Version 2.77

Panel Hierarchy

Details for each LOINC in Panel LHC-Forms

LOINC Name R/O/C Cardinality Example UCUM Units
101111-3 MDS v3.0 - RAI v1.18.11 - Interim Payment Assessment (IPA) item set during assessment period [CMS Assessment]
Indent90503-4 Identification Information
IndentIndent58198-3 Type of Record
IndentIndent54581-4 Facility Provider Numbers
IndentIndentIndent76468-8 National Provider Identifier (NPI)
IndentIndentIndent69417-4 CMS Certification Number (CCN)
IndentIndentIndent45398-5 State Provider Number
IndentIndent85632-8 Type of Provider
IndentIndent90571-1 Type of Assessment
IndentIndentIndent54583-0 Federal OBRA Reason for Assessment
IndentIndentIndent54584-8 PPS Assessment
IndentIndentIndent54587-1 Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry?
IndentIndentIndent58108-2 Entry/discharge reporting
IndentIndentIndent71440-2 Type of discharge
IndentIndent86526-1 Unit Certification or Licensure Designation
IndentIndent54503-8 Legal Name of Resident
IndentIndentIndent45392-8 First name
IndentIndentIndent45393-6 Middle initial
IndentIndentIndent45394-4 Last name
IndentIndentIndent45395-1 Suffix
IndentIndent45966-9 Social Security and Medicare Numbers
IndentIndentIndent45396-9 Social Security Number
IndentIndentIndent45397-7 Medicare number
IndentIndent45400-9 Medicaid Number
IndentIndent46098-0 Gender
IndentIndent21112-8 Birth Date {mm/dd/yyyy}
IndentIndent69854-8 Ethnicity. Are you of Hispanic, Latino/a, or Spanish origin? 1..4
IndentIndent103708-4 Race. What is your race? 1..14
IndentIndent93186-5 Language
IndentIndentIndent54899-0 What is your preferred language?
IndentIndentIndent54588-9 Do you need or want an interpreter to communicate with a doctor or health care staff?
IndentIndent45404-1 Marital Status
IndentIndent54506-1 Optional Resident Items
IndentIndentIndent46106-1 Medical record number
IndentIndentIndent45403-3 Room number
IndentIndentIndent52462-9 Name by which resident prefers to be addressed
IndentIndentIndent21843-8 Lifetime occupation(s)
IndentIndent54593-9 Assessment Reference Date. Observation end date {mm/dd/yyyy}
IndentIndent54507-9 Medicare Stay
IndentIndentIndent54594-7 Has the resident had a Medicare-covered stay since the most recent entry?
IndentIndentIndent54595-4 Start date of most recent Medicare stay {mm/dd/yyyy}
IndentIndentIndent54596-2 End date of most recent Medicare stay {mm/dd/yyyy}
Indent90505-9 Hearing, Speech, and Vision
IndentIndent54597-0 Comatose. Persistent vegetative state/no discernible consciousness
IndentIndent95737-3 Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression
Indent93050-3 Cognitive Patterns
IndentIndent54605-1 Should Brief Interview for Mental Status (C0200-C0500) be Conducted?
IndentIndent103694-6 Brief Interview for Mental Status (BIMS)
IndentIndentIndent103696-1 Repetition of Three Words. Number of words repeated after first attempt
IndentIndentIndent103702-7 Temporal Orientation (orientation to year, month, and day)
IndentIndentIndentIndent103697-9 Able to report correct year
IndentIndentIndentIndent103698-7 Able to report correct month
IndentIndentIndentIndent103703-5 Able to report correct day of the week
IndentIndentIndent103695-3 Recall
IndentIndentIndentIndent103699-5 Able to recall "sock"
IndentIndentIndentIndent103700-1 Able to recall "blue"
IndentIndentIndentIndent103701-9 Able to recall "bed"
IndentIndentIndent103704-3 BIMS Summary Score {score}
IndentIndent54615-0 Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted?
IndentIndent86814-1 Staff Assessment for Mental Status
IndentIndentIndent54616-8 Short-term Memory OK. Seems or appears to recall after 5 minutes
