83265-9
Deprecated Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.4 [CMS Assessment]
Deprecated
Status Information
- Status
- DEPRECATED
Term Description
This panel only includes the IRF-PAI items that are not a part of the FIM Instrument (an instrument copyrighted by UBFA, Inc ©1993, 2001). This panel should be used for CMS IRF-PAI v1.4 assessments performed between October 1, 2016 and September 30, 2017.
Source: Regenstrief LOINC
Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
| LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
|---|---|---|---|---|
| 83265-9 | Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 1.4 | |||
| Indent85410-9 | Discharge Information | |||
| Indent Indent52525-3 | Discharge Date | {mm/dd/yyyy} | ||
| Indent Indent85411-7 | Patient discharged against medical advice? | |||
| Indent Indent85412-5 | Program Interruption(s) | |||
| Indent Indent85483-6 | Program Interruption Dates | 0..3 | ||
| Indent Indent Indent85413-3 | Program Interruption Date | 1..1 | {mm/dd/yyyy} | |
| Indent Indent Indent85414-1 | Program Return Date | 1..1 | {mm/dd/yyyy} | |
| Indent Indent85415-8 | Was the patient discharged alive? | |||
| Indent Indent55128-3 | Patient's discharge destination/living setting | |||
| Indent Indent85417-4 | Discharge to Living With | |||
| Indent Indent85418-2 | Diagnosis for Interruption or Death | |||
| Indent Indent85419-0 | Complications during rehabilitation stay | 0..6 | ||
| Indent85395-2 | Identification Information | |||
| Indent Indent85396-0 | Facility Information | |||
| Indent Indent Indent76696-4 | Facility Name | |||
| Indent Indent Indent69417-4 | Facility Medicare Provider Number | |||
| Indent Indent45397-7 | Patient Medicare Number | |||
| Indent Indent45400-9 | Patient Medicaid Number | |||
| Indent Indent45392-8 | Patient First Name | |||
| Indent Indent45394-4 | Patient Last Name | |||
| Indent Indent52463-7 | Patient Identification Number | |||
| Indent Indent21112-8 | Birth Date | {mm/dd/yyyy} | ||
| Indent Indent45396-9 | Social Security Number | |||
| Indent Indent46098-0 | Gender | |||
| Indent Indent59362-4 | Race/Ethnicity | 0..6 | ||
| Indent Indent45404-1 | Marital status | |||
| Indent Indent52539-4 | Zip Code of Patient's Pre-Hospital Residence | |||
| Indent Indent52455-3 | Admission Date | {mm/dd/yyyy} | ||
| Indent Indent54593-9 | Assessment reference date - observation end date during assessment period [CMS Assessment] | {mm/dd/yyyy} | ||
| Indent Indent85397-8 | Admission Class | |||
| Indent Indent85398-6 | Admit From | |||
| Indent Indent85399-4 | Pre-hospital Living Setting | |||
| Indent Indent85400-0 | Pre-hospital Living With | |||
| Indent85404-2 | Medical Information | |||
| Indent Indent85405-9 | Impairment Group - Admission | |||
| Indent Indent Indent85845-6 | Impairment Group | |||
| Indent Indent85406-7 | Impairment Group - Discharge | |||
| Indent Indent Indent85845-6 | Impairment Group | |||
| Indent Indent52797-8 | Etiologic Diagnosis | 1..3 | ||
| Indent Indent85585-8 | Date of Onset of Impairment | {mm/dd/yyyy} | ||
| Indent Indent75618-9 | Comorbid Conditions | 0..25 | ||
| Indent Indent85407-5 | Are there any arthritis conditions recorded in items #21, #22, or #24 that meet all of the regulatory requirements for IRF classification (in 42 CFR 412.29(b)(2)(x), (xi), and (xii))? | |||
| Indent Indent54567-3 | Height and Weight | |||
| Indent Indent Indent3137-7 | Height on admission (in inches) | [in_us];cm;m | ||
| Indent Indent Indent3141-9 | Weight on admission (in pounds) | [lb_av];kg | ||
| Indent Indent85408-3 | Swallowing Status - Admission | |||
| Indent Indent Indent85846-4 | Swallowing Status | |||
| Indent Indent85409-1 | Swallowing Status - Discharge | |||
| Indent Indent Indent85846-4 | Swallowing Status | |||
| Indent85401-8 | Payer information | |||
| Indent Indent85813-4 | Payment Source | |||
