Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. MDS Summary -- Model Of Use

12/01/2011

Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
A     Identification Information N/A                
  A0200   Type of provider TRUE     Typical pattern CD   54582-2   1.3.6.1.4.1.12009.10.1.61
  A0200 1 Nursing home (SNF/NF) TRUE     Typical pattern CD   54582-2 LA10882-1 1.3.6.1.4.1.12009.10.1.61
  A0200 2 Swing bed TRUE     Typical pattern CD   54582-2 LA10883-9 1.3.6.1.4.1.12009.10.1.61
  A0310A   Type of assessment: OBRA TRUE 99 - Not OBRA required assessment/tracking   Typical pattern CD   54583-0   1.3.6.1.4.1.12009.10.1.60
  A0310A 1 Admission assessment (required by day 14) TRUE     Typical pattern CD   54583-0 LA10-4 1.3.6.1.4.1.12009.10.1.60
  A0310A 2 Quarterly review assessment TRUE     Typical pattern CD   54583-0 LA15-3 1.3.6.1.4.1.12009.10.1.60
  A0310A 3 Annual assessment TRUE     Typical pattern CD   54583-0 LA12-0 1.3.6.1.4.1.12009.10.1.60
  A0310A 4 Significant change in status assessment TRUE     Typical pattern CD   54583-0 LA13-8 1.3.6.1.4.1.12009.10.1.60
  A0310A 5 Significant correction to prior comprehensive assessment TRUE     Typical pattern CD   54583-0 LA10888-8 1.3.6.1.4.1.12009.10.1.60
  A0310A 6 Significant correction to prior quarterly assessment TRUE     Typical pattern CD   54583-0 LA10889-6 1.3.6.1.4.1.12009.10.1.60
  A0500A   Resident first name TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A0500B   Resident middle initial TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A0500C   Resident last name TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A0500D   Resident name suffix TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A0600A   Social Security Number TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A0700   Resident Medicaid number TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A0800   Gender TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A0800 1 Male TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A0800 2 Female TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A0900   Birthdate TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A1000A   Ethnicity: American Indian or Alaska Native TRUE     Ethnicity pattern CD       2.16.840.1.113883.1.11.15836
  A1000B   Ethnicity: Asian TRUE     Ethnicity pattern CD       2.16.840.1.113883.1.11.15836
  A1000C   Ethnicity: Black or African American TRUE     Ethnicity pattern CD       2.16.840.1.113883.1.11.15836
  A1000D   Ethnicity: Hispanic or Latino TRUE     Ethnicity pattern CD       2.16.840.1.113883.1.11.15836
  A1000E   Ethnicity: Native Hawaiian/Pacific Islander TRUE     Ethnicity pattern CD       2.16.840.1.113883.1.11.15836
  A1000F   Ethnicity: White TRUE     Ethnicity pattern CD       2.16.840.1.113883.1.11.15836
  A1100A   Does the resident need or want an interpreter TRUE 0 - No;
9 - Unable to determine
  Typical pattern CD   54588-9   1.3.6.1.4.1.12009.10.1.58
  A1100A 1 Yes TRUE     Typical pattern CD   54588-9 LA33-6 1.3.6.1.4.1.12009.10.1.58
  A1100B   Preferred language TRUE     Other response data type pattern ED   54899-0    
  A1200   Marital status TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A1200 1 Never married TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A1200 2 Married TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A1200 3 Widowed TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A1200 4 Separated TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A1200 5 Divorced TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A1300A MDCL_REC_NUM Medical record number TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A1300C PREFRD_NAME Name by which resident prefers to be addressed TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A1300D   Lifetime occupation(s) TRUE     Other response data type pattern ED   45418-1    
  A1550A   MR/DD status: Down syndrome TRUE     Multiple response pattern BL   45422-3    
  A1550B   MR/DD status: Autism TRUE     Multiple response pattern BL   45423-1    
  A1550C   MR/DD status: Epilepsy TRUE     Multiple response pattern BL   45424-9    
  A1550D   MR/DD status: other organic MR/DD condition TRUE     Multiple response pattern BL    45425-6    
  A1550E   MR/DD status: MR/DD with no organic condition TRUE     Multiple response pattern BL   45426-4    
  A1600   Entry date (date of admission/reentry in facility) TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A1700   Type of entry TRUE     Typical pattern CD   54590-5   1.3.6.1.4.1.12009.10.1.56
  A1700 1 Admission TRUE     Typical pattern CD   54590-5 LA10922-5 1.3.6.1.4.1.12009.10.1.56
  A1700 2 Reentry TRUE     Typical pattern CD   54590-5 LA54-2 1.3.6.1.4.1.12009.10.1.56
  A1800   Entered from TRUE 99 - Other   Typical pattern CD   54591-3   1.3.6.1.4.1.12009.10.1.55
  A1800 1 Community (private home/apt., board/care, assisted living, group home) TRUE     Typical pattern CD   54591-3 LA10924-1 1.3.6.1.4.1.12009.10.1.55
  A1800 2 Another nursing home or swing bed TRUE     Typical pattern CD   54591-3 LA10925-8 1.3.6.1.4.1.12009.10.1.55
  A1800 3 Acute hospital TRUE     Typical pattern CD   54591-3 LA9928-8 1.3.6.1.4.1.12009.10.1.55
  A1800 4 Psychiatric hospital TRUE     Typical pattern CD   54591-3 LA10064-6 1.3.6.1.4.1.12009.10.1.55
  A1800 5 Inpatient rehabilitation facility TRUE     Typical pattern CD   54591-3 LA10928-2 1.3.6.1.4.1.12009.10.1.55
  A1800 6 MR/DD facility TRUE     Typical pattern CD   54591-3 LA10929-0 1.3.6.1.4.1.12009.10.1.55
  A1800 7 Hospice TRUE     Typical pattern CD   54591-3 LA6216-1 1.3.6.1.4.1.12009.10.1.55
  A2000   Discharge date TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A2100   Discharge status TRUE 99 - Other See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A2100 1 Community (private home/apt., board/care, assisted living, group home) TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A2100 2 Another nursing home or swing bed TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A2100 3 Acute hospital TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A2100 4 Psychiatric hospital TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A2100 5 Inpatient rehabilitation facility TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A2100 6 MR/DD facility TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A2100 7 Hospice TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A2100 8 Deceased TRUE   See CDA X-Path Mapping Table 6 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
  A2300   Assessment reference date TRUE     Other response data type pattern TS   54593-9    
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
B     Hearing, Speech, and Vision N/A                
  B0100   Comatose TRUE 0 - No   Typical pattern CD   54597-0   1.3.6.1.4.1.12009.10.1.62
  B0100 1 Yes TRUE     Typical pattern CD   54597-0 LA33-6 1.3.6.1.4.1.12009.10.1.62
  B0200   Hearing TRUE     Typical pattern CD   54598-8   1.3.6.1.4.1.12009.10.1.53
  B0200 0 Adequate - no difficulty in normal conversation, social interaction, listening to TV TRUE     Typical pattern CD   54598-8 LA10941-5 1.3.6.1.4.1.12009.10.1.53
