86521-2  Minimum Data Set (MDS) - version 3.0 - Resident Assessment and Care Screening (RAI) version 1.14.1 [CMS Assessment]Minimum Data Set (MDS) - version 3.0 - Resident Assessment and Care Screening (RAI) version 1.14.1 [CMS Assessment]Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.14.1: -: Pt: ^Patient: -: CMS Assessment  

PANEL HIERARCHY  (view this panel in the LForms viewer)

  LOINC#   LOINC Name R/O/C  Cardinality  Ex. UCUM Units 
  86521-2   Minimum Data Set (MDS) - version 3.0 - Resident Assessment and Care Screening (RAI) version 1.14.1 [CMS Assessment]Minimum Data Set (MDS) - version 3.0 - Resident Assessment and Care Screening (RAI) version 1.14.1 [CMS Assessment]Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.14.1: -: Pt: ^Patient: -: CMS Assessment    
       86522-0   MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set    
            86523-8   Identification Information    
                 58198-3   Type of Record    
                 54581-4   Facility Provider Numbers    
                      76468-8   National Provider Identifier (NPI)    
                      69417-4   CMS Certification Number (CCN)    
                      45398-5   State Provider Number    
                 85632-8   Type of Provider    
                 86524-6   Type of Assessment    
                      54583-0   Federal OBRA Reason for Assessment    
                      54584-8   PPS Assessment    
                      54585-5   PPS Other Medicare Required Assessment - OMRA    
                      58107-4   Is this a Swing Bed clinical change assessment?    
                      54587-1   Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry?    
                      58108-2   Entry/discharge reporting    
                      71440-2   Type of discharge    
                      86525-3   Is this a SNF Part A PPS Discharge Assessment?    
                 86526-1   Unit Certification or Licensure Designation    
                 54503-8   Legal Name of Resident    
                      45392-8   First name    
                      45393-6   Middle initial    
                      45394-4   Last name    
                      45395-1   Suffix    
                 45966-9   Social Security and Medicare Numbers    
                      45396-9   Social Security Number    
                      45397-7   Medicare number (or comparable railroad insurance number)    
                 45400-9   Medicaid Number    
                 46098-0   Gender    
                 21112-8   Birth Date   {mm/dd/yyyy} 
                 59362-4   Race/Ethnicity 1..6   
                 54505-3   Language    
                      54588-9   Does the resident need or want an interpreter to communicate with a doctor or health care staff?    
                      54899-0   Preferred language    
                 45404-1   Marital Status    
                 54506-1   Optional Resident Items    
                      46106-1   Medical record number [Identifier]Medical record number [Identifier]Medical record number: ID: Pt: ^Patient: Nom:    
                      45403-3   Room number [Location]Room number [Location]Room number: Loc: Pt: ^Patient: Nom:    
                      52462-9   Name by which resident prefers to be addressed    
                      21843-8   Lifetime occupation(s)    
                 54589-7   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 ("mental retardation" in federal regulation) or a related condition?    
                 71441-0   Level II Preadmission Screening and Resident Review (PASRR) Conditions 1..3   
                 86527-9   Conditions Related to ID/DD Status 1..5   
                 86528-7   Most Recent Admission/Entry or Reentry into this Facility    
                      50786-3   Entry Date   {mm/dd/yyyy} 
                      54590-5   Type of Entry    
                      85398-6   Entered From    
                 52455-3   Admission Date (Date this episode of care in this facility began)   {mm/dd/yyyy} 
                 52525-3   Discharge Date   {mm/dd/yyyy} 
                 55128-3   Discharge Status    
                 54592-1   Previous Assessment Reference Date for Significant Correction   {mm/dd/yyyy} 
                 54593-9   Assessment Reference Date. Observation end date   {mm/dd/yyyy} 
                 54507-9   Medicare Stay    
                      54594-7   Has the resident had a Medicare-covered stay since the most recent entry?    
                      54595-4   Start date of most recent Medicare stay   {mm/dd/yyyy} 
                      54596-2   End date of most recent Medicare stay   {mm/dd/yyyy} 
            54508-7   Hearing, Speech, and Vision    
                 54597-0   Comatose. Persistent vegetative state/no discernible consciousness    
                 54598-8   Hearing. Ability to hear (with hearing aid or hearing appliances if normally used)    
                 54599-6   Hearing Aid. Hearing aid or other hearing appliance used in completing B0200, Hearing    
                 54600-2   Speech Clarity. Select best description of speech pattern    
                 54601-0   Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression    
                 54602-8   Ability to Understand Others. Understanding verbal content, however able (with hearing aid or device if used)    
                 54603-6   Vision. Ability to see in adequate light (with glasses or other visual appliances)    
                 54604-4   Corrective Lenses. Corrective lenses (contacts, glasses, or magnifying glass) used in completing B1000, Vision    
            86529-5   Cognitive Patterns    
                 54605-1   Should Brief Interview for Mental Status (C0200-C0500) be Conducted?    
                 52491-8   Brief Interview for Mental Status (BIMS)    
                      52731-7   Repetition of Three Words. Number of words repeated after first attempt    
                      54510-3   Temporal Orientation (orientation to year, month, and day)    
                           52732-5   Able to report correct year    
                           52733-3   Able to report correct month    
                           54609-3   Able to report correct day of the week    
                      52493-4   Recall    
                           52735-8   Able to recall "sock"    
                           52736-6   Able to recall "blue"    
                           52737-4   Able to recall "bed"    
                      54614-3   BIMS Summary Score   {score} 
                 54615-0   Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted?    
                 86595-6   Staff Assessment for Mental Status    
                      54616-8   Short-term Memory OK. Seems or appears to recall after 5 minutes    
                      54617-6   Long-term Memory OK. Seems or appears to recall long past    
                      86583-2   Memory/Recall Ability 1..4   
                      54624-2   Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life    
                 86584-0   Delirium    
                      86585-7   Signs and Symptoms of Delirium (from CAM)    
                           54632-5   Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline?    
                           54628-3   Inattention - Did the resident have difficulty focusing attention, for example being easily distractible, or having difficulty keeping track of what was being said?    
                           54629-1   Disorganized thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)?    
                           54630-9   Altered level of consciousness - Did the resident have altered level of consciousness as indicated by any of the following criteria?    
            54633-3   Mood    
                 54634-1   Should Resident Mood Interview be Conducted?    
                 54635-8   Resident Mood Interview (PHQ-9)    
                      86843-0   Symptom Presence    
                           54636-6   Little interest or pleasure in doing things    
                           54638-2   Feeling down, depressed or hopeless    
                           54640-8   Trouble falling or staying asleep, or sleeping too much    
                           54642-4   Feeling tired or having little energy    
                           54644-0   Poor appetite or overeating    
                           54646-5   Feeling bad about yourself - or that you are a failure or have let yourself or your family down    
                           54648-1   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54650-7   Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual    
                           54652-3   Thoughts that you would be better off dead, or of hurting yourself in some way    
                      86844-8   Symptom Frequency    
                           54637-4   Little interest or pleasure in doing things    
                           54639-0   Feeling down, depressed or hopeless    
                           54641-6   Trouble falling or staying asleep, or sleeping too much    
                           54643-2   Feeling tired or having little energy    
                           54645-7   Poor appetite or overeating    
                           54647-3   Feeling bad about yourself - or that you are a failure or have let yourself or your family down    
                           54649-9   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54651-5   Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual    
                           54653-1   Thoughts that you would be better off dead, or of hurting yourself in some way    
                 54654-9   Total Severity Score   {score} 
                 54655-6   Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm?    
                 54657-2   Staff Assessment of Resident Mood (PHQ-9-OV)    
                      86833-1   Symptom Presence    
                           54658-0   Little interest or pleasure in doing things    
                           54660-6   Feeling or appearing down, depressed, or hopeless    
                           54662-2   Trouble falling or staying asleep, or sleeping too much    
                           54664-8   Feeling tired or having little energy    
                           54666-3   Poor appetite or overeating    
                           54668-9   Indicating that s/he feels bad about self, is a failure, or has let self or family down    
                           54670-5   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54672-1   Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual    
                           54673-9   States that life isn't worth living, wishes for death, or attempts to harm self    
                           54675-4   Being short-tempered, easily annoyed    
                      86891-9   Symptom Frequency    
                           54659-8   Little interest or pleasure in doing things    
                           54661-4   Feeling or appearing down, depressed, or hopeless    
                           54663-0   Trouble falling or staying asleep, or sleeping too much    
                           54665-5   Feeling tired or having little energy    
                           54667-1   Poor appetite or overeating    
                           54669-7   Indicating that s/he feels bad about self, is a failure, or has let self or family down    
                           54671-3   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54904-8   Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual    
                           54674-7   States that life isn't worth living, wishes for death, or attempts to harm self    
                           54676-2   Being short-tempered, easily annoyed    
                 54677-0   Total Severity Score   {score} 
                 54655-6   Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm?    
            86596-4   Behavior    
                 86597-2   Potential Indicators of Psychosis 1..2   
                 54514-5   Behavioral Symptom - Presence & Frequency    
                      54682-0   Physical behavioral symptoms directed toward others   d/(7.d) 
                      54683-8   Verbal behavioral symptoms directed toward others   d/(7.d) 
                      54684-6   Other behavioral symptoms not directed toward others   d/(7.d) 
                 54685-3   Overall Presence of Behavioral Symptoms.Were any behavioral symptoms in questions E0200 coded 1, 2, or 3?    
                 54515-2   Impact on Resident    
                      54686-1   Did any of the identified symptom(s): Put the resident at significant risk for physical illness or injury?    
                      54687-9   Did any of the identified symptom(s): Significantly interfere with the resident's care?    
                      54688-7   Did any of the identified symptom(s): Significantly interfere with the resident's participation in activities or social interactions?    
                 54516-0   Impact on Others    
                      54689-5   Did any of the identified symptom(s): Put others at significant risk for physical injury?    
                      54690-3   Did any of the identified symptom(s): Significantly intrude on the privacy or activity of others?    
                      54691-1   Did any of the identified symptom(s): Significantly disrupt care or living environment?    
                 54692-9   Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being?   d/(7.d) 
                 54693-7   Wandering - Presence & Frequency. Has the resident wandered?   d/(7.d) 
                 54517-8   Wandering - Impact    
                      54694-5   Does the wandering place the resident at significant risk of getting to a potentially dangerous place?    
                      54695-2   Does the wandering significantly intrude on the privacy or activities of others?    
                 54696-0   Change in Behavior or Other Symptoms.How does resident's current behavior status, care rejection, or wandering compare to prior assessment (OBRA or Scheduled PPS)?    
            86600-4   Preferences for Customary Routine and Activities    
                 54697-8   Should Interview for Daily and Activity Preferences be Conducted?    
                 54519-4   Interview for Daily Preferences    
                      54698-6   While you are in this facility how important is it to you to choose what clothes to wear?    
                      54699-4   While you are in this facility how important is it to you to take care of your personal belongings or things?    
                      54700-0   While you are in this facility how important is it to you to choose between a tub bath, shower, bed bath, or sponge bath?    
                      54701-8   While you are in this facility how important is it to you to have snacks available between meals?    
                      54702-6   While you are in this facility how important is it to you to choose your own bedtime?    
                      54703-4   While you are in this facility how important is it to you to have your family or a close friend involved in discussions about your care?    
                      54704-2   While you are in this facility how important is it to you to be able to use the phone in private?    
                      54705-9   While you are in this facility how important is it to you to have a place to lock your things to keep them safe?    
                 54520-2   Interview for Activity Preferences    
                      54706-7   While you are in this facility how important is it to you to have books, newspapers, and magazines to read?    
                      54707-5   While you are in this facility how important is it to you to listen to music you like?    
                      54708-3   While you are in this facility how important is it to you to be around animals such as pets?    
                      54709-1   While you are in this facility how important is it to you to keep up with the news?    
                      54710-9   While you are in this facility how important is it to you to do things with groups of people?    
                      54711-7   While you are in this facility how important is it to you to do your favorite activities?    
                      54712-5   While you are in this facility how important is it to you to go outside to get fresh air when the weather is good?    
                      54713-3   While you are in this facility how important is it to you to participate in religious services or practices?    
                 54714-1   Daily and Activity Preferences Primary Respondent. Indicate primary respondent for Daily and Activity Preferences (F0400 and F0500)    
                 54715-8   Should the Staff Assessment of Daily and Activity Preferences be Conducted?    
                 86599-8   Staff Assessment of Daily and Activity Preferences. Resident Prefers:    
            86601-2   Functional Status    
                 86880-2   Activities of Daily Living (ADL) Assistance. Self-Performance    
                      45588-1   Bed mobility    
                      45590-7   Transfer    
                      45592-3   Walk in room    
                      45594-9   Walk in corridor    
                      45596-4   Locomotion on unit    
                      45598-0   Locomotion off unit    
                      45600-4   Dressing    
                      45602-0   Eating    
                      45604-6   Toilet use    
                      45606-1   Personal hygiene    
                 86881-0   Activities of Daily Living (ADL) Assistance. Support Provided    
                      45589-9   Bed mobility    
                      45591-5   Transfer    
                      45593-1   Walk in room    
                      45595-6   Walk in corridor    
                      45597-2   Locomotion on unit    
                      45599-8   Locomotion off unit    
                      45601-2   Dressing    
                      45603-8   Eating    
                      45605-3   Toilet use    
                      45607-9   Personal hygiene    
                 46008-9   Bathing    
                      45608-7   Self-performance    
                      45609-5   Support provided    
                 54524-4   Balance During Transitions and Walking    
                      54749-7   Moving from seated to standing position    
                      54750-5   Walking (with assistive device if used)    
                      54751-3   Turning around and facing the opposite direction while walking    
                      54752-1   Moving on and off toilet    
                      54753-9   Surface-to-surface transfer (transfer between bed and chair or wheelchair)    
                 54525-1   Functional Limitation in Range of Motion    
                      54754-7   Upper extremity (shoulder, elbow, wrist, hand)    
                      54755-4   Lower extremity (hip, knee, ankle, foot)    
                 86602-0   Mobility Devices 1..4   
                 54527-7   Functional Rehabilitation Potential    
                      55123-4   Resident believes he or she is capable of increased independence in at least some ADLs.    
                      45613-7   Direct care staff believe resident is capable of increased independence in at least some ADLs    
            86612-9   Functional Abilities and Goals - Admission (Start of SNF PPS Stay)    
                 86613-7   Self-care - Admission Performance    
                      83232-9   Eating    
                      83230-3   Oral hygiene    
                      83228-7   Toileting hygiene    
                 86618-6   Self-Care - Discharge Goal    
                      83231-1   Eating    
                      83229-5   Oral hygiene    
                      83227-9   Toileting hygiene    
                 86614-5   Mobility - Admission Performance    
                      83216-2   Sit to lying    
                      83214-7   Lying to sitting on side of bed    
                      83212-1   Sit to stand    
                      83210-5   Chair/bed-to-chair transfer    
                      83208-9   Toilet transfer    
                      83270-9   Does the resident walk?    
                      83202-2   Walk 50 feet with two turns    
                      83200-6   Walk 150 feet    
                      83271-7   Does the resident use a wheelchair/scooter?    
