| Data Type | Length |
Field Name |
Field Description |
|---|
| CHAR | 9 |
Agent ID |
This is the identification of the current software agent used by the facility to handle the computerization of the assessment requirement, if applicable. |
| DATE | 8 |
Assessment Beginning Version Date |
Beginning date of the submission file that contains the version of this assessment. |
| NUM | 2 |
Assessment Correction Version Number |
The number of the assessment. 00 = Original, 01 = First correction, 02 = Second correction, etc. |
| DATE | 8 |
Assessment Ending Version Date |
Ending date of the submission file that contains the version of this assessment. |
| NUM | 10 |
Assessment Internal ID |
This field is used as a key to uniquely identify an assessment and to tie together all the different tables that compose one assessment record received from a facility. |
| CHAR | 1 |
Assessment Modification Code |
A code designating the version of the assessment: C = Current, M = Modified, X = Inactive. |
| CHAR | 5 |
Calculated Age Code |
A preliminary calculation made prior to determining the CMG group. Age is computed on the basis of the difference between the Admission Date (Item 12) and the Birth Date (Item 6). |
| CHAR | 10 |
Calculated CMG Code |
The Case-Mix Group code that is calculated from the data submitted to the NACD. |
| CHAR | 10 |
Calculated CMG Version Code |
The version code of the CMG Grouper on the NACD. |
| CHAR | 5 |
Calculated Cognitive Scale Code |
A preliminary calculation made prior to determining the CMG group. The cognitive score is based upon 5 variables that are taken from Item 39 on the IRF-PAI form. |
| CHAR | 5 |
Calculated Motor Scale Code |
A preliminary calculation made prior to determining the CMG group. The motor score is based upon 12 variables that are taken from Item 39 on the IRF-PAI form. |
| NUM | 10 |
Original Assessment Internal ID |
Original version (ASMT INT ID) of this assessment where Correction Number is 00. |
| NUM | 10 |
Provider Internal Number |
This field is used as a key to uniquely identify a provider in the CSP_PRVDR table. |
| DATE | 8 |
Resident Data Update Timestamp |
The last updated date and time of resident data. |
| NUM | 10 |
Resident Internal ID |
A unique number, assigned by the submission system, which identifies a resident. The combination of State Code and Resident Internal ID uniquely identifies the resident in the national repository. |
| NUM | 2 |
Resident Match Criteria Code |
This field is used in determining if a record should be written to the resident history table. It is a number showing which of the resident matching criteria was positive for a match, and is zero if it is a new resident or patient. |
| CHAR | 9 |
Software ID |
This field contains the identification number of the software vendor or agent the provider is using to automate the assessment requirement. |
| CHAR | 10 |
Software Version |
This field contains the version number of the vendor software being used by the facility or the facility's agent to automate the assessment submission process. |
| CHAR | 2 |
State ID |
The two-character state abbreviation. |
| DATE | 8 |
Submission Date |
The date the submission was received by the system. |
| NUM | 10 |
Submission Sequence Number |
Submission Sequence Number |
| CHAR | 10 |
Submitted CMG Code |
The Case-Mix Group code submitted by the facility. This CMG code is calculated by the software the facility utilizes. |
| CHAR | 10 |
Submitted CMG Version Code |
The version code of the CMG Grouper that was used by the facility's software in the calculation of the submitted. |
| DATE | 8 |
Target Date |
For MDS, the target date is the R4 Discharge Date for any discharge, the A4A Reentry Date for any re-entry and the A3A Assessment Reference Date for any other type of assessment. For IRF-PAI, the Target Date is 12: Admission Date. For SB the Target Date is the same as the Event Date and is equal to the following dates: 10a (A3a) - Assessment Reference Date, 15 (R4) - Discharge Date and 16 (A4a) - Reentry Date. |
| CHAR | 5 |
Version Code 1 |
This code represents the version of the form actually completed in the hospital. |
| CHAR | 5 |
Version Code 2 |
This code represents the version of the data specifications used to create the data record for submission to the National System. |
| CHAR | 12 |
(1B) Facility Medicare Provider Number |
Facility Medicare Provider Number assigned by CMS. |
| CHAR | 13 |
(2) Patient Medicare Number |
The patient's Medicare Number (Part A). |
| CHAR | 14 |
(3) Patient Medicaid Number |
The patient's Medicaid Number. |
| CHAR | 12 |
(4) Patient First Name |
The patient's first name. |
| CHAR | 18 |
(5A) Patient Last Name |
The patient's last name. |
| DATE | 8 |
(6) Birth Date |
The patient's birthdate. |
| CHAR | 9 |
(7) Social Security Number |
The patient's Social Security Number. |
| CHAR | 1 |
(8) Gender Code |
The patient's gender: 1)Male; 2)Female. |
| CHAR | 1 |
(9A) Race: American Indian/Alaskan Native |
The patient's race/ethnicity: American Indian or Alaskan Native. |
| CHAR | 1 |
(9B) Race: Asian |
The patient's race/ethnicity: Asian. |
| CHAR | 1 |
(9C) Race: Black or African American |
The patient's race/ethnicity: Black or African American. |
| CHAR | 1 |
(9D) Ethnicity: Hispanic or Latino |
The patient's race/ethnicity: Hispanic or Latino. |
| CHAR | 1 |
(9E) Race: Native Hawaiian or other Pacific Islander |
The patient's race/ethnicity: Native Hawaiian or other Pacific Islander. |
| CHAR | 1 |
(9F) Race: White |
The patient's race/ethnicity: White. |
| CHAR | 2 |
(10) Marital Status |
The patient's marital status at the time of admission. |
| CHAR | 5 |
(11) ZIP code of patients pre-hospital residence |
The 5-digit ZIP code of the patient's pre-hospital residence. |
| DATE | 8 |
(12) Admission Date |
