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https://datamapper.geo.census.gov/map.html https://onthemap.ces.census.gov/em/ county: state: 2016 Provider MEDICARE Source>Medicare Referring Provider DMEPOS NPI Aggregate Condition | COUNT DISTINCT NPI REPORTING 0% - 25% members id with condition | COUNT DISTINCT NPI REPORTING 26% - 50% members id with condition | COUNT DISTINCT NPI REPORTING 51% - 75% members id with condition | COUNT DISTINCT NPI REPORTING 76% - 100% members id with condition |
---|---|---|---|---|
alzheimer_or_dementia | ||||
asthma | ||||
atrial_fibrillation | ||||
cancer | ||||
chronic_kidney_disease | ||||
chronic_obstructive_pulmonary_disease | ||||
depression | ||||
diabetes | ||||
heart_failure | ||||
hyperlipidemia | ||||
hypertension | ||||
ischemic_heart_disease | ||||
osteoporosis | ||||
rheumatoid_arthritis_osteoarthritis | ||||
schizophrenia_other_psychotic_disorders | ||||
stroke |
HIT Standard Name | HIT Standard Version | Item HIT Code | Item HIT Text | Assessment Instrument | Assessment Instrument Version | Item ID | Short Name | Item Subsets | Response HIT Code | Assessment Response Codes | Response HIT Text |
---|---|---|---|---|---|---|---|---|---|---|---|
LOINC | 2.64 | 58198-3 | Type of record [CMS Assessment] | MDS3.0 | 1.16 | A0050 | Type of transaction | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
1 | Add new record | ||||||||||
2 | Modify existing record | ||||||||||
3 | Inactivate existing record | ||||||||||
LOINC | 2.64 | 54581-4 | Facility provider #s | MDS3.0 | 1.16 | A0100 | {Facility/provider} numbers | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 76468-8 | Org NPI | MDS3.0 | 1.16 | A0100A | {Facility/provider} National Provider Identifier (NPI) | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 69417-4 | CMS certification # Facility | MDS3.0 | 1.16 | A0100B | {Facility/provider} CMS Certification Number (CCN) | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 45398-5 | State provider # Facility | MDS3.0 | 1.16 | A0100C | State {facility/provider} Medicaid number | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 85632-8 | Facility type [CMS Assessment] | MDS3.0 | 1.16 | A0200 | Type of {facility/provider} | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
1 | Nursing home (SNF/NF) | ||||||||||
2 | Swing bed | ||||||||||
LOINC | 2.64 | 86524-6 | Type of assessment [CMS Assessment] | MDS3.0 | 1.16 | A0310 | Type of assessment | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 54583-0 | Federal OBRA reason for assessment [CMS Assessment] | MDS3.0 | 1.16 | A0310A | Type of assessment: OBRA | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
01 | Admission assessment (required by day 14) | ||||||||||
02 | Quarterly review assessment | ||||||||||
03 | Annual assessment | ||||||||||
04 | Significant change in status assessment | ||||||||||
05 | Significant correction to prior comprehensive assessment | ||||||||||
06 | Significant correction to prior quarterly assessment | ||||||||||
99 | None of the above | ||||||||||
LOINC | 2.64 | 54584-8 | PPS Assessment [CMS Assessment] | MDS3.0 | 1.16 | A0310B | Type of assessment: PPS | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
01 | 5-day scheduled assessment | ||||||||||
02 | 14-day scheduled assessment | ||||||||||
03 | 30-day scheduled assessment | ||||||||||
04 | 60-day scheduled assessment | ||||||||||
05 | 90-day scheduled assessment | ||||||||||
07 | Unscheduled assessment used for PPS (OMRA, significant or clinical change, or significant correction assessment) | ||||||||||
99 | None of the above | ||||||||||
LOINC | 2.64 | 54585-5 | PPS Other Medicare Required Assessment - OMRA [CMS Assessment] | MDS3.0 | 1.16 | A0310C | Type of assessment: OMRA | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
0 | No | ||||||||||
1 | Start of therapy assessment | ||||||||||
2 | End of therapy assessment | ||||||||||
3 | Both Start and End of therapy assessment | ||||||||||
4 | Change of therapy assessment | ||||||||||
LOINC | 2.64 | 58107-4 | Swing bed clinical change assessment [CMS Assessment] | MDS3.0 | 1.16 | A0310D | Swing bed clinical change assessment | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54587-1 | First assessment since the most recent admission &or reentry [CMS Assessment] | MDS3.0 | 1.16 | A0310E | First assessment since most recent entry | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 58108-2 | Entry &or discharge reporting [CMS Assessment] | MDS3.0 | 1.16 | A0310F | Entry/discharge reporting | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
01 | Entry tracking record | ||||||||||
10 | Discharge assessment - return not anticipated | ||||||||||
11 | Discharge assessment - return anticipated | ||||||||||
12 | Death in facility tracking record | ||||||||||
99 | None of the above | ||||||||||
LOINC | 2.64 | 71440-2 | Discharge [CMS Assessment] | MDS3.0 | 1.16 | A0310G | Planned/unplanned discharge | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
1 | Planned | ||||||||||
2 | Unplanned | ||||||||||
LOINC | 2.64 | 86525-3 | SNF Part A PPS discharge assessment [CMS Assessment] | MDS3.0 | 1.16 | A0310H | SNF PPS part A discharge (end of stay) assessment | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 86526-1 | Unit certification or licensure designation [CMS Assessment] | MDS3.0 | 1.16 | A0410 | Submission requirement | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
1 | Unit is neither Medicare nor Medicaid certified and MDS data is not required by the State | ||||||||||
2 | Unit is neither Medicare nor Medicaid certified but MDS data is required by the State | ||||||||||
3 | Unit is Medicare and/or Medicaid certified | ||||||||||
LOINC | 2.64 | 54503-8 | Legal name of patient | MDS3.0 | 1.16 | A0500 | Legal name of {patient/resident} | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 45392-8 | First name | MDS3.0 | 1.16 | A0500A | {Patient/resident} first name | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 45393-6 | Middle initial | MDS3.0 | 1.16 | A0500B | {Patient/resident} middle initial | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 45394-4 | Last name | MDS3.0 | 1.16 | A0500C | {Patient/resident} last name | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 45395-1 | Name suffix | MDS3.0 | 1.16 | A0500D | {Patient/resident} name suffix | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 45966-9 | Social Security & Medicare numbers | MDS3.0 | 1.16 | A0600 | Social security and Medicare numbers | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 45396-9 | Social Security # | MDS3.0 | 1.16 | A0600A | Social security number | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 45397-7 | Medicare or comparable # | MDS3.0 | 1.16 | A0600B | Medicare/railroad insurance number | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 45400-9 | Medicaid # | MDS3.0 | 1.16 | A0700 | Medicaid number | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 46098-0 | Sex | MDS3.0 | 1.16 | A0800 | Gender | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
1 | Male | ||||||||||
2 | Female | ||||||||||
LOINC | 2.64 | 21112-8 | Birth date | MDS3.0 | 1.16 | A0900 | Birth date | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 59362-4 | Race or ethnicity OMB.1997 | MDS3.0 | 1.16 | A1000 | Race/ethnicity. Check all that apply | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
A | American Indian or Alaska Native | ||||||||||
B | Asian | ||||||||||
C | Black or African American | ||||||||||
D | Hispanic or Latino | ||||||||||
E | Native Hawaiian or Other Pacific Islander | ||||||||||
F | White | ||||||||||
LOINC | 2.64 | 54505-3 | Language | MDS3.0 | 1.16 | A1100 | Language | NC,ND,NO,NOD,NP,NPE,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 54588-9 | Interpreter needed | MDS3.0 | 1.16 | A1100A | Does {patient/resident} need or want an interpreter | NC,ND,NO,NOD,NP,NPE,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | Unable to determine | ||||||||||
LOINC | 2.64 | 54899-0 | Preferred language | MDS3.0 | 1.16 | A1100B | Preferred language | NC,ND,NO,NOD,NP,NPE,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 45404-1 | Marital status | MDS3.0 | 1.16 | A1200 | Marital status | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
1 | Never married | ||||||||||
2 | Married | ||||||||||
3 | Widowed | ||||||||||
4 | Separated | ||||||||||
5 | Divorced | ||||||||||
LOINC | 2.64 | 54506-1 | Optional resident items | MDS3.0 | 1.16 | A1300 | Optional {patient/resident} items | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 46106-1 | MRN | MDS3.0 | 1.16 | A1300A | Medical record number | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 45403-3 | Room # | MDS3.0 | 1.16 | A1300B | Room number | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 52462-9 | Nickname | MDS3.0 | 1.16 | A1300C | Name by which {patient/resident} prefers to be addressed | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 21843-8 | Hx of Usual occupation | MDS3.0 | 1.16 | A1300D | Lifetime occupation(s) | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 54589-7 | Preadmission Screening and Resident Review (PASRR) [CMS Assessment] | MDS3.0 | 1.16 | A1500 | Resident evaluated by PASRR | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | Not a Medicaid-certified unit | ||||||||||
LOINC | 2.64 | 71441-0 | Level II Preadmission Screening and Resident Review (PASRR) [CMS Assessment] | MDS3.0 | 1.16 | A1510 | Level II PASRR conditions. Check all that apply | NC, | + | ||
A | Serious mental illness | ||||||||||
B | Intellectual disability ('mental retardation' in federal regulation) | ||||||||||
C | Other related conditions | ||||||||||
LOINC | 2.64 | 86527-9 | Conditions related to intellectual disability and developmental disability status [CMS Assessment] | MDS3.0 | 1.16 | A1550 | Conditions related to ID/DD status. Check all that apply | NC, | + | ||
A | Down syndrome | ||||||||||
B | Autism | ||||||||||
C | Epilepsy | ||||||||||
D | Other organic condition related to ID/DD | ||||||||||
E | ID/DD with no organic condition | ||||||||||
Z | None of the above | ||||||||||
LOINC | 2.64 | 50786-3 | Date of entry | MDS3.0 | 1.16 | A1600 | Entry date (date of admission/reentry in {facility/provider}) | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 54590-5 | Entry type [CMS Assessment] | MDS3.0 | 1.16 | A1700 | Type of entry | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
1 | Admission | ||||||||||
2 | Reentry | ||||||||||
LOINC | 2.64 | 85398-6 | Admitted from | MDS3.0 | 1.16 | A1800 | Entered from | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
01 | Community (private home/apt., board/care, assisted living, group home) | ||||||||||
02 | Another nursing home or swing bed | ||||||||||
03 | Acute hospital | ||||||||||
04 | Psychiatric hospital | ||||||||||
05 | Inpatient rehabilitation facility | ||||||||||
06 | ID/DD facility | ||||||||||
07 | Hospice | ||||||||||
09 | Long-term care hospital (LTCH) | ||||||||||
99 | Other | ||||||||||
LOINC | 2.64 | 52455-3 | Admission date | MDS3.0 | 1.16 | A1900 | Admission date | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 52525-3 | Discharge date | MDS3.0 | 1.16 | A2000 | Discharge date | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 55128-3 | Discharge status [CMS Assessment] | MDS3.0 | 1.16 | A2100 | Discharge status | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
01 | Community (private home/apt., board/care, assisted living, group home) | ||||||||||
02 | Another nursing home or swing bed | ||||||||||
03 | Acute hospital | ||||||||||
04 | Psychiatric hospital | ||||||||||
05 | Inpatient rehabilitation facility | ||||||||||
06 | ID/DD facility | ||||||||||
07 | Hospice | ||||||||||
08 | Deceased | ||||||||||
09 | Long-term care hospital (LTCH) | ||||||||||
99 | Other | ||||||||||
LOINC | 2.64 | 54592-1 | Previous assessment reference date for significant correction [CMS Assessment] | MDS3.0 | 1.16 | A2200 | Previous assessment reference date for significant correction | NC,NP,NQ, | |||
LOINC | 2.64 | 54593-9 | Assessment reference date - observation end date [CMS Assessment] | MDS3.0 | 1.16 | A2300 | Assessment reference date | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 54507-9 | Medicare stay [CMS Assessment] | MDS3.0 | 1.16 | A2400 | Medicare stay | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 54594-7 | Medicare-covered stay since the most recent entry [CMS Assessment] | MDS3.0 | 1.16 | A2400A | Has {patient/resident} had Medicare-covered stay | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54595-4 | Start date of most recent Medicare stay [CMS Assessment] | MDS3.0 | 1.16 | A2400B | Start date of most recent Medicare stay | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 54596-2 | End date of most recent Medicare stay [CMS Assessment] | MDS3.0 | 1.16 | A2400C | End date of most recent Medicare stay | NC,ND,NO,NOD,NP,NPE,NQ,NS,NSD,NT,SD,SO,SOD,SP,SS,SSD,ST, | |||
LOINC | 2.64 | 54597-0 | Comatose in last 7D [CMS Assessment] | MDS3.0 | 1.16 | B0100 | Comatose | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54598-8 | Hearing.ability to hear in last 7D [CMS Assessment] | MDS3.0 | 1.16 | B0200 | Hearing | NC,NP,NQ,SP, | + | ||
0 | Adequate - no difficulty in normal conversation, social interaction, listening to TV | ||||||||||
1 | Minimal difficulty - difficulty in some environments (e.g. when person speaks softly or setting is noisy) | ||||||||||
2 | Moderate difficulty - speaker has to increase volume and speak distinctly | ||||||||||
3 | Highly impaired - absence of useful hearing | ||||||||||
LOINC | 2.64 | 54599-6 | Hearing aid used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | B0300 | Hearing aid | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54600-2 | Speech clarity.description of speech pattern in last 7D [CMS Assessment] | MDS3.0 | 1.16 | B0600 | Speech clarity | NC,NP,NQ,SP, | + | ||
0 | Clear speech - distinct intelligible words | ||||||||||
1 | Unclear speech - slurred or mumbled words | ||||||||||
2 | No speech - absence of spoken words | ||||||||||
LOINC | 2.64 | 54601-0 | Express ideas and wants in last 7D [CMS Assessment] | MDS3.0 | 1.16 | B0700 | Makes self understood | NC,NO,NOD,NP,NQ,SO,SOD,SP, | + | ||
0 | Understood | ||||||||||
1 | Usually understood - difficulty communicating some words or finishing thoughts but is able if prompted or given time | ||||||||||
2 | Sometimes understood - ability is limited to making concrete requests | ||||||||||
3 | Rarely/never understood | ||||||||||
LOINC | 2.64 | 54602-8 | Understanding verbal content in last 7D [CMS Assessment] | MDS3.0 | 1.16 | B0800 | Ability to understand others | NC,NP,NQ,SP, | + | ||
0 | Understands - clear comprehension | ||||||||||
1 | Usually understands - misses some part/intent of message but comprehends most conversation | ||||||||||
2 | Sometimes understands - responds adequately to simple, direct communication only | ||||||||||
3 | Rarely/never understood | ||||||||||
LOINC | 2.64 | 54603-6 | Vision.ability to see in adequate light in last 7D [CMS Assessment] | MDS3.0 | 1.16 | B1000 | Vision | NC,NP,NQ,SP, | + | ||
0 | Adequate - sees fine detail, such as regular print in newspapers/books | ||||||||||
1 | Impaired - sees large print, but not regular print in newspapers/books | ||||||||||
2 | Moderately impaired - limited vision; not able to see newspaper headlines but can identify objects | ||||||||||
3 | Highly impaired - object identification in question, but eyes appear to follow objects | ||||||||||
4 | Severely impaired - no vision or sees only light, colors or shapes; eyes do not appear to follow objects | ||||||||||
LOINC | 2.64 | 54604-4 | Corrective lenses used in last 7D [CMS Assessment] | MDS3.0 | 1.16 | B1200 | Corrective lenses | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54605-1 | Brief interview for mental status should be conducted [CMS Assessment] | MDS3.0 | 1.16 | C0100 | BIMS: should {patient/resident} interview be conducted | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No (resident is rarely/never understood) | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 52731-7 | Repetition of three words - BIMS | MDS3.0 | 1.16 | C0200 | BIMS interview: repetition of three words | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | None | ||||||||||
1 | One | ||||||||||
2 | Two | ||||||||||
3 | Three | ||||||||||
LOINC | 2.64 | 54510-3 | Temporal orientation (orientation to year, month, and day) - BIMS | MDS3.0 | 1.16 | C0300 | Temporal orientation (orientation to year, month, and day) | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 52732-5 | Temporal orientation - current year - BIMS | MDS3.0 | 1.16 | C0300A | BIMS interview: able to report correct year | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Missed by > 5 years or no answer | ||||||||||
1 | Missed by 2-5 years | ||||||||||
2 | Missed by 1 year | ||||||||||
3 | Correct | ||||||||||
LOINC | 2.64 | 52733-3 | Temporal orientation - current month - BIMS | MDS3.0 | 1.16 | C0300B | BIMS interview: able to report correct month | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Missed by > 1 month or no answer | ||||||||||
1 | Missed by 6 days to 1 month | ||||||||||
2 | Accurate within 5 days | ||||||||||
LOINC | 2.64 | 54609-3 | Temporal orientation - current day of the week - BIMS | MDS3.0 | 1.16 | C0300C | BIMS interview: can report correct day of week | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Incorrect or no answer | ||||||||||
1 | Correct | ||||||||||
LOINC | 2.64 | 52493-4 | Recall - BIMS | MDS3.0 | 1.16 | C0400 | Recall | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 52735-8 | Recall - sock - BIMS | MDS3.0 | 1.16 | C0400A | BIMS interview: able to recall 'sock' | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No - could not recall | ||||||||||
1 | Yes, after cueing ('something to wear') | ||||||||||
2 | Yes, no cue required | ||||||||||
LOINC | 2.64 | 52736-6 | Recall - blue - BIMS | MDS3.0 | 1.16 | C0400B | BIMS interview: able to recall 'blue' | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No - could not recall | ||||||||||
1 | Yes, after cueing ('a color') | ||||||||||
2 | Yes, no cue required | ||||||||||
LOINC | 2.64 | 52737-4 | Recall - bed - BIMS | MDS3.0 | 1.16 | C0400C | BIMS interview: able to recall 'bed' | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No - could not recall | ||||||||||
