| Data Type | Length | Field Name | Field Description |
|---|---|---|---|
| DATE | 8 | Assessment Beginning Version Date | Beginning date of the submission file that contains the version of this assessment. |
| DATE | 8 | Assessment Correction Version Date | Date of the submission file that contains the correction or inactivation request of this assessment. |
| DATE | 8 | Assessment Effective Date | The effective date is based on the M0100 RFA field. This is the (M0030) Start of Care date for RFA 01 or 02; (M0032) Resumption of Care Date for 03; (M0090) Information Completion Date for 04 or 05; and (M0906) Discharge/Transfer/Death date for 06, 07, 08, 09, or 10. |
| CHAR | 1 | Assessment Modification Indicator | Designates version of the assessment. C = Current, M = Modified, X = Inactive. |
| CHAR | 1 | Birthdate Submit Indicator | Indicates if the full birthdate was submitted or if part of the date was defaulted. S = the stored birth date is the complete birthdate submitted; M = the submitted birthdate contained only a year (YYYY) so the stored birthdate contains the default month (06) and day (15); D = the submitted birthdate contained only a year and a month (YYYYMM) so the stored birthdate contains the default day (15); U = the submitted birthdate contained all dashes as the birthdate was unknown. Null will be stored in the birthdate; I = the submitted birthdate was invalid (spaces or an invalid date was submitted). Null will be stored in the birthdate. |
| CHAR | 10 | Branch Identifier | Agency assigned branch identifier. |
| CHAR | 5 | Calculated HIPPS Code | The value of the HIPPS (Health Insurance Prospective Payment System) code calculated by the state system using the OASIS PPS dll for this assessment. |
| CHAR | 5 | Calculated HIPPS Version | The version of the HIPPS (Health Insurance Prospective Payment System) code calculated. |
| NUM | 2 | Correction Number | Sequential correction number of assessment. |
| NUM | 10 | Facility Internal ID | The CMS facility internal identifier that is unique within a state. For the NATL_MDS_FAC_SUBMSN_SMRY, NATL_HHA_FAC_SUBMSN_SMRY, OBQI_ROLLUPS, OBQI_CMIX_RISK_ADJSTD_ROLLUPS, OBQI_RAO_RISK_ADJSTD_ROLLUPS, OBQI_BRIEFG_BOOK_MISC_MSR and MEGA_QI_INITL_ROLLUP tables, if the number is a positive value, it is the CMS facility internal identifier. Other values include: -1 = the data is averaged to the state, -2 = the data is averaged to the region and -3 = the data is averaged to the whole nation |
| NUM | 15 | HHA Assessment Internal ID | The assessment internal identification number. |
| NUM | 10 | HHA Submission Sequence Number | Internal database tracking number for submissions |
| DATE | 8 | Lock Date | The lock-in date for the HHA assessment. |
| CHAR | 20 | Masking Algorithm Version Code | Masking algorithm version code. 1) If M0150 CPAY MCARE FFS = 0 and M0150 CPAY MCARE HMO = 0 and M0150 CPAY MCAID FFS = 0 and M0150 CPAY MCAID HMO = 0, then the patient's care is not paid by Medicare or Medicaid and MASK VERSION CD must be completed. The only valid value for MASK VERSION CODE is 'FIPS SHA-1 V1.00' (left justified, blank filled). 2) If M0150 CPAY MCARE FFS = 1 or M0150 CPAY MCARE HMO = 1 or M0150 CPAY MCAID FFS = 1 or M0150 CPAY MCAID HMO = 1 then the patient's care is paid by Medicare or Medicaid and MASK VERSION CD must be blank. 3) If MASK VERSION CD is not blank, then the following non-blank fields must be masked: M0020 PAT ID, M0040 PAT FNAME, M0040 PAT LNAME, M0063 MEDICARE NUM, M0064 SSN, and M0065 MEDICAID NUM. If any of these fields is blank, then do not mask the field -- submit blanks for that field instead. Do not mask an entirely blank field. 4) If MASK VERSION CD is blank, then no field in the record is to be masked. |
| CHAR | 10 | National Provider Identifier | Mandated by HIPAA as a unique provider number assigned for each health care provider to be used in standard electronic health care transactions. |
| NUM | 15 | Original Assessment Internal ID | Original version (ASMT INT ID) of this assessment where Correction Number is 00. |
| 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 Matching Criteria | When a record is submitted to the state server, the resident matching algorithm determines whether the record represents an existing patient or a new patient. The resident matching algorithm uses a set of key fields on the incoming record to try to make a match to records on the resident master table. A match can be made on any of 8 criteria, listed below. The field contains the code representing the criterion under which a successful match, if any, was made. The criteria are as follows (listed in the order in which the algorithm runs its tests): 01) Uses Facility, SSN, date of birth, last name, first name, gender, 09) Uses SSN, date of birth, last name, first name, gender, 11) Uses Facility, SSN, gender, last name, 03) Uses Date of birth, last name, first name, gender, 04) Uses SSN, date of birth, gender, 05) Uses SSN, last name, first name, gender, 06) Uses Facility, date of birth (close), last name, first name, gender, 10) Uses SSN, date of birth, last name, first name. The following matching criteria are no longer in use, but may appear on older assessment records: 02) Uses facility, SSN, gender, 07) Uses facility date of birth, name (see note a), gender, 08) Uses facility, date of birth (see note b), name (see note a), gender. Note a) Last name or (first name and first 4 characters of last name) or (last name = first name and first name = last name); Note b) month and year match. Will contain one of the codes listed above, or it will contain '00' if no match was made (i.e., if the record represented a new patient). |
| CHAR | 9 | Software Vendor Tax ID | Software vendor tax identifier. The software vendor is the author of the software used to encode the assessment data. |
| CHAR | 9 | 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 | State Prepared Date | This field represents the date when the state prepared the data to be pulled to the national. Used for replication purposes only. |
| DATE | 8 | Submission Date | The date the submission was received by the system. |
| CHAR | 5 | Submitted HIPPS Code | The value of the HIPPS (Health Insurance Prospective Payment System) code submitted for this assessment. |
| CHAR | 5 | Submitted HIPPS Version | The version of the submitted HIPPS (Health Insurance Prospective Payment System) code. |
| CHAR | 12 | Version Code | Layout submitted version code field which contains the version number for the data specifications used for submission. Valid values are 01.60, 01.50, 01.40, 01.30, 01.20, 01.10, or 1.04. |
| CHAR | 5 | Version Completed Code | Version completed code indicating the version of OASIS actually completed. A value of 'B1-1098' will be used for all assessments with a M0090 date prior to 10/1/2000 and a value of 'B1-0800' is used for all assessments with a M0090 date of 10/1/2000 or later. |
| CHAR | 6 | (M0010) Agency Medicare Number | Agency Medicare provider number. |
| CHAR | 2 | (M0110) Episode Timing | Medicare home health payment episode for which this assessment will define a case mix group an "early" episode or a "later" episode - 1= Early, 2 = Later, UK = Unknown, NA = Not Applicable. |
| CHAR | 15 | (M0012) Agency Medicaid Number | Agency Medicaid provider number. |
| CHAR | 2 | (M0014) Branch State | Branch state. |
| CHAR | 10 | (M0016) Branch Identifier Number | Branch ID number. |
| CHAR | 20 | (M0020) Patient ID | Patient identification number. |
| DATE | 8 | (M0030) Start of Care Date | Start of care date. |
| NUM | 1 | (M0032) Resumption of Care Date Not Applicable | Resumption of care date is not applicable.0=Not Checked 1=Checked |
| DATE | 8 | (M0032) Resumption of Care Date | Resumption of care date. |