                      83188-3   Wheel 50 feet with two turns    
                      83272-5   Indicate the type of wheelchair/scooter used    
                      83235-2   Wheel 150 feet    
                      83272-5   Indicate the type of wheelchair/scooter used    
                 86619-4   Mobility - discharge goal    
                      83215-4   Sit to lying    
                      83213-9   Lying to sitting on side of bed    
                      83211-3   Sit to stand    
                      83209-7   Chair/Bed-to-chair transfer    
                      83207-1   Toilet transfer    
                      83201-4   Walk 50 feet with two turns    
                      83199-0   Walk 150 feet    
                      83187-5   Wheel 50 feet with two turns    
                      83236-0   Wheel 150 feet    
            86615-2   Functional Abilities and Goals - Discharge (End of SNF PPS Stay)    
                 86616-0   Self-Care - Discharge Performance    
                      83232-9   Eating    
                      83230-3   Oral hygiene    
                      83228-7   Toileting hygiene    
                 86617-8   Mobility - Discharge Performance    
                      83216-2   Sit to lying    
                      83214-7   Lying to sitting on side of bed    
                      83212-1   Sit to stand    
                      83210-5   Chair/bed-to-chair transfer    
                      83208-9   Toilet transfer    
                      83278-2   Does the resident walk?    
                      83202-2   Walk 50 feet with two turns    
                      83200-6   Walk 150 feet    
                      83271-7   Does the resident use a wheelchair/scooter?    
                      83188-3   Wheel 50 feet with two turns    
                      83272-5   Indicate the type of wheelchair/scooter used    
                      83235-2   Wheel 150 feet    
                      83272-5   Indicate the type of wheelchair/scooter used    
            86623-6   Bladder and Bowel    
                 86624-4   Appliances 1..4   
                 54530-1   Urinary Toileting Program    
                      54767-9   Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility?    
                      54768-7   Response - What was the resident's response to the trial program?    
                      54769-5   Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence?    
                 54770-3   Urinary Continence 1..1   
                 54771-1   Bowel Continence 1..1   
                 54772-9   Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence?    
                 54773-7   Bowel Patterns. Constipation present?    
            86670-7   Active Diagnoses    
                 86671-5   Active Diagnoses in the last 7 days 1..*   
                 52797-8   Additional active diagnoses 0..10   
            86686-3   Health Conditions    
                 54557-4   Pain Management    
                      71447-7   At any time in the last 5 days, has the resident: Received scheduled pain medication regimen?    
                      71448-5   At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined?    
                      71449-3   At any time in the last 5 days, has the resident: Received non-medication intervention for pain?    
                 54828-9   Should Pain Assessment Interview be Conducted?    
                 54558-2   Pain Assessment Interview    
                      54829-7   Pain Presence. Have you had pain or hurting at any time in the last 5 days?    
                      54830-5   Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days?    
                      54559-0   Pain Effect on Function    
                           54831-3   Over the past 5 days, has pain made it hard for you to sleep at night?    
                           54832-1   Over the past 5 days, have you limited your day-to-day activities because of pain?    
                      54560-8   Pain Intensity    
                           54833-9   Numeric Rating Scale (00-10)    
                           54834-7   Verbal Descriptor Scale    
                 58117-3   Should the Staff Assessment for Pain be Conducted?    
                 86672-3   Staff Assessment for Pain    
                      86673-1   Indicators of Pain or Possible Pain in the last 5 days 1..4   
                      58118-1   Frequency of Indicator of Pain or Possible Pain in the last 5 days. Frequency with which resident complains or shows evidence of pain or possible pain   d/(5.d) 
                 86674-9   Other Health Conditions    
                      86675-6   Shortness of Breath (dyspnea) 1..3   
                      54845-3   Current Tobacco Use    
                      54846-1   Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?    
                      86676-4   Problem Conditions 1..4   
                      54849-5   Fall History on Admission/Entry or Reentry    
                           54850-3   Did the resident have a fall any time in the last month prior to admission/entry or reentry?    
                           54851-1   Did the resident have a fall any time in the last 2-6 months prior to admission/entry or reentry?    
                           54852-9   Did the resident have any fracture related to a fall in the 6 months prior to admission/entry or reentry?    
                      54853-7   Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent?    
                      54854-5   Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent    
                           54855-2   No injury    
                           54856-0   Injury (except major)    
                           54857-8   Major injury    
            86625-1   Swallowing/Nutritional Status    
                 86677-2   Swallowing Disorder. Signs and symptoms of possible swallowing disorder 1..4   
                 54567-3   Height and Weight    
                      3137-7   Height (in inches)   [in_us];cm 
                      3141-9   Weight (in pounds)   [lb_av];kg 
                 54863-6   Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months    
                 86678-0   Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months    
                 54568-1   Nutritional Approaches    
                      71444-4   Nutritional Approaches. While NOT a Resident 1..4   
                      71445-1   Nutritional Approaches. While a Resident 1..4   
                 86679-8   Percent Intake by Artificial Route    
                      86680-6   Proportion of total calories the resident received through parenteral or tube feeding. While NOT a Resident    
                      86681-4   Proportion of total calories the resident received through parenteral or tube feeding. While a Resident    
                      86687-1   Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days    
                      86682-2   Average fluid intake per day by IV or tube feeding. While NOT a Resident    
                      86683-0   Average fluid intake per day by IV or tube feeding. While a Resident    
                      86684-8   Average fluid intake per day by IV or tube feeding. During Entire 7 Days    
            86685-5   Oral/Dental Status    
                 86706-9   Dental 1..7   
            86707-7   Skin Conditions    
                 86708-5   Determination of Pressure Ulcer Risk 1..3   
                 57280-0   Risk of Pressure Ulcers. Is this resident at risk of developing pressure ulcers?    
                 58214-8   Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher?    
                 86745-7   Current Number of Unhealed Pressure Ulcers at Each Stage    
                      54884-2   Number of Stage 1 pressure ulcers   {#} 
                      55124-2   Number of Stage 2 pressure ulcers   {#} 
                      54886-7   Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry   {#} 
                      58123-1   Date of oldest Stage 2 pressure ulcer   {mm/dd/yyyy} 
                      55125-9   Number of Stage 3 pressure ulcers   {#} 
                      54887-5   Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry   {#} 
                      55126-7   Number of Stage 4 pressure ulcers   {#} 
                      54890-9   Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry   {#} 
                      54893-3   Number of unstageable pressure ulcers due to non-removable dressing/device   {#} 
                      54894-1   Number of these unstageable pressure ulcers that were present upon admission/entry or reentry   {#} 
                      54946-9   Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar   {#} 
                      54947-7   Number of these unstageable pressure ulcers that were present upon admission/entry or reentry   {#} 
                      54950-1   Number of unstageable pressure injuries presenting as deep tissue injury   {#} 
                      54951-9   Number of these unstageable pressure ulcers that were present upon admission/entry or reentry   {#} 
                 86746-5   Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar    
                      86901-6   Pressure ulcer length: Longest length from head to toe   cm 
                      86902-4   Pressure ulcer width: Widest width of the same pressure ulcer, side-to-side perpendicular (90-degree angle) to length   cm 
                      57228-9   Pressure ulcer depth: Depth of the same pressure ulcer from the visible surface to the deepest area   cm 
                 86903-2   Most Severe Tissue Type for Any Pressure Ulcer    
                 54952-7   Worsening in Pressure Ulcer Status Since Prior Assessment (OBRA or Scheduled PPS) or Last Admission/Entry or Reentry    
                      54953-5   Stage 2   {#} 
                      54954-3   Stage 3   {#} 
                      54955-0   Stage 4   {#} 
                 54956-8   Healed Pressure Ulcers    
                      54957-6   Were pressure ulcers present on the prior assessment (OBRA or scheduled PPS)?    
                      54958-4   Stage 2   {#} 
                      54959-2   Stage 3   {#} 
                      54960-0   Stage 4   {#} 
                 54970-9   Number of Venous and Arterial Ulcers   {#} 
                 86747-3   Other Ulcers, Wounds and Skin Problems 1..8   
                 86748-1   Skin and Ulcer Treatments 1..9   
            86749-9   Medications [CMS Assessment]Medications [CMS Assessment]Medications: -: Pt: ^Patient: -: CMS Assessment    
                 54982-4   Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days.   d/(7.d) 
                 58217-1   Insulin    
                      58127-2   Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days   d/(7.d) 
                      58128-0   Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days   d/(7.d) 
                 86750-7   Medications Received    
                      86751-5   Antipsychotic   d/(7.d) 
                      86752-3   Antianxiety   d/(7.d) 
                      86753-1   Antidepressant   d/(7.d) 
                      86754-9   Hypnotic   d/(7.d) 
                      86755-6   Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin)   d/(7.d) 
                      86756-4   Antibiotic   d/(7.d) 
                      86757-2   Diuretic   d/(7.d) 
            86758-0   Special Treatments, Procedures, and Programs    
                 86759-8   Special Treatments, Procedures, and Programs    
                      86760-6   While NOT a Resident 1..12   
                      86761-4   While a Resident 1..13   
                 69339-0   Influenza Vaccine    
                      55019-4   Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season?    
                      58131-4   Date influenza vaccine received   {mm/dd/yyyy} 
                      55020-2   If influenza vaccine not received, state reason:    
                 55021-0   Pneumococcal Vaccine    
                      55022-8   Is the resident's Pneumococcal vaccination up to date?    
                      45956-0   If Pneumococcal vaccine not received, state reason:    
                 86762-2   Therapies    
                      86763-0   Speech-Language Pathology and Audiology Services    
                           58218-9   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58133-0   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58134-8   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86765-5   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45760-6   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55025-1   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55026-9   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86767-1   Occupational Therapy    
                           58219-7   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58136-3   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58137-1   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86764-8   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45762-2   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55027-7   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55028-5   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86768-9   Physical Therapy    
                           58220-5   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58139-7   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58140-5   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86766-3   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45764-8   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55029-3   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55030-1   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      58141-3   Respiratory Therapy    
                           45767-1   Total minutes - record the total number of minutes this therapy was administered to the resident in the last 7 days   min 
                           45766-3   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                      58142-1   Psychological Therapy (by any licensed mental health professional)    
                           45852-1   Total minutes - record the total number of minutes this therapy was administered to the resident in the last 7 days   min 
                           45768-9   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days.   d/(7.d) 
                      58143-9   Recreational Therapy (includes recreational and music therapy)    
                           55035-0   Total minutes - record the total number of minutes this therapy was administered to the resident in the last 7 days   min 
                           55036-8   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                 86769-7   Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days.  
                 86770-5   Resumption of Therapy    
                      86772-1   Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline?    
                      86771-3   Date on which therapy regimen resumed   {mm/dd/yyyy} 
                 86773-9   Restorative Nursing Programs    
                      86774-7   Technique. Range of motion (passive)   d/(7.d) 
                      86775-4   Technique. Range of motion (active)   d/(7.d) 
                      86776-2   Technique. Splint or brace assistance   d/(7.d) 
                      86777-0   Training and Skill Practice In: Bed mobility   d/(7.d) 
                      86778-8   Training and Skill Practice In: Transfer   d/(7.d) 
                      86779-6   Training and Skill Practice In: Walking   d/(7.d) 
                      86780-4   Training and Skill Practice In: Dressing and/or grooming   d/(7.d) 
                      86781-2   Training and Skill Practice In: Eating and/or swallowing   d/(7.d) 
                      86782-0   Training and Skill Practice In: Amputation/prostheses care   d/(7.d) 
                      86783-8   Training and Skill Practice In: Communication   d/(7.d) 
                 55040-0   Physician Examinations. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) examine the resident?   d/(14.d) 
                 55041-8   Physician Orders. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) change the resident's orders?   d/(14.d) 
            86784-6   Restraints    
                 86785-3   Physical Restraints    
                      86786-1   Used in Bed. Bed rail   d/(7.d) 
                      86787-9   Used in Bed. Trunk restraint   d/(7.d) 
                      86788-7   Used in Bed. Limb restraint   d/(7.d) 
                      86789-5   Used in Bed. Other   d/(7.d) 
                      86790-3   Used in Chair or Out of Bed. Trunk restraint   d/(7.d) 
                      86791-1   Used in Chair or Out of Bed. Limb restraint   d/(7.d) 
                      86792-9   Used in Chair or Out of Bed. Chair prevents rising   d/(7.d) 
                      86793-7   Used in Chair or Out of Bed. Other   d/(7.d) 
            86794-5   Participation in Assessment and Goal Setting    
                 55053-3   Participation in Assessment    
                      55054-1   Resident participated in assessment    
                      55074-9   Family or significant other participated in assessment    
                      58221-3   Guardian or legally authorized representative participated in assessment    
                 55056-6   Resident's Overall Expectation    
                      55057-4   Select one for resident's overall goal established during assessment process    
                      55058-2   Indicate information source for Q0300A    
                 58146-2   Discharge Plan. Is active discharge planning already occurring for the resident to return to the community?    
                 86795-2   Resident's Preference to Avoid Being Asked Question Q0500B. Does the resident's clinical record document a request that this question be asked only on comprehensive assessments?    
                 58149-6   Return to Community. Do you want to talk to someone about the possiblity of leaving this facility and returning to live and receive services in the community?    
                 86796-0   Resident's Preference to Avoid Being Asked Question Q0500B Again    
                      86797-8   Does the resident (or family or significant other or guardian or legally authorized representative if resident is unable to understand or respond) want to be asked about returning to the community on all assessments?    
                      86798-6   Indicate information source for Q0550A    
                 58150-4   Referral. Has a referral been made to the Local Contact Agency?    
            87207-7   Care Area Assessment (CAA) Summary    
                 87208-5   Items From the Most Recent Prior OBRA or Scheduled PPS Assessment    
                      54583-0   Prior Assessment Federal OBRA Reason for Assessment    
                      54584-8   Prior Assessment PPS Reason for Assessment    
                      54593-9   Prior Assessment Reference Date   {mm/dd/yyyy} 
                      54614-3   Prior Assessment Brief Interview for Mental Status (BIMS) Summary Score   {score} 
                      54654-9   Prior Assessment Resident Mood Interview (PHQ-9©) Total Severity Score   {score} 
                      54677-0   Prior Assessment Staff Assessment of Resident Mood (PHQ-9-OV) Total Severity Score   {score} 
                 87210-1   CAAs and Care Planning    
                      87211-9   CAA Results    
                           87212-7   Care Area Triggered    
                           87213-5   Care Planning Decision    
            87224-2   Correction Request    
                 85632-8   Type of Provider    
                 87226-7   Name of Resident    
                      45392-8   First nameFirst nameFirst name: Pn: Pt: ^Patient: Nom:    
                      45394-4   Last nameLast nameLast name: Pn: Pt: ^Patient: Nom:    
                 46098-0   Gender    
                 21112-8   Birth Date   {mm/dd/yyyy} 
                 45396-9   Social Security Number    
                 87227-5   Type of Assessment    
                      54583-0   Federal OBRA Reason for Assessment    
                      54584-8   PPS Assessment    
                      54585-5   PPS Other Medicare Required Assessment - OMRA    
                      58107-4   Is this a Swing Bed clinical change assessment?    
                      58108-2   Entry/discharge reporting    
                      86525-3   Is this a SNF Part A PPS Discharge Assessment?    
                 87216-8   Date on existing record to be modified/inactivated    
                      54593-9   Assessment Reference Date   {mm/dd/yyyy} 
                      52525-3   Discharge Date   {mm/dd/yyyy} 
                      50786-3   Entry Date   {mm/dd/yyyy} 
                 87209-3   Correction Attestation Section    
                      58200-7   Correction Number   {#} 
                      87217-6   Reasons for Modification 1..6   
                      87225-9   Reasons for Inactivation 1..2   
                      87218-4   RN Assessment Coordinator Attestation of Completion    
                           87219-2   Attesting individual's first name    
                           87220-0   Attesting individual's last name    
                           87221-8   Attesting individual's title    
                           87222-6   Attestation date   {mm/dd/yyyy} 
            87223-4   Assessment Administration    
                 55064-0   Medicare Part A Billing    
                      55065-7   Medicare Part A HIPPS code    
                      55066-5   RUG version code    
                      58421-9   Is this a Medicare Short Stay assessment?    