| Indent Indent Indent85402-6 | Primary Source | |||
| Indent Indent Indent85403-4 | Secondary Source | |||
| Indent83266-7 | Quality Indicators - Admission | |||
| Indent Indent83251-9 | Hearing, Speech, and Vision | |||
| Indent Indent Indent83250-1 | Expression of Ideas and Wants | |||
| Indent Indent Indent83249-3 | Understanding Verbal Content (with hearing aid or device, if used and excluding language barriers) | |||
| Indent Indent83267-5 | Cognitive Patterns | |||
| Indent Indent Indent83248-5 | Should Brief Interview for Mental Status (C0200-C0500) be conducted? | |||
| Indent Indent Indent52491-8 | Brief Interview for Mental Status | |||
| Indent Indent Indent Indent52731-7 | Repetition of Three Words. Number of words repeated by patient after first attempt | |||
| Indent Indent Indent Indent54510-3 | Temporal Orientation: Year, Month, and Day | |||
| Indent Indent Indent Indent Indent52732-5 | Please tell me what year it is right now | |||
| Indent Indent Indent Indent Indent52733-3 | What month are we in right now? | |||
| Indent Indent Indent Indent Indent54609-3 | What day of the week is today? | |||
| Indent Indent Indent Indent52493-4 | Recall | |||
| Indent Indent Indent Indent Indent52735-8 | Recalls "sock"? | |||
| Indent Indent Indent Indent Indent52736-6 | Recalls "blue"? | |||
| Indent Indent Indent Indent Indent52737-4 | Recalls "bed"? | |||
| Indent Indent Indent Indent54614-3 | BIMS Summary Score | {score} | ||
| Indent Indent Indent54615-0 | Should the Staff Assessment for Mental Status (C0900) be Conducted? | |||
| Indent Indent Indent83241-0 | Staff Assessment for Mental Status | |||
| Indent Indent Indent Indent83240-2 | Memory/Recall Ability | 1..4 | ||
| Indent Indent83268-3 | Functional Abilities and Goals - Admission | |||
| Indent Indent Indent83239-4 | Prior Functioning: Everyday Activities | |||
| Indent Indent Indent Indent85070-1 | Self-Care | |||
| Indent Indent Indent Indent85071-9 | Indoor Mobility (Ambulation) | |||
| Indent Indent Indent Indent85072-7 | Stairs | |||
| Indent Indent Indent Indent85073-5 | Functional Cognition | |||
| Indent Indent Indent83234-5 | Prior Device Use | 1..5 | ||
| Indent Indent Indent83233-7 | Self-Care - Admission Performance | |||
| Indent Indent Indent Indent83232-9 | Eating | |||
| Indent Indent Indent Indent83230-3 | Oral hygiene | |||
| Indent Indent Indent Indent83228-7 | Toileting hygiene | |||
| Indent Indent Indent Indent83226-1 | Shower/bathe self | |||
| Indent Indent Indent Indent83224-6 | Upper body dressing | |||
| Indent Indent Indent Indent83222-0 | Lower body dressing | |||
| Indent Indent Indent Indent83220-4 | Putting on/taking off footwear | |||
| Indent Indent Indent85054-5 | Self-Care - Discharge Goal | |||
| Indent Indent Indent Indent83231-1 | Eating | |||
| Indent Indent Indent Indent83229-5 | Oral hygiene | |||
| Indent Indent Indent Indent83227-9 | Toileting hygiene | |||
| Indent Indent Indent Indent83225-3 | Shower/bathe self | |||
| Indent Indent Indent Indent83223-8 | Upper body dressing | |||
| Indent Indent Indent Indent83221-2 | Lower body dressing | |||
| Indent Indent Indent Indent83219-6 | Putting on/taking off footwear | |||
| Indent Indent Indent83269-1 | Mobility - Admission Performance | |||
| Indent Indent Indent Indent83218-8 | Roll left and right | |||
| Indent Indent Indent Indent83216-2 | Sit to lying | |||
| Indent Indent Indent Indent83214-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83212-1 | Sit to stand | |||
| Indent Indent Indent Indent83210-5 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent83208-9 | Toilet transfer | |||
| Indent Indent Indent Indent83206-3 | Car transfer | |||
| Indent Indent Indent Indent83270-9 | Does the patient walk? | |||
| Indent Indent Indent Indent83204-8 | Walk 10 feet | |||
| Indent Indent Indent Indent83202-2 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83200-6 | Walk 150 feet | |||