  B0200 1 Minimal difficulty - difficulty in some environments (e.g., when person speaks softly or setting is noisy) TRUE     Typical pattern CD   54598-8 LA10942-3 1.3.6.1.4.1.12009.10.1.53
  B0200 2 Moderate difficulty - speaker has to increase volume and speak distinctly TRUE     Typical pattern CD   54598-8 LA10943-1 1.3.6.1.4.1.12009.10.1.53
  B0200 3 Highly impaired - absence of useful hearing TRUE     Typical pattern CD   54598-8 LA10944-9 1.3.6.1.4.1.12009.10.1.53
  B0300   Hearing aid TRUE 0 - No   Typical pattern CD   54599-6   1.3.6.1.4.1.12009.10.1.62
  B0300 1 Yes TRUE     Typical pattern CD   54599-6 LA33-6 1.3.6.1.4.1.12009.10.1.62
  B0600   Speech clarity TRUE     Typical pattern CD   54600-2   1.3.6.1.4.1.12009.10.1.52
  B0600 0 Clear speech - distinct intelligible words TRUE     Typical pattern CD   54600-2 LA10945-6 1.3.6.1.4.1.12009.10.1.52
  B0600 1 Unclear speech - slurred or mumbled words TRUE     Typical pattern CD   54600-2 LA10946-4 1.3.6.1.4.1.12009.10.1.52
  B0600 2 No speech - absence of spoken words TRUE     Typical pattern CD   54600-2 LA10947-2 1.3.6.1.4.1.12009.10.1.52
  B0700   Makes self understood TRUE     Typical pattern CD   54601-0   1.3.6.1.4.1.12009.10.1.51
  B0700 0 Understood TRUE     Typical pattern CD   54601-0 LA71-6 1.3.6.1.4.1.12009.10.1.51
  B0700 1 Usually understood - difficulty communicating some words or finishing thoughts but is able if prompted or given time TRUE     Typical pattern CD   54601-0 LA10949-8 1.3.6.1.4.1.12009.10.1.51
  B0700 2 Sometimes understood - ability is limited to making concrete requests TRUE     Typical pattern CD   54601-0 LA10950-6 1.3.6.1.4.1.12009.10.1.51
  B0700 3 Rarely/never understood TRUE     Typical pattern CD   54601-0 LA74-0 1.3.6.1.4.1.12009.10.1.51
  B0800   Ability to understand others TRUE     Typical pattern CD   54602-8   1.3.6.1.4.1.12009.10.1.50
  B0800 0 Understands - clear comprehension TRUE     Typical pattern CD   54602-8 LA10952-2 1.3.6.1.4.1.12009.10.1.50
  B0800 1 Usually understands - misses some part/intent of message but comprehends most conversation TRUE     Typical pattern CD   54602-8 LA10953-0 1.3.6.1.4.1.12009.10.1.50
  B0800 2 Sometimes understands - responds adequately to simple, direct communication only TRUE     Typical pattern CD   54602-8 LA10954-8 1.3.6.1.4.1.12009.10.1.50
  B0800 3 Rarely/never understands TRUE     Typical pattern CD   54602-8 LA81-5 1.3.6.1.4.1.12009.10.1.50
  B1000   Vision TRUE     Typical pattern CD   54603-6   1.3.6.1.4.1.12009.10.1.49
  B1000 0 Adequate - sees fine detail, including regular print in newspapers/books TRUE     Typical pattern CD   54603-6 LA10956-3 1.3.6.1.4.1.12009.10.1.49
  B1000 1 Impaired - sees large print, but not regular print in newspapers/books TRUE     Typical pattern CD   54603-6 LA10957-1 1.3.6.1.4.1.12009.10.1.49
  B1000 2 Moderately Impaired - limited vision; not able to see newspaper headlines but can identify objects TRUE     Typical pattern CD   54603-6 LA10958-9 1.3.6.1.4.1.12009.10.1.49
  B1000 3 Highly impaired - object identification in question, but eyes appear to follow objects TRUE     Typical pattern CD   54603-6 LA10959-7 1.3.6.1.4.1.12009.10.1.49
  B1000 4 Severely impaired - no vision or sees only light, colors or shapes; eyes do not appear to follow objects TRUE     Typical pattern CD   54603-6 LA10960-5 1.3.6.1.4.1.12009.10.1.49
  B1200   Corrective lenses TRUE 0 - No   Typical pattern CD   54604-4   1.3.6.1.4.1.12009.10.1.62
  B1200 1 Yes TRUE     Typical pattern CD   54604-4 LA33-6 1.3.6.1.4.1.12009.10.1.62
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
C     Cognitive Patterns N/A                
  C0500   BIMS res interview: summary score TRUE     Other response data type pattern INT   54614-3    
  C0700   Staff asmt mental status: short-term memory OK TRUE     Typical pattern CD   54616-8   1.3.6.1.4.1.12009.10.1.42
  C0700 0 Memory OK TRUE     Typical pattern CD   54616-8 LA55-9 1.3.6.1.4.1.12009.10.1.42
  C0700 1 Memory problem TRUE     Typical pattern CD   54616-8 LA56-7 1.3.6.1.4.1.12009.10.1.42
  C0800   Staff asmt mental status: long-term memory OK TRUE     Typical pattern CD   54617-6   1.3.6.1.4.1.12009.10.1.42
  C0800 0 Memory OK TRUE     Typical pattern CD   54617-6 LA55-9 1.3.6.1.4.1.12009.10.1.42
  C0800 1 Memory problem TRUE     Typical pattern CD   54617-6 LA56-7 1.3.6.1.4.1.12009.10.1.42
  C0900A   Staff asmt mental status: recall current season TRUE     Multiple response pattern BL   54619-2    
  C0900B   Staff asmt mental status: recall location of room TRUE     Multiple response pattern BL   54620-0    
  C0900C   Staff asmt mental status: recall staff names/faces TRUE     Multiple response pattern BL   54621-8    
  C0900D   Staff asmt mental status: recall in nursing home TRUE     Multiple response pattern BL   54622-6    
  C1000   Cognitive skills for daily decision making TRUE     Typical pattern CD   54624-2   1.3.6.1.4.1.12009.10.1.41
  C1000 0 Independent - decisions consistent/reasonable TRUE     Typical pattern CD   54624-2 LA10985-2 1.3.6.1.4.1.12009.10.1.41
  C1000 1 Modified independence - some difficulty in new situations only TRUE     Typical pattern CD   54624-2 LA10986-0 1.3.6.1.4.1.12009.10.1.41
  C1000 2 Moderately impaired - decisions poor; cues/supervision required TRUE     Typical pattern CD   54624-2 LA10987-8 1.3.6.1.4.1.12009.10.1.41
  C1000 3 Severely impaired - never/rarely made decisions TRUE     Typical pattern CD   54624-2 LA10988-6 1.3.6.1.4.1.12009.10.1.41
  C1300A   Signs of delirium: inattention TRUE 0 - Behavior not present   Typical pattern CD   54628-3   1.3.6.1.4.1.12009.10.1.39
  C1300A 1 Behavior continuously present, does not fluctuate TRUE     Typical pattern CD   54628-3 LA11143-7 1.3.6.1.4.1.12009.10.1.39
  C1300A 2 Behavior present, fluctuates (comes and goes, changes in severity) TRUE     Typical pattern CD   54628-3 LA10993-6 1.3.6.1.4.1.12009.10.1.39
  C1300B   Signs of delirium: disorganized thinking TRUE 0 - Behavior not present   Typical pattern CD   54629-1   1.3.6.1.4.1.12009.10.1.39
  C1300B 1 Behavior continuously present, does not fluctuate TRUE     Typical pattern CD   54629-1 LA11143-7 1.3.6.1.4.1.12009.10.1.39
  C1300B 2 Behavior present, fluctuates (comes and goes, changes in severity) TRUE     Typical pattern CD   54629-1 LA10993-6 1.3.6.1.4.1.12009.10.1.39
  C1300C   Signs of delirium: altered level of consciousness TRUE 0 - Behavior not present   Typical pattern CD   54630-9   1.3.6.1.4.1.12009.10.1.39
  C1300C 1 Behavior continuously present, does not fluctuate TRUE     Typical pattern CD   54630-9 LA11143-7 1.3.6.1.4.1.12009.10.1.39
  C1300C 2 Behavior present, fluctuates (comes and goes, changes in severity) TRUE     Typical pattern CD   54630-9 LA10993-6 1.3.6.1.4.1.12009.10.1.39
  C1300D   Signs of delirium: psychomotor retardation TRUE 0 - Behavior not present   Typical pattern CD   54631-7   1.3.6.1.4.1.12009.10.1.39
  C1300D 1 Behavior continuously present, does not fluctuate TRUE     Typical pattern CD   54631-7 LA11143-7 1.3.6.1.4.1.12009.10.1.39
  C1300D 2 Behavior present, fluctuates (comes and goes, changes in severity) TRUE     Typical pattern CD   54631-7 LA10993-6 1.3.6.1.4.1.12009.10.1.39
