106623-2
Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 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 |
|---|---|---|---|---|
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] | |||
| Indent106935-0 | Administrative 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 Indent106631-5 | Site of Service at Admission | |||
| Indent Indent52455-3 | Admission Date | {mm/dd/yyyy} | ||
| Indent Indent52454-6 | Reason for Record | |||
| Indent Indent54503-8 | Legal Name of Patient | |||
| Indent Indent Indent45392-8 | First name | |||
| Indent Indent Indent45393-6 | Middle initial | |||
| Indent Indent Indent45394-4 | Last name | |||
| Indent Indent Indent45395-1 | Suffix | |||
| Indent Indent106632-3 | Patient ZIP Code | |||
| 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..5 | ||
| Indent Indent103708-4 | Race. What is your race? | 1..15 | ||
| Indent Indent93186-5 | Language | |||
| Indent Indent Indent54899-0 | What is your preferred language? | |||
| Indent Indent Indent54588-9 | Do you need or want an interpreter to communicate with a doctor or health care staff? | |||
| Indent Indent52556-8 | Payer Information | 1..9 | ||
| Indent Indent85398-6 | Admitted From | |||
| Indent Indent85950-4 | Living Arrangements | |||
| Indent Indent94912-3 | Availability of Assistance | |||
| Indent95033-7 | Preferences for Customary Routine and Activities | |||
| Indent Indent106636-4 | CPR Preference | |||
| Indent Indent Indent106637-2 | Was the patient/responsible party asked about preference regarding the use of cardiopulmonary resuscitation (CPR)? | |||
| Indent Indent Indent106635-6 | Date the patient/responsible party was first asked about preference regarding the use of CPR: | {mm/dd/yyyy} | ||
| Indent Indent106638-0 | Other Life-Sustaining Treatment Preferences | |||
| Indent Indent Indent106639-8 | Was the patient/responsible party asked about preferences regarding life-sustaining treatments other than CPR? | |||
| Indent Indent Indent106640-6 | Date the patient/responsible party was first asked about preferences regarding life-sustaining treatments other than CPR: | {mm/dd/yyyy} | ||
| Indent Indent106641-4 | Hospitalization Preference | |||
| Indent Indent Indent106646-3 | Was the patient/responsible party asked about preference regarding hospitalization? | |||
| Indent Indent Indent106645-5 | Date the patient/responsible party was first asked about preference regarding hospitalization: | {mm/dd/yyyy} | ||
| Indent Indent106644-8 | Spiritual/Existential Concerns | |||
| Indent Indent Indent106643-0 | Was the patient and/or caregiver asked about spiritual/existential concerns? | |||
| Indent Indent Indent106642-2 | Date the patient and/or caregiver was first asked about spiritual/existential concerns: | {mm/dd/yyyy} | ||
| Indent54531-9 | Active Diagnoses | |||
| Indent Indent106647-1 | Principal Diagnosis | |||
| Indent Indent106649-7 | Comorbidities and Co-existing Conditions | |||
| Indent99170-3 | Health Conditions | |||
| Indent Indent106664-6 | Death is Imminent | |||
| Indent Indent106663-8 | Pain Screening | |||
| Indent Indent Indent106665-3 | Was the patient screened for pain? | |||
| Indent Indent Indent106666-1 | Date of first screening for pain | {mm/dd/yyyy} | ||
| Indent Indent Indent106667-9 | The patient’s pain severity was: | |||
| Indent Indent Indent106669-5 | Type of standardized pain tool used: | |||
| Indent Indent106670-3 | Pain Active Problem. Is pain an active problem for the patient? | |||
| Indent Indent106671-1 | Comprehensive Pain Assessment | |||
| Indent Indent Indent106668-7 | Was a comprehensive pain assessment done | |||
| Indent Indent Indent106672-9 | Date of comprehensive pain assessment | {mm/dd/yyyy} | ||