| CHAR | 12 | (M0040) Patient First Name | Patient First Name |
| CHAR | 18 | (M0040) Patient Last Name | Patient Last Name |
| CHAR | 1 | (M0040) Patient Middle Initial | Patient Middle Initial |
| CHAR | 3 | (M0040) Patient Suffix | Patient Suffix |
| CHAR | 2 | (M0050) Patient State | Patient's state of residence. |
| CHAR | 11 | (M0060) Patient ZIP Code | Patient's ZIP code. |
| CHAR | 12 | (M0063) Medicare Number | Patient's Medicare number |
| NUM | 1 | (M0063) No Medicare Number | Patient has no Medicare number. 0 = No, 1 = Yes. |
| NUM | 1 | (M0064) Social Security Number Unknown | Patient's Social Security number is unknown or not available. 0 = No, 1 = Yes. |
| CHAR | 9 | (M0064) Social Security Number | Patient's Social Security number. |
| NUM | 1 | (M0065) No Medicaid Number | Patient has no Medicaid number. 0 = No, 1 = Yes. |
| CHAR | 14 | (M0065) Patient Medicaid Number | Patient's Medicaid number. |
| DATE | 8 | (M0066) Patient Birth Date | Patient's birth date. If only the year (YYYY) was submitted, the month is defaulted to 06 and the day is defaulted to 15. If only the month and year are submitted, the day is defaulted to 15. If this field is null, either no date was submitted or an invalid date was submitted. |
| NUM | 1 | (M0069) Gender | Patient's gender. 1 = Male, 2 = Female. |
| NUM | 1 | (M0072) Primary Referring Physician ID Unknown | Primary referring physician is unknown or not available. 0 = No, 1 = Yes. |
| CHAR | 10 | (M0072) Primary Referring Physician ID | Primary referring physician identification. Spaces = Unknown. |
| CHAR | 2 | (M0080) Discipline of Person Completing Assessment | Discipline of person completing assessment. 01 = RN, 02 = PT, 03 = SLP/ST, 04 = OT. |
| DATE | 8 | (M0090) Date Assessment Completed | The date the assessment was completed |
| CHAR | 2 | (M0100) Assessment Reason | The reason the assessment is currently being completed. 01 = Start of care - further visits planned, 02 = Start of care - no further visits planned, 03 = Resumption of care (after inpatient stay), 04 = Recertification (follow-up) reassessment, 05 = Other follow-up, 06 = Transferred to an inpatient facility - patient not discharged from agency, 07 = Transferred to an inpatient facility - patient discharged from agency, 08 = Death at home, 09 = Discharged from agency 10 = Discharged from agency - no visits completed after start/resumption of care assessment. |
| NUM | 1 | (M0140) American Indian or Alaska Native | Race/ethnicity as identified by patient: American Indian or Alaska native. 0 = No, 1 = Yes. |
| NUM | 1 | (M0140) Asian | Race/ethnicity as identified by patient: Asian. 0 = No, 1 = Yes. |
| NUM | 1 | (M0140) Black or African-American | Race/ethnicity as identified by patient: Black or African-American. 0 = No, 1 = Yes |
| NUM | 1 | (M0140) Hispanic or Latino | Race/ethnicity as identified by patient: Hispanic or Latino. 0 = No, 1 = Yes. |
| NUM | 1 | (M0140) Native Hawiian or Pacific Islander | Race/ethnicity as identified by patient: Native Hawaiian or Pacific Islander. 0 = No, 1 = Yes |
| NUM | 1 | (M0140) Unknown Race/Ethnicity | Race/ethnicity as identified by patient: Unknown. 0 = No, 1 = Yes. |
| NUM | 1 | (M0140) White | Race/ethnicity as identified by patient: White. 0 = No, 1 = Yes. |
| NUM | 1 | (M0150) Medicaid Fee-For-Service | Current payment sources for home care: Medicaid (traditional fee-for-service). 0 = No, 1 = Yes. |
| NUM | 1 | (M0150) Medicaid HMO/Managed Care | Current payment sources for home care: Medicaid (HMO/managed care). 0 = No, 1 = Yes. |
| NUM | 1 | (M0150) Medicare Fee-For-Service | Current payment sources for home care: Medicare (traditonal fee-for-service). 0 = No, 1 = Yes. |
| NUM | 1 | (M0150) Medicare HMO/Managed Care | Current payment sources for home care: Medicare (HMO/managed care). 0 = No, 1 = Yes. |
| NUM | 1 | (M0150) No Charge for Current Services | Current payment sources for home care: none, no charge for current services. 0 = No, 1 = Yes. |
| NUM | 1 | (M0150) Other Government | Current payment sources for home care: other government (e.g., CHAMPUS, VA, etc.). 0 = No, 1 = Yes. |
| NUM | 1 | (M0150) Other Payment Source | Current payment sources for home care: other (specify). 0 = No, 1 = Yes. |
| NUM | 1 | (M0150) Private HMO/Managed Care | Current payment sources for home care: private HMO/managed care. 0 = No, 1 = Yes. |
| NUM | 1 | (M0150) Private Insurance | Current payment sources for home care: private insurance. 0 = No, 1 = Yes. |
| NUM | 1 | (M0150) Self-Pay | Current payment sources for home care: self-pay. 0 = No, 1 = Yes. |
| NUM | 1 | (M0150) Title Programs | Current payment sources for home care: title programs (e.g., Title III, V, or XX). 0 = No, 1 = Yes |
| NUM | 1 | (M0150) Unknown Payment Source | Current payment sources for home care: unknown. 0 = No, 1 = Yes. |
| NUM | 1 | (M0150) Workers Compensation | Current payment sources for home care: Worker's Compensation. 0 = No, 1 = Yes. |
| NUM | 1 | (M0160) Limited Financial Factors - Food | Financial factors limiting ability of patient/family to meet basic health needs: unable to afford food. 0 = No, 1 = Yes. |
| NUM | 1 | (M0160) Limited Financial Factors - Medical Expenses | Financial factors limiting ability of patient/family to meet basic health needs: unable to afford medical expenses not covered by insurance/Medicare (e.g., co-payments). 0 = No, 1 = Yes. |
| NUM | 1 | (M0160) Limited Financial Factors - Medicine/Medical Supplies | Financial factors limiting ability of patient/family to meet basic health needs: unable to afford medicine or medical supplies. 0 = No, 1 = Yes. |
| NUM | 1 | (M0160) Limited Financial Factors - None | Financial factors limiting ability of patient/family to meet basic health needs: none. 0 = No, 1 = Yes. |
| NUM | 1 | (M0160) Limited Financial Factors - Other | Financial factors limiting ability of patient/family to meet basic health needs: other (specify). 0 = No, 1 = Yes. |
| NUM | 1 | (M0160) Limited Financial Factors - Rent/Utilities | Financial factors limiting ability of patient/family to meet basic health needs: unable to afford rent/utility bills. 0 = No, 1 = Yes. |
| NUM | 1 | (M0170) Hospital | From which of following inpatient facilities was the patient discharged during past 14 days? Hospital. 0 = No, 1 = Yes. |
| NUM | 1 | (M0170) Nursing Home | From which of following inpatient facilities was the patient discharged during past 14 days? Nursing home. 0 = No, 1 = Yes. |
| NUM | 1 | (M0170) Other Inpatient Facility | From which of following inpatient facilities was the patient discharged during past 14 days? Other (specify). 0 = No, 1 = Yes |
| NUM | 1 | (M0170) Patient Not Discharged From Inpatient Facility | From which of following inpatient facilities was the patient discharged during past 14 days? Patient was not discharged from an inpatient facility. 0 = No, 1 = Yes. |
| NUM | 1 | (M0170) Rehabilitation Facility | From which of following inpatient facilities was the patient discharged during past 14 days? Rehabilitation facility. 0 = No, 1 = Yes. |
| CHAR | 1 | (M0175) Inpatient Facility Admitted From during past 14 Days - Hospital | Inpatient facility admitted from during past 14 Days - hospital. |
| CHAR | 1 | (M0175) Inpatient Facility Admitted From during past 14 Days - Not Discharged from an Inpatient Facility | Inpatient facility admitted from during past 14 Days - not discharged from an inpatient facility. |
| CHAR | 1 | (M0175) Inpatient Facility Admitted From during past 14 Days - Other Nursing Home | Inpatient facility admitted from during past 14 days - other nursing home. |
| CHAR | 1 | (M0175) Inpatient Facility Admitted From during past 14 Days - Other | Inpatient facility admitted from during past 14 Days - other. |