                 59375-6   Medicare Part A Non-Therapy Billing    
                      58210-6   Medicare Part A non-therapy HIPPS code    
                      58211-4   RUG version code    
                 55067-3   State Medicaid Billing (if required by the state)    
                      55068-1   RUG Case Mix group    
                      55069-9   RUG version code    
                 58422-7   Alternate State Medicaid Billing (if required by the state)    
                      58212-2   RUG Case Mix Group    
                      58213-0   RUG version code    
                 55070-7   Insurance Billing    
                      55071-5   RUG billing code    
                      55072-3   RUG billing version    
       86856-2   MDS v3.0 - RAI v1.14.1 - Nursing home PPS (NP) and Nursing home quarterly (NQ) item set [CMS Assessment]MDS v3.0 - RAI v1.14.1 - Nursing home PPS (NP) and Nursing home quarterly (NQ) item set [CMS Assessment]MDS v3.0 - RAI v1.14.1 - Nursing home PPS (NP) & Nursing home quarterly (NQ) item set: -: Pt: ^Patient: -: CMS Assessment    
            86809-1   Identification Information    
                 58198-3   Type of Record    
                 54581-4   Facility Provider Numbers    
                      76468-8   National Provider Identifier (NPI)    
                      69417-4   CMS Certification Number (CCN)    
                      45398-5   State Provider Number    
                 85632-8   Type of Provider    
                 86524-6   Type of Assessment    
                      54583-0   Federal OBRA Reason for Assessment    
                      54584-8   PPS Assessment    
                      54585-5   PPS Other Medicare Required Assessment - OMRA    
                      58107-4   Is this a Swing Bed clinical change assessment?    
                      54587-1   Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry?    
                      58108-2   Entry/discharge reporting    
                      71440-2   Type of discharge    
                      86525-3   Is this a SNF Part A PPS Discharge Assessment?    
                 86526-1   Unit Certification or Licensure Designation    
                 54503-8   Legal Name of Resident    
                      45392-8   First name    
                      45393-6   Middle initial    
                      45394-4   Last name    
                      45395-1   Suffix    
                 45966-9   Social Security and Medicare Numbers    
                      45396-9   Social Security Number    
                      45397-7   Medicare number (or comparable railroad insurance number)    
                 45400-9   Medicaid Number    
                 46098-0   Gender    
                 21112-8   Birth Date   {mm/dd/yyyy} 
                 59362-4   Race/Ethnicity 1..6   
                 54505-3   Language    
                      54588-9   Does the resident need or want an interpreter to communicate with a doctor or health care staff?    
                      54899-0   Preferred language    
                 45404-1   Marital Status    
                 54506-1   Optional Resident Items    
                      46106-1   Medical record number [Identifier]Medical record number [Identifier]Medical record number: ID: Pt: ^Patient: Nom:    
                      45403-3   Room number [Location]Room number [Location]Room number: Loc: Pt: ^Patient: Nom:    
                      52462-9   Name by which resident prefers to be addressed    
                      21843-8   Lifetime occupation(s)    
                 86528-7   Most Recent Admission/Entry or Reentry into this Facility    
                      50786-3   Entry Date   {mm/dd/yyyy} 
                      54590-5   Type of Entry    
                      85398-6   Entered From    
                 52455-3   Admission Date (Date this episode of care in this facility began)   {mm/dd/yyyy} 
                 52525-3   Discharge Date   {mm/dd/yyyy} 
                 55128-3   Discharge Status    
                 54592-1   Previous Assessment Reference Date for Significant Correction   {mm/dd/yyyy} 
                 54593-9   Assessment Reference Date. Observation end date   {mm/dd/yyyy} 
                 54507-9   Medicare Stay    
                      54594-7   Has the resident had a Medicare-covered stay since the most recent entry?    
                      54595-4   Start date of most recent Medicare stay   {mm/dd/yyyy} 
                      54596-2   End date of most recent Medicare stay   {mm/dd/yyyy} 
            54508-7   Hearing, Speech, and Vision    
                 54597-0   Comatose. Persistent vegetative state/no discernible consciousness    
                 54598-8   Hearing. Ability to hear (with hearing aid or hearing appliances if normally used)    
                 54599-6   Hearing Aid. Hearing aid or other hearing appliance used in completing B0200, Hearing    
                 54600-2   Speech Clarity. Select best description of speech pattern    
                 54601-0   Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression    
                 54602-8   Ability to Understand Others. Understanding verbal content, however able (with hearing aid or device if used)    
                 54603-6   Vision. Ability to see in adequate light (with glasses or other visual appliances)    
                 54604-4   Corrective Lenses. Corrective lenses (contacts, glasses, or magnifying glass) used in completing B1000, Vision    
            86529-5   Cognitive Patterns    
                 54605-1   Should Brief Interview for Mental Status (C0200-C0500) be Conducted?    
                 52491-8   Brief Interview for Mental Status (BIMS)    
                      52731-7   Repetition of Three Words. Number of words repeated after first attempt    
                      54510-3   Temporal Orientation (orientation to year, month, and day)    
                           52732-5   Able to report correct year    
                           52733-3   Able to report correct month    
                           54609-3   Able to report correct day of the week    
                      52493-4   Recall    
                           52735-8   Able to recall "sock"    
                           52736-6   Able to recall "blue"    
                           52737-4   Able to recall "bed"    
                      54614-3   BIMS Summary Score   {score} 
                 54615-0   Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted?    
                 86595-6   Staff Assessment for Mental Status    
                      54616-8   Short-term Memory OK. Seems or appears to recall after 5 minutes    
                      54617-6   Long-term Memory OK. Seems or appears to recall long past    
                      86583-2   Memory/Recall Ability 1..4   
                      54624-2   Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life    
                 86584-0   Delirium    
                      86585-7   Signs and Symptoms of Delirium (from CAM)    
                           54632-5   Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline?    
                           54628-3   Inattention - Did the resident have difficulty focusing attention, for example being easily distractible, or having difficulty keeping track of what was being said?    
                           54629-1   Disorganized thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)?    
                           54630-9   Altered level of consciousness - Did the resident have altered level of consciousness as indicated by any of the following criteria?    
            54633-3   Mood    
                 54634-1   Should Resident Mood Interview be Conducted?    
                 54635-8   Resident Mood Interview (PHQ-9)    
                      86843-0   Symptom Presence    
                           54636-6   Little interest or pleasure in doing things    
                           54638-2   Feeling down, depressed or hopeless    
                           54640-8   Trouble falling or staying asleep, or sleeping too much    
                           54642-4   Feeling tired or having little energy    
                           54644-0   Poor appetite or overeating    
                           54646-5   Feeling bad about yourself - or that you are a failure or have let yourself or your family down    
                           54648-1   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54650-7   Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual    
                           54652-3   Thoughts that you would be better off dead, or of hurting yourself in some way    
                      86844-8   Symptom Frequency    
                           54637-4   Little interest or pleasure in doing things    
                           54639-0   Feeling down, depressed or hopeless    
                           54641-6   Trouble falling or staying asleep, or sleeping too much    
                           54643-2   Feeling tired or having little energy    
                           54645-7   Poor appetite or overeating    
                           54647-3   Feeling bad about yourself - or that you are a failure or have let yourself or your family down    
                           54649-9   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54651-5   Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual    
                           54653-1   Thoughts that you would be better off dead, or of hurting yourself in some way    
                 54654-9   Total Severity Score   {score} 
                 54655-6   Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm?    
                 54657-2   Staff Assessment of Resident Mood (PHQ-9-OV)    
                      86833-1   Symptom Presence    
                           54658-0   Little interest or pleasure in doing things    
                           54660-6   Feeling or appearing down, depressed, or hopeless    
                           54662-2   Trouble falling or staying asleep, or sleeping too much    
                           54664-8   Feeling tired or having little energy    
                           54666-3   Poor appetite or overeating    
                           54668-9   Indicating that s/he feels bad about self, is a failure, or has let self or family down    
                           54670-5   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54672-1   Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual    
                           54673-9   States that life isn't worth living, wishes for death, or attempts to harm self    
                           54675-4   Being short-tempered, easily annoyed    
                      86891-9   Symptom Frequency    
                           54659-8   Little interest or pleasure in doing things    
                           54661-4   Feeling or appearing down, depressed, or hopeless    
                           54663-0   Trouble falling or staying asleep, or sleeping too much    
                           54665-5   Feeling tired or having little energy    
                           54667-1   Poor appetite or overeating    
                           54669-7   Indicating that s/he feels bad about self, is a failure, or has let self or family down    
                           54671-3   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54904-8   Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual    
                           54674-7   States that life isn't worth living, wishes for death, or attempts to harm self    
                           54676-2   Being short-tempered, easily annoyed    
                 54677-0   Total Severity Score   {score} 
                 54655-6   Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm?    
            86815-8   Behavior    
                 86597-2   Potential Indicators of Psychosis 1..2   
                 54514-5   Behavioral Symptom - Presence & Frequency    
                      54682-0   Physical behavioral symptoms directed toward others   d/(7.d) 
                      54683-8   Verbal behavioral symptoms directed toward others   d/(7.d) 
                      54684-6   Other behavioral symptoms not directed toward others   d/(7.d) 
                 54692-9   Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being?   d/(7.d) 
                 54693-7   Wandering - Presence & Frequency. Has the resident wandered?   d/(7.d) 
            86816-6   Functional status    
                 86880-2   Activities of Daily Living (ADL) Assistance. Self-Performance    
                      45588-1   Bed mobility    
                      45590-7   Transfer    
                      45592-3   Walk in room    
                      45594-9   Walk in corridor    
                      45596-4   Locomotion on unit    
                      45598-0   Locomotion off unit    
                      45600-4   Dressing    
                      45602-0   Eating    
                      45604-6   Toilet use    
                      45606-1   Personal hygiene    
                 86881-0   Activities of Daily Living (ADL) Assistance. Support Provided    
                      45589-9   Bed mobility    
                      45591-5   Transfer    
                      45593-1   Walk in room    
                      45595-6   Walk in corridor    
                      45597-2   Locomotion on unit    
                      45599-8   Locomotion off unit    
                      45601-2   Dressing    
                      45603-8   Eating    
                      45605-3   Toilet use    
                      45607-9   Personal hygiene    
                 46008-9   Bathing    
                      45608-7   Self-performance    
                      45609-5   Support provided    
                 54524-4   Balance During Transitions and Walking    
                      54749-7   Moving from seated to standing position    
                      54750-5   Walking (with assistive device if used)    
                      54751-3   Turning around and facing the opposite direction while walking    
                      54752-1   Moving on and off toilet    
                      54753-9   Surface-to-surface transfer (transfer between bed and chair or wheelchair)    
                 54525-1   Functional Limitation in Range of Motion    
                      54754-7   Upper extremity (shoulder, elbow, wrist, hand)    
                      54755-4   Lower extremity (hip, knee, ankle, foot)    
                 86602-0   Mobility Devices 1..4   
            86612-9   Functional Abilities and Goals - Admission (Start of SNF PPS Stay)    
                 86613-7   Self-care - Admission Performance    
                      83232-9   Eating    
                      83230-3   Oral hygiene    
                      83228-7   Toileting hygiene    
                 86618-6   Self-Care - Discharge Goal    
                      83231-1   Eating    
                      83229-5   Oral hygiene    
                      83227-9   Toileting hygiene    
                 86614-5   Mobility - Admission Performance    
                      83216-2   Sit to lying    
                      83214-7   Lying to sitting on side of bed    
                      83212-1   Sit to stand    
                      83210-5   Chair/bed-to-chair transfer    
                      83208-9   Toilet transfer    
                      83270-9   Does the resident walk?    
                      83202-2   Walk 50 feet with two turns    
                      83200-6   Walk 150 feet    
                      83271-7   Does the resident use a wheelchair/scooter?    
                      83188-3   Wheel 50 feet with two turns    
                      83272-5   Indicate the type of wheelchair/scooter used    
                      83235-2   Wheel 150 feet    
                      83272-5   Indicate the type of wheelchair/scooter used    
                 86619-4   Mobility - discharge goal    
                      83215-4   Sit to lying    
                      83213-9   Lying to sitting on side of bed    
                      83211-3   Sit to stand    
                      83209-7   Chair/Bed-to-chair transfer    
                      83207-1   Toilet transfer    
                      83201-4   Walk 50 feet with two turns    
                      83199-0   Walk 150 feet    
                      83187-5   Wheel 50 feet with two turns    
                      83236-0   Wheel 150 feet    
            86615-2   Functional Abilities and Goals - Discharge (End of SNF PPS Stay)    
                 86616-0   Self-Care - Discharge Performance    
                      83232-9   Eating    
                      83230-3   Oral hygiene    
                      83228-7   Toileting hygiene    
                 86617-8   Mobility - Discharge Performance    
                      83216-2   Sit to lying    
                      83214-7   Lying to sitting on side of bed    
                      83212-1   Sit to stand    
                      83210-5   Chair/bed-to-chair transfer    
                      83208-9   Toilet transfer    
                      83278-2   Does the resident walk?    
                      83202-2   Walk 50 feet with two turns    
                      83200-6   Walk 150 feet    
                      83271-7   Does the resident use a wheelchair/scooter?    
                      83188-3   Wheel 50 feet with two turns    
                      83272-5   Indicate the type of wheelchair/scooter used    
                      83235-2   Wheel 150 feet    
                      83272-5   Indicate the type of wheelchair/scooter used    
            86820-8   Bladder and Bowel    
                 86624-4   Appliances 1..4   
                 86866-1   Urinary Toileting Program    
                      54767-9   Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility?    
                      54769-5   Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence?    
                 54770-3   Urinary Continence 1..1   
                 54771-1   Bowel Continence 1..1   
                 54772-9   Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence?    
            86670-7   Active Diagnoses    
                 86671-5   Active Diagnoses in the last 7 days 1..*   
                 52797-8   Additional active diagnoses 0..10   
            86867-9   Health Conditions    
                 54557-4   Pain Management    
                      71447-7   At any time in the last 5 days, has the resident: Received scheduled pain medication regimen?    
                      71448-5   At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined?    
                      71449-3   At any time in the last 5 days, has the resident: Received non-medication intervention for pain?    
                 54828-9   Should Pain Assessment Interview be Conducted?    
                 54558-2   Pain Assessment Interview    
                      54829-7   Pain Presence. Have you had pain or hurting at any time in the last 5 days?    
                      54830-5   Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days?    
                      54559-0   Pain Effect on Function    
                           54831-3   Over the past 5 days, has pain made it hard for you to sleep at night?    
                           54832-1   Over the past 5 days, have you limited your day-to-day activities because of pain?    
                      54560-8   Pain Intensity    
                           54833-9   Numeric Rating Scale (00-10)    
                           54834-7   Verbal Descriptor Scale    
                 58117-3   Should the Staff Assessment for Pain be Conducted?    
                 86672-3   Staff Assessment for Pain    
                      86673-1   Indicators of Pain or Possible Pain in the last 5 days 1..4   
                      58118-1   Frequency of Indicator of Pain or Possible Pain in the last 5 days. Frequency with which resident complains or shows evidence of pain or possible pain   d/(5.d) 
                 86868-7   Other Health Conditions    
                      86675-6   Shortness of Breath (dyspnea) 1..3   
                      54846-1   Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?    
                      86676-4   Problem Conditions 1..4   
                      54849-5   Fall History on Admission/Entry or Reentry    
                           54850-3   Did the resident have a fall any time in the last month prior to admission/entry or reentry?    
                           54851-1   Did the resident have a fall any time in the last 2-6 months prior to admission/entry or reentry?    