1 | Yes, after cueing ('a piece of furniture') | ||||||||||
2 | Yes, no cue required | ||||||||||
LOINC | 2.64 | 54614-3 | Brief interview for mental status - summary score - BIMS | MDS3.0 | 1.16 | C0500 | BIMS interview: summary score | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 54615-0 | Should staff assessment for mental status be conducted [CMS Assessment] | MDS3.0 | 1.16 | C0600 | Staff assessment mental status: conduct assessment | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No (resident was able to complete Brief Interview for Mental Status) | ||||||||||
1 | Yes (resident was unable to complete Brief Interview for Mental Status) | ||||||||||
LOINC | 2.64 | 54616-8 | Short-term memory OK in last 7D [CMS Assessment] | MDS3.0 | 1.16 | C0700 | Staff assessment mental status: short-term memory OK | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Memory OK | ||||||||||
1 | Memory problem | ||||||||||
LOINC | 2.64 | 54617-6 | Long-term memory OK in last 7D [CMS Assessment] | MDS3.0 | 1.16 | C0800 | Staff assessment mental status: long-term memory OK | NC,NP,NQ,SP, | + | ||
0 | Memory OK | ||||||||||
1 | Memory problem | ||||||||||
LOINC | 2.64 | 86583-2 | Memory &or recall ability in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | C0900 | Staff assessment: memory/recall ability. Check all that apply | NC,NP,NQ,SP, | + | ||
A | Current season | ||||||||||
B | Location of own room | ||||||||||
C | Staff names and faces | ||||||||||
D | That he or she is in a nursing home/hospital swing bed | ||||||||||
Z | None of the above were recalled | ||||||||||
LOINC | 2.64 | 54624-2 | Cognitive skills for daily decision making in last 7D [CMS Assessment] | MDS3.0 | 1.16 | C1000 | Cognitive skills for daily decision making | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Independent - decisions consistent/reasonable | ||||||||||
1 | Modified independence - some difficulty in new situations only | ||||||||||
2 | Moderately impaired - decisions poor; cues/supervision required | ||||||||||
3 | Severely impaired - never/rarely made decisions | ||||||||||
LOINC | 2.64 | 86585-7 | MDS v3.0 - RAI - Signs and symptoms of delirium (from CAM) [CMS Assessment] | MDS3.0 | 1.16 | C1310 | Signs and symptoms of delirium (from CAM) | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54632-5 | Acute onset mental status change [CMS Assessment] | MDS3.0 | 1.16 | C1310A | CAM: Acute onset mental status change | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54628-3 | Inattention in last 7D [CMS Assessment] | MDS3.0 | 1.16 | C1310B | CAM: Inattention | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Behavior not present | ||||||||||
1 | Behavior continuously present, does not fluctuate | ||||||||||
2 | Behavior present, fluctuates (comes and goes, changes in severity) | ||||||||||
LOINC | 2.64 | 54629-1 | Disorganized thinking in last 7D [CMS Assessment] | MDS3.0 | 1.16 | C1310C | CAM: Disorganized Thinking | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Behavior not present | ||||||||||
1 | Behavior continuously present, does not fluctuate | ||||||||||
2 | Behavior present, fluctuates (comes and goes, changes in severity) | ||||||||||
LOINC | 2.64 | 54630-9 | Altered level of consciousness in last 7D [CMS Assessment] | MDS3.0 | 1.16 | C1310D | CAM: Altered Level of Consciousness | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Behavior not present | ||||||||||
1 | Behavior continuously present, does not fluctuate | ||||||||||
2 | Behavior present, fluctuates (comes and goes, changes in severity) | ||||||||||
LOINC | 2.64 | 54634-1 | Should resident mood interview be conducted [CMS Assessment] | MDS3.0 | 1.16 | D0100 | PHQ: should {patient/resident} mood interview be conducted | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No (resident is rarely/never understood) | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54635-8 | Resident mood interview (PHQ-9) - PHQ-9 | MDS3.0 | 1.16 | D0200 | {Patient/resident} mood interview (PHQ-9) | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 54636-6 | Little interest or pleasure in doing things in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0200A1 | PHQ9: little interest or pleasure - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | No response | ||||||||||
LOINC | 2.64 | 54637-4 | Little interest or pleasure in doing things in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0200A2 | PHQ9: little interest or pleasure - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54638-2 | Feeling down, depressed or hopeless in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0200B1 | PHQ9: feeling down, depressed - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | No response | ||||||||||
LOINC | 2.64 | 54639-0 | Feeling down, depressed or hopeless in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0200B2 | PHQ9: feeling down, depressed - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54640-8 | Trouble falling or staying asleep, or sleeping too much in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0200C1 | PHQ9: trouble with sleep - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | No response | ||||||||||
LOINC | 2.64 | 54641-6 | Trouble falling or staying asleep, or sleeping too much in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0200C2 | PHQ9: trouble with sleep - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54642-4 | Feeling tired or having little energy in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0200D1 | PHQ9: feeling tired/little energy - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | No response | ||||||||||
LOINC | 2.64 | 54643-2 | Feeling tired or having little energy in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0200D2 | PHQ9: feeling tired/little energy - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54644-0 | Poor appetite or overeating in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0200E1 | PHQ9: poor appetite or overeating - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | No response | ||||||||||
LOINC | 2.64 | 54645-7 | Poor appetite or overeating in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0200E2 | PHQ9: poor appetite or overeating - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54646-5 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0200F1 | PHQ9: feeling bad about self - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | No response | ||||||||||
LOINC | 2.64 | 54647-3 | Feeling bad about yourself - or that you are a failure or have let yourself or your family down in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0200F2 | PHQ9: feeling bad about self - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54648-1 | Trouble concentrating on things, such as reading the newspaper or watching television in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0200G1 | PHQ9: trouble concentrating - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | No response | ||||||||||
LOINC | 2.64 | 54649-9 | Trouble concentrating on things, such as reading the newspaper or watching television in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0200G2 | PHQ9: trouble concentrating - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54650-7 | 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 in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0200H1 | PHQ9: slow, fidgety, restless - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | No response | ||||||||||
LOINC | 2.64 | 54651-5 | 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 in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0200H2 | PHQ9: slow, fidgety, restless - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54652-3 | Thoughts that you would be better off dead, or of hurting yourself in some way in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0200I1 | PHQ9: thoughts better off dead - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | No response | ||||||||||
LOINC | 2.64 | 54653-1 | Thoughts that you would be better off dead, or of hurting yourself in some way in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0200I2 | PHQ9: thoughts better off dead - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54654-9 | Mood interview total severity score - PHQ-9 | MDS3.0 | 1.16 | D0300 | PHQ9: total mood severity score | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 54655-6 | Responsible staff or provider was informed of potential for resident self harm [CMS Assessment] | MDS3.0 | 1.16 | D0350 | PHQ: safety notification | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54657-2 | Staff assessment of resident mood (PHQ-9-OV) - PHQ-9 | MDS3.0 | 1.16 | D0500 | Staff assessment of {patient/resident} mood (PHQ-9-OV*) | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 54658-0 | Little interest or pleasure in doing things in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0500A1 | PHQ9 staff: little interest or pleasure - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54659-8 | Little interest or pleasure in doing things in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0500A2 | PHQ9 staff: little interest or pleasure - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54660-6 | Feeling or appearing down, depressed or hopeless in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0500B1 | PHQ9 staff: feeling down, depressed - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54661-4 | Feeling or appearing down, depressed, or hopeless in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0500B2 | PHQ9 staff: feeling down, depressed - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54662-2 | Trouble falling or staying asleep, or sleeping too much in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0500C1 | PHQ9 staff: trouble with sleep - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54663-0 | Trouble falling or staying asleep, or sleeping too much in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0500C2 | PHQ9 staff: trouble with sleep - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54664-8 | Feeling tired or having little energy in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0500D1 | PHQ9 staff: feeling tired/little energy - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54665-5 | Feeling tired or having little energy in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0500D2 | PHQ9 staff: feeling tired/little energy - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54666-3 | Poor appetite or overeating in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0500E1 | PHQ9 staff: poor appetite or overeating - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54667-1 | Poor appetite or overeating in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0500E2 | PHQ9 staff: poor appetite or overeating - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54668-9 | Indicating that (s)he feels bad about self, is a failure, or has let self or family down in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0500F1 | PHQ9 staff: feeling bad about self - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54669-7 | Indicating that (s)he feels bad about self, is a failure, or has let self or family down in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0500F2 | PHQ9 staff: feeling bad about self - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54670-5 | Trouble concentrating on things, such as reading the newspaper or watching television in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0500G1 | PHQ9 staff: trouble concentrating - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54671-3 | Trouble concentrating on things, such as reading the newspaper or watching television in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0500G2 | PHQ9 staff: trouble concentrating - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54672-1 | Moving or speaking so slowly that other people have noticed. Or the opposite - being so fidgety or restless that (s)he has been moving around a lot more than usual in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0500H1 | PHQ9 staff: slow, fidgety, restless - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54904-8 | Moving or speaking so slowly that other people have noticed. Or the opposite - being so fidgety or restless that (s)he has been moving around a lot more than usual in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0500H2 | PHQ9 staff: slow, fidgety, restless - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54673-9 | States that life isn't worth living, wishes for death, or attempts to harm self in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0500I1 | PHQ9 staff: thoughts better off dead - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54674-7 | States that life isn't worth living, wishes for death, or attempts to harm self in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0500I2 | PHQ9 staff: thoughts better off dead - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54675-4 | Being short-tempered, easily annoyed in last 2W.presence - PHQ-9 | MDS3.0 | 1.16 | D0500J1 | PHQ9 staff: short-tempered - presence | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54676-2 | Being short-tempered, easily annoyed in last 2W.frequency - PHQ-9 | MDS3.0 | 1.16 | D0500J2 | PHQ9 staff: short-tempered - frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Never or 1 day | ||||||||||
1 | 2-6 days (several days) | ||||||||||
2 | 7-11 days (half or more of the days) | ||||||||||
3 | 12-14 days (nearly every day) | ||||||||||
LOINC | 2.64 | 54677-0 | Staff assessment of resident mood total severity score - PHQ-9 | MDS3.0 | 1.16 | D0600 | PHQ staff: total mood score | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 54655-6 | Responsible staff or provider was informed of potential for resident self harm [CMS Assessment] | MDS3.0 | 1.16 | D0650 | PHQ staff: safety notification | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 86597-2 | Potential indicators of psychosis in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0100 | Potential indicators of psychosis. Check all that apply | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
A | Hallucinations (perceptual experiences in the absence of real external sensory stimuli) | ||||||||||
B | Delusions (misconceptions or beliefs that are firmly held, contrary to reality) | ||||||||||
Z | None of the above | ||||||||||
LOINC | 2.64 | 54514-5 | Behavioral symptom - presence & frequency [CMS Assessment] | MDS3.0 | 1.16 | E0200 | Behavioral symptom- Presence & frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 54682-0 | Physical behavioral symptoms directed toward others in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0200A | Physical behavioral symptoms directed toward others | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Behavior not exhibited | ||||||||||
1 | Behavior of this type occurred 1 to 3 days | ||||||||||
2 | Behavior of this type occurred 4 to 6 days, but less than daily | ||||||||||
3 | Behavior of this type occurred daily | ||||||||||
LOINC | 2.64 | 54683-8 | Verbal behavioral symptoms directed toward others in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0200B | Verbal behavioral symptoms directed toward others | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Behavior not exhibited | ||||||||||
1 | Behavior of this type occurred 1 to 3 days | ||||||||||
2 | Behavior of this type occurred 4 to 6 days, but less than daily | ||||||||||
3 | Behavior of this type occurred daily | ||||||||||
LOINC | 2.64 | 54684-6 | Other behavioral symptoms not directed toward others in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0200C | Other behavioral symptoms not directed toward others | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Behavior not exhibited | ||||||||||
1 | Behavior of this type occurred 1 to 3 days | ||||||||||
2 | Behavior of this type occurred 4 to 6 days, but less than daily | ||||||||||
3 | Behavior of this type occurred daily | ||||||||||
LOINC | 2.64 | 54685-3 | Overall presence of behavioral symptoms in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0300 | Overall presence of behavioral symptoms | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54515-2 | Impact on resident [CMS Assessment] | MDS3.0 | 1.16 | E0500 | Impact of {patient/resident} | NC, | |||
LOINC | 2.64 | 54686-1 | Put the resident at significant risk for physical illness or injury in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0500A | Behavioral symptoms put {patient/resident} at risk for illness/injury | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54687-9 | Significantly interfere with the resident's care in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0500B | Behavioral symptoms interfere with {patient/resident} care | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54688-7 | Significantly interfere with the resident's participation in activities or social interactions in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0500C | Behavioral symptoms interfere with social activities | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54516-0 | Impact on others [CMS Assessment] | MDS3.0 | 1.16 | E0600 | Impact on others | NC, | |||
LOINC | 2.64 | 54689-5 | Put others at significant risk for physical injury in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0600A | Behavioral symptoms put others at risk for injury | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54690-3 | Significantly intrude on the privacy or activity of others in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0600B | Behavioral symptoms intrude on privacy of others | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54691-1 | Significantly disrupt care or living environment in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0600C | Behavioral symptoms disrupt care or living environment | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54692-9 | Rejection of care - presence and frequency in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0800 | Rejection of care: presence and frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Behavior not exhibited | ||||||||||
1 | Behavior of this type occurred 1 to 3 days | ||||||||||
2 | Behavior of this type occurred 4 to 6 days, but less than daily | ||||||||||
3 | Behavior of this type occurred daily | ||||||||||
