1 2299-2299 Other Public - Secondary Payor
S8040D3 Asmt Checklist 1 2300-2300 Other Public Payor
S8040Z Asmt Checklist 1 2301-2301 Other government not a payment source
S8050A1 Asmt Checklist 1 2302-2302 Other - Primary Payor
S8050A2 Asmt Checklist 1 2303-2303 Other - Secondary Payor
S8050A3 Asmt Checklist 1 2304-2304 Other Payor
S8050B Asmt Text 30 2305-2334 Other Payor Name 1
S8050C Asmt Text 30 2335-2364 Other Payor Name 2
S8050D Asmt Text 30 2365-2394 Other Payor Name 3
S8055 Asmt Code 1 2533-2533 Primary payor
S8099 Asmt Checklist 1 2395-2395 Payor: None of the Above
S8500 Asmt Date 8 2396-2403 Medicaid begin date
S8510A Asmt Number 1 2404-2404 Medicaid Therapeutic bed-hold days since last asmt
S8510B Asmt Number 1 2405-2405 Medicaid Therapeutic bed-hold days - YTD
S8512A Asmt Number 1 2406-2406 Medicaid hospital bed-hold days since last asmt
S8512B Asmt Number 1 2407-2407 Medicaid hospital bed-hold days - YTD
S8520A Asmt Code 1 2408-2408 Medicaid Leave Days Type 1
S8520B Asmt Date 8 2409-2416 Leave Days for Medicaid begin date 1
S8520C Asmt Date 8 2417-2424 Leave Days for Medicaid end date 1
S8521A Asmt Code 1 2425-2425 Medicaid Leave Days Type 2
S8521B Asmt Date 8 2426-2433 Leave Days for Medicaid begin date 2
S8521C Asmt Date 8 2434-2441 Leave Days for Medicaid end date 2
S9000 Asmt Code 1 2442-2442 IL Skills Training
S9001 Asmt Code 1 2443-2443 IL IDPH Subpart S criteria
S9002A Asmt Checklist 1 2444-2444 IL IDPH Subpart S: Schizophrenia
S9002B Asmt Checklist 1 2445-2445 IL IDPH Subpart S: Delusional disorder
S9002C Asmt Checklist 1 2446-2446 IL IDPH Subpart S: Schizoaffective disorder
S9002D Asmt Checklist 1 2447-2447 IL IDPH Subpart S:Psychotic disorder not specified
S9002E Asmt Checklist 1 2448-2448 IL IDPH Subpart S: Bipolar I mixed, manic, & depr
S9002F Asmt Checklist 1 2449-2449 IL IDPH Subpart S: Bipolar disorder II
S9002G Asmt Checklist 1 2450-2450 IL IDPH Subpart S: Cyclothymic disorder
S9002H Asmt Checklist 1 2451-2451 IL IDPH Subpart S: Bipolar disorder not specified
S9002I Asmt Checklist 1 2452-2452 IL IDPH Subpart S: Major depression, recurrent
S9003 Asmt Code 1 2453-2453 IL IDPH Subpart S: Ancillary
S9020 Asmt Text 8 2454-2461 FL FRAES number
S9040A Asmt Code 1 2462-2462 CA POLST
S9040B Asmt Code 1 2463-2463 CA POLST Section A
S9040C Asmt Code 1 2464-2464 CA POLST Section B
S9040D Asmt Code 1 2465-2465 CA POLST Section C
S9040E Asmt Code 1 2466-2466 CA POLST D physician signature
S9040F Asmt Code 1 2467-2467 CA POLST D resident signature
S9040G Asmt Code 1 2468-2468 CA POLST D discussed with patient or decisionmaker
S9040H Asmt Code 1 2534-2534 CA POLST advanced directive
S9060 Asmt Code 1 2469-2469 NY Medicaid add-on eligibility
S9080A Asmt Code 1 2470-2470 PA MA CASE-MIX
S9080B Asmt Date 8 2471-2478 PA MA CASE-MIX Date
S9080C Asmt Text 10 2479-2488 PA MA CASE-MIX Access Card Number
S9080D Asmt Date 8 2489-2496 PA MA CASE-MIX MA NF Effective Date
S9080E Asmt Code 1 2497-2497 PA MA CASE-MIX Day One MA
S9100A Asmt Code 1 2498-2498 VA Room & Board Payment Assessment Reference Date
S9100B Asmt Code 1 2499-2499 VA Room & Board Payment Entry Date
S9100C Asmt Date 8 2500-2507 VA Medicaid Room & Board initial date
S9120 Asmt Code 1 2508-2508 CT Approved LTC
STATE_ITEMS_FILLER Filler Text 370 2557-2926 Section S (State items) filler
ASSESSMENT_ID Calc Number 15 2951-2965 Assessment internal ID
ORIGINAL_ASSESSMENT_ID Calc Number 15 2966-2980 Original assessment ID
RESIDENT_INTERNAL_ID Calc Number 10 2981-2990 Resident internal ID
TARGET_DATE Calc Date 8 2927-2934 Target date
FACILITY_PROVIDER_INTERNAL_ID Calc Number 10 3063-3072 Facility/provider internal ID
SUBMISSION_ID Calc Number 15 3021-3035 Submission ID
SUBMISSION_DATE Calc Date 8 3036-3043 Submission date
SUBMISSION_COMPLETE_DATE Calc Date 8 3044-3051 Submission processing completion date
SUBMITTING_USER_ID Calc Text 30 2991-3020 Submitter user ID
RESIDENT_MATCH_CRITERIA Calc Number 2 3052-3053 Resident matching criteria
RESIDENT_AGE Calc Number 8 2935-2942 Age of resident on the target date
BIRTHDATE_SUBMIT_CODE Calc Code 1 3258-3258 Birth date submit code
CBSA_URBAN_RURAL_CODE Calc Code 1 3054-3054 CBSA urban/rural code.