The date that the patient begins receiving Part A covered Medicare services in an inpatient rehabilitation facility. |
| DATE | 8 |
(13) Assessment Reference Date |
The third calendar day of the rehabilitation stay, which represents the last day of the the 3-day admission assessment time period. These three calendar days are the days during which the patient's clinical condition should be assessed. |
| CHAR | 2 |
(14) Admission Class |
The patient's admission classification: 1)Initial Rehabilitation; 2)Evaluation; 3)Readmission; 4)Unplanned Discharge; 5)Continuing Rehabilitation. |
| CHAR | 2 |
(15) Admit From (at date of admission) |
The living setting from which the patient was admitted to rehabilitation: 01)Home; 02)Board & Care; 03)Transitional Living; 04)Intermediate Care (nursing home); 05)Skilled Nursing Facility (nursing home) 06)Acute Unit of Own Facility; 07)Acute Unit of Another Facility; 08)Chronic Hospital; 09)Rehabilitation Facility; 10)Other; 12)Alternate Level of Care (ALC) Unit; 13)Subacute Setting; 14)Assisted Living Residence. |
| CHAR | 2 |
(16) Pre-Hospital Living Setting |
The setting where the patient was living prior to being hospitalized: 01)Home; 02)Board & Care; 03)Transitional Living; 04)Intermediate Care (nursing home); 05)Skilled Nursing Facility (nursing home) 06)Acute Unit of Own Facility; 07)Acute Unit of Another Facility; 08)Chronic Hospital; 09)Rehabilitation Facility; 10)Other; 12)Alternate Level of Care (ALC) Unit; 13)Subacute Setting; 14)Assisted Living Residence. |
| CHAR | 2 |
(17) Pre-Hospital Living With |
The relationship of any individuals who resided with the patient prior to the patient's hospitalization. This item is used only if code 01 (Home) in Item 16 (Prehospital Living Setting) was coded. |
| CHAR | 2 |
(18) Pre-Hospital Vocational Category |
Indicates the vocational status of the patient prior to hospitalization: 1)Employed; 2)Sheltered; 3)Student; 4)Homemaker; 5)Not Working; 6)Retired for Age; 7)Retired for Disability. |
| CHAR | 2 |
(19) Pre-Hospital Vocational Effort |
The patient's vocational effort prior to hospitalization (if Item 18 - Pre-hospital Vocational Category is coded 14): 1)Full-time; 2)Part-time; 3)Adjusted Workload. |
| CHAR | 2 |
(20A) Primary Payment Source |
A code indicating the primary source of payment for inpatient rehabilitation services. |
| CHAR | 2 |
(20B) Secondary Payment Source |
A code indicating the secondary source of payment for inpatient rehabilitation services. |
| CHAR | 9 |
(21a) Impairment Group: Admission |
The Impairment Group Code (IGC) that best describes the primary reason for admission to the rehabilitation program. Each IGC consists of a two-digit number (indicating the major Impairment Group) followed by a decimal point and 1 to 4 additional digits identifying the subgroup. |
| CHAR | 9 |
(21d) Impairment Group: Discharge |
The Impairment Group Code (IGC) that best describes the patient's primary impairment at discharge from the rehabilitation program. Each IGC consists of a two-digit number (indicating the major Impairment Group) followed by a decimal point and 1 to 4 additional digits identifying the subgroup |
| CHAR | 7 |
(22) Etiologic Diagnosis Code (ICD-9 Code) |
The ICD-9-CM code that indicates the etiologic problem that led to the impairment for which the patient is receiving rehabilitation (Item 21 - Impairment Group). |
| DATE | 8 |
(23) Date of Onset |
The onset date of the impairment that was coded in Item 21 (Impairment Group). |
| CHAR | 7 |
(24A) Comorbid Conditions (ICD-9 Code) |
An ICD-9 Code for comorbid conditions. A comorbidity is a specific condition that also affects a patient in addition to the principal diagnosis or impairment that is used to place a patient into a rehabilitation impairment category. |
| CHAR | 7 |
(24B) Comorbid Conditions (ICD-9 Code) |
An ICD-9 Code for comorbid conditions. A comorbidity is a specific condition that also affects a patient in addition to the principal diagnosis or impairment that is used to place a patient into a rehabilitation impairment category. |
| CHAR | 7 |
(24C) Comorbid Conditions (ICD-9 Code) |
An ICD-9 Code for comorbid conditions. A comorbidity is a specific condition that also affects a patient in addition to the principal diagnosis or impairment that is used to place a patient into a rehabilitation impairment category. |
| CHAR | 7 |
(24D) Comorbid Conditions (ICD-9 Code) |
An ICD-9 Code for comorbid conditions. A comorbidity is a specific condition that also affects a patient in addition to the principal diagnosis or impairment that is used to place a patient into a rehabilitation impairment category. |
| CHAR | 7 |
(24E) Comorbid Conditions (ICD-9 Code) |
An ICD-9 Code for comorbid conditions. A comorbidity is a specific condition that also affects a patient in addition to the principal diagnosis or impairment that is used to place a patient into a rehabilitation impairment category. |
| CHAR | 7 |
(24F) Comorbid Conditions (ICD-9 Code) |
An ICD-9 Code for comorbid conditions. A comorbidity is a specific condition that also affects a patient in addition to the principal diagnosis or impairment that is used to place a patient into a rehabilitation impairment category. |
| CHAR | 7 |
(24G) Comorbid Conditions (ICD-9 Code) |
An ICD-9 Code for comorbid conditions. A comorbidity is a specific condition that also affects a patient in addition to the principal diagnosis or impairment that is used to place a patient into a rehabilitation impairment category. |
| CHAR | 7 |
(24H) Comorbid Conditions (ICD-9 Code) |
An ICD-9 Code for comorbid conditions. A comorbidity is a specific condition that also affects a patient in addition to the principal diagnosis or impairment that is used to place a patient into a rehabilitation impairment category. |
| CHAR | 7 |