                           54852-9   Did the resident have any fracture related to a fall in the 6 months prior to admission/entry or reentry?    
                      54853-7   Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent?    
                      54854-5   Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent    
                           54855-2   No injury    
                           54856-0   Injury (except major)    
                           54857-8   Major injury    
            86625-1   Swallowing/Nutritional Status    
                 86677-2   Swallowing Disorder. Signs and symptoms of possible swallowing disorder 1..4   
                 54567-3   Height and Weight    
                      3137-7   Height (in inches)   [in_us];cm 
                      3141-9   Weight (in pounds)   [lb_av];kg 
                 54863-6   Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months    
                 86678-0   Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months    
                 54568-1   Nutritional Approaches    
                      71444-4   Nutritional Approaches. While NOT a Resident 1..4   
                      71445-1   Nutritional Approaches. While a Resident 1..4   
                 86679-8   Percent Intake by Artificial Route    
                      86680-6   Proportion of total calories the resident received through parenteral or tube feeding. While NOT a Resident    
                      86681-4   Proportion of total calories the resident received through parenteral or tube feeding. While a Resident    
                      86687-1   Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days    
                      86682-2   Average fluid intake per day by IV or tube feeding. While NOT a Resident    
                      86683-0   Average fluid intake per day by IV or tube feeding. While a Resident    
                      86684-8   Average fluid intake per day by IV or tube feeding. During Entire 7 Days    
            86685-5   Oral/Dental Status    
                 86706-9   Dental 1..2   
            86707-7   Skin Conditions    
                 86708-5   Determination of Pressure Ulcer Risk 1..3   
                 57280-0   Risk of Pressure Ulcers. Is this resident at risk of developing pressure ulcers?    
                 58214-8   Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher?    
                 86745-7   Current Number of Unhealed Pressure Ulcers at Each Stage    
                      54884-2   Number of Stage 1 pressure ulcers   {#} 
                      55124-2   Number of Stage 2 pressure ulcers   {#} 
                      54886-7   Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry   {#} 
                      58123-1   Date of oldest Stage 2 pressure ulcer   {mm/dd/yyyy} 
                      55125-9   Number of Stage 3 pressure ulcers   {#} 
                      54887-5   Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry   {#} 
                      55126-7   Number of Stage 4 pressure ulcers   {#} 
                      54890-9   Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry   {#} 
                      54893-3   Number of unstageable pressure ulcers due to non-removable dressing/device   {#} 
                      54894-1   Number of these unstageable pressure ulcers that were present upon admission/entry or reentry   {#} 
                      54946-9   Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar   {#} 
                      54947-7   Number of these unstageable pressure ulcers that were present upon admission/entry or reentry   {#} 
                      54950-1   Number of unstageable pressure ulcers with suspected deep tissue injury in evolution   {#} 
                      54951-9   Number of these unstageable pressure ulcers that were present upon admission/entry or reentry   {#} 
                 86746-5   Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar    
                      86901-6   Pressure ulcer length: Longest length from head to toe   cm 
                      86902-4   Pressure ulcer width: Widest width of the same pressure ulcer, side-to-side perpendicular (90-degree angle) to length   cm 
                      57228-9   Pressure ulcer depth: Depth of the same pressure ulcer from the visible surface to the deepest area   cm 
                 86903-2   Most Severe Tissue Type for Any Pressure Ulcer    
                 54952-7   Worsening in Pressure Ulcer Status Since Prior Assessment (OBRA or Scheduled PPS) or Last Admission/Entry or Reentry    
                      54953-5   Stage 2   {#} 
                      54954-3   Stage 3   {#} 
                      54955-0   Stage 4   {#} 
                 54956-8   Healed Pressure Ulcers    
                      54957-6   Were pressure ulcers present on the prior assessment (OBRA or scheduled PPS)?    
                      54958-4   Stage 2   {#} 
                      54959-2   Stage 3   {#} 
                      54960-0   Stage 4   {#} 
                 54970-9   Number of Venous and Arterial Ulcers   {#} 
                 86747-3   Other Ulcers, Wounds and Skin Problems 1..8   
                 86748-1   Skin and Ulcer Treatments 1..9   
            86749-9   Medications [CMS Assessment]Medications [CMS Assessment]Medications: -: Pt: ^Patient: -: CMS Assessment    
                 54982-4   Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days.   d/(7.d) 
                 58217-1   Insulin    
                      58127-2   Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days   d/(7.d) 
                      58128-0   Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days   d/(7.d) 
                 86750-7   Medications Received    
                      86751-5   Antipsychotic   d/(7.d) 
                      86752-3   Antianxiety   d/(7.d) 
                      86753-1   Antidepressant   d/(7.d) 
                      86754-9   Hypnotic   d/(7.d) 
                      86755-6   Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin)   d/(7.d) 
                      86756-4   Antibiotic   d/(7.d) 
                      86757-2   Diuretic   d/(7.d) 
            86834-9   Special treatments, procedures, and programs    
                 86759-8   Special Treatments, Procedures, and Programs    
                      86760-6   While NOT a Resident 0..9   
                      86761-4   While a Resident 0..11   
                 69339-0   Influenza Vaccine    
                      55019-4   Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season?    
                      58131-4   Date influenza vaccine received   {mm/dd/yyyy} 
                      55020-2   If influenza vaccine not received, state reason:    
                 55021-0   Pneumococcal Vaccine    
                      55022-8   Is the resident's Pneumococcal vaccination up to date?    
                      45956-0   If Pneumococcal vaccine not received, state reason:    
                 86841-4   Therapies    
                      86763-0   Speech-Language Pathology and Audiology Services    
                           58218-9   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58133-0   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58134-8   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86765-5   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45760-6   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55025-1   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55026-9   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86767-1   Occupational Therapy    
                           58219-7   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58136-3   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58137-1   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86764-8   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45762-2   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55027-7   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55028-5   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86768-9   Physical Therapy    
                           58220-5   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58139-7   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58140-5   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86766-3   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45764-8   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55029-3   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55030-1   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86849-7   Respiratory therapy    
                           45766-3   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                      86850-5   Psychological therapy    
                           45768-9   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days.   d/(7.d) 
                 86769-7   Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days.  
                 86770-5   Resumption of Therapy    
                      86772-1   Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline?    
                      86771-3   Date on which therapy regimen resumed   {mm/dd/yyyy} 
                 86773-9   Restorative Nursing Programs    
                      86774-7   Technique. Range of motion (passive)   d/(7.d) 
                      86775-4   Technique. Range of motion (active)   d/(7.d) 
                      86776-2   Technique. Splint or brace assistance   d/(7.d) 
                      86777-0   Training and Skill Practice In: Bed mobility   d/(7.d) 
                      86778-8   Training and Skill Practice In: Transfer   d/(7.d) 
                      86779-6   Training and Skill Practice In: Walking   d/(7.d) 
                      86780-4   Training and Skill Practice In: Dressing and/or grooming   d/(7.d) 
                      86781-2   Training and Skill Practice In: Eating and/or swallowing   d/(7.d) 
                      86782-0   Training and Skill Practice In: Amputation/prostheses care   d/(7.d) 
                      86783-8   Training and Skill Practice In: Communication   d/(7.d) 
                 55040-0   Physician Examinations. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) examine the resident?   d/(14.d) 
                 55041-8   Physician Orders. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) change the resident's orders?   d/(14.d) 
            86784-6   Restraints    
                 86785-3   Physical Restraints    
                      86786-1   Used in Bed. Bed rail   d/(7.d) 
                      86787-9   Used in Bed. Trunk restraint   d/(7.d) 
                      86788-7   Used in Bed. Limb restraint   d/(7.d) 
                      86789-5   Used in Bed. Other   d/(7.d) 
                      86790-3   Used in Chair or Out of Bed. Trunk restraint   d/(7.d) 
                      86791-1   Used in Chair or Out of Bed. Limb restraint   d/(7.d) 
                      86792-9   Used in Chair or Out of Bed. Chair prevents rising   d/(7.d) 
                      86793-7   Used in Chair or Out of Bed. Other   d/(7.d) 
            86794-5   Participation in Assessment and Goal Setting    
                 55053-3   Participation in Assessment    
                      55054-1   Resident participated in assessment    
                      55074-9   Family or significant other participated in assessment    
                      58221-3   Guardian or legally authorized representative participated in assessment    
                 55056-6   Resident's Overall Expectation    
                      55057-4   Select one for resident's overall goal established during assessment process    
                      55058-2   Indicate information source for Q0300A    
                 58146-2   Discharge Plan. Is active discharge planning already occurring for the resident to return to the community?    
                 86795-2   Resident's Preference to Avoid Being Asked Question Q0500B. Does the resident's clinical record document a request that this question be asked only on comprehensive assessments?    
                 58149-6   Return to Community. Do you want to talk to someone about the possiblity of leaving this facility and returning to live and receive services in the community?    
                 86796-0   Resident's Preference to Avoid Being Asked Question Q0500B Again    
                      86797-8   Does the resident (or family or significant other or guardian or legally authorized representative if resident is unable to understand or respond) want to be asked about returning to the community on all assessments?    
                      86798-6   Indicate information source for Q0550A    
                 58150-4   Referral. Has a referral been made to the Local Contact Agency?    
            87224-2   Correction Request    
                 85632-8   Type of Provider    
                 87226-7   Name of Resident    
                      45392-8   First nameFirst nameFirst name: Pn: Pt: ^Patient: Nom:    
                      45394-4   Last nameLast nameLast name: Pn: Pt: ^Patient: Nom:    
                 46098-0   Gender    
                 21112-8   Birth Date   {mm/dd/yyyy} 
                 45396-9   Social Security Number    
                 87227-5   Type of Assessment    
                      54583-0   Federal OBRA Reason for Assessment    
                      54584-8   PPS Assessment    
                      54585-5   PPS Other Medicare Required Assessment - OMRA    
                      58107-4   Is this a Swing Bed clinical change assessment?    
                      58108-2   Entry/discharge reporting    
                      86525-3   Is this a SNF Part A PPS Discharge Assessment?    
                 87216-8   Date on existing record to be modified/inactivated    
                      54593-9   Assessment Reference Date   {mm/dd/yyyy} 
                      52525-3   Discharge Date   {mm/dd/yyyy} 
                      50786-3   Entry Date   {mm/dd/yyyy} 
                 87209-3   Correction Attestation Section    
                      58200-7   Correction Number   {#} 
                      87217-6   Reasons for Modification 1..6   
                      87225-9   Reasons for Inactivation 1..2   
                      87218-4   RN Assessment Coordinator Attestation of Completion    
                           87219-2   Attesting individual's first name    
                           87220-0   Attesting individual's last name    
                           87221-8   Attesting individual's title    
                           87222-6   Attestation date   {mm/dd/yyyy} 
            87223-4   Assessment Administration    
                 55064-0   Medicare Part A Billing    
                      55065-7   Medicare Part A HIPPS code    
                      55066-5   RUG version code    
                      58421-9   Is this a Medicare Short Stay assessment?    
                 59375-6   Medicare Part A Non-Therapy Billing    
                      58210-6   Medicare Part A non-therapy HIPPS code    
                      58211-4   RUG version code    
                 55067-3   State Medicaid Billing (if required by the state)    
                      55068-1   RUG Case Mix group    
                      55069-9   RUG version code    
                 58422-7   Alternate State Medicaid Billing (if required by the state)    
                      58212-2   RUG Case Mix Group    
                      58213-0   RUG version code    
                 55070-7   Insurance Billing    
                      55071-5   RUG billing code    
                      55072-3   RUG billing version    
       86876-0   MDS v3.0 - RAI v1.14.1 - Swing bed PPS (SP) item set [CMS Assessment]MDS v3.0 - RAI v1.14.1 - Swing bed PPS (SP) item set [CMS Assessment]MDS v3.0 - RAI v1.14.1 - Swing bed PPS (SP) item set: -: Pt: ^Patient: -: CMS Assessment    
            86811-7   Identification Information    
                 58198-3   Type of Record    
                 54581-4   Facility Provider Numbers    
                      76468-8   National Provider Identifier (NPI)    
                      69417-4   CMS Certification Number (CCN)    
                      45398-5   State Provider Number    
                 85632-8   Type of Provider    
                 86524-6   Type of Assessment    
                      54583-0   Federal OBRA Reason for Assessment    
                      54584-8   PPS Assessment    
                      54585-5   PPS Other Medicare Required Assessment - OMRA    
                      58107-4   Is this a Swing Bed clinical change assessment?    
                      54587-1   Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry?    
                      58108-2   Entry/discharge reporting    
                      71440-2   Type of discharge    
                      86525-3   Is this a SNF Part A PPS Discharge Assessment?    
                 86526-1   Unit Certification or Licensure Designation    
                 54503-8   Legal Name of Resident    
                      45392-8   First name    
                      45393-6   Middle initial    
                      45394-4   Last name    
                      45395-1   Suffix    
                 45966-9   Social Security and Medicare Numbers    
                      45396-9   Social Security Number    
                      45397-7   Medicare number (or comparable railroad insurance number)    
                 45400-9   Medicaid Number    
                 46098-0   Gender    
                 21112-8   Birth Date   {mm/dd/yyyy} 
                 59362-4   Race/Ethnicity 1..6   
                 54505-3   Language    
                      54588-9   Does the resident need or want an interpreter to communicate with a doctor or health care staff?    
                      54899-0   Preferred language    
                 45404-1   Marital Status    
                 54506-1   Optional Resident Items    
                      46106-1   Medical record number [Identifier]Medical record number [Identifier]Medical record number: ID: Pt: ^Patient: Nom:    
                      45403-3   Room number [Location]Room number [Location]Room number: Loc: Pt: ^Patient: Nom:    
                      52462-9   Name by which resident prefers to be addressed    
                      21843-8   Lifetime occupation(s)    
                 86528-7   Most Recent Admission/Entry or Reentry into this Facility    
                      50786-3   Entry Date   {mm/dd/yyyy} 
                      54590-5   Type of Entry    
                      85398-6   Entered From    
                 52455-3   Admission Date (Date this episode of care in this facility began)   {mm/dd/yyyy} 
                 52525-3   Discharge Date   {mm/dd/yyyy} 
                 55128-3   Discharge Status    
                 54593-9   Assessment Reference Date. Observation end date   {mm/dd/yyyy} 
                 54507-9   Medicare Stay    
                      54594-7   Has the resident had a Medicare-covered stay since the most recent entry?    
                      54595-4   Start date of most recent Medicare stay   {mm/dd/yyyy} 
                      54596-2   End date of most recent Medicare stay   {mm/dd/yyyy} 
            54508-7   Hearing, Speech, and Vision    
                 54597-0   Comatose. Persistent vegetative state/no discernible consciousness    
                 54598-8   Hearing. Ability to hear (with hearing aid or hearing appliances if normally used)    
                 54599-6   Hearing Aid. Hearing aid or other hearing appliance used in completing B0200, Hearing    
                 54600-2   Speech Clarity. Select best description of speech pattern    
                 54601-0   Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression    
                 54602-8   Ability to Understand Others. Understanding verbal content, however able (with hearing aid or device if used)    
                 54603-6   Vision. Ability to see in adequate light (with glasses or other visual appliances)    
                 54604-4   Corrective Lenses. Corrective lenses (contacts, glasses, or magnifying glass) used in completing B1000, Vision    
            86529-5   Cognitive Patterns    
                 54605-1   Should Brief Interview for Mental Status (C0200-C0500) be Conducted?    