IndentIndentIndent54624-2 Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life
Indent90482-1 Mood
IndentIndent54634-1 Should Resident Mood Interview be Conducted?
IndentIndent54635-8 Resident Mood Interview (PHQ-2 to 9)
IndentIndentIndent86843-0 Symptom Presence
IndentIndentIndentIndent54636-6 Little interest or pleasure in doing things
IndentIndentIndentIndent54638-2 Feeling down, depressed or hopeless
IndentIndentIndentIndent54640-8 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndent54642-4 Feeling tired or having little energy
IndentIndentIndentIndent54644-0 Poor appetite or overeating
IndentIndentIndentIndent54646-5 Feeling bad about yourself - or that you are a failure or have let yourself or your family down
IndentIndentIndentIndent54648-1 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndent54650-7 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
IndentIndentIndentIndent54652-3 Thoughts that you would be better off dead, or of hurting yourself in some way
IndentIndentIndent86844-8 Symptom Frequency
IndentIndentIndentIndent54637-4 Little interest or pleasure in doing things
IndentIndentIndentIndent54639-0 Feeling down, depressed or hopeless
IndentIndentIndentIndent54641-6 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndent54643-2 Feeling tired or having little energy
IndentIndentIndentIndent54645-7 Poor appetite or overeating
IndentIndentIndentIndent54647-3 Feeling bad about yourself - or that you are a failure or have let yourself or your family down
IndentIndentIndentIndent54649-9 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndent54651-5 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
IndentIndentIndentIndent54653-1 Thoughts that you would be better off dead, or of hurting yourself in some way
IndentIndent103705-0 Total Severity Score {score}
IndentIndent103706-8 Staff Assessment of Resident Mood (PHQ-9-OV)
IndentIndentIndent86833-1 Symptom Presence
IndentIndentIndentIndent54658-0 Little interest or pleasure in doing things
IndentIndentIndentIndent54660-6 Feeling or appearing down, depressed, or hopeless
IndentIndentIndentIndent54662-2 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndent54664-8 Feeling tired or having little energy
IndentIndentIndentIndent54666-3 Poor appetite or overeating
IndentIndentIndentIndent54668-9 Indicating that they feel bad about self, are a failure, or have let self or family down.
IndentIndentIndentIndent54670-5 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndent54672-1 Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that they have been moving around a lot more than usual
IndentIndentIndentIndent54673-9 States that life isn't worth living, wishes for death, or attempts to harm self
IndentIndentIndentIndent54675-4 Being short-tempered, easily annoyed
IndentIndentIndent86891-9 Symptom Frequency
IndentIndentIndentIndent54659-8 Little interest or pleasure in doing things
IndentIndentIndentIndent54661-4 Feeling or appearing down, depressed, or hopeless
IndentIndentIndentIndent54663-0 Trouble falling or staying asleep, or sleeping too much
IndentIndentIndentIndent54665-5 Feeling tired or having little energy
IndentIndentIndentIndent54667-1 Poor appetite or overeating
IndentIndentIndentIndent54669-7 Indicating that they feel bad about self, are a failure, or have let self or family down.
IndentIndentIndentIndent54671-3 Trouble concentrating on things, such as reading the newspaper or watching television
IndentIndentIndentIndent54904-8 Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that they have been moving around a lot more than usual
IndentIndentIndentIndent54674-7 States that life isn't worth living, wishes for death, or attempts to harm self