(24I) Comorbid Conditions (ICD-9 Code) |
A code (1-3) used to describe the patient's swallowing status at time of admission. |
| CHAR | 7 |
(24J) Comorbid Conditions (ICD-9 Code) |
An ICD-9 Code for comorbid conditions. A comorbidity is a specific condition that also affects a patient in addition to the principal diagnosis or impairment that is used to place a patient into a rehabilitation impairment category. |
| CHAR | 1 |
(25) Comatose: Admission |
A code indicating whether the patient is diagnosed as comatose or in a persistent vegetative state at the time of admission. |
| CHAR | 1 |
(26) Delirious: Admission |
A code indicating whether the patient has exhibited symptoms of delirium at time of admission. Delirium may be manifested as disoriented thinking, being easily distracted, disorganized speech, restlessness, lethargy, or altered perceptions or awareness of surroundings. |
| CHAR | 2 |
(27a) Swallowing Status: Admission |
A code (1-3) used to describe the patient's swallowing status at time of admission. |
| CHAR | 2 |
(27d) Swallowing Status: Discharge |
A code (1-3) describing the patient's swallowing status at time of discharge. |
| CHAR | 1 |
(28a) Clinical Signs of Dehydration: Admission |
A code indicating whether the patient exhibits signs of dehydration at time of admission. |
| CHAR | 1 |
(28d) Clinical Signs of Dehydration: Discharge |
A code indicating whether the patient exhibits signs of dehydration at time of discharge. |
| CHAR | 2 |
(29a) Bladder Level of Assistance: Admission |
A score (0-7) indicating the level of assistance needed for the patient's bladder management at admission. Bladder management - level of assistance includes the safe use of equipment or agents for bladder management. |
| CHAR | 2 |
(29d) Bladder Level of Assistance: Discharge |
A score (0-7) indicating the level of assistance needed for the patient's bladder management at discharge. Bladder management - level of assistance includes the safe use of equipment or agents for bladder management. |
| CHAR | 2 |
(30a) Bladder Frequency of Accidents: Admission |
A score (0-7) indicating the frequency of bladder accidents at admission. Bladder accidents refers to the act of wetting linen or clothing with urine, and includes bedpan and urinal spills. |
| CHAR | 2 |
(30d) Bladder Frequency of Accidents: Discharge |
A score (0-7) indicating the frequency of bladder accidents at discharge. Bladder accidents refers to the act of wetting linen or clothing with urine, and includes bedpan and urinal spills. |
| CHAR | 2 |
(31a) Bowel Level of Assistance: Admission |
A score (0-7) indicating the level of assistance needed for the patient's bowel management at admission. Bowel management - level of assistance includes the safe use of equipment or agents for bowel management. |
| CHAR | 2 |
(31d) Bowel Level of Assistance: Discharge |
A score (0-7) indicating the level of assistance needed for the patient's bowel management at discharge. Bowel management - level of assistance includes the safe use of equipment or agents for bowel management. |
| CHAR | 2 |
(32a) Bowel Frequency of Accidents: Admission |
A score (0-7) indicating the frequency of bowel accidents at admission. Bowel accidents refers to the act of soiling linen or clothing with stool, and includes bedpan spills. |
| CHAR | 2 |
(32d) Bowel Frequency of Accidents: Discharge |
A score (0-7) indicating the frequency of bowel accidents at discharge. Bowel accidents refers to the act of soiling linen or clothing with stool, and includes bedpan spills. |
| CHAR | 2 |
(33a) Tub Transfer: Admission |
A score (0-7) indicating the patient's ability to get into and out of a tub at admission. |
| CHAR | 2 |
(33d) Tub Transfer: Discharge |
A score (0-7) indicating the patient's ability to get into and out of a tub at discharge. |
| CHAR | 2 |
(34a) Shower Transfer: Admission |
A score (0-7) indicating the patient's ability to get into and out of a shower at admission. |
| CHAR | 2 |
(34d) Shower Transfer: Discharge |
A score (0-7) indicating the patient's ability to get into and out of a shower at discharge. |
| CHAR | 2 |
(35a) Distance Walked: Admission |
A code (0-3) indicating the distance the patient walked at admission. |
| CHAR | 2 |
(35d) Distance Walked: Discharge |
A code (0-3) indicating the distance the patient walked at discharge. |
| CHAR | 2 |
(36a) Distance Traveled in Wheelchair: Admission |
A code (0-3) indicating the distance the patient traveled in a wheelchair at admission. |
| CHAR | 2 |
(36d) Distance Traveled in Wheelchair: Discharge |
A code (0-3) indicating the distance the patient traveled in a wheelchair at discharge. |
| CHAR | 2 |
(37a) Walk: Admission |
A score (0-7) indicating the patient's ability to walk on a level surface at admission |
| CHAR | 2 |
(37d) Walk: Discharge |
A score (0-7) indicating the patient's ability to walk on a level surface at discharge. |
| CHAR | 2 |
(38a) Wheelchair: Admission |
A score (0-7) indicating the patient's ability to use a wheelchair on a level surface once seated at admission. |
| CHAR | 2 |
(38d) Wheelchair: Discharge |
A score (0-7) indicating the patient's ability to use a wheelchair on a level surface once seated at discharge. |
| CHAR | 2 |
(39Aa) Self-Care: Eating: Admission |
A score (0-7) indicating the patient's ability to eat at admission. Eating includes the ability to use suitable utensils to bring food to the mouth, as well as the ability to chew and swallow the food once the meal is presented in the customary manner on a table or tray. |
| CHAR | 2 |
(39Ad) Self-Care: Eating: Discharge |
A score (0-7) indicating the patient's ability to eat at discharge. Eating includes the ability to use suitable utensils to bring food to the mouth, as well as the ability to chew and swallow the food once the meal is presented in the customary manner on a table or tray. |