LOINC | 2.64 | 54693-7 | Wandering - presence and frequency in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E0900 | Wandering: presence and frequency | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | Behavior not exhibited | ||||||||||
1 | Behavior of this type occurred 1 to 3 days | ||||||||||
2 | Behavior of this type occurred 4 to 6 days, but less than daily | ||||||||||
3 | Behavior of this type occurred daily | ||||||||||
LOINC | 2.64 | 54517-8 | Wandering - impact [CMS Assessment] | MDS3.0 | 1.16 | E1000 | Wandering - impact | NC, | |||
LOINC | 2.64 | 54694-5 | Wandering places resident at significant risk of getting to a potentially dangerous place in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E1000A | Wandering: risk of getting to dangerous place | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54695-2 | Wandering significantly intrudes on the privacy or activities of others in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E1000B | Wandering: intrude on privacy of others | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54696-0 | Change in behavioral or other symptoms in last 7D [CMS Assessment] | MDS3.0 | 1.16 | E1100 | Change in behavioral or other symptoms | NC, | + | ||
0 | Same | ||||||||||
1 | Improved | ||||||||||
2 | Worse | ||||||||||
3 | N/A because no prior MDS assessment | ||||||||||
LOINC | 2.64 | 54697-8 | Interview for daily and activity preferences should be conducted [CMS Assessment] | MDS3.0 | 1.16 | F0300 | Conduct {patient/resident} interview for daily/activity preferences | NC, | + | ||
0 | No (resident is rarely/never understood and family/significant other not available) | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54519-4 | Interview for daily preferences [CMS Assessment] | MDS3.0 | 1.16 | F0400 | Interview for daily preferences | NC, | |||
LOINC | 2.64 | 54698-6 | How important it is to choose what clothes to wear while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0400A | Interview: choose clothes to wear | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54699-4 | How important it is to take care of your personal belongings or things while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0400B | Interview: take care of personal belongings | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54700-0 | How important it is to choose between a tub bath, shower, bed bath, or sponge bath while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0400C | Interview: choose tub bath, shower, bed bath, or sponge bath | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54701-8 | How important it is to have snacks available between meals while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0400D | Interview: have snacks between meals | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54702-6 | How important it is to choose your own bedtime while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0400E | Interview: choose own bedtime | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54703-4 | How important it is to have your family or a close friend involved in discussions about your care while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0400F | Interview: discuss care with family/friend | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54704-2 | How important it is to be able to use the phone in private while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0400G | Interview: use phone in private | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54705-9 | How important it is to have a place to lock your things to keep them safe while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0400H | Interview: lock things to keep them safe | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54520-2 | Interview for activity preferences [CMS Assessment] | MDS3.0 | 1.16 | F0500 | Interview for activity preferences | NC, | |||
LOINC | 2.64 | 54706-7 | How important it is to have books, newspapers, and magazines to read while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0500A | Interview: have books, newspaper, magazines to read | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54707-5 | How important it is to listen to music you like while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0500B | Interview: listen to music | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54708-3 | How important it is to be around animals such as pets while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0500C | Interview: be around animals/pets | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54709-1 | How important it is to keep up with the news while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0500D | Interview: keep up with news | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54710-9 | How important it is to do things with groups of people while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0500E | Interview: do things with groups of people | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54711-7 | How important it is to do your favorite activities while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0500F | Interview: do favorite activities | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54712-5 | How important it is to go outside to get fresh air when the weather is good while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0500G | Interview: go outside when good weather | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54713-3 | How important it is to participate in religious services or practices while in this facility [CMS Assessment] | MDS3.0 | 1.16 | F0500H | Interview: participate in religious practices | NC, | + | ||
1 | Very important | ||||||||||
2 | Somewhat important | ||||||||||
3 | Not very important | ||||||||||
4 | Not important at all | ||||||||||
5 | Important, but can't do or no choice | ||||||||||
9 | No response or non-responsive | ||||||||||
LOINC | 2.64 | 54714-1 | Primary respondent for daily and activity preferences [CMS Assessment] | MDS3.0 | 1.16 | F0600 | Primary respondent: daily/activities preferences | NC, | + | ||
1 | Resident | ||||||||||
2 | Family or significant other (close friend or other representative) | ||||||||||
9 | Interview could not be completed by resident or family/significant other ('No response'' to 3 or more items) | ||||||||||
LOINC | 2.64 | 54715-8 | Staff assessment of daily and activity preferences should be conducted [CMS Assessment] | MDS3.0 | 1.16 | F0700 | Conduct staff assessment for daily/activity preferences | NC, | + | ||
0 | No (because Interview for Daily and Activity Preferences (F0400 and F0500) was completed by resident or family/significant other) | ||||||||||
1 | Yes (because 3 or more items in Interview for Daily and Activity Preferences (F0400 and F0500) were not completed by resident or family/significant other) | ||||||||||
LOINC | 2.64 | 86599-8 | Staff assessment of daily and activity preferences [CMS Assessment] | MDS3.0 | 1.16 | F0800 | Staff assessment of daily and activity preferences. Check all that apply | NC, | + | ||
A | Choosing clothes to wear | ||||||||||
B | Caring for personal belongings | ||||||||||
C | Receiving tub bath | ||||||||||
D | Receiving shower | ||||||||||
E | Receiving bed bath | ||||||||||
F | Receiving sponge bath | ||||||||||
G | Snacks between meals | ||||||||||
H | Staying up past 8:00 p.m. | ||||||||||
I | Family or significant other involvement in care discussions | ||||||||||
J | Use of phone in private | ||||||||||
K | Place to lock personal belongings | ||||||||||
L | Reading books, newspapers, or magazines | ||||||||||
M | Listening to music | ||||||||||
N | Being around animals such as pets | ||||||||||
O | Keeping up with the news | ||||||||||
P | Doing things with groups of people | ||||||||||
Q | Participating in favorite activities | ||||||||||
R | Spending time away from the nursing home | ||||||||||
S | Spending time outdoors | ||||||||||
T | Participating in religious activities or practices | ||||||||||
Z | None of the above | ||||||||||
LOINC | 2.64 | 45588-1 | Bed mobility - self-performance during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110A1 | Bed mobility: self-performance | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | + | ||
0 | Independent - no help or staff oversight at any time | ||||||||||
1 | Supervision - oversight, encouragement or cueing | ||||||||||
2 | Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance | ||||||||||
3 | Extensive assistance - resident involved in activity, staff provide weight-bearing support | ||||||||||
4 | Total dependence - full staff performance every time during entire 7-day period | ||||||||||
7 | Activity occurred only once or twice - activity did occur but only once or twice | ||||||||||
8 | Activity did not occur - activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45589-9 | Bed mobility - support provided during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110A2 | Bed mobility: support provided | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | + | ||
0 | No setup or physical help from staff | ||||||||||
1 | Setup help only | ||||||||||
2 | One person physical assist | ||||||||||
3 | Two+ persons physical assist | ||||||||||
8 | ADL activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45590-7 | Transfer - self-performance during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110B1 | Transfer: self-performance | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | + | ||
0 | Independent - no help or staff oversight at any time | ||||||||||
1 | Supervision - oversight, encouragement or cueing | ||||||||||
2 | Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance | ||||||||||
3 | Extensive assistance - resident involved in activity, staff provide weight-bearing support | ||||||||||
4 | Total dependence - full staff performance every time during entire 7-day period | ||||||||||
7 | Activity occurred only once or twice - activity did occur but only once or twice | ||||||||||
8 | Activity did not occur - activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45591-5 | Transfer - support provided during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110B2 | Transfer: support provided | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | + | ||
0 | No setup or physical help from staff | ||||||||||
1 | Setup help only | ||||||||||
2 | One person physical assist | ||||||||||
3 | Two+ persons physical assist | ||||||||||
8 | ADL activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45592-3 | Walk in room - self-performance during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110C1 | Walk in room: self-performance | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Independent - no help or staff oversight at any time | ||||||||||
1 | Supervision - oversight, encouragement or cueing | ||||||||||
2 | Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance | ||||||||||
3 | Extensive assistance - resident involved in activity, staff provide weight-bearing support | ||||||||||
4 | Total dependence - full staff performance every time during entire 7-day period | ||||||||||
7 | Activity occurred only once or twice - activity did occur but only once or twice | ||||||||||
8 | Activity did not occur - activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45593-1 | Walk in room - support provided during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110C2 | Walk in room: support provided | NC,NP,NQ,SP, | + | ||
0 | No setup or physical help from staff | ||||||||||
1 | Setup help only | ||||||||||
2 | One person physical assist | ||||||||||
3 | Two+ persons physical assist | ||||||||||
8 | ADL activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45594-9 | Walk in corridor - self-performance during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110D1 | Walk in corridor: self-performance | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Independent - no help or staff oversight at any time | ||||||||||
1 | Supervision - oversight, encouragement or cueing | ||||||||||
2 | Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance | ||||||||||
3 | Extensive assistance - resident involved in activity, staff provide weight-bearing support | ||||||||||
4 | Total dependence - full staff performance every time during entire 7-day period | ||||||||||
7 | Activity occurred only once or twice - activity did occur but only once or twice | ||||||||||
8 | Activity did not occur - activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45595-6 | Walk in corridor - support provided during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110D2 | Walk in corridor: support provided | NC,NP,NQ,SP, | + | ||
0 | No setup or physical help from staff | ||||||||||
1 | Setup help only | ||||||||||
2 | One person physical assist | ||||||||||
3 | Two+ persons physical assist | ||||||||||
8 | ADL activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45596-4 | Locomotion on unit - self-performance during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110E1 | Locomotion on unit: self-performance | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Independent - no help or staff oversight at any time | ||||||||||
1 | Supervision - oversight, encouragement or cueing | ||||||||||
2 | Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance | ||||||||||
3 | Extensive assistance - resident involved in activity, staff provide weight-bearing support | ||||||||||
4 | Total dependence - full staff performance every time during entire 7-day period | ||||||||||
7 | Activity occurred only once or twice - activity did occur but only once or twice | ||||||||||
8 | Activity did not occur - activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45597-2 | Locomotion on unit - support provided during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110E2 | Locomotion on unit: support provided | NC,NP,NQ,SP, | + | ||
0 | No setup or physical help from staff | ||||||||||
1 | Setup help only | ||||||||||
2 | One person physical assist | ||||||||||
3 | Two+ persons physical assist | ||||||||||
8 | ADL activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45598-0 | Locomotion off unit - self-performance during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110F1 | Locomotion off unit: self-performance | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Independent - no help or staff oversight at any time | ||||||||||
1 | Supervision - oversight, encouragement or cueing | ||||||||||
2 | Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance | ||||||||||
3 | Extensive assistance - resident involved in activity, staff provide weight-bearing support | ||||||||||
4 | Total dependence - full staff performance every time during entire 7-day period | ||||||||||
7 | Activity occurred only once or twice - activity did occur but only once or twice | ||||||||||
8 | Activity did not occur - activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45599-8 | Locomotion off unit - support provided during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110F2 | Locomotion off unit: support provided | NC,NP,NQ,SP, | + | ||
0 | No setup or physical help from staff | ||||||||||
1 | Setup help only | ||||||||||
2 | One person physical assist | ||||||||||
3 | Two+ persons physical assist | ||||||||||
8 | ADL activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45600-4 | Dressing - self-performance during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110G1 | Dressing: self-performance | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Independent - no help or staff oversight at any time | ||||||||||
1 | Supervision - oversight, encouragement or cueing | ||||||||||
2 | Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance | ||||||||||
3 | Extensive assistance - resident involved in activity, staff provide weight-bearing support | ||||||||||
4 | Total dependence - full staff performance every time during entire 7-day period | ||||||||||
7 | Activity occurred only once or twice - activity did occur but only once or twice | ||||||||||
8 | Activity did not occur - activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45601-2 | Dressing - support provided during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110G2 | Dressing: support provided | NC,NP,NQ,SP, | + | ||
0 | No setup or physical help from staff | ||||||||||
1 | Setup help only | ||||||||||
2 | One person physical assist | ||||||||||
3 | Two+ persons physical assist | ||||||||||
8 | ADL activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45602-0 | Eating - self-performance during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110H1 | Eating: self-performance | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | + | ||
0 | Independent - no help or staff oversight at any time | ||||||||||
1 | Supervision - oversight, encouragement or cueing | ||||||||||
2 | Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance | ||||||||||
3 | Extensive assistance - resident involved in activity, staff provide weight-bearing support | ||||||||||
4 | Total dependence - full staff performance every time during entire 7-day period | ||||||||||
7 | Activity occurred only once or twice - activity did occur but only once or twice | ||||||||||
8 | Activity did not occur - activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45603-8 | Eating - support provided during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110H2 | Eating: support provided | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | + | ||
0 | No setup or physical help from staff | ||||||||||
1 | Setup help only | ||||||||||
2 | One person physical assist | ||||||||||
3 | Two+ persons physical assist | ||||||||||
8 | ADL activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45604-6 | Toilet use - self-performance during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110I1 | Toilet use: self-performance | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | + | ||
0 | Independent - no help or staff oversight at any time | ||||||||||
1 | Supervision - oversight, encouragement or cueing | ||||||||||
2 | Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance | ||||||||||
3 | Extensive assistance - resident involved in activity, staff provide weight-bearing support | ||||||||||
4 | Total dependence - full staff performance every time during entire 7-day period | ||||||||||
7 | Activity occurred only once or twice - activity did occur but only once or twice | ||||||||||