IndentIndentIndentIndent54676-2 Being short-tempered, easily annoyed
IndentIndent103707-6 Total Severity Score {score}
Indent86815-8 Behavior
IndentIndent86597-2 Potential Indicators of Psychosis 1..2
IndentIndent54514-5 Behavioral Symptom - Presence & Frequency
IndentIndentIndent54682-0 Physical behavioral symptoms directed toward others d/(7.d)
IndentIndentIndent54683-8 Verbal behavioral symptoms directed toward others d/(7.d)
IndentIndentIndent54684-6 Other behavioral symptoms not directed toward others d/(7.d)
IndentIndent54692-9 Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being? d/(7.d)
IndentIndent54693-7 Wandering - Presence & Frequency. Has the resident wandered? d/(7.d)
Indent101267-3 Functional Abilities and Goals - OBRA &or Interim
IndentIndent101430-7 Self-Care - OBRA/Interim Performance
IndentIndentIndent89409-7 Eating
IndentIndentIndent89404-8 Oral hygiene
IndentIndentIndent89389-1 Toileting hygiene
IndentIndent101432-3 Mobility - OBRA/Interim Performance
IndentIndentIndent89394-1 Sit to lying
IndentIndentIndent95009-7 Lying to sitting on side of bed
IndentIndentIndent89392-5 Sit to stand
IndentIndentIndent89414-7 Chair/bed-to-chair transfer
IndentIndentIndent89390-9 Toilet transfer
IndentIndentIndent89385-9 Walk 10 feet
IndentIndentIndent89381-8 Walk 50 feet with two turns
IndentIndentIndent89383-4 Walk 150 feet
Indent90507-5 Bladder and Bowel
IndentIndent86624-4 Appliances 1..2
IndentIndent54769-5 Urinary Toileting Program. Current toileting program or trial - Is a toileting program currently being used to manage the resident's urinary continence?
IndentIndent88695-2 Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence?
Indent90485-4 Active Diagnoses
IndentIndent86671-5 Active Diagnoses in the last 7 days 1..*
IndentIndent52797-8 Additional active diagnoses 0..10
Indent96095-5 Indicate the resident's primary medical condition category
Indent52797-8 ICD Code
Indent90488-8 Health Conditions
IndentIndent86889-3 Other Health Conditions
IndentIndentIndent86675-6 Shortness of Breath (dyspnea) 1..1
IndentIndentIndent86676-4 Problem Conditions 1..2
IndentIndent90542-2 Recent Surgery Requiring Active SNF Care. Did the resident have a major surgical procedure during the prior inpatient hospital stay that requires active care during the SNF stay?
IndentIndent90745-1 Surgical Procedures
Indent90509-1 Swallowing/Nutritional Status
IndentIndent86677-2 Swallowing Disorder 1..4
IndentIndent54863-6 Weight Loss
IndentIndent54568-1 Nutritional Approaches
IndentIndentIndent71444-4 Nutritional Approaches. While NOT a Resident 1..2
IndentIndentIndent71445-1 Nutritional Approaches. While a Resident 1..3
IndentIndent90543-0 Percent Intake by Artificial Route
IndentIndentIndent86681-4 Proportion of total calories the resident received through parenteral or tube feeding. While a Resident
IndentIndentIndent86687-1 Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days
IndentIndentIndent86683-0 Average fluid intake per day by IV or tube feeding. While a Resident mL/d;L/d
IndentIndentIndent86684-8 Average fluid intake per day by IV or tube feeding. During Entire 7 Days mL/d;L/d
Indent89051-7 Skin Conditions
IndentIndent58214-8 Unhealed Pressure Ulcers/Injuries. Does this resident have one or more unhealed pressure ulcers/injuries?
IndentIndent86892-7 Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage
IndentIndentIndent55124-2 Number of Stage 2 pressure ulcers {#}
IndentIndentIndent55125-9 Number of Stage 3 pressure ulcers {#}
IndentIndentIndent55126-7 Number of Stage 4 pressure ulcers {#}
IndentIndentIndent54946-9 Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar {#}