| CHAR | 1 | (M0175) Inpatient Facility Admitted From during past 14 Days - Rehabilitation Facility | Inpatient facility admitted from during past 14 Days - rehabilitation facility. |
| CHAR | 1 | (M0175) Inpatient Facility Admitted From during past 14 Days - Skilled Nursing Facility | Inpatient facility admitted from during past 14 days - skilled nursing facility. |
| CHAR | 1 | (M0180) Inpatient Discharge Date Unknown | Inpatient discharge date (most recent): unknown. 0 = No, 1 = Yes. |
| DATE | 8 | (M0180) Inpatient Discharge Date | Inpatient discharge date (most recent). |
| CHAR | 7 | (M0190) Inpatient Diagnosis and ICD Code - a | Inpatient diagnoses and ICD code categories: inpatient facility diagnosis, ICD Code - a. |
| CHAR | 7 | (M0190) Inpatient Diagnosis and ICD Code - b | Inpatient diagnoses and ICD code categories: inpatient facility diagnosis, ICD code - b. |
| NUM | 1 | (M0200) Medical/Treatment Regimen Change | Medical treatment regimen change within past 14 days. 0 = No, 1 = Yes. |
| CHAR | 7 | (M0210) Medical Diagnosis and ICD Code - a | List patient's medical diagnosis and ICD code categories (three digits required; five optional), ICD - a. |
| CHAR | 7 | (M0210) Medical Diagnosis and ICD Code - b | List patient's medical diagnosis and ICD code categories (three digits required; five optional), ICD - b. |
| CHAR | 7 | (M0210) Medical Diagnosis and ICD Code - c | List patient's medical diagnosis and ICD code categories (three digits required; five optional), ICD - c. |
| CHAR | 7 | (M0210) Medical Diagnosis and ICD Code - d | List patient's medical diagnosis and ICD code categories (three digits required; five optional), ICD - d. |
| CHAR | 1 | (M0220) Disruptive/Socially Inappropriate Behavior | Conditions prior to medical or treatment regimen change or inpatient stay within past 14 days: disruptive or socially inappropriate behavior. 0 = No, 1 = Yes, spaces = Unknown. |
| CHAR | 1 | (M0220) Impaired Decision Making | Conditions prior to medical or treatment regimen change or inpatient stay within past 14 days: impaired decisionmaking. 0 = No, 1 = Yes, spaces = Unknown. |
| CHAR | 1 | (M0220) Indwelling/Suprapubic Catheter | Conditions prior to medical or treatment regimen change or inpatient stay within past 14 days: indwelling/suprapubic catheter. 0 = No, 1 = Yes, spaces = Unknown. |
| CHAR | 1 | (M0220) Intractable Pain | Conditions prior to medical or treatment regimen change or inpatient stay within past 14 days: intractable pain. 0 = No, 1 = Yes, spaces = Unknown. |
| CHAR | 1 | (M0220) Memory Loss to Extent Supervision Required | Conditions prior to medical or treatment regimen change or inpatient stay within past 14 days: memory loss to the extent that supervision required. 0 = No, 1 = Yes, spaces = Unknown. |
| CHAR | 1 | (M0220) No Inpatient Discharge and No Regimen Change | Conditions prior to medical or treatment regimen change or inpatient stay within past 14 days: no inpatient facility discharge and no change in medical or treatment regimen in past 14 days. 0 = No, 1 = Yes. |
| CHAR | 1 | (M0220) None of the Above Regimen Change | Conditions prior to medical or treatment regimen change or inpatient stay within past 14 days: none of the above. 0 = No, 1 = Yes, Spaces = Unknown. |
| CHAR | 1 | (M0220) Unknown Regimen Change | Conditions prior to medical or treatment regimen change or inpatient stay within past 14 days: unknown. 0 = No, 1 = Yes. |
| CHAR | 1 | (M0220) Urinary Incontinence | Conditions prior to medical or treatment regimen change or inpatient stay within past 14 days: urinary incontinence. 0 = No, 1 = Yes, Spaces = Unknown. |
| CHAR | 2 | (M0230) Primary Diagnosis Severity Rating - a | Primary Diagnosis Severity Rating (0-4) a. 00 = Asymptomatic, 01 = Symptoms well controlled with current therapy, 02 = Symptoms controlled with difficulty, patient needs ongoing monitoring, 03 = Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring, 04 = Symptoms poorly controlled, history of rehospitalizations. |
| CHAR | 7 | (M0230) Primary Diagnosis and ICD Code - a | The values available describing the primary diagnosis. |
| CHAR | 2 | (M0240) Other Diagnosis Severity Rating - b | Other diagnosis severity rating (0-4) b. 00 = Asymptomatic, 01 = Symptoms well controlled with current therapy, 02 = Symptoms controlled with difficulty, patient needs ongoing monitoring, 03 = Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring, 04 = Symptoms poorly controlled, history of rehospitalizations. |
| CHAR | 2 | (M0240) Other Diagnosis Severity Rating - c | Other diagnosis severity rating (0-4) c. 00 = Asymptomatic, 01 = Symptoms well controlled with current therapy, 02 = Symptoms controlled with difficulty, patient needs ongoing monitoring, 03 = Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring, 04 = Symptoms poorly controlled, history of rehospitalizations. |
| CHAR | 2 | (M0240) Other Diagnosis Severity Rating - d | Other diagnosis severity rating (0-4) d. 00 = Asymptomatic, 01 = Symptoms well controlled with current therapy, 02 = Symptoms controlled with difficulty, patient needs ongoing monitoring, 03 = Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring, 04 = Symptoms poorly controlled, history of rehospitalizations. |
| CHAR | 2 | (M0240) Other Diagnosis Severity Rating - e | Other diagnosis severity rating (0-4) e. 00 = Asymptomatic, 01 = Symptoms well controlled with current therapy, 02 = Symptoms controlled with difficulty, patient needs ongoing monitoring, 03 = Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring, 04 = Symptoms poorly controlled, history of rehospitalizations. |
| CHAR | 2 | (M0240) Other Diagnosis Severity Rating - f | Other diagnosis severity rating (0-4) f. 00 = Asymptomatic, 01 = Symptoms well controlled with current therapy, 02 = Symptoms controlled with difficulty, patient needs ongoing monitoring, 03 = Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring, 04 = Symptoms poorly controlled, history of rehospitalizations. |
| CHAR | 7 | (M0240) Other Diagnosis and ICD Code - b | Other Diagnosis ICD b. |
| CHAR | 7 | (M0240) Other Diagnosis and ICD Code - c | Other diagnosis ICD c. |
| CHAR | 7 | (M0240) Other Diagnosis and ICD Code - d | Other diagnosis ICD d. |
| CHAR | 7 | (M0240) Other Diagnosis and ICD Code - e | Other diagnosis ICD e. |
| CHAR | 7 | (M0240) Other Diagnosis and ICD Code - f | Other diagnosis ICD f. |
| CHAR | 7 | (M0245) Payment Diagnosis: First Secondary ICD | The ICD-9 Code indicating the first secondary payment reason. |
| CHAR | 7 | (M0245) Payment Diagnosis: Primary ICD | The ICD-9 Code indicating the primary payment reason. |
| CHAR | 7 | (M0246) A3 - Case Mix Diagnosis | Optional field to capture the Case Mix Diagnosis for PPS Payment if payment diagnosis is replaced 'V-Code' in M0230. |
| CHAR | 7 | (M0246) A4 - Case Mix Diagnosis | Optional field to capture the Case Mix Diagnosis. |
| CHAR | 7 | (M0246) B3 - Case Mix Diagnosis | Optional field to capture the Case Mix Diagnosis for PPS Payment if payment diagnosis is replaced 'V-Code' in M0240 b. |
| CHAR | 7 | (M0246) B4 - Case Mix Diagnosis | Optional field to capture the Case Mix Diagnosis. |
| CHAR | 7 | (M0246) C3 - Case Mix Diagnosis | Optional field to capture the Case Mix Diagnosis for PPS Payment if payment diagnosis is replaced 'V-Code' in M0240 c. |
| CHAR | 7 | (M0246) C4 - Case Mix Diagnosis | Optional field to capture the Case Mix Diagnosis. |
| CHAR | 7 | (M0246) D3 - Case Mix Diagnosis | Optional field to capture the Case Mix Diagnosis for PPS Payment if payment diagnosis is replaced 'V-Code' in M0240 d. |
| CHAR | 7 | (M0246) D4 - Case Mix Diagnosis | Optional field to capture the Case Mix Diagnosis. |
| CHAR | 7 | (M0246) E3 - Case Mix Diagnosis | Optional field to capture the Case Mix Diagnosis for PPS Payment if payment diagnosis is replaced 'V-Code' in M0240 e. |
