101109-7
MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment]
Active
Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
---|---|---|---|---|
101109-7 | MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set during assessment period [CMS Assessment] | |||
Indent101258-2 | Identification Information | |||
Indent Indent58198-3 | Type of Record | |||
Indent Indent54581-4 | Facility Provider Numbers | |||
Indent Indent Indent76468-8 | National Provider Identifier (NPI) | |||
Indent Indent Indent69417-4 | CMS Certification Number (CCN) | |||
Indent Indent Indent45398-5 | State Provider Number | |||
Indent Indent85632-8 | Type of Provider | |||
Indent Indent90489-6 | Type of Assessment | |||
Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
Indent Indent Indent54584-8 | PPS Assessment | |||
Indent Indent Indent54587-1 | Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry? | |||
Indent Indent Indent58108-2 | Entry/discharge reporting | |||
Indent Indent Indent71440-2 | Type of discharge | |||
Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
Indent Indent86526-1 | Unit Certification or Licensure Designation | |||
Indent Indent54503-8 | Legal Name of Resident | |||
Indent Indent Indent45392-8 | First name | |||
Indent Indent Indent45393-6 | Middle initial | |||
Indent Indent Indent45394-4 | Last name | |||
Indent Indent Indent45395-1 | Suffix | |||
Indent Indent45966-9 | Social Security and Medicare Numbers | |||
Indent Indent Indent45396-9 | Social Security Number | |||
Indent Indent Indent45397-7 | Medicare number | |||
Indent Indent45400-9 | Medicaid Number | |||
Indent Indent46098-0 | Gender | |||
Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
Indent Indent69854-8 | Ethnicity. Are you of Hispanic, Latino/a, or Spanish origin? | 1..4 | ||
Indent Indent103708-4 | Race. What is your race? | 1..14 | ||
Indent Indent45404-1 | Marital Status | |||
Indent Indent101351-5 | Transportation (from NACHC©). Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living? | |||
Indent Indent54506-1 | Optional Resident Items | |||
Indent Indent Indent46106-1 | Medical record number | |||
Indent Indent Indent45403-3 | Room number | |||
Indent Indent Indent52462-9 | Name by which resident prefers to be addressed | |||
Indent Indent Indent21843-8 | Lifetime occupation(s) | |||
Indent Indent86528-7 | Most Recent Admission/Entry or Reentry into this Facility | |||
Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
Indent Indent Indent54590-5 | Type of Entry | |||
Indent Indent Indent85398-6 | Entered From | |||
Indent Indent52455-3 | Admission Date (Date this episode of care in this facility began) | {mm/dd/yyyy} | ||
Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
Indent Indent93182-4 | Provision of Current Reconciled Medication List to Subsequent Provider at Discharge. At the time of discharge to another provider, did your facility provide the resident's current reconciled medication list to the subsequent provider? | |||
Indent Indent93184-0 | Route of Current Reconciled Medication List Transmission to Subsequent Provider. | 1..5 | ||
Indent Indent54593-9 | Assessment Reference Date. Observation end date | {mm/dd/yyyy} | ||
Indent Indent54507-9 | Medicare Stay | |||
Indent Indent Indent54594-7 | Has the resident had a Medicare-covered stay since the most recent entry? | |||
Indent Indent Indent54595-4 | Start date of most recent Medicare stay | {mm/dd/yyyy} | ||
Indent Indent Indent54596-2 | End date of most recent Medicare stay | {mm/dd/yyyy} | ||
Indent101259-0 | Hearing, Speech, and Vision | |||
Indent Indent103709-2 | Health Literacy. How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy? | |||
Indent101260-8 | Cognitive Patterns | |||
Indent Indent54605-1 | Should Brief Interview for Mental Status (C0200-C0500) be Conducted? | |||
Indent Indent103694-6 | Brief Interview for Mental Status (BIMS) | |||