| Indent Indent Indent Indent83198-2 | Walking 10 feet on uneven surfaces | |||
| Indent Indent Indent Indent83196-6 | 1 step (curb) | |||
| Indent Indent Indent Indent83194-1 | 4 steps | |||
| Indent Indent Indent Indent83192-5 | 12 steps | |||
| Indent Indent Indent Indent83190-9 | Picking up object | |||
| Indent Indent Indent Indent83271-7 | Does the patient use a wheelchair/scooter? | |||
| Indent Indent Indent Indent83188-3 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent Indent83235-2 | Wheel 150 feet | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent Indent85056-0 | Mobility - Discharge Goal | |||
| Indent Indent Indent Indent83217-0 | Roll left and right | |||
| Indent Indent Indent Indent83215-4 | Sit to lying | |||
| Indent Indent Indent Indent83213-9 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83211-3 | Sit to stand | |||
| Indent Indent Indent Indent83209-7 | Chair/Bed-to-chair transfer | |||
| Indent Indent Indent Indent83207-1 | Toilet transfer | |||
| Indent Indent Indent Indent83205-5 | Car transfer | |||
| Indent Indent Indent Indent83203-0 | Walk 10 feet | |||
| Indent Indent Indent Indent83201-4 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83199-0 | Walk 150 feet | |||
| Indent Indent Indent Indent83197-4 | Walking 10 feet on uneven surfaces | |||
| Indent Indent Indent Indent83195-8 | 1 step (curb) | |||
| Indent Indent Indent Indent83193-3 | 4 steps | |||
| Indent Indent Indent Indent83191-7 | 12 steps | |||
| Indent Indent Indent Indent83189-1 | Picking up object | |||
| Indent Indent Indent Indent83187-5 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83236-0 | Wheel 150 feet | |||
| Indent Indent83237-8 | Bladder and Bowel | |||
| Indent Indent Indent83238-6 | Bladder continence | |||
| Indent Indent Indent83242-8 | Bowel continence | |||
| Indent Indent83264-2 | Active diagnoses | |||
| Indent Indent Indent83243-6 | Comorbidities and Co-existing Conditions | 1..2 | ||
| Indent Indent83273-3 | Health Conditions - Admission | |||
| Indent Indent Indent52552-7 | History of Falls. Has the patient had two or more falls in the past year or any fall with injury in the past year? | |||
| Indent Indent Indent83274-1 | Prior Surgery. Did the resident have major surgery during the 100 days prior to admission? | |||
| Indent Indent83244-4 | Swallowing/Nutritional Status | |||
| Indent Indent Indent83245-1 | Swallowing/Nutritional Status | 1..3 | ||
| Indent Indent85055-2 | Skin Conditions - Admission | |||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcer(s). Does this patient have one or more unhealed pressure ulcer(s) at Stage 1 or higher? | |||
| Indent Indent Indent83246-9 | Current Number of Unhealed Pressure Ulcers at Each Stage - Admission | |||
| Indent Indent Indent Indent54884-2 | Number of Stage 1 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers due to non-removable dressing/device | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of pressure unstageable ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure ulcers with suspected deep tissue injury in evolution | {#} | ||
| Indent Indent83261-8 | Special Treatments, Procedures, and Programs - Admission | |||
| Indent Indent Indent83252-7 | Special Treatments, Procedures, and Programs | 0..1 | ||
| Indent83275-8 | Quality Indicators - Discharge | |||
| Indent Indent83276-6 | Functional Abilities and Goals - Discharge | |||
| Indent Indent Indent83254-3 | Self-Care - Discharge Performance | |||
| Indent Indent Indent Indent83232-9 | Eating | |||
| Indent Indent Indent Indent83230-3 | Oral hygiene | |||
| Indent Indent Indent Indent83228-7 | Toileting hygiene | |||
| Indent Indent Indent Indent83226-1 | Shower/bathe self | |||
| Indent Indent Indent Indent83224-6 | Upper body dressing | |||
| Indent Indent Indent Indent83222-0 | Lower body dressing | |||