| Indent Indent Indent106673-7 | Comprehensive pain assessment included: | 1..7 | ||
| Indent Indent106674-5 | Neuropathic Pain | |||
| Indent Indent106675-2 | Screening for Shortness of Breath | |||
| Indent Indent Indent106676-0 | Was the patient screened for shortness of breath? | |||
| Indent Indent Indent106677-8 | Date of first screening for shortness of breath: | {mm/dd/yyyy} | ||
| Indent Indent Indent106678-6 | Did the screening indicate the patient had shortness of breath? | |||
| Indent Indent106679-4 | Treatment for Shortness of Breath | |||
| Indent Indent Indent106680-2 | Was treatment for shortness of breath initiated? | |||
| Indent Indent Indent106681-0 | Date treatment for shortness of breath initiated: | {mm/dd/yyyy} | ||
| Indent Indent106685-1 | Symptom Impact Screening | |||
| Indent Indent Indent106684-4 | Was a symptom impact screening completed? | |||
| Indent Indent Indent106683-6 | Date of symptom impact screening: | {mm/dd/yyyy} | ||
| Indent Indent106682-8 | Symptom Impact | |||
| Indent Indent Indent106688-5 | Pain | |||
| Indent Indent Indent106689-3 | Shortness of breath | |||
| Indent Indent Indent106690-1 | Anxiety | |||
| Indent Indent Indent106692-7 | Nausea | |||
| Indent Indent Indent106691-9 | Vomiting | |||
| Indent Indent Indent106693-5 | Diarrhea | |||
| Indent Indent Indent106694-3 | Constipation | |||
| Indent Indent Indent106695-0 | Agitation | |||
| Indent Indent106704-0 | Symptom Follow-up Visit (SFV) | |||
| Indent Indent Indent106705-7 | Was an in-person SFV completed? | |||
| Indent Indent Indent106706-5 | Date of in-person SFV | {mm/dd/yyyy} | ||
| Indent Indent Indent106707-3 | Reason SFV Not Completed | |||
| Indent Indent106708-1 | SFV Symptom Impact | |||
| Indent Indent Indent106703-2 | Pain | |||
| Indent Indent Indent106702-4 | Shortness of breath | |||
| Indent Indent Indent106701-6 | Anxiety | |||
| Indent Indent Indent106700-8 | Nausea | |||
| Indent Indent Indent106699-2 | Vomiting | |||
| Indent Indent Indent106698-4 | Diarrhea | |||
| Indent Indent Indent106697-6 | Constipation | |||
| Indent Indent Indent106696-8 | Agitation | |||
| Indent54572-3 | Skin Conditions | |||
| Indent Indent106709-9 | Skin Conditions. Does the patient have one or more skin conditions? | |||
| Indent Indent106710-7 | Types of Skin Conditions | 1..8 | ||
| Indent Indent106711-5 | Skin and Ulcer/Injury Treatments | 1..10 | ||
| Indent88962-6 | Medications | |||
| Indent Indent106718-0 | Scheduled Opioid | |||
| Indent Indent Indent106719-8 | Was a scheduled opioid initiated or continued? | |||
| Indent Indent Indent106720-6 | Date scheduled opioid initiated or continued: | {mm/dd/yyyy} | ||
| Indent Indent106717-2 | PRN Opioid | |||
| Indent Indent Indent106716-4 | Was a PRN opioid initiated or continued | |||
| Indent Indent Indent106714-9 | Date PRN opioid initiated or continued: | {mm/dd/yyyy} | ||
| Indent Indent106715-6 | Bowel Regimen | |||
| Indent Indent Indent106713-1 | Was a bowel regimen initiated or continued? | |||
| Indent Indent Indent106712-3 | Date bowel regimen initiated or continued: | {mm/dd/yyyy} | ||
| Indent101280-6 | Assessment Administration | |||
| Indent Indent85648-4 | Signature(s) of Person(s) Completing the Record | |||
| Indent Indent70127-6 | Signature of Person Verifying Record Completion | |||
| Indent Indent Indent70127-6 | Signature: | |||
| Indent Indent Indent30947-6 | Date | {mm/dd/yyyy} |
Fully-Specified Name
- Component
- Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.80
- Last Updated
- Version 2.80 (ADD)
- Order vs. Observation
- Order
- Panel Type
- Panel
LOINC Terminology Service (API) using HL7® FHIR® Get Info
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- https:
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