8 | Activity did not occur - activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45605-3 | Toilet use - support provided during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110I2 | Toilet use: support provided | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | + | ||
0 | No setup or physical help from staff | ||||||||||
1 | Setup help only | ||||||||||
2 | One person physical assist | ||||||||||
3 | Two+ persons physical assist | ||||||||||
8 | ADL activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45606-1 | Personal hygiene - self-performance during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110J1 | Personal hygiene: self-performance | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Independent - no help or staff oversight at any time | ||||||||||
1 | Supervision - oversight, encouragement or cueing | ||||||||||
2 | Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance | ||||||||||
3 | Extensive assistance - resident involved in activity, staff provide weight-bearing support | ||||||||||
4 | Total dependence - full staff performance every time during entire 7-day period | ||||||||||
7 | Activity occurred only once or twice - activity did occur but only once or twice | ||||||||||
8 | Activity did not occur - activity did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45607-9 | Personal hygiene - support provided during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0110J2 | Personal hygiene: support provided | NC,NP,NQ,SP, | + | ||
0 | No setup or physical help from staff | ||||||||||
1 | Setup help only | ||||||||||
2 | One person physical assist | ||||||||||
3 | Two+ persons physical assist | ||||||||||
8 | ADL activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 46008-9 | Bathing [CMS Assessment] | MDS3.0 | 1.16 | G0120 | Bathing | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 45608-7 | Bathing - self-performance during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0120A | Bathing: self-performance | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Independent - no help provided | ||||||||||
1 | Supervision - oversight help only | ||||||||||
2 | Physical help limited to transfer only | ||||||||||
3 | Physical help in part of bathing activity | ||||||||||
4 | Total dependence | ||||||||||
8 | Activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 45609-5 | Bathing - support provided during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0120B | Bathing: support provided | NC,NP,NQ,SP, | + | ||
0 | No setup or physical help from staff | ||||||||||
1 | Setup help only | ||||||||||
2 | One person physical assist | ||||||||||
3 | Two+ persons physical assist | ||||||||||
8 | ADL activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity over the entire 7-day period | ||||||||||
LOINC | 2.64 | 54524-4 | Balance during transitions and walking [CMS Assessment] | MDS3.0 | 1.16 | G0300 | Balance during transitions and walking | NC,NP,NQ,SP, | |||
LOINC | 2.64 | 54749-7 | Moving from seated to standing position in last 7D [CMS Assessment] | MDS3.0 | 1.16 | G0300A | Balance: moving from seated to standing position | NC,NP,NQ,SP, | + | ||
0 | Steady at all times | ||||||||||
1 | Not steady, but able to stabilize without staff assistance | ||||||||||
2 | Not steady, only able to stabilize with staff assistance | ||||||||||
8 | Activity did not occur | ||||||||||
LOINC | 2.64 | 54750-5 | Walking (with assistive device if used) in last 7D [CMS Assessment] | MDS3.0 | 1.16 | G0300B | Balance: walking (with assistive device if used) | NC,NP,NQ,SP, | + | ||
0 | Steady at all times | ||||||||||
1 | Not steady, but able to stabilize without staff assistance | ||||||||||
2 | Not steady, only able to stabilize with staff assistance | ||||||||||
8 | Activity did not occur | ||||||||||
LOINC | 2.64 | 54751-3 | Turning around and facing the opposite direction while walking in last 7D [CMS Assessment] | MDS3.0 | 1.16 | G0300C | Balance: turning around while walking | NC,NP,NQ,SP, | + | ||
0 | Steady at all times | ||||||||||
1 | Not steady, but able to stabilize without staff assistance | ||||||||||
2 | Not steady, only able to stabilize with staff assistance | ||||||||||
8 | Activity did not occur | ||||||||||
LOINC | 2.64 | 54752-1 | Moving on and off toilet in last 7D [CMS Assessment] | MDS3.0 | 1.16 | G0300D | Balance: moving on and off toilet | NC,NP,NQ,SP, | + | ||
0 | Steady at all times | ||||||||||
1 | Not steady, but able to stabilize without staff assistance | ||||||||||
2 | Not steady, only able to stabilize with staff assistance | ||||||||||
8 | Activity did not occur | ||||||||||
LOINC | 2.64 | 54753-9 | Surface-to-surface transfer in last 7D [CMS Assessment] | MDS3.0 | 1.16 | G0300E | Balance: surface-to-surface transfer | NC,NP,NQ,SP, | + | ||
0 | Steady at all times | ||||||||||
1 | Not steady, but able to stabilize without staff assistance | ||||||||||
2 | Not steady, only able to stabilize with staff assistance | ||||||||||
8 | Activity did not occur | ||||||||||
LOINC | 2.64 | 54525-1 | Functional limitation in range of motion [CMS Assessment] | MDS3.0 | 1.16 | G0400 | Functional limitation in range of motion | NC,NP,NQ,SP, | |||
LOINC | 2.64 | 54754-7 | Range of motion:Upper extremity [CMS Assessment] | MDS3.0 | 1.16 | G0400A | ROM limitation: upper extremity | NC,NP,NQ,SP, | + | ||
0 | No impairment | ||||||||||
1 | Impairment on one side | ||||||||||
2 | Impairment on both sides | ||||||||||
LOINC | 2.64 | 54755-4 | Range of motion:Lower extremity [CMS Assessment] | MDS3.0 | 1.16 | G0400B | ROM limitation: lower extremity | NC,NP,NQ,SP, | + | ||
0 | No impairment | ||||||||||
1 | Impairment on one side | ||||||||||
2 | Impairment on both sides | ||||||||||
LOINC | 2.64 | 86602-0 | Mobility devices normally used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | G0600 | Mobility devices. Check all that apply | NC,NP,NQ,SP, | + | ||
A | Cane/crutch | ||||||||||
B | Walker | ||||||||||
C | Wheelchair (manual or electric) | ||||||||||
D | Limb prosthesis | ||||||||||
Z | None of the above were used | ||||||||||
LOINC | 2.64 | 54527-7 | Functional rehabilitation potential [CMS Assessment] | MDS3.0 | 1.16 | G0900 | Functional rehabilitation potential | NC, | |||
LOINC | 2.64 | 55123-4 | Resident believes he or she is capable of increased independence in at least some ADLs [CMS Assessment] | MDS3.0 | 1.16 | G0900A | {Patient/resident} believes capable of increased independence | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | Unable to determine | ||||||||||
LOINC | 2.64 | 45613-7 | Direct care staff believe resident is capable of increased independence in at least some ADLs [CMS Assessment] | MDS3.0 | 1.16 | G0900B | Staff believes {patient/resident} capable of increased independence | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 83239-4 | Prior functioning: everyday activities [CMS Assessment] | MDS3.0 | 1.16 | GG0100 | Prior functioning: everyday activities | NC,NP,NQ,SP, | |||
LOINC | 2.64 | 85070-1 | Prior functioning.self care [CMS Assessment] | MDS3.0 | 1.16 | GG0100A | Prior function - self care | NC,NP,NQ,SP, | + | ||
1 | Dependent - A helper completed the activities for the resident. | ||||||||||
2 | Needed Some Help - Resident needed partial assistance from another person to complete activities. | ||||||||||
3 | Independent - Resident completed the activities by him/herself, with or without an assistive device, with no assistance from a helper. | ||||||||||
8 | Unknown | ||||||||||
9 | Not applicable | ||||||||||
LOINC | 2.64 | 85071-9 | Prior functioning.indoor mobility-ambulation [CMS Assessment] | MDS3.0 | 1.16 | GG0100B | Indoor mobility (ambulation) | NC,NP,NQ,SP, | + | ||
1 | Dependent - A helper completed the activities for the resident. | ||||||||||
2 | Needed Some Help - Resident needed partial assistance from another person to complete activities. | ||||||||||
3 | Independent - Resident completed the activities by him/herself, with or without an assistive device, with no assistance from a helper. | ||||||||||
8 | Unknown | ||||||||||
9 | Not applicable | ||||||||||
LOINC | 2.64 | 85072-7 | Prior functioning.stairs [CMS Assessment] | MDS3.0 | 1.16 | GG0100C | Prior function - stairs | NC,NP,NQ,SP, | + | ||
1 | Dependent - A helper completed the activities for the resident. | ||||||||||
2 | Needed Some Help - Resident needed partial assistance from another person to complete activities. | ||||||||||
3 | Independent - Resident completed the activities by him/herself, with or without an assistive device, with no assistance from a helper. | ||||||||||
8 | Unknown | ||||||||||
9 | Not applicable | ||||||||||
LOINC | 2.64 | 85073-5 | Prior functioning.functional cognition [CMS Assessment] | MDS3.0 | 1.16 | GG0100D | Prior function - functional cognition | NC,NP,NQ,SP, | + | ||
1 | Dependent - A helper completed the activities for the resident. | ||||||||||
2 | Needed Some Help - Resident needed partial assistance from another person to complete activities. | ||||||||||
3 | Independent - Resident completed the activities by him/herself, with or without an assistive device, with no assistance from a helper. | ||||||||||
8 | Unknown | ||||||||||
9 | Not applicable | ||||||||||
LOINC | 2.64 | 83234-5 | Prior device use [CMS Assessment] | MDS3.0 | 1.16 | GG0110 | Prior device use. Check all that apply | NC,NP,NQ,SP, | + | ||
A | Manual wheelchair | ||||||||||
B | Motorized wheelchair and/or scooter | ||||||||||
C | Mechanical lift | ||||||||||
D | Walker | ||||||||||
E | Orthotics/Prosthetics | ||||||||||
Z | None of the above | ||||||||||
LOINC | 2.64 | 83232-9 | Eating - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130A1 | Self-care (admission performance) - eating | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83231-1 | Eating - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130A2 | Self-care (discharge goal) - eating | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83232-9 | Eating - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130A3 | Self-care (discharge performance) - eating | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83230-3 | Oral hygiene - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130B1 | Self-care (admission performance) - oral hygiene | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83229-5 | Oral hygiene - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130B2 | Self-care (discharge goal) - oral hygiene | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83230-3 | Oral hygiene - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130B3 | Self-care (discharge performance) - oral hygiene | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83228-7 | Toileting hygiene - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130C1 | Self-care (admission performance) - toileting hygiene | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83227-9 | Toileting hygiene - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130C2 | Self-care (discharge goal) - toileting hygiene | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83228-7 | Toileting hygiene - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130C3 | Self-care (discharge performance) - toileting hygiene | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83226-1 | Shower &or bathe self - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130E1 | Self-care (admission performance) - shower/bathe self | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83225-3 | Shower &or bathe self - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130E2 | Self-care (discharge goal) - shower/bathe self | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83226-1 | Shower &or bathe self - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130E3 | Self-care (discharge performance) - shower/bathe self | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83224-6 | Upper body dressing - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130F1 | Self-care (admission performance) - upper body dressing | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83223-8 | Upper body dressing - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130F2 | Self-care (discharge Goal) - upper body dressing | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83224-6 | Upper body dressing - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130F3 | Self-care (discharge performance) - upper body dressing | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83222-0 | Lower body dressing - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130G1 | Self-care (admission performance) - lower body dressing | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83221-2 | Lower body dressing - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130G2 | Self-care (discharge goal) - lower body dressing | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83222-0 | Lower body dressing - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130G3 | Self-care (discharge performance) - lower body dressing | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83220-4 | Putting on and taking off footwear - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130H1 | Self-care (admission performance) - on/off footwear | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83219-6 | Putting on and taking off footwear - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130H2 | Self-care (discharge goal) - on/off footwear | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83220-4 | Putting on and taking off footwear - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0130H3 | Self-care (discharge performance) - on/off footwear | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83218-8 | Roll left and right - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170A1 | Functional mobility (admission performance) - roll left and right | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83217-0 | Roll left and right - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170A2 | Functional mobility (discharge goal) - roll left and right | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83218-8 | Roll left and right - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170A3 | Functional mobility (discharge performance) - roll left and right | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83216-2 | Sit to lying - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170B1 | Functional mobility (admission performance) - sit to lying | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83215-4 | Sit to lying - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170B2 | Functional mobility (discharge goal) - sit to lying | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83216-2 | Sit to lying - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170B3 | Functional mobility (discharge performance) - sit to lying | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83214-7 | Lying to sitting on side of bed - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170C1 | Functional mobility (admission performance) - lying to sit on side | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83213-9 | Lying to sitting on side of bed - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170C2 | Functional mobility (discharge goal) - lying to sitting on side | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83214-7 | Lying to sitting on side of bed - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170C3 | Functional mobility (discharge performance) - lying to sitting on side | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83212-1 | Sit to stand - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170D1 | Functional mobility (admission performance) - sit to stand | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83211-3 | Sit to stand - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170D2 | Functional mobility (discharge goal) - sit to stand | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83212-1 | Sit to stand - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170D3 | Functional mobility (discharge performance) - sit to stand | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83210-5 | Bed-to-chair transfer - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170E1 | Functional mobility (admission performance) - chair/bed-to-chair transfer | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83209-7 | Bed-to-chair transfer - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170E2 | Functional mobility (discharge goal) - chair/bed-to-chair transfer | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83210-5 | Bed-to-chair transfer - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170E3 | Functional mobility (discharge performance) - chair/bed-to-chair transfer | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83208-9 | Toilet transfer - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170F1 | Functional mobility (admission performance) - toilet transfer | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83207-1 | Toilet transfer - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170F2 | Functional mobility (discharge goal) - toilet transfer | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83208-9 | Toilet transfer - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170F3 | Functional mobility (discharge performance) - toilet transfer | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83206-3 | Car transfer - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170G1 | Functional mobility (admission performance) - car transfer | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83205-5 | Car transfer - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170G2 | Functional mobility (discharge goal) - car transfer | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83206-3 | Car transfer - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170G3 | Functional mobility (discharge performance) - car transfer | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83204-8 | Walk 10 feet - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170I1 | Functional mobility (admission performance) - walk 10 feet | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83203-0 | Walk 10 feet - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170I2 | Functional mobility (discharge goal) - walk 10 feet | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83204-8 | Walk 10 feet - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170I3 | Functional mobility (discharge performance) - walk 10 feet | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83202-2 | Walk 50 feet with two turns - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170J1 | Functional mobility (admission performance) - walk 50 feet w/2 turns | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83201-4 | Walk 50 feet with two turns - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170J2 | Functional mobility (discharge goal) - walk 50 feet w/2 turns | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83202-2 | Walk 50 feet with two turns - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170J3 | Functional mobility (discharge performance) - walk 50 feet w/2 turns | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83200-6 | Walk 150 feet - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170K1 | Functional mobility (admission performance) - walk 150 feet | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83199-0 | Walk 150 feet - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170K2 | Functional mobility (discharge goal) - walk 150 feet | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83200-6 | Walk 150 feet - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170K3 | Functional mobility (discharge performance) - walk 150 feet | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83198-2 | Walking 10 feet on uneven surfaces - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170L1 | Functional mobility (admission performance) - walk 10 feet uneven surface | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83197-4 | Walking 10 feet on uneven surfaces - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170L2 | Functional mobility (discharge goal) - walk 10 feet uneven surface | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83198-2 | Walking 10 feet on uneven surfaces - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170L3 | Functional mobility (discharge performance) - walk 10 feet uneven surface | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83196-6 | 1 step (curb) - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170M1 | Functional mobility (admission performance) - 1 step (curb) | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83195-8 | 1 step (curb) - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170M2 | Functional mobility (discharge goal) - 1 step (curb) | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83196-6 | 1 step (curb) - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170M3 | Functional mobility (discharge performance) - 1 step (curb) | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83194-1 | 4 steps - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170N1 | Functional mobility (admission performance) - 4 steps | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83193-3 | 4 steps - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170N2 | Functional mobility (discharge goal) - 4 steps | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83194-1 | 4 steps - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170N3 | Functional mobility (discharge performance) - 4 steps | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83192-5 | 12 steps - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170O1 | Functional mobility (admission performance) - 12 steps | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83191-7 | 12 steps - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170O2 | Functional mobility (discharge goal) - 12 steps | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83192-5 | 12 steps - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170O3 | Functional mobility (discharge performance) - 12 steps | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83190-9 | Picking up object - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170P1 | Functional mobility (admission performance) - picking up object | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83189-1 | Picking up object - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170P2 | Functional mobility (discharge goal) - picking up object | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83190-9 | Picking up object - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170P3 | Functional mobility (discharge performance) - picking up object | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83271-7 | Does the patient use a wheelchair or scooter during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170Q1 | Does the {patient/resident} use a wheelchair and/or scooter | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 83271-7 | Does the patient use a wheelchair or scooter during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170Q3 | Does the {patient/resident} use a wheelchair and/or scooter | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 83188-3 | Wheel 50 feet with two turns - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170R1 | Functional mobility (admission performance) - wheel 50 feet w/2 turns | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83187-5 | Wheel 50 feet with two turns - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170R2 | Functional mobility (discharge goal) - wheel 50 feet w/2 turns | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83188-3 | Wheel 50 feet with two turns - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170R3 | Functional mobility (discharge performance) - wheel 50 feet w/2 turns | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83272-5 | Indicate the type of wheelchair or scooter used during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170RR1 | Indicate the type of wheelchair or scooter used | NC,NP,NQ,SP, | + | ||
1 | Manual | ||||||||||
2 | Motorized | ||||||||||
LOINC | 2.64 | 83272-5 | Indicate the type of wheelchair or scooter used during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170RR3 | Indicate the type of wheelchair or scooter used | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
1 | Manual | ||||||||||
2 | Motorized | ||||||||||
LOINC | 2.64 | 83235-2 | Wheel 150 feet - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170S1 | Functional mobility (admission performance) - wheel 150 feet | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83236-0 | Wheel 150 feet - functional goal recorded during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170S2 | Functional mobility (discharge goal) - wheel 150 feet | NC,NP,NQ,SP, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83235-2 | Wheel 150 feet - functional ability during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170S3 | Functional mobility (discharge performance) - wheel 150 feet | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
01 | Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity. | ||||||||||
02 | Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort. | ||||||||||
03 | Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort. | ||||||||||
04 | Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently. | ||||||||||
05 | Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. | ||||||||||
06 | Independent - Resident completes the activity by him/herself with no assistance from a helper. | ||||||||||
07 | Resident refused | ||||||||||
09 | Not applicable - Not attempted and the resident did not perform this activity prior to the current illness, exacerbation, or injury. | ||||||||||
10 | Not attempted due to environmental limitations (e.g., lack of equipment, weather constraints). | ||||||||||
88 | Not attempted due to medical condition or safety concerns | ||||||||||
LOINC | 2.64 | 83272-5 | Indicate the type of wheelchair or scooter used during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170SS1 | Indicate the type of wheelchair or scooter used | NC,NP,NQ,SP, | + | ||
1 | Manual | ||||||||||
2 | Motorized | ||||||||||
LOINC | 2.64 | 83272-5 | Indicate the type of wheelchair or scooter used during 3D assessment period [CMS Assessment] | MDS3.0 | 1.16 | GG0170SS3 | Indicate the type of wheelchair or scooter used | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
1 | Manual | ||||||||||
2 | Motorized | ||||||||||
LOINC | 2.64 | 86624-4 | Bladder and bowel appliances used in last 7D [CMS Assessment] | MDS3.0 | 1.16 | H0100 | Appliances. Check all that apply | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
A | Indwelling catheter (including suprapubic catheter and nephrostomy tube) | ||||||||||
B | External catheter | ||||||||||
C | Ostomy (including urostomy, ileostomy, and colostomy) | ||||||||||
D | Intermittent catheterization | ||||||||||
Z | None of the above | ||||||||||
LOINC | 2.64 | 54530-1 | Urinary toileting program [CMS Assessment] | MDS3.0 | 1.16 | H0200 | Urinary toileting program | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 54767-9 | Trial of toileting program has been attempted on admission or reentry or since urinary incontinence was noted in this facility [CMS Assessment] | MDS3.0 | 1.16 | H0200A | Urinary toileting program: has been attempted | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | Unable to determine | ||||||||||
LOINC | 2.64 | 54768-7 | Response to toileting program [CMS Assessment] | MDS3.0 | 1.16 | H0200B | Urinary toileting program: response | NC, | + | ||
0 | No improvement | ||||||||||
1 | Decreased wetness | ||||||||||
2 | Completely dry (continent) | ||||||||||
9 | Unable to determine or trial in progress | ||||||||||
LOINC | 2.64 | 54769-5 | Current toileting program or trial [CMS Assessment] | MDS3.0 | 1.16 | H0200C | Urinary toileting program: current program/trial | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54770-3 | Urinary continence in last 7D [CMS Assessment] | MDS3.0 | 1.16 | H0300 | Urinary continence | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Always continent | ||||||||||
1 | Occasionally incontinent (less than 7 episodes of incontinence) | ||||||||||
2 | Frequently incontinent (7 or more episodes of urinary incontinence, but with at least one episode of continent voiding) | ||||||||||
3 | Always incontinent (no episodes of continent voiding) | ||||||||||
9 | Not rated, resident had a catheter (indwelling, condom), urinary ostomy, or no urine output for the entire 7 days | ||||||||||
LOINC | 2.64 | 54771-1 | Bowel continence in last 7D [CMS Assessment] | MDS3.0 | 1.16 | H0400 | Bowel continence | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Always continent | ||||||||||
1 | Occasionally incontinent (one episode of bowel incontinence) | ||||||||||
2 | Frequently incontinent (2 or more episodes of bowel incontinence, but at least one continent bowel movement) | ||||||||||
3 | Always incontinent (no episodes of continent bowel movements) | ||||||||||
9 | Not rated, resident had an ostomy or did not have a bowel movement for the entire 7 days | ||||||||||
LOINC | 2.64 | 88695-2 | Used bowel toileting program in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | H0500 | Bowel toileting program being used | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54773-7 | Constipation present in last 7D [CMS Assessment] | MDS3.0 | 1.16 | H0600 | Constipation | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 86671-5 | Active diagnoses in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | I0000 | Active Diagnoses (Comorbidities and co-existing conditions). Check all that apply | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
I0100 | Cancer (with or without metastasis) | ||||||||||
I0200 | Anemia (e.g. aplastic, iron deficiency, pernicious, and sickle cell) | ||||||||||
I0300 | Atrial fibrillation or other dysrhythmias (e.g. bradycardias and tachycardias) | ||||||||||
I0400 | Coronary artery disease (CAD) (e.g., angina, myocardial infarction, and atherosclerotic heart disease (ASHD)) | ||||||||||
I0500 | Deep venous thrombosis (DVT), pulmonary embolus (PE), or Pulmonary thrombo-embolism (PTE) | ||||||||||
I0600 | Heart failure (e.g., congestive heart failure (CHF) and pulmonary edema) | ||||||||||
I0700 | Hypertension | ||||||||||
I0800 | Orthostatic hypotension | ||||||||||
I0900 | Peripheral vascular disease (PVD) or peripheral arterial disease (PAD) | ||||||||||
I1100 | Cirrhosis | ||||||||||
I1200 | Gastroesophageal reflux disease (GERD) or ulcer (e.g., esophageal, gastric, and peptic ulcers) | ||||||||||
I1300 | Ulcerative colitis, Crohn's disease, or inflammatory bowel disease | ||||||||||
I1400 | Benign prostatic hyperplasia (BPH) | ||||||||||
I1500 | Renal insufficiency, renal failure, or end-stage renal disease (ESRD) | ||||||||||
I1550 | Neurogenic bladder | ||||||||||
I1650 | Obstructive uropathy | ||||||||||
I1700 | Multidrug-resistant organism (MDRO) | ||||||||||
I2000 | Pneumonia | ||||||||||
I2100 | Septicemia | ||||||||||
I2200 | Tuberculosis | ||||||||||
I2300 | Urinary tract infection (UTI) (last 30 days) | ||||||||||
I2400 | Viral hepatitis (e.g., Hepatitis A, B, C, D, and E) | ||||||||||
I2500 | Wound infection (other than foot) | ||||||||||
I2900 | Diabetes Mellitus (DM) (e.g., diabetic retinopathy, nephropathy, and neuropathy) | ||||||||||
I3100 | Hyponatremia | ||||||||||
I3200 | Hyperkalemia | ||||||||||
I3300 | Hyperlipidemia (e.g., hypercholesterolemia) | ||||||||||
I3400 | Thyroid disorder (e.g., hypothyroidism, hyperthyroidism, and Hashimoto's thyroiditis) | ||||||||||
I3700 | Arthritis (e.g., degenerative joint disease (DJD), osteoarthritis, and rheumatoid arthritis (RA)) | ||||||||||
I3800 | Osteoporosis | ||||||||||
I3900 | Hip fracture - any hip fracture that has a relationship to current status, treatments, monitoring (e.g., sub-capital fractures, and fractures of the trochanter and femoral neck) | ||||||||||
I4000 | Other fracture | ||||||||||
I4200 | Alzheimer's disease | ||||||||||
I4300 | Aphasia | ||||||||||
I4400 | Cerebral palsy | ||||||||||
I4500 | Cerebrovascular accident (CVA), transient ischemic attack (TIA), or stroke | ||||||||||
I4800 | Non-Alzheimer's dementia (e.g., Lewy body dementia, vascular or multi-infarct dementia; mixed dementia; frontotemporal dementia such as Pick's disease; and dementia related to stroke, Parkinson's or Creutzfeldt-Jakob diseases) | ||||||||||
I4900 | Hemiplegia or hemiparesis | ||||||||||
I5000 | Paraplegia | ||||||||||
I5100 | Quadriplegia | ||||||||||
I5200 | Multiple sclerosis (MS) | ||||||||||
I5250 | Huntington's disease | ||||||||||
I5300 | Parkinson's disease | ||||||||||
I5350 | Tourette's syndrome | ||||||||||
I5400 | Seizure disorder or epilepsy | ||||||||||
I5500 | Traumatic brain injury (TBI) | ||||||||||
I5600 | Malnutrition (protein or calorie) or at risk for malnutrition | ||||||||||
I5700 | Anxiety disorder | ||||||||||
I5800 | Depression (other than bipolar) | ||||||||||
I5900 | Manic depression (bipolar disease) | ||||||||||
I5950 | Psychotic disorder (other than schizophrenia) | ||||||||||
I6000 | Schizophrenia (e.g., schizoaffective and schizophreniform disorders) | ||||||||||
I6100 | Post traumatic stress disorder (PTSD) | ||||||||||
I6200 | Asthma, chronic obstructive pulmonary disease (COPD), or chronic lung disease (e.g., chronic bronchitis and restrictive lung diseases such as asbestosis) | ||||||||||
I6300 | Respiratory failure | ||||||||||
I6500 | Cataracts, glaucoma, or macular degeneration | ||||||||||
I7900 | None of the above active diagnoses within the last 7 days | ||||||||||
LOINC | 2.64 | 89045-9 | Indicate the patient's primary medical condition category [CMS Assessment] | MDS3.0 | 1.16 | I0020 | Primary Medical Condition Category | NC,NP,NQ,SP, | + | ||
01 | Stroke | ||||||||||
02 | Non-traumatic brain dysfunction | ||||||||||
03 | Traumatic brain dysfunction | ||||||||||
04 | Non-traumatic spinal cord dysfunction | ||||||||||
05 | Traumatic spinal cord dysfunction | ||||||||||
06 | Progressive neurological conditions | ||||||||||
07 | Other neurological conditions | ||||||||||
08 | Amputation | ||||||||||
09 | Hip and knee replacement | ||||||||||
10 | Fractures and other multiple trauma | ||||||||||
11 | Other orthopedic conditions | ||||||||||
12 | Debility, cardiorespiratory conditions | ||||||||||
13 | Medically complex conditions | ||||||||||
14 | Other medical condition | ||||||||||
LOINC | 2.64 | 52797-8 | Dx ICD code | MDS3.0 | 1.16 | I0020A | Other Medical Condition ICD | NC,NP,NQ,SP, | |||
LOINC | 2.64 | 52797-8 | Dx ICD code | MDS3.0 | 1.16 | I8000A | Additional active ICD diagnosis 1 | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 52797-8 | Dx ICD code | MDS3.0 | 1.16 | I8000B | Additional active ICD diagnosis 2 | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 52797-8 | Dx ICD code | MDS3.0 | 1.16 | I8000C | Additional active ICD diagnosis 3 | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 52797-8 | Dx ICD code | MDS3.0 | 1.16 | I8000D | Additional active ICD diagnosis 4 | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 52797-8 | Dx ICD code | MDS3.0 | 1.16 | I8000E | Additional active ICD diagnosis 5 | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 52797-8 | Dx ICD code | MDS3.0 | 1.16 | I8000F | Additional active ICD diagnosis 6 | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 52797-8 | Dx ICD code | MDS3.0 | 1.16 | I8000G | Additional active ICD diagnosis 7 | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 52797-8 | Dx ICD code | MDS3.0 | 1.16 | I8000H | Additional active ICD diagnosis 8 | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 52797-8 | Dx ICD code | MDS3.0 | 1.16 | I8000I | Additional active ICD diagnosis 9 | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 52797-8 | Dx ICD code | MDS3.0 | 1.16 | I8000J | Additional active ICD diagnosis 10 | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54557-4 | Pain management [CMS Assessment] | MDS3.0 | 1.16 | J0100 | Pain management | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 71447-7 | Received scheduled pain medication regimen in last 5D [CMS Assessment] | MDS3.0 | 1.16 | J0100A | Pain: received scheduled pain medication regimen | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 71448-5 | Received PRN pain medications or was offered and declined in the last 5D [CMS Assessment] | MDS3.0 | 1.16 | J0100B | Pain: received PRN pain medications | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 71449-3 | Received non-medication intervention for pain in last 5D [CMS Assessment] | MDS3.0 | 1.16 | J0100C | Pain: received non-medication intervention | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54828-9 | Pain assessment interview should be conducted [CMS Assessment] | MDS3.0 | 1.16 | J0200 | Should pain assessment interview be conducted | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No (resident is rarely/never understood) | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54829-7 | Pain presence in last 5D [CMS Assessment] | MDS3.0 | 1.16 | J0300 | Pain interview: presence | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | Unable to answer | ||||||||||
