This page is part of the PACIO Transitions of Care Implementation Guide (v1.0.0-ballot: STU 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. No current official version has been published yet. For a full list of available versions, see the Directory of published versions

Selecting Discipline-Specific Data Elements from the CMS Data Element Library

Page standards status: Informative

The Centers for Medicare & Medicaid Services (CMS) Data Element Library (DEL) is a centralized repository that provides standardized definitions and mappings for data elements used in post-acute care (PAC) assessments, such as the Minimum Data Set (MDS), the Outcome and Assessment Information Set (OASIS), and the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI). By offering consistent terminology and interoperability standards, the DEL can significantly inform and improve transitions of care, particularly for patients moving between care settings. Below is an explanation of how the DEL contributes to transitions of care, supported by references:

Standardized Data for Continuity of Care

The DEL ensures that PAC providers use standardized data elements, which are mapped to health IT standards such as Logical Observation Identifiers Names and Codes (LOINC) and Systematized Medical Nomenclature for Medicine–Clinical Terminology (SNOMED CT). This standardization allows for seamless communication and data exchange between different care settings, reducing the risk of errors or omissions during transitions of care.

Supporting Reference: CMS emphasizes that the DEL supports interoperability by aligning data elements with standards required for electronic health records (EHRs) under the 21st Century Cures Act. This alignment ensures that data can be shared across systems without loss of meaning or accuracy. (Centers for Medicare & Medicaid Services, 2023)

Improved Care Coordination

The DEL facilitates the sharing of critical patient information, such as functional status, cognitive abilities, and social determinants of health, which are essential for care planning during transitions. For example, when a patient is discharged from a skilled nursing facility to home health care, the receiving provider can access standardized data to tailor interventions to the patient’s needs.

Supporting Reference: Research shows that standardized data improves care coordination by enabling providers to quickly understand a patient’s clinical status and history, reducing the likelihood of adverse events during transitions. (Kripalani et al., 2007, JAMA)

Compliance with Interoperability Mandates

The DEL supports compliance with federal interoperability mandates, such as the CMS Interoperability and Patient Access Final Rule. By using DEL data elements, providers can ensure that patient information is shared in a format that meets regulatory requirements, promoting smoother transitions of care.

Supporting Reference: CMS states that the DEL is a key resource for aligning PAC data with interoperability requirements, ensuring that providers can meet regulatory standards while improving patient outcomes. (CMS, 2023)

Facilitating Patient-Centered Care

The DEL includes data elements that capture patient preferences, goals, and outcomes, which are critical for delivering patient-centered care during transitions. For example, understanding a patient’s mobility goals or pain management preferences can help ensure that care plans are aligned with their needs as they move between settings.

Supporting Reference: Studies highlight the importance of incorporating patient preferences into care transitions to improve satisfaction and outcomes. Standardized data elements, like those in the DEL, make this integration feasible. (Coleman, 2003, Annals of Internal Medicine)

Reducing Readmissions and Adverse Events

By providing accurate and comprehensive data during transitions, the DEL helps reduce hospital readmissions and adverse events. Standardized data ensures that critical information, such as medication reconciliation and discharge instructions, is consistently communicated to the next care provider.

Supporting Reference: Evidence suggests that poor communication during transitions is a leading cause of readmissions and adverse events. The use of standardized data, like that in the DEL, mitigates these risks. (Jencks et al., 2009, New England Journal of Medicine)

In Summary

The CMS Data Element Library is a powerful tool for improving transitions of care by promoting standardized, interoperable, and patient-centered data exchange. Its alignment with health IT standards and regulatory requirements ensures that providers can deliver high-quality care while reducing risks associated with care transitions.

The PACIO Community divided into several sub-groups, each representing a different medical discipline, to produce a minimum set of data elements that can support each discipline and provide comprehensive transitions of care information to a new facility receiving a patient. The different groups included:

• Dieticians
• Doctors, Nurse Practitioners (NPs), Physician Assistants (PAs)
• Occupational and Physical Therapists (OT/PTs)
• Speech and Language Pathologists
• Pharmacists
• Nurses
• Behavioral Health Specialists

Data elements from additional disciplines will be added as time and availability permits. If you are interested in participating in this analysis, please contact us at info (at) pacioproject.org.

Transitions of Care Data Elements

The following table is the result of that analysis:

Question ID	Question Text	Dietician	Doctor/NP/PA	OT/PT	Speech and Language Professionals	Pharmacists	Nurses	Behavioral Health	Yes Votes
22A	Etiologic diagnosis code A (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
22B	Etiologic diagnosis code B (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
22C	Etiologic diagnosis code C (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24A	Comorbid condition 1 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24B	Comorbid condition 2 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24C	Comorbid condition 3 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24D	Comorbid condition 4 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24E	Comorbid condition 5 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24F	Comorbid condition 6 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24G	Comorbid condition 7 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24H	Comorbid condition 8 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24I	Comorbid condition 9 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24J	Comorbid condition 10 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24K	Comorbid condition 11 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24L	Comorbid condition 12 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24M	Comorbid condition 13 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24N	Comorbid condition 14 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24O	Comorbid condition 15 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24P	Comorbid condition 16 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24Q	Comorbid condition 17 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24R	Comorbid condition 18 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24S	Comorbid condition 19 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24T	Comorbid condition 20 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24U	Comorbid condition 21 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24V	Comorbid condition 22 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24W	Comorbid condition 23 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24X	Comorbid condition 24 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
24Y	Comorbid condition 25 (ICD code)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
E0200A	"Physical behavioral symptoms directed towards others (e. g., hitting, kicking, pushing, scratching, grabbing, abusing others sexually)"	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
E0500C	Behavioral symptoms interfere with social activities	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
E0600A	Behavioral symptoms put others at risk for injury	Yes	Yes	Yes	Yes	Yes	Yes	Yes	7
17	Pre-hospital living with	Yes	Yes	Yes	Yes	Yes	No	Yes	6
23	Date of onset	Yes	Yes	Yes	Yes	Yes	No	Yes	6
16A	Pre-hospital living setting	Yes	Yes	Yes	Yes	Yes	No	Yes	6
E0100	Potential indicators of psychosis. Check all that apply	Yes	Yes	Yes	Yes	Yes	No	Yes	6
E0100A	Psychosis: hallucinations	No	Yes	Yes	Yes	Yes	Yes	Yes	6
E0100B	Psychosis: delusions	No	Yes	Yes	Yes	Yes	Yes	Yes	6
E0200B	"Verbal behavioral symptoms directed toward others (e.g., threatening others, screaming at others, cursing at others)"	No	Yes	Yes	Yes	Yes	Yes	Yes	6
E0200C	"Other behavioral symptoms not directed toward others (e.g., physical symptoms such as hitting or scratching self, pacing, rummaging, public sexual acts, disrobing in public, throwing or smearing food or bodily wastes, or verbal/vocal symptoms like screaming, disruptive sounds)"	No	Yes	Yes	Yes	Yes	Yes	Yes	6
E0500A	Behavioral symptoms put {patient/resident} at risk for illness/injury	No	Yes	Yes	Yes	Yes	Yes	Yes	6
E0500B	Behavioral symptoms interfere with {patient/resident} care	No	Yes	Yes	Yes	Yes	Yes	Yes	6
E0900	Wandering: presence and frequency	No	Yes	Yes	Yes	Yes	Yes	Yes	6
E1000A	Wandering: risk of getting to dangerous place	No	Yes	Yes	Yes	Yes	Yes	Yes	6
GG0125P	Assistive device - Glasses or contact lenses	Yes	Yes	Yes	Yes	Yes	Yes	No	6
GG0125Q	Assistive device - hearing aid	Yes	Yes	Yes	Yes	Yes	Yes	No	6
GG0125R	Assistive device - communication device	Yes	Yes	Yes	Yes	Yes	Yes	No	6
GG0125Y	Assistive device - oxygen concentrator	Yes	Yes	Yes	Yes	Yes	Yes	No	6
I0020B	Primary medical condition ICD	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I0100	Cancer (with or without metastasis)	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I0200	Anemia	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I0300	Atrial fibrillation and other dysrhythmias	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I0400	Coronary artery disease (CAD)	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I0500	"Deep venous thrombosis (DVT), PE or PTE"	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I0600	Heart failure	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I0800	Orthostatic hypotension	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I1100	Cirrhosis	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I1200	Gastroesophageal reflux disease (GERD) or ulcer	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I1300	"Ulcerative colitis, Chrohn's, inflam bowel disease"	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I1500	"Renal insufficiency. renal failure. ESRD"	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I1700	Multidrug resistant organism (MDRO)	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I2000	Pneumonia	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I2100	Septicemia	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I2200	Tuberculosis	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I2300	Urinary tract infection (UTI) (LAST 30 DAYS)	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I2400	"Viral hepatitis (includes type A, B, C, D, and E)"	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I2900	Diabetes mellitus (DM)	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I3100	Hyponatremia	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I3200	Hyperkalemia	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I3700	Arthritis	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I4200	Alzheimer's disease	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I4300	Aphasia	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I4400	Cerebral palsy	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I4500	"Cerebrovascular accident (CVA), TIA, or stroke"	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I4800	Non-Alzheimer's dementia	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I4900	Hemiplegia or hemiparesis	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5000	Paraplegia	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5100	Quadriplegia	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5200	Multiple sclerosis	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5250	Huntington's disease	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5300	Parkinson's disease	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5350	Tourette's syndrome	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5400	Seizure disorder or epilepsy	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5500	Traumatic brain injury (TBI)	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5600	"Malnutrition (protein, calorie), risk of malnutrit"	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5700	Anxiety disorder	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5800	Depression (other than bipolar)	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5900	Manic depression (bipolar disease)	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I5950	Psychotic disorder (other than schizophrenia)	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I6000	Schizophrenia	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I6100	Post-traumatic stress disorder (PTSD)	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I6200	Asthma (COPD) or chronic lung disease	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I6300	Respiratory failure	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I6500	"Cataracts, glaucoma, or macular degeneration"	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I8000A	Additional active ICD diagnosis 1	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I8000B	Additional active ICD diagnosis 2	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I8000C	Additional active ICD diagnosis 3	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I8000D	Additional active ICD diagnosis 4	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I8000E	Additional active ICD diagnosis 5	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I8000F	Additional active ICD diagnosis 6	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I8000G	Additional active ICD diagnosis 7	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I8000H	Additional active ICD diagnosis 8	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I8000I	Additional active ICD diagnosis 9	Yes	Yes	Yes	Yes	Yes	No	Yes	6
I8000J	Additional active ICD diagnosis 10	Yes	Yes	Yes	Yes	Yes	No	Yes	6
J0905	Is pain an active problem for the {patient/resident}?	Yes	Yes	Yes	Yes	Yes	No	Yes	6
J1100	"Shortness of Breath (dyspnea): Check all that apply: (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"	Yes	Yes	Yes	Yes	Yes	Yes	No	6
J1700A	Did the {patient/resident} have a fall any time in the last month prior to {admission}?	Yes	Yes	Yes	No	Yes	Yes	Yes	6
J1750	History of Falls: Has the {patient/resident} had two or more falls in the past year or any fall with injury in the past year?	Yes	Yes	Yes	Yes	Yes	Yes	No	6
M0040_PAT_FNAME	Patient's first name	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M0040_PAT_LNAME	Patient's last name	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M0040_PAT_MI	Patient's middle initial	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M1242	Frequency of pain interfering with {patient/resident} activity/movement	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M1242_PAIN_FREQ_ACTVTY_MVMT	Freq of pain interfering with pt activity/movement	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M1700	Cognitive functioning	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M1710	When confused (reported or observed)	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M1720	When anxious (reported or observed)	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M1740_BD_DELUSIONS	Behavior demonstrated: delusions	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M1740_BD_IMP_DECISN	Behavior demonstrated: impaired decision-making	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M1740_BD_MEM_DEFICIT	Behavior demonstrated: memory deficit	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M1740_BD_PHYSICAL	Behavior demonstrated: physical aggression	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M1740_BD_SOC_INAPPRO	Behavior demonstrated: socially inappropriate	Yes	Yes	Yes	Yes	Yes	No	Yes	6
M1740_BD_VERBAL	Behavior demonstrated: verbal disruption	Yes	Yes	Yes	Yes	Yes	No	Yes	6
45	Discharge to living with	Yes	Yes	Yes	Yes	Yes	No	No	5
44D/A2105	Patient's discharge destination/living setting/Discharge Status/Discharge Location	Yes	No	Yes	Yes	Yes	No	Yes	5
A1300C	Name by which {patient/resident} prefers to be addressed	Yes	Yes	Yes	Yes	No	No	Yes	5
B0100	Comatose. Persistent vegetative state/no discernible consciousness	Yes	Yes	No	Yes	Yes	Yes	No	5
D0600	PHQ staff: total mood score	No	Yes	Yes	Yes	Yes	No	Yes	5
D0700	Social Isolation	Yes	Yes	No	Yes	Yes	No	Yes	5
E0100Z	Psychosis: none of the above	No	Yes	Yes	Yes	Yes	No	Yes	5
E0300	Overall presence of behavioral symptoms	No	Yes	Yes	Yes	Yes	No	Yes	5
E0600B	Behavioral symptoms intrude on privacy of others	No	Yes	No	Yes	Yes	Yes	Yes	5
E0600C	Behavioral symptoms disrupt care or living environment	No	Yes	No	Yes	Yes	Yes	Yes	5
GG0125A	Assistive device - cane/crutch	Yes	Yes	Yes	No	Yes	Yes	No	5
GG0125AA	"Assistive devices - used, expressed or demonstrated need"	Yes	Yes	Yes	Yes	Yes	No	No	5
GG0125C	Assistive device - wheelchair	Yes	Yes	Yes	No	Yes	Yes	No	5
GG0125D	Assistive device - limb prosthesis	Yes	Yes	Yes	No	Yes	Yes	No	5
GG0125W	Assistive device - glucometer	Yes	Yes	Yes	No	Yes	Yes	No	5
GG0125X	Assistive device - CPAP	Yes	Yes	Yes	No	Yes	Yes	No	5
GG0170HH	Does the {patient/resident} walk?	Yes	Yes	No	Yes	Yes	Yes	No	5
I0000	Active diagnoses (comorbidities and co-existing conditions). Check all that apply	Yes	Yes	Yes	Yes	Yes	No	No	5
I0700	Hypertension	Yes	Yes	Yes	No	Yes	No	Yes	5
I0900	Peripheral vascular disease (PVD) or PAD	Yes	Yes	Yes	No	Yes	No	Yes	5
I1400	Benign prostatic hyperplasia (BPH)	Yes	Yes	Yes	No	Yes	No	Yes	5
I1550	Neurogenic bladder	Yes	Yes	Yes	No	Yes	No	Yes	5
I1650	Obstructive uropathy	Yes	Yes	Yes	No	Yes	No	Yes	5
I2500	Wound infection (other than foot)	Yes	Yes	Yes	No	Yes	No	Yes	5
I3300	"Hyperlipidemia (e.g., hypercholesterolemia)"	Yes	Yes	Yes	No	Yes	No	Yes	5
I3400	Thyroid disorder	Yes	Yes	Yes	No	Yes	No	Yes	5
I3800	Osteoporosis	Yes	Yes	Yes	No	Yes	No	Yes	5
I3900	Hip fracture	Yes	Yes	Yes	No	Yes	No	Yes	5
I4000	Other fracture	Yes	Yes	Yes	No	Yes	No	Yes	5
I7900	None of above active diseases within last 7 days	Yes	Yes	Yes	No	Yes	No	Yes	5
J0520	Pain Interference with Therapy Activities	Yes	Yes	Yes	Yes	Yes	No	No	5
J0530/M1242	Pain Interference with Day-to-Day Activities	Yes	Yes	Yes	Yes	Yes	No	No	5
J1550C	Problem conditions: dehydrated	Yes	Yes	Yes	Yes	Yes	No	No	5
J1800	Falls since admission: any falls	Yes	Yes	Yes	Yes	Yes	No	No	5
J1900A	No injury: No evidence of any injury is noted on physical assessment by the nurse or primary care clinician; no complaints of pain or injury by the {patient/resident}; no change in the {patient's/resident's} behavior is noted after the fall.	Yes	Yes	Yes	No	Yes	Yes	No	5
J1900B	"Injury (except major): skin tears, abrasions, lacerations, superficial bruises, hematomas and sprains; or any fall-related injury that causes the {patient/resident} to complain of pain"	Yes	Yes	Yes	No	Yes	Yes	No	5
J1900C	Falls since admit/prior assessment: major injury	Yes	Yes	Yes	No	Yes	Yes	No	5
K0100A	Swallow disorder: loss liquids/solids from mouth	Yes	Yes	Yes	Yes	Yes	No	No	5
K0100B	Swallow disorder: holds food in mouth/cheeks	Yes	Yes	Yes	Yes	Yes	No	No	5
K0100C	Swallow disorder: cough/choke with meals/meds	Yes	Yes	Yes	Yes	Yes	No	No	5
K0100D	Swallow disorder: difficulty or pain swallowing	Yes	Yes	Yes	Yes	Yes	No	No	5
K0300B	Weight Gain	Yes	Yes	No	Yes	Yes	No	Yes	5
K0520A1/M1030	Nutritional approaches: Parenteral/IV Feeding - Adm	Yes	Yes	Yes	Yes	Yes	No	No	5
K0520A5	Nutritional approaches: Parenteral/IV Feeding - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
K0520B1/M1030	Nutritional approaches: Feeding Tube - Adm	Yes	Yes	Yes	Yes	Yes	No	No	5
K0520B5	Nutritional approaches: Feeding Tube - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
K0520C1	Nutritional approaches: Mechanically Altered Diet - Adm	Yes	Yes	Yes	Yes	Yes	No	No	5