| CHAR | 2 |
(39Ag) Self-Care: Eating: Goal |
A score (0-7) indicating the desired goal for the patient to achieve for eating at discharge. Eating includes the ability to use suitable utensils to bring food to the mouth, as well as the ability to chew and swallow the food once the meal is presented in the customary manner on a table or tray. |
| CHAR | 2 |
(39Ba) Self-Care: Grooming: Admission |
A score (0-7) indicating the patient's ability to groom at admission. Grooming includes oral care, hair grooming (combing or brushing hair), washing the hands, face, and either shaving the face or applying make-up. If the patient neither shaves nor applies make-up, grooming includes only the first four tasks. This item includes obtaining articles necessary for grooming. |
| CHAR | 2 |
(39Bd) Self-Care: Grooming: Discharge |
A score (0-7) indicating the patient's ability to groom at discharge. Grooming includes oral care, hair grooming (combing or brushing hair), washing the hands, face, and either shaving the face or applying make-up. If the patient neither shaves nor applies make-up, grooming includes only the first four tasks. This item includes obtaining articles necessary for grooming. |
| CHAR | 2 |
(39Bg) Self-Care: Grooming: Goal |
A score (0-7) indicating the desired goal for the patient to achieve for grooming at discharge. Grooming includes oral care, hair grooming (combing or brushing hair), washing the hands, face, and either shaving the face or applying make-up. If the patient neither shaves nor applies make-up, grooming includes only the first four tasks. This item includes obtaining articles necessary for grooming. |
| CHAR | 2 |
(39Ca) Self-Care: Bathing: Admission |
A score (0-7) indicating the patient's ability to bathe at admission. Bathing includes washing, rinsing, and drying the body from the neck down in either a tub, shower, or sponge/bed bath. |
| CHAR | 2 |
(39Cd) Self-Care: Bathing: Discharge |
A score (0-7) indicating the patient's ability to bathe at discharge. Bathing includes washing, rinsing, and drying the body from the neck down in either a tub, shower, or sponge/bed bath. |
| CHAR | 2 |
(39Cg) Self-Care: Bathing: Goal |
A score (0-7) indicating the desired goal for the patient to achieve for bathing at discharge. Bathing includes washing, rinsing, and drying the body from the neck down in either a tub, shower, or sponge/bed bath. |
| CHAR | 2 |
39Da) Self-Care: Dressing-Upper: Admission |
A score (0-7) indicating the patient's ability to dress the upper body at admission. Dressing the upper body includes dressing and undressing above the waist, as well as applying and removing a prosthesis or orthosis when applicable. |
| CHAR | 2 |
(39Dd) Self-Care: Dressing-Upper: Discharge |
A score (0-7) indicating the patient's ability to dress the upper body at discharge. Dressing the upper body includes dressing and undressing above the waist, as well as applying and removing a prosthesis or orthosis when applicable. |
| CHAR | 2 |
(39Dg) Self-Care: Dressing-Upper: Goal |
A score (0-7) indicating the desired goal for the patient to achieve to dress the upper body at discharge. Dressing the upper body includes dressing and undressing above the waist, as well as applying and removing a prosthesis or orthosis when applicable. |
| CHAR | 2 |
(39Ea) Self-Care: Dressing-Lower: Admission |
A score (0-7) indicating the patient's ability to dress the lower body at admission. Dressing the lower body includes dressing and undressing from the waist down, as well as applying and removing a prosthesis or orthosis when applicable. |
| CHAR | 2 |
(39Ed) Self-Care: Dressing-Lower: Discharge |
A score (0-7) indicating the patient's ability to dress the lower body at discharge. Dressing the lower body includes dressing and undressing from the waist down, as well as applying and removing a prosthesis or orthosis when applicable. |
| CHAR | 2 |
(39Eg) Self-Care: Dressing-Lower: Goal |
A score (0-7) indicating the desired goal for the patient to achieve to dress the lower body at discharge. Dressing the lower body includes dressing and undressing from the waist down, as well as applying and removing a prosthesis or orthosis when applicable. |
| CHAR | 2 |
(39Fa) Self-Care: Toileting: Admission |
A score (0-7) indicating the patient's ability to maintain perineal hygiene and adjusting clothing before and after using a toilet, commode, bedpan, or urinal at admission. |
| CHAR | 2 |
(39Fd) Self-Care: Toileting: Discharge |
A score (0-7) indicating the patient's ability to maintain perineal hygiene and adjusting clothing before and after using a toilet, commode, bedpan, or urinal at discharge. |
| CHAR | 2 |
(39Fg) Self-Care: Toileting: Goal |
A score (0-7) indicating the the desired goal for the patient to achieve the ability to maintain perineal hygiene and adjusting clothing before and after using a toilet, commode, bedpan, or urinal at discharge. |
| CHAR | 2 |
(39Ga) Sphincter Control - Bladder: Admission |
A score (0-7) indicating the level of assistance needed for the patient's bladder management at admission. Bladder management - level of assistance includes the safe use of equipment or agents for bladder management. |
| CHAR | 2 |
(39Gd) Sphincter Control - Bladder: Discharge |
A score (0-7) indicating the level of assistance needed for the patient's bladder management at discharge. Bladder management - level of assistance includes the safe use of equipment or agents for bladder management. |
| CHAR | 2 |
(39Gg) Sphincter Control - Bladder: Goal |
A score (0-7) indicating indicating the desired goal for the patient to achieve for bladder management at discharge. Bladder management - level of assistance includes the safe use of equipment or agents for bladder management. |