| CHAR | 7 | (M0246) E4 - Case Mix Diagnosis | Optional field to capture the Case Mix Diagnosis. |
| CHAR | 7 | (M0246) F3 - Case Mix Diagnosis | Optional field to capture the Case Mix Diagnosis for PPS Payment if payment diagnosis is replaced 'V-Code' in M0240 f. |
| CHAR | 7 | (M0246) F4 - Case Mix Diagnosis | Optional field to capture the Case Mix Diagnosis. |
| NUM | 1 | (M0250) Enteral Nutrition | Enteral nutrition (nasogastric, gastrostomy, jejunostomy, or any other artificial entry into alimentary canal). 0 = No, 1 = Yes. |
| NUM | 1 | (M0250) Intravenous or Infusion Therapy | Intravenous or infusion therapy (excludes TPN). 0 = No, 1 = Yes. |
| NUM | 1 | (M0250) None of the Above Therapies | None of the above therapies. 0 = No, 1 = Yes. |
| NUM | 1 | (M0250) Parenteral Nutrition | Parenteral nutrition (TPN or lipids). 0 = No, 1 = Yes. |
| CHAR | 2 | (M0260) Overall Prognosis | Overall prognosis: best description of patient's overall prognosis for recovery from this episode of illness. 00 = Poor, 01 = Good/Fair, UK = Unknown. |
| CHAR | 2 | (M0270) Rehabilitive Prognosis | Rehabilitative prognosis: best description of patient's prognosis for functional status. 00 = Guarded, 01 = Good, UK = Unknown. |
| CHAR | 2 | (M0280) Life Expectancy | Life expectancy (physician documentation is not required). 00 = Life expectancy is greater than 6 months, 01 = Life expectancy is 6 months or less. |
| NUM | 1 | (M0290) Alcohol Dependency | High risk factors characterizing this patient: alcoholism. 0 = No, 1 = Yes. |
| NUM | 1 | (M0290) Drug Dependency | High risk factors characterizing this patient: drug dependency. 0 = No, 1 = Yes. |
| NUM | 1 | (M0290) Heavy Smoking | High risk factors characterizing this patient: heavy smoking. 0 = No, 1 = Yes. |
| NUM | 1 | (M0290) None of Above High Risk Factors | High risk factors characterizing this patient: none of the above. 0 = No, 1 = Yes. |
| NUM | 1 | (M0290) Obesity | High risk factors characterizing this patient: obesity. 0 = No, 1 = Yes. |
| NUM | 1 | (M0290) Unknown High Risk Factors | High risk factors characterizing this patient: unknown. 0 = No, 1 = Yes. |
| CHAR | 2 | (M0300) Current Residence | Current residence. 01 = Patient's owned or rented residence, 02 = Family member's residence, 03 = Boarding home or rented room, 04 = Board and care or assisted living facility, 05 = Other. |
| NUM | 1 | (M0310) Narrow or Obstructed Doorways | Stuctural barriers: narrow or obstructed doorways. 0 = No, 1 = Yes. |
| NUM | 1 | (M0310) No Structural Barriers | Structural barriers: none. 0 = No, 1 = Yes. |
| NUM | 1 | (M0310) Stairs Inside Home Must Be Used | Structural barriers: stairs inside which must be used by patient. 0 = No, 1 = Yes. |
| NUM | 1 | (M0310) Stairs Inside Home Used Optionally | Structural barriers: stairs inside home which are used optionally. 0 = No, 1 = Yes. |
| NUM | 1 | (M0310) Stairs Leading Inside Home | Structural barriers: stairs leading from inside to outside house. 0 = No, 1 = Yes. |
| NUM | 1 | (M0320) Improperly Stored Hazardous Materials | Safety hazards: improperly stored hazardous materials. 0 = No, 1 = Yes. |
| NUM | 1 | (M0320) Inadequate Cooling | Safety hazards: inadequate cooling. 0 = No, 1 = Yes. |
| NUM | 1 | (M0320) Inadequate Floor/Roof/Windows | Safety hazards: inadequate floor, roof, or windows. 0 = No, 1 = Yes. |
| NUM | 1 | (M0320) Inadequate Heating | Safety hazards: inadequate heating. 0 = No, 1 = Yes. |
| NUM | 1 | (M0320) Inadequate Lighting | Safety hazards: inadequate lighting. 0 = No, 1 = Yes. |
| NUM | 1 | (M0320) Inadequate Stair Railings | Safety hazards: inadequate stair railings. 0 = No, 1 = Yes. |
| NUM | 1 | (M0320) Lack of Fire Safety Devices | Safety hazards: lack of fire safety devices. 0 = No, 1 = Yes. |
| NUM | 1 | (M0320) Lead-Based Paint | Safety hazards: lead-based paint. 0 = No, 1 = Yes. |
| NUM | 1 | (M0320) No Safety Hazards | Safety hazards: none. 0 = No, 1 = Yes. |
| NUM | 1 | (M0320) Other Safety Hazards | Safety hazards: other (specify). 0 = No, 1 = Yes. |
| NUM | 1 | (M0320) Unsafe Floor Coverings | Safety hazards: unsafe floor coverings. 0 = No, 1 = Yes. |
| NUM | 1 | (M0320) Unsafe Gas/Electric Appliance | Safey hazards: unsafe gas/electric appliance. 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) Cluttered/Soiled Living Area | Sanitation hazards: cluttered/soiled living area. 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) Contaminated Water | Sanitation hazards: contaminated water. 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) Inadequate Sewage Disposal | Sanitation hazards: inadequate sewage disposal. 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) Inadequate/Improper Food Storage | Sanitation hazards: inadequate/improper food storage. 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) Insects/Rodents Present | Sanitation hazards: insects/rodents present. 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) No Cooking Facilities | Sanitation hazards: no cooking facilities. 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) No Food Refrigeration | Sanitation hazards: no food refrigeration. 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) No Running Water | Sanitation hazards: no running water. 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) No Sanitation Hazards | Sanitation hazards: none. 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) No Scheduled Trash Pickup | Sanitation hazards: no scheduled trash pickup. 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) No Toileting Facilities | Sanitation hazards: no toileting facilities. 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) Other Sanitation Hazards | Sanitation hazards: other (specify). 0 = No, 1 = Yes. |
| NUM | 1 | (M0330) Outdoor Toileting Facilities Only | Sanitation hazards: outdoor toileting facilities only. 0 = No, 1 = Yes. |
| NUM | 1 | (M0340) Lives Alone | Patient lives alone. 0 = No, 1 = Yes. |
| NUM | 1 | (M0340) Lives With Friend | Patient lives with friend. 0 = No, 1 = Yes. |
| NUM | 1 | (M0340) Lives With Other Family Member | Patient lives with other family member. 0 = No, 1 = Yes. |
| NUM | 1 | (M0340) Lives With Other Than Above | Patient lives with other than above. 0 = No, 1 = Yes. |
| NUM | 1 | (M0340) Lives With Paid Help | Patient lives with paid help. 0 = No, 1 = Yes. |
| NUM | 1 | (M0340) Lives With Spouse/Significant Other | Patient lives with spouse or significant other. 0 = No, 1 = Yes. |
| NUM | 1 | (M0350) None of the Above Assisting Persons | Assisting person(s): none of the above. 0 = No, 1 = Yes. |
| NUM | 1 | (M0350) Paid Help | Assisting person(s): paid help. 0 = No, 1 = Yes. |
| NUM | 1 | (M0350) Person Residing in Home | Assisting person(s): person residing in the home (excluding paid help). 0 = No, 1 = Yes. |
| NUM | 1 | (M0350) Relatives/Friends/Neighbors Living Outside Home | Assisting person(s): relatives, friends, or neighbors living outside the home. 0 = No, 1 = Yes. |
| NUM | 1 | (M0350) Unknown Assisting Persons | Assisting person(s): unknown. 0 = No, 1 = Yes. |
| CHAR | 2 | (M0360) Primary Caregiver | Primary caregiver taking lead responsibility. 00 = No one person, 01 = Spouse or significant other, 02 = Daughter or son, 03 = Other family member, 04 = Friend or neighbor or community or church member, 05 = Paid help, UK = Unknown, Spaces = M0350. |
| CHAR | 2 | (M0370) Frequency Patient Receives Assistance | How often does patient receive assistance from primary caregiver. 01 = Several times during the day and night, 02 = Several times during the day, 03 = Once daily, 04 = Three or more times per week, 05 = One to two times per week, 06 = Less often than weekly, UK = Unknown, Spaces = M0350 None = 1 or M0350 Unknown = 1 or M0360 = 00 or UK. |