  C1600   Acute onset mental status change TRUE 0 - No   Typical pattern CD   54632-5   1.3.6.1.4.1.12009.10.1.62
  C1600 1 Yes TRUE     Typical pattern CD   54632-5 LA33-6 1.3.6.1.4.1.12009.10.1.62
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
D     Mood N/A                
  D0300   PHQ res: total mood severity score TRUE     Other response data type pattern INT   54654-9    
  D0600   PHQ staff: total mood score TRUE     Other response data type pattern INT   54677-0    
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
E     Behavior N/A                
  E0100A   Psychosis: hallucinations TRUE     Multiple response pattern BL   54678-8    
  E0100B   Psychosis: delusions TRUE     Multiple response pattern BL   54680-4    
  E0200A   Physical behav symptoms directed toward others TRUE 0 - Behavior not exhibited   Typical pattern CD   54682-0   1.3.6.1.4.1.12009.10.1.35
  E0200A 1 Behavior of this type occurred 1 to 3 days TRUE     Typical pattern CD   54682-0 LA11006-6 1.3.6.1.4.1.12009.10.1.35
  E0200A 2 Behavior of this type occurred 4 to 6 days, but less than daily TRUE     Typical pattern CD   54682-0 LA94-8 1.3.6.1.4.1.12009.10.1.35
  E0200A 3 Behavior of this type occurred daily TRUE     Typical pattern CD   54682-0 LA95-5 1.3.6.1.4.1.12009.10.1.35
  E0200B   Verbal behav symptoms directed toward others TRUE 0 - Behavior not exhibited   Typical pattern CD   54683-8   1.3.6.1.4.1.12009.10.1.35
  E0200B 1 Behavior of this type occurred 1 to 3 days TRUE     Typical pattern CD   54683-8 LA11006-6 1.3.6.1.4.1.12009.10.1.35
  E0200B 2 Behavior of this type occurred 4 to 6 days, but less than daily TRUE     Typical pattern CD   54683-8 LA94-8 1.3.6.1.4.1.12009.10.1.35
  E0200B 3 Behavior of this type occurred daily TRUE     Typical pattern CD   54683-8 LA95-5 1.3.6.1.4.1.12009.10.1.35
  E0200C   Other behav symptoms not directed toward others TRUE 0 - Behavior not exhibited   Typical pattern CD   54684-6   1.3.6.1.4.1.12009.10.1.35
  E0200C 1 Behavior of this type occurred 1 to 3 days TRUE     Typical pattern CD   54684-6 LA11006-6 1.3.6.1.4.1.12009.10.1.35
  E0200C 2 Behavior of this type occurred 4 to 6 days, but less than daily TRUE     Typical pattern CD   54684-6 LA94-8 1.3.6.1.4.1.12009.10.1.35
  E0200C 3 Behavior of this type occurred daily TRUE     Typical pattern CD   54684-6 LA95-5 1.3.6.1.4.1.12009.10.1.35
  E0500A   Behav symptoms put res at risk for illness/injury TRUE 0 - No   Typical pattern CD   54686-1   1.3.6.1.4.1.12009.10.1.62
  E0500A 1 Yes TRUE     Typical pattern CD   54686-1 LA33-6 1.3.6.1.4.1.12009.10.1.62
  E0500B   Behav symptoms interfere with resident care TRUE 0 - No   Typical pattern CD   54687-9   1.3.6.1.4.1.12009.10.1.62
  E0500B 1 Yes TRUE     Typical pattern CD   54687-9 LA33-6 1.3.6.1.4.1.12009.10.1.62
  E0500C   Behav symptoms interfere with social activities TRUE 0 - No   Typical pattern CD   54688-7   1.3.6.1.4.1.12009.10.1.62
  E0500C 1 Yes TRUE     Typical pattern CD   54688-7 LA33-6 1.3.6.1.4.1.12009.10.1.62
  E0600A   Behav symptoms put others at risk for injury TRUE 0 - No   Typical pattern CD   54689-5   1.3.6.1.4.1.12009.10.1.62
  E0600A 1 Yes TRUE     Typical pattern CD   54689-5 LA33-6 1.3.6.1.4.1.12009.10.1.62
  E0600B   Behav symptoms intrude on privacy of others TRUE 0 - No   Typical pattern CD   54690-3   1.3.6.1.4.1.12009.10.1.62
  E0600B 1 Yes TRUE     Typical pattern CD   54690-3 LA33-6 1.3.6.1.4.1.12009.10.1.62
  E0600C   Behav symptoms disrupt care or living environment TRUE 0 - No   Typical pattern CD   54691-1   1.3.6.1.4.1.12009.10.1.62
  E0600C 1 Yes TRUE     Typical pattern CD   54691-1 LA33-6 1.3.6.1.4.1.12009.10.1.62
  E0800   Rejection of care: presence and frequency TRUE 0 - Behavior not exhibited   Typical pattern CD   54692-9   1.3.6.1.4.1.12009.10.1.35
  E0800 1 Behavior of this type occurred 1 to 3 days TRUE     Typical pattern CD   54692-9 LA11006-6 1.3.6.1.4.1.12009.10.1.35
  E0800 2 Behavior of this type occurred 4 to 6 days, but less than daily TRUE     Typical pattern CD   54692-9 LA94-8 1.3.6.1.4.1.12009.10.1.35
  E0800 3 Behavior of this type occurred daily TRUE     Typical pattern CD   54692-9 LA95-5 1.3.6.1.4.1.12009.10.1.35
  E0900   Wandering: presence and frequency TRUE 0 - Behavior not exhibited   Typical pattern CD   54693-7   1.3.6.1.4.1.12009.10.1.35
  E0900 1 Behavior of this type occurred 1 to 3 days TRUE     Typical pattern CD   54693-7 LA11006-6 1.3.6.1.4.1.12009.10.1.35
  E0900 2 Behavior of this type occurred 4 to 6 days, but less than daily TRUE     Typical pattern CD   54693-7 LA94-8 1.3.6.1.4.1.12009.10.1.35
  E0900 3 Behavior of this type occurred daily TRUE     Typical pattern CD   54693-7 LA95-5 1.3.6.1.4.1.12009.10.1.35
  E1100   Change in behavioral or other symptoms TRUE 0 - Same;
9 - N/A because no prior MDS assessment
  Typical pattern CD   54696-0   1.3.6.1.4.1.12009.10.1.34
  E1100 1 Improved TRUE     Typical pattern CD   54696-0 LA65-8 1.3.6.1.4.1.12009.10.1.34
  E1100 2 Worse TRUE     Typical pattern CD   54696-0 LA11011-6 1.3.6.1.4.1.12009.10.1.34
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
F     Preferences for Customary Routine and Activities N/A                
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
G     Functional Status N/A                
  G0110A1   Bed mobility: self-performance TRUE     Typical pattern CD   45588-1   1.3.6.1.4.1.12009.10.1.70
  G0110A1 0 Independent - no help or staff oversight at any time TRUE     Typical pattern CD   45588-1 LA12637-7 1.3.6.1.4.1.12009.10.1.70
  G0110A1 1 Supervision - oversight, encouragement or cueing TRUE     Typical pattern CD   45588-1 LA12638-5 1.3.6.1.4.1.12009.10.1.70
  G0110A1 2 Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance TRUE     Typical pattern CD   45588-1 LA12639-3 1.3.6.1.4.1.12009.10.1.70
  G0110A1 3 Extensive assistance - resident involved in activity, staff provide weight-bearing support TRUE     Typical pattern CD   45588-1 LA12640-1 1.3.6.1.4.1.12009.10.1.70
  G0110A1 4 Total dependence - full staff performance every time during entire 7-day period TRUE     Typical pattern CD   45588-1 LA12641-9 1.3.6.1.4.1.12009.10.1.70
  G0110A1 7 Activity occurred only once or twice - activity did occur but only once or twice. TRUE     Typical pattern CD   45588-1 LA12642-7 1.3.6.1.4.1.12009.10.1.70
  G0110A1 8 Activity did not occur - activity (or any part of the ADL) was not performed by resident or staff at all over the entire 7-day period TRUE     Typical pattern CD   45588-1 LA12643-5 1.3.6.1.4.1.12009.10.1.70
  G0110B1   Transfer: self-performance TRUE     Typical pattern CD   45590-7   1.3.6.1.4.1.12009.10.1.70
  G0110B1 0 Independent - no help or staff oversight at any time TRUE     Typical pattern CD   45590-7 LA12637-7 1.3.6.1.4.1.12009.10.1.70
  G0110B1 1 Supervision - oversight, encouragement or cueing TRUE     Typical pattern CD   45590-7 LA12638-5 1.3.6.1.4.1.12009.10.1.70
  G0110B1 2 Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance TRUE     Typical pattern CD   45590-7 LA12639-3 1.3.6.1.4.1.12009.10.1.70
  G0110B1 3 Extensive assistance - resident involved in activity, staff provide weight-bearing support TRUE     Typical pattern CD   45590-7 LA12640-1 1.3.6.1.4.1.12009.10.1.70