K0520C5	Nutritional approaches: Mechanically Altered Diet - At D/C	Yes	Yes	Yes	Yes	Yes	No	No	5
K0520D1	Nutritional approaches: Therapeutic Diet - Adm	Yes	Yes	Yes	Yes	Yes	No	No	5
K0520D5	Nutritional approaches: Therapeutic Diet - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
M0020	{Patient/Resident} ID number	Yes	Yes	Yes	No	Yes	No	Yes	5
M0020_PAT_ID	Patient ID number	Yes	Yes	Yes	No	Yes	No	Yes	5
M0040_PAT_SUFFIX	Patient's suffix	Yes	Yes	Yes	No	Yes	No	Yes	5
M0066_PAT_BIRTH_DT	Date of birth	Yes	Yes	Yes	No	Yes	No	Yes	5
M1018_PRIOR_MEM_LOSS	"Prior condition: memory loss, supervision required"	Yes	Yes	No	Yes	Yes	No	Yes	5
M1020_PRIMARY_DIAG_ICD	Primary Home Care Diagnosis ICD Code:	Yes	Yes	No	Yes	Yes	No	Yes	5
M1020_PRIMARY_DIAG_SEVERITY	Primary Home Care Diagnosis Severity Rating:	Yes	Yes	No	Yes	Yes	No	Yes	5
M1021	Primary diagnosis	Yes	Yes	No	Yes	Yes	No	Yes	5
M1021_A2_ICD	Primary diagnosis ICD code	Yes	Yes	No	Yes	Yes	No	Yes	5
M1021_A2_SEV	Primary diagnosis severity rating	Yes	Yes	No	Yes	Yes	No	Yes	5
M1022_OTH_DIAG1_ICD	Home Care Diagnosis 1: ICD Code:	Yes	Yes	No	Yes	Yes	No	Yes	5
M1022_OTH_DIAG1_SEVERITY	Home Care Diagnosis 1: Severity Rating:	Yes	Yes	No	Yes	Yes	No	Yes	5
M1022_OTH_DIAG2_ICD	Home Care Diagnosis 2: ICD Code:	Yes	Yes	No	Yes	Yes	No	Yes	5
M1022_OTH_DIAG2_SEVERITY	Home Care Diagnosis 2: Severity Rating:	Yes	Yes	No	Yes	Yes	No	Yes	5
M1022_OTH_DIAG3_ICD	Home Care Diagnosis 3: ICD Code:	Yes	Yes	No	Yes	Yes	No	Yes	5
M1022_OTH_DIAG3_SEVERITY	Home Care Diagnosis 3: Severity Rating:	Yes	Yes	No	Yes	Yes	No	Yes	5
M1022_OTH_DIAG4_ICD	Home Care Diagnosis 4: ICD Code:	Yes	Yes	No	Yes	Yes	No	Yes	5
M1022_OTH_DIAG4_SEVERITY	Home Care Diagnosis 4: Severity Rating:	Yes	Yes	No	Yes	Yes	No	Yes	5
M1022_OTH_DIAG5_ICD	Home Care Diagnosis 5: ICD Code:	Yes	Yes	No	Yes	Yes	No	Yes	5
M1022_OTH_DIAG5_SEVERITY	Home Care Diagnosis 5: Severity Rating:	Yes	Yes	No	Yes	Yes	No	Yes	5
M1023	Other diagnoses	Yes	Yes	No	Yes	Yes	No	Yes	5
M1023_B2_ICD	Other diagnosis 1: ICD code	Yes	Yes	No	Yes	Yes	No	Yes	5
M1023_B2_SEV	Other diagnosis 1: severity rating	Yes	Yes	No	Yes	Yes	No	Yes	5
M1023_C2_ICD	Other diagnosis 2: ICD code	Yes	Yes	No	Yes	Yes	No	Yes	5
M1023_C2_SEV	Other diagnosis 2: severity rating	Yes	Yes	No	Yes	Yes	No	Yes	5
M1023_D2_ICD	Other diagnosis 3: ICD code	Yes	Yes	No	Yes	Yes	No	Yes	5
M1023_D2_SEV	Other diagnosis 3: severity rating	Yes	Yes	No	Yes	Yes	No	Yes	5
M1023_E2_ICD	Other diagnosis 4: ICD code	Yes	Yes	No	Yes	Yes	No	Yes	5
M1023_E2_SEV	Other diagnosis 4: severity rating	Yes	Yes	No	Yes	Yes	No	Yes	5
M1023_F2_ICD	Other diagnosis 5: ICD code	Yes	Yes	No	Yes	Yes	No	Yes	5
M1023_F2_SEV	Other diagnosis 5: severity rating	Yes	Yes	No	Yes	Yes	No	Yes	5
M1220_UNDRSTG_VERBAL_CNTNT	Understanding verbal content in patient's language	Yes	Yes	No	Yes	Yes	No	Yes	5
M1340	Does this {patient/resident} have a surgical wound	Yes	Yes	Yes	No	Yes	No	Yes	5
M1400	When dyspneic	Yes	Yes	Yes	Yes	Yes	No	No	5
M1410_RESPTX_VENTILATOR	Respiratory treatments: ventilator	Yes	Yes	Yes	Yes	Yes	No	No	5
M1630	Ostomy for bowel elimination	Yes	Yes	Yes	No	Yes	Yes	No	5
M1730_1_STDZ_DPRSN_SCRNG	Has The Patient Been Screened For Depression Using Stdzed Screen Tool:	Yes	Yes	Yes	No	Yes	No	Yes	5
M1730_2_PHQ2_LACK_INTRST	PHQ2 Pfizer Little Interest Or Pleasure In Doing Things:	Yes	Yes	Yes	No	Yes	No	Yes	5
M1730_3_PHQ2_DPRSN	"PHQ2 Pfizer Feeling Down, Depressed Or Hopeless:"	Yes	Yes	Yes	No	Yes	No	Yes	5
M1730_A	PHQ2: little interest or pleasure in doing things	Yes	Yes	Yes	No	Yes	No	Yes	5
M1730_B	"PHQ2: feeling down, depressed or hopeless"	Yes	Yes	Yes	No	Yes	No	Yes	5
M1740_BD_NONE	Behavior demonstrated: none of the above	Yes	Yes	Yes	No	Yes	No	Yes	5
M1745	Frequency of disruptive behavior symptoms	Yes	Yes	Yes	Yes	No	No	Yes	5
M1745_BEH_PROB_FREQ	Frequency of behavior problems	Yes	Yes	Yes	Yes	No	No	Yes	5
M1870	Current: feeding	Yes	Yes	Yes	Yes	Yes	No	No	5
M1870_CUR_FEEDING	Current Ability: Feeding:	Yes	Yes	Yes	Yes	Yes	No	No	5
M2020	Current: management of oral medications	Yes	Yes	Yes	No	Yes	No	Yes	5
M2030	Current: management of injectable medications	Yes	Yes	Yes	No	Yes	No	Yes	5
M2310_ECR_MENTL_BHVRL_PRBLM	Emergent care reason: acute mental/behav problem	Yes	Yes	No	Yes	Yes	No	Yes	5
N0410A	Medication received: days: antipsychotic	Yes	Yes	No	Yes	Yes	No	Yes	5
N0410B	Medication received: days: antianxiety	Yes	Yes	No	Yes	Yes	No	Yes	5
N0410C	Medication received: days: antidepressant	Yes	Yes	No	Yes	Yes	No	Yes	5
N0410H	Medication received: days: opioid	Yes	Yes	No	Yes	Yes	No	Yes	5
O0110B1c	Treatment: Radiation - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
O0110C1c	Treatment: Oxygen Therapy - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
O0110C2c	Treatment: Oxygen Therapy - Continuous - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
O0110C3c	Treatment: Oxygen Therapy - Intermittent - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
O0110C4c	Treatment: Oxygen Therapy - High-concentration - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
O0110D1c	Treatment: Suctioning - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
O0110D2c	Treatment: Suctioning - Scheduled - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
O0110D3c	Treatment: Suctioning - As Needed - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
O0110E1c	Treatment: Tracheostomy care - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
O0110F1c	Treatment: Invasive Mechanical Ventilator - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
O0110G1c	Treatment: Non-Invasive Mechanical Ventilator - At Discharge	Yes	Yes	Yes	Yes	Yes	No	No	5
O0110G2c	Treatment: Non-Invasive Mechanical Ventilator - BiPAP - At D/C	Yes	Yes	Yes	Yes	Yes	No	No	5
O0110G3c	Treatment: Non-Invasive Mechanical Ventilator - CPAP - At D/C	Yes	Yes	Yes	Yes	Yes	No	No	5
41	{Patient/Resident} discharged against medical advice	Yes	Yes	No	No	Yes	No	Yes	4
24A1	Arthritis conditions recorded	No	Yes	No	Yes	Yes	Yes	No	4
26A	Weight (in pounds)	No	Yes	Yes	No	Yes	No	Yes	4
A1400	Payer information. Check all that apply	No	No	Yes	Yes	No	Yes	Yes	4
A1550E	ID/DD status: ID/DD with no organic condition	Yes	No	No	Yes	Yes	No	Yes	4
A1550Z	ID/DD status: none of the above	Yes	No	No	Yes	Yes	No	Yes	4
A2121	Provision of Current Reconciled Medication List (To Provider)	Yes	Yes	No	No	Yes	No	Yes	4
C0500	BIMS: Summary score	No	Yes	No	Yes	Yes	No	Yes	4
C0700	Staff assessment mental status: short-term memory OK	Yes	No	No	Yes	Yes	No	Yes	4
C0800	Staff assessment mental status: long-term memory OK	Yes	No	No	Yes	Yes	No	Yes	4
C0900Z	Staff asmt mental status: none of above recalled	Yes	Yes	No	Yes	Yes	No	No	4
C1300A	Signs of delirium: inattention	No	Yes	No	Yes	Yes	No	Yes	4
C1300B	Signs of delirium: disorganized thinking	No	Yes	No	Yes	Yes	No	Yes	4
C1300C	Signs of delirium: altered level of consciousness	No	Yes	No	Yes	Yes	No	Yes	4
C1310A	Acute Onset Mental Status Change	No	Yes	No	Yes	Yes	No	Yes	4
E0800	Rejection of care: presence and frequency	Yes	Yes	No	No	Yes	No	Yes	4
E1000B	Wandering: intrude on privacy of others	No	Yes	No	No	Yes	Yes	Yes	4
GG0110A	Manual wheelchair	Yes	Yes	Yes	No	Yes	No	No	4
GG0110B	Motorized wheelchair and/or scooter	Yes	Yes	Yes	No	Yes	No	No	4
GG0110C	Mechanical lift	Yes	Yes	Yes	No	Yes	No	No	4
GG0110D	Walker	Yes	Yes	Yes	No	Yes	No	No	4
GG0110E	Orthotics/Prosthetics	Yes	Yes	Yes	No	Yes	No	No	4
GG0125B	Assistive device - walker	Yes	Yes	No	No	Yes	Yes	No	4
GG0125C1	Assistive device - manual wheelchair	Yes	Yes	Yes	No	Yes	No	No	4
GG0125C2	Assistive device - motorized wheelchair	Yes	Yes	Yes	No	Yes	No	No	4
GG0125Z	Assistive device - other (specify)	Yes	Yes	Yes	No	Yes	No	No	4
GG0130A7	Self-care (usual performance) - eating	Yes	No	Yes	Yes	Yes	No	No	4
GG0130B7	Self-care (usual performance) - oral hygiene	Yes	No	Yes	Yes	Yes	No	No	4
GG0170C7	Functional mobility (usual performance) - lying to sitting on side of bed	Yes	Yes	Yes	No	Yes	No	No	4
GG0170I7	Functional mobility (usual performance) - walk 10 feet	Yes	Yes	Yes	No	Yes	No	No	4
GG0170O7	Functional mobility (usual performance) - 12 steps	Yes	Yes	Yes	No	Yes	No	No	4
GG0170U7	Functional mobility (usual performance) - walk indoors	Yes	Yes	Yes	No	Yes	No	No	4
J0510	Pain Effect on Sleep	Yes	Yes	Yes	No	Yes	No	No	4
J1100A	Short breath/trouble breathing: with exertion	Yes	Yes	Yes	No	Yes	No	No	4
J1100B	Short breath/trouble breathing: sitting at rest	Yes	Yes	Yes	No	Yes	No	No	4
J1100C	Short breath/trouble breathing: lying flat	Yes	Yes	Yes	No	Yes	No	No	4
J1100Z	Short breath/trouble breathing: none of above	Yes	Yes	Yes	No	Yes	No	No	4
J1300	Current tobacco use	Yes	Yes	No	No	Yes	No	Yes	4
J1550A	Problem conditions: fever	Yes	Yes	Yes	No	Yes	No	No	4
J1550B	Problem conditions: vomiting	Yes	Yes	Yes	No	Yes	No	No	4
J1550D	Problem conditions: internal bleeding	Yes	Yes	Yes	No	Yes	No	No	4
J1700B	Did the {patient/resident} have a fall any time in the last 2-6 months prior to admission?	Yes	Yes	Yes	No	Yes	No	No	4
J1700C	Fall history: fracture from fall 6 month pre admit	Yes	Yes	Yes	No	Yes	No	No	4
J1900	Number of falls since admission/entry or reentry	Yes	Yes	Yes	No	Yes	No	No	4
J2040A	Was treatment for shortness of breath initiated?	No	Yes	No	Yes	Yes	Yes	No	4
J2040C	"Type(s) of treatment for shortness of breath initiated: Check all that apply: (1) Opioids, (2) Other medication, (3) Oxygen, (4) Non-medication"	No	Yes	Yes	No	Yes	Yes	No	4
K0310	Weight gain	Yes	Yes	No	Yes	Yes	No	No	4
K0510A1	Nutrition approach: Not Res: parenteral/IV feeding	Yes	Yes	No	Yes	Yes	No	No	4
K0510B1	Nutrition approach: Not Res: feeding tube	Yes	Yes	No	Yes	Yes	No	No	4
L0200A	Dental: broken or loosely fitting denture	Yes	Yes	No	Yes	Yes	No	No	4
L0200B	Dental: no natural teeth or tooth fragment(s)	Yes	Yes	No	Yes	Yes	No	No	4
L0200C	Dental: abnormal mouth tissue	Yes	Yes	No	Yes	Yes	No	No	4
L0200D	Dental: cavity or broken natural teeth	Yes	Yes	No	Yes	Yes	No	No	4
L0200E	Dental: inflamed/bleeding gums or loose teeth	Yes	Yes	No	Yes	Yes	No	No	4
L0200F	"Dental: pain, discomfort, difficulty chewing"	Yes	Yes	No	Yes	Yes	No	No	4
M0050	{Patient/Resident} state of residence	No	Yes	Yes	No	Yes	No	Yes	4
M0050_PAT_ST	Patient state of residence	No	Yes	Yes	No	Yes	No	Yes	4
M0060_PAT_ZIP	Patient zip code	No	Yes	Yes	No	Yes	No	Yes	4
M0300G2	Number of these unstageable pressure injuries that were present upon {admission}	Yes	Yes	No	No	Yes	Yes	No	4
M1018_PRIOR_DISRUPTIVE	Prior condition: disruptive/inappropriate behav	Yes	Yes	No	Yes	Yes	No	No	4
M1018_PRIOR_IMPR_DECSN	Prior condition: impaired decision-making	Yes	Yes	No	Yes	Yes	No	No	4
M1018_PRIOR_INTRACT_PAIN	Prior condition: intractable pain	Yes	Yes	No	Yes	Yes	No	No	4
M1030	Number of venous and arterial ulcers	Yes	Yes	No	No	Yes	Yes	No	4
M1030_THH_ENT_NUTRITION	Therapies received at home: enteral nutrition	Yes	Yes	No	Yes	Yes	No	No	4
M1030_THH_PAR_NUTRITION	Therapies received at home: parenteral nutrition	Yes	Yes	No	Yes	Yes	No	No	4
M1033_HOSP_RISK_MLTPL_ED_VISIT	Hosp risk: 2+ emergcy dept visits in past 6 months	Yes	Yes	No	No	Yes	No	Yes	4
M1033_HOSP_RISK_MLTPL_HOSPZTN	Hosp risk: 2+ hospitalizations in past 12 months	Yes	Yes	No	No	Yes	No	Yes	4
M1033_HOSP_RISK_MNTL_BHV_DCLN	Hosp risk: decline mental/emotional/behav status	Yes	Yes	No	No	Yes	No	Yes	4
M1033_HOSP_RISK_NONE_ABOVE	Hosp risk: none of the above	Yes	Yes	No	No	Yes	No	Yes	4
M1033_HOSP_RISK_WEIGHT_LOSS	Hosp risk: unintentional weight loss	Yes	Yes	No	No	Yes	No	Yes	4
M1034_PTNT_OVRAL_STUS	Patient's overall status	Yes	Yes	No	No	Yes	No	Yes	4
M1036_RSK_ALCOHOLISM	High risk factor: alcoholism	Yes	Yes	No	No	Yes	No	Yes	4
M1036_RSK_DRUGS	High risk factor: drugs	Yes	Yes	No	No	Yes	No	Yes	4
M1036_RSK_NONE	High risk factor: none of the above	Yes	Yes	No	No	Yes	No	Yes	4
M1036_RSK_OBESITY	High risk factor: obesity	Yes	Yes	No	No	Yes	No	Yes	4
M1036_RSK_SMOKING	High risk factor: smoking	Yes	Yes	No	No	Yes	No	Yes	4
M1200	Sensory status: vision	Yes	Yes	No	Yes	Yes	No	No	4
M1210_HEARG_ABLTY	Ability to hear	Yes	Yes	No	Yes	Yes	No	No	4
M1230_SPEECH	Sensory status: speech	Yes	Yes	No	Yes	Yes	No	No	4
M1350_LESION_OPEN_WND	Has skin lesion or open wound	Yes	Yes	Yes	No	Yes	No	No	4
M1410_RESPTX_AIRPRESS	Respiratory treatments: airway pressure	No	Yes	Yes	Yes	Yes	No	No	4
M1410_RESPTX_OXYGEN	Respiratory treatments: oxygen	No	Yes	Yes	Yes	Yes	No	No	4
M1610	Urinary incontinence or urinary catheter present	Yes	Yes	Yes	No	Yes	No	No	4
M1615_INCNTNT_TIMING	When urinary incontinence occurs	Yes	Yes	Yes	No	Yes	No	No	4
M1620	Bowel incontinence frequency	Yes	Yes	Yes	No	Yes	No	No	4
M1800	Current: grooming	Yes	Yes	Yes	No	Yes	No	No	4
M1830	Current: bathing	Yes	Yes	Yes	No	Yes	No	No	4
M1840	Current: toilet transfer	Yes	Yes	Yes	No	Yes	No	No	4
M1840_CRNT_TOILTG	Current: toileting	Yes	Yes	Yes	No	Yes	No	No	4
M1840_CUR_TOILTG	Current Ability: Toilet Transferring:	Yes	Yes	Yes	No	Yes	No	No	4
M1845_CUR_TOILTG_HYGN	Current Ability: Toileting Hygiene:	Yes	Yes	Yes	No	Yes	No	No	4
M1850	Current: transferring	Yes	Yes	Yes	No	Yes	No	No	4
M1850_CUR_TRNSFRNG	Current Ability: Transferring:	Yes	Yes	Yes	No	Yes	No	No	4
M1860	Current: ambulation/locomotion	Yes	Yes	Yes	No	Yes	No	No	4
M1860_CRNT_AMBLTN	Current: ambulation	Yes	Yes	Yes	No	Yes	No	No	4
M1880_CRNT_PREP_LT_MEALS	Current: prepare light meals	Yes	Yes	Yes	No	Yes	No	No	4
M1880_CUR_PREP_LT_MEALS	Current Ability: Prepare Light Meals:	Yes	Yes	Yes	No	Yes	No	No	4
M1890_CRNT_PHONE_USE	Current: telephone use	Yes	Yes	Yes	No	Yes	No	No	4
M1890_CUR_PHONE_USE	Current Ability: Telephone Use:	Yes	Yes	Yes	No	Yes	No	No	4
M2102_CARE_TYPE_SRC_SPRVSN	"Care mgmt, types/sources: supervision and safety"	Yes	No	Yes	Yes	Yes	No	No	4
M2102_D	"Care management, types/sources: medical procedures/treatments"	Yes	No	Yes	Yes	Yes	No	No	4
M2102_F	"Care management, types/sources: supervision and safety"	Yes	No	Yes	Yes	Yes	No	No	4
M2310_ECR_DHYDRTN_MALNTR	"Emergent care reason: dehydration, malnutrition"	Yes	Yes	No	Yes	Yes	No	No	4
M2310_ECR_INJRY_BY_FALL	Emergent care reason: injury caused by fall	Yes	Yes	No	Yes	Yes	No	No	4
M2310_ECR_RSPRTRY_INFCTN	Emergent care reason: respiratory infection	Yes	Yes	No	Yes	Yes	No	No	4
M2310_ECR_RSPRTRY_OTHR	Emergent care reason: respiratory other	Yes	Yes	No	Yes	Yes	No	No	4
M2310_ECR_STROKE_TIA	Emergent care reason: stroke (CVA) or TIA	Yes	Yes	No	Yes	Yes	No	No	4
M2310_ECR_UTI	Emergent care reason: urinary tract infection	Yes	Yes	No	Yes	Yes	No	No	4
N0410D	Medication received: days: hypnotic	Yes	Yes	No	No	Yes	No	Yes	4
N0415A1	High-Risk Drug Classes: Antipsychotic: Is taking	Yes	Yes	No	No	Yes	No	Yes	4
N0415A2	High-Risk Drug Classes: Antipsychotic: Indication noted	Yes	Yes	No	No	Yes	No	Yes	4
N0415F1	High-Risk Drug Classes: Antibiotic: Is taking	Yes	Yes	No	No	Yes	No	Yes	4
N0415F2	High-Risk Drug Classes: Antibiotic: Indication noted	Yes	Yes	No	No	Yes	No	Yes	4
N0415H1	High-Risk Drug Classes: Opioid: Is taking	Yes	Yes	No	No	Yes	No	Yes	4
N0415H2	High-Risk Drug Classes: Opioid: Indication noted	Yes	Yes	No	No	Yes	No	Yes	4
N0450A	{Patient/Resident} received antipsychotic medications	Yes	Yes	No	No	Yes	No	Yes	4
N0450B	Gradual dose reduction attempted	Yes	Yes	No	No	Yes	No	Yes	4