| CHAR | 1 | (M0380) ADL Assistance | Type of primary caregiver assistance: ADL assistance. 0 = No, 1 = Yes, Space = M0350 None = 1 or M0350 Unknown = 1 or M0360 Primary Caregiver = 00 or Unknown. |
| CHAR | 1 | (M0380) Advocates Participation in Medical Care | Type of primary caregiver assistance: advocates or facilitates patient's participation in appropriate medical care. 0 = No, 1 = Yes, Space = M0350 None = 1 or M0350 Unknown = 1 or M0360 Primary Caregiver = 00 or Unknown. |
| CHAR | 1 | (M0380) Environmental Support | Type of primary caregiver assistance: environmental support. 0 = No, 1 = Yes, Space = M0350 None= 1 or M0350 Unknown = 1 or M0360 Primary Caregiver = 00 or Unknown. |
| CHAR | 1 | (M0380) Financial Agent/Power of Attorney/Conservator of Finance | Type of primary caregiver assistance: financial agent, power of attorney, or conservator of finance. 0 = No, 1 = Yes, Space = M0350 None = 1 or M0350 Unknown = 1 or M0360 Primary Caregiver = 00 or Unknown. |
| CHAR | 1 | (M0380) Health Care Agent/Conservator of Person/Power of Attorney | Type of primary caregiver assistance: health care agent, conservator of person, medical power of attorney. 0 = No, 1 = Yes, Space = M0350 None= 1 or M0350 Unknown = 1 or M0360 Primary Caregiver = 00 or Unknown. |
| CHAR | 1 | (M0380) IADL Assistance | Type of Primary Caregiver Assistance: IADL assistance. 0 = No, 1 = Yes, Space = M0350 none= 1 or M0350 unknown = 1 or M0360 Primary Caregiver = 00 or Unknown. |
| CHAR | 1 | (M0380) Psychosocial Support | Type of primary caregiver assistance: psychosocial support. 0 = No, 1 = Yes, Space = M0350 none = 1 or M0350 unknown = 1 or M0360 Primary Caregiver = 00 or Unknown. |
| CHAR | 1 | (M0380) Unknown Primary Caregiver Assistance | Type of primary caregiver assistance: unknown. 0 = No, 1 = Yes, Space = M0350 None= 1 or M0350 Unknown = 1 or M0360 Primary Caregiver = 00 or Unknown. |
| CHAR | 2 | (M0390) Vision | Vision with corrective lenses if the patient usually wears them. 00 = Normal vision, 01 = Partially impaired, 02 = Severely impaired. |
| CHAR | 2 | (M0400) Hearing | Hearing and ability to understand spoken language in patient's own language. 00 = No observable impairment, 01 = Minimal difficulty, 02 = Moderate difficulty, 03 = Severe difficulty, 04 = Unable to hear. |
| CHAR | 2 | (M0410) Speech | Speech and oral (verbal) expression of language in patient's own language. 00 = Expresses complex feelings and needs clearly, 01 = Minimal difficulty, 02 = Moderate difficulty, 03 = Severe difficulty, 04 = Unable to express basic needs, 05 = Patient unresponsive. |
| CHAR | 2 | (M0420) Frequency of Pain | Frequency of pain interfering with patient's activity or movement. 00 = No pain, 01 = Less often than daily, 02 = Daily, but not constantly, 03 = All of the time. |
| NUM | 1 | (M0430) Intractable Pain | Intractable pain. 0 = No, 1 = Yes. |
| NUM | 1 | (M0440) Skin Lesion/Open Wound | Does patient have skin lesion or open wound? 0 = No, 1 = Yes. |
| CHAR | 1 | (M0445) Pressure Ulcer | Does patient have pressure ulcer? 0 = No, 1 = Yes, Space = M0440 = No. |
| CHAR | 2 | (M0450) Number Stage 1 Pressure Ulcers | Number of pressure ulcers, stage 1. 00 = Zero, 01 = One, 02 = Two, 03 = Three, 04 = Four or more, space = M0440 = No. |
| CHAR | 2 | (M0450) Number Stage 2 Pressure Ulcers | Number of pressure ulcers, stage 2. 00 = Zero, 01 = One, 02 = Two, 03 = Three, 04 = Four or more, space = M0440 = No. |
| CHAR | 2 | (M0450) Number Stage 3 Pressure Ulcers | Number of pressure ulcers, stage 3. 00 = Zero, 01 = One, 02 = Two, 03 = Three, 04 = Four or more, space = M0440 = No. |
| CHAR | 2 | (M0450) Number Stage 4 Pressure Ulcers | Number of pressure ulcers, stage 4. 00 = Zero, 01 = One, 02 = Two, 03 = Three, 04 = Four or more, space = M0440 = No. |
| CHAR | 1 | (M0450) Unobservable Pressure Ulcer | In addition to above, is there at least one pressure ulcer that cannot be observed due to eschar or nonremovable dressing, including casts? 0 = No, 1 = Yes, Space = M0440 = No. |
| CHAR | 2 | (M0460) Stage of Most Problematic Pressure Ulcer | Stage of most problematic pressure ulcer. 01 = Stage 1, 02 = Stage 2, 03 = Stage 3, 04 = Stage 4, NA = No observable pressure ulcer, Space = M0440 = No. |
| CHAR | 2 | (M0464) Status of Most Problematic Pressure Ulcer | Status of most problematic pressure ulcer. 01 = Fully granulating, 02 = Early/partial granulation, 03 = Not healing, NA = No observable pressure ulcer, Space = M0440 = no. |
| CHAR | 1 | (M0468) Stasis Ulcer | Does patient have stasis ulcer? 0 = No, 1 = Yes, Space = M0440 no. |
| CHAR | 2 | (M0470) Number Stasis Ulcers | Current number of observable stasis ulcers. 00 = Zero, 01 = One, 02 = Two, 03 = Three, 04 = Four or more, Space = M0440 No, or M0468 No. |
| CHAR | 1 | (M0474) Unobservable Stasis Ulcer | Does patient have at least one stasis ulcer that cannot be observed due to nonremovable dressing? 0 = No, 1 = Yes, Space = M0440 no or M0468 no. |
| CHAR | 2 | (M0476) Status of Most Problematic Stasis Ulcer | Status of most problematic stasis ulcer. 01 = Fully granulated, 02 = Early/partial granulation, 03 = Not healing, NA = No observable statis ulcer, Space = M0440 No, or M0468 No. |
| CHAR | 1 | (M0482) Surgical Wound | Does patient have a surgical wound? 0 = No, 1 = Yes, Space = M0440 No. |
| CHAR | 2 | (M0484) Number Surgical Wounds | Current number of observable surgical wounds. 00 = Zero, 01 = One, 02 = Two, 03 = Three, 04 = Four or more, Space = M0440 no or M0482 no. |
| CHAR | 1 | (M0486) Unobservable Surgical Wound | Does patient have at least one surgical wound that cannot be observed due to nonremovable dressing? 0 = No, 1 Yes, Space = M0440 No, or M0482 No. |
| CHAR | 2 | (M0488) Status of Most Problematic Surgical Wound | Status of most problematic (observable) surgical wound. 01 = Fully granulating, 02 = Early/partial granulation, 03 = Not healing, NA = No observable surgical wound, Space = M0440 no or M0482 no. |
| CHAR | 2 | (M0490) Patient Dyspneic/Short of Breath | When patient is dyspneic or noticeably short of breath. 00 = Never, patient not short of breath, 01 = When walking more than 20 feet, climbing stairs, 02 = With moderate excertion (e.g., while dressing, using commode or bedpan, walking distances less than 20 feet), 03 = With minimal exertion (e.g., while eating, talking, or performing other ADLs) or with agitation, 04 = At rest (during day or night). |
| NUM | 1 | (M0500) Continuous Positive Airway Pressure | Respiratory treatments utilized at home: continuous positive airway pressure. 0 = No, 1 = Yes. |
| NUM | 1 | (M0500) None of the Above Respiratory Treatments | Respiratory treatments utilized at home: none of the above. 0 = No, 1 = Yes. |
| NUM | 1 | (M0500) Oxygen | Respiratory treatments utilized at home: oxygen (intermittent or continuous). 0 = No, 1 = Yes. |
| NUM | 1 | (M0500) Ventilator | Respiratory treatments utilized at home: ventilator (continually or at night). 0 = No, 1 = Yes. |
| CHAR | 2 | (M0510) Urinary Tract Infection | Patient has been treated for urinary tract infection in past 14 days. 00 = No, 01 = Yes, NA = Patient on prophylactic treatment, UK = Unknown. |
| CHAR | 2 | (M0520) Urinary Incontinence | Urinary incontinence or urinary catheter presence. 00 = No incontinence or catheter, 01 = Patient is incontinent, 02 = Patient requires a urinary catheter. |
| CHAR | 2 | (M0530) When Urinary Incontinence Occurs | When urinary incontinence occurs. 00 = Timed voiding defers incontinence, 01 = During the night only, 02 = During the day and night, Space = M0520 contains 00 or 02. |