  G0110B1 4 Total dependence - full staff performance every time during entire 7-day period TRUE     Typical pattern CD   45590-7 LA12641-9 1.3.6.1.4.1.12009.10.1.70
  G0110B1 7 Activity occurred only once or twice - activity did occur but only once or twice. TRUE     Typical pattern CD   45590-7 LA12642-7 1.3.6.1.4.1.12009.10.1.70
  G0110B1 8 Activity did not occur - activity (or any part of the ADL) was not performed by resident or staff at all over the entire 7-day period TRUE     Typical pattern CD   45590-7 LA12643-5 1.3.6.1.4.1.12009.10.1.70
  G0110C1   Walk in room: self-performance TRUE     Typical pattern CD   45592-3   1.3.6.1.4.1.12009.10.1.70
  G0110C1 0 Independent - no help or staff oversight at any time TRUE     Typical pattern CD   45592-3 LA12637-7 1.3.6.1.4.1.12009.10.1.70
  G0110C1 1 Supervision - oversight, encouragement or cueing TRUE     Typical pattern CD   45592-3 LA12638-5 1.3.6.1.4.1.12009.10.1.70
  G0110C1 2 Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance TRUE     Typical pattern CD   45592-3 LA12639-3 1.3.6.1.4.1.12009.10.1.70
  G0110C1 3 Extensive assistance - resident involved in activity, staff provide weight-bearing support TRUE     Typical pattern CD   45592-3 LA12640-1 1.3.6.1.4.1.12009.10.1.70
  G0110C1 4 Total dependence - full staff performance every time during entire 7-day period TRUE     Typical pattern CD   45592-3 LA12641-9 1.3.6.1.4.1.12009.10.1.70
  G0110C1 7 Activity occurred only once or twice - activity did occur but only once or twice. TRUE     Typical pattern CD   45592-3 LA12642-7 1.3.6.1.4.1.12009.10.1.70
  G0110C1 8 Activity did not occur - activity (or any part of the ADL) was not performed by resident or staff at all over the entire 7-day period TRUE     Typical pattern CD   45592-3 LA12643-5 1.3.6.1.4.1.12009.10.1.70
  G0110E1   Locomotion on unit: self-performance TRUE     Typical pattern CD   45596-4   1.3.6.1.4.1.12009.10.1.70
  G0110E1 0 Independent - no help or staff oversight at any time TRUE     Typical pattern CD   45596-4 LA12637-7 1.3.6.1.4.1.12009.10.1.70
  G0110E1 1 Supervision - oversight, encouragement or cueing TRUE     Typical pattern CD   45596-4 LA12638-5 1.3.6.1.4.1.12009.10.1.70
  G0110E1 2 Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance TRUE     Typical pattern CD   45596-4 LA12639-3 1.3.6.1.4.1.12009.10.1.70
  G0110E1 3 Extensive assistance - resident involved in activity, staff provide weight-bearing support TRUE     Typical pattern CD   45596-4 LA12640-1 1.3.6.1.4.1.12009.10.1.70
  G0110E1 4 Total dependence - full staff performance every time during entire 7-day period TRUE     Typical pattern CD   45596-4 LA12641-9 1.3.6.1.4.1.12009.10.1.70
  G0110E1 7 Activity occurred only once or twice - activity did occur but only once or twice. TRUE     Typical pattern CD   45596-4 LA12642-7 1.3.6.1.4.1.12009.10.1.70
  G0110E1 8 Activity did not occur - activity (or any part of the ADL) was not performed by resident or staff at all over the entire 7-day period TRUE     Typical pattern CD   45596-4 LA12643-5 1.3.6.1.4.1.12009.10.1.70
  G0110H1   Eating: self-performance TRUE     Typical pattern CD   45602-0   1.3.6.1.4.1.12009.10.1.70
  G0110H1 0 Independent - no help or staff oversight at any time TRUE     Typical pattern CD   45602-0 LA12637-7 1.3.6.1.4.1.12009.10.1.70
  G0110H1 1 Supervision - oversight, encouragement or cueing TRUE     Typical pattern CD   45602-0 LA12638-5 1.3.6.1.4.1.12009.10.1.70
  G0110H1 2 Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance TRUE     Typical pattern CD   45602-0 LA12639-3 1.3.6.1.4.1.12009.10.1.70
  G0110H1 3 Extensive assistance - resident involved in activity, staff provide weight-bearing support TRUE     Typical pattern CD   45602-0 LA12640-1 1.3.6.1.4.1.12009.10.1.70
  G0110H1 4 Total dependence - full staff performance every time during entire 7-day period TRUE     Typical pattern CD   45602-0 LA12641-9 1.3.6.1.4.1.12009.10.1.70
  G0110H1 7 Activity occurred only once or twice - activity did occur but only once or twice. TRUE     Typical pattern CD   45602-0 LA12642-7 1.3.6.1.4.1.12009.10.1.70
  G0110H1 8 Activity did not occur - activity (or any part of the ADL) was not performed by resident or staff at all over the entire 7-day period TRUE     Typical pattern CD   45602-0 LA12643-5 1.3.6.1.4.1.12009.10.1.70
  G0110I1   Toilet use: self-performance TRUE     Typical pattern CD   45604-6   1.3.6.1.4.1.12009.10.1.70
  G0110I1 0 Independent - no help or staff oversight at any time TRUE     Typical pattern CD   45604-6 LA12637-7 1.3.6.1.4.1.12009.10.1.70
  G0110I1 1 Supervision - oversight, encouragement or cueing TRUE     Typical pattern CD   45604-6 LA12638-5 1.3.6.1.4.1.12009.10.1.70
  G0110I1 2 Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance TRUE     Typical pattern CD   45604-6 LA12639-3 1.3.6.1.4.1.12009.10.1.70
  G0110I1 3 Extensive assistance - resident involved in activity, staff provide weight-bearing support TRUE     Typical pattern CD   45604-6 LA12640-1 1.3.6.1.4.1.12009.10.1.70
  G0110I1 4 Total dependence - full staff performance every time during entire 7-day period TRUE     Typical pattern CD   45604-6 LA12641-9 1.3.6.1.4.1.12009.10.1.70
  G0110I1 7 Activity occurred only once or twice - activity did occur but only once or twice. TRUE     Typical pattern CD   45604-6 LA12642-7 1.3.6.1.4.1.12009.10.1.70
  G0110I1 8 Activity did not occur - activity (or any part of the ADL) was not performed by resident or staff at all over the entire 7-day period TRUE     Typical pattern CD   45604-6 LA12643-5 1.3.6.1.4.1.12009.10.1.70
  G0110J1   Personal hygiene: self-performance TRUE     Typical pattern CD   45606-1   1.3.6.1.4.1.12009.10.1.70
  G0110J1 0 Independent - no help or staff oversight at any time TRUE     Typical pattern CD   45606-1 LA12637-7 1.3.6.1.4.1.12009.10.1.70
  G0110J1 1 Supervision - oversight, encouragement or cueing TRUE     Typical pattern CD   45606-1 LA12638-5 1.3.6.1.4.1.12009.10.1.70
  G0110J1 2 Limited assistance - resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing assistance TRUE     Typical pattern CD   45606-1 LA12639-3 1.3.6.1.4.1.12009.10.1.70
  G0110J1 3 Extensive assistance - resident involved in activity, staff provide weight-bearing support TRUE     Typical pattern CD   45606-1 LA12640-1 1.3.6.1.4.1.12009.10.1.70
  G0110J1 4 Total dependence - full staff performance every time during entire 7-day period TRUE     Typical pattern CD   45606-1 LA12641-9 1.3.6.1.4.1.12009.10.1.70
  G0110J1 7 Activity occurred only once or twice - activity did occur but only once or twice. TRUE     Typical pattern CD   45606-1 LA12642-7 1.3.6.1.4.1.12009.10.1.70
  G0110J1 8 Activity did not occur - activity (or any part of the ADL) was not performed by resident or staff at all over the entire 7-day period TRUE     Typical pattern CD   45606-1 LA12643-5 1.3.6.1.4.1.12009.10.1.70
  G0400A   ROM limitation: upper extremity TRUE 0 - No impairment   Typical pattern CD   54754-7   1.3.6.1.4.1.12009.10.1.36
  G0400A 1 Impairment on one side TRUE     Typical pattern CD   54754-7 LA11036-3 1.3.6.1.4.1.12009.10.1.36
  G0400A 2 Impairment on both sides TRUE     Typical pattern CD   54754-7 LA11037-1 1.3.6.1.4.1.12009.10.1.36