N0450E	Date physician documented gradual dose reduction	Yes	Yes	No	No	Yes	No	Yes	4
N0500A	Was scheduled opioid initiated or continued	Yes	Yes	No	No	Yes	No	Yes	4
N0500B	Date scheduled opioid initiated or continued	Yes	Yes	No	No	Yes	No	Yes	4
N0510A	Was PRN opioid initiated or continued	Yes	Yes	No	No	Yes	No	Yes	4
O0100B1	Treatment: radiation - while not resident	Yes	Yes	No	Yes	Yes	No	No	4
O0100B2	Treatment: radiation - while resident	Yes	Yes	No	Yes	Yes	No	No	4
O0100C1	Treatment: oxygen therapy - while not resident	Yes	Yes	No	Yes	Yes	No	No	4
O0100C2	Treatment: oxygen therapy - while resident	Yes	Yes	No	Yes	Yes	No	No	4
O0100D1	Treatment: suctioning - while not resident	Yes	Yes	No	Yes	Yes	No	No	4
O0100D2	Treatment: suctioning - while resident	Yes	Yes	No	Yes	Yes	No	No	4
O0100E2	Treatment: tracheostomy care - while resident	Yes	Yes	No	Yes	Yes	No	No	4
O0100F2	Treatment: vent/respirator - while resident	Yes	Yes	No	Yes	Yes	No	No	4
O0100M2	Treatment: isolate/quarantine - while resident	Yes	Yes	No	Yes	Yes	No	No	4
O0110A10c	Treatment: Chemotherapy - Other - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110A1c	Treatment: Chemotherapy - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110A2c	Treatment: Chemotherapy - IV - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110A3c	Treatment: Chemotherapy - Oral - At Discharge.	Yes	Yes	Yes	No	Yes	No	No	4
O0110B1a	Treatment: Radiation - On Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110C1a	Treatment: Oxygen Therapy - On Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110C2a	Treatment: Oxygen Therapy - Continuous - On Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110C3a	Treatment: Oxygen Therapy - Intermittent - On Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110C4a	Treatment: Oxygen Therapy - High-concentration - On Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110D1a	Treatment: Suctioning - On Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110D2a	Treatment: Suctioning - Scheduled - Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110D3a	Treatment: Suctioning - As Needed - Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110E1a	Treatment: Tracheostomy care - Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110F1a	Treatment: Invasive Mechanical Ventilator - Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110G1a	Treatment: Non-Invasive Mechanical Ventilator - On Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110G2a	Treatment: Non-Invasive Mechanical Ventilator - BiPAP - On Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110G3a	Treatment: Non-Invasive Mechanical Ventilator - CPAP - On Adm	Yes	Yes	No	Yes	Yes	No	No	4
O0110H10c	Treatment: IV Medications - Other - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110H1c	Treatment: IV Medications - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110H2c	Treatment: IV Medications - Vasoactive Med - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110H3c	Treatment: IV Medications - Antibiotics - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110I1c	Treatment: Transfusions - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110J1c	Treatment: Dialysis - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110J2c	Treatment: Dialysis - Hemodialysis - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110J3c	Treatment: Dialysis - Peritoneal - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110O1c	Treatment: IV Access - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110O2c	Treatment: IV Access - Peripheral - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110O3c	Treatment: IV Access - Midline - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
O0110O4c	Treatment: IV Access - Central - At Discharge	Yes	Yes	Yes	No	Yes	No	No	4
S0170G	Advanced directive: Feeding restrictions	Yes	No	Yes	Yes	Yes	No	No	4
20	Payment source	No	No	Yes	Yes	No	No	Yes	3
46	Diagnosis for interruption or death (ICD code)	No	Yes	No	Yes	No	No	Yes	3
15A	Admit from	Yes	No	No	Yes	No	No	Yes	3
1A	{Facility/Provider} name	Yes	No	No	No	Yes	No	Yes	3
5B	{Patient/Resident} identification number	Yes	No	No	No	Yes	No	Yes	3
A1005	Ethnicity. Check all that apply	Yes	No	No	No	Yes	No	Yes	3
A1005A	"Ethnicity: No, not of Hispanic, Latino/a, or Spanish origin"	Yes	No	No	No	Yes	No	Yes	3
A1005B	"Ethnicity: Yes, Mexican, Mexican American, Chicano/a"	Yes	No	No	No	Yes	No	Yes	3
A1005C	"Ethnicity: Yes, Puerto Rican"	Yes	No	No	No	Yes	No	Yes	3
A1005D	"Ethnicity: Yes, Cuban"	Yes	No	No	No	Yes	No	Yes	3
A1005E	"Ethnicity: Yes, another Hispanic, Latino, or Spanish origin"	Yes	No	No	No	Yes	No	Yes	3
A1005X	Ethnicity: Resident/Patient unable to respond	Yes	No	No	No	Yes	No	Yes	3
A1010A	Race: White	Yes	No	No	No	Yes	No	Yes	3
A1010B	Race: Black or African American	Yes	No	No	No	Yes	No	Yes	3
A1010C	Race: American Indian or Alaska Native	Yes	No	No	No	Yes	No	Yes	3
A1010D	Race: Asian Indian	Yes	No	No	No	Yes	No	Yes	3
A1010E	Race: Chinese	Yes	No	No	No	Yes	No	Yes	3
A1010F	Race: Filipino	Yes	No	No	No	Yes	No	Yes	3
A1010G	Race: Japanese	Yes	No	No	No	Yes	No	Yes	3
A1010H	Race: Korean	Yes	No	No	No	Yes	No	Yes	3
A1010I	Race: Vietnamese	Yes	No	No	No	Yes	No	Yes	3
A1010J	Race: Other Asian	Yes	No	No	No	Yes	No	Yes	3
A1010K	Race: Native Hawaiian	Yes	No	No	No	Yes	No	Yes	3
A1010L	Race: Guamanian or Chamorro	Yes	No	No	No	Yes	No	Yes	3
A1010M	Race: Samoan	Yes	No	No	No	Yes	No	Yes	3
A1010N	Race: Other Pacific Islander	Yes	No	No	No	Yes	No	Yes	3
A1010X	Resident/Patient unable to respond	No	Yes	No	Yes	No	No	Yes	3
A1802	Admitted from	Yes	No	Yes	Yes	No	No	No	3
A1990	Discharge against medical advice	No	Yes	No	No	Yes	No	Yes	3
A2115	Reason for discharge	No	Yes	No	No	Yes	No	Yes	3
A2123	Provision of Current Reconciled Medication List (To Resident/Patient)	Yes	No	No	No	Yes	No	Yes	3
C0100	BIMS: Should brief interview for mental status be conducted?	No	No	No	Yes	Yes	No	Yes	3
C0200	BIMS: repetition of three words	No	No	No	Yes	Yes	No	Yes	3
C0300A	BIMS: able to report correct year	No	No	No	Yes	Yes	No	Yes	3
C0300B	BIMS: able to report correct month	No	No	No	Yes	Yes	No	Yes	3
C0300C	BIMS: Able report correct day of week	No	No	No	Yes	Yes	No	Yes	3
C0400A	"BIMS: able to recall ""sock"""	No	No	No	Yes	Yes	No	Yes	3
C0400B	"BIMS: able to recall ""blue"""	No	No	No	Yes	Yes	No	Yes	3
C0400C	"BIMS: able to recall ""bed"""	No	No	No	Yes	Yes	No	Yes	3
C0900A	Staff asmt mental status: recall current season	No	Yes	No	Yes	Yes	No	No	3
C0900B	Staff asmt mental status: recall location of room	No	Yes	No	Yes	Yes	No	No	3
C0900C	Staff asmt mental status: recall staff names/faces	No	Yes	No	Yes	Yes	No	No	3
C0900D	Staff asmt mental status: recall in nh/hosp sw bed	No	Yes	No	Yes	Yes	No	No	3
C1300D	Signs of delirium: psychomotor retardation	No	Yes	No	Yes	Yes	No	No	3
D0150D1	PHQ 2 to 9: feeling tired/little energy - presence	Yes	No	No	Yes	Yes	No	No	3
D0150D2	PHQ 2 to 9: feeling tired/little energy - frequency	Yes	No	No	Yes	Yes	No	No	3
D0150E1	PHQ 2 to 9: poor appetite or overeating - presence	Yes	No	No	Yes	Yes	No	No	3
D0150E2	PHQ 2 to 9: poor appetite or overeating - frequency	Yes	No	No	Yes	Yes	No	No	3
D0200D1	PHQ9: feeling tired/little energy - presence	Yes	No	No	Yes	Yes	No	No	3
D0200D2	PHQ9: feeling tired/little energy - frequency	Yes	No	No	Yes	Yes	No	No	3
D0200E1	PHQ9: poor appetite or overeating - presence	Yes	No	No	Yes	Yes	No	No	3
D0200E2	PHQ9: poor appetite or overeating - frequency	Yes	No	No	Yes	Yes	No	No	3
D0300	PHQ9: total mood severity score	No	Yes	No	Yes	Yes	No	No	3
D0500E1	PHQ9 staff: poor appetite or overeating - presence	Yes	No	No	Yes	Yes	No	No	3
D0500E2	PHQ9 staff: poor appetite or overeating - frequency	Yes	No	No	Yes	Yes	No	No	3
D0500I1	PHQ9 staff: thoughts better off dead - presence	No	No	No	Yes	Yes	No	Yes	3
D0500I2	PHQ9 staff: thoughts better off dead - frequency	No	No	No	Yes	Yes	No	Yes	3
E1100	Change in behavioral or other symptoms	Yes	No	No	Yes	No	No	Yes	3
F0910A	Assistance in home	No	No	Yes	Yes	Yes	No	No	3
F2100A	Was {patient/resident} asked about treatments other than CPR	Yes	Yes	No	No	Yes	No	No	3
F2100B	Date asked about treatment other than CPR	Yes	Yes	No	No	Yes	No	No	3
GG0125B1	Assistive device - standard folding walker	No	Yes	Yes	No	Yes	No	No	3
GG0125B2	Assistive device - walker with seat	No	Yes	Yes	No	Yes	No	No	3
GG0125B3	Assistive device - walker with wheels	No	Yes	Yes	No	Yes	No	No	3
GG0125E	Assistive device - specialized seating pad	No	Yes	Yes	No	Yes	No	No	3
GG0125F	Assistive device - mechanical lift	No	Yes	Yes	No	Yes	No	No	3
GG0125G	Assistive device - reacher/grabber	No	Yes	Yes	No	Yes	No	No	3
GG0125H	Assistive device - sock aid	No	Yes	Yes	No	Yes	No	No	3
GG0125I	Assistive device - orthotics/brace	No	Yes	Yes	No	Yes	No	No	3
GG0125J	Assistive device - bed rail	No	Yes	Yes	No	Yes	No	No	3
GG0125K	Assistive device - electronic bed	No	Yes	Yes	No	Yes	No	No	3
GG0125L	Assistive device - grab bars	No	Yes	Yes	No	Yes	No	No	3
GG0125M	Assistive device - transfer board	No	Yes	Yes	No	Yes	No	No	3
GG0125N	Assistive device - shower/commode chair	No	Yes	Yes	No	Yes	No	No	3
GG0125O	Assistive device - walk/wheel-in shower	No	Yes	Yes	No	Yes	No	No	3
GG0125S	Assistive device - stair rails	No	Yes	Yes	No	Yes	No	No	3
GG0125T	Assistive device - lift chair	No	Yes	Yes	No	Yes	No	No	3
GG0125U	Assistive device - ramps	No	Yes	Yes	No	Yes	No	No	3
GG0125V	Assistive device - raised toilet seat	No	Yes	Yes	No	Yes	No	No	3
GG0130A8	Self-care (most dependent performance) - eating	Yes	No	No	Yes	Yes	No	No	3
GG0170A7	Functional mobility (usual performance) - roll left and right	No	Yes	Yes	No	Yes	No	No	3
GG0170B7	Functional mobility (usual performance) - sit to lying	No	Yes	Yes	No	Yes	No	No	3
GG0170D7	Functional mobility (usual performance) - sit to stand	No	Yes	Yes	No	Yes	No	No	3
GG0170E7	Functional mobility (usual performance) - chair/bed-to-chair transfer	No	Yes	Yes	No	Yes	No	No	3
GG0170J7	Functional mobility (usual performance) - walk 50 feet w/2 turns	Yes	No	Yes	No	Yes	No	No	3
GG0170K7	Functional mobility (usual performance) - walk 150 feet	Yes	No	Yes	No	Yes	No	No	3
GG0170M7	Functional mobility (usual performance) - 1 step (curb)	Yes	No	Yes	No	Yes	No	No	3
GG0170N7	Functional mobility (usual performance) - 4 steps	Yes	No	Yes	No	Yes	No	No	3
GG0170P7	Functional mobility (usual performance) - picking up object	Yes	No	Yes	No	Yes	No	No	3
GG0170Q1	Does the {patient/resident} use a wheelchair and/or scooter (admission)	Yes	Yes	No	No	Yes	No	No	3
GG0170V7	Functional mobility (usual performance) - carry something in both hands	Yes	No	Yes	No	Yes	No	No	3
GG0170W7	Functional mobility (usual performance) - walk for 15 minutes	Yes	No	Yes	No	Yes	No	No	3
GG0185A7	IADL (usual performance) - make light cold meal	Yes	No	Yes	No	Yes	No	No	3
GG0185B7	IADL (usual performance) - make light hot meal	Yes	No	Yes	No	Yes	No	No	3
GG0185C7	IADL (usual performance) - light daily housework	Yes	No	Yes	No	Yes	No	No	3
GG0185D7	IADL (usual performance) - heavier periodic housework	Yes	No	Yes	No	Yes	No	No	3
GG0185E7	IADL (usual performance) - light shopping	Yes	No	Yes	No	Yes	No	No	3
GG0185H7	IADL (usual performance) - oral medication management	No	No	Yes	No	Yes	No	Yes	3
GG0185J7	IADL (usual performance) - injectable medication management	No	No	Yes	No	Yes	No	Yes	3
GG0185K7	IADL (usual performance) - simple financial management	No	No	Yes	No	Yes	No	Yes	3
GG0185L7	IADL (usual performance) - complex financial management	No	No	Yes	No	Yes	No	Yes	3
H0600	Constipation	Yes	Yes	No	No	Yes	No	No	3
J0800A	Staff pain asmt: non-verbal sounds	No	Yes	Yes	No	Yes	No	No	3
J0800B	Staff pain asmt: vocal complaints of pain	No	Yes	Yes	No	Yes	No	No	3
J0800C	Staff pain asmt: facial expressions	No	Yes	Yes	No	Yes	No	No	3
J0800D	Staff pain asmt: protective movements/postures	No	Yes	Yes	No	Yes	No	No	3
J0850	Staff pain assessment: frequency of pain	No	Yes	Yes	Yes	No	No	No	3
J2030C	Did screening indicate {patient/resident} had shortness of breath	No	Yes	Yes	Yes	No	No	No	3
K0100Z	Swallow disorder: none of the above	No	Yes	Yes	Yes	No	No	No	3
K0520Z1	Nutritional approaches: None of the above - Adm	Yes	No	Yes	Yes	No	No	No	3
K0520Z5	Nutritional approaches: None of the above - At Discharge	Yes	No	Yes	Yes	No	No	No	3
M0018_PHYSICIAN_ID	Attending physician National Provider ID (NPI)	No	Yes	No	No	Yes	No	Yes	3
M0150_CPAY_MCAID_FFS	Payment sources: Medicaid fee-for-service	Yes	No	No	No	Yes	No	Yes	3
M0150_CPAY_MCAID_HMO	Payment sources: Medicaid HMO/managed care	Yes	No	No	No	Yes	No	Yes	3
M0150_CPAY_MCARE_FFS	Payment sources: Medicare fee-for-service	Yes	No	No	No	Yes	No	Yes	3
M0150_CPAY_MCARE_HMO	Payment sources: Medicare HMO/managed care	Yes	No	No	No	Yes	No	Yes	3
M0906	"Discharge, transfer, death date"	No	Yes	No	No	Yes	No	Yes	3
M1018_PRIOR_CATH	Prior condition: indwelling/suprapubic catheter	Yes	Yes	No	No	Yes	No	No	3
M1018_PRIOR_UR_INCON	Prior condition: urinary incontinence	Yes	Yes	No	No	Yes	No	No	3
M1028	Comorbidities and co-existing conditions. Check all that apply	Yes	Yes	No	No	Yes	No	No	3
M1030_THH_IV_INFUSION	"Therapies received at home: intravenous, infusion"	Yes	Yes	No	No	Yes	No	No	3
M1030_THH_NONE_ABOVE	Therapies received at home: none of the above	Yes	Yes	No	No	Yes	No	No	3
M1032_HOSP_RISK_5PLUS_MDCTN	Risk For Hospitalization:	Yes	Yes	No	No	Yes	No	No	3
M1033	Risk for hospitalization. Check all that apply	Yes	Yes	No	No	Yes	No	No	3
M1033_HOSP_RISK_5PLUS_MDCTN	Hosp risk: taking five or more medications	Yes	Yes	No	No	Yes	No	No	3
M1033_HOSP_RISK_COMPLIANCE	Hosp risk: difficulty with medical instructions	Yes	Yes	No	No	Yes	No	No	3
M1033_HOSP_RISK_CRNT_EXHSTN	Hosp risk: current exhaustion	Yes	Yes	No	No	Yes	No	No	3
M1033_HOSP_RISK_HSTRY_FALLS	Hosp risk: 2+ falls or injury fall in past year	Yes	Yes	No	No	Yes	No	No	3
M1033_HOSP_RISK_OTHR_RISK	Hosp risk: other risk(s) not listed	Yes	Yes	No	No	Yes	No	No	3
M1036_RSK_UNKNOWN	High risk factor: unknown	Yes	Yes	No	No	Yes	No	No	3
M1302_RISK_OF_PRSR_ULCR	Does this patient have a risk of developing PUs	Yes	Yes	No	No	Yes	No	No	3
M1306	{Patient/Resident} has 1+ unhealed pressure ulcer/injury at stage 2 or higher	Yes	Yes	No	No	Yes	No	No	3
M1306_UNHLD_STG2_PRSR_ULCR	Patient has 1+ unhealed PU at stage 2 or higher	Yes	Yes	No	No	Yes	No	No	3
M1307	Status of oldest stage 2 pressure ulcer at discharge	Yes	Yes	No	No	Yes	No	No	3
M1307_DT	Date of onset of oldest stage 2 pressure ulcer	Yes	Yes	No	No	Yes	No	No	3
M1307_OLDST_STG2_AT_DSCHRG	Status of oldest stage 2 pressure ulcer at disch	Yes	Yes	No	No	Yes	No	No	3
M1308_NBR_PRSULC_STG2	Number of stage 2 pressure ulcers	Yes	Yes	No	No	Yes	No	No	3
M1308_NBR_PRSULC_STG3	Number of stage 3 pressure ulcers	Yes	Yes	No	No	Yes	No	No	3
M1308_NBR_PRSULC_STG4	Number of stage 4 pressure ulcers	Yes	Yes	No	No	Yes	No	No	3
M1308_NBR_STG2_AT_SOC_ROC	Number of pressure ulcers present: Stage 2 At SOC/ROC:	Yes	Yes	No	No	Yes	No	No	3
M1308_NBR_STG3_AT_SOC_ROC	Number of pressure ulcers present: Stage 3 At SOC/ROC:	Yes	Yes	No	No	Yes	No	No	3
M1308_NBR_STG4_AT_SOC_ROC	Number of pressure ulcers present: Stage 4 At SOC/ROC:	Yes	Yes	No	No	Yes	No	No	3
M1308_NSTG_CVRG	Unstageable: coverage by slough or eschar	Yes	Yes	No	No	Yes	No	No	3