| CHAR | 2 | (M0540) Bowel Incontinence Frequency | Bowel incontinence frequency. 00 = Very rarely or never has bowel incontinence, 01 = Less than once weekly, 02 = One to three times weekly, 03 = Four to six times weekly, 04 = On a daily basis, 05 = More often than once daily, NA = Patient has ostomy for bowel elimination, UK = Unknown. |
| CHAR | 2 | (M0550) Ostomy for Bowel Elimination | Ostomy for bowel elimination. 00 = Patient does not have an ostomy, 01 = Patient's ostomy was not related to an inpatient stay and did not necessitate change in medical or treatment regimen, 02 = The ostomy was related to an inpatient stay or did necessitate change in medical treatment regimen. |
| CHAR | 2 | (M0560) Cognitive Functioning | Cognitive functioning. 00 = Alert and oriented, 01 = Requires prompting only under stressful or unfamiliar conditions, 02 = Requires assistance and some direction in specific situations or consistently requires low stimulus environment due to distractibility, 03 = Requires considerable assistance in routine situations. Is not alert and oriented or is unable to shift attention and recall directions more than half the time, 04 = Totally dependent due to disturbances such as constant disorientation, coma, persistent vegetative state, or delirium. |
| CHAR | 2 | (M0570) When Confused | When confused (reported or observed). 00 = Never, 01 = In new or complex situations only, 02 = On awakening or at night only, 03 = During the day and evening but not constantly, 04 = Constantly, NA = Patient nonresponsive. |
| CHAR | 2 | (M0580) When Anxious | When anxious (reported or observed). 00 = None of the time, 01 = Less often than daily, 02 = Daily, but not constantly, 03 = All of the time, NA = Patient nonresponsive. |
| NUM | 1 | (M0590) Depressed Mood | Depressive feelings: depressed mood. 0 = No, 1 = Yes. |
| NUM | 1 | (M0590) Hopelessness | Depressive feelings: hopelessness. 0 = No, 1 = Yes. |
| NUM | 1 | (M0590) None of the Above Depressive Feelings | Depressive feelings: none of the above. 0 = No, 1 = Yes. |
| NUM | 1 | (M0590) Recurrent Thoughts of Death | Depressive feelings: recurrent thoughts of death. 0 = No, 1 = Yes. |
| NUM | 1 | (M0590) Sense of Failure/Self Reproach | Depressive feelings: sense of failure or self reproach. 0 = No, 1 = Yes. |
| NUM | 1 | (M0590) Thoughts of Suicide | Depressive feelings: thoughts of suicide. 0 = No, 1 = Yes. |
| NUM | 1 | (M0600) A Suicide Attempt | Patient behaviors: a suicide attempt. 0 = No, 1 = Yes. |
| NUM | 1 | (M0600) Agitation | Patient behaviors: agitation. 0 = No, 1 = Yes. |
| NUM | 1 | (M0600) Diminished Interest in Most Activities | Patient behaviors: diminished interest in most activities. 0 = No, 1 = Yes. |
| NUM | 1 | (M0600) Indecisiveness, Lack of Concentration | Patient behaviors: indecisiveness, lack of concentration. 0 = No, 1 = Yes |
| NUM | 1 | (M0600) None of the Above Behaviors Observed | Patient behaviors: None of the above behaviors. 0 = No, 1 = Yes. |
| NUM | 1 | (M0600) Recent Change in Appetite or Weight | Patient behaviors: recent change in appetite or weight. 0 = No, 1 = Yes. |
| NUM | 1 | (M0600) Sleep Disturbances | Patient behaviors: sleep disturbances. 0 = No, 1 = Yes. |
| NUM | 1 | (M0610) Delusional/Hallucinatory/Paranoid Behavior | Behaviors demonstrated at least once a week: delusional, hallucinatory, paranoid behavior. 0 = No, 1 = Yes. |
| NUM | 1 | (M0610) Disruptive/Infantile/Inappropriate Behavior | Behaviors demonstrated at least once a week: disruptive, infantile, or socially inappropriate behavior. 0 = No, 1 = Yes. |
| NUM | 1 | (M0610) Impaired Decision Making | Behaviors demonstrated at least once a week: impaired decision-making. 0 = No, 1 = Yes. |
| NUM | 1 | (M0610) Memory Deficit | Behaviors demonstrated at least once a week: memory deficit. 0 = No, 1 = Yes. |
| NUM | 1 | (M0610) None of the Above Behaviors Demonstrated | Behaviors demonstrated at least once a week: none of the above. 0 = No, 1 = Yes. |
| NUM | 1 | (M0610) Physical Aggression | Behaviors demonstrated at least once a week: physical aggression. 0 = No, 1 = Yes. |
| NUM | 1 | (M0610) Verbal disruption | Behaviors demonstrated at least once a week: verbal disruption. 0 = No, 1 = Yes. |
| CHAR | 2 | (M0620) Frequency of Behavior Problems | Frequency of behavior problems. 00 = Never, 01 = Less than once a month, 02 = Once a month, 03 = Several times each month, 04 = Several times a week, 05 = At least daily. |
| NUM | 1 | (M0630) Psychiatric Nursing Services | Is patient receiving psychiatric nursing services at home provided by a qualified psychiatric nurse? 0 = No, 1 = Yes. |
| CHAR | 2 | (M0640) Current Grooming | Current grooming ability to tend to personal hygiene needs. 00 = Able to groom self unaided, with or without the use of assistive devices or adapted methods, 01 = Grooming utensils must be placed within reach before able to complete grooming activities, 02 = Someone must assist the patient to groom self, 03 = Patient depends entirely upon someone else for grooming needs. |
| CHAR | 2 | (M0640) Prior Grooming | Prior grooming ability to tend to personal hygiene needs. 00 = Able to groom self unaided, with or without the use of assistive devices or adapted methods, 01 = Grooming utensils must be placed within reach before able to complete grooming activities, 02 = Someone must assist the patient to groom self, 03 = Patient depends entirely upon someone else for grooming needs, UK = Unknown. |
| CHAR | 2 | (M0650) Current Ability to Dress Upper Body | Current ability to dress upper body. 00 = Able to get clothes out of closets and drawers, put them on and remove them from upper body without assistance, 01 = Able to dress upper body without assistance if clothing is laid out or handed to patient, 02 = Someone must help the patient put on upper body clothing, 03 = Patient depends entirely upon another person to dress the upper body. |
| CHAR | 2 | (M0650) Prior Ability to Dress Upper Body | Prior ability to dress upper body. 00 = Able to get clothes out of closets and drawers, put them on and remove them from upper body without assistance, 01 = Able to dress upper body without assistance if clothing is laid out or handed to patient, 02 = Someone must help the patient put on upper body clothing, 03 = Patient depends entirely upon another person to dress the upper body, UK = Unknown. |
| CHAR | 2 | (M0660) Current Ability to Dress Lower Body | Current ability to dress lower body. 00 = Able to obtain, put on, and remove clothing and shoes without assistance, 01 = Able to dress lower body without assistance if clothing and shoes are laid out or handed to the patient, 02 = Someone must help the patient put on undergarments, slacks, socks or nylons, and shoes, 03 = Patient depends entirely upon another person to dress lower body. |
| CHAR | 2 | (M0660) Prior Ability to Dress Lower Body | Prior ability to dress lower body. 00 = Able to obtain, put on, and remove clothing and shoes without assistance, 01 = Able to dress lower body without assistance if clothing and shoes are laid out or handed to the patient, 02 = Someone must help the patient put on undergarments, slacks, socks or nylons, and shoes, 03 = Patient depends entirely upon another person to dress lower body, UK = Unkown. |
| CHAR | 2 | (M0670) Current Bathing | Current abilty to wash entire body. 00 = Able to bathe self in shower or tub independently. 01 = With the use of devices, is able to bathe self in shower or tub independently, 02 = Able to bathe in shower or tub with the assistance of another person, a) for intermittent supervision or encouragement or reminders, or b) to get in and out of the shower or tub, or c) for washing difficult to reach areas, 03 = Participates in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision, 04 = Unable to use shower or tub and is bathed in bed or bedside chair, 05 = Unable to effectively participate in bathing and is totally bathed by another person. |