  G0400B   ROM limitation: lower extremity TRUE 0 - No impairment   Typical pattern CD   54755-4   1.3.6.1.4.1.12009.10.1.36
  G0400B 1 Impairment on one side TRUE     Typical pattern CD   54755-4 LA11036-3 1.3.6.1.4.1.12009.10.1.36
  G0400B 2 Impairment on both sides TRUE     Typical pattern CD   54755-4 LA11037-1 1.3.6.1.4.1.12009.10.1.36
  G0600A   Mobility devices: cane/crutch TRUE     Multiple response pattern BL   54756-2    
  G0600B   Mobility devices: walker TRUE     Multiple response pattern BL   54757-0    
  G0600C   Mobility devices: wheelchair (manual or electric) TRUE     Multiple response pattern BL   54758-8    
  G0600D   Mobility devices: limb prosthesis TRUE     Multiple response pattern BL   54759-6    
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
H     Bladder and Bowel N/A                
  H0100A   Appliances: indwelling catheter TRUE     Multiple response pattern BL   54762-0    
  H0100B   Appliances: external catheter TRUE     Multiple response pattern BL   54763-8    
  H0100C   Appliances: ostomy TRUE     Multiple response pattern BL   54764-6    
  H0100D   Appliances: intermittent catheterization TRUE     Multiple response pattern BL   54765-3    
  H0200C   Urinary toileting program: current program/trial TRUE 0 - No   Typical pattern CD   54769-5   1.3.6.1.4.1.12009.10.1.62
  H0200C 1 Yes TRUE     Typical pattern CD   54769-5 LA33-6 1.3.6.1.4.1.12009.10.1.62
  H0300   Urinary continence TRUE     Typical pattern CD   54770-3   1.3.6.1.4.1.12009.10.1.29
  H0300 0 Always continent TRUE     Typical pattern CD   54770-3 LA11042-1 1.3.6.1.4.1.12009.10.1.29
  H0300 1 Occasionally incontinent (less than 7 episodes of incontinence) TRUE     Typical pattern CD   54770-3 LA11043-9 1.3.6.1.4.1.12009.10.1.29
  H0300 2 Frequently incontinent (7 or more episodes of urinary incontinence, but at least one episode of continent voiding) TRUE     Typical pattern CD   54770-3 LA11044-7 1.3.6.1.4.1.12009.10.1.29
  H0300 3 Always incontinent (no episodes of continent voiding) TRUE     Typical pattern CD   54770-3 LA11045-4 1.3.6.1.4.1.12009.10.1.29
  H0300 9 Not rated, resident had a catheter (indwelling, condom), urinary ostomy, or no urine output for entire 7 days TRUE     Typical pattern CD   54770-3 LA11046-2 1.3.6.1.4.1.12009.10.1.29
  H0400   Bowel continence TRUE     Typical pattern CD   54771-1    1.3.6.1.4.1.12009.10.1.28
  H0400 0 Always continent TRUE     Typical pattern CD   54771-1 LA11042-1 1.3.6.1.4.1.12009.10.1.28
  H0400 1 Occasionally incontinent (one episode of bowel incontinence) TRUE     Typical pattern CD   54771-1 LA11048-8 1.3.6.1.4.1.12009.10.1.28
  H0400 2 Frequently incontinent (2 or more episodes of bowel incontinence, but at least one continent bowel movement) TRUE     Typical pattern CD   54771-1 LA11049-6 1.3.6.1.4.1.12009.10.1.28
  H0400 3 Always incontinent (no episodes of continent bowel movements) TRUE     Typical pattern CD   54771-1 LA11050-4 1.3.6.1.4.1.12009.10.1.28
  H0400 9 Not rated, resident had an ostomy or did not have a bowel movement for the entire 7 days TRUE     Typical pattern CD   54771-1 LA11051-2 1.3.6.1.4.1.12009.10.1.28
  H0500   Bowel toileting program being used TRUE 0 - No   Typical pattern CD   54772-9   1.3.6.1.4.1.12009.10.1.62
  H0500 1 Yes TRUE     Typical pattern CD   54772-9 LA33-6 1.3.6.1.4.1.12009.10.1.62
  H0600   Constipation TRUE 0 - No   Typical pattern CD   54773-7   1.3.6.1.4.1.12009.10.1.62
  H0600 1 Yes TRUE     Typical pattern CD   54773-7 LA33-6 1.3.6.1.4.1.12009.10.1.62
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
I     Active Disease Diagnosis N/A                
  I0100   Cancer (with or without metastasis) TRUE     Multiple response pattern BL   54774-5    
  I0200   Anemia TRUE     Multiple response pattern BL   54775-2    
  I0300   Atrial fibrillation and other dysrhythmias TRUE     Multiple response pattern BL   54776-0    
  I0400   Coronary artery disease (CAD) TRUE     Multiple response pattern BL   54777-8    
  I0500   Deep venous thrombosis (DVT), PE, or PTE TRUE     Multiple response pattern BL   54778-6    
  I0600   Heart failure TRUE     Multiple response pattern BL   54779-4    
  I0700   Hypertension TRUE     Multiple response pattern BL   54780-2    
  I0800   Orthostatic hypotension TRUE     Multiple response pattern BL   54781-0    
  I0900   Peripheral vascular disease (PVD) or PAD TRUE     Multiple response pattern BL   54782-8    
  I1100   Cirrhosis TRUE     Multiple response pattern BL   54783-6    
  I1200   Gastroesophageal reflux disease (GERD) or ulcer TRUE     Multiple response pattern BL   54784-4    
  I1300   Ulcerative colitis, Crohn’s, inflam bowel disease TRUE     Multiple response pattern BL   54785-1    
  I1400   Benign prostatic hyperplasia (BPH) TRUE     Multiple response pattern BL   54786-9    
  I1500   Renal insufficiency, renal failure, ESRD TRUE     Multiple response pattern BL   54787-7    
  I1550   Neurogenic bladder TRUE     Multiple response pattern BL   58111-6    
  I1650   Obstructive uropathy TRUE     Multiple response pattern BL   58112-4    
  I1700   Multidrug resistant organism (MDRO) TRUE     Multiple response pattern BL   58109-0    
  I2000   Pneumonia TRUE     Multiple response pattern BL   54790-1    
  I2100   Septicemia TRUE     Multiple response pattern BL   54791-9    
  I2200   Tuberculosis TRUE     Multiple response pattern BL   54792-7    
  I2300   Urinary tract infection (UTI) (LAST 30 DAYS) TRUE     Multiple response pattern BL   54793-5    
  I2400   Viral hepatitis (includes type A, B, C, D, and E) TRUE     Multiple response pattern BL   54794-3    
  I2500   Wound infection (other than foot) TRUE     Multiple response pattern BL   54965-9    
  I2900   Diabetes mellitus (DM) TRUE     Multiple response pattern BL   54795-0    
  I3100   Hyponatremia TRUE     Multiple response pattern BL   54796-8    
  I3200   Hyperkalemia TRUE     Multiple response pattern BL   54797-6    
  I3300   Hyperlipidemia (e.g.,  hypercholesterolemia) TRUE     Multiple response pattern BL   54798-4    
  I3400   Thyroid disorder TRUE     Multiple response pattern BL   54799-2    
  I3700   Arthritis TRUE     Multiple response pattern BL   54800-8    
  I3800   Osteoporosis TRUE     Multiple response pattern BL   54801-6    
  I3900   Hip fracture TRUE     Multiple response pattern BL   54802-4    
  I4000   Other fracture TRUE     Multiple response pattern BL   54803-2    
  I4200   Alzheimer's disease TRUE     Multiple response pattern BL   54804-0    
  I4300   Aphasia TRUE     Multiple response pattern BL   54805-7    
  I4400   Cerebral palsy TRUE     Multiple response pattern BL   54806-5    
  I4500   Cerebrovascular accident (CVA), TIA, or stroke TRUE     Multiple response pattern BL   54807-3    
  I4800   Dementia TRUE     Multiple response pattern BL   54808-1    
  I4900   Hemiplegia or hemiparesis TRUE     Multiple response pattern BL   54809-9    
  I5000   Paraplegia TRUE     Multiple response pattern BL   54810-7    
  I5100   Quadriplegia TRUE     Multiple response pattern BL   54811-5    
  I5200   Multiple sclerosis TRUE     Multiple response pattern BL   54812-3    