M1308_NSTG_DEEP_TISUE	Unstageable: suspect deep tissue injury	Yes	Yes	No	No	Yes	No	No	3
M1308_NSTG_DRSG	Unstageable: non-removable dressing/device	Yes	Yes	No	No	Yes	No	No	3
M1308_NSTG_DRSG_SOC_ROC	Unstageable Due To:	Yes	Yes	No	No	Yes	No	No	3
M1309_NBR_NEW_WRS_PRSULC_NSTG	Number of new or worsening unstageable	Yes	Yes	No	No	Yes	No	No	3
M1309_NBR_NEW_WRS_PRSULC_STG2	Number of new or worsening stage 2	Yes	Yes	No	No	Yes	No	No	3
M1309_NBR_NEW_WRS_PRSULC_STG3	Number of new or worsening stage 3	Yes	Yes	No	No	Yes	No	No	3
M1309_NBR_NEW_WRS_PRSULC_STG4	Number of new or worsening stage 4	Yes	Yes	No	No	Yes	No	No	3
M1320_STUS_PRBLM_PRSR_ULCR	Status of most problematic pressure ulcer	Yes	Yes	No	No	Yes	No	No	3
M1330	Does this {patient/resident} have a stasis ulcer	Yes	Yes	No	No	Yes	No	No	3
M1330_STAS_ULCR_PRSNT	Does this patient have a stasis ulcer	Yes	Yes	No	No	Yes	No	No	3
M1332	Number of stasis ulcers	Yes	Yes	No	No	Yes	No	No	3
M1334	Status of most problematic stasis ulcer	Yes	Yes	No	No	Yes	No	No	3
M1340_SRGCL_WND_PRSNT	Does this patient have a surgical wound	Yes	No	Yes	No	Yes	No	No	3
M1342	Status of most problematic surgical wound	Yes	No	Yes	No	Yes	No	No	3
M1410_RESPTX_NONE	Respiratory treatments: none of the above	No	Yes	Yes	No	Yes	No	No	3
M1500_SYMTM_HRT_FAILR_PTNTS	Symptoms in heart failure patients	Yes	Yes	No	No	Yes	No	No	3
M1730	Screened for depression using validated tool	Yes	No	Yes	No	No	No	Yes	3
M1750_REC_PSYCH_NURS	Receives psychiatric nursing	No	No	Yes	Yes	No	No	Yes	3
M1810	Current: dress upper body	No	Yes	Yes	No	Yes	No	No	3
M1810_CUR_DRESS_UPPER	Current Ability: Dress Upper Body:	No	Yes	Yes	No	Yes	No	No	3
M1820	Current: dress lower body	No	Yes	Yes	No	Yes	No	No	3
M1820_CUR_DRESS_LOWER	Current Ability: Dress Lower Body:	No	Yes	Yes	No	Yes	No	No	3
M2100_CARE_TYPE_SRC_ADL	"Care Mgmt, Types And Sources Of Assist:"	Yes	No	Yes	No	Yes	No	No	3
M2102	Types and sources of assistance	Yes	No	Yes	No	Yes	No	No	3
M2102_A	"Care management, types/sources: ADL"	Yes	No	Yes	No	Yes	No	No	3
M2102_C	"Care management, types/sources: medication administration"	Yes	No	Yes	No	Yes	No	No	3
M2102_CARE_TYPE_SRC_ADL	"Care mgmt, types/sources: ADL"	Yes	No	Yes	No	Yes	No	No	3
M2102_CARE_TYPE_SRC_ADVCY	"Care mgmt, types/sources: advocacy or facilitation"	Yes	No	Yes	No	Yes	No	No	3
M2102_CARE_TYPE_SRC_EQUIP	"Care mgmt, types/sources: equipment"	Yes	No	Yes	No	Yes	No	No	3
M2102_CARE_TYPE_SRC_IADL	"Care mgmt, types/sources: IADL"	Yes	No	Yes	No	Yes	No	No	3
M2102_CARE_TYPE_SRC_MDCTN	"Care mgmt, types/sources: med admin"	Yes	No	Yes	No	Yes	No	No	3
M2102_CARE_TYPE_SRC_PRCDR	"Care mgmt, types/sources: med procs tx"	Yes	No	Yes	No	Yes	No	No	3
M2110_ADL_IADL_ASTNC_FREQ	How often recv non-HHA caregiver ADL/IADL assist	Yes	No	Yes	No	Yes	No	No	3
M2300_EMER_USE_AFTR_LAST_ASMT	Emergent care: use since previous OASIS	Yes	Yes	No	No	Yes	No	No	3
M2301	Emergent care: use since most recent SOC/ROC	Yes	Yes	No	No	Yes	No	No	3
M2310	Reason for emergent care. Check all that apply	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_CRDC_DSRTHM	Emergent care reason: cardiac dysrhythmia	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_CTHTR_CMPLCTN	Emergent care reason: IV catheter infect/complic	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_DVT_PULMNRY	Emergent care reason: deep vein thromb/pulm embol	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_GI_PRBLM	Emergent care: GI bleed/obstruct/constip/impact	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_HRT_FAILR	Emergent care reason: heart failure	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_HYPOGLYC	Emergent care reason: hypoglycemia/hyperglycemia	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_MEDICATION	Emergent care reason: medication	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_MI_CHST_PAIN	Emergent care reason: myocard infarct/chest pain	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_OTHER	Emergent care reason: other than above	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_OTHR_HRT_DEASE	Emergent care reason: other heart disease	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_UNCNTLD_PAIN	Emergent care reason: uncontrolled pain	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_UNKNOWN	Emergent care reason: unknown	Yes	Yes	No	No	Yes	No	No	3
M2310_ECR_WND_INFCTN_DTRORTN	Emergent care reason: wound infect/deterioration	Yes	Yes	No	No	Yes	No	No	3
N0350A	Insulin: insulin injections	Yes	Yes	No	No	Yes	No	No	3
N0350B	Insulin: orders for insulin	Yes	Yes	No	No	Yes	No	No	3
N0410E	Medication received: days: anticoagulant	Yes	Yes	No	No	Yes	No	No	3
N0410F	Medication received: days: antibiotic	Yes	Yes	No	No	Yes	No	No	3
N0415E1	High-Risk Drug Classes: Anticoagulant: Is taking	Yes	Yes	No	No	Yes	No	No	3
N0415E2	High-Risk Drug Classes: Anticoagulant: Indication noted	Yes	Yes	No	No	Yes	No	No	3
N0415I1	High-Risk Drug Classes: Antiplatelet: Is taking	Yes	Yes	No	No	Yes	No	No	3
N0415I2	High-Risk Drug Classes: Antiplatelet: Indication noted	Yes	Yes	No	No	Yes	No	No	3
N0415J1	High-Risk Drug Classes: Hypoglycemic: Is taking	Yes	Yes	No	No	Yes	No	No	3
N0415J2	High-Risk Drug Classes: Hypoglycemic: Indication noted	Yes	Yes	No	No	Yes	No	No	3
N0450C	Date of last attempted gradual dose reduction	No	Yes	No	No	Yes	No	Yes	3
N0450D	Physician documented gradual dose reduction	No	Yes	No	No	Yes	No	Yes	3
N0510B	Date PRN opioid initiated or continued	No	Yes	No	No	Yes	No	Yes	3
N0520A	Was bowel regimen initiated or continued	Yes	Yes	No	No	Yes	No	No	3
N0520B	Date bowel regimen initiated or continued	Yes	Yes	No	No	Yes	No	No	3
O0100A1	Treatment: chemotherapy - while not resident	Yes	Yes	No	No	Yes	No	No	3
O0100A2	Treatment: chemotherapy - while resident	Yes	Yes	No	No	Yes	No	No	3
O0100E1	Treatment: tracheostomy care - while not resident	No	Yes	No	Yes	Yes	No	No	3
O0100F1	Treatment: vent/respirator - while not resident	No	Yes	No	Yes	Yes	No	No	3
O0100J2	Treatment: dialysis - while resident	Yes	Yes	No	No	Yes	No	No	3
O0100K1	Treatment: hospice care - while not resident	No	Yes	No	Yes	Yes	No	No	3
O0100K2	Treatment: hospice care - while resident	No	Yes	No	Yes	Yes	No	No	3
O0110A10a	Treatment: Chemotherapy - Other - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110A1a	Treatment: Chemotherapy - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110A2a	Treatment: Chemotherapy - IV - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110A3a	Treatment: Chemotherapy - Oral - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110H10a	Treatment: IV Medications - Other - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110H1a	Treatment: IV Medications - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110H2a	Treatment: IV Medications - Vasoactive Med - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110H3a	Treatment: IV Medications - Antibiotics - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110H4c	Treatment: IV Medications - Anticoagulation - At Discharge	No	Yes	Yes	No	Yes	No	No	3
O0110I1a	Treatment: Transfusions - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110J1a	Treatment: Dialysis - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110J2a	Treatment: Dialysis - Hemodialysis - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110J3a	Treatment: Dialysis - Peritoneal - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110O1a	Treatment: IV Access - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110O2a	Treatment: IV Access - Peripheral - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110O3a	Treatment: IV Access - Midline - On Adm	Yes	Yes	No	No	Yes	No	No	3
O0110O4a	Treatment: IV Access - Central - On Adm	Yes	Yes	No	No	Yes	No	No	3
S0170D	Advanced directive: Do not resuscitate	No	No	Yes	Yes	No	No	Yes	3
S0170E	Advanced directive: Do not hospitalize	No	No	Yes	Yes	No	No	Yes	3
S0170F	Advanced directive: Do not intubate	No	No	Yes	Yes	No	No	Yes	3
S0170H	Advanced directive: Other treatment restrictions	No	No	Yes	Yes	No	No	Yes	3
S0174	Resident has Advanced Directive	No	No	Yes	Yes	No	No	Yes	3
S0175	Resident has POA for Health Care	No	No	Yes	Yes	No	No	Yes	3
S1100A	Disease: Clostridium Difficile	Yes	Yes	No	Yes	No	No	No	3
S1200A	Primary/secondary SMI dx: schizophrenia	Yes	No	No	Yes	No	No	Yes	3
S1200B	Primary/secondary SMI dx: delusional disorder	Yes	No	No	Yes	No	No	Yes	3
S1200C	Primary/secondary SMI dx: schizoaffective disorder	Yes	No	No	Yes	No	No	Yes	3
S1200D	Primary/secondary SMI dx: psychotic disorder NOS	Yes	No	No	Yes	No	No	Yes	3
S1200E	Primary/secondary SMI dx: bipolar disorder I	Yes	No	No	Yes	No	No	Yes	3
S1200F	Primary/secondary SMI dx: bipolar disorder II	Yes	No	No	Yes	No	No	Yes	3
S1200G	Primary/secondary SMI dx: cyclothymic disorder	Yes	No	No	Yes	No	No	Yes	3
S1200H	Primary/secondary SMI dx: bipolar disorder NOS	Yes	No	No	Yes	No	No	Yes	3
S1200I	Primary/secondary SMI dx: major depress recurrent	Yes	No	No	Yes	No	No	Yes	3
1	{Facility/Provider} information	No	No	Yes	No	No	No	Yes	2
7	Social security number	No	No	No	No	Yes	No	Yes	2
11	ZIP code of {patient's/resident's} pre-hospital residence	No	No	No	No	Yes	No	Yes	2
47A	Complication during rehab stay 1 (ICD code)	No	Yes	No	Yes	No	No	No	2
47B	Complication during rehab stay 2 (ICD code)	No	Yes	No	Yes	No	No	No	2
47C	Complication during rehab stay 3 (ICD code)	No	Yes	No	Yes	No	No	No	2
47D	Complication during rehab stay 4 (ICD code)	No	Yes	No	Yes	No	No	No	2
47E	Complication during rehab stay 5 (ICD code)	No	Yes	No	Yes	No	No	No	2
47F	Complication during rehab stay 6 (ICD code)	No	Yes	No	Yes	No	No	No	2
A0310G	Planned/unplanned discharge	Yes	No	No	No	Yes	No	No	2
A0550	{Patient/Resident} zip code	No	No	No	No	Yes	No	Yes	2
A1250A	"Transportation: Yes, kept from med appts."	No	No	No	No	Yes	No	Yes	2
A1250B	"Transportation: Yes, kept from non-med appts."	No	No	No	No	Yes	No	Yes	2
A1250C	Transportation: No	No	No	No	No	Yes	No	Yes	2
A1300D	Lifetime occupation(s)	Yes	No	No	No	Yes	No	No	2
A1500	Preadmission Screening and Resident Review (PASRR). Is the resident currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition?	No	No	No	No	No	Yes	Yes	2
A1600	Entry date (date of admission/reentry in facility)	Yes	No	No	No	No	No	Yes	2
A1800	Entered from	No	No	Yes	Yes	No	No	No	2
A2100	Discharge status	No	No	No	No	Yes	No	Yes	2
C0600	Staff assessment mental status: conduct assessment	No	No	No	Yes	No	No	Yes	2
D0100	Consider not including	No	No	No	Yes	No	No	Yes	2
D0150A1/M1730	PHQ 2 to 9: little interest or pleasure - presence	No	No	No	Yes	Yes	No	No	2
D0150A2	PHQ 2 to 9: little interest or pleasure - frequency	No	No	No	Yes	Yes	No	No	2
D0150B1	"PHQ 2 to 9: feeling down, depressed - presence"	No	No	No	Yes	Yes	No	No	2
D0150B2	"PHQ 2 to 9: feeling down, depressed - frequency"	No	No	No	Yes	Yes	No	No	2
D0150C1	PHQ 2 to 9: trouble with sleep - presence	No	No	No	Yes	Yes	No	No	2
D0150C2	PHQ 2 to 9: trouble with sleep - frequency	No	No	No	Yes	Yes	No	No	2
D0150F1	PHQ 2 to 9: feeling bad about self - presence	No	No	No	Yes	Yes	No	No	2
D0150F2	PHQ 2 to 9: feeling bad about self - frequency	No	No	No	Yes	Yes	No	No	2
D0150G1	PHQ 2 to 9: trouble concentrating - presence	No	No	No	Yes	Yes	No	No	2
D0150G2	PHQ 2 to 9: trouble concentrating - frequency	No	No	No	Yes	Yes	No	No	2
D0150H1	"PHQ 2 to 9: slow, fidgety, restless - presence"	No	No	No	Yes	Yes	No	No	2
D0150H2	"PHQ 2 to 9: slow, fidgety, restless - frequency"	No	No	No	Yes	Yes	No	No	2
D0200A1	PHQ9: little interest or pleasure - presence	No	No	No	Yes	Yes	No	No	2
D0200A2	PHQ9: little interest or pleasure - frequency	No	No	No	Yes	Yes	No	No	2
D0200B1	"PHQ9: feeling down, depressed - presence"	No	No	No	Yes	Yes	No	No	2
D0200B2	"PHQ9: feeling down, depressed - frequency"	No	No	No	Yes	Yes	No	No	2
D0200C1	PHQ9: trouble with sleep - presence	No	No	No	Yes	Yes	No	No	2
D0200C2	PHQ9: trouble with sleep - frequency	No	No	No	Yes	Yes	No	No	2
D0200F1	PHQ9: feeling bad about yourself - presence	No	No	No	Yes	Yes	No	No	2
D0200F2	PHQ9: feeling bad about self - frequency	No	No	No	Yes	Yes	No	No	2
D0200G1	PHQ9: trouble concentrating - presence	No	No	No	Yes	Yes	No	No	2
D0200G2	PHQ9: trouble concentrating - frequency	No	No	No	Yes	Yes	No	No	2
D0200H1	"PHQ9: slow, fidgety, restless - presence"	No	No	No	Yes	Yes	No	No	2
D0200H2	"PHQ9: slow, fidgety, restless - frequency"	No	No	No	Yes	Yes	No	No	2
D0200I1	PHQ9: thoughts better off dead - presence	No	No	No	Yes	Yes	No	No	2
D0200I2	PHQ9: thoughts better off dead - frequency	No	No	No	Yes	Yes	No	No	2
D0500A1	PHQ9 staff: little interest or pleasure - Presence	No	No	No	Yes	Yes	No	No	2
D0500A2	PHQ9 staff: little interest or pleasure - frequency	No	No	No	Yes	Yes	No	No	2
D0500B1	"PHQ9 staff: feeling down, depressed - presence"	No	No	No	Yes	Yes	No	No	2
D0500B2	"PHQ9 staff: feeling down, depressed - frequency"	No	No	No	Yes	Yes	No	No	2
D0500C1	PHQ9 staff: trouble with sleep - presence	No	No	No	Yes	Yes	No	No	2
D0500C2	PHQ9 staff: trouble with sleep - frequency	No	No	No	Yes	Yes	No	No	2
D0500D1	PHQ9 staff: feeling tired/little energy - presence	No	No	No	Yes	Yes	No	No	2
D0500D2	PHQ9 staff: feeling tired/little energy - frequency	No	No	No	Yes	Yes	No	No	2
D0500F1	PHQ9 staff: feeling bad about self - presence	No	No	No	Yes	Yes	No	No	2
D0500F2	PHQ9 staff: feeling bad about self - frequency	No	No	No	Yes	Yes	No	No	2
D0500G1	PHQ9 staff: trouble concentrating - presence	No	No	No	Yes	Yes	No	No	2
D0500G2	PHQ9 staff: trouble concentrating - frequency	No	No	No	Yes	Yes	No	No	2
D0500H1	"PHQ9 staff: slow, fidgety, restless - presence"	No	No	No	Yes	Yes	No	No	2
D0500H2	"PHQ9 staff: slow, fidgety, restless - frequency"	No	No	No	Yes	Yes	No	No	2
D0500J1	PHQ9 staff: short-tempered - presence	No	No	No	Yes	Yes	No	No	2
D0500J2	PHQ9 staff: short-tempered - frequency	No	No	No	Yes	Yes	No	No	2
F0800G	Staff assessment: snacks between meals	Yes	No	No	No	Yes	No	No	2
F0800P	Staff assessment: doing things with groups	Yes	No	No	No	Yes	No	No	2
F0900A2	Living arrangement - past month	No	No	Yes	No	Yes	No	No	2
F0920D1	Availability - medication administration - paid	No	No	No	No	Yes	No	Yes	2
F0920D2	Availability - medication administration - unpaid	No	No	No	No	Yes	No	Yes	2
F2000A	Was {patient/resident} asked about CPR	No	Yes	No	No	Yes	No	No	2
F2000B	Date asked about CPR	No	Yes	No	No	Yes	No	No	2
F2200A	Was {patient/resident} asked about hospitalization	No	Yes	No	No	Yes	No	No	2
F2200B	Date asked about hospitalization	No	Yes	No	No	Yes	No	No	2
GG0130A2	Self-care (discharge goal) - eating	Yes	No	No	No	Yes	No	No	2
GG0130B8	Self-care (most dependent performance) - oral hygiene	Yes	No	No	No	Yes	No	No	2
GG0130CC7	Self-care (usual performance) - toileting hygiene	No	No	Yes	No	Yes	No	No	2
GG0130D7	Self-care (usual performance) - wash upper body	No	No	Yes	No	Yes	No	No	2
GG0130EE7	Self-care (usual performance) - shower/bathe self	No	No	Yes	No	Yes	No	No	2
GG0130F7	Self-care (usual performance) - upper body dressing	No	No	Yes	No	Yes	No	No	2
GG0130G7	Self-care (usual performance) - lower body dressing	No	No	Yes	No	Yes	No	No	2
GG0130H7	Self-care (usual performance) - on/off footwear	No	No	Yes	No	Yes	No	No	2