| CHAR | 2 | (M0670) Prior Bathing | Prior ability to wash entire body. 00 = Able to bathe self in shower or tub independently. 01 = With the use of devices, is able to bathe self in shower or tub independently, 02 = Able to bathe in shower or tub with the assistance of another person, a) for intermittent supervision or encouragement or reminders, or b) to get in and out of the shower or tub, or c) for washing difficult to reach areas, 03 = Participates in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision, 04 = Unable to use shower or tub and is bathed in bed or bedside chair, 05 = Unable to effectively participate in bathing and is totally bathed by another person, UK = Unknown. |
| CHAR | 2 | (M0680) Current Toileting | Current ability to get to and from toilet or bedside commode. 00 = Able to get to and from the toilet independently with or without a device, 01 = When reminded, assisted, or supervised by another person, able to get to and from the toilet, 02 = Unable to get to and from the toilet but is able to use a bedside commode (with or without assistance), 03 = Unable to get to and from the toilet or bedside commode but is able to use a bedpan/urinal independently, 04 = Is totally dependent in toileting. |
| CHAR | 2 | (M0680) Prior Toileting | Prior ability to get to and from toilet or bedside commode. 00 = Able to get to and from the toilet independently with or without a device, 01 = When reminded, assisted, or supervised by another person, able to get to and from the toilet, 02 = Unable to get to and from the toilet but is able to use a bedside commode (with or without assistance), 03 = Unable to get to and from the toilet or bedside commode but is able to use a bedpan/urinal independently, 04 = Is totally dependent in toileting, UK = Unknown. |
| CHAR | 2 | (M0690) Current Transferring | Current ability to transfer. 00 = Able to independently transfer, 01 = Transfers with minimal human assistance or with use of an assistive device, 02 = Unable to transfer self but is able to bear weight and pivot during transfer process, 03 = Unable to transfer self and is unable to bear weight or pivot when transferred by another person, 04 = Bedfast, unable to transfer but is able to turn and position self in bed, 05 = Bedfast, unable to transfer and is unable to turn and position self. |
| CHAR | 2 | (M0690) Prior Transferring | Prior ability to transfer. 00 = Able to independently transfer, 01 = Transfers with minimal human assistance or with use of an assistive device, 02 = Unable to transfer self but is able to bear weight and pivot during transfer process, 03 = Unable to transfer self and is unable to bear weight or pivot when transferred by another person, 04 = Bedfast, unable to transfer but is able to turn and position self in bed, 05=Bedfast, unable to transfer and is unable to turn and position self, UK = Unknown. |
| CHAR | 2 | (M0700) Current Ambulation/Locomotion | Current ambulation/locomotion ability. 00 = Able to independently walk on even and uneven surfaces and climb stairs with or without railings, 01 = Requires use of device to walk alone or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces, 02 = Able to walk only with supervision or assistance of another person at all times, 03 = Chairfast, unable to ambulate but is able to wheel self independently, 04 = Chairfast, unable to ambulate and is unable to wheel self, 05 = Bedfast, unable to ambulate or be up in a chair. |
| CHAR | 2 | (M0700) Prior Ambulation/Locomotion | Prior ambulation/locomotion ability. 00 = Able to independently walk on even and uneven surfaces and climb stairs with or without railings, 01 = Requires use of device to walk alone or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces, 02 = Able to walk only with supervision or assistance of another person at all times, 03 = Chairfast, unable to ambulate but is able to wheel self independently, 04 = Chairfast, unable to ambulate and is unable to wheel self, 05 = Bedfast, unable to ambulate or be up in a chair, UK = Unknown. |
| CHAR | 2 | (M0710) Current Feeding/Eating | Current ability to feed self. 00 = Able to independently feed self, 01 = Able to feed self independently but requires: a) meal setup, or b) intermittent assistance or supervision from another person, or c) a liquid, pureed or ground meat diet, 02 = Unable to feed self and must be assisted or supervised throughout the meal/snack, 03 = Able to take in nutrients orally and receives supplemental nutrients through a nasogastric tube or gastrostomy. 04 = Unable to take in nutrients orally and is fed nutrients through a nasograstic tube or gastrostomy. 05 = Unable to take in nutrients orally or by tube feeding. |
| CHAR | 2 | (M0710) Prior Feeding/Eating | Prior ability to feed self. 00 = Able to independently feed self, 01 = Able to feed self independently but requires: a) meal setup, or b) intermittent assistance or supervision from another person, or c) a liquid, pureed or ground meat diet, 02 = Unable to feed self and must be assisted or supervised throughout the meal/snack, 03 = Able to take in nutrients orally and receives supplemental nutrients through a nasogastric tube or gastrostomy, 04 = Unable to take in nutrients orally and is fed nutrients through a nasograstic tube or gastrostomy, 05 = Unable to take in nutrients orally or by tube feeding, UK = Unknown. |
| CHAR | 2 | (M0720) Current Preparing Light Meals | Current ability to plan and prepare light meals. 00 = a) able to independently plan and prepare all light meals for self or reheat delivered meals; or b) is physically, cognitively, and mentally able to prepare light meals on a regular basis but has not routinely preformed light meal preparation in the past, 01 = Unable to prepare light meals on a regular basis due to physical, cognitive, or mental limitations, 02 = Unable to prepare any light meals or reheat any delivered meals, UK = Unknown. |
| CHAR | 2 | (M0720) Prior Preparing Light Meals | Prior ability to plan and prepare light meals. 00 = a) Able to independently plan and prepare all light meals for self or reheat delivered meals, or b)is physically, cognitively, and mentally able to prepare light meals on a regular basis but has not routinely preformed light meal preparation in the past. 01 - Unable to prepare light meals on a regular basis due to physical, cognitive, or mental limitations, 02 = Unable to prepare any light meals or reheat any delivered meals, UK = Unknown. |
| CHAR | 2 | (M0730) Current Transportation | Current physical and mental ability to safely use car, taxi, public transportation. 00 = Able to independently drive a regular or adapted car, OR uses a regular or handicap-accessible public bus, 01 = Able to ride in car only when driven by another person, OR able to use a bus or handicap van only when assisted or accompanied by another person, 02 = Unable to ride in a car, taxi, bus or van, and requires transportation by ambulance. |
| CHAR | 2 | (M0730) Prior Transportation | Prior physical and mental ability to safely use car, taxi, public transportation. 00 = Able to independently drive a regular or adapted car, OR uses a regular or handicap-accessible public bus, 01 = Able to ride in car only when driven by another person, OR able to use a bus or handicap van only when assisted or accompanied by another person, 02 = Unable to ride in a car, taxi, bus or van, and requires transportation by ambulance, UK = Unknown. |