| Indent Indent Indent Indent83220-4 | Putting on/taking off footwear | |||
| Indent Indent Indent83277-4 | Mobility - Discharge Performance | |||
| Indent Indent Indent Indent83218-8 | Roll left and right | |||
| Indent Indent Indent Indent83216-2 | Sit to lying | |||
| Indent Indent Indent Indent83214-7 | Lying to sitting on side of bed | |||
| Indent Indent Indent Indent83212-1 | Sit to stand | |||
| Indent Indent Indent Indent83210-5 | Chair/bed-to-chair transfer | |||
| Indent Indent Indent Indent83208-9 | Toilet transfer | |||
| Indent Indent Indent Indent83206-3 | Car transfer | |||
| Indent Indent Indent Indent83278-2 | Does the patient walk? | |||
| Indent Indent Indent Indent83204-8 | Walk 10 feet | |||
| Indent Indent Indent Indent83202-2 | Walk 50 feet with two turns | |||
| Indent Indent Indent Indent83200-6 | Walk 150 feet | |||
| Indent Indent Indent Indent83198-2 | Walking 10 feet on uneven surfaces | |||
| Indent Indent Indent Indent83196-6 | 1 step (curb) | |||
| Indent Indent Indent Indent83194-1 | 4 steps | |||
| Indent Indent Indent Indent83192-5 | 12 steps | |||
| Indent Indent Indent Indent83190-9 | Picking up object | |||
| Indent Indent Indent Indent83271-7 | Does the patient use a wheelchair/scooter? | |||
| Indent Indent Indent Indent83188-3 | Wheel 50 feet with two turns | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchairscooter used | |||
| Indent Indent Indent Indent83235-2 | Wheel 150 feet | |||
| Indent Indent Indent Indent83272-5 | Indicate the type of wheelchair/scooter used | |||
| Indent Indent83279-0 | Health Conditions - Discharge | |||
| Indent Indent Indent83280-8 | Any falls since admission. Has the patient had any falls since admission? | |||
| Indent Indent Indent54854-5 | Number of Falls Since Admission | |||
| Indent Indent Indent Indent54855-2 | No injury | |||
| Indent Indent Indent Indent54856-0 | Injury (except major) | |||
| Indent Indent Indent Indent54857-8 | Major injury | |||
| Indent Indent83281-6 | Skin Conditions - Discharge | |||
| Indent Indent Indent58214-8 | Unhealed Pressure Ulcer(s). Does this patient have one or more unhealed pressure ulcer(s) at Stage 1 or higher? | |||
| Indent Indent Indent83256-8 | Current Number of Unhealed Pressure Ulcers at Each Stage - Discharge | |||
| Indent Indent Indent Indent54884-2 | Number of Stage 1 pressure ulcers | {#} | ||
| Indent Indent Indent Indent55124-2 | Number of Stage 2 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54886-7 | Number of these Stage 2 pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent55125-9 | Number of Stage 3 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54887-5 | Number of these Stage 3 pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent55126-7 | Number of Stage 4 pressure ulcers | {#} | ||
| Indent Indent Indent Indent54890-9 | Number of these Stage 4 pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent54893-3 | Number of unstageable pressure ulcers due to non-removable dressing | {#} | ||
| Indent Indent Indent Indent54894-1 | Number of these unstageable pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent54946-9 | Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar | {#} | ||
| Indent Indent Indent Indent54947-7 | Number of these unstageable pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent Indent54950-1 | Number of unstageable pressure ulcers with suspected deep tissue injury in evolution | {#} | ||
| Indent Indent Indent Indent54951-9 | Number of these unstageable pressure ulcers that were present upon admission | {#} | ||
| Indent Indent Indent83282-4 | Worsening in Pressure Ulcer Status Since Admission | |||
| Indent Indent Indent Indent83283-2 | Stage 2 | {#} | ||
| Indent Indent Indent Indent83284-0 | Stage 3 | {#} | ||
| Indent Indent Indent Indent83285-7 | Stage 4 | {#} | ||
| Indent Indent Indent Indent83286-5 | Unstageable - Non-removable dressing | {#} | ||