GG0170C8	Functional mobility (most dependent performance) - lying to sitting on side of bed	Yes	No	No	No	Yes	No	No	2
GG0170F7	Functional mobility (usual performance) - toilet transfer	No	No	Yes	No	Yes	No	No	2
GG0170G7	Functional mobility (usual performance) - car transfer	No	No	Yes	No	Yes	No	No	2
GG0170I8	Functional mobility (most dependent performance) - walk 10 feet	Yes	No	No	No	Yes	No	No	2
GG0170J8	Functional mobility (most dependent performance) - walk 50 feet w/2 turns	Yes	No	No	No	Yes	No	No	2
GG0170K8	Functional mobility (most dependent performance) - walk 150 feet	Yes	No	No	No	Yes	No	No	2
GG0170L7	Functional mobility (usual performance) - walk 10 feet uneven surface	No	No	Yes	No	Yes	No	No	2
GG0170M8	Functional mobility (most dependent performance) - 1 step (curb)	Yes	No	No	No	Yes	No	No	2
GG0170N8	Functional mobility (most dependent performance) - 4 steps	Yes	No	No	No	Yes	No	No	2
GG0170O8	Functional mobility (most dependent performance) - 12 steps	Yes	No	No	No	Yes	No	No	2
GG0170P8	Functional mobility (most dependent performance) - picking up object	Yes	No	No	No	Yes	No	No	2
GG0170U8	Functional mobility (most dependent performance) - walk indoors	Yes	No	No	No	Yes	No	No	2
GG0170V8	Functional mobility (most dependent performance) - carry something in both hands	Yes	No	No	No	Yes	No	No	2
GG0170W8	Functional mobility (most dependent performance) - walk for 15 minutes	Yes	No	No	No	Yes	No	No	2
GG0170X7	Functional mobility (usual performance) - walk across street	No	No	Yes	No	Yes	No	No	2
GG0175	Mobility (Wheelchair)	Yes	No	No	No	Yes	No	No	2
GG0175A	Does the {patient/resident} use a manual wheelchair	No	Yes	No	No	Yes	No	No	2
GG0175B7	Wheelchair mobility (usual performance) - wheel 50 feet w/2 turns - manual wheelchair	No	No	Yes	No	Yes	No	No	2
GG0175C7	Wheelchair mobility (usual performance) - wheel 150 feet - manual wheelchair	No	No	Yes	No	Yes	No	No	2
GG0175D7	Wheelchair mobility (usual performance) - wheel for 15 min - manual wheelchair	No	No	Yes	No	Yes	No	No	2
GG0175E7	Wheelchair mobility (usual performance) - wheel across street - manual wheelchair	No	No	Yes	No	Yes	No	No	2
GG0175G7	Wheelchair mobility (usual performance) - wheel 50 feet w/2 turns - motorized wheelchair	No	No	Yes	No	Yes	No	No	2
GG0175H7	Wheelchair mobility (usual performance) - wheel 150 feet - motorized wheelchair	No	No	Yes	No	Yes	No	No	2
GG0175I7	Wheelchair mobility (usual performance) - wheel for 15 min - motorized wheelchair	No	No	Yes	No	Yes	No	No	2
GG0175J7	Wheelchair mobility (usual performance) - wheel across street - motorized wheelchair	No	No	Yes	No	Yes	No	No	2
GG0185A8	IADL (most dependent performance) - make light cold meal	Yes	No	No	No	Yes	No	No	2
GG0185B8	IADL (most dependent performance) - make light hot meal	Yes	No	No	No	Yes	No	No	2
GG0185C8	IADL (most dependent performance) - light daily housework	Yes	No	No	No	Yes	No	No	2
GG0185D8	IADL (most dependent performance) - heavier periodic housework	Yes	No	No	No	Yes	No	No	2
GG0185E8	IADL (most dependent performance) - light shopping	Yes	No	No	No	Yes	No	No	2
GG0185F7	IADL (usual performance) - telephone - answering call	No	No	Yes	No	Yes	No	No	2
GG0185G7	IADL (usual performance) - telephone - placing call	No	No	Yes	No	Yes	No	No	2
GG0185H8	IADL (most dependent performance) - oral medication management	No	No	No	No	Yes	No	Yes	2
GG0185I7	IADL (usual performance) - inhalant/mist medication management	No	No	Yes	No	Yes	No	No	2
GG0185J8	IADL (most dependent performance) - injectable medication management	No	No	No	No	Yes	No	Yes	2
GG0185K8	IADL (most dependent performance) - simple financial management	No	No	No	No	Yes	No	Yes	2
GG0185L8	IADL (most dependent performance) - complex financial management	No	No	No	No	Yes	No	Yes	2
J0500B	Pain interview: limited daily activities	Yes	Yes	No	No	No	No	No	2
J0600A	"Numeric Rating Scale (00-10). Ask {patient/resident} ""Please rate your worst pain over the last 5 days on a zero to ten scale, with zero being no pain and ten as the worst pain you can imagine."" (Show {patient/resident} 00-10 pain scale) Enter two-digit response. Enter 99 if unable to answer."	No	Yes	No	No	No	Yes	No	2
J0600B	"Verbal Descriptor Scale. Ask {patient/resident} ""Please rate the intensity of your worst pain over the last 5 days."" (Show {patient/resident} verbal scale)"	No	Yes	No	No	No	Yes	No	2
J2040B	Date treatment for shortness of breath initiated	No	Yes	No	No	Yes	No	No	2
K0510Z1	Nutrition approach: Not Res: none of the above	Yes	No	No	Yes	No	No	No	2
K0510Z2	Nutrition approach: Res: none of the above	Yes	No	No	Yes	No	No	No	2
K0710	Percent intake by artificial route	Yes	No	No	Yes	No	No	No	2
K0710A1	Prop calories parenteral/tube feed: not resident	No	No	No	Yes	Yes	No	No	2
K0710B1	Avg fluid intake per day IV/tube: not resident	No	No	No	Yes	Yes	No	No	2
M0150_CPAY_NONE	Payment sources: no charge for current services	No	No	No	No	Yes	No	Yes	2
M0150_CPAY_OTH_GOVT	Payment sources: other government	No	No	No	No	Yes	No	Yes	2
M0150_CPAY_OTHER	Payment sources: other	No	No	No	No	Yes	No	Yes	2
M0150_CPAY_PRIV_HMO	Payment sources: private HMO/managed care	No	No	No	No	Yes	No	Yes	2
M0150_CPAY_PRIV_INS	Payment sources: private insurance	No	No	No	No	Yes	No	Yes	2
M0150_CPAY_SELFPAY	Payment sources: self-pay	No	No	No	No	Yes	No	Yes	2
M0150_CPAY_TITLEPGMS	Payment sources: title programs	No	No	No	No	Yes	No	Yes	2
M0150_CPAY_UK	Payment sources: unknown	No	No	No	No	Yes	No	Yes	2
M0150_CPAY_WRKCOMP	Payment sources: worker's compensation	No	No	No	No	Yes	No	Yes	2
M0300B3	Stage 2 pressure ulcers: date of oldest	Yes	Yes	No	No	No	No	No	2
M0610A	Stage 3 or 4 pressure ulcer longest length	Yes	Yes	No	No	No	No	No	2
M0610B	Stage 3 or 4 pressure ulcer width (same ulcer)	Yes	Yes	No	No	No	No	No	2
M0610C	Stage 3 or 4 pressure ulcer depth (same ulcer)	Yes	Yes	No	No	No	No	No	2
M0800A	Worsened since prior asmt: Stage 2 pressure ulcers	Yes	Yes	No	No	No	No	No	2
M0800B	Worsened since prior asmt: Stage 3 pressure ulcers	Yes	Yes	No	No	No	No	No	2
M0800C	Worsened since prior asmt: Stage 4 pressure ulcers	Yes	Yes	No	No	No	No	No	2
M0900A	Pressure ulcers on prior assessment	Yes	Yes	No	No	No	No	No	2
M0900B	Healed pressure ulcers: Stage 2	Yes	Yes	No	No	No	No	No	2
M0900C	Healed pressure ulcers: Stage 3	Yes	Yes	No	No	No	No	No	2
M0900D	Healed pressure ulcers: Stage 4	Yes	Yes	No	No	No	No	No	2
M1010_14_DAY_INP1_ICD	Inpatient Stay Within Last 14 Days: ICD Code 1:	No	No	No	Yes	No	No	Yes	2
M1010_14_DAY_INP2_ICD	Inpatient Stay Within Last 14 Days: ICD Code 2:	No	No	No	Yes	No	No	Yes	2
M1010_14_DAY_INP3_ICD	Inpatient Stay Within Last 14 Days: ICD Code 3:	No	No	No	Yes	No	No	Yes	2
M1010_14_DAY_INP4_ICD	Inpatient Stay Within Last 14 Days: ICD Code 4:	No	No	No	Yes	No	No	Yes	2
M1018_PRIOR_NOCHG_14D	Prior condition: no inpt disch/no change regimen	Yes	No	No	No	Yes	No	No	2
M1018_PRIOR_NONE	Prior condition: none of the above	Yes	No	No	No	Yes	No	No	2
M1018_PRIOR_UNKNOWN	Prior condition: unknown	Yes	No	No	No	Yes	No	No	2
M1046	Did {patient/resident} receive influenza vaccine	No	Yes	No	No	Yes	No	No	2
M1050_PPV_RCVD_AGNCY	Did the patient receive pneumococcal polysaccharide vaccine (PPV):	No	Yes	No	No	Yes	No	No	2
M1051	Was pneumococcal vaccine received	No	Yes	No	No	Yes	No	No	2
M1310_PRSR_ULCR_LNGTH	Head To Toe Length Of Stage III Or IV Pressure Ulcer With Largest Area:	Yes	Yes	No	No	No	No	No	2
M1322_NBR_PRSULC_STG1	Number of stage 1 pressure ulcers	Yes	Yes	No	No	No	No	No	2
M1600	Treated for urinary tract infection past 14 days	No	Yes	No	No	Yes	No	No	2
M1900_PRIOR_ADLIADL_AMBLTN	Prior functioning ADL/IADL: ambulation	No	No	Yes	No	No	No	Yes	2
M1900_PRIOR_ADLIADL_HSEHOLD	Prior functioning ADL/IADL: household tasks	No	No	Yes	No	No	No	Yes	2
M1900_PRIOR_ADLIADL_SELF	Prior functioning ADL/IADL: self-care	No	No	Yes	No	No	No	Yes	2
M2430_HOSP_DHYDRTN_MALNTR	"Hospitalized: dehydration, malnutrition"	Yes	No	No	Yes	No	No	No	2
M2430_HOSP_MENTL_BHVRL_PRBLM	Hospitalized: acute mental/behav problem	No	No	No	Yes	No	No	Yes	2
N0410G	Medication received: days: diuretic	Yes	No	No	No	Yes	No	No	2
N0415Z1	High-Risk Drug Classes: None of Above: Is taking	Yes	No	No	No	Yes	No	No	2
O0100G1	Treatment: BiPAP/CPAP - while not resident	No	Yes	No	No	Yes	No	No	2
O0100G2	Treatment: BIPAP/CPAP - while resident	No	Yes	No	No	Yes	No	No	2
O0100H1	Treatment: IV medications - while not resident	No	Yes	No	No	Yes	No	No	2
O0100H2	Treatment: IV medications - while resident	No	Yes	No	No	Yes	No	No	2
O0100I1	Treatment: transfusions - while not resident	No	Yes	No	No	Yes	No	No	2
O0100I2	Treatment: transfusions - while resident	No	Yes	No	No	Yes	No	No	2
O0100J1	Treatment: dialysis - while not resident	No	Yes	No	No	Yes	No	No	2
O0100L2	Treatment: respite care - while resident	No	Yes	No	Yes	No	No	No	2
O0100M1	Treatment: isolate/quarantine - while not resident	No	Yes	No	No	Yes	No	No	2
O0110H4a	Treatment: IV Medications - Anticoagulation - On Adm	No	Yes	No	No	Yes	No	No	2
O0150A	Invasive Mechanical Ventilator Support upon admission	No	No	No	Yes	No	Yes	No	2
O0150A2	Ventilator weaning status	No	No	No	Yes	No	Yes	No	2
O0200A	Invasive Mechanical Ventilator: Liberation Status at Discharge	No	No	No	Yes	No	Yes	No	2
O0250A	Was influenza vaccine received	No	Yes	No	No	Yes	No	No	2
O0250B	Date influenza vaccine received	No	Yes	No	No	Yes	No	No	2
O0250C	"If influenza vaccine not received, state reason"	No	Yes	No	No	Yes	No	No	2
O0300A	Is pneumococcal vaccination up to date	No	Yes	No	No	Yes	No	No	2
O0400A	Speech-language pathology and audiology services	Yes	No	No	Yes	No	No	No	2
Q0300A	{Patient's/resident's} overall goal	No	No	No	Yes	No	No	Yes	2
Q0400A	Active discharge planning for return to community	No	No	No	Yes	No	No	Yes	2
Q0500B	Do you want to talk about returning to community	No	No	No	Yes	No	No	Yes	2
S0111	Lived Alone	No	No	No	Yes	No	No	Yes	2
S0130	Highest Education Completed	No	No	No	Yes	No	No	Yes	2
S0161A	Requires specialized unit: dementia/Alzheimer	No	No	No	Yes	No	No	Yes	2
S0161B	Requires specialized unit: behavioral health	No	No	No	Yes	No	No	Yes	2
S0161C	Requires specialized unit: TBI	No	No	No	Yes	No	No	Yes	2
S0165A	Specialty services: Dementia/Alzheimers	No	No	No	Yes	No	No	Yes	2
S0165B	Specialty services: Behavioral Health	No	No	No	Yes	No	No	Yes	2
S0165C	Specialty services: Traumatic Brain Injury	No	No	No	Yes	No	No	Yes	2
S0170A	Advanced directive: Guardian	No	No	Yes	No	No	No	Yes	2
S0170B	Advanced directive: DPOA-HC	No	No	Yes	No	No	No	Yes	2
S0170C	Advanced directive: Living will	No	No	Yes	No	No	No	Yes	2
S0170Z	Advanced directive: None of the above	No	No	Yes	No	No	No	Yes	2
S0171A	Resident healthcare proxy exists	No	No	Yes	No	No	No	Yes	2
S0171B	Resident healthcare proxy invoked	No	No	Yes	No	No	No	Yes	2
S0180	Discharged to Community	No	No	No	Yes	No	No	Yes	2
S1100B	Disease: MRSA	No	Yes	No	Yes	No	No	No	2
S1100C	Disease: VRE	No	Yes	No	Yes	No	No	No	2
S1100D	Disease: VISA	No	Yes	No	Yes	No	No	No	2
S1100E	Disease: VRSA	No	Yes	No	Yes	No	No	No	2
S1100F	Disease: Other MDRO	No	Yes	No	Yes	No	No	No	2
S1100F1	Disease: MDRO Name1	No	Yes	No	Yes	No	No	No	2
S1100F2	Disease: MDRO Name2	No	Yes	No	Yes	No	No	No	2
S1100G	Disease: Tuberculosis	No	Yes	No	Yes	No	No	No	2
S1100H	Disease: Herpes Zoster	No	Yes	No	Yes	No	No	No	2
S1100I	Disease: Scabies	No	Yes	No	Yes	No	No	No	2
S1100J	Disease: CRE	No	Yes	No	Yes	No	No	No	2
S1150	Active TBI Diagnosis	No	No	No	Yes	No	No	Yes	2
S2000	Capable of self-administration of medications	No	No	No	Yes	No	No	Yes	2
S2001	Wishes to self-medicate	No	No	No	Yes	No	No	Yes	2
S2010	Refused meds 3 days	No	No	No	Yes	No	No	Yes	2
S2011	Staff support for meds 3 days	No	No	No	Yes	No	No	Yes	2
S2040	Behavior Management Program	No	No	No	Yes	No	No	Yes	2
S4500	Substance Abuse: Alcoholic Drinks	No	No	No	Yes	No	No	Yes	2
S4510A	Substance Abuse: Inhalants	No	No	No	Yes	No	No	Yes	2
S4510B	Substance Abuse: Hallucinogens	No	No	No	Yes	No	No	Yes	2
S4510C	Substance Abuse: Cocaine and Crack	No	No	No	Yes	No	No	Yes	2
S4510D	Substance Abuse: Stimulants	No	No	No	Yes	No	No	Yes	2
S4510E	Substance Abuse: Opiates	No	No	No	Yes	No	No	Yes	2
S4510F	Substance Abuse: Cannabis	No	No	No	Yes	No	No	Yes	2
S6000	Parenteral/IV feeding in NH	Yes	No	No	Yes	No	No	No	2
S6050	Isolation precautions needed	Yes	No	No	Yes	No	No	No	2
6	Birth Date	No	No	No	No	No	Yes	No	1
8	Gender	No	No	No	No	No	Yes	No	1
42	Were there program interruption(s) during stay	No	No	No	No	No	No	Yes	1
20A	Primary source	No	No	Yes	No	No	No	No	1
A0100A	National Provider Identifier (NPI)	No	No	No	No	Yes	No	No	1
A0270	Discharge Date	No	No	No	No	No	Yes	No	1
A0310	Type of assessment	Yes	No	No	No	No	No	No	1
A1000A	Ethnicity: American Indian or Alaska Native	No	No	No	No	Yes	No	No	1
A1000B	Ethnicity: Asian	No	No	No	No	Yes	No	No	1
A1000C	Ethnicity: Black or African American	No	No	No	No	Yes	No	No	1
A1000D	Ethnicity: Hispanic or Latino	No	No	No	No	Yes	No	No	1
A1000E	Ethnicity: Native Hawaiian/Pacific Islander	No	No	No	No	Yes	No	No	1
A1000F	Ethnicity: White	No	No	No	No	Yes	No	No	1
A1110A	What is your preferred language?	No	No	No	No	No	Yes	No	1
A1110B	Do you need or want an interpreter to communicate with a doctor or health care staff?	No	No	No	No	No	Yes	No	1
A1250	"Transportation (from NACHC). Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed from daily living?"	No	No	No	No	No	Yes	No	1
A1510	"Level II Preadmission Screening and Resident Review (PASRR) Conditions: Check all that apply: (A) Serious mental illness, (B) Intellectual Disability, (C) Other related conditions"	No	No	No	No	No	Yes	No	1
A1550	"Conditions Related to ID/DD Status. Check all conditions that are related to ID/DD status that were manifested before age 22, and are likely to continue indefinitely: (A) Down syndrome, (B) Autism, (C) Epilepsy, (D) Other organic condition related to ID/DD, (E) ID/DD with no organic condition"	No	No	No	No	No	Yes	No	1
A2400A	Has {patient/resident} had Medicare-covered stay	No	No	No	No	Yes	No	No	1
B0200	"Hearing. Ability to hear (with hearing aid or hearing appliances if normally used): (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"	No	No	No	No	No	Yes	No	1
B0300	Hearing Aid. Hearing aid or other hearing appliance used in completing {Hearing question}	No	No	No	No	No	Yes	No	1
B0600	"Speech Clarity. Select best description of speech pattern: (0) Clear speech - distinct intelligible words, (1) Unclear speech - slurred or mumbled words, (2) No speech - absence of spoken words"	No	No	No	No	No	Yes	No	1
B0700	"Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression: (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"	No	No	No	No	No	Yes	No	1
B0800	"Ability To Understand Others. Understanding verbal content, however able (with hearing aid or device if used): (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 understands"	No	No	No	No	No	Yes	No	1
B1000	"Vision. Ability to see in adequate light (with glasses or other visual appliances): (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"	No	No	No	No	No	Yes	No	1
B1200	"Corrective lenses (contacts, glasses or magnifying glass) used in completing {Vision question}"	No	No	No	No	No	Yes	No	1