| CHAR | 2 |
(39Ha) Sphincter Control - Bowel: Admission |
A score (0-7) indicating the level of assistance needed for the patient's bowel management at admission. Bowel management - level of assistance includes use of equipment or agents for bowel management. |
| CHAR | 2 |
(39Hd) Sphincter Control - Bowel: Discharge |
A score (0-7) indicating the level of assistance needed for the patient's bowel management at discharge. Bowel management - level of assistance includes use of equipment or agents for bowel management. |
| CHAR | 2 |
(39Hg) Sphincter Control - Bowel: Goal |
A score (0-7) indicating the desired goal for the level of assistance needed for the patient's bowel management at discharge. Bowel management - level of assistance includes use of equipment or agents for bowel management. |
| CHAR | 2 |
(39Ia) Transfers - Bed, chair, wheelchair: Admission |
A score (0-7) indicating the patient's ability to transfer from a bed to a chair and back, or from a bed to a wheelchair and back, or coming to a standing position if walking is the typical mode of locomotion at admission. |
| CHAR | 2 |
(39Id) Transfers - Bed, chair, wheelchair: Discharge |
A score (0-7) indicating the patient's ability to transfer from a bed to a chair and back, or from a bed to a wheelchair and back, or coming to a standing position if walking is the typical mode of locomotion at discharge. |
| CHAR | 2 |
(39Ig) Transfers - Bed, chair, wheelchair: Goal |
A score (0-7) indicating the desired goal for the patient to achieve the ability to transfer from a bed to a chair and back, or from a bed to a wheelchair and back, or coming to a standing position if walking is the typical mode of locomotion at discharge. |
| CHAR | 2 |
(39Ja) Transfers - Toilet: Admission |
A score (0-7) indicating the patient's ability to safely get on and off a toilet at admission. |
| CHAR | 2 |
(39Jd) Transfers - Toilet: Discharge |
A score (0-7) indicating the patient's ability to safely get on and off a toilet at discharge. |
| CHAR | 2 |
(39Jg) Transfers - Toilet: Goal |
A score (0-7) indicating the desired goal for the patient to achieve to safely get on and off a toilet at discharge. |
| CHAR | 2 |
(39Ka) Transfers - Tub, Shower: Admission |
A score (0-7) indicating the patient's ability to get into and out of a tub or shower at admission. |
| CHAR | 2 |
(39Kd) Transfers - Tub, Shower: Discharge |
A score (0-7) indicating the patient's ability to get into and out of a tub or shower at discharge. |
| CHAR | 2 |
(39Kg) Transfers - Tub, Shower: Goal |
A score (0-7) indicating the desired goal for the patient to achieve to get into and out of a tub or shower at discharge. |
| CHAR | 2 |
(39La) Locomotion - Walk/wheelchair: Admission |
A score (0-7) indicating the patient's ability to walk or use a wheelchair on a level surface at admission. This item indicates the most frequent mode of locomotion the patient uses - 'walk' or 'wheelchair'. |
| CHAR | 1 |
(39Laa) Locomotion - Walk/wheelchair/both: Admission |
A score (0-7) indicating the patient's ability to both walk and use a wheelchair at admission. This item indicates that the patient uses 'both' means of locomotion about equally. |
| CHAR | 2 |
(39Ld) Locomotion - Walk/wheelchair: Discharge |
A score (0-7) indicating the patient's ability to walk or use a wheelchair on a level surface at discharge. This item indicates the most frequent mode of locomotion the patient uses - 'walk' or 'wheelchair'. |
| CHAR | 1 |
(39Ldd) Locomotion - Walk/wheelchair/both: Discharge |
A score (0-7) indicating the patient's ability to both walk and use a wheelchair at discharge. This item indicates that the patient uses 'both' means of locomotion about equally. |
| CHAR | 2 |
(39Lg) Locomotion - Walk/wheelchair: Goal |
A score (0-7) indicating the desired goal for the patient to achieve to walk or use a wheelchair on a level surface at discharge. This item indicates the most frequent mode of locomotion the patient uses - 'walk' or 'wheelchair'. |
| CHAR | 2 |
(39Ma) Locomotion - Stairs: Admission |
A score (0-7) indicating the patient's ability to go up and down 12 to 14 stairs (one flight) indoors in a safe manner at admission. |
| CHAR | 2 |
(39Md) Locomotion - Stairs: Discharge |
A score (0-7) indicating the patient's ability to go up and down 12 to 14 stairs (one flight) indoors in a safe manner at discharge. |
| CHAR | 2 |
(39Mg) Locomotion - Stairs: Goal |
A score (0-7) indicating the desired goal for the patient's ability to go up and down 12 to 14 stairs (one flight) indoors in a safe manner at discharge. |
| CHAR | 2 |
(39Na) Communication - Comprehension: Admission |
A score (0-7) indicating the patient's ability to comprehend at admission. Comprehension includes understanding of either auditory or visual communication (for example, writing, sign language, gestures). |
| CHAR | 1 |
(39Naa) Communication - Auditory/Visual/Both: Admission |
A score (0-7) indicating the patient's ability to comprehend at admission. Comprehension includes understanding of either auditory or visual communication (for example, writing, sign language, gestures). The more usual mode of comprehension ('Auditory' or 'Visual') is evaluated; 'Both' indicates auditory and visual are used about equally. |
| CHAR | 2 |
(39Nd) Communication - Comprehension: Discharge |
A score (0-7) indicating the patient's ability to comprehend at discharge. Comprehension includes understanding of either auditory or visual communication (for example, writing, sign language, gestures). |
| CHAR | 1 |
(39Ndd) Communication - Auditory/Visual/Both: Discharge |
A score (0-7) indicating the patient's ability to comprehend at discharge. Comprehension includes understanding of either auditory or visual communication (for example, writing, sign language, gestures). The more usual mode of comprehension ('Auditory' or 'Visual') is evaluated; 'Both' indicates auditory and visual are used about equally. |