Indent Indent Indent103696-1 | Repetition of Three Words. Number of words repeated after first attempt | |||
Indent Indent Indent103702-7 | Temporal Orientation (orientation to year, month, and day) | |||
Indent Indent Indent Indent103697-9 | Able to report correct year | |||
Indent Indent Indent Indent103698-7 | Able to report correct month | |||
Indent Indent Indent Indent103703-5 | Able to report correct day of the week | |||
Indent Indent Indent103695-3 | Recall | |||
Indent Indent Indent Indent103699-5 | Able to recall "sock" | |||
Indent Indent Indent Indent103700-1 | Able to recall "blue" | |||
Indent Indent Indent Indent103701-9 | Able to recall "bed" | |||
Indent Indent Indent103704-3 | BIMS Summary Score | {score} | ||
Indent Indent96901-4 | Delirium | |||
Indent Indent Indent95816-5 | Signs and Symptoms of Delirium (from CAM©) | |||
Indent Indent Indent Indent95813-2 | Acute Onset Mental Change | |||
Indent Indent Indent Indent95812-4 | Inattention | |||
Indent Indent Indent Indent95814-0 | Disorganized Thinking | |||
Indent Indent Indent Indent95815-7 | Altered Level of Consciousness | |||
Indent101261-6 | Mood | |||
Indent Indent54634-1 | Should Resident Mood Interview be Conducted? | |||
Indent Indent54635-8 | Resident Mood Interview (PHQ-2 to 9) | |||
Indent Indent Indent86843-0 | Symptom Presence | |||
Indent Indent Indent Indent54636-6 | Little interest or pleasure in doing things | |||
Indent Indent Indent Indent54638-2 | Feeling down, depressed or hopeless | |||
Indent Indent Indent Indent54640-8 | Trouble falling or staying asleep, or sleeping too much | |||
Indent Indent Indent Indent54642-4 | Feeling tired or having little energy | |||
Indent Indent Indent Indent54644-0 | Poor appetite or overeating | |||
Indent Indent Indent Indent54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
Indent Indent Indent Indent54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
Indent Indent Indent Indent54650-7 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
Indent Indent Indent Indent54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
Indent Indent Indent86844-8 | Symptom Frequency | |||
Indent Indent Indent Indent54637-4 | Little interest or pleasure in doing things | |||
Indent Indent Indent Indent54639-0 | Feeling down, depressed or hopeless | |||
Indent Indent Indent Indent54641-6 | Trouble falling or staying asleep, or sleeping too much | |||
Indent Indent Indent Indent54643-2 | Feeling tired or having little energy | |||
Indent Indent Indent Indent54645-7 | Poor appetite or overeating | |||
Indent Indent Indent Indent54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down | |||
Indent Indent Indent Indent54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television | |||
Indent Indent Indent Indent54651-5 | Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual | |||
Indent Indent Indent Indent54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way | |||
Indent Indent103705-0 | Total Severity Score | {score} | ||
Indent Indent93159-2 | Social Isolation. How often do you feel lonely or isolated from those around you? | |||
Indent101264-0 | Functional Abilities and Goals | |||
Indent Indent101266-5 | Functional Abilities and Goals - Discharge | |||
Indent Indent Indent101429-9 | Self-Care - Discharge Performance (Assessment period is the last 3 days of the stay) | |||
Indent Indent Indent Indent89409-7 | Eating | |||
Indent Indent Indent Indent89404-8 | Oral hygiene | |||
Indent Indent Indent Indent89389-1 | Toileting hygiene | |||
Indent Indent Indent Indent89396-6 | Shower/bathe self | |||
Indent Indent Indent Indent89387-5 | Upper body dressing | |||
Indent Indent Indent Indent89406-3 | Lower body dressing | |||
Indent Indent Indent Indent89400-6 | Putting on/taking off footwear | |||
Indent Indent Indent101431-5 | Mobility - Discharge Performance (Assessment period is the last 3 days of the Stay) | |||