BB0700	"Expression of Ideas and Wants (consider both verbal and non-verbal expression and excluding language barriers): (4) Expresses complex messages without difficulty and with speech that is clear and easy to understand, (3) Exhibits some difficulty with expressing needs and ideas (e.g., some words or finishing thoughts) or speech is not clear, (2) Frequently exhibits difficulty with expressing needs and ideas, (1) Rarely/Never expresses self or speech is very difficult to understand, (-) Not assessed/no information"	No	No	No	No	No	Yes	No	1
BB0800	"Understanding Verbal and Non-Verbal Content (with hearing aid or device, if used, and excluding language barriers): (4) Understands: Clear comprehension without cues or repetitions, (3) Usually understands: Understands most conversations, but misses some part/intent of message. Requires cues at times to understand, (2) Sometimes understands: Understands only basic conversations or simple, direct phrases. Frequently requires cues to understand, (1) Rarely/never understands, (-) Not assessed/no information"	No	No	No	No	No	Yes	No	1
D0350	PHQ res: safety notification	No	No	No	Yes	No	No	No	1
D0650	PHQ staff: safety notification	No	No	No	Yes	No	No	No	1
F0300	Conduct {patient/resident} interview for daily/activity preferences	Yes	No	No	No	No	No	No	1
F0400	Interview for daily preferences	Yes	No	No	No	No	No	No	1
F0400D	Interview: have snacks between meals	Yes	No	No	No	No	No	No	1
F0500H	Interview: participate in religious practices	Yes	No	No	No	No	No	No	1
F0800A	Staff assessment: choosing clothes to wear	No	No	No	No	Yes	No	No	1
F0800B	Staff assessment: caring for personal belongings	No	No	No	No	Yes	No	No	1
F0800C	Staff assessment: receiving tub bath	No	No	No	No	Yes	No	No	1
F0800D	Staff assessment: receiving shower	No	No	No	No	Yes	No	No	1
F0800E	Staff assessment: receiving bed bath	No	No	No	No	Yes	No	No	1
F0800F	Staff assessment: receiving sponge bath	No	No	No	No	Yes	No	No	1
F0800H	Staff assessment: staying up past 8PM	No	No	No	No	Yes	No	No	1
F0800I	Staff assessment: discuss care with family/other	No	No	No	No	Yes	No	No	1
F0800J	Staff assessment: use phone in private	No	No	No	No	Yes	No	No	1
F0800K	Staff assessment: place to lock personal things	No	No	No	No	Yes	No	No	1
F0800L	"Staff assessment: reading books, newspapers, mags"	No	No	No	No	Yes	No	No	1
F0800M	Staff assessment: listening to music	No	No	No	No	Yes	No	No	1
F0800N	Staff assessment: being around animals/pets	No	No	No	No	Yes	No	No	1
F0800O	Staff assessment: keeping up with news	No	No	No	No	Yes	No	No	1
F0800Q	Staff assessment: participate favorite activities	No	No	No	No	Yes	No	No	1
F0800R	Staff assessment: spend time away from nursing home	No	No	No	No	Yes	No	No	1
F0800S	Staff assessment: spend time outdoors	No	No	No	No	Yes	No	No	1
F0800T	Staff assessment: participate religious activities	No	No	No	No	Yes	No	No	1
F0900A1	Living arrangement - past 3 days	No	No	No	No	Yes	No	No	1
F0905A	Living arrangement priority - A	No	No	No	No	Yes	No	No	1
F0905B	Living arrangement priority - B	No	No	No	No	Yes	No	No	1
F0910B1	Level of assistance in home - paid	No	No	No	No	Yes	No	No	1
F0910B2	Level of assistance in home - unpaid	No	No	No	No	Yes	No	No	1
F0920	Availability of paid and unpaid assistance	No	No	No	No	Yes	No	No	1
F0920A1	Availability - self-care assistance - paid	No	No	No	No	Yes	No	No	1
F0920A2	Availability - self-care assistance - unpaid	No	No	No	No	Yes	No	No	1
F0920B1	Availability - mobility assistance - paid	No	No	No	No	Yes	No	No	1
F0920B2	Availability - mobility assistance - unpaid	No	No	No	No	Yes	No	No	1
F0920C1	Availability - IADL assistance - paid	No	No	No	No	Yes	No	No	1
F0920C2	Availability - IADL assistance - unpaid	No	No	No	No	Yes	No	No	1
F0920E1	Availability - medical procedures/treatments - paid	No	No	No	No	Yes	No	No	1
F0920E2	Availability - medical procedure/treatments - unpaid	No	No	No	No	Yes	No	No	1
F0920F1	Availability - management of equipment - paid	No	No	No	No	Yes	No	No	1
F0920F2	Availability - management of equipment - unpaid	No	No	No	No	Yes	No	No	1
F0920G1	Availability - supervision - paid	No	No	No	No	Yes	No	No	1
F0920G2	Availability - supervision - unpaid	No	No	No	No	Yes	No	No	1
F0920H1	Availability - advocacy/facility of medical care - paid	No	No	No	No	Yes	No	No	1
F0920H2	Availability - advocacy/facility of medical care - unpaid	No	No	No	No	Yes	No	No	1
F0925A	Caregiving priority - A	No	No	No	No	Yes	No	No	1
F0925B	Caregiving priority - B	No	No	No	No	Yes	No	No	1
F3000A	Was {patient/resident} asked spiritual/existential concerns	No	No	No	No	Yes	No	No	1
F3000B	Date asked about spiritual/existential concerns	No	No	No	No	Yes	No	No	1
GG0100A	Prior function - self care	No	No	Yes	No	No	No	No	1
GG0100D	Prior function - functional cognition	No	No	No	Yes	No	No	No	1
GG0115A	"Upper Extremity (shoulder, elbow, wrist, hand)"	No	No	No	No	No	Yes	No	1
GG0115B	"Lower Extremity (hip, knee, ankle, foot)"	No	No	No	No	No	Yes	No	1
GG0130A1	Eating: The ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the {patient/resident}. - Admission Performance	No	No	No	No	No	Yes	No	1
GG0130C1	"Toileting hygiene: The ability to maintain perineal hygiene, adjust clothes before and after voiding or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment. - Admission Performance"	No	No	No	No	No	Yes	No	1
GG0130C4	Self-care (follow-up performance) - toileting hygiene	No	No	No	No	Yes	No	No	1
GG0130CC8	Self-care (most dependent performance) - toileting hygiene	No	No	No	No	Yes	No	No	1
GG0130D1	Self-care (admission performance) - wash upper body	No	No	Yes	No	No	No	No	1
GG0130D3	Self-care (discharge performance) - wash upper body	No	No	Yes	No	No	No	No	1
GG0130D8	Self-care (most dependent performance) - wash upper body	No	No	No	No	Yes	No	No	1
GG0130EE8	Self-care (most dependent performance) - shower/bathe self	No	No	No	No	Yes	No	No	1
GG0130F8	Self-care (most dependent performance) - upper body dressing	No	No	No	No	Yes	No	No	1
GG0130G8	Self-care (most dependent performance) - lower body dressing	No	No	No	No	Yes	No	No	1
GG0130H8	Self-care (most dependent performance) - on/off footwear	No	No	No	No	Yes	No	No	1
GG0135A	Self-care priority - A	No	No	No	No	Yes	No	No	1
GG0135B	Self-care priority - B	No	No	No	No	Yes	No	No	1
GG0170A8	Functional mobility (most dependent performance) - roll left and right	No	No	No	No	Yes	No	No	1
GG0170B8	Functional mobility (most dependent performance) - sit to lying	No	No	No	No	Yes	No	No	1
GG0170D8	Functional mobility (most dependent performance) - sit to stand	No	No	No	No	Yes	No	No	1
GG0170E8	Functional mobility (most dependent performance) - chair/bed-to-chair transfer	No	No	No	No	Yes	No	No	1
GG0170F3	Functional mobility (discharge performance) - toilet transfer	No	No	No	No	Yes	No	No	1
GG0170F5	Functional mobility (interim performance) - toilet transfer	No	No	No	No	Yes	No	No	1
GG0170F8	Functional mobility (most dependent performance) - toilet transfer	No	No	No	No	Yes	No	No	1
GG0170G3	Functional mobility (discharge performance) - car transfer	No	No	No	No	Yes	No	No	1
GG0170G8	Functional mobility (most dependent performance) - car transfer	No	No	No	No	Yes	No	No	1
GG0170I5	Functional mobility (interim performance) - walk 10 feet	No	No	No	No	Yes	No	No	1
GG0170J3	Functional mobility (discharge performance) - walk 50 feet w/2 turns	No	No	No	No	Yes	No	No	1
GG0170J5	Functional mobility (interim performance) - walk 50 feet w/2 turns	No	No	No	No	Yes	No	No	1
GG0170K1	Functional mobility (admission performance) - walk 150 feet	No	No	No	No	Yes	No	No	1
GG0170K3	Functional mobility (discharge performance) - walk 150 feet	No	No	No	No	Yes	No	No	1
GG0170L8	Functional mobility (most dependent performance) - walk 10 feet uneven surface	No	No	No	No	Yes	No	No	1
GG0170M3	Functional mobility (discharge performance) - 1 step (curb)	No	No	No	No	Yes	No	No	1
GG0170N3	Functional mobility (discharge performance) - 4 steps	No	No	No	No	Yes	No	No	1
GG0170O3	Functional mobility (discharge performance) - 12 steps	No	No	No	No	Yes	No	No	1
GG0170P3	Functional mobility (discharge performance) - picking up object	No	No	No	No	Yes	No	No	1
GG0170Q3	Does the {patient/resident} use a wheelchair and/or scooter (discharge)	No	No	No	No	Yes	No	No	1
GG0170R3	Functional mobility (discharge performance) - wheel 50 feet w/2 turns	No	No	No	No	Yes	No	No	1
GG0170RR3	Indicate the type of wheelchair or scooter used (Discharge Performance)	No	No	Yes	No	No	No	No	1
GG0170X8	Functional mobility (most dependent performance) - walk across street	No	No	No	No	Yes	No	No	1
GG0175B8	Wheelchair mobility (most dependent performance) - wheel 50 feet w/2 turns - manual wheelchair	No	No	No	No	Yes	No	No	1
GG0175C8	Wheelchair mobility (most dependent performance) - wheel 150 feet - manual wheelchair	No	No	No	No	Yes	No	No	1
GG0175D8	Wheelchair mobility (most dependent performance) - wheel for 15 min - manual wheelchair	No	No	No	No	Yes	No	No	1
GG0175E8	Wheelchair mobility (most dependent performance) - wheel across street - manual wheelchair	No	No	No	No	Yes	No	No	1
GG0175F	Does the {patient/resident} use a motorized wheelchair	No	No	No	No	Yes	No	No	1
GG0175G8	Wheelchair mobility (most dependent performance) - wheel 50 feet w/2 turns - motorized wheelchair	No	No	No	No	Yes	No	No	1
GG0175H8	Wheelchair mobility (most dependent performance) - wheel 150 feet - motorized wheelchair	No	No	No	No	Yes	No	No	1
GG0175I8	Wheelchair mobility (most dependent performance) - wheel for 15 min - motorized wheelchair	No	No	No	No	Yes	No	No	1
GG0175J8	Wheelchair mobility (most dependent performance) - wheel across street - motorized wheelchair	No	No	No	No	Yes	No	No	1
GG0180A	Mobility priority - A	No	No	No	No	Yes	No	No	1
GG0180B	Mobility priority - B	No	No	No	No	Yes	No	No	1
GG0185F8	IADL (most dependent performance) - telephone - answering call	No	No	No	No	Yes	No	No	1
GG0185G8	IADL (most dependent performance) - telephone - placing call	No	No	No	No	Yes	No	No	1
GG0185I8	IADL (most dependent performance) - inhalant/mist medication management	No	No	No	No	Yes	No	No	1
GG0190A	IADL Priority - A	No	No	No	No	Yes	No	No	1
GG0190B	IADL Priority - B	No	No	No	No	Yes	No	No	1
H0100	"Appliances: Check all that apply: (A) Indwelling catheter (including suprapubic catheter and nephrostomy tube), (B) External catheter, (C) Ostomy (including urostomy, ileostomy, and colostomy), (D) Intermittent catheterization"	No	No	No	No	No	Yes	No	1
J0100A	Received scheduled pain medication regimen?	No	No	No	No	No	Yes	No	1
J0100B	Received PRN pain medications OR was offered and declined?	No	No	No	No	No	Yes	No	1
J0100C	Received non-medication intervention for pain?	No	No	No	No	No	Yes	No	1
J0500	Pain effect on function	No	No	No	Yes	No	No	No	1
J0500A	Pain interview: made it hard to sleep	No	Yes	No	No	No	No	No	1
J0800Z	Staff pain asmt: none of these signs observed	No	No	Yes	No	No	No	No	1
J0900A	Was {patient/resident} screened for pain	No	No	No	Yes	No	No	No	1
J0900C	{Patient's/resident's} pain severity was	No	No	No	Yes	No	No	No	1
J0910C	"Comprehensive pain assessment included: Check all that apply: (1) Location, (2) Severity, (3) Character, (4) Duration, (5) Frequency, (6) What relieves/worsens pain, (7) Effect on function or quality of life, (9) None of the above"	No	No	No	No	No	Yes	No	1
J1400	Prognosis. Does the {patient/resident} have a condition or chronic disease that may result in a life expectancy of less than 6 months? (Requires physician documentation)	No	No	No	No	No	Yes	No	1
J1550	"Problem Conditions: Check all that apply: (A) Fever, (B) Vomiting, (C) Dehydrated, (D) Internal bleeding, (Z) None of the above"	No	No	No	No	No	Yes	No	1
J1550Z	Problem conditions: none of the above	No	No	Yes	No	No	No	No	1
J2040	Treatment for shortness of breath	No	No	Yes	No	No	No	No	1
K0100	"Swallowing Disorder. Signs and symptoms of possible swallowing disorder: Check all that apply: (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"	No	No	No	No	No	Yes	No	1
K0520_1	"Check all of the following nutritional approaches that apply on {admission}: (A) Parenteral/IV feeding, (B) Feeding tube (e.g., nasogastric or abdominal (PEG)), (C) ]Mechanically altered diet - require change in texture of food or liquids (e.g., pureed food, thickened liquids), (D) Therapeutic diet (e.g., low salt, diabetic, low cholesterol)"	No	No	No	No	No	Yes	No	1
L0200Z	Dental: none of the above	No	No	No	Yes	No	No	No	1
M0063_MEDICARE_NUM	"Medicare number, including suffix"	No	No	No	No	No	No	Yes	1
M0064_SSN	Patient's Social Security number	No	No	No	No	No	No	Yes	1
M0065_MEDICAID_NA	No Medicaid number	No	No	No	No	No	No	Yes	1
M0100	"Determination of Pressure Ulcer/Injury Risk: Check all that apply: (A) {Patient/Resident/Person} 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"	No	No	No	No	No	Yes	No	1
M0150	"Current Payment Sources for Home Care. Check all that apply: Risk of Pressure Ulcers/Injuries. Is this {patient/resident} at risk of developing pressure ulcers/injuries?"	No	No	No	No	No	Yes	No	1
M0210	Unhealed Pressure Ulcers/Injuries. Does this {patient/resident} have one or more unhealed pressure ulcers/injuries?	No	No	No	No	No	Yes	No	1
M0300	Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage - Admission	No	No	No	No	No	Yes	No	1
M0300_a	Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage - Admission	No	No	No	No	No	Yes	No	1
M0300_d	Current Number of Unhealed Pressure Ulcers/Injuries at Each Stage - Discharge	No	No	No	No	No	Yes	No	1
M0300A	Stage 1: Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have a visible blanching; in dark skin tones only it may appear with persistent blue or purple hues	No	No	No	No	No	Yes	No	1
M0300A1	Number of Stage 1 pressure injuries	No	No	No	No	No	Yes	No	1
M0300B	"Stage 2: Partial thickness loss of dermis presenting as a shallow open ulcer with a red or pink wound bed, without slough. May also present as an intact or open/ruptured blister."	No	No	No	No	No	Yes	No	1
M0300B1	Number of Stage 2 pressure ulcers	No	No	No	No	No	Yes	No	1
M0300B2	Number of these Stage 2 pressure ulcers that were present upon {admission}	No	No	No	No	No	Yes	No	1
M0300C	"Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling"	No	No	No	No	No	Yes	No	1
M0300C1	Number of Stage 3 pressure ulcers	No	No	No	No	No	Yes	No	1
M0300C2	Number of these Stage 3 pressure ulcers that were present upon {admission}	No	No	No	No	No	Yes	No	1
M0300D	"Stage 4: Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling"	No	No	No	No	No	Yes	No	1
M0300D1	Number of Stage 4 pressure ulcers	No	No	No	No	No	Yes	No	1
M0300D2	Number of these Stage 4 pressure ulcers that were present upon {admission}	No	No	No	No	No	Yes	No	1
M0300E	Unstageable - Non-removable dressing/device: Known but not stageable due to non-removable dressing/device	No	No	No	No	No	Yes	No	1
M0300E1	Number of unstageable pressure ulcers/injuries due to non-removable dressing/device	No	No	No	No	No	Yes	No	1
M0300E2	Number of these unstageable pressure ulcers/injuries that were present upon {admission}	No	No	No	No	No	Yes	No	1
M0300F	Unstageable - Slough and/or eschar: Known but not stageable due to coverage of wound bed by slough and/or eschar	No	No	No	No	No	Yes	No	1