                 52491-8   Brief Interview for Mental Status (BIMS)    
                      52731-7   Repetition of Three Words. Number of words repeated after first attempt    
                      54510-3   Temporal Orientation (orientation to year, month, and day)    
                           52732-5   Able to report correct year    
                           52733-3   Able to report correct month    
                           54609-3   Able to report correct day of the week    
                      52493-4   Recall    
                           52735-8   Able to recall "sock"    
                           52736-6   Able to recall "blue"    
                           52737-4   Able to recall "bed"    
                      54614-3   BIMS Summary Score   {score} 
                 54615-0   Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted?    
                 86595-6   Staff Assessment for Mental Status    
                      54616-8   Short-term Memory OK. Seems or appears to recall after 5 minutes    
                      54617-6   Long-term Memory OK. Seems or appears to recall long past    
                      86583-2   Memory/Recall Ability 1..4   
                      54624-2   Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life    
                 86584-0   Delirium    
                      86585-7   Signs and Symptoms of Delirium (from CAM)    
                           54632-5   Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline?    
                           54628-3   Inattention - Did the resident have difficulty focusing attention, for example being easily distractible, or having difficulty keeping track of what was being said?    
                           54629-1   Disorganized thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)?    
                           54630-9   Altered level of consciousness - Did the resident have altered level of consciousness as indicated by any of the following criteria?    
            54633-3   Mood    
                 54634-1   Should Resident Mood Interview be Conducted?    
                 54635-8   Resident Mood Interview (PHQ-9)    
                      86843-0   Symptom Presence    
                           54636-6   Little interest or pleasure in doing things    
                           54638-2   Feeling down, depressed or hopeless    
                           54640-8   Trouble falling or staying asleep, or sleeping too much    
                           54642-4   Feeling tired or having little energy    
                           54644-0   Poor appetite or overeating    
                           54646-5   Feeling bad about yourself - or that you are a failure or have let yourself or your family down    
                           54648-1   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54650-7   Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual    
                           54652-3   Thoughts that you would be better off dead, or of hurting yourself in some way    
                      86844-8   Symptom Frequency    
                           54637-4   Little interest or pleasure in doing things    
                           54639-0   Feeling down, depressed or hopeless    
                           54641-6   Trouble falling or staying asleep, or sleeping too much    
                           54643-2   Feeling tired or having little energy    
                           54645-7   Poor appetite or overeating    
                           54647-3   Feeling bad about yourself - or that you are a failure or have let yourself or your family down    
                           54649-9   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54651-5   Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual    
                           54653-1   Thoughts that you would be better off dead, or of hurting yourself in some way    
                 54654-9   Total Severity Score   {score} 
                 54655-6   Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm?    
                 54657-2   Staff Assessment of Resident Mood (PHQ-9-OV)    
                      86833-1   Symptom Presence    
                           54658-0   Little interest or pleasure in doing things    
                           54660-6   Feeling or appearing down, depressed, or hopeless    
                           54662-2   Trouble falling or staying asleep, or sleeping too much    
                           54664-8   Feeling tired or having little energy    
                           54666-3   Poor appetite or overeating    
                           54668-9   Indicating that s/he feels bad about self, is a failure, or has let self or family down    
                           54670-5   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54672-1   Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual    
                           54673-9   States that life isn't worth living, wishes for death, or attempts to harm self    
                           54675-4   Being short-tempered, easily annoyed    
                      86891-9   Symptom Frequency    
                           54659-8   Little interest or pleasure in doing things    
                           54661-4   Feeling or appearing down, depressed, or hopeless    
                           54663-0   Trouble falling or staying asleep, or sleeping too much    
                           54665-5   Feeling tired or having little energy    
                           54667-1   Poor appetite or overeating    
                           54669-7   Indicating that s/he feels bad about self, is a failure, or has let self or family down    
                           54671-3   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54904-8   Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual    
                           54674-7   States that life isn't worth living, wishes for death, or attempts to harm self    
                           54676-2   Being short-tempered, easily annoyed    
                 54677-0   Total Severity Score   {score} 
                 54655-6   Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm?    
            86815-8   Behavior    
                 86597-2   Potential Indicators of Psychosis 1..2   
                 54514-5   Behavioral Symptom - Presence & Frequency    
                      54682-0   Physical behavioral symptoms directed toward others   d/(7.d) 
                      54683-8   Verbal behavioral symptoms directed toward others   d/(7.d) 
                      54684-6   Other behavioral symptoms not directed toward others   d/(7.d) 
                 54692-9   Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being?   d/(7.d) 
                 54693-7   Wandering - Presence & Frequency. Has the resident wandered?   d/(7.d) 
            86816-6   Functional Status    
                 86880-2   Activities of Daily Living (ADL) Assistance. Self-Performance    
                      45588-1   Bed mobility    
                      45590-7   Transfer    
                      45592-3   Walk in room    
                      45594-9   Walk in corridor    
                      45596-4   Locomotion on unit    
                      45598-0   Locomotion off unit    
                      45600-4   Dressing    
                      45602-0   Eating    
                      45604-6   Toilet use    
                      45606-1   Personal hygiene    
                 86881-0   Activities of Daily Living (ADL) Assistance. Support Provided    
                      45589-9   Bed mobility    
                      45591-5   Transfer    
                      45593-1   Walk in room    
                      45595-6   Walk in corridor    
                      45597-2   Locomotion on unit    
                      45599-8   Locomotion off unit    
                      45601-2   Dressing    
                      45603-8   Eating    
                      45605-3   Toilet use    
                      45607-9   Personal hygiene    
                 46008-9   Bathing    
                      45608-7   Self-performance    
                      45609-5   Support provided    
                 54524-4   Balance During Transitions and Walking    
                      54749-7   Moving from seated to standing position    
                      54750-5   Walking (with assistive device if used)    
                      54751-3   Turning around and facing the opposite direction while walking    
                      54752-1   Moving on and off toilet    
                      54753-9   Surface-to-surface transfer (transfer between bed and chair or wheelchair)    
                 54525-1   Functional Limitation in Range of Motion    
                      54754-7   Upper extremity (shoulder, elbow, wrist, hand)    
                      54755-4   Lower extremity (hip, knee, ankle, foot)    
                 86602-0   Mobility Devices 1..4   
            86612-9   Functional Abilities and Goals - Admission (Start of SNF PPS Stay)    
                 86613-7   Self-care - Admission Performance    
                      83232-9   Eating    
                      83230-3   Oral hygiene    
                      83228-7   Toileting hygiene    
                 86618-6   Self-Care - Discharge Goal    
                      83231-1   Eating    
                      83229-5   Oral hygiene    
                      83227-9   Toileting hygiene    
                 86614-5   Mobility - Admission Performance    
                      83216-2   Sit to lying    
                      83214-7   Lying to sitting on side of bed    
                      83212-1   Sit to stand    
                      83210-5   Chair/bed-to-chair transfer    
                      83208-9   Toilet transfer    
                      83270-9   Does the resident walk?    
                      83202-2   Walk 50 feet with two turns    
                      83200-6   Walk 150 feet    
                      83271-7   Does the resident use a wheelchair/scooter?    
                      83188-3   Wheel 50 feet with two turns    
                      83272-5   Indicate the type of wheelchair/scooter used    
                      83235-2   Wheel 150 feet    
                      83272-5   Indicate the type of wheelchair/scooter used    
                 86619-4   Mobility - discharge goal    
                      83215-4   Sit to lying    
                      83213-9   Lying to sitting on side of bed    
                      83211-3   Sit to stand    
                      83209-7   Chair/Bed-to-chair transfer    
                      83207-1   Toilet transfer    
                      83201-4   Walk 50 feet with two turns    
                      83199-0   Walk 150 feet    
                      83187-5   Wheel 50 feet with two turns    
                      83236-0   Wheel 150 feet    
            86615-2   Functional Abilities and Goals - Discharge (End of SNF PPS Stay)    
                 86616-0   Self-Care - Discharge Performance    
                      83232-9   Eating    
                      83230-3   Oral hygiene    
                      83228-7   Toileting hygiene    
                 86617-8   Mobility - Discharge Performance    
                      83216-2   Sit to lying    
                      83214-7   Lying to sitting on side of bed    
                      83212-1   Sit to stand    
                      83210-5   Chair/bed-to-chair transfer    
                      83208-9   Toilet transfer    
                      83278-2   Does the resident walk?    
                      83202-2   Walk 50 feet with two turns    
                      83200-6   Walk 150 feet    
                      83271-7   Does the resident use a wheelchair/scooter?    
                      83188-3   Wheel 50 feet with two turns    
                      83272-5   Indicate the type of wheelchair/scooter used    
                      83235-2   Wheel 150 feet    
                      83272-5   Indicate the type of wheelchair/scooter used    
            86820-8   Bladder and Bowel    
                 86624-4   Appliances 1..4   
                 86866-1   Urinary Toileting Program    
                      54767-9   Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility?    
                      54769-5   Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence?    
                 54770-3   Urinary Continence 1..1   
                 54771-1   Bowel Continence 1..1   
                 54772-9   Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence?    
            86670-7   Active Diagnoses    
                 86671-5   Active Diagnoses in the last 7 days 1..*   
                 52797-8   Additional active diagnoses 0..10   
            86867-9   Health Conditions    
                 54557-4   Pain Management    
                      71447-7   At any time in the last 5 days, has the resident: Received scheduled pain medication regimen?    
                      71448-5   At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined?    
                      71449-3   At any time in the last 5 days, has the resident: Received non-medication intervention for pain?    
                 54828-9   Should Pain Assessment Interview be Conducted?    
                 54558-2   Pain Assessment Interview    
                      54829-7   Pain Presence. Have you had pain or hurting at any time in the last 5 days?    
                      54830-5   Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days?    
                      54559-0   Pain Effect on Function    
                           54831-3   Over the past 5 days, has pain made it hard for you to sleep at night?    
                           54832-1   Over the past 5 days, have you limited your day-to-day activities because of pain?    
                      54560-8   Pain Intensity    
                           54833-9   Numeric Rating Scale (00-10)    
                           54834-7   Verbal Descriptor Scale    
                 58117-3   Should the Staff Assessment for Pain be Conducted?    
                 86672-3   Staff Assessment for Pain    
                      86673-1   Indicators of Pain or Possible Pain in the last 5 days 1..4   
                      58118-1   Frequency of Indicator of Pain or Possible Pain in the last 5 days. Frequency with which resident complains or shows evidence of pain or possible pain   d/(5.d) 
                 86868-7   Other Health Conditions    
                      86675-6   Shortness of Breath (dyspnea) 1..3   
                      54846-1   Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?    
                      86676-4   Problem Conditions 1..4   
                      54849-5   Fall History on Admission/Entry or Reentry    
                           54850-3   Did the resident have a fall any time in the last month prior to admission/entry or reentry?    
                           54851-1   Did the resident have a fall any time in the last 2-6 months prior to admission/entry or reentry?    
                           54852-9   Did the resident have any fracture related to a fall in the 6 months prior to admission/entry or reentry?    
                      54853-7   Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent?    
                      54854-5   Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent    
                           54855-2   No injury    
                           54856-0   Injury (except major)    
                           54857-8   Major injury    
            86826-5   Swallowing/Nutritional Status    
                 54567-3   Height and Weight    
                      3137-7   Height (in inches)   [in_us];cm 
                      3141-9   Weight (in pounds)   [lb_av];kg 
                 54863-6   Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months    
                 86678-0   Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months    
                 54568-1   Nutritional Approaches    
                      71444-4   Nutritional Approaches. While NOT a Resident 1..4   
                      71445-1   Nutritional Approaches. While a Resident 1..4   
                 86679-8   Percent Intake by Artificial Route    
                      86680-6   Proportion of total calories the resident received through parenteral or tube feeding. While NOT a Resident    
                      86681-4   Proportion of total calories the resident received through parenteral or tube feeding. While a Resident    
                      86687-1   Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days    
                      86682-2   Average fluid intake per day by IV or tube feeding. While NOT a Resident    
                      86683-0   Average fluid intake per day by IV or tube feeding. While a Resident    
                      86684-8   Average fluid intake per day by IV or tube feeding. During Entire 7 Days    
            86707-7   Skin Conditions    
                 86708-5   Determination of Pressure Ulcer Risk 1..3   
                 57280-0   Risk of Pressure Ulcers. Is this resident at risk of developing pressure ulcers?    
                 58214-8   Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher?    
                 86745-7   Current Number of Unhealed Pressure Ulcers at Each Stage    
                      54884-2   Number of Stage 1 pressure ulcers   {#} 
                      55124-2   Number of Stage 2 pressure ulcers   {#} 
                      54886-7   Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry   {#} 
                      58123-1   Date of oldest Stage 2 pressure ulcer   {mm/dd/yyyy} 
                      55125-9   Number of Stage 3 pressure ulcers   {#} 
                      54887-5   Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry   {#} 
                      55126-7   Number of Stage 4 pressure ulcers   {#} 
                      54890-9   Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry   {#} 
                      54893-3   Number of unstageable pressure ulcers due to non-removable dressing/device   {#} 
                      54894-1   Number of these unstageable pressure ulcers that were present upon admission/entry or reentry   {#} 
                      54946-9   Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar   {#} 
                      54947-7   Number of these unstageable pressure ulcers that were present upon admission/entry or reentry   {#} 
                      54950-1   Number of unstageable pressure ulcers with suspected deep tissue injury in evolution   {#} 
                      54951-9   Number of these unstageable pressure ulcers that were present upon admission/entry or reentry   {#} 
                 86746-5   Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar    
                      86901-6   Pressure ulcer length: Longest length from head to toe   cm 
                      86902-4   Pressure ulcer width: Widest width of the same pressure ulcer, side-to-side perpendicular (90-degree angle) to length   cm 
                      57228-9   Pressure ulcer depth: Depth of the same pressure ulcer from the visible surface to the deepest area   cm 
                 86903-2   Most Severe Tissue Type for Any Pressure Ulcer    
                 54952-7   Worsening in Pressure Ulcer Status Since Prior Assessment (OBRA or Scheduled PPS) or Last Admission/Entry or Reentry    
                      54953-5   Stage 2   {#} 
                      54954-3   Stage 3   {#} 
                      54955-0   Stage 4   {#} 
                 54956-8   Healed Pressure Ulcers    
                      54957-6   Were pressure ulcers present on the prior assessment (OBRA or scheduled PPS)?    
                      54958-4   Stage 2   {#} 
                      54959-2   Stage 3   {#} 
                      54960-0   Stage 4   {#} 
                 54970-9   Number of Venous and Arterial Ulcers   {#} 
                 86747-3   Other Ulcers, Wounds and Skin Problems 1..8   
                 86748-1   Skin and Ulcer Treatments 1..9   
            86749-9   Medications [CMS Assessment]Medications [CMS Assessment]Medications: -: Pt: ^Patient: -: CMS Assessment    
                 54982-4   Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days.   d/(7.d) 
                 58217-1   Insulin    
                      58127-2   Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days   d/(7.d) 
                      58128-0   Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days   d/(7.d) 
                 86750-7   Medications Received    
                      86751-5   Antipsychotic   d/(7.d) 
                      86752-3   Antianxiety   d/(7.d) 
                      86753-1   Antidepressant   d/(7.d) 
                      86754-9   Hypnotic   d/(7.d) 
                      86755-6   Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin)   d/(7.d) 
                      86756-4   Antibiotic   d/(7.d) 
                      86757-2   Diuretic   d/(7.d) 
            86840-6   Special Treatments, Procedures, and Programs    
                 86761-4   Special Treatments, Procedures, and Programs. While a Resident 0..10   
                 69339-0   Influenza Vaccine    
                      55019-4   Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season?    
                      58131-4   Date influenza vaccine received   {mm/dd/yyyy} 
                      55020-2   If influenza vaccine not received, state reason:    
                 55021-0   Pneumococcal Vaccine    
                      55022-8   Is the resident's Pneumococcal vaccination up to date?    