| CHAR | 2 |
(39Ng) Communication - Comprehension: Goal |
A score (0-7) indicating the desired goal for the patient to achieve for comprehension at discharge. Comprehension includes understanding of either auditory or visual communication (for example, writing, sign language, gestures). |
| CHAR | 2 |
(39Oa) Communication - Expression: Admission |
A score (0-7) indicating the patient's ability for expression at admission. Expression includes clear vocal or nonvocal expression of language. This item includes either intelligible speech or clear expression of language using writing or a communication device. |
| CHAR | 1 |
(39Oaa) Communication - Vocal/Nonvocal/Both: Admission |
A score (0-7) indicating the patient's ability for expression at admission. Expression includes clear vocal or nonvocal expression of language. This item includes either intelligible speech or clear expression of language using writing or a communication device. The more usual mode of expression ('Vocal' or 'Nonvocal') is evaluated; 'Both' indicates vocal and nonvocal are used about equally. |
| CHAR | 2 |
(39Od) Communication - Expression: Discharge |
A score (0-7) indicating the patient's ability for expression at discharge. Expression includes clear vocal or nonvocal expression of language. This item includes either intelligible speech or clear expression of language using writing or a communication device. |
| CHAR | 1 |
(39Odd) Communication - Vocal/Nonvocal/Both: Discharge |
A score (0-7) indicating the patient's ability for expression at discharge. Expression includes clear vocal or nonvocal expression of language. This item includes either intelligible speech or clear expression of language using writing or a communication device. The more usual mode of expression ('Vocal' or 'Nonvocal') is evaluated; 'Both' indicates vocal and nonvocal are used about equally. |
| CHAR | 2 |
(39Og) Communication - Expression: Goal |
A score (0-7) indicating the desired goal for the patient to achieve for expression at discharge. Expression includes clear vocal or nonvocal expression of language. This item includes either intelligible speech or clear expression of language using writing or a communication device. |
| CHAR | 2 |
(39Pa) Social Cognition - Social Interaction: Admission |
A score (0-7) indicating the patient's ability for social interaction at admission. Social interaction includes skills related to getting along and participating with others in therapeutic and social situations. It represents how one deals with one's own needs together with the needs of others. |
| CHAR | 2 |
(39Pd) Social Cognition - Social Interaction: Discharge |
A score (0-7) indicating the patient's ability for social interaction at discharge. Social interaction includes skills related to getting along and participating with others in therapeutic and social situations. It represents how one deals with one's own needs together with the needs of others. |
| CHAR | 2 |
(39Pg) Social Cognition - Social Interaction: Goal |
A score (0-7) indicating the desired goal for the patient to achieve for social interaction at discharge. Social interaction includes skills related to getting along and participating with others in therapeutic and social situations. It represents how one deals with one's own needs together with the needs of others. |
| CHAR | 2 |
(39Qa) Social Cognition - Problem Solving: Admission |
A score (0-7) indicating the patient's ability for problem solving at admission. Problem solving includes skills related to solving problems of daily living. This means making reasonable, safe, and timely decisions regarding financial, social, and personal affairs, as well as the initiation, sequencing, and self-correcting of tasks and activities to solve problems. |
| CHAR | 2 |
(39Qd) Social Cognition - Problem Solving: Discharge |
A score (0-7) indicating the patient's ability for problem solving at discharge. Problem solving includes skills related to solving problems of daily living. This means making reasonable, safe, and timely decisions regarding financial, social, and personal affairs, as well as the initiation, sequencing, and self-correcting of tasks and activities to solve problems. |
| CHAR | 2 |
(39Qg) Social Cognition - Problem Solving: Goal |
A score (0-7) indicating the desired goal for the patient to achieve for problem solving at dischrage. Problem solving includes skills related to solving problems of daily living. This means making reasonable, safe, and timely decisions regarding financial, social, and personal affairs, as well as the initiation, sequencing, and self-correcting of tasks and activities to solve problems. |
| CHAR | 2 |
(39Ra) Social Cognition - Memory: Admission |
A score (0-7) indicating the patient's ability to remember at admission. Memory includes skills related to recognizing and remembering while performing daily activities in an institutional or community setting. Memory in this context includes the ability to store and retrieve information, particularly verbal and visual. |
| CHAR | 2 |
(39Rd) Social Cognition - Memory: Discharge |
A score (0-7) indicating the patient's ability to remember at discharge. Memory includes skills related to recognizing and remembering while performing daily activities in an institutional or community setting. Memory in this context includes the ability to store and retrieve information, particularly verbal and visual. |
| CHAR | 2 |
(39Rg) Social Cognition - Memory: Goal |
A score (0-7) indicating the desired goal for the patient to achieve for memory at discharge. Memory includes skills related to recognizing and remembering while performing daily activities in an institutional or community setting. Memory in this context includes the ability to store and retrieve information, particularly verbal and visual. |