M0300F1	Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar	No	No	No	No	No	Yes	No	1
M0300F2	Number of these unstageable pressure ulcers that were present upon {admission}	No	No	No	No	No	Yes	No	1
M0300G	Unstageable - Deep tissue injury	No	No	No	No	No	Yes	No	1
M0300G1	Number of unstageable pressure injuries presenting as deep tissue injury	No	No	No	No	No	Yes	No	1
M0700	Tissue type for ulcer at most advanced stage	Yes	No	No	No	No	No	No	1
M1000	Discharge facilities. Check all that apply	No	No	No	No	No	No	Yes	1
M1000_DC_IPPS_14_DA	Past 14 days: disch from short stay acute hospital	No	No	No	No	No	No	Yes	1
M1000_DC_IRF_14_DA	Past 14 days: disch from inpatient rehab facility	No	No	No	No	No	No	Yes	1
M1000_DC_LTC_14_DA	Past 14 days: disch from LTC NH	No	No	No	No	No	No	Yes	1
M1000_DC_LTCH_14_DA	Past 14 days: disch from long term care hospital	No	No	No	No	No	No	Yes	1
M1000_DC_NONE_14_DA	Past 14 days: not disch from inpatient facility	No	No	No	No	No	No	Yes	1
M1000_DC_OTH_14_DA	Past 14 days: disch from other	No	No	No	No	No	No	Yes	1
M1000_DC_PSYCH_14_DA	Past 14 days: disch from psych hospital or unit	No	No	No	No	No	No	Yes	1
M1000_DC_SNF_14_DA	Past 14 days: disch from skilled nursing facility	No	No	No	No	No	No	Yes	1
M1005	Most recent inpatient discharge date	No	No	No	No	No	No	Yes	1
M1010_14_DAY_INP5_ICD	Inpatient Stay Within Last 14 Days: ICD Code 5:	No	No	No	Yes	No	No	No	1
M1010_14_DAY_INP6_ICD	Inpatient Stay Within Last 14 Days: ICD Code 6:	No	No	No	Yes	No	No	No	1
M1011_14_DAY_INP1_ICD	Inpatient stay within last 14 days: ICD code 1	No	No	No	Yes	No	No	No	1
M1011_14_DAY_INP2_ICD	Inpatient stay within last 14 days: ICD code 2	No	No	No	Yes	No	No	No	1
M1011_14_DAY_INP3_ICD	Inpatient stay within last 14 days: ICD code 3	No	No	No	Yes	No	No	No	1
M1011_14_DAY_INP4_ICD	Inpatient stay within last 14 days: ICD code 4	No	No	No	Yes	No	No	No	1
M1011_14_DAY_INP5_ICD	Inpatient stay within last 14 days: ICD code 5	No	No	No	Yes	No	No	No	1
M1011_14_DAY_INP6_ICD	Inpatient stay within last 14 days: ICD code 6	No	No	No	Yes	No	No	No	1
M1016_CHGREG_ICD1	Regimen Change in Past 14 Days: ICD Code 1:	No	No	No	Yes	No	No	No	1
M1016_CHGREG_ICD2	Regimen Change in Past 14 Days: ICD Code 2:	No	No	No	Yes	No	No	No	1
M1016_CHGREG_ICD3	Regimen Change in Past 14 Days: ICD Code 3:	No	No	No	Yes	No	No	No	1
M1016_CHGREG_ICD4	Regimen Change in Past 14 Days: ICD Code 4:	No	No	No	Yes	No	No	No	1
M1016_CHGREG_ICD5	Regimen Change In Past 14 Days: ICD Code 5:	No	No	No	Yes	No	No	No	1
M1016_CHGREG_ICD6	Regimen Change In Past 14 Days: ICD Code 6:	No	No	No	Yes	No	No	No	1
M1017_CHGREG_ICD1	Regimen change in past 14 days: ICD code 1	No	No	No	Yes	No	No	No	1
M1017_CHGREG_ICD2	Regimen change in past 14 days: ICD code 2	No	No	No	Yes	No	No	No	1
M1017_CHGREG_ICD3	Regimen change in past 14 days: ICD code 3	No	No	No	Yes	No	No	No	1
M1017_CHGREG_ICD4	Regimen change in past 14 days: ICD code 4	No	No	No	Yes	No	No	No	1
M1017_CHGREG_ICD5	Regimen change in past 14 days: ICD code 5	No	No	No	Yes	No	No	No	1
M1017_CHGREG_ICD6	Regimen change in past 14 days: ICD code 6	No	No	No	Yes	No	No	No	1
M1040	"Other Ulcers, Wounds and Skin Problems: Check all that apply: (A) Infection of the foot (e.g., cellulitis, purulent drainage), (B) Diabetic foot ulcer(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)"	No	No	No	No	No	Yes	No	1
M1200Z	Skin/ulcer treat: none of the above	Yes	No	No	No	No	No	No	1
M1300_PRSR_ULCR_RISK_ASMT	Was patient assessed for risk of developing PUs	Yes	No	No	No	No	No	No	1
M1324	Stage of most problematic pressure ulcer	Yes	No	No	No	No	No	No	1
M1900_PRIOR_ADLIADL_TRNSFR	Prior functioning ADL/IADL: transfer	No	No	Yes	No	No	No	No	1
M1910	Has {patient/resident} had a multi-factor fall risk assessment	No	No	Yes	No	No	No	No	1
M1910_MLT_FCTR_FALL_RISK_ASMT	Has patient had a multi-factor fall risk asmt	No	No	Yes	No	No	No	No	1
M2000_DRUG_RGMN_RVW	Drug regimen review	No	No	No	No	No	No	Yes	1
M2002_MDCTN_FLWP	Medication follow-up	No	No	No	No	No	No	Yes	1
M2010	{Patient/Resident}/caregiver high-risk drug education	No	No	No	No	No	No	Yes	1
M2010_HIGH_RISK_DRUG_EDCTN	Patient/caregiver high risk drug education	No	No	No	No	No	No	Yes	1
M2015_DRUG_EDCTN_INTRVTN	Patient/caregiver drug education intervention	No	No	No	No	No	No	Yes	1
M2016	{Patient/Resident}/caregiver drug education intervention	No	No	No	No	No	No	Yes	1
M2400_INTRVTN_SMRY_DPRSN	Intervention synopsis: depression intervention	No	No	No	No	No	No	Yes	1
M2420	Discharge disposition	No	No	No	Yes	No	No	No	1
M2430_HOSP_GI_PRBLM	Hospitalized: GI bleed/obstruct/constip/impact	Yes	No	No	No	No	No	No	1
M2430_HOSP_HRT_FAILR	Hospitalized: heart failure	Yes	No	No	No	No	No	No	1
M2430_HOSP_HYPOGLYC	Hospitalized: hypoglycemia/hyperglycemia	Yes	No	No	No	No	No	No	1
M2430_HOSP_INJRY_BY_FALL	Hospitalized: injury caused by fall	No	No	No	Yes	No	No	No	1
M2430_HOSP_RSPRTRY_INFCTN	Hospitalized: respiratory infection	No	No	No	Yes	No	No	No	1
M2430_HOSP_RSPRTRY_OTHR	Hospitalized: other respiratory	No	No	No	Yes	No	No	No	1
M2430_HOSP_STROKE_TIA	Hospitalized: stroke (CVA) or TIA	No	No	No	Yes	No	No	No	1
M2430_HOSP_UR_TRACT	Hospitalized: urinary tract infection	No	No	No	Yes	No	No	No	1
M2430_HOSP_WND_INFCTN	Hospitalized: wound infect/deterioration	Yes	No	No	No	No	No	No	1
N0520	Bowel regimen	Yes	No	No	No	No	No	No	1
NATL_PRVDR_ID	Agency National Provider ID (NPI)	No	No	No	No	Yes	No	No	1
O0110_a	"Special Treatments, Procedures, and Programs - On Admission: (1) Chemotherapy, (A2) Chemotherapy - IV, (A3) Chemotherapy - Oral, (A10) Chemotherapy - Other, (B1) Radiation, (C1) Oxygen Therapy, (C2) Oxygen Therapy - Continuous, (C3) Oxygen Therapy - Intermittent, (C4) Oxygen Therapy - High-concentration, (D1) Suctioning, (D2) Suctioning - Scheduled, (D3) Suctioning - As Needed, (E1) Tracheostomy care, (F1) Invasive Mechanical Ventilator (ventilator or respirator), (G1) Non-Invasive Mechanical Ventilator, (G2) Non-Invasive Mechanical Ventilator - BiPAP, (G3) Non-Invasive Mechanical Ventilator - CPAP, (H1) IV Medications, (H2) IV Medications - Vasoactive medications, (H3) IV Medications - Antibiotics, (H4) IV Medications - Anticoagulant, (H10) IV Medications - Other, (I1) Transfusions, (J1) Dialysis, (J2) Dialysis - Hemodialysis, (J3) Dialysis - Peritoneal dialysis, (O1) IV Access, (O2) IV Access - Peripheral, (O3) IV Access - Midline, (O4) IV Access - Central (e.g., PICC, tunneled, port)"	No	No	No	No	No	Yes	No	1
O0110_b	"Special Treatments, Procedures, and Programs - While a {Patient/Resident/Person}: (A1) Chemotherapy, (B1) Radiation, (C1) Oxygen Therapy, (D1) Suctioning, (E1) Tracheostomy care, (F1) Invasive Mechanical Ventilator (ventilator or respirator), (G1) Non-Invasive, (H1) IV Medications, (I1) Transfusions, (J1) Dialysis, (K1) Hospice care, (M1) Isolation or quarantine for active infectious disease (does not include standard body/fluid, (O1) IV Access"	No	No	No	No	No	Yes	No	1
O0110Z1c	Treatment: None of the above - At Discharge	No	No	Yes	No	No	No	No	1
O0150	Spontaneous Breathing Trial (SBT)	No	No	No	Yes	No	No	No	1
O0150B	Assessed for readiness for SBT	No	No	No	Yes	No	No	No	1
O0150C	Deemed medically ready for SBT	No	No	No	Yes	No	No	No	1
O0150D	Documentation medically unready for SBT	No	No	No	Yes	No	No	No	1
O0150E	SBT performed	No	No	No	Yes	No	No	No	1
O0400B	Occupational therapy	Yes	No	No	No	No	No	No	1
O0400C	Physical therapy	Yes	No	No	No	No	No	No	1
O0400D	Respiratory therapy	No	No	No	Yes	No	No	No	1
O0401C	Speech-language pathology	Yes	No	No	No	No	No	No	1
O0425	Part A therapies	Yes	No	No	No	No	No	No	1
P0100A	Restraints used in bed: bed rail	No	No	No	No	Yes	No	No	1
P0100B	Restraints used in bed: trunk restraint	No	No	No	No	Yes	No	No	1
P0100C	Restraints used in bed: limb restraint	No	No	No	No	Yes	No	No	1
P0100D	Restraints used in bed: other	No	No	No	No	Yes	No	No	1
P0100E	Restraints in chair/out of bed: trunk restraint	No	No	No	No	Yes	No	No	1
P0100F	Restraints in chair/out of bed: limb restraint	No	No	No	No	Yes	No	No	1
P0100G	Restraints in chair/out of bed: chair stops rising	No	No	No	No	Yes	No	No	1
P0100H	Restraints in chair/out of bed: other	No	No	No	No	Yes	No	No	1
P0200	Alarms	No	Yes	No	No	No	No	No	1
P0200A	Bed alarm	No	Yes	No	No	No	No	No	1
P0200B	Chair alarm	No	Yes	No	No	No	No	No	1
P0200C	Floor mat alarm	No	Yes	No	No	No	No	No	1
P0200D	Motion sensor alarm	No	Yes	No	No	No	No	No	1
P0200E	Wander/elopement alarm	No	Yes	No	No	No	No	No	1
P0200F	Other alarm	No	Yes	No	No	No	No	No	1
Q0100B	Family/significant other participated in assessment	No	No	No	No	No	No	Yes	1
Q0100C	Guardian/legal representative participated in assessment	No	No	No	No	No	No	Yes	1
Q0300B	Information source for {patient's/resident's} goal	No	No	No	No	No	No	Yes	1
Q0490	{Patient's/resident's} preference to avoid being asked	No	No	No	No	No	No	Yes	1
Q0550	{Patient's/resident's} preference to avoid being asked question Q0500B again	No	No	No	No	No	No	Yes	1
Q0600	Referral been made to Local Contact Agency	No	No	No	No	No	No	Yes	1
S0101	Admitted from Community	No	No	No	No	No	No	Yes	1
S0102	Admitted from NH or SB	No	No	No	No	No	No	Yes	1
S0115	Spouse Location	No	No	No	No	No	No	Yes	1
S0120	Prior Residence ZIP Code	No	No	No	No	No	No	Yes	1
S0122	Prior Residence State	No	No	No	No	No	No	Yes	1
S0161D	Requires specialized unit: ventilator	No	No	No	Yes	No	No	No	1
S0165D	Specialty services: Ventilator	No	No	No	Yes	No	No	No	1
S0172A	Goal discussion: documentation received	No	No	No	No	No	No	Yes	1
S0172B	Goal discussion: hospital	No	No	No	No	No	No	Yes	1
S0172C	Goal discussion: previous NH	No	No	No	No	No	No	Yes	1
S0172D	Goal discussion: Home without home health services	No	No	No	No	No	No	Yes	1
S0172E	Goal discussion: Home with home health services	No	No	No	No	No	No	Yes	1
S0172F	Goal discussion: PCP office	No	No	No	No	No	No	Yes	1
S0172G	Goal discussion: Other	No	No	No	No	No	No	Yes	1
S0172H	Goal discussion: Not occur reason	No	No	No	No	No	No	Yes	1
S0173	Documentation of goals of care discussion	No	No	No	No	No	No	Yes	1
S0183	Discharged prior to admission assessment	No	No	No	No	No	No	Yes	1
S0500	Level of Care	No	No	No	No	No	No	Yes	1
S0520	Reason for Admission	No	No	No	Yes	No	No	No	1
S2015	Refused meds occasionally 30 days	No	No	No	No	No	No	Yes	1
S2016	Refused meds frequently 30 days	No	No	No	No	No	No	Yes	1
S2050	Resists grooming/hygiene	No	No	No	No	No	No	Yes	1
S3100A	Contractures: Hand	Yes	No	No	No	No	No	No	1
S3100B	Contractures: Wrist	Yes	No	No	No	No	No	No	1
S3315A	COPD Treatment - Oxygen	No	No	No	Yes	No	No	No	1
S3315B	COPD Treatment - Inhaler/Nebulizer	No	No	No	Yes	No	No	No	1
S3315C	COPD Treatment - Acute Monitoring Of Respiratory	No	No	No	Yes	No	No	No	1
S3315D	COPD Treatment - Medications	No	No	No	Yes	No	No	No	1
S3315Y	COPD Treatment - Other	No	No	No	Yes	No	No	No	1
S4000A	Harm: Self Injury/Self-injurious attempt	No	No	No	No	No	No	Yes	1
S4000B	Harm: Attempt was to kill self	No	No	No	No	No	No	Yes	1
S4000C	Harm: Considered injuring self	No	No	No	No	No	No	Yes	1
S4000D	Harm: Self-injury caregiver concern	No	No	No	No	No	No	Yes	1
S4010A	Hourly Interval Observation	No	No	No	No	No	No	Yes	1
S4010B	15- Min. Interval Observation	No	No	No	No	No	No	Yes	1
S4010C	5- Min. Interval Observation	No	No	No	No	No	No	Yes	1
S4010D	Constant Observation for < 1 hr	No	No	No	No	No	No	Yes	1
S4010E	Constant Observation for > 1 hr	No	No	No	No	No	No	Yes	1
S5000	Number of New Pressure Ulcers	Yes	No	No	No	No	No	No	1
S5005	New Pressure Ulcer setting	Yes	No	No	No	No	No	No	1
S5010A1	Pressure ulcer 1 location	Yes	No	No	No	No	No	No	1
S5010A2	Pressure ulcer 1 status	Yes	No	No	No	No	No	No	1
S5010B1	Pressure ulcer 2 location	Yes	No	No	No	No	No	No	1
S5010B2	Pressure ulcer 2 status	Yes	No	No	No	No	No	No	1
S5010C1	Pressure ulcer 3 location	Yes	No	No	No	No	No	No	1
S5010C2	Pressure ulcer 3 status	Yes	No	No	No	No	No	No	1
S5010D1	Pressure ulcer 4 location	Yes	No	No	No	No	No	No	1
S5010D2	Pressure ulcer 4 status	Yes	No	No	No	No	No	No	1
S5010E1	Pressure ulcer 5 location	Yes	No	No	No	No	No	No	1
S5010E2	Pressure ulcer 5 status	Yes	No	No	No	No	No	No	1
S5010F1	Pressure ulcer 6 location	Yes	No	No	No	No	No	No	1
S5010F2	Pressure ulcer 6 status	Yes	No	No	No	No	No	No	1
S5010G1	Pressure ulcer 7 location	Yes	No	No	No	No	No	No	1
S5010G2	Pressure ulcer 7 status	Yes	No	No	No	No	No	No	1
S5010H1	Pressure ulcer 8 location	Yes	No	No	No	No	No	No	1
S5010H2	Pressure ulcer 8 status	Yes	No	No	No	No	No	No	1
S5010I1	Pressure ulcer 9 location	Yes	No	No	No	No	No	No	1
S5010I2	Pressure ulcer 9 status	Yes	No	No	No	No	No	No	1
S6010	Oxygen Therapy in NH	No	No	No	Yes	No	No	No	1
S6051A	Isolation Precaution: Airborne	No	No	No	Yes	No	No	No	1
S6051B	Isolation Precaution: Contact	No	No	No	Yes	No	No	No	1
S6051C	Isolation Precaution: Droplet	No	No	No	Yes	No	No	No	1
S6051D	Isolation Precaution: Protective	No	No	No	Yes	No	No	No	1
S6052	Isolation Required	No	No	No	Yes	No	No	No	1
S6053A	Met Isolation Requirements Start Date	No	No	No	Yes	No	No	No	1
S6053B	Met Isolation Requirements End Date	No	No	No	Yes	No	No	No	1
S6220	Alzheimer's/Dementia Special Care Unit	No	No	No	Yes	No	No	No	1
S6230	Has resident received antipsychotic	No	No	No	Yes	No	No	No	1
S6232	Is resident currently receiving antipsychotic	No	No	No	Yes	No	No	No	1
S6234	Attempt to reduce amount of antipsychotic	No	No	No	Yes	No	No	No	1
S6236	Was reduction in antipsychotic maintained	No	No	No	Yes	No	No	No	1
S7000	Dental Care	No	No	No	Yes	No	No	No	1
S8000B1	Medicare Part A - Primary Payor	No	No	No	Yes	No	No	No	1
S8000B3	Medicare Part A Payor	No	No	No	Yes	No	No	No	1
S8000C3	Medicare Part B Payor	No	No	No	Yes	No	No	No	1
S8000D3	Medicare Part C Payor	No	No	No	Yes	No	No	No	1
S8010A1	In-state Medicaid - Primary Payor	No	No	No	Yes	No	No	No	1
S8010A3	In-state Medicaid payor	No	No	No	Yes	No	No	No	1
S8010B1	Out-of-state Medicaid - Primary Payor	No	No	No	Yes	No	No	No	1
S8020A3	Private Payor	No	No	No	Yes	No	No	No	1
S8030A1	Self-pay - Primary Payor	No	No	No	Yes	No	No	No	1
V0200A12A	CAA-Nutritional status: triggered	Yes	No	No	No	No	No	No	1
V0200A12B	CAA-Nutritional status: plan	Yes	No	No	No	No	No	No	1
V0200A13A	CAA-Feeding tubes: triggered	Yes	No	No	No	No	No	No	1
V0200A13B	CAA-Feeding tubes: plan	Yes	No	No	No	No	No	No	1
V0200A14A	CAA-Dehydration/fluid maintenance: triggered	Yes	No	No	No	No	No	No	1
V0200A14B	CAA-Dehydration/fluid maintenance: plan	Yes	No	No	No	No	No	No	1
V0200A15A	CAA-Dental care: triggered	Yes	No	No	No	No	No	No	1
V0200A15B	CAA-Dental care: plan	Yes	No	No	No	No	No	No	1
V0200A16A	CAA-Pressure ulcer: triggered	Yes	No	No	No	No	No	No	1
V0200A16B	CAA-Pressure ulcer: plan	Yes	No	No	No	No	No	No	1

References

• Centers for Medicare & Medicaid Services (CMS). (2023). Data Element Library Overview. Retrieved from https://www.cms.gov
• Kripalani, S., et al. (2007). "Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians." JAMA, 297(8), 831-841.
• Coleman, E. A. (2003). "Falling Through the Cracks: Challenges and Opportunities for Improving Transitional Care." Annals of Internal Medicine, 141(7), 533-536.
• Jencks, S. F., et al. (2009). "Rehospitalizations Among Patients in Medicare Fee-for-Service Program." New England Journal of Medicine, 360(14), 1418-1428.