                      45956-0   If Pneumococcal vaccine not received, state reason:    
                 86847-1   Therapies    
                      86763-0   Speech-Language Pathology and Audiology Services    
                           58218-9   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58133-0   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58134-8   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86765-5   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45760-6   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55025-1   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55026-9   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86767-1   Occupational Therapy    
                           58219-7   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58136-3   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58137-1   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86764-8   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45762-2   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55027-7   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55028-5   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86768-9   Physical Therapy    
                           58220-5   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58139-7   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58140-5   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86766-3   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45764-8   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55029-3   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55030-1   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86849-7   Respiratory therapy    
                           45766-3   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                 86769-7   Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days.  
                 86770-5   Resumption of Therapy    
                      86772-1   Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline?    
                      86771-3   Date on which therapy regimen resumed   {mm/dd/yyyy} 
                 86773-9   Restorative Nursing Programs    
                      86774-7   Technique. Range of motion (passive)   d/(7.d) 
                      86775-4   Technique. Range of motion (active)   d/(7.d) 
                      86776-2   Technique. Splint or brace assistance   d/(7.d) 
                      86777-0   Training and Skill Practice In: Bed mobility   d/(7.d) 
                      86778-8   Training and Skill Practice In: Transfer   d/(7.d) 
                      86779-6   Training and Skill Practice In: Walking   d/(7.d) 
                      86780-4   Training and Skill Practice In: Dressing and/or grooming   d/(7.d) 
                      86781-2   Training and Skill Practice In: Eating and/or swallowing   d/(7.d) 
                      86782-0   Training and Skill Practice In: Amputation/prostheses care   d/(7.d) 
                      86783-8   Training and Skill Practice In: Communication   d/(7.d) 
                 55040-0   Physician Examinations. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) examine the resident?   d/(14.d) 
                 55041-8   Physician Orders. Over the last 14 days, on how many days did the physician (or authorized assistant or practitioner) change the resident's orders?   d/(14.d) 
            86784-6   Restraints    
                 86785-3   Physical Restraints    
                      86786-1   Used in Bed. Bed rail   d/(7.d) 
                      86787-9   Used in Bed. Trunk restraint   d/(7.d) 
                      86788-7   Used in Bed. Limb restraint   d/(7.d) 
                      86789-5   Used in Bed. Other   d/(7.d) 
                      86790-3   Used in Chair or Out of Bed. Trunk restraint   d/(7.d) 
                      86791-1   Used in Chair or Out of Bed. Limb restraint   d/(7.d) 
                      86792-9   Used in Chair or Out of Bed. Chair prevents rising   d/(7.d) 
                      86793-7   Used in Chair or Out of Bed. Other   d/(7.d) 
            86794-5   Participation in Assessment and Goal Setting    
                 55053-3   Participation in Assessment    
                      55054-1   Resident participated in assessment    
                      55074-9   Family or significant other participated in assessment    
                      58221-3   Guardian or legally authorized representative participated in assessment    
                 55056-6   Resident's Overall Expectation    
                      55057-4   Select one for resident's overall goal established during assessment process    
                      55058-2   Indicate information source for Q0300A    
                 58146-2   Discharge Plan. Is active discharge planning already occurring for the resident to return to the community?    
                 86795-2   Resident's Preference to Avoid Being Asked Question Q0500B. Does the resident's clinical record document a request that this question be asked only on comprehensive assessments?    
                 58149-6   Return to Community. Do you want to talk to someone about the possiblity of leaving this facility and returning to live and receive services in the community?    
                 86796-0   Resident's Preference to Avoid Being Asked Question Q0500B Again    
                      86797-8   Does the resident (or family or significant other or guardian or legally authorized representative if resident is unable to understand or respond) want to be asked about returning to the community on all assessments?    
                      86798-6   Indicate information source for Q0550A    
                 58150-4   Referral. Has a referral been made to the Local Contact Agency?    
            87224-2   Correction Request    
                 85632-8   Type of Provider    
                 87226-7   Name of Resident    
                      45392-8   First nameFirst nameFirst name: Pn: Pt: ^Patient: Nom:    
                      45394-4   Last nameLast nameLast name: Pn: Pt: ^Patient: Nom:    
                 46098-0   Gender    
                 21112-8   Birth Date   {mm/dd/yyyy} 
                 45396-9   Social Security Number    
                 87227-5   Type of Assessment    
                      54583-0   Federal OBRA Reason for Assessment    
                      54584-8   PPS Assessment    
                      54585-5   PPS Other Medicare Required Assessment - OMRA    
                      58107-4   Is this a Swing Bed clinical change assessment?    
                      58108-2   Entry/discharge reporting    
                      86525-3   Is this a SNF Part A PPS Discharge Assessment?    
                 87216-8   Date on existing record to be modified/inactivated    
                      54593-9   Assessment Reference Date   {mm/dd/yyyy} 
                      52525-3   Discharge Date   {mm/dd/yyyy} 
                      50786-3   Entry Date   {mm/dd/yyyy} 
                 87209-3   Correction Attestation Section    
                      58200-7   Correction Number   {#} 
                      87217-6   Reasons for Modification 1..6   
                      87225-9   Reasons for Inactivation 1..2   
                      87218-4   RN Assessment Coordinator Attestation of Completion    
                           87219-2   Attesting individual's first name    
                           87220-0   Attesting individual's last name    
                           87221-8   Attesting individual's title    
                           87222-6   Attestation date   {mm/dd/yyyy} 
            87228-3   Assessment Administration    
                 55064-0   Medicare Part A Billing    
                      55065-7   Medicare Part A HIPPS code    
                      55066-5   RUG version code    
                      58421-9   Is this a Medicare Short Stay assessment?    
                 59375-6   Medicare Part A Non-Therapy Billing    
                      58210-6   Medicare Part A non-therapy HIPPS code    
                      58211-4   RUG version code    
                 55070-7   Insurance Billing    
                      55071-5   RUG billing code    
                      55072-3   RUG billing version    
       86873-7   MDS v3.0 - RAI v1.14.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]MDS v3.0 - RAI v1.14.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]MDS v3.0 - RAI v1.14.1 - Nursing home OMRA-discharge (NOD) & Swing bed OMRA-discharge (SOD) item set: -: Pt: ^Patient: -: CMS Assessment    
            86811-7   Identification Information    
                 58198-3   Type of Record    
                 54581-4   Facility Provider Numbers    
                      76468-8   National Provider Identifier (NPI)    
                      69417-4   CMS Certification Number (CCN)    
                      45398-5   State Provider Number    
                 85632-8   Type of Provider    
                 86524-6   Type of Assessment    
                      54583-0   Federal OBRA Reason for Assessment    
                      54584-8   PPS Assessment    
                      54585-5   PPS Other Medicare Required Assessment - OMRA    
                      58107-4   Is this a Swing Bed clinical change assessment?    
                      54587-1   Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry?    
                      58108-2   Entry/discharge reporting    
                      71440-2   Type of discharge    
                      86525-3   Is this a SNF Part A PPS Discharge Assessment?    
                 86526-1   Unit Certification or Licensure Designation    
                 54503-8   Legal Name of Resident    
                      45392-8   First name    
                      45393-6   Middle initial    
                      45394-4   Last name    
                      45395-1   Suffix    
                 45966-9   Social Security and Medicare Numbers    
                      45396-9   Social Security Number    
                      45397-7   Medicare number (or comparable railroad insurance number)    
                 45400-9   Medicaid Number    
                 46098-0   Gender    
                 21112-8   Birth Date   {mm/dd/yyyy} 
                 59362-4   Race/Ethnicity 1..6   
                 54505-3   Language    
                      54588-9   Does the resident need or want an interpreter to communicate with a doctor or health care staff?    
                      54899-0   Preferred language    
                 45404-1   Marital Status    
                 54506-1   Optional Resident Items    
                      46106-1   Medical record number [Identifier]Medical record number [Identifier]Medical record number: ID: Pt: ^Patient: Nom:    
                      45403-3   Room number [Location]Room number [Location]Room number: Loc: Pt: ^Patient: Nom:    
                      52462-9   Name by which resident prefers to be addressed    
                      21843-8   Lifetime occupation(s)    
                 86528-7   Most Recent Admission/Entry or Reentry into this Facility    
                      50786-3   Entry Date   {mm/dd/yyyy} 
                      54590-5   Type of Entry    
                      85398-6   Entered From    
                 52455-3   Admission Date (Date this episode of care in this facility began)   {mm/dd/yyyy} 
                 52525-3   Discharge Date   {mm/dd/yyyy} 
                 55128-3   Discharge Status    
                 54593-9   Assessment Reference Date. Observation end date   {mm/dd/yyyy} 
                 54507-9   Medicare Stay    
                      54594-7   Has the resident had a Medicare-covered stay since the most recent entry?    
                      54595-4   Start date of most recent Medicare stay   {mm/dd/yyyy} 
                      54596-2   End date of most recent Medicare stay   {mm/dd/yyyy} 
            86813-3   Hearing, Speech, and Vision    
                 54597-0   Comatose. Persistent vegetative state/no discernible consciousness    
                 54601-0   Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression    
            86882-8   Cognitive Patterns    
                 54605-1   Should Brief Interview for Mental Status (C0200-C0500) be Conducted?    
                 52491-8   Brief Interview for Mental Status (BIMS)    
                      52731-7   Repetition of Three Words. Number of words repeated after first attempt    
                      54510-3   Temporal Orientation (orientation to year, month, and day)    
                           52732-5   Able to report correct year    
                           52733-3   Able to report correct month    
                           54609-3   Able to report correct day of the week    
                      52493-4   Recall    
                           52735-8   Able to recall "sock"    
                           52736-6   Able to recall "blue"    
                           52737-4   Able to recall "bed"    
                      54614-3   BIMS Summary Score   {score} 
                 54615-0   Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted?    
                 86814-1   Staff Assessment for Mental Status    
                      54616-8   Short-term Memory OK. Seems or appears to recall after 5 minutes    
                      54624-2   Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life    
                 86584-0   Delirium    
                      86585-7   Signs and Symptoms of Delirium (from CAM)    
                           54632-5   Acute Onset Mental Status Change. Is there evidence of an acute change in mental status from the resident's baseline?    
                           54628-3   Inattention - Did the resident have difficulty focusing attention, for example being easily distractible, or having difficulty keeping track of what was being said?    
                           54629-1   Disorganized thinking - Was the resident's thinking disorganized or incoherent (rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject)?    
                           54630-9   Altered level of consciousness - Did the resident have altered level of consciousness as indicated by any of the following criteria?    
            54633-3   Mood    
                 54634-1   Should Resident Mood Interview be Conducted?    
                 54635-8   Resident Mood Interview (PHQ-9)    
                      86843-0   Symptom Presence    
                           54636-6   Little interest or pleasure in doing things    
                           54638-2   Feeling down, depressed or hopeless    
                           54640-8   Trouble falling or staying asleep, or sleeping too much    
                           54642-4   Feeling tired or having little energy    
                           54644-0   Poor appetite or overeating    
                           54646-5   Feeling bad about yourself - or that you are a failure or have let yourself or your family down    
                           54648-1   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54650-7   Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual    
                           54652-3   Thoughts that you would be better off dead, or of hurting yourself in some way    
                      86844-8   Symptom Frequency    
                           54637-4   Little interest or pleasure in doing things    
                           54639-0   Feeling down, depressed or hopeless    
                           54641-6   Trouble falling or staying asleep, or sleeping too much    
                           54643-2   Feeling tired or having little energy    
                           54645-7   Poor appetite or overeating    
                           54647-3   Feeling bad about yourself - or that you are a failure or have let yourself or your family down    
                           54649-9   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54651-5   Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual    
                           54653-1   Thoughts that you would be better off dead, or of hurting yourself in some way    
                 54654-9   Total Severity Score   {score} 
                 54655-6   Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm?    
                 54657-2   Staff Assessment of Resident Mood (PHQ-9-OV)    
                      86833-1   Symptom Presence    
                           54658-0   Little interest or pleasure in doing things    
                           54660-6   Feeling or appearing down, depressed, or hopeless    
                           54662-2   Trouble falling or staying asleep, or sleeping too much    
                           54664-8   Feeling tired or having little energy    
                           54666-3   Poor appetite or overeating    
                           54668-9   Indicating that s/he feels bad about self, is a failure, or has let self or family down    
                           54670-5   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54672-1   Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual    
                           54673-9   States that life isn't worth living, wishes for death, or attempts to harm self    
                           54675-4   Being short-tempered, easily annoyed    
                      86891-9   Symptom Frequency    
                           54659-8   Little interest or pleasure in doing things    
                           54661-4   Feeling or appearing down, depressed, or hopeless    
                           54663-0   Trouble falling or staying asleep, or sleeping too much    
                           54665-5   Feeling tired or having little energy    
                           54667-1   Poor appetite or overeating    
                           54669-7   Indicating that s/he feels bad about self, is a failure, or has let self or family down    
                           54671-3   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54904-8   Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual    
                           54674-7   States that life isn't worth living, wishes for death, or attempts to harm self    
                           54676-2   Being short-tempered, easily annoyed    
                 54677-0   Total Severity Score   {score} 
                 54655-6   Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm?    
            86815-8   Behavior    
                 86597-2   Potential Indicators of Psychosis 1..2   
                 54514-5   Behavioral Symptom - Presence & Frequency    
                      54682-0   Physical behavioral symptoms directed toward others   d/(7.d) 
                      54683-8   Verbal behavioral symptoms directed toward others   d/(7.d) 
                      54684-6   Other behavioral symptoms not directed toward others   d/(7.d) 
                 54692-9   Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being?   d/(7.d) 
                 54693-7   Wandering - Presence & Frequency. Has the resident wandered?   d/(7.d) 
            86818-2   Functional Status    
                 86880-2   Activities of Daily Living (ADL) Assistance. Self-Performance    
                      45588-1   Bed mobility    
                      45590-7   Transfer    
                      45592-3   Walk in room    
                      45594-9   Walk in corridor    
                      45596-4   Locomotion on unit    
                      45598-0   Locomotion off unit    
                      45600-4   Dressing    
                      45602-0   Eating    
                      45604-6   Toilet use    
                      45606-1   Personal hygiene    
                 86884-4   Activities of daily living (ADL) assistance. Support provided    
                      45589-9   Bed mobility    
                      45591-5   Transfer    
                      45603-8   Eating    
                      45605-3   Toilet use    
                 86887-7   Bathing    
                      45608-7   Self-performance    
            86615-2   Functional Abilities and Goals - Discharge (End of SNF PPS Stay)    
                 86616-0   Self-Care - Discharge Performance    
                      83232-9   Eating    
                      83230-3   Oral hygiene    
                      83228-7   Toileting hygiene    
                 86617-8   Mobility - Discharge Performance    
                      83216-2   Sit to lying    
                      83214-7   Lying to sitting on side of bed    
                      83212-1   Sit to stand    
                      83210-5   Chair/bed-to-chair transfer    
                      83208-9   Toilet transfer    
                      83278-2   Does the resident walk?    
                      83202-2   Walk 50 feet with two turns    
                      83200-6   Walk 150 feet    
                      83271-7   Does the resident use a wheelchair/scooter?    
                      83188-3   Wheel 50 feet with two turns    
                      83272-5   Indicate the type of wheelchair/scooter used    
                      83235-2   Wheel 150 feet    
                      83272-5   Indicate the type of wheelchair/scooter used    
            86820-8   Bladder and Bowel    
                 86624-4   Appliances 1..4   
                 86866-1   Urinary Toileting Program    
                      54767-9   Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility?    