  I5250   Huntington's disease TRUE     Multiple response pattern BL   58113-2    
  I5300   Parkinson's disease TRUE     Multiple response pattern BL   54813-1    
  I5350   Tourette's syndrome TRUE     Multiple response pattern BL   58114-0    
  I5400   Seizure disorder or epilepsy TRUE     Multiple response pattern BL   54814-9    
  I5500   Traumatic brain injury (TBI) TRUE     Multiple response pattern BL   54815-6    
  I5600   Malnutrition (protein, calorie), risk of malnutrit TRUE     Multiple response pattern BL   54816-4    
  I5700   Anxiety disorder TRUE     Multiple response pattern BL    54817-2    
  I5800   Depression (other than bipolar) TRUE     Multiple response pattern BL   54818-0    
  I5900   Manic depression (bipolar disease) TRUE     Multiple response pattern BL   54819-8    
  I5950   Psychotic disorder (other than schizophrenia) TRUE     Multiple response pattern BL   58115-7    
  I6000   Schizophrenia TRUE     Multiple response pattern BL   54820-6    
  I6100   Post-traumatic stress disorder (PTSD) TRUE     Multiple response pattern BL   54821-4    
  I6200   Asthma (COPD) or chronic lung disease TRUE     Multiple response pattern BL   54822-2    
  I6300   Respiratory failure TRUE     Multiple response pattern BL   58116-5    
  I6500   Cataracts, glaucoma, or macular degeneration TRUE     Multiple response pattern BL   54823-0    
  I8000A   Additional active ICD diagnosis 1 TRUE     Other response data type pattern CD   54546-7    
  I8000B   Additional active ICD diagnosis 2 TRUE     Other response data type pattern CD   54547-5    
  I8000C   Additional active ICD diagnosis 3 TRUE     Other response data type pattern CD   54548-3    
  I8000D   Additional active ICD diagnosis 4 TRUE     Other response data type pattern CD   54549-1    
  I8000E   Additional active ICD diagnosis 5 TRUE     Other response data type pattern CD   54550-9    
  I8000F   Additional active ICD diagnosis 6 TRUE     Other response data type pattern CD   54551-7    
  I8000G   Additional active ICD diagnosis 7 TRUE     Other response data type pattern CD   54552-5    
  I8000H   Additional active ICD diagnosis 8 TRUE     Other response data type pattern CD   54553-3    
  I8000I   Additional active ICD diagnosis 9 TRUE     Other response data type pattern CD   54554-1    
  I8000J   Additional active ICD diagnosis 10 TRUE     Other response data type pattern CD   54555-8    
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
J     Health Conditions N/A                
  J0100A   Pain: been on scheduled pain med regimen TRUE 0 - No   Typical pattern CD   54825-5   1.3.6.1.4.1.12009.10.1.62
  J0100A 1 Yes TRUE     Typical pattern CD   54825-5 LA33-6 1.3.6.1.4.1.12009.10.1.62
  J0400   Res pain interview: frequency TRUE 9 - Unable to answer   Typical pattern CD   54830-5   1.3.6.1.4.1.12009.10.1.26
  J0400 1 Almost constantly TRUE     Typical pattern CD   54830-5 LA11055-3 1.3.6.1.4.1.12009.10.1.26
  J0400 2 Frequently TRUE     Typical pattern CD   54830-5 LA6482-9 1.3.6.1.4.1.12009.10.1.26
  J0400 3 Occasionally TRUE     Typical pattern CD   54830-5 LA6483-7 1.3.6.1.4.1.12009.10.1.26
  J0400 4 Rarely TRUE     Typical pattern CD   54830-5 LA10066-1 1.3.6.1.4.1.12009.10.1.26
  J0600A   Res pain interview: intensity rating scale TRUE     Other response data type pattern INT   54833-9    
  J0600B   Res pain interview: verbal descriptor scale TRUE 9 - Unable to answer   Typical pattern CD   54834-7   1.3.6.1.4.1.12009.10.1.25
  J0600B 1 Mild TRUE     Typical pattern CD   54834-7 LA6752-5 1.3.6.1.4.1.12009.10.1.25
  J0600B 2 Moderate TRUE     Typical pattern CD   54834-7 LA6751-7 1.3.6.1.4.1.12009.10.1.25
  J0600B 3 Severe TRUE     Typical pattern CD   54834-7 LA6750-9 1.3.6.1.4.1.12009.10.1.25
  J0600B 4 Very severe, horrible TRUE     Typical pattern CD   54834-7 LA11063-7 1.3.6.1.4.1.12009.10.1.25
  J1100A   Short breath/trouble breathing: with exertion TRUE     Multiple response pattern BL   54841-2    
  J1100B   Short breath/trouble breathing: sitting at rest TRUE     Multiple response pattern BL   54842-0    
  J1100C   Short breath/trouble breathing: lying flat TRUE     Multiple response pattern BL   54843-8    
  J1300   Current tobacco use TRUE 0 - No   Typical pattern CD   54845-3   1.3.6.1.4.1.12009.10.1.62
  J1300 1 Yes TRUE     Typical pattern CD   54845-3 LA33-6 1.3.6.1.4.1.12009.10.1.62
  J1400   Prognosis: life expectancy of less than 6 months TRUE 0 - No   Typical pattern CD   54846-1   1.3.6.1.4.1.12009.10.1.62
  J1400 1 Yes TRUE     Typical pattern CD   54846-1 LA33-6 1.3.6.1.4.1.12009.10.1.62
  J1700A   Fall history: fall during month before admission TRUE 0 - No;
9 - Unable to determine
  Typical pattern CD   54850-3   1.3.6.1.4.1.12009.10.1.27
  J1700A 1 Yes TRUE     Typical pattern CD   54850-3 LA33-6 1.3.6.1.4.1.12009.10.1.27
  J1700B   Fall history: fall 2-6 months before admission TRUE 0 - No;
9 - Unable to determine
  Typical pattern CD   54851-1   1.3.6.1.4.1.12009.10.1.27
  J1700B 1 Yes TRUE     Typical pattern CD   54851-1 LA33-6 1.3.6.1.4.1.12009.10.1.27
  J1700C   Fall history: fracture from fall 6 month pre admit TRUE 0 - No;
9 - Unable to determine
  Typical pattern CD   54852-9   1.3.6.1.4.1.12009.10.1.27
  J1700C 1 Yes TRUE     Typical pattern CD   54852-9 LA33-6 1.3.6.1.4.1.12009.10.1.27
  J1800   Falls since admit/prior asmt: any falls TRUE 0 - No   Typical pattern CD   54853-7   1.3.6.1.4.1.12009.10.1.62
  J1800 1 Yes TRUE     Typical pattern CD   54853-7 LA33-6 1.3.6.1.4.1.12009.10.1.62
  J1900B   Falls since admit/prior asmt: injury (not major) TRUE 0 - None   Typical pattern CD   54856-0   1.3.6.1.4.1.12009.10.1.22
  J1900B 1 One TRUE     Typical pattern CD   54856-0 LA6306-0 1.3.6.1.4.1.12009.10.1.22
  J1900B 2 Two or more TRUE     Typical pattern CD   54856-0 LA11073-6 1.3.6.1.4.1.12009.10.1.22
  J1900C   Falls since admit/prior asmt: major injury TRUE 0 - None   Typical pattern CD   54857-8   1.3.6.1.4.1.12009.10.1.22
  J1900C 1 One TRUE     Typical pattern CD   54857-8 LA6306-0 1.3.6.1.4.1.12009.10.1.22
  J1900C 2 Two or more TRUE     Typical pattern CD   54857-8 LA11073-6 1.3.6.1.4.1.12009.10.1.22
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
K     Swallowing/Nutritional Status N/A                
  K0100A   Swallow disorder: loss liquids/solids from mouth TRUE     Multiple response pattern BL   54858-6    
  K0100B   Swallow disorder: holds food in mouth/cheeks TRUE     Multiple response pattern BL   54859-4    
  K0100C   Swallow disorder: cough/choke with meals/meds TRUE     Multiple response pattern BL   54860-2    
  K0100D   Swallow disorder: difficulty or pain swallowing TRUE     Multiple response pattern BL   54861-0    
  K0200A   Height (in inches) TRUE     Other response data type pattern PQ [in_i] 3137-7    
  K0200B   Weight (in pounds) TRUE     Other response data type pattern PQ [lb_av] 3141-9    
  K0300   Weight loss TRUE 0 - No, or unknown   Typical pattern CD   54863-6   1.3.6.1.4.1.12009.10.1.21
  K0300 1 Yes, on physician - prescribed weight - loss regimen TRUE     Typical pattern CD   54863-6 LA11075-1 1.3.6.1.4.1.12009.10.1.21
