95033-7
Preferences for Customary Routine and Activities
Active
94911-5 Living Arrangement Priorities
Observation ID in Form
F0905
Form Coding Instructions
Please ask the person to describe at least one or two personal priorities in the area of living arrangements for the next six months. If the person does not express any personal priorities in this area, please note this below
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Living arrangement priorities for the next 6Mo
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Nar
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Change Reason
- Release 2.78: ORDER_OBS: FASI v1.1; Release 2.77: TIME_ASPCT: Decision by CMS to update the Timing to RptPeriod from Pt for all CMS Assessments;
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95034-5 Availability of Assistance
Observation ID in Form
F0910
Fully-Specified Name
- Component
- FASI v1.0 - Availability of Assistance
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- 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
- Subset
- Panel Type
- Organizer
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94912-3 Does the person have assistance in their home?
Observation ID in Form
F0910A
Skip Logic
If 0, Do not code availability of assistance - skip to question F0920. If 1, Continue to question F0910B.
Fully-Specified Name
- Component
- Availability of caregiver assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- 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
- Observation
Normative Answer List LL251-0
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) | 0 | LA32-8 | |
| Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) | 1 | LA33-6 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
Third Party Copyright
This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights reserved. SNOMED CT® was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.
This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.
Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org<mailto:info@snomed.org>. This may incur a fee in SNOMED International non-Member countries.
95414-9 Code the level of assistance in the person's home (both Paid and Unpaid) during the past month.
Observation ID in Form
F0910B
Fully-Specified Name
- Component
- Level of paid and unpaid caregiver assistance
- Property
- -
- Time
- 1Mo
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- Order vs. Observation
- Subset
- Panel Type
- Organizer
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94913-1 Code the level of assistance in the person's home during the past month - paid assistance
Observation ID in Form
F0910B1
Fully-Specified Name
- Component
- Level of paid caregiver assistance in the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5577-3
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| No assistance received | 05 | LA12345-7 | |
| Occasional/short term assistance | 04 | LA30934-6 | |
| Regular night-time | 03 | LA30935-3 | |
| Regular daytime | 02 | LA12164-2 | |
| Around the clock | 01 | LA12163-4 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94914-9 Code the level of assistance in the person's home during the past month - unpaid assistance
Observation ID in Form
F0910B2
Fully-Specified Name
- Component
- Level of unpaid caregiver assistance in the past Mo
- Property
- Find
- Time
- 1Mo
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.68
- Order vs. Observation
- Observation
Normative Answer List LL5577-3
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| No assistance received | 05 | LA12345-7 | |
| Occasional/short term assistance | 04 | LA30934-6 | |
| Regular night-time | 03 | LA30935-3 | |
| Regular daytime | 02 | LA12164-2 | |
| Around the clock | 01 | LA12163-4 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95035-2 Availability of Paid and Unpaid Assistance
Observation ID in Form
F0920
Form Coding Instructions
Code the Paid and Unpaid caregiver's usual ability and willingness to provide assistance with each activity during the past 3 days. If the activity was not attempted, code as Not applicable (11). Please complete the Caregiving Priorities section F0925 at the bottom of this page. Code safety and quality of BOTH Paid and Unpaid caregiver assistance and their willingness to provide assistance with each of the following activities
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- FASI v1.0 - Availability of Paid and Unpaid Assistance
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- 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
- Subset
- Panel Type
- Organizer
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95036-0 Availability of Paid Assistance
Observation ID in Form
F0920_1
Fully-Specified Name
- Component
- FASI v1.0 - Availability of Paid Assistance
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- 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
- Subset
- Panel Type
- Organizer
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94915-6 Self-care assistance
Observation ID in Form
F0920A1
Form Context
(for example, bathing, dressing, toileting, or eating/feeding)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide self-care assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94917-2 Mobility assistance
Observation ID in Form
F0920B1
Form Context
(for example, bed mobility, transfers, ambulating, or wheeling)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide mobility assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94919-8 IADL assistance
Observation ID in Form
F0920C1
Form Context
(for example, making meals, housekeeping, telephone, shopping, or finances)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide instrumental activities of daily living assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94921-4 Medication administration
Observation ID in Form
F0920D1
Form Context