LOINC | 2.64 | 54830-5 | Pain frequency in last 5D [CMS Assessment] | MDS3.0 | 1.16 | J0400 | Pain interview: frequency | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
1 | Almost constantly | ||||||||||
2 | Frequently | ||||||||||
3 | Occasionally | ||||||||||
4 | Rarely | ||||||||||
9 | Unable to answer | ||||||||||
LOINC | 2.64 | 54559-0 | Pain effect on function [CMS Assessment] | MDS3.0 | 1.16 | J0500 | Pain effect on function | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54831-3 | Pain has made it hard to sleep in last 5D [CMS Assessment] | MDS3.0 | 1.16 | J0500A | Pain interview: made it hard to sleep | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | Unable to answer | ||||||||||
LOINC | 2.64 | 54832-1 | Limited activities because of pain in last 5D [CMS Assessment] | MDS3.0 | 1.16 | J0500B | Pain interview: limited daily activities | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | Unable to answer | ||||||||||
LOINC | 2.64 | 54560-8 | Pain intensity [CMS Assessment] | MDS3.0 | 1.16 | J0600 | Pain intensity | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54833-9 | Pain severity in last 5D [CMS Assessment] | MDS3.0 | 1.16 | J0600A | Pain interview: intensity rating scale | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54834-7 | Rate pain severity in last 5D using verbal descriptor scale [CMS Assessment] | MDS3.0 | 1.16 | J0600B | Pain interview: verbal descriptor scale | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
1 | Mild | ||||||||||
2 | Moderate | ||||||||||
3 | Severe | ||||||||||
4 | Very severe, horrible | ||||||||||
9 | Unable to answer | ||||||||||
LOINC | 2.64 | 58117-3 | Staff pain assessment interview should be conducted [CMS Assessment] | MDS3.0 | 1.16 | J0700 | Should staff assessment for pain be conducted | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 86673-1 | Indicators of pain or possible pain in the last 5D [CMS Assessment] | MDS3.0 | 1.16 | J0800 | Indicators of pain or possible pain. Check all that apply | NC,NP,NQ,SP, | + | ||
A | Non-verbal sounds (e.g., crying, whining, gasping, moaning, or groaning) | ||||||||||
B | Vocal complaints of pain (e.g., that hurts, ouch, stop) | ||||||||||
C | Facial Expressions (e.g., grimaces, winces, wrinkled forehead, furrowed brow, clenched teeth or jaw) | ||||||||||
D | Protective body movements or postures (e.g., bracing, guarding, rubbing or massaging a body part/area, clutching or holding a body part during movement) | ||||||||||
Z | None of these signs observed or documented | ||||||||||
LOINC | 2.64 | 58118-1 | Frequency of indicator of pain or possible pain in last 5D [CMS Assessment] | MDS3.0 | 1.16 | J0850 | Staff pain assessment: frequency of pain | NC,NP,NQ,SP, | + | ||
1 | Indicators of pain or possible pain observed 1 to 2 days | ||||||||||
2 | Indicators of pain or possible pain observed 3 to 4 days | ||||||||||
3 | Indicators of pain or possible pain observed daily | ||||||||||
LOINC | 2.64 | 86675-6 | Shortness of breath in last 7D [CMS Assessment] | MDS3.0 | 1.16 | J1100 | Shortness of breath (dyspnea). Check all that apply | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
A | Shortness of breath or trouble breathing with exertion (e.g., walking, bathing, transferring) | ||||||||||
B | Shortness of breath or trouble breathing when sitting at rest | ||||||||||
C | Shortness of breath or trouble breathing when lying flat | ||||||||||
Z | None of the above | ||||||||||
LOINC | 2.64 | 54845-3 | Tobacco use in last 7D [CMS Assessment] | MDS3.0 | 1.16 | J1300 | Current tobacco use | NC, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54846-1 | Life expectancy of less than 6M [CMS Assessment] | MDS3.0 | 1.16 | J1400 | Prognosis: life expectancy of less than 6 months | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 86676-4 | Problem conditions in last 7D [CMS Assessment] | MDS3.0 | 1.16 | J1550 | Problem conditions. Check all that apply | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
A | Fever | ||||||||||
B | Vomiting | ||||||||||
C | Dehydrated | ||||||||||
D | Internal bleeding | ||||||||||
Z | None of the above | ||||||||||
LOINC | 2.64 | 54849-5 | Fall history on admission [CMS Assessment] | MDS3.0 | 1.16 | J1700 | Fall history on admission/entry or reentry | NC,NP,NQ,SP, | |||
LOINC | 2.64 | 54850-3 | Fall one or more times in the last Mo prior to admission [CMS Assessment] | MDS3.0 | 1.16 | J1700A | Fall history: fall during month before admission | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | Unable to determine | ||||||||||
LOINC | 2.64 | 54851-1 | Fall one or more times in the last 2 to 6Mo prior to admission [CMS Assessment] | MDS3.0 | 1.16 | J1700B | Fall history: fall 2-6 months before admission | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | Unable to determine | ||||||||||
LOINC | 2.64 | 54852-9 | Any fracture related to a fall in the 6Mo prior to admission [CMS Assessment] | MDS3.0 | 1.16 | J1700C | Fall history: fracture from fall 6 month pre admit | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | `Unable to determine | ||||||||||
LOINC | 2.64 | 54853-7 | Has the patient had any falls since admission or prior assessment [CMS Assessment] | MDS3.0 | 1.16 | J1800 | Falls since admit/prior assessment: any falls | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 54854-5 | Number of falls since admission or prior assessment [CMS Assessment] | MDS3.0 | 1.16 | J1900 | Number of falls since admission/entry or reentry | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54855-2 | Number of falls since admission or prior assessment - no injury [CMS Assessment] | MDS3.0 | 1.16 | J1900A | Falls since admit/prior assessment: no injury | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | None | ||||||||||
1 | One | ||||||||||
2 | Two or more | ||||||||||
LOINC | 2.64 | 54856-0 | Number of falls since admission or prior assessment - injury except major [CMS Assessment] | MDS3.0 | 1.16 | J1900B | Falls since admit/prior assessment: injury (not major) | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | None | ||||||||||
1 | One | ||||||||||
2 | Two or more | ||||||||||
LOINC | 2.64 | 54857-8 | Number of falls since admission or prior assessment - major injury [CMS Assessment] | MDS3.0 | 1.16 | J1900C | Falls since admit/prior assessment: major injury | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | None | ||||||||||
1 | One | ||||||||||
2 | Two or more | ||||||||||
LOINC | 2.64 | 83274-1 | Did the patient have major surgery during the 100D prior to admission [CMS Assessment] | MDS3.0 | 1.16 | J2000 | Prior surgery | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
8 | Unknown | ||||||||||
LOINC | 2.64 | 86677-2 | Signs and symptoms of swallowing disorder in last 7D [CMS Assessment] | MDS3.0 | 1.16 | K0100 | Swallowing disorders. Check all that apply | NC,NP,NQ, | + | ||
A | Loss of liquids/solids from mouth when eating or drinking | ||||||||||
B | Holding food in mouth/cheeks or residual food in mouth after meals | ||||||||||
C | Coughing or choking during meals or when swallowing medications | ||||||||||
D | Complaints of difficulty or pain with swallowing | ||||||||||
Z | None of the above | ||||||||||
LOINC | 2.64 | 54567-3 | Height and weight | MDS3.0 | 1.16 | K0200 | Height and weight | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 3137-7 | Body height Measured | MDS3.0 | 1.16 | K0200A | Height (in inches) | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 3141-9 | Weight Measured | MDS3.0 | 1.16 | K0200B | Weight (in pounds) | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54863-6 | Weight loss of 5% or more in the last Mo or loss of 10% or more in last 6Mo [CMS Assessment] | MDS3.0 | 1.16 | K0300 | Weight loss | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No or unknown | ||||||||||
1 | Yes, on physician-prescribed weight-loss regimen | ||||||||||
2 | Yes, not on physician-prescribed weight-loss regimen | ||||||||||
LOINC | 2.64 | 86678-0 | Weight gain of 5% or more in the last month or gain of 10% or more in last 6Mo [CMS Assessment] | MDS3.0 | 1.16 | K0310 | Weight gain | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No or unknown | ||||||||||
1 | Yes, on physician-prescribed weight-gain regimen | ||||||||||
2 | Yes, not on physician-prescribed weight-gain regimen | ||||||||||
LOINC | 2.64 | 54568-1 | Nutritional approaches [CMS Assessment] | MDS3.0 | 1.16 | K0510 | Nutritional approaches. Check all that apply | NC,ND,NO,NOD,NP,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
A1 | Parenteral/IV feeding | ||||||||||
A2 | Parenteral/IV feeding | ||||||||||
B1 | Feeding tube - nasogastric or abdominal (PEG) | ||||||||||
B2 | Feeding tube - nasogastric or abdominal (PEG) | ||||||||||
C1 | Mechanically altered diet - require change in texture of food or liquids (e.g., pureed food, thickened liquids) | ||||||||||
C2 | Mechanically altered diet - require change in texture of food or liquids (e.g., pureed food, thickened liquids) | ||||||||||
D1 | Therapeutic diet (e.g. low salt, diabetic, low cholesterol) | ||||||||||
D2 | Therapeutic diet (e.g. low salt, diabetic, low cholesterol) | ||||||||||
Z1 | None of the above | ||||||||||
Z2 | None of the above | ||||||||||
LOINC | 2.64 | 86679-8 | Percent intake by artificial route [CMS Assessment] | MDS3.0 | 1.16 | K0710 | Percent intake by artificial route | NC,NO,NOD,NP,NQ,SO,SOD,SP, | |||
LOINC | 2.64 | 86680-6 | Proportion of total calories the resident received through parenteral or tube feeding in the 7D - while not a resident [CMS Assessment] | MDS3.0 | 1.16 | K0710A1 | Proportion calories parenteral/tube feed: not {patient/resident} | NC,NO,NOD,NP,NQ,SO,SOD,SP, | + | ||
1 | 25% or less | ||||||||||
2 | 26-50% | ||||||||||
3 | 51% or more | ||||||||||
LOINC | 2.64 | 86681-4 | Proportion of total calories the resident received through parenteral or tube feeding in last 7D - while a resident [CMS Assessment] | MDS3.0 | 1.16 | K0710A2 | Proportion calories parenteral/tube feed: while {patient/resident} | NC,NO,NOD,NP,NQ,SO,SOD,SP, | + | ||
1 | 25% or less | ||||||||||
2 | 26-50% | ||||||||||
3 | 51% or more | ||||||||||
LOINC | 2.64 | 86687-1 | Proportion of total calories the resident received through parenteral or tube feeding during entire 7D [CMS Assessment] | MDS3.0 | 1.16 | K0710A3 | Proportion calories parenteral/tube feed: 7 days | NC,NO,NOD,NP,NQ,SO,SOD,SP, | + | ||
1 | 25% or less | ||||||||||
2 | 26-50% | ||||||||||
3 | 51% or more | ||||||||||
LOINC | 2.64 | 86682-2 | Average fluid intake per day by IV or tube feeding in last 7D - while not a resident [CMS Assessment] | MDS3.0 | 1.16 | K0710B1 | Average fluid intake per day IV/tube: not {patient/resident} | NC,NO,NOD,NP,NQ,SO,SOD,SP, | + | ||
1 | 500 cc/day or less | ||||||||||
2 | 501 cc/day or more | ||||||||||
LOINC | 2.64 | 86683-0 | Average fluid intake per day by IV or tube feeding in last 7D - while a resident [CMS Assessment] | MDS3.0 | 1.16 | K0710B2 | Average fluid intake per day IV/ tube: while {patient/resident} | NC,NO,NOD,NP,NQ,SO,SOD,SP, | + | ||
1 | 500 cc/day or less | ||||||||||
2 | 501 cc/day or more | ||||||||||
LOINC | 2.64 | 86684-8 | Average fluid intake per day by IV or tube feeding during entire 7D [CMS Assessment] | MDS3.0 | 1.16 | K0710B3 | Average fluid intake per day IV/tube: 7 days | NC,NO,NOD,NP,NQ,SO,SOD,SP, | + | ||
1 | 500 cc/day or less | ||||||||||
2 | 501 cc/day or more | ||||||||||
LOINC | 2.64 | 86706-9 | Dental problems during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | L0200 | Dental. Check all that apply | NC,NP,NQ, | + | ||
A | Broken or loosely fitting full or partial denture (chipped, cracked, uncleanable, or loose) | ||||||||||
B | No natural teeth or tooth fragment(s) (edentulous) | ||||||||||
C | Abnormal mouth tissue (ulcers, masses, oral lesions, including under denture or partial if one is worn) | ||||||||||
D | Obvious or likely cavity or broken natural teeth | ||||||||||
E | Inflamed or bleeding gums or loose natural teeth | ||||||||||
F | Mouth or facial pain, discomfort or difficulty with chewing | ||||||||||
G | Unable to examine | ||||||||||
Z | None of the above were present | ||||||||||
LOINC | 2.64 | 86708-5 | Determination of pressure injury risk in last 7D [CMS Assessment] | MDS3.0 | 1.16 | M0100 | Determination of pressure ulcer risk. Check all that apply | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
A | Resident has a pressure ulcer/injury, a scar over bony prominence, or a non-removable dressing/device | ||||||||||
B | Formal assessment instrument/tool (e.g., Braden, Norton, or other) | ||||||||||
C | Clinical assessment | ||||||||||
Z | None of the above | ||||||||||
LOINC | 2.64 | 57280-0 | Risk of developing pressure injuries [CMS Assessment] | MDS3.0 | 1.16 | M0150 | Risk of pressure ulcers/injuries | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 58214-8 | One or more unhealed pressure injuries stage 1 or higher [CMS Assessment] | MDS3.0 | 1.16 | M0210 | Unhealed pressure ulcer(s)/injuries | NC,ND,NO,NOD,NP,NPE,NQ,NSD,SD,SO,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 88961-8 | MDS v3.0 - RAI - Current number of unhealed pressure injuries at each stage [CMS Assessment] | MDS3.0 | 1.16 | M0300 | Current number of unhealed pressure ulcers at each stage | NC,ND,NO,NOD,NP,NPE,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 54884-2 | Number of pressure injuries - stage 1 [CMS Assessment] | MDS3.0 | 1.16 | M0300A1 | Number of Stage 1 pressure injuries | NC,NP,NQ,SP, | |||
LOINC | 2.64 | 55124-2 | Number of pressure injuries - stage 2 [CMS Assessment] | MDS3.0 | 1.16 | M0300B1 | Stage 2 pressure ulcers: number present | NC,ND,NO,NOD,NP,NPE,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 54886-7 | Number of pressure injuries present upon admission &or reentry - stage 2 [CMS Assessment] | MDS3.0 | 1.16 | M0300B2 | Stage 2 pressure ulcers: number at admit/reentry | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 55125-9 | Number of pressure injuries - stage 3 [CMS Assessment] | MDS3.0 | 1.16 | M0300C1 | Stage 3 pressure ulcers: number present | NC,ND,NO,NOD,NP,NPE,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 54887-5 | Number of pressure injuries present upon admission &or reentry - stage 3 [CMS Assessment] | MDS3.0 | 1.16 | M0300C2 | Stage 3 pressure ulcers: number at admit/reentry | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 55126-7 | Number of pressure injuries - stage 4 [CMS Assessment] | MDS3.0 | 1.16 | M0300D1 | Stage 4 pressure ulcers: number present | NC,ND,NO,NOD,NP,NPE,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 54890-9 | Number of pressure injuries present upon admission &or reentry - stage 4 [CMS Assessment] | MDS3.0 | 1.16 | M0300D2 | Stage 4 pressure ulcers: number at admit/reentry | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54893-3 | Number of pressure injuries - unstageable due to non-removable dressing or device [CMS Assessment] | MDS3.0 | 1.16 | M0300E1 | Unstaged due to dressing/device: number present | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54894-1 | Number of pressure injuries present upon admission &or reentry - unstageable due to non-removable dressing [CMS Assessment] | MDS3.0 | 1.16 | M0300E2 | Unstaged due to dressing/device: number at admit/reentry | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54946-9 | Number of pressure injuries - unstageable due to coverage of wound bed by slough &or eschar [CMS Assessment] | MDS3.0 | 1.16 | M0300F1 | Unstaged slough/eschar: number present | NC,ND,NO,NOD,NP,NPE,NQ,NSD,SD,SO,SOD,SP,SSD, | |||
LOINC | 2.64 | 54947-7 | Number of pressure injuries present upon admission &or reentry - unstageable due to coverage of wound bed by slough &or eschar [CMS Assessment] | MDS3.0 | 1.16 | M0300F2 | Unstaged slough/eschar: number at admit/reentry | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54950-1 | Number of pressure injuries - unstageable with suspected deep tissue injury in evolution [CMS Assessment] | MDS3.0 | 1.16 | M0300G1 | Unstageable - deep tissue injury: number present | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54951-9 | Number of pressure injuries present upon admission &or reentry - unstageable with suspected deep tissue injury in evolution [CMS Assessment] | MDS3.0 | 1.16 | M0300G2 | Unstageable - deep tissue injury: number at admission/reentry | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 54970-9 | Number of venous and arterial ulcers in last 7D [CMS Assessment] | MDS3.0 | 1.16 | M1030 | Number of venous and arterial ulcers | NC,NO,NOD,NP,NQ,SO,SOD,SP, | |||
LOINC | 2.64 | 88696-0 | Ulcers, wounds and skin problems in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | M1040 | Other ulcers, wounds and skin problems. Check all that apply | NC,NO,NOD,NP,NQ,SO,SOD,SP, | + | ||
A | Infection of the foot (e.g., cellulitis, purulent drainage) | ||||||||||
B | Diabetic foot ulcers(s) | ||||||||||
C | Other open lesion(s) on the foot | ||||||||||
D | Open lesion(s) other than ulcers, rashes, cuts (e.g., cancer lesion) | ||||||||||
E | Surgical wound(s) | ||||||||||
F | Burn(s) (second or third degree) | ||||||||||
G | Skin tear(s) | ||||||||||
H | Moisture associated skin damage (MASD) (e.g., incontinence-associated dermatitis [IAD], perspiration, drainage) | ||||||||||
Z | None of the above were present | ||||||||||
LOINC | 2.64 | 86748-1 | Skin and ulcer &or injury treatments during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | M1200 | Skin and ulcer treatments. Check all that apply | NC,NO,NOD,NP,NQ,SO,SOD,SP, | + | ||
A | Pressure reducing device for chair | ||||||||||
B | Pressure reducing device for bed | ||||||||||
C | Turning/repositioning program | ||||||||||
D | Nutrition or hydration intervention to manage skin problems | ||||||||||
E | Pressure ulcer/injury care | ||||||||||
F | Surgical wound care | ||||||||||