                      54769-5   Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence?    
                 54770-3   Urinary Continence 1..1   
                 54771-1   Bowel Continence 1..1   
                 54772-9   Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence?    
            86670-7   Active Diagnoses    
                 86671-5   Active Diagnoses in the last 7 days 1..*   
                 52797-8   Additional active diagnoses 0..10   
            86822-4   Health Conditions    
                 54557-4   Pain Management    
                      71447-7   At any time in the last 5 days, has the resident: Received scheduled pain medication regimen?    
                      71448-5   At any time in the last 5 days, has the resident: Received PRN pain medications OR was offered and declined?    
                      71449-3   At any time in the last 5 days, has the resident: Received non-medication intervention for pain?    
                 54828-9   Should Pain Assessment Interview be Conducted?    
                 54558-2   Pain Assessment Interview    
                      54829-7   Pain Presence. Have you had pain or hurting at any time in the last 5 days?    
                      54830-5   Pain Frequency. How much of the time have you experienced pain or hurting over the last 5 days?    
                      54559-0   Pain Effect on Function    
                           54831-3   Over the past 5 days, has pain made it hard for you to sleep at night?    
                           54832-1   Over the past 5 days, have you limited your day-to-day activities because of pain?    
                      54560-8   Pain Intensity    
                           54833-9   Numeric Rating Scale (00-10)    
                           54834-7   Verbal Descriptor Scale    
                 86890-1   Other Health Conditions    
                      86675-6   Shortness of Breath (dyspnea) 1..3   
                      54846-1   Prognosis. Does the resident have a condition or chronic disease that may result in a life expectancy of less than 6 months?    
                      86676-4   Problem Conditions 1..4   
                 54853-7   Has the resident had any falls since admission/entry or reentry or the prior assessment (OBRA or Scheduled PPS), whichever is more recent?    
                 54854-5   Number of Falls Since Admission/Entry or Reentry or Prior Assessment (OBRA or Scheduled PPS), whichever is more recent    
                      54855-2   No injury    
                      54856-0   Injury (except major)    
                      54857-8   Major injury    
            86826-5   Swallowing/Nutritional Status    
                 54567-3   Height and Weight    
                      3137-7   Height (in inches)   [in_us];cm 
                      3141-9   Weight (in pounds)   [lb_av];kg 
                 54863-6   Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months    
                 86678-0   Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months    
                 54568-1   Nutritional Approaches    
                      71444-4   Nutritional Approaches. While NOT a Resident 1..4   
                      71445-1   Nutritional Approaches. While a Resident 1..4   
                 86679-8   Percent Intake by Artificial Route    
                      86680-6   Proportion of total calories the resident received through parenteral or tube feeding. While NOT a Resident    
                      86681-4   Proportion of total calories the resident received through parenteral or tube feeding. While a Resident    
                      86687-1   Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days    
                      86682-2   Average fluid intake per day by IV or tube feeding. While NOT a Resident    
                      86683-0   Average fluid intake per day by IV or tube feeding. While a Resident    
                      86684-8   Average fluid intake per day by IV or tube feeding. During Entire 7 Days    
            86829-9   Skin Conditions    
                 86708-5   Determination of Pressure Ulcer Risk 0..1   
                 58214-8   Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher?    
                 86270-6   Current Number of Unhealed Pressure Ulcers at Each Stage    
                      55124-2   Number of Stage 2 pressure ulcers   {#} 
                      54886-7   Number of these Stage 2 pressure ulcers that were present upon admission/entry or reentry   {#} 
                      55125-9   Number of Stage 3 pressure ulcers   {#} 
                      54887-5   Number of these Stage 3 pressure ulcers that were present upon admission/entry or reentry   {#} 
                      55126-7   Number of Stage 4 pressure ulcers   {#} 
                      54890-9   Number of these Stage 4 pressure ulcers that were present upon admission/entry or reentry   {#} 
                      54893-3   Number of unstageable pressure ulcers due to non-removable dressing/device   {#} 
                      54894-1   Number of these unstageable pressure ulcers that were present upon admission/entry or reentry   {#} 
                      54946-9   Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar   {#} 
                      54947-7   Number of these unstageable pressure ulcers that were present upon admission/entry or reentry   {#} 
                      54950-1   Number of unstageable pressure ulcers with suspected deep tissue injury in evolution   {#} 
                      54951-9   Number of these unstageable pressure ulcers that were present upon admission/entry or reentry   {#} 
                 86746-5   Dimensions of Unhealed Stage 3 or 4 Pressure Ulcers or Eschar    
                      86901-6   Pressure ulcer length: Longest length from head to toe   cm 
                      86902-4   Pressure ulcer width: Widest width of the same pressure ulcer, side-to-side perpendicular (90-degree angle) to length   cm 
                      57228-9   Pressure ulcer depth: Depth of the same pressure ulcer from the visible surface to the deepest area   cm 
                 54952-7   Worsening in Pressure Ulcer Status Since Prior Assessment (OBRA or Scheduled PPS) or Last Admission/Entry or Reentry    
                      54953-5   Stage 2   {#} 
                      54954-3   Stage 3   {#} 
                      54955-0   Stage 4   {#} 
                 54956-8   Healed Pressure Ulcers    
                      54957-6   Were pressure ulcers present on the prior assessment (OBRA or scheduled PPS)?    
                      54958-4   Stage 2   {#} 
                      54959-2   Stage 3   {#} 
                      54960-0   Stage 4   {#} 
                 54970-9   Number of Venous and Arterial Ulcers   {#} 
                 86747-3   Other Ulcers, Wounds and Skin Problems 1..8   
                 86748-1   Skin and Ulcer Treatments 1..9   
            86749-9   Medications [CMS Assessment]Medications [CMS Assessment]Medications: -: Pt: ^Patient: -: CMS Assessment    
                 54982-4   Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days.   d/(7.d) 
                 58217-1   Insulin    
                      58127-2   Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days   d/(7.d) 
                      58128-0   Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days   d/(7.d) 
                 86750-7   Medications Received    
                      86751-5   Antipsychotic   d/(7.d) 
                      86752-3   Antianxiety   d/(7.d) 
                      86753-1   Antidepressant   d/(7.d) 
                      86754-9   Hypnotic   d/(7.d) 
                      86755-6   Anticoagulant (e.g., warfarin, heparin, or low-molecular weight heparin)   d/(7.d) 
                      86756-4   Antibiotic   d/(7.d) 
                      86757-2   Diuretic   d/(7.d) 
            86839-8   Special Treatments, Procedures, and Programs    
                 86761-4   Special Treatments, Procedures, and Programs. While a Resident 0..10   
                 69339-0   Influenza Vaccine    
                      55019-4   Did the resident receive the influenza vaccine in this facility for this year's influenza vaccination season?    
                      58131-4   Date influenza vaccine received   {mm/dd/yyyy} 
                      55020-2   If influenza vaccine not received, state reason:    
                 55021-0   Pneumococcal Vaccine    
                      55022-8   Is the resident's Pneumococcal vaccination up to date?    
                      45956-0   If Pneumococcal vaccine not received, state reason:    
                 86846-3   Therapies    
                      86763-0   Speech-Language Pathology and Audiology Services    
                           58218-9   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58133-0   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58134-8   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86765-5   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45760-6   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55025-1   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55026-9   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86767-1   Occupational Therapy    
                           58219-7   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58136-3   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58137-1   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86764-8   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45762-2   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55027-7   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55028-5   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86768-9   Physical Therapy    
                           58220-5   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58139-7   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58140-5   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86766-3   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45764-8   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55029-3   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55030-1   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86849-7   Respiratory therapy    
                           45766-3   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                 86769-7   Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days.  
                 86770-5   Resumption of Therapy    
                      86772-1   Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline?    
                      86771-3   Date on which therapy regimen resumed   {mm/dd/yyyy} 
                 86773-9   Restorative Nursing Programs    
                      86774-7   Technique. Range of motion (passive)   d/(7.d) 
                      86775-4   Technique. Range of motion (active)   d/(7.d) 
                      86776-2   Technique. Splint or brace assistance   d/(7.d) 
                      86777-0   Training and Skill Practice In: Bed mobility   d/(7.d) 
                      86778-8   Training and Skill Practice In: Transfer   d/(7.d) 
                      86779-6   Training and Skill Practice In: Walking   d/(7.d) 
                      86780-4   Training and Skill Practice In: Dressing and/or grooming   d/(7.d) 
                      86781-2   Training and Skill Practice In: Eating and/or swallowing   d/(7.d) 
                      86782-0   Training and Skill Practice In: Amputation/prostheses care   d/(7.d) 
                      86783-8   Training and Skill Practice In: Communication   d/(7.d) 
            86784-6   Restraints    
                 86785-3   Physical Restraints    
                      86786-1   Used in Bed. Bed rail   d/(7.d) 
                      86787-9   Used in Bed. Trunk restraint   d/(7.d) 
                      86788-7   Used in Bed. Limb restraint   d/(7.d) 
                      86789-5   Used in Bed. Other   d/(7.d) 
                      86790-3   Used in Chair or Out of Bed. Trunk restraint   d/(7.d) 
                      86791-1   Used in Chair or Out of Bed. Limb restraint   d/(7.d) 
                      86792-9   Used in Chair or Out of Bed. Chair prevents rising   d/(7.d) 
                      86793-7   Used in Chair or Out of Bed. Other   d/(7.d) 
            86853-9   Participation in Assessment and Goal Setting    
                 55053-3   Participation in Assessment    
                      55054-1   Resident participated in assessment    
                      55074-9   Family or significant other participated in assessment    
                      58221-3   Guardian or legally authorized representative participated in assessment    
                 58146-2   Discharge Plan. Is active discharge planning already occurring for the resident to return to the community?    
                 58150-4   Referral. Has a referral been made to the Local Contact Agency?    
            87224-2   Correction Request    
                 85632-8   Type of Provider    
                 87226-7   Name of Resident    
                      45392-8   First nameFirst nameFirst name: Pn: Pt: ^Patient: Nom:    
                      45394-4   Last nameLast nameLast name: Pn: Pt: ^Patient: Nom:    
                 46098-0   Gender    
                 21112-8   Birth Date   {mm/dd/yyyy} 
                 45396-9   Social Security Number    
                 87227-5   Type of Assessment    
                      54583-0   Federal OBRA Reason for Assessment    
                      54584-8   PPS Assessment    
                      54585-5   PPS Other Medicare Required Assessment - OMRA    
                      58107-4   Is this a Swing Bed clinical change assessment?    
                      58108-2   Entry/discharge reporting    
                      86525-3   Is this a SNF Part A PPS Discharge Assessment?    
                 87216-8   Date on existing record to be modified/inactivated    
                      54593-9   Assessment Reference Date   {mm/dd/yyyy} 
                      52525-3   Discharge Date   {mm/dd/yyyy} 
                      50786-3   Entry Date   {mm/dd/yyyy} 
                 87209-3   Correction Attestation Section    
                      58200-7   Correction Number   {#} 
                      87217-6   Reasons for Modification 1..6   
                      87225-9   Reasons for Inactivation 1..2   
                      87218-4   RN Assessment Coordinator Attestation of Completion    
                           87219-2   Attesting individual's first name    
                           87220-0   Attesting individual's last name    
                           87221-8   Attesting individual's title    
                           87222-6   Attestation date   {mm/dd/yyyy} 
            87228-3   Assessment Administration    
                 55064-0   Medicare Part A Billing    
                      55065-7   Medicare Part A HIPPS code    
                      55066-5   RUG version code    
                      58421-9   Is this a Medicare Short Stay assessment?    
                 59375-6   Medicare Part A Non-Therapy Billing    
                      58210-6   Medicare Part A non-therapy HIPPS code    
                      58211-4   RUG version code    
                 55070-7   Insurance Billing    
                      55071-5   RUG billing code    
                      55072-3   RUG billing version    
       86870-3   MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed OMRA (NO/​SO) item set [CMS Assessment]MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed OMRA (NO/​SO) item set [CMS Assessment]MDS v3.0 - RAI v1.14.1 - Nursing home & Swing bed OMRA (NO & SO) item set: -: Pt: ^Patient: -: CMS Assessment    
            86811-7   Identification Information    
                 58198-3   Type of Record    
                 54581-4   Facility Provider Numbers    
                      76468-8   National Provider Identifier (NPI)    
                      69417-4   CMS Certification Number (CCN)    
                      45398-5   State Provider Number    
                 85632-8   Type of Provider    
                 86524-6   Type of Assessment    
                      54583-0   Federal OBRA Reason for Assessment    
                      54584-8   PPS Assessment    
                      54585-5   PPS Other Medicare Required Assessment - OMRA    
                      58107-4   Is this a Swing Bed clinical change assessment?    
                      54587-1   Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry?    
                      58108-2   Entry/discharge reporting    
                      71440-2   Type of discharge    
                      86525-3   Is this a SNF Part A PPS Discharge Assessment?    
                 86526-1   Unit Certification or Licensure Designation    
                 54503-8   Legal Name of Resident    
                      45392-8   First name    
                      45393-6   Middle initial    
                      45394-4   Last name    
                      45395-1   Suffix    
                 45966-9   Social Security and Medicare Numbers    
                      45396-9   Social Security Number    
                      45397-7   Medicare number (or comparable railroad insurance number)    
                 45400-9   Medicaid Number    
                 46098-0   Gender    
                 21112-8   Birth Date   {mm/dd/yyyy} 
                 59362-4   Race/Ethnicity 1..6   
                 54505-3   Language    
                      54588-9   Does the resident need or want an interpreter to communicate with a doctor or health care staff?    
                      54899-0   Preferred language    
                 45404-1   Marital Status    
                 54506-1   Optional Resident Items    
                      46106-1   Medical record number [Identifier]Medical record number [Identifier]Medical record number: ID: Pt: ^Patient: Nom:    
                      45403-3   Room number [Location]Room number [Location]Room number: Loc: Pt: ^Patient: Nom:    
                      52462-9   Name by which resident prefers to be addressed    
                      21843-8   Lifetime occupation(s)    
                 86528-7   Most Recent Admission/Entry or Reentry into this Facility    
                      50786-3   Entry Date   {mm/dd/yyyy} 
                      54590-5   Type of Entry    
                      85398-6   Entered From    
                 52455-3   Admission Date (Date this episode of care in this facility began)   {mm/dd/yyyy} 
                 52525-3   Discharge Date   {mm/dd/yyyy} 
                 55128-3   Discharge Status    
                 54593-9   Assessment Reference Date. Observation end date   {mm/dd/yyyy} 
                 54507-9   Medicare Stay    
                      54594-7   Has the resident had a Medicare-covered stay since the most recent entry?    
                      54595-4   Start date of most recent Medicare stay   {mm/dd/yyyy} 
                      54596-2   End date of most recent Medicare stay   {mm/dd/yyyy} 
            86813-3   Hearing, Speech, and Vision    
                 54597-0   Comatose. Persistent vegetative state/no discernible consciousness    
                 54601-0   Makes Self Understood. Ability to express ideas and wants, consider both verbal and non-verbal expression    
            86883-6   Cognitive patterns    
                 54605-1   Should Brief Interview for Mental Status (C0200-C0500) be Conducted?    
                 52491-8   Brief Interview for Mental Status (BIMS)    
                      52731-7   Repetition of Three Words. Number of words repeated after first attempt    
                      54510-3   Temporal Orientation (orientation to year, month, and day)    
                           52732-5   Able to report correct year    
                           52733-3   Able to report correct month    
                           54609-3   Able to report correct day of the week    
                      52493-4   Recall    
                           52735-8   Able to recall "sock"    
                           52736-6   Able to recall "blue"    
                           52737-4   Able to recall "bed"    
                      54614-3   BIMS Summary Score   {score} 
                 54615-0   Should the Staff Assessment for Mental Status (C0700-C1000) be Conducted?    