| DATE | 8 |
(40) Discharge Date |
The date the patient is discharged from the rehabilitation facility. |
| CHAR | 1 |
(41) Patient Discharged Against Medical Advice |
A code indicating whether the patient was discharged against medical advice. |
| CHAR | 1 |
(42) Program Interruption(s) |
A code indicating whether the Medicare inpatient is discharged from the inpatient rehabilitation facility and returns to the same inpatient rehabilitation facility within 3 consecutive calendar days. |
| DATE | 8 |
(43A) First Interruption Date |
The date when the patient leaves the inpatient rehabilitation facility in a program interruption situation (Item 42 a situation where a Medicare inpatient is discharged from the inpatient rehabilitation facility and returns to the same inpatient rehabilitation facility within 3 consecutive calendar days). |
| DATE | 8 |
(43B) First Return Date |
The date when the patient returns to the inpatient rehabilitation facility in a program interruption situation (Item 42 - a situation where a Medicare inpatient is discharged from the inpatient rehabilitation facility and returns to the same inpatient rehabilitation facility within 3 consecutive calendar days). |
| DATE | 8 |
(43C) Second Interruption Date |
The second date when the patient leaves the inpatient rehabilitation facility in a program interruption situation (Item 42 - a situation where a Medicare inpatient is discharged from the inpatient rehabilitation facility and returns to the same inpatient rehabilitation facility within 3 consecutive calendar days). |
| DATE | 8 |
(43D) Second Return Date |
The date when the patient returns to the inpatient rehabilitation facility in a program interruption situation (Item 42 - a situation where a Medicare inpatient is discharged from the inpatient rehabilitation facility and returns to the same inpatient rehabilitation facility within 3 consecutive calendar days). |
| DATE | 8 |
(43E) Third Interruption Date |
The third date when the patient leaves the inpatient rehabilitation facility in a program interruption situation (Item 42 - a situation where a Medicare inpatient is discharged from the inpatient rehabilitation facility and returns to the same inpatient rehabilitation facility within 3 consecutive calendar days). |
| DATE | 8 |
(43F) Third Return Date |
The date when the patient returns to the inpatient rehabilitation facility in a program interruption situation (Item 42 - a situation where a Medicare inpatient is discharged from the inpatient rehabilitation facility and returns to the same inpatient rehabilitation facility within 3 consecutive calendar days). |
| CHAR | 2 |
(44A) Discharge to Living Setting |
A code indicating the setting to which the patient is discharged. |
| CHAR | 1 |
(44B) Was Patient Discharged with Home Health Services? |
A code indicating whether the patient was discharged with Home Health Services (if the patient was discharged to a community-based setting, i.e., Item 44A is coded 01-Home; 02-Board and Care; 03-Transitional Living; 14 Assisted Living Residence). |
| CHAR | 2 |
(45) Discharge to Living With |
A code which indicates with whom the resident will be living if Item 44A (Discharge to Living Setting) is coded. |
| CHAR | 7 |
(46) Diagnosis for Interruption or Death (ICD-9 Code) |
An ICD-9 Code indicating the reason for the program interruption or death. |
| CHAR | 7 |
(47A) Complications During Rehabilitation Stay (ICD-9 Code) |
An ICD-9-CM code indicating the complications or comorbidities that began after the rehabilitation stay started. This code identifies conditions which delayed or compromised the effectiveness of the rehabilitation program or represent high-risk medical disorders. |
| CHAR | 7 |
(47B) Complications During Rehabilitation Stay (ICD-9 Code) |
An ICD-9-CM code indicating the complications or comorbidities that began after the rehabilitation stay started. This code identifies conditions which delayed or compromised the effectiveness of the rehabilitation program or represent high-risk medical disorders. |
| CHAR | 7 |
(47C) Complications During Rehabilitation Stay (ICD-9 Code) |
An ICD-9-CM code indicating the complications or comorbidities that began after the rehabilitation stay started. This code identifies conditions which delayed or compromised the effectiveness of the rehabilitation program or represent high-risk medical disorders. |
| CHAR | 7 |
(47D) Complications During Rehabilitation Stay (ICD-9 Code) |
An ICD-9-CM code indicating the complications or comorbidities that began after the rehabilitation stay started. This code identifies conditions which delayed or compromised the effectiveness of the rehabilitation program or represent high-risk medical disorders. |
| CHAR | 7 |
(47E) Complications During Rehabilitation Stay (ICD-9 Code) |
An ICD-9-CM code indicating the complications or comorbidities that began after the rehabilitation stay started. This code identifies conditions which delayed or compromised the effectiveness of the rehabilitation program or represent high-risk medical disorders. |
| CHAR | 7 |
(47F) Complications During Rehabilitation Stay (ICD-9 Code) |
An ICD-9-CM code indicating the complications or comorbidities that began after the rehabilitation stay started. This code identifies conditions which delayed or compromised the effectiveness of the rehabilitation program or represent high-risk medical disorders. |
| CHAR | 1 |
(48a) Shortness of Breath With Exertion: Admission |
A code which indicates whether the patient reports one or more episodes of becoming 'breathless' or short of breath (dyspneic), or the patient is observed to be short of breath with mild exertion, such as during bathing or transferring, on at least one occasion at the time of admission. |