Indent Indent Indent Indent89398-2 | Roll left and right | |||
Indent Indent Indent Indent89394-1 | Sit to lying | |||
Indent Indent Indent Indent95009-7 | Lying to sitting on side of bed | |||
Indent Indent Indent Indent89392-5 | Sit to stand | |||
Indent Indent Indent Indent89414-7 | Chair/bed-to-chair transfer | |||
Indent Indent Indent Indent89390-9 | Toilet transfer | |||
Indent Indent Indent Indent89412-1 | Car transfer | |||
Indent Indent Indent Indent89385-9 | Walk 10 feet | |||
Indent Indent Indent Indent89381-8 | Walk 50 feet with two turns | |||
Indent Indent Indent Indent89383-4 | Walk 150 feet | |||
Indent Indent Indent Indent89379-2 | Walking 10 feet on uneven surfaces | |||
Indent Indent Indent Indent95000-6 | 1 step (curb) | |||
Indent Indent Indent Indent89416-2 | 4 steps | |||
Indent Indent Indent Indent89418-8 | 12 steps | |||
Indent Indent Indent Indent89402-2 | Picking up object | |||
Indent Indent Indent Indent95738-1 | Does the resident use a wheelchair and/or scooter? | |||
Indent Indent Indent Indent94992-5 | Wheel 50 feet with two turns | |||
Indent Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
Indent Indent Indent Indent94991-7 | Wheel 150 feet | |||
Indent Indent Indent Indent95739-9 | Indicate the type of wheelchair or scooter used | |||
Indent101270-7 | Health Conditions | |||
Indent Indent54828-9 | Should Pain Assessment Interview be Conducted? | |||
Indent Indent101326-7 | Pain Assessment Interview | |||
Indent Indent Indent54829-7 | Pain Presence | |||
Indent Indent Indent93156-8 | Pain Effect on Sleep | |||
Indent Indent Indent93160-0 | Pain Interference with Therapy Activities | |||
Indent Indent Indent93158-4 | Pain Interference with Day-to-Day Activities | |||
Indent Indent54853-7 | Any Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent | |||
Indent Indent54854-5 | Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent | |||
Indent Indent Indent54855-2 | No injury | |||
Indent Indent Indent54856-0 | Injury (except major) | |||
Indent Indent Indent54857-8 | Major injury | |||
Indent101271-5 | Swallowing &or Nutritional Status | |||
Indent Indent54568-1 | Nutritional Approaches | |||
Indent Indent Indent101328-3 | Nutritional Approaches. At Discharge. | 1..4 | ||
Indent101273-1 | Skin Conditions | |||
Indent Indent58214-8 | Unhealed Pressure Ulcers/Injuries. Does this resident have one or more unhealed pressure ulcers/injuries? | |||
Indent Indent88961-8 | Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage | |||
Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
Indent Indent Indent54886-7 | Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
Indent Indent Indent54887-5 | Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
Indent Indent Indent54890-9 | Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry | {#} | ||
Indent Indent Indent54893-3 | Number of unstageable pressure ulcers/injuries due to non-removable dressing/device | {#} | ||
Indent Indent Indent54894-1 | Number of these unstageable pressure ulcers/injuries that were present upon admission/entry or reentry | {#} | ||
Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
Indent Indent Indent54947-7 | Number of these unstageable pressure ulcers that were present upon admission/entry or reentry | {#} | ||
Indent Indent Indent54950-1 | Number of unstageable pressure injuries presenting as deep tissue injury | {#} | ||
Indent Indent Indent54951-9 | Number of these unstageable pressure injuries that were present upon admission/entry or reentry | {#} | ||
Indent101274-9 | Medications | |||
Indent Indent93155-0 | High-Risk Drug Classes: Use and Indication | |||
Indent Indent Indent93153-5 | Is taking | 1..10 | ||
Indent Indent Indent93154-3 | Indication noted | 1..10 | ||
Indent Indent57256-0 | Medication Intervention | |||