G | Application of nonsurgical dressings (with or without topical medications) other than to feet | ||||||||||
H | Applications of ointments/medications other than to feet | ||||||||||
I | Application of dressings to feet (with or without topical medications) | ||||||||||
Z | None of the above were provided | ||||||||||
LOINC | 2.64 | 54982-4 | Number of D injectable substances received in last 7D or since admission &or reentry if less than 7D [CMS Assessment] | MDS3.0 | 1.16 | N0300 | Number of days injectable medications received | NC,NO,NOD,NP,NQ,SO,SOD,SP, | |||
LOINC | 2.64 | 58217-1 | Insulin [CMS Assessment] | MDS3.0 | 1.16 | N0350 | Insulin | NC,NO,NOD,NP,NQ,SO,SOD,SP, | |||
LOINC | 2.64 | 58127-2 | Number of D insulin injections were received in last 7D or since admission &or reentry if less than 7D [CMS Assessment] | MDS3.0 | 1.16 | N0350A | Insulin: insulin injections | NC,NO,NOD,NP,NQ,SO,SOD,SP, | |||
LOINC | 2.64 | 58128-0 | Number of D the physician changed the resident's insulin orders in last 7D or since admission &or reentry if less than 7D [CMS Assessment] | MDS3.0 | 1.16 | N0350B | Insulin: orders for insulin | NC,NO,NOD,NP,NQ,SO,SOD,SP, | |||
LOINC | 2.64 | 88290-2 | MDS v3.0 - RAI - Medications received [CMS Assessment] | MDS3.0 | 1.16 | N0410 | Medications received | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 86751-5 | Number of D antipsychotic received in last 7D or since admission &or reentry if less than 7D [CMS Assessment] | MDS3.0 | 1.16 | N0410A | Medication received: days: antipsychotic | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 86752-3 | Number of D antianxiety received in last 7D or since admission &or reentry if less than 7D [CMS Assessment] | MDS3.0 | 1.16 | N0410B | Medication received: days: antianxiety | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 86753-1 | Number of D antidepressant received in last 7D or since admission &or reentry if less than 7D [CMS Assessment] | MDS3.0 | 1.16 | N0410C | Medication received: days: antidepressant | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 86754-9 | Number of D hypnotic received in last 7D or since admission &or reentry if less than 7D [CMS Assessment] | MDS3.0 | 1.16 | N0410D | Medication received: days: hypnotic | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 86755-6 | Number of D anticoagulant received in last 7D or since admission &or reentry if less than 7D [CMS Assessment] | MDS3.0 | 1.16 | N0410E | Medication received: days: anticoagulant | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 86756-4 | Number of D antibiotic received in last 7D or since admission &or reentry if less than 7D [CMS Assessment] | MDS3.0 | 1.16 | N0410F | Medication received: days: antibiotic | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 86757-2 | Number of D diuretic received in last 7D or since admission &or reentry if less than 7D [CMS Assessment] | MDS3.0 | 1.16 | N0410G | Medication received: days: diuretic | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 88291-0 | Number of D opiod received in last 7D or since admission &or reentry if less than 7D [CMS Assessment] | MDS3.0 | 1.16 | N0410H | Medication received: days: opioid | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 88295-1 | Antipsychotic medication review [CMS Assessment] | MDS3.0 | 1.16 | N0450 | Antipsychotic Medication Review | NC,NQ, | |||
LOINC | 2.64 | 88296-9 | Antipsychotic medications since admission or entry or reentry or the prior OBRA assessment, whichever is more recent [CMS Assessment] | MDS3.0 | 1.16 | N0450A | {Patient/resident} received antipsychotic medications | NC,NQ, | + | ||
0 | No - Antipsychotics were not received | ||||||||||
1 | Yes - Antipsychotics were received on a routine basis only | ||||||||||
2 | Yes - Antipsychotics were received on a PRN basis only | ||||||||||
3 | Yes - Antipsychotics were received on a routine and PRN basis | ||||||||||
LOINC | 2.64 | 88297-7 | Gradual dose reduction (GDR) attempted [CMS Assessment] | MDS3.0 | 1.16 | N0450B | Gradual dose reduction attempted | NC,NQ, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 88298-5 | Date of last attempted GDR [CMS Assessment] | MDS3.0 | 1.16 | N0450C | Date of last attempted gradual dose reduction | NC,NQ, | |||
LOINC | 2.64 | 88299-3 | Physician documented GDR as clinically contraindicated [CMS Assessment] | MDS3.0 | 1.16 | N0450D | Physician documented gradual dose reduction | NC,NQ, | + | ||
0 | No - GDR has not been documented by a physician as clinically contraindicated | ||||||||||
1 | Yes - GDR has been documented by a physician as clinically contraindicated | ||||||||||
LOINC | 2.64 | 88300-9 | Date physician documented GDR as clinically contraindicated [CMS Assessment] | MDS3.0 | 1.16 | N0450E | Date physician documented gradual dose reduction | NC,NQ, | |||
LOINC | 2.64 | 57255-2 | Drug regimen review identified potential medication issues [CMS Assessment] | MDS3.0 | 1.16 | N2001 | Drug regimen review | NC,NP,NQ,SP, | + | ||
0 | No - No issues found during review | ||||||||||
1 | Yes - Issues found during review | ||||||||||
9 | NA - Patient is not taking any medications | ||||||||||
LOINC | 2.64 | 57281-8 | Medication follow-up [CMS Assessment] | MDS3.0 | 1.16 | N2003 | Medication follow-up | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 57256-0 | Medication intervention since admission &or reentry [CMS Assessment] | MDS3.0 | 1.16 | N2005 | Medication intervention | NC,ND,NOD,NP,NPE,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | NA - There were no potential clinically significant medication issues identified since admission or resident is not taking any medications | ||||||||||
LOINC | 2.64 | 86759-8 | Special treatments, procedures, and programs [CMS Assessment] | MDS3.0 | 1.16 | O0100 | Special treatments, procedures, and programs. Check all that apply | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | + | ||
A1 | Chemotherapy | ||||||||||
A2 | Chemotherapy | ||||||||||
B1 | Radiation | ||||||||||
B2 | Radiation | ||||||||||
C1 | Oxygen therapy | ||||||||||
C2 | Oxygen therapy | ||||||||||
D1 | Suctioning | ||||||||||
D2 | Suctioning | ||||||||||
E1 | Tracheostomy care | ||||||||||
E2 | Tracheostomy care | ||||||||||
F1 | Invasive mechanical ventilator (ventilator or respirator) | ||||||||||
F2 | Invasive mechanical ventilator (ventilator or respirator) | ||||||||||
G1 | Non-invasive mechanical ventilator (BiPAP/CPAP) | ||||||||||
G2 | Non-invasive mechanical ventilator (BiPAP/CPAP) | ||||||||||
H1 | IV medications | ||||||||||
H2 | IV medications | ||||||||||
I1 | Transfusions | ||||||||||
I2 | Transfusions | ||||||||||
J1 | Dialysis | ||||||||||
J2 | Dialysis | ||||||||||
K1 | Hospice care | ||||||||||
K2 | Hospice care | ||||||||||
L2 | Respite care | ||||||||||
M1 | Isolation or quarantine for active infectious disease (does not include standard body/fluid precautions) | ||||||||||
M2 | Isolation or quarantine for active infectious disease (does not include standard body/fluid precautions) | ||||||||||
Z1 | None of the above | ||||||||||
Z2 | None of the above | ||||||||||
LOINC | 2.64 | 69339-0 | Influenza vaccine [CMS Assessment] | MDS3.0 | 1.16 | O0250 | Influenza vaccine | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 55019-4 | Influenza virus vaccine received in facility [CMS Assessment] | MDS3.0 | 1.16 | O0250A | Was influenza vaccine received | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 58131-4 | Flu vaccine date | MDS3.0 | 1.16 | O0250B | Date influenza vaccine received | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 55020-2 | Reason influenza virus vaccine not received [CMS Assessment] | MDS3.0 | 1.16 | O0250C | If influenza vaccine not received, state reason | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
1 | Resident not in facility during this year's influenza vaccination season | ||||||||||
2 | Received outside of this facility | ||||||||||
3 | Not eligible - medical contraindication | ||||||||||
4 | Offered and declined | ||||||||||
5 | Not offered | ||||||||||
6 | Inability to obtain influenza vaccine due to a declared shortage | ||||||||||
9 | None of the above | ||||||||||
LOINC | 2.64 | 55021-0 | Pneumococcal vaccine | MDS3.0 | 1.16 | O0300 | Pneumococcal vaccine | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 55022-8 | Pneumococcal vaccination up to date [CMS Assessment] | MDS3.0 | 1.16 | O0300A | Is pneumococcal vaccination up to date | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 45956-0 | Reason pneumococcal vaccine not received [CMS Assessment] | MDS3.0 | 1.16 | O0300B | If pneumococcal vaccination not received, state reason | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
1 | Not eligible - medical contraindication | ||||||||||
2 | Offered and declined | ||||||||||
3 | Not offered | ||||||||||
LOINC | 2.64 | 86762-2 | Therapies [CMS Assessment] | MDS3.0 | 1.16 | O0400 | Therapies | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86763-0 | Speech-language pathology and audiology services [CMS Assessment] | MDS3.0 | 1.16 | O0400A | Speech-language pathology and audiology services | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58218-9 | Speech-language pathology and audiology services - individual minutes in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400A1 | Speech-language/audiology: individual minutes | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58133-0 | Speech-language pathology and audiology services - concurrent minutes in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400A2 | Speech-language/audiology: concurrent minutes | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58134-8 | Speech-language pathology and audiology services - group minutes in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400A3 | Speech-language/audiology: group minutes | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86765-5 | Speech-language pathology and audiology services - co-treatment minutes during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | O0400A3A | Speech-language/audiology: co-treatment minutes | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 45760-6 | Number of D with at least 15M of speech language pathology and audiology services in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400A4 | Speech-language/audiology: number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 55025-1 | Start date of speech language pathology and audiology services [CMS Assessment] | MDS3.0 | 1.16 | O0400A5 | Speech-language/audiology: start date | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 55026-9 | End date of speech language pathology and audiology services [CMS Assessment] | MDS3.0 | 1.16 | O0400A6 | Speech-language/audiology: end date | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86767-1 | Occupational therapy [CMS Assessment] | MDS3.0 | 1.16 | O0400B | Occupational therapy | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58219-7 | Occupational therapy - individual minutes in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400B1 | Occupational therapy: individual minutes | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58136-3 | Occupational therapy - concurrent minutes in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400B2 | Occupational therapy: concurrent minutes | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58137-1 | Occupational therapy - group minutes in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400B3 | Occupational therapy: group minutes | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86764-8 | Occupational therapy - co-treatment minutes during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | O0400B3A | Occupational therapy: co-treatment minutes | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 45762-2 | Number of D with at least 15M of occupational therapy in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400B4 | Occupational therapy: number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 55027-7 | Start date of occupational therapy [CMS Assessment] | MDS3.0 | 1.16 | O0400B5 | Occupational therapy: start date | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 55028-5 | End date of occupational therapy [CMS Assessment] | MDS3.0 | 1.16 | O0400B6 | Occupational therapy: end date | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86768-9 | Physical therapy [CMS Assessment] | MDS3.0 | 1.16 | O0400C | Physical therapy | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58220-5 | Physical therapy - individual minutes in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400C1 | Physical therapy: individual minutes | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58139-7 | Physical therapy - concurrent minutes in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400C2 | Physical therapy: concurrent minutes | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58140-5 | Physical therapy - group minutes in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400C3 | Physical therapy: group minutes | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86766-3 | Physical therapy - co-treatment minutes during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | O0400C3A | Physical therapy: co-treatment minutes | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 45764-8 | Number of D with at least 15M of physical therapy in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400C4 | Physical therapy: number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 55029-3 | Start date of physical therapy [CMS Assessment] | MDS3.0 | 1.16 | O0400C5 | Physical therapy: start date | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 55030-1 | End date of physical therapy [CMS Assessment] | MDS3.0 | 1.16 | O0400C6 | Physical therapy: end date | NC,ND,NO,NOD,NP,NQ,NS,NSD,SD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58141-3 | Respiratory therapy [CMS Assessment] | MDS3.0 | 1.16 | O0400D | Respiratory therapy | NC,NO,NOD,NP,NQ,SO,SOD,SP, | |||
LOINC | 2.64 | 45767-1 | Total minutes of respiratory therapy in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400D1 | Respiratory therapy: number of minutes | NC, | |||
LOINC | 2.64 | 45766-3 | Number of D with at least 15M of respiratory therapy in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400D2 | Respiratory therapy: number of days | NC,NO,NOD,NP,NQ,SO,SOD,SP, | |||
LOINC | 2.64 | 58142-1 | Psychological therapy [CMS Assessment] | MDS3.0 | 1.16 | O0400E | Psychological therapy | NC,NP,NQ, | |||
LOINC | 2.64 | 45852-1 | Total minutes of psychological therapy by any licensed mental health professional in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400E1 | Psychological therapy: number of minutes | NC, | |||
LOINC | 2.64 | 45768-9 | Number of D with at least 15M of psychological therapy by any licensed mental health professional in the last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400E2 | Psychological therapy: number of days | NC,NP,NQ, | |||
LOINC | 2.64 | 58143-9 | Recreational therapy [CMS Assessment] | MDS3.0 | 1.16 | O0400F | Recreational therapy | NC, | |||
LOINC | 2.64 | 55035-0 | Total minutes of recreational and music therapy in last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400F1 | Recreational therapy: number of minutes | NC, | |||
LOINC | 2.64 | 55036-8 | Number of D with at least 15M of recreational and music therapy in last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0400F2 | Recreational therapy: number of days | NC, | |||
LOINC | 2.64 | 86769-7 | Distinct calendar days of therapy in last 7D [CMS Assessment] | MDS3.0 | 1.16 | O0420 | Distinct calendar days of therapy | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86770-5 | Resumption of therapy [CMS Assessment] | MDS3.0 | 1.16 | O0450 | Resumption of therapy | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86772-1 | Previous rehabilitation therapy regimen (speech, occupational, &or physical therapy) ended, & regimen now resumed at exactly the same level for each discipline [CMS Assessment] | MDS3.0 | 1.16 | O0450A | Has therapy resumed | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 86771-3 | Date therapy regimen resumed [CMS Assessment] | MDS3.0 | 1.16 | O0450B | Therapy resumption date | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86773-9 | Restorative nursing programs [CMS Assessment] | MDS3.0 | 1.16 | O0500 | Restorative nursing programs | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86774-7 | Number of D of passive range of motion in last 7 calendar D [CMS Assessment] | MDS3.0 | 1.16 | O0500A | Range of motion (passive): number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86775-4 | Number of D of active range of motion in last 7 calendar D [CMS Assessment] | MDS3.0 | 1.16 | O0500B | Range of motion (active): number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86776-2 | Number of D of splint or brace assistance in last 7 calendar D [CMS Assessment] | MDS3.0 | 1.16 | O0500C | Splint or brace assistance: number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86777-0 | Number of D of training & skill practice in bed mobility in last 7 calendar D [CMS Assessment] | MDS3.0 | 1.16 | O0500D | Bed mobility training: number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86778-8 | Number of D of training & skill practice in transfer in last 7 calendar D [CMS Assessment] | MDS3.0 | 1.16 | O0500E | Transfer training: number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86779-6 | Number of D of training & skill practice in walking in last 7 calendar D [CMS Assessment] | MDS3.0 | 1.16 | O0500F | Walking training: number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86780-4 | Number of D of training & skill practice in dressing or grooming in last 7 calendar D [CMS Assessment] | MDS3.0 | 1.16 | O0500G | Dressing and/or grooming training: number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86781-2 | Number of D of training & skill practice in eating or swallowing in last 7 calendar D [CMS Assessment] | MDS3.0 | 1.16 | O0500H | Eating and/or swallowing training: number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86782-0 | Number of D of training & skill practice in amputation or prosthesis care in last 7 calendar D [CMS Assessment] | MDS3.0 | 1.16 | O0500I | Amputation/prosthesis training: number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 86783-8 | Number of D of training & skill practice in communication in last 7 calendar D [CMS Assessment] | MDS3.0 | 1.16 | O0500J | Communication training: number of days | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 55040-0 | Number of D physician examined the patient in last 14D [CMS Assessment] | MDS3.0 | 1.16 | O0600 | Physician examinations: number of days | NC,NP,NQ,SP, | |||