                 86814-1   Staff Assessment for Mental Status    
                      54616-8   Short-term Memory OK. Seems or appears to recall after 5 minutes    
                      54624-2   Cognitive Skills for Daily Decision Making. Made decisions regarding tasks of daily life    
            54633-3   Mood    
                 54634-1   Should Resident Mood Interview be Conducted?    
                 54635-8   Resident Mood Interview (PHQ-9)    
                      86843-0   Symptom Presence    
                           54636-6   Little interest or pleasure in doing things    
                           54638-2   Feeling down, depressed or hopeless    
                           54640-8   Trouble falling or staying asleep, or sleeping too much    
                           54642-4   Feeling tired or having little energy    
                           54644-0   Poor appetite or overeating    
                           54646-5   Feeling bad about yourself - or that you are a failure or have let yourself or your family down    
                           54648-1   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54650-7   Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual    
                           54652-3   Thoughts that you would be better off dead, or of hurting yourself in some way    
                      86844-8   Symptom Frequency    
                           54637-4   Little interest or pleasure in doing things    
                           54639-0   Feeling down, depressed or hopeless    
                           54641-6   Trouble falling or staying asleep, or sleeping too much    
                           54643-2   Feeling tired or having little energy    
                           54645-7   Poor appetite or overeating    
                           54647-3   Feeling bad about yourself - or that you are a failure or have let yourself or your family down    
                           54649-9   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54651-5   Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual    
                           54653-1   Thoughts that you would be better off dead, or of hurting yourself in some way    
                 54654-9   Total Severity Score   {score} 
                 54655-6   Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm?    
                 54657-2   Staff Assessment of Resident Mood (PHQ-9-OV)    
                      86833-1   Symptom Presence    
                           54658-0   Little interest or pleasure in doing things    
                           54660-6   Feeling or appearing down, depressed, or hopeless    
                           54662-2   Trouble falling or staying asleep, or sleeping too much    
                           54664-8   Feeling tired or having little energy    
                           54666-3   Poor appetite or overeating    
                           54668-9   Indicating that s/he feels bad about self, is a failure, or has let self or family down    
                           54670-5   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54672-1   Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual    
                           54673-9   States that life isn't worth living, wishes for death, or attempts to harm self    
                           54675-4   Being short-tempered, easily annoyed    
                      86891-9   Symptom Frequency    
                           54659-8   Little interest or pleasure in doing things    
                           54661-4   Feeling or appearing down, depressed, or hopeless    
                           54663-0   Trouble falling or staying asleep, or sleeping too much    
                           54665-5   Feeling tired or having little energy    
                           54667-1   Poor appetite or overeating    
                           54669-7   Indicating that s/he feels bad about self, is a failure, or has let self or family down    
                           54671-3   Trouble concentrating on things, such as reading the newspaper or watching television    
                           54904-8   Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that s/he has been moving around a lot more than usual    
                           54674-7   States that life isn't worth living, wishes for death, or attempts to harm self    
                           54676-2   Being short-tempered, easily annoyed    
                 54677-0   Total Severity Score   {score} 
                 54655-6   Safety Notification. Was responsible staff or provider informed that there is a potential for resident self harm?    
            86815-8   Behavior    
                 86597-2   Potential Indicators of Psychosis 1..2   
                 54514-5   Behavioral Symptom - Presence & Frequency    
                      54682-0   Physical behavioral symptoms directed toward others   d/(7.d) 
                      54683-8   Verbal behavioral symptoms directed toward others   d/(7.d) 
                      54684-6   Other behavioral symptoms not directed toward others   d/(7.d) 
                 54692-9   Rejection of Care - Presence & Frequency. Did the resident reject evaluation or care (e.g., bloodwork, taking medications, ADL assistance) that is necessary to achieve the resident's goals for health and well-being?   d/(7.d) 
                 54693-7   Wandering - Presence & Frequency. Has the resident wandered?   d/(7.d) 
            86817-4   Functional Status    
                 86885-1   Activities of Daily Living (ADL) Assistance. Self-Performance    
                      45588-1   Bed mobility    
                      45590-7   Transfer    
                      45602-0   Eating    
                      45604-6   Toilet use    
                 86886-9   Activities of Daily Living (ADL) Assistance. Support Provided    
                      45589-9   Bed mobility    
                      45591-5   Transfer    
                      45603-8   Eating    
                      45605-3   Toilet use    
            86878-6   Bladder and Bowel    
                 86866-1   Urinary Toileting Program    
                      54767-9   Has a trial of a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) been attempted on admission/entry or reentry or since urinary incontinence was noted in this facility?    
                      54769-5   Current toileting program or trial - Is a toileting program (e.g., scheduled toileting, prompted voiding, or bladder training) currently being used to manage the resident's urinary continence?    
                 54772-9   Bowel Toileting Program. Is a toileting program currently being used to manage the resident's bowel continence?    
            86821-6   Active Diagnoses    
                 86671-5   Active Diagnoses in the last 7 days 1..*   
            86888-5   Health conditions    
                 86889-3   Other Health Conditions    
                      86675-6   Shortness of Breath (dyspnea) 0..1   
                      86676-4   Problem Conditions 0..2   
            86824-0   Swallowing/Nutritional Status    
                 54863-6   Weight Loss. Loss of 5% or more in the last month or loss of 10% or more in last 6 months    
                 86678-0   Weight Gain. Gain of 5% or more in the last month or gain of 10% or more in last 6 months    
                 54568-1   Nutritional Approaches    
                      71444-4   Nutritional Approaches. While NOT a Resident 0..2   
                      71445-1   Nutritional Approaches. While a Resident 0..2   
                 86679-8   Percent Intake by Artificial Route    
                      86680-6   Proportion of total calories the resident received through parenteral or tube feeding. While NOT a Resident    
                      86681-4   Proportion of total calories the resident received through parenteral or tube feeding. While a Resident    
                      86687-1   Proportion of total calories the resident received through parenteral or tube feeding. During Entire 7 Days    
                      86682-2   Average fluid intake per day by IV or tube feeding. While NOT a Resident    
                      86683-0   Average fluid intake per day by IV or tube feeding. While a Resident    
                      86684-8   Average fluid intake per day by IV or tube feeding. During Entire 7 Days    
            86827-3   Skin Conditions    
                 58214-8   Unhealed Pressure Ulcer(s). Does this resident have one or more unhealed pressure ulcer(s) at Stage 1 or higher?    
                 86892-7   Current Number of Unhealed Pressure Ulcers at Each Stage    
                      55124-2   Number of Stage 2 pressure ulcers   {#} 
                      55125-9   Number of Stage 3 pressure ulcers   {#} 
                      55126-7   Number of Stage 4 pressure ulcers   {#} 
                      54946-9   Number of unstageable pressure ulcers due to coverage of wound bed by slough and/or eschar   {#} 
                 54970-9   Number of Venous and Arterial Ulcers   {#} 
                 86747-3   Other Ulcers, Wounds and Skin Problems 1..8   
                 86748-1   Skin and Ulcer Treatments 1..9   
            86831-5   Medications    
                 54982-4   Injections. Record the number of days that injections of any type were received during the last 7 days or since admission/entry or reentry if less than 7 days.   d/(7.d) 
                 58217-1   Insulin    
                      58127-2   Insulin injections - Record the number of days that insulin injections were received during the last 7 days or since admission/entry or reentry if less than 7 days   d/(7.d) 
                      58128-0   Orders for insulin - Record the number of days the physician (or authorized assistant or practitioner) changed the resident's insulin orders during the last 7 days or since admission/entry or reentry if less than 7 days   d/(7.d) 
            86836-4   Special Treatments, Procedures, and Programs    
                 86761-4   Special Treatments, Procedures, and Programs. While a Resident 0..9   
                 86846-3   Therapies    
                      86763-0   Speech-Language Pathology and Audiology Services    
                           58218-9   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58133-0   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58134-8   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86765-5   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45760-6   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55025-1   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55026-9   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86767-1   Occupational Therapy    
                           58219-7   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58136-3   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58137-1   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86764-8   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45762-2   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55027-7   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55028-5   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86768-9   Physical Therapy    
                           58220-5   Individual minutes - record the total number of minutes this therapy was administered to the resident individually in the last 7 days   min 
                           58139-7   Concurrent minutes - record the total number of minutes this therapy was administered to the resident concurrently with one other resident in the last 7 days   min 
                           58140-5   Group minutes - record the total number of minutes this therapy was administered to the resident as part of a group of residents in the last 7 days   min 
                           86766-3   Co-treatment minutes - record the total number of minutes this therapy was administered to the resident in co-treatment sessions in the last 7 days   min 
                           45764-8   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                           55029-3   Therapy start date - record the date the most recent therapy regimen (since the most recent entry) started   {mm/dd/yyyy} 
                           55030-1   Therapy end date - record the date the most recent therapy regimen (since the most recent entry) ended   {mm/dd/yyyy} 
                      86849-7   Respiratory therapy    
                           45766-3   Days - record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days   d/(7.d) 
                 86769-7   Distinct Calendar Days of Therapy. Record the number of calendar days that the resident received Speech-Language Pathology and Audiology Services, Occupational Therapy, or Physical Therapy for at least 15 minutes in the past 7 days.  
                 86770-5   Resumption of Therapy    
                      86772-1   Has a previous rehabilitation therapy regimen (speech, occupational, and/or physical therapy) ended, as reported on this End of Therapy OMRA, and has this regimen now resumed at exactly the same level for each discipline?    
                      86771-3   Date on which therapy regimen resumed   {mm/dd/yyyy} 
                 86773-9   Restorative Nursing Programs    
                      86774-7   Technique. Range of motion (passive)   d/(7.d) 
                      86775-4   Technique. Range of motion (active)   d/(7.d) 
                      86776-2   Technique. Splint or brace assistance   d/(7.d) 
                      86777-0   Training and Skill Practice In: Bed mobility   d/(7.d) 
                      86778-8   Training and Skill Practice In: Transfer   d/(7.d) 
                      86779-6   Training and Skill Practice In: Walking   d/(7.d) 
                      86780-4   Training and Skill Practice In: Dressing and/or grooming   d/(7.d) 
                      86781-2   Training and Skill Practice In: Eating and/or swallowing   d/(7.d) 
                      86782-0   Training and Skill Practice In: Amputation/prostheses care   d/(7.d) 
                      86783-8   Training and Skill Practice In: Communication   d/(7.d) 
            86852-1   Participation in Assessment and Goal Setting    
                 55053-3   Participation in Assessment    
                      55054-1   Resident participated in assessment    
                      55074-9   Family or significant other participated in assessment    
                      58221-3   Guardian or legally authorized representative participated in assessment    
            87224-2   Correction Request    
                 85632-8   Type of Provider    
                 87226-7   Name of Resident    
                      45392-8   First nameFirst nameFirst name: Pn: Pt: ^Patient: Nom:    
                      45394-4   Last nameLast nameLast name: Pn: Pt: ^Patient: Nom:    
                 46098-0   Gender    
                 21112-8   Birth Date   {mm/dd/yyyy} 
                 45396-9   Social Security Number    
                 87227-5   Type of Assessment    
                      54583-0   Federal OBRA Reason for Assessment    
                      54584-8   PPS Assessment    
                      54585-5   PPS Other Medicare Required Assessment - OMRA    
                      58107-4   Is this a Swing Bed clinical change assessment?    
                      58108-2   Entry/discharge reporting    
                      86525-3   Is this a SNF Part A PPS Discharge Assessment?    
                 87216-8   Date on existing record to be modified/inactivated    
                      54593-9   Assessment Reference Date   {mm/dd/yyyy} 
                      52525-3   Discharge Date   {mm/dd/yyyy} 
                      50786-3   Entry Date   {mm/dd/yyyy} 
                 87209-3   Correction Attestation Section    
                      58200-7   Correction Number   {#} 
                      87217-6   Reasons for Modification 1..6   
                      87225-9   Reasons for Inactivation 1..2   
                      87218-4   RN Assessment Coordinator Attestation of Completion    
                           87219-2   Attesting individual's first name    
                           87220-0   Attesting individual's last name    
                           87221-8   Attesting individual's title    
                           87222-6   Attestation date   {mm/dd/yyyy} 
            87228-3   Assessment Administration    
                 55064-0   Medicare Part A Billing    
                      55065-7   Medicare Part A HIPPS code    
                      55066-5   RUG version code    
                      58421-9   Is this a Medicare Short Stay assessment?    
                 59375-6   Medicare Part A Non-Therapy Billing    
                      58210-6   Medicare Part A non-therapy HIPPS code    
                      58211-4   RUG version code    
                 55070-7   Insurance Billing    
                      55071-5   RUG billing code    
                      55072-3   RUG billing version    
       86874-5   MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed OMRA start of therapy (NS/​SS) item set [CMS Assessment]MDS v3.0 - RAI v1.14.1 - Nursing home and Swing bed OMRA start of therapy (NS/​SS) item set [CMS Assessment]MDS v3.0 - RAI v1.14.1 - Nursing home & Swing bed OMRA start of therapy (NS & SS) item set: -: Pt: ^Patient: -: CMS Assessment    
            86810-9   Identification Information    
                 58198-3   Type of Record    
                 54581-4   Facility Provider Numbers    
                      76468-8   National Provider Identifier (NPI)    
                      69417-4   CMS Certification Number (CCN)    
                      45398-5   State Provider Number    
                 85632-8   Type of Provider    
                 86524-6   Type of Assessment    
                      54583-0   Federal OBRA Reason for Assessment    
                      54584-8   PPS Assessment    
                      54585-5   PPS Other Medicare Required Assessment - OMRA    
                      58107-4   Is this a Swing Bed clinical change assessment?    
                      54587-1   Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry?    
                      58108-2   Entry/discharge reporting    
                      71440-2   Type of discharge    
                      86525-3   Is this a SNF Part A PPS Discharge Assessment?    
                 86526-1   Unit Certification or Licensure Designation    
                 54503-8   Legal Name of Resident    
                      45392-8   First name    
                      45393-6   Middle initial    
                      45394-4   Last name    
                      45395-1   Suffix    
                 45966-9   Social Security and Medicare Numbers    
                      45396-9   Social Security Number    
                      45397-7   Medicare number (or comparable railroad insurance number)    
                 45400-9   Medicaid Number    
                 46098-0   Gender    
                 21112-8   Birth Date   {mm/dd/yyyy} 
                 59362-4   Race/Ethnicity 1..6   
                 45404-1   Marital Status    
                 54506-1   Optional Resident Items    
                      46106-1   Medical record number [Identifier]Medical record number [Identifier]Medical record number: ID: Pt: ^Patient: Nom:    
                      45403-3   Room number [Location]Room number [Location]Room number: Loc: Pt: ^Patient: Nom:    
                      52462-9   Name by which resident prefers to be addressed    
                      21843-8   Lifetime occupation(s)    
                 86528-7   Most Recent Admission/Entry or Reentry into this Facility    
                      50786-3   Entry Date   {mm/dd/yyyy} 
                      54590-5   Type of Entry    
                      85398-6   Entered From    
                 52455-3   Admission Date (Date this episode of care in this facility began)   {mm/dd/yyyy} 
                 52525-3   Discharge Date   {mm/dd/yyyy} 
                 55128-3   Discharge Status    
                 54593-9   Assessment Reference Date. Observation end date   {mm/dd/yyyy} 
                 54507-9   Medicare Stay    
                      54594-7   Has the resident had a Medicare-covered stay since the most recent entry?