  K0300 2 Yes, not on physician - prescribed weight - loss regimen TRUE     Typical pattern CD   54863-6 LA11076-9 1.3.6.1.4.1.12009.10.1.21
  K0500A   Nutritional approaches: parenteral /IV feeding TRUE     Multiple response pattern BL   54864-4    
  K0500B   Nutritional approaches: feeding tube TRUE     Multiple response pattern BL   54865-1    
  K0500C   Nutritional approaches: mechanically altered diet TRUE     Multiple response pattern BL   54866-9    
  K0500D   Nutritional approaches: therapeutic diet TRUE     Multiple response pattern BL   54867-7    
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
L     Oral/Dental Status N/A                
  L0200A   Dental: broken or loosely fitting denture TRUE     Multiple response pattern BL   54871-9    
  L0200B   Dental: no natural teeth or tooth fragment(s) TRUE     Multiple response pattern BL   54872-7    
  L0200C   Dental: abnormal mouth tissue TRUE     Multiple response pattern BL   54873-5    
  L0200D   Dental: cavity or broken natural teeth TRUE     Multiple response pattern BL   54874-3    
  L0200E   Dental: inflamed/bleeding gums or loose teeth TRUE     Multiple response pattern BL   54875-0    
  L0200F   Dental: pain, discomfort, difficulty chewing TRUE     Multiple response pattern BL   54876-8    
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
M     Skin Conditions N/A                
  M0150   Is resident at risk of developing pressure ulcer TRUE 0 - No   Typical pattern CD   54882-6   1.3.6.1.4.1.12009.10.1.62
  M0150 1 Yes TRUE     Typical pattern CD   54882-6 LA33-6 1.3.6.1.4.1.12009.10.1.62
  M0210   Resident has Stage 1 or higher pressure ulcers TRUE 0 - No   Typical pattern CD   58214-8   1.3.6.1.4.1.12009.10.1.62
  M0210 1 Yes TRUE     Typical pattern CD   58214-8 LA33-6 1.3.6.1.4.1.12009.10.1.62
  M0300A   Stage 1 pressure ulcers: number present TRUE 0   Other response data type pattern INT   54884-2    
  M0300B1   Stage 2 pressure ulcers: number present TRUE 0   Other response data type pattern INT   55124-2    
  M0300B2   Stage 2 pressure ulcers: number at admit/reentry TRUE 0   Other response data type pattern INT   54886-7    
  M0300B3   Stage 2 pressure ulcers: date of oldest TRUE     Other response data type pattern TS   58123-1    
  M0300C1   Stage 3 pressure ulcers: number present TRUE 0   Other response data type pattern INT   55125-9    
  M0300C2   Stage 3 pressure ulcers: number at admit/reentry TRUE 0   Other response data type pattern INT   54887-5    
  M0300D1   Stage 4 pressure ulcers: number present TRUE 0   Other response data type pattern INT   55126-7    
  M0300D2   Stage 4 pressure ulcers: number at admit/reentry TRUE 0   Other response data type pattern INT   54890-9    
  M0300E1   Unstaged due to dressing: number present TRUE 0   Other response data type pattern INT   54893-3    
  M0300E2   Unstaged due to dressing: number at admit/reentry TRUE 0   Other response data type pattern INT   54894-1    
  M0300F1   Unstaged slough/eschar: number present TRUE 0   Other response data type pattern INT   54946-9    
  M0300F2   Unstaged slough/eschar: number at admit/reentry TRUE 0   Other response data type pattern INT   54947-7    
  M0300G1   Unstageable - deep tissue: number present TRUE 0   Other response data type pattern INT   54950-1    
  M0300G2   Unstageable - deep tissue: number at admit/reentry TRUE 0   Other response data type pattern INT   54951-9    
  M0610A   Stage 3 or 4 pressure ulcer longest length TRUE     Other response data type pattern PQ cm 52728-3    
  M0610B   Stage 3 or 4 pressure ulcer width (same ulcer) TRUE     Other response data type pattern PQ cm 52729-1    
  M0610C   Stage 3 or 4 pressure ulcer depth (same ulcer) TRUE     Other response data type pattern PQ cm 57228-9    
  M0800A   Worsened since prior asmt: Stage 2 pressure ulcers TRUE 0   Other response data type pattern INT   54953-5    
  M0800B   Worsened since prior asmt: Stage 3 pressure ulcers TRUE 0   Other response data type pattern INT   54954-3    
  M0800C   Worsened since prior asmt: Stage 4 pressure ulcers TRUE 0   Other response data type pattern INT   54955-0    
  M1030   Number of venous and arterial ulcers TRUE 0   Other response data type pattern INT   54970-9    
  M1040A   Other skin probs: infection of the foot TRUE     Multiple response pattern BL   58228-8    
  M1040B   Other skin probs: diabetic foot ulcer(s) TRUE     Multiple response pattern BL   54963-4    
  M1040C   Other skin probs: other open lesion(s) on the foot TRUE     Multiple response pattern BL   58125-6    
  M1040D   Other skin probs: lesions not ulcers, rashes, cuts TRUE     Multiple response pattern BL   54967-5    
  M1040E   Other skin probs: surgical wound(s) TRUE     Multiple response pattern BL   54966-7    
  M1040F   Other skin probs: burn(s) (second or third degree) TRUE     Multiple response pattern BL   54968-3    
  M1200A   Skin/ulcer treat: pressure reduce device for chair TRUE     Multiple response pattern BL   54972-5    
  M1200B   Skin/ulcer treat: pressure reducing device for bed TRUE     Multiple response pattern BL   54973-3    
  M1200C   Skin/ulcer treat: turning/repositioning TRUE     Multiple response pattern BL   54974-1    
  M1200D   Skin/ulcer treat: nutrition/hydration TRUE     Multiple response pattern BL   54975-8    
  M1200E   Skin/ulcer treat: ulcer care TRUE     Multiple response pattern BL   54976-6    
  M1200F   Skin/ulcer treat: surgical wound care TRUE     Multiple response pattern BL   54977-4    
  M1200G   Skin/ulcer treat: application of dressings TRUE     Multiple response pattern BL   54978-2    
  M1200H   Skin/ulcer treat: apply ointments/medications TRUE     Multiple response pattern BL   54979-0    
  M1200I   Skin/ulcer treat: apply dressings to feet TRUE     Multiple response pattern BL   54980-8    
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
N     Medications N/A                
  N0350A   Insulin: insulin injections TRUE     Other response data type pattern PQ d 58127-2    
  N0400A   Medications: antipsychotic TRUE     Multiple response pattern BL   54984-0    
  N0400B   Medications: antianxiety TRUE     Multiple response pattern BL   54985-7    
  N0400C   Medications: antidepressant TRUE     Multiple response pattern BL   54986-5    
  N0400D   Medications: hypnotic TRUE     Multiple response pattern BL   54987-3    
  N0400E   Medications: anticoagulant TRUE     Multiple response pattern BL   54988-1    
  N0400F   Medications: antibiotic TRUE     Multiple response pattern BL   58129-8    
  N0400G   Medications: diuretic TRUE     Multiple response pattern BL   58130-6    
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
O     Special Treatments and Procedures N/A                
  O0100A2   Treatment: chemotherapy - while resident TRUE     Multiple response pattern BL   54993-1    
  O0100B2   Treatment: radiation - while resident TRUE     Multiple response pattern BL   54995-6    
  O0100C2   Treatment: oxygen therapy - while resident TRUE     Multiple response pattern BL   54997-2    
  O0100D2   Treatment: suctioning - while resident TRUE     Multiple response pattern BL   54999-8    
  O0100E2   Treatment: tracheostomy care - while resident TRUE     Multiple response pattern BL   55001-2    