| CHAR | 1 |
(48d) Shortness of Breath With Exertion: Discharge |
A code which indicates whether the patient reports one or more episodes of becoming 'breathless' or short of breath (dyspneic), or the patient is observed to be short of breath with mild exertion, such as during bathing or transferring, on at least one occasion at the time of discharge. |
| CHAR | 1 |
(49a) Shortness of Breath At Rest: Admission |
A code which indicates whether the patient reports one or more episodes of becoming 'breathless' or short of breath (dyspneic), or the patient is observed to be short of breath while at rest (e.g., while sitting, talking) on at least one occasion at the time of admission. |
| CHAR | 1 |
(49d) Shortness of Breath At Rest: Discharge |
A code which indicates whether the patient reports one or more episodes of becoming 'breathless' or short of breath (dyspneic), or the patient is observed to be short of breath while at rest (e.g., while sitting, talking) on at least one occasion at the time of discharge. |
| CHAR | 1 |
(50a) Weak Cough and Difficulty Clearing Airway Secretions: Admission |
A code which indicates whether the patient reports or is observed to be unable to cough effectively to expel respiratory secretions or sputum from the mouth on at least one occasion at the time of admission. |
| CHAR | 1 |
(50d) Weak Cough and Difficulty Clearing Airway Secretions: Discharge |
A code which indicates whether the patient reports or is observed to be unable to cough effectively to expel respiratory secretions or sputum from the mouth on at least one occasion at the time of discharge |
| CHAR | 2 |
(51a) Rate the Highest Level of Pain Reported by the Patient Within the Assessment Period: Admission |
A rating (0-10) indicating the highest level of pain reported by the patient within the assessment period regardless of whether taking pain medication at the time of admission. Pain refers to any type of physical pain or discomfort in any part of the body. |
| CHAR | 2 |
(51d) Rate the Highest Level of Pain Reported by the Patient Within the Assessment Period: Discharge |
A rating (0-10) indicating the highest level of pain reported by the patient within the assessment period regardless of whether taking pain medication at the time of discharge. Pain refers to any type of physical pain or discomfort in any part of the body. |
| CHAR | 2 |
(52Aa) Highest Current Pressure Ulcer stage: Admission |
A code (0-5) indicating the highest current pressure ulcer stage at the time of admission. |
| CHAR | 2 |
(52Ad) Highest Current Pressure Ulcer stage: Discharge |
A code (0-5) indicating the highest current pressure ulcer stage at the time of discharge. |
| CHAR | 2 |
(52Ba) Number of Current Pressure Ulcers: Admission |
The number of pressure ulcers, including ulcers that cannot be accurately staged at the time of admission. |
| CHAR | 2 |
(52Bd) Number of Current Pressure Ulcers: Discharge |
The number of pressure ulcers, including ulcers that cannot be accurately staged at the time of discharge. |
| CHAR | 2 |
(52Ca) Length Multiplied by Width: Admission |
A score (0-10) indicating the largest pressure ulcer's open surface area at the time of admission. |
| CHAR | 2 |
(52Cd) Length Multiplied by Width: Discharge |
A score (0-10) indicating the largest pressure ulcer's open surface area at the time of discharge. |
| CHAR | 2 |
(52Da) Exudate Amount: Admission |
A code (0-3) indicating the amount of exudate (drainage) present after removing the dressing and applying any topical agent to the ulcer for the largest pressure ulcer at the time of admission. |
| CHAR | 2 |
(52Dd) Exudate Amount: Discharge |
A code (0-3) indicating the amount of exudate (drainage) present after removing the dressing and applying any topical agent to the ulcer for the largest pressure ulcer at the time of discharge. |
| CHAR | 2 |
(52Ea) Tissue Type: Admission |
A code (0-4) that indicates the type of tissue that occupies the majority of the ulcer bed of the largest pressure ulcer at the time of admission. |
| CHAR | 2 |
(52Ed) Tissue Type: Discharge |
A code (0-4) that indicates the type of tissue that occupies the majority of the ulcer bed of the largest pressure ulcer at the time of discharge. =Blank 00=Closed/resurfaced: /The wound is completely covered with epithelium (new skin) 01=Epithelial tissue: Fors superficial ulcers, new pink or shiny tissue (skin) that grows in from the edges or as islands on the ulcer surface 02=Granulation tissue: Pink or beefy red tissue with a shiny, moist, granular appearance 03=Slough: Yellow or white tissue that adheres to the ulcer bed in strings or thick clumps or is mucinous 04=Necrotic tissue (eschar): Black, brown, or tan tissue that adheres firmly to the wound bed or ulcer edges |
| CHAR | 2 |
(52Fa) Total PUSH Score: Admission |
The sum of the scores of the three items (52C + 52D + 52E) to derive the total PUSH tool score at the time of admission. |
| CHAR | 2 |
(52Fd) Total PUSH Score: Discharge |
The sum of the scores of the three items (52C + 52D + 52E) to derive the total PUSH tool score at the time of discharge. |
| CHAR | 1 |
(53a) Standing Balance Problem: Admission |
A code indicating whether the patient reports at least one episode of dizziness, vertigo, or light-headedness while sitting or standing at the time of admission. |
| CHAR | 1 |
(53d) Standing Balance Problem: Discharge |
A code indicating whether the patient reports at least one episode of dizziness, vertigo, or light-headedness while sitting or standing at the time of discharge. |
| NUM | 3 |
(54) Total Number of Falls During the Rehabilitation Stay: Discharge |
The total number of falls during the rehabilitation stay recorded at the time of discharge. |