IndentIndent54970-9 Number of Venous and Arterial Ulcers {#}
IndentIndent88696-0 Other Ulcers, Wounds and Skin Problems 1..6
IndentIndent86748-1 Skin and Ulcer/Injury Treatments 1..9
Indent90513-3 Medications
IndentIndent58217-1 Insulin
IndentIndentIndent58127-2 Insulin injections d/(7.d)
IndentIndentIndent58128-0 Orders for insulin d/(7.d)
Indent101614-6 Special Treatments, Procedures, and Programs
IndentIndent86761-4 Special Treatments, Procedures, and Programs - While a Resident 1..13
IndentIndent55024-4 Therapies
IndentIndentIndent58141-3 Respiratory Therapy
IndentIndentIndentIndent45766-3 Respiratory Therapy - Days d/(7.d)
IndentIndentIndent86773-9 Restorative Nursing Programs
IndentIndentIndentIndent86774-7 Technique. Range of motion (passive) d/(7.d)
IndentIndentIndentIndent86775-4 Technique. Range of motion (active) d/(7.d)
IndentIndentIndentIndent86776-2 Technique. Splint or brace assistance d/(7.d)
IndentIndentIndentIndent86777-0 Training and Skill Practice In: Bed mobility d/(7.d)
IndentIndentIndentIndent86778-8 Training and Skill Practice In: Transfer d/(7.d)
IndentIndentIndentIndent86779-6 Training and Skill Practice In: Walking d/(7.d)
IndentIndentIndentIndent86780-4 Training and Skill Practice In: Dressing and/or grooming d/(7.d)
IndentIndentIndentIndent86781-2 Training and Skill Practice In: Eating and/or swallowing d/(7.d)
IndentIndentIndentIndent86782-0 Training and Skill Practice In: Amputation/prostheses care d/(7.d)
IndentIndentIndentIndent86783-8 Training and Skill Practice In: Communication d/(7.d)
Indent91579-3 Correction Request
IndentIndent85632-8 Type of Provider
IndentIndent87226-7 Name of Resident
IndentIndentIndent45392-8 First name
IndentIndentIndent45394-4 Last name
IndentIndent46098-0 Gender
IndentIndent21112-8 Birth Date {mm/dd/yyyy}
IndentIndent45396-9 Social Security Number
IndentIndent91580-1 Type of Assessment
IndentIndentIndent54583-0 Federal OBRA Reason for Assessment
IndentIndentIndent54584-8 PPS Assessment
IndentIndentIndent58108-2 Entry/discharge reporting
IndentIndent87216-8 Date on existing record to be modified/inactivated.
IndentIndentIndent54593-9 Assessment Reference Date {mm/dd/yyyy}
IndentIndent87209-3 Correction Attestation Section
IndentIndentIndent58200-7 Correction Number {#}
IndentIndentIndent87217-6 Reasons for Modification 1..5
IndentIndentIndent87225-9 Reasons for Inactivation 1..2
IndentIndentIndent87218-4 RN Assessment Coordinator Attestation of Completion
IndentIndentIndentIndent87219-2 Attesting individual's first name
IndentIndentIndentIndent87220-0 Attesting individual's last name
IndentIndentIndentIndent87221-8 Attesting individual's title
IndentIndentIndentIndent87222-6 Attestation date {mm/dd/yyyy}
Indent90495-3 Assessment Administration
IndentIndent90498-7 Medicare Part A Billing
IndentIndentIndent55065-7 Medicare Part A HIPPS code
IndentIndentIndent55081-4 Version code
IndentIndentIndent85648-4 Signature of Persons Completing the Assessment or Entry/Death Reporting
IndentIndentIndent70127-6 Signature of RN Assessment Coordinator Verifying Assessment Completion
IndentIndentIndentIndent70127-6 Signature:
IndentIndentIndentIndent30947-6 Date RN Assessment Coordinator signed assessment as complete: {mm/dd/yyyy}

Fully-Specified Name

Component
MDS v3.0 - RAI v1.18.11 - Interim Payment Assessment (IPA) 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

LOINC Terminology Service (API) using HL7® FHIR® Get Info

CodeSystem lookup
https://fhir.loinc.org/CodeSystem/$lookup?system=http://loinc.org&code=101111-3
Questionnaire definition
https://fhir.loinc.org/Questionnaire/?url=http://loinc.org/q/101111-3