LOINC | 2.64 | 55041-8 | Number of D physician orders changed in last 14D [CMS Assessment] | MDS3.0 | 1.16 | O0700 | Physician orders: number of days | NC,NP,NQ,SP, | |||
LOINC | 2.64 | 86785-3 | Physical restraints [CMS Assessment] | MDS3.0 | 1.16 | P0100 | Physical restraints | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | |||
LOINC | 2.64 | 86786-1 | Physical restraints used in bed - bed rail used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0100A | Restraints used in bed: bed rail | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 86787-9 | Physical restraints used in bed - trunk restraint used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0100B | Restraints used in bed: trunk restraint | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 86788-7 | Physical restraints used in bed - limb restraint during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0100C | Restraints used in bed: limb restraint | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 86789-5 | Other physical restraints used in bed during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0100D | Restraints used in bed: other | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 86790-3 | Physical restraints used in chair or out of bed - trunk restraint used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0100E | Restraints in chair/out of bed: trunk restraint | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 86791-1 | Physical restraints used in chair or out of bed - limb restraint used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0100F | Restraints in chair/out of bed: limb restraint | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 86792-9 | Physical restraints used in chair or out of bed - chair prevents rising used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0100G | Restraints in chair/out of bed: chair stops rising | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 86793-7 | Other physical restraints used in chair or out of bed used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0100H | Restraints in chair/out of bed: other | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 88309-0 | Alarms [CMS Assessment] | MDS3.0 | 1.16 | P0200 | Alarms | NC,NQ, | |||
LOINC | 2.64 | 88310-8 | Bed alarm used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0200A | Bed alarm | NC,NQ, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 88311-6 | Chair alarm used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0200B | Chair alarm | NC,NQ, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 88312-4 | Floor mat alarm used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0200C | Floor mat alarm | NC,NQ, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 88313-2 | Motion sensor alarm used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0200D | Motion sensor alarm | NC,NQ, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 88314-0 | Wander or elopement alarm used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0200E | Wander/elopement alarm | NC,NQ, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 88308-2 | Other alarm used during 7D assessment period [CMS Assessment] | MDS3.0 | 1.16 | P0200F | Other alarm | NC,NQ, | + | ||
0 | Not used | ||||||||||
1 | Used less than daily | ||||||||||
2 | Used daily | ||||||||||
LOINC | 2.64 | 55053-3 | Participation in assessment | MDS3.0 | 1.16 | Q0100 | Participation in assessment | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 55054-1 | Participation in assessment [CMS Assessment] | MDS3.0 | 1.16 | Q0100A | {Patient/resident} participated in assessment | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 55074-9 | Participation in assessment:^Family or significant other [CMS Assessment] | MDS3.0 | 1.16 | Q0100B | Family/significant other participated in assessment | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | Resident has no family or significant other | ||||||||||
LOINC | 2.64 | 58221-3 | Participation in assessment:^Guardian or legally authorized representative [CMS Assessment] | MDS3.0 | 1.16 | Q0100C | Guardian/legal representative participated in assessment | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | Resident has no guardian or legally authorized representative | ||||||||||
LOINC | 2.64 | 55056-6 | Resident's overall goals [CMS Assessment] | MDS3.0 | 1.16 | Q0300 | {Patient's/resident's} overall expectation | NC,NP,NQ,SP, | |||
LOINC | 2.64 | 55057-4 | Goals established during assessment process [CMS Assessment] | MDS3.0 | 1.16 | Q0300A | {Patient's/resident's} overall goal | NC,NP,NQ,SP, | + | ||
1 | Expects to be discharged to the community | ||||||||||
2 | Expects to remain in this facility | ||||||||||
3 | Expects to be discharged to another facility/institution | ||||||||||
9 | Unknown or uncertain | ||||||||||
LOINC | 2.64 | 55058-2 | Information source for resident's overall goal [CMS Assessment] | MDS3.0 | 1.16 | Q0300B | Information source for {patient's/resident's} goal | NC,NP,NQ,SP, | + | ||
1 | Resident | ||||||||||
2 | If not resident, then family or significant other | ||||||||||
3 | If not resident, family, or significant other, then guardian or legally authorized representative | ||||||||||
9 | Unknown or uncertain | ||||||||||
LOINC | 2.64 | 58146-2 | Active discharge planning in place for resident return to community [CMS Assessment] | MDS3.0 | 1.16 | Q0400A | Active discharge planning for return to community | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 86795-2 | Clinical record documents a request that questions regarding possible return to the community be asked only on comprehensive assessments [CMS Assessment] | MDS3.0 | 1.16 | Q0490 | {Patient's/resident's} preference to avoid being asked | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 58149-6 | Wants to talk to someone about the possibility of returning to the community [CMS Assessment] | MDS3.0 | 1.16 | Q0500B | Do you want to talk about returning to community | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
9 | Unknown or uncertain | ||||||||||
LOINC | 2.64 | 86796-0 | Resident's preference to avoid being asked about returning to the community [CMS Assessment] | MDS3.0 | 1.16 | Q0550 | {Patient's/resident's} preference to avoid being asked question Q0500B again | NC,NP,NQ,SP, | |||
LOINC | 2.64 | 86797-8 | Resident (or legally authorized representative) wants to be asked about returning to the community on all assessments [CMS Assessment] | MDS3.0 | 1.16 | Q0550A | Reasking {patient/resident} preference | NC,NP,NQ,SP, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
8 | Information not available | ||||||||||
LOINC | 2.64 | 86798-6 | Information source for preference on return to community queries [CMS Assessment] | MDS3.0 | 1.16 | Q0550B | Reasking {patient/resident} preference source | NC,NP,NQ,SP, | + | ||
1 | Resident | ||||||||||
2 | If not resident, then family or significant other | ||||||||||
3 | If not resident, family, or significant other, then guardian or legally authorized representative | ||||||||||
9 | None of the above | ||||||||||
LOINC | 2.64 | 58150-4 | Referral has been made to the local contact agency [CMS Assessment] | MDS3.0 | 1.16 | Q0600 | Referral been made to Local Contact Agency | NC,ND,NOD,NP,NQ,NSD,SD,SOD,SP,SSD, | + | ||
0 | No - referral not needed | ||||||||||
1 | No - referral is or may be needed | ||||||||||
2 | Yes - referral made | ||||||||||
LOINC | 2.64 | 87208-5 | Items from the most recent prior OBRA or scheduled PPS Assessment [CMS Assessment] | MDS3.0 | 1.16 | V0100 | Items from the most recent prior OBRA or scheduled PPS assessment | NC, | |||
LOINC | 2.64 | 54583-0 | Federal OBRA reason for assessment [CMS Assessment] | MDS3.0 | 1.16 | V0100A | Prior OBRA reason for assessment | NC, | + | ||
01 | Admission assessment (required by day 14) | ||||||||||
02 | Quarterly review assessment | ||||||||||
03 | Annual assessment | ||||||||||
04 | Significant change in status assessment | ||||||||||
05 | Significant correction to prior comprehensive assessment | ||||||||||
06 | Significant correction to prior quarterly assessment | ||||||||||
99 | None of the above | ||||||||||
LOINC | 2.64 | 54584-8 | PPS Assessment [CMS Assessment] | MDS3.0 | 1.16 | V0100B | Prior PPS reason for assessment | NC, | + | ||
01 | 5-day scheduled assessment | ||||||||||
02 | 14-day scheduled assessment | ||||||||||
03 | 30-day scheduled assessment | ||||||||||
04 | 60-day scheduled assessment | ||||||||||
05 | 90-day scheduled assessment | ||||||||||
07 | Unscheduled assessment used for PPS (OMRA, significant or clinical change, or significant correction assessment) | ||||||||||
99 | None of the above | ||||||||||
LOINC | 2.64 | 54593-9 | Assessment reference date - observation end date [CMS Assessment] | MDS3.0 | 1.16 | V0100C | Prior assessment reference date | NC, | |||
LOINC | 2.64 | 54614-3 | Brief interview for mental status - summary score - BIMS | MDS3.0 | 1.16 | V0100D | Prior assessment BIMS summary score | NC, | |||
LOINC | 2.64 | 54654-9 | Mood interview total severity score - PHQ-9 | MDS3.0 | 1.16 | V0100E | Prior assessment PHQ {patient/resident}: total mood severity score | NC, | |||
LOINC | 2.64 | 54677-0 | Staff assessment of resident mood total severity score - PHQ-9 | MDS3.0 | 1.16 | V0100F | Prior assessment PHQ staff: total mood score | NC, | |||
LOINC | 2.64 | 87210-1 | Care Area Assessment (CAA) and Care Planning [CMS Assessment] | MDS3.0 | 1.16 | V0200 | CAAs and care planning | NC, | |||
LOINC | 2.64 | 87211-9 | Care Area Assessment (CAA) results [CMS Assessment] | MDS3.0 | 1.16 | V0200A | CAAs and care planning. Check all that apply | NC, | + | ||
01A | Delirium | ||||||||||
01B | Delirium | ||||||||||
02A | Cognitive loss/dementia | ||||||||||
02B | Cognitive loss/dementia | ||||||||||
03A | Visual function | ||||||||||
03B | Visual function | ||||||||||
04A | Communication | ||||||||||
04B | Communication | ||||||||||
05A | ADL functional/rehabilitation potential | ||||||||||
05B | ADL functional/rehabilitation potential | ||||||||||
06A | Urinary incontinence and indwelling catheter | ||||||||||
06B | Urinary incontinence and indwelling catheter | ||||||||||
07A | Psychosocial well-being | ||||||||||
07B | Psychosocial well-being | ||||||||||
08A | Mood state | ||||||||||
08B | Mood state | ||||||||||
09A | Behavioral symptoms | ||||||||||
09B | Behavioral symptoms | ||||||||||
10A | Activities | ||||||||||
10B | Activities | ||||||||||
11A | Falls | ||||||||||
11B | Falls | ||||||||||
12A | Nutritional status | ||||||||||
12B | Nutritional status | ||||||||||
13A | Feeding tube | ||||||||||
13B | Feeding tube | ||||||||||
14A | Dehydration/fluid maintenance | ||||||||||
14B | Dehydration/fluid maintenance | ||||||||||
15A | Dental care | ||||||||||
15B | Dental care | ||||||||||
16A | Pressure ulcer | ||||||||||
16B | Pressure ulcer | ||||||||||
17A | Psychotropic drug use | ||||||||||
17B | Psychotropic drug use | ||||||||||
18A | Physical restraints | ||||||||||
18B | Physical restraints | ||||||||||
19A | Pain | ||||||||||
19B | Pain | ||||||||||
20A | Return to community referral | ||||||||||
20B | Return to community referral | ||||||||||
LOINC | 2.64 | 55064-0 | Medicare part A billing | MDS3.0 | 1.16 | Z0100 | Medicare part A billing | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 55065-7 | Medicare part A - HIPPS code for billing | MDS3.0 | 1.16 | Z0100A | Medicare part A: HIPPS code | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 55066-5 | Medicare part A - RUG version code | MDS3.0 | 1.16 | Z0100B | Medicare part A: RUG version code | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58421-9 | Medicare short stay assessment [CMS Assessment] | MDS3.0 | 1.16 | Z0100C | Medicare part A: Medicare short stay assessment | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | + | ||
0 | No | ||||||||||
1 | Yes | ||||||||||
LOINC | 2.64 | 59375-6 | Medicare non-therapy Part A billing [CMS Assessment] | MDS3.0 | 1.16 | Z0150 | Medicare part A non-therapy billing | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58210-6 | Medicare non-therapy Part A HIPPS code [CMS Assessment] | MDS3.0 | 1.16 | Z0150A | Medicare part A: non-therapy HIPPS code | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 58211-4 | Medicare non-therapy Part A - RUG version code [CMS Assessment] | MDS3.0 | 1.16 | Z0150B | Medicare part A: non-therapy RUG version code | NC,NO,NOD,NP,NQ,NS,NSD,SO,SOD,SP,SS,SSD, | |||
LOINC | 2.64 | 55067-3 | State Medicaid billing | MDS3.0 | 1.16 | Z0200 | State Medicaid billing (if required by the state) | NC,NP,NQ, | |||
LOINC | 2.64 | 55068-1 | State case mix - RUG group | MDS3.0 | 1.16 | Z0200A | State case mix: RUG group | NC,NP,NQ, | |||
LOINC | 2.64 | 55069-9 | State case mix - RUG version code | MDS3.0 | 1.16 | Z0200B | State case mix: RUG version code | NC,NP,NQ, | |||
LOINC | 2.64 | 58422-7 | Alternate state Medicaid billing | MDS3.0 | 1.16 | Z0250 | Alternate state Medicaid billing (if required by the state) | NC,NP,NQ, | |||
LOINC | 2.64 | 58212-2 | Alternate state Medicaid billing - RUG group [CMS Assessment] | MDS3.0 | 1.16 | Z0250A | State case mix: alternate RUG group | NC,NP,NQ, | |||
LOINC | 2.64 | 58213-0 | Alternate state Medicaid billing - RUG version code [CMS Assessment] | MDS3.0 | 1.16 | Z0250B | State case mix: alternate RUG version code | NC,NP,NQ, | |||
LOINC | 2.64 | 55070-7 | Insurance billing | MDS3.0 | 1.16 | Z0300 | Insurance billing | NC,NP,NQ, | |||
LOINC | 2.64 | 55071-5 | Insurance case mix - RUG group | MDS3.0 | 1.16 | Z0300A | RUG billing code | NC,NP,NQ, | |||
LOINC | 2.64 | 55072-3 | Insurance case mix - RUG version code | MDS3.0 | 1.16 | Z0300B | RUG billing version | NC,NP,NQ, |
recID | Characteristics ⇵ Language & Technology | Value |
---|---|---|
00 | Percentage calculated by dividing Age5p_Arabic_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
01 | Percentage calculated by dividing Age5p_Arabic_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
02 | Percentage calculated by dividing Age5p_Chinese_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
03 | Percentage calculated by dividing Age5p_Chinese_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
04 | Percentage calculated by dividing Age5p_French_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
05 | Percentage calculated by dividing Age5p_French_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
06 | Percentage calculated by dividing Age5p_German_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
07 | Percentage calculated by dividing Age5p_German_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
08 | Percentage calculated by dividing Age5p_Korean_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
09 | Percentage calculated by dividing Age5p_Korean_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
10 | Percentage calculated by dividing Age5p_Only_English_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
11 | Percentage calculated by dividing Age5p_Only_English_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
12 | Percentage calculated by dividing Age5p_OthAsian_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
13 | Percentage calculated by dividing Age5p_OthAsian_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
14 | Percentage calculated by dividing Age5p_OthEuro_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
15 | Percentage calculated by dividing Age5p_OthEuro_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
16 | Percentage calculated by dividing Age5p_OthUnSp_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
17 | Percentage calculated by dividing Age5p_OthUnSp_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
18 | Percentage calculated by dividing Age5p_Russian_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
19 | Percentage calculated by dividing Age5p_Russian_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
20 | Percentage calculated by dividing Age5p_Spanish_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
21 | Percentage calculated by dividing Age5p_Spanish_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
22 | Percentage calculated by dividing Age5p_Tagalog_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
23 | Percentage calculated by dividing Age5p_Tagalog_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
24 | Percentage calculated by dividing Age5p_Vietnamese_ACS_14_18 by Pop_5yrs_Over_ACS_14_18 | |
25 | Percentage calculated by dividing Age5p_Vietnamese_ACS_14_18 by Pop_5yrs_Over_ACS_14_18(MOE) | |
26 | Population 5 years and older that speak a language other than English at home in the ACS | |
27 | Population 5 years and older that speak a language other than English at home(MOE) | |
28 | Percentage calculated by dividing HHD_No_Internet_ACS_14_18 by Tot_Occp_Units_ACS_14_18 | |
29 | Percentage calculated by dividing HHD_No_Internet_ACS_14_18 by Tot_Occp_Units_ACS_14_18(MOE) | |
30 | Percentage calculated by dividing HHD_NoCompDevic_ACS_14_18 by Tot_Occp_Units_ACS_14_18 | |
31 | Percentage calculated by dividing HHD_NoCompDevic_ACS_14_18 by Tot_Occp_Units_ACS_14_18(MOE) | |
32 | Percentage calculated by dividing HHD_w_Broadband_ACS_14_18 by Tot_Occp_Units_ACS_14_18 | |
33 | Percentage calculated by dividing HHD_w_Broadband_ACS_14_18 by Tot_Occp_Units_ACS_14_18(MOE) | |
34 | Percentage calculated by dividing HHD_w_Computer_ACS_14_18 by Tot_Occp_Units_ACS_14_18 | |
35 | Percentage calculated by dividing HHD_w_Computer_ACS_14_18 by Tot_Occp_Units_ACS_14_18(MOE) | |
36 | Percentage calculated by dividing HHD_w_OnlySPhne_ACS_14_18 by Tot_Occp_Units_ACS_14_18 | |
37 | Percentage calculated by dividing HHD_w_OnlySPhne_ACS_14_18 by Tot_Occp_Units_ACS_14_18(MOE) | |
38 | Percentage calculated by dividing Occp_U_NO_PH_SRVC_ACS_14_18 by Tot_Occp_Units_ACS_14_18 | |
39 | Percentage calculated by dividing Occp_U_NO_PH_SRVC_ACS_14_18 by Tot_Occp_Units_ACS_14_18(MOE) | |
40 | Percentage calculated by dividing No_Plumb_ACS_14_18 by Tot_Housing_Units_ACS_14_18 | |
41 | Percentage calculated by dividing No_Plumb_ACS_14_18 by Tot_Housing_Units_ACS_14_18(MOE) |