Indent101275-6 | Special Treatments, Procedures, and Programs | |||
Indent Indent101346-5 | Special Treatments, Procedures, and Programs | |||
Indent Indent Indent93185-7 | Special Treatments, Procedures, and Programs - At Discharge | 1..31 | ||
Indent Indent90544-8 | Part A Therapies | |||
Indent Indent Indent90545-5 | Speech-Language Pathology and Audiology Services | |||
Indent Indent Indent Indent90539-8 | Individual minutes | min | ||
Indent Indent Indent Indent90536-4 | Concurrent minutes | min | ||
Indent Indent Indent Indent90538-0 | Group minutes | min | ||
Indent Indent Indent Indent90537-2 | Co-treatment minutes | min | ||
Indent Indent Indent Indent90551-3 | Days | d/{#} | ||
Indent Indent Indent90546-3 | Occupational Therapy | |||
Indent Indent Indent Indent90531-5 | Individual minutes | min | ||
Indent Indent Indent Indent90527-3 | Concurrent minutes | min | ||
Indent Indent Indent Indent90529-9 | Group minutes | min | ||
Indent Indent Indent Indent90528-1 | Co-treatment minutes | min | ||
Indent Indent Indent Indent90530-7 | Days | d/{#} | ||
Indent Indent Indent90547-1 | Physical Therapy | |||
Indent Indent Indent Indent90535-6 | Individual minutes | min | ||
Indent Indent Indent Indent90532-3 | Concurrent minutes | min | ||
Indent Indent Indent Indent90534-9 | Group minutes | min | ||
Indent Indent Indent Indent90533-1 | Co-treatment minutes | min | ||
Indent Indent Indent Indent90550-5 | Days | d/{#} | ||
Indent Indent90548-9 | Distinct Calendar Days of Part A Therapy | {#} | ||
Indent101279-8 | Correction Request | |||
Indent Indent85632-8 | Type of Provider | 1..1 | ||
Indent Indent87226-7 | Name of Resident | |||
Indent Indent Indent45392-8 | First name | |||
Indent Indent Indent45394-4 | Last name | |||
Indent Indent46098-0 | Gender | |||
Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
Indent Indent45396-9 | Social Security Number | |||
Indent Indent90492-0 | Type of Assessment | |||
Indent Indent Indent54583-0 | Federal OBRA Reason for Assessment | |||
Indent Indent Indent54584-8 | PPS Assessment | |||
Indent Indent Indent58108-2 | Entry/discharge reporting | |||
Indent Indent Indent86525-3 | Is this a SNF Part A PPS Discharge Assessment? | |||
Indent Indent87216-8 | Date on existing record to be modified/inactivated | |||
Indent Indent Indent54593-9 | Assessment Reference Date | {mm/dd/yyyy} | ||
Indent Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
Indent Indent Indent50786-3 | Entry Date | {mm/dd/yyyy} | ||
Indent Indent87209-3 | Correction Attestation Section | |||
Indent Indent Indent58200-7 | Correction Number | {#} | ||
Indent Indent Indent87217-6 | Reasons for Modification | 1..5 | ||
Indent Indent Indent87225-9 | Reasons for Inactivation | 1..2 | ||
Indent Indent Indent87218-4 | RN Assessment Coordinator Attestation of Completion | |||
Indent Indent Indent Indent87219-2 | Attesting individual's first name | |||
Indent Indent Indent Indent87220-0 | Attesting individual's last name | |||
Indent Indent Indent Indent87221-8 | Attesting individual's title | |||
Indent Indent Indent Indent87222-6 | Attestation date | {mm/dd/yyyy} | ||
Indent101280-6 | Assessment Administration | |||
Indent Indent85648-4 | Signature of Persons Completing the Assessment or Entry/Death Reporting | |||
Indent Indent70127-6 | Signature of RN Assessment Coordinator Verifying Assessment Completion | |||
Indent Indent Indent70127-6 | Signature: | |||
Indent Indent Indent30947-6 | Date RN Assessment Coordinator signed assessment as complete: | {mm/dd/yyyy} |
Fully-Specified Name
- Component
- MDS v3.0 - RAI v1.18.11 - Nursing home part A PPS discharge (NPE) item set
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.75
- Last Updated
- Version 2.77
- Change Reason
- Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;
- Order vs. Observation
- Order
- Panel Type
- Panel
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