  O0100F2   Treatment: vent/respirator - while resident TRUE     Multiple response pattern BL   55003-8    
  O0100G2   Treatment: BIPAP/CPAP - while resident TRUE     Multiple response pattern BL   55005-3    
  O0100H2   Treatment: IV medications - while resident TRUE     Multiple response pattern BL   55007-9    
  O0100I2   Treatment: transfusions - while resident TRUE     Multiple response pattern BL   55009-5    
  O0100J2   Treatment: dialysis - while resident TRUE     Multiple response pattern BL   55011-1    
  O0100K2   Treatment: hospice care - while resident TRUE     Multiple response pattern BL   55013-7    
  O0100L2   Treatment: respite care - while resident TRUE     Multiple response pattern BL   55015-2    
  O0100M2   Treatment: isolate/quarantine - while resident TRUE     Multiple response pattern BL   55017-8    
  O0250A   Was influenza vaccine received TRUE     Typical pattern CD   55019-4   1.3.6.1.4.1.12009.10.1.62
  O0250A 0 No TRUE     Typical pattern CD   55019-4 LA32-8 1.3.6.1.4.1.12009.10.1.62
  O0250A 1 Yes TRUE     Typical pattern CD   55019-4 LA33-6 1.3.6.1.4.1.12009.10.1.62
  O0250B   Date influenza vaccine received. TRUE     Other response data type pattern TS   58131-4    
  O0250C   If influenza vaccine not received, state reason TRUE 9 - None of the above   Typical pattern CD   55020-2   1.3.6.1.4.1.12009.10.1.16
  O0250C 1 Resident not in facility during this year's flu season TRUE     Typical pattern CD   55020-2 LA12666-6 1.3.6.1.4.1.12009.10.1.16
  O0250C 2 Received outside of this facility TRUE     Typical pattern CD   55020-2 LA184-4 1.3.6.1.4.1.12009.10.1.16
  O0250C 3 Not eligible - medical contraindication TRUE     Typical pattern CD   55020-2 LA11091-8 1.3.6.1.4.1.12009.10.1.16
  O0250C 4 Offered and declined TRUE     Typical pattern CD   55020-2 LA186-9 1.3.6.1.4.1.12009.10.1.16
  O0250C 5 Not offered TRUE     Typical pattern CD   55020-2 LA187-7 1.3.6.1.4.1.12009.10.1.16
  O0250C 6 Inability to obtain vaccine due to a declared shortage TRUE     Typical pattern CD   55020-2 LA12156-8 1.3.6.1.4.1.12009.10.1.16
  O0300A   Is pneumococcal vaccination up to date TRUE     Typical pattern CD   55022-8   1.3.6.1.4.1.12009.10.1.62
  O0300A 0 No TRUE     Typical pattern CD   55022-8 LA32-8 1.3.6.1.4.1.12009.10.1.62
  O0300A 1 Yes TRUE     Typical pattern CD   55022-8 LA33-6 1.3.6.1.4.1.12009.10.1.62
  O0300B   If pneumococcal vacc not received, state reason TRUE     Typical pattern CD   55023-6   1.3.6.1.4.1.12009.10.1.15
  O0300B 1 Not eligible - medical contraindication TRUE     Typical pattern CD   55023-6 LA11091-8 1.3.6.1.4.1.12009.10.1.15
  O0300B 2 Offered and declined TRUE     Typical pattern CD   55023-6 LA186-9 1.3.6.1.4.1.12009.10.1.15
  O0300B 3 Not offered TRUE     Typical pattern CD   55023-6 LA187-7 1.3.6.1.4.1.12009.10.1.15
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
P     Restraints N/A                
  P0100A   Restraints used in bed: bed rail TRUE 0 - Not used   Typical pattern CD   55044-2   1.3.6.1.4.1.12009.10.1.63
  P0100A 1 Used less than daily TRUE     Typical pattern CD   55044-2 LA158-8 1.3.6.1.4.1.12009.10.1.63
  P0100A 2 Used daily TRUE     Typical pattern CD   55044-2 LA159-6 1.3.6.1.4.1.12009.10.1.63
  P0100B   Restraints used in bed: trunk restraint TRUE 0 - Not used   Typical pattern CD   55045-9   1.3.6.1.4.1.12009.10.1.63
  P0100B 1 Used less than daily TRUE     Typical pattern CD   55045-9 LA158-8 1.3.6.1.4.1.12009.10.1.63
  P0100B 2 Used daily TRUE     Typical pattern CD   55045-9 LA159-6 1.3.6.1.4.1.12009.10.1.63
  P0100C   Restraints used in bed: limb restraint TRUE 0 - Not used   Typical pattern CD   55046-7   1.3.6.1.4.1.12009.10.1.63
  P0100C 1 Used less than daily TRUE     Typical pattern CD   55046-7 LA158-8 1.3.6.1.4.1.12009.10.1.63
  P0100C 2 Used daily TRUE     Typical pattern CD   55046-7 LA159-6 1.3.6.1.4.1.12009.10.1.63
  P0100D   Restraints used in bed: other TRUE 0 - Not used   Typical pattern CD   55047-5   1.3.6.1.4.1.12009.10.1.63
  P0100D 1 Used less than daily TRUE     Typical pattern CD   55047-5 LA158-8 1.3.6.1.4.1.12009.10.1.63
  P0100D 2 Used daily TRUE     Typical pattern CD   55047-5 LA159-6 1.3.6.1.4.1.12009.10.1.63
  P0100E   Restraints in chair/out of bed: trunk restraint TRUE 0 - Not used   Typical pattern CD   55048-3   1.3.6.1.4.1.12009.10.1.63
  P0100E 1 Used less than daily TRUE     Typical pattern CD   55048-3 LA158-8 1.3.6.1.4.1.12009.10.1.63
  P0100E 2 Used daily TRUE     Typical pattern CD   55048-3 LA159-6 1.3.6.1.4.1.12009.10.1.63
  P0100F   Restraints in chair/out of bed: limb restraint TRUE 0 - Not used   Typical pattern CD   55049-1   1.3.6.1.4.1.12009.10.1.63
  P0100F 1 Used less than daily TRUE     Typical pattern CD   55049-1 LA158-8 1.3.6.1.4.1.12009.10.1.63
  P0100F 2 Used daily TRUE     Typical pattern CD   55049-1 LA159-6 1.3.6.1.4.1.12009.10.1.63
  P0100G   Restraints in chair/out of bed: chair stops rising TRUE 0 - Not used   Typical pattern CD   55050-9   1.3.6.1.4.1.12009.10.1.63
  P0100G 1 Used less than daily TRUE     Typical pattern CD   55050-9 LA158-8 1.3.6.1.4.1.12009.10.1.63
  P0100G 2 Used daily TRUE     Typical pattern CD   55050-9 LA159-6 1.3.6.1.4.1.12009.10.1.63
  P0100H   Restraints in chair/out of bed: other TRUE 0 - Not used   Typical pattern CD   55051-7   1.3.6.1.4.1.12009.10.1.63
  P0100H 1 Used less than daily TRUE     Typical pattern CD   55051-7 LA158-8 1.3.6.1.4.1.12009.10.1.63
  P0100H 2 Used daily TRUE     Typical pattern CD   55051-7 LA159-6 1.3.6.1.4.1.12009.10.1.63
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
Q     Participation in Assessment and Goal Setting N/A                
  Q0400B   Determination regarding discharge to community TRUE     Typical pattern CD   58147-0   1.3.6.1.4.1.12009.10.1.74
  Q0400B 0 Determination not made TRUE     Typical pattern CD   58147-0 LA12653-4 1.3.6.1.4.1.12009.10.1.74
  Q0400B 1 Discharge to community determined to be feasible TRUE     Typical pattern CD   58147-0 LA12654-2 1.3.6.1.4.1.12009.10.1.74
  Q0400B 2 Discharge to community determined to be not feasible TRUE     Typical pattern CD   58147-0 LA12655-9 1.3.6.1.4.1.12009.10.1.74
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
T     Therapy Supplement for Medicare PPS N/A                
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
V       N/A                
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
X       N/A                
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
Z     Assessment Administration N/A                
  Z0500B   Date RN signed assessment as complete TRUE   See CDA X-Path Mapping Table 27 Implementation Guide for CDA R2 - CDA Framework/MDS Questionnaire Assessment DSTU, Update Release 2.0 (April 21, 2010)            
Section CMS Question ID Answer CMS Description
Light Blue Shading Indicates Start of New Question per CMS Data Dictionary
FINAL SUMMARY ITEM Response(s) Triggering Omission of MDS Question from Summary General Guidance Pattern Data Type Units LOINC Question Code LOINC Answer Code LOINC Answer Set OID
OTHER       N/A                

 

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