(for example, oral, inhaled, or injectable medications)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide medication administration assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94923-0 Medical procedures/treatments
Observation ID in Form
F0920E1
Form Context
(for example, changing wound dressing, or home exercise program)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide medical procedure &or treatment assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94925-5 Management of equipment
Observation ID in Form
F0920F1
Form Context
(for example, oxygen, IV/infusion equipment, enteral/parenteral nutrition, or ventilator therapy equipment and supplies)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide management of equipment assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94927-1 Supervision
Observation ID in Form
F0920G1
Form Context
(for example, due to safety concerns)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide supervision
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94929-7 Advocacy or facilitation of person's participation in appropriate medical care
Observation ID in Form
F0920H1
Form Context
(for example, transportation to or from appointments)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Paid caregiver's ability and willingness to provide advocacy or facilitation of person's participation
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
95037-8 Availability of Unpaid Assistance
Observation ID in Form
F0920_2
Fully-Specified Name
- Component
- FASI v1.0 - Availability of Unpaid Assistance
- Property
- -
- Time
- RptPeriod
- System
- ^Patient
- Scale
- -
- Method
- CMS Assessment
Basic Attributes
- Class
- PANEL.SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.78
- 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
- Subset
- Panel Type
- Organizer
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94916-4 Self-care assistance
Observation ID in Form
F0920A2
Form Context
(for example, bathing, dressing, toileting, or eating/feeding)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide self-care assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94918-0 Mobility assistance
Observation ID in Form
F0920B2
Form Context
(for example, bed mobility, transfers, ambulating, or wheeling)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide mobility assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94920-6 IADL assistance
Observation ID in Form
F0920C2
Form Context
(for example, making meals, housekeeping, telephone, shopping, or finances)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide instrumental activities of daily living assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94922-2 Medication administration
Observation ID in Form
F0920D2
Form Context
(for example, oral, inhaled, or injectable medications)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide medication administration assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94924-8 Medical procedures/treatments
Observation ID in Form
F0920E2
Form Context
(for example, changing wound dressing, or home exercise program)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide medical procedure &or treatment assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94926-3 Management of equipment
Observation ID in Form
F0920F2
Form Context
(for example, oxygen, IV/infusion equipment, enteral/parenteral nutrition, or ventilator therapy equipment and supplies)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide management of equipment assistance
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94928-9 Supervision
Observation ID in Form
F0920G2
Form Context
(for example, due to safety concerns)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide supervision
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94930-5 Advocacy or facilitation of person's participation in appropriate medical care
Observation ID in Form
F0920H2
Form Context
(for example, transportation to or from appointments)
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Unpaid caregiver's ability and willingness to provide advocacy or facilitation of person's participation
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- Last Updated
- Version 2.69
- Order vs. Observation
- Observation
Normative Answer List LL5578-1
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Assistance not needed - No assistance needed. | 05 | LA30938-7 | |
| Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance. | 04 | LA30939-5 | |
| Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support. | 03 | LA30940-3 | |
| Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance. | 02 | LA30941-1 | |
| Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home. | 01 | LA30942-9 | |
| Assistance needed but person declines assistance - Person needs caregiving but declines this assistance. | 00 | LA30943-7 | |
| Not applicable - Person does not do this activity. | 11 | LA30944-5 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |
94931-3 Caregiving Priorities
Observation ID in Form
F0925
Form Coding Instructions
Please ask the person to describe at least one or two personal priorities in the area of caregiving for the next six months. If the person does not express any personal priorities in this area, please note this below
Source: Centers for Medicare & Medicaid ServicesFully-Specified Name
- Component
- Caregiving priorities for the next 6Mo
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Nar
- Method
- CMS Assessment
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.68
- 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
- Observation
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 105175-4 | Functional assessment standardized items (FASI) - v1.1 during assessment period [CMS Assessment] |
| 94848-9 | Functional assessment standardized items (FASI) - version 1.0 [CMS Assessment] |