STATE_EXTRACT_FILE_ID Calc Number 8 3055-3062 State extract file identifier
RECALCULATED_Z0100A Calc Text 7 3073-3079 Calculated Medicare Part A HIPPS code
CMI_VALUE_FOR_RECALC_Z0100A Calc Text 7 3091-3097 Medicare CMI value returned for Part A
CMI_SET_FOR_RECALC_Z0100A Calc Text 3 3098-3100 Medicare CMI Set Code used for Part A
RECALCULATED_Z0100B Calc Text 10 3080-3089 Calculated Medicare Part A RUG version code
RECALCULATED_Z0100C Calc Text 1 3090-3090 Calculated Medicare Part A HIPPS stay type code
RECALCULATED_Z0150A Calc Text 7 3101-3107 Calculated Medicare Non-therapy Part A RUG code
CMI_VALUE_FOR_RECALC_Z0150A Calc Text 7 3118-3124 Medicare CMI value returned for Part A Non-therapy
CMI_SET_FOR_RECALC_Z0150A Calc Text 3 3125-3127 Medicare CMI Set Code used for Part A Non-therapy
RECALCULATED_Z0150B Calc Text 10 3108-3117 Calculated Medicare Non-therapy Part A RUG version
RECALCULATED_Z0200A Calc Text 10 3128-3137 Calculated Medicaid RUG code
CMI_VALUE_FOR_Z0200A Calc Text 7 3148-3154 Medicaid CMI value returned for Medicaid RUG
CMI_SET_FOR_RECALC_Z0200A Calc Text 3 3155-3157 Medicare Set Code used for Medicaid RUG
RECALCULATED_Z0200B Calc Text 10 3138-3147 Calculated Medicaid RUG version code
RECALCULATED_Z0250A Calc Text 10 3158-3167 Alternate Calculated Medicaid RUG code
CMI_VALUE_FOR_RECALC_Z0250A Calc Text 7 3178-3184 Alternate Medicaid CMI value for Medicaid RUG
CMI_SET_FOR_RECALC_Z0250A Calc Text 3 3185-3187 Alternate Medicaid Set Code used for Medicaid RUG
RECALCULATED_Z0250B Calc Text 10 3168-3177 Alternate Calculated Medicaid RUG version code
MEDICARE_RUG4_HIER_GRP Calc Text 10 3188-3197 RUG IV Medicare hierarchical group
MEDICARE_RUG4_HIER_VERSION Calc Text 10 3198-3207 RUG IV Medicare hierarchical version
MEDICARE_RUG3_IDX_MAX_GRP Calc Text 10 3208-3217 RUG III Medicare index max group
MEDICARE_RUG3_IDX_MAX_VERSION Calc Text 10 3218-3227 RUG III Medicare index max version
MEDICARE_RUG3_IDX_MAX_CMI_VAL Calc Text 7 3228-3234 RUG III Medicare index max case mix index
MEDICARE_RUG3_IDX_MAX_CMI_SET Calc Text 3 3235-3237 RUG III Medicare index max case mix index set
MEDICARE_RUG3_HIER_GRP Calc Text 10 3238-3247 RUG III Medicare hierarchical group
MEDICARE_RUG3_HIER_VERSION Calc Text 10 3248-3257 RUG III Medicare hierarchical version
CALCULATED_ITEMS_FILLER1 Calc Text 429 3259-3687 Calculated items filler
DATA_END_INDICATOR Calc Code 1 3688-3688 End of data terminator code
CR Calc Code 1 3689-3689 Carriage return (ASCII 013)
LF Calc Code 1 3690-3690 Line feed character (ASCII 010)

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