| Indent Indent Indent Indent83287-3 | Unstageable - Slough and/or eschar | {#} | ||
| Indent Indent Indent Indent83288-1 | Unstageable - Deep tissue injury | {#} | ||
| Indent Indent Indent83258-4 | Healed Pressure Ulcers | |||
| Indent Indent Indent Indent83260-0 | Stage 1 | {#} | ||
| Indent Indent Indent Indent54958-4 | Stage 2 | {#} | ||
| Indent Indent Indent Indent54959-2 | Stage 3 | {#} | ||
| Indent Indent Indent Indent54960-0 | Stage 4 | {#} | ||
| Indent Indent83247-7 | Special Treatments, Procedures, and Programs - Discharge | |||
| Indent Indent Indent69339-0 | Influenza Vaccine | |||
| Indent Indent Indent Indent55019-4 | Did the patient receive the influenza vaccine in this facility for this year's influenza vaccination season? | |||
| Indent Indent Indent Indent58131-4 | Date influenza vaccine received | {mm/dd/yyyy} | ||
| Indent Indent Indent Indent55020-2 | If influenza vaccine not received, state reason: | C | ||
| Indent85814-2 | Signature of Persons Completing the Assessment | |||
| Indent Indent85647-6 | Signature | |||
| Indent Indent85650-0 | Title | |||
| Indent Indent70158-1 | Date Information is Provided and Time | |||
| Indent85420-8 | Therapy Information | |||
| Indent Indent85494-3 | Week 1: Total Number of Minutes Provided | |||
| Indent Indent Indent85566-8 | Physical Therapy | |||
| Indent Indent Indent Indent85557-7 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85558-5 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85559-3 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85560-1 | Total minutes of co-treatment therapy | min | ||
| Indent Indent Indent85561-9 | Occupational Therapy | |||
| Indent Indent Indent Indent85562-7 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85563-5 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85564-3 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85565-0 | Total minutes of co-treatment therapy | min | ||
| Indent Indent Indent85493-5 | Speech-language Pathology | |||
| Indent Indent Indent Indent85492-7 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85491-9 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85490-1 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85489-3 | Total minutes of co-treatment therapy | min | ||
| Indent Indent85495-0 | Week 2: Total Number of Minutes Provided | |||
| Indent Indent Indent85589-0 | Physical Therapy | |||
| Indent Indent Indent Indent85567-6 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85568-4 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85569-2 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85570-0 | Total minutes of co-treatment therapy | min | ||
| Indent Indent Indent85590-8 | Occupational Therapy | |||
| Indent Indent Indent Indent85571-8 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85572-6 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85573-4 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85574-2 | Total minutes of co-treatment therapy | min | ||
| Indent Indent Indent85591-6 | Speech-language Pathology | |||
| Indent Indent Indent Indent85575-9 | Total minutes of individual therapy | min | ||
| Indent Indent Indent Indent85576-7 | Total minutes of concurrent therapy | min | ||
| Indent Indent Indent Indent85577-5 | Total minutes of group therapy | min | ||
| Indent Indent Indent Indent85578-3 | Total minutes of co-treatment therapy | min |
Fully-Specified Name
- Component
- Inpatient Rehabilitation Facility - Patient Assessment Instrument - version 1.4
- Property
- -
- Time
- Pt
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.73
- Change Reason
- Release 2.73: Status: LOINC will keep most current version and one prior version of CMS assessments active and discourage all older versions.;
- Order vs. Observation
- Order
- Panel Type
- Panel
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