| CHAR | 2 | (M0740) Current Laundry | Current ability to do own laundry. 00 = a) Able to independently take care of all laundry tasks, OR b) Physically, cognitively, and mentally able to do laundry and access facilities, but has not routinely performed laundry tasks in the past, 01 = Able to do only light laundry, such as minor hand wash or light washer loads. Due to physical, cognitive, or mental limitations, needs assistance with heavy laundry such as carrying large loads of laundry. 02 = Unable to do laundry due to physical limitation or needs continual supervision and assistance due to cognitive or mental limitation. |
| CHAR | 2 | (M0740) Prior Laundry | Prior ability to do own laundry. 00 = a) Able to independently take care of all laundry tasks, OR b) Physically, cognitively, and mentally able to do laundry and access facilities, but has not routinely performed laundry tasks in the past, 01 = Able to do only light laundry, such as minor hand wash or light washer loads. Due to physical, cognitive, or mental limitations, needs assistance with heavy laundry such as carrying large loads of laundry, 02 = Unable to do laundry due to physical limitation or needs continual supervision an assistance due to cognitive or mental limitation. UK = Unknown. |
| CHAR | 2 | (M0750) Current Housekeeping | Current ability to safely and effectively perform light housekeeping and heavier cleaning tasks. 00 = a) Able to independently take care of all housekeeping tasks, OR b) Physically, cognitively, and mentally able to do housekeeping and access facilities, but has not routinely performed housekeeping tasks in the past, 01 = Able to perform only light housekeeping task independently, 02 = Able to perform housekeeping tasks with intermittent assistance or supervision from another person, 03 = Unable to consistently perform any housekeeping tasks unless assisted by another person throughout the process, 04 = Unable to effectively participate in any housekeeping tasks. |
| CHAR | 2 | (M0750) Prior Housekeeping | Prior ability to safely and effectively perform light housekeeping and heavier cleaning tasks. 00 = a) Able to independently take care of all housekeeping tasks, OR b) Physically, cognitively, and mentally able to do housekeeping and access facilities, but has not routinely performed housekeeping tasks in the past, 01 = Able to perform only light housekeeping tasks independently, 02 = Able to perform housekeeping tasks with intermittent assistance or supervision from another person, 03 = Unable to consistently perform any housekeeping tasks unless assisted by another person throughout the process. 04 = Unable to effectively participate in any housekeeping tasks. UK = Unknown. |
| CHAR | 2 | (M0760) Current Shopping | Current ability to shop. 00 = a) Able to plan for shopping needs and independently perform shopping tasks, including carrying packages, OR b) Physically, cognitively, and mentally able to take care of shopping but has not done shopping in the past, 01 = Able to go shopping but needs some assistance: a) By self is able to do only light shopping and carry small packages, but needs someone to do occasional major shopping; OR b) Unable to go shopping alone but can go with someone to assist, 02 = Unable to go shopping, but is able to identify items needed, place orders, and arrange home delivery, 03 = Needs someone to do all shopping and errands. |
| CHAR | 2 | (M0760) Prior Shopping | Prior ability to shop. 00 = a) Able to plan for shopping needs and independently perform shopping tasks, including carrying packages, OR b) Physically, cognitively, and mentally able to take care of shopping but has not done shopping in the past, 01 = Able to go shopping but needs some assistance: a) By self is able to do only light shopping and carry small packages, but needs someone to do occasional major shopping; OR b) Unable to go shopping alone but can go with someone to assist, 02 = Unable to go shopping, but is able to identify items needed, place orders, and arrange home delivery, 03 = Needs someone to do all shopping and errands, UK = Unknown. |
| CHAR | 2 | (M0770) Current Ability to Use Telephone | Current ability to use telephone. 00 = Able to dial numbers and answer calls appropriately and as desired, 01 = Able to use a specially adapted telephone (i.e., large numbers on the dial, teletype phone for the deaf) and call essential numbers, 02 = Able to answer the telephone and carry on a normal conversation but has difficulty with placing calls, 03 = Able to answer the telephone only some of the time or is able to carry on only a limited conversation, 04 = Unable to answer the telephone at all but can listen if assisted with equipment, 05 = Totally unable to use the telephone, NA = Patient does not have a telephone. |
| CHAR | 2 | (M0770) Prior Ability to Use Telephone | Prior ability to use telephone. 00 = Able to dial numbers and answer calls appropriately and as desired, 01 = Able to use a specially adapted telephone (i.e., large numbers on the dial, teletype phone for the deaf) and call essential numbers. 02 = Able to answer the telephone and carry on a normal conversation but has difficulty with placing calls, 03 = Able to answer the telephone only some of the time or is able to carry on only a limited conversation, 04 = Unable to answer the telephone at all but can listen if assisted with equipment. 05 = Totally unable to use the telephone, NA = Patient does not have a telephone, UK = Unknown. |
| CHAR | 2 | (M0780) Current Management of Oral Medications | Current ability to prepare and take oral medications. 00 = Able to independently take the correct oral medication(s) and proper dosage(s) at the correct times, 01 = Able to take medication(s) at the correct times if: (a) individual dosages are prepared in advance by another person, OR (b)given daily reminders, OR (c) someone develops a drug diary or chart, 02 = Unable to take medication unless administered by someone else, NA = No oral medications prescribed. |
| CHAR | 2 | (M0780) Prior Management of Oral Medications | Prior ability to prepare and take oral medications. 00 = Able to independently take the correct oral medication(s) and proper dosage(s) at the correct times. 01 = Able to take medication(s) at the correct times if: (a) individual dosages are prepared in advance by another person; OR (b)given daily reminders; OR (c) someone develops a drug diary or chart. 02 = Unable to take medication unless administered by someone else. NA = No oral medications prescribed. UK = Unknown. |
| CHAR | 2 | (M0790) Current Management of Inhalant Medications | Current ability to prepare and take inhalant/mist medications. 00 = Able to independently take the correct medication and proper dosage at the correct times, 01 = Able to take medication at the correct times if: (a) individual dosages are prepared in advance by another person, OR (b) given daily reminders, 02 = Unable to take medication unless administered by someone else, NA = No inhalant/mist medications prescribed. |
| CHAR | 2 | (M0790) Prior Management of Inhalant Medications | Prior ability to prepare and take inhalant/mist medications. 00 = Able to independently take the correct medication and proper dosage at the correct times, 01 = Able to take medication at the correct times if: (a) individual dosages are prepared in advance by another person, OR (b) given daily reminders, 02 = Unable to take medication unless administered by someone else, NA = No inhalant/mist medications prescribed, UK = Unknown. |
| CHAR | 2 | (M0800) Current Management of Injectable Medications | Current ability to prepare and take injectable medications. 00 = Able to independently take the correct medication and proper dosage at the correct times. 01 = Able to take injectable medication at correct times if: (a) individual syringes are prepared in advance by another person, OR (b) given daily reminders. 02 = Unable to take injectable medications unless administered by someone else. NA = No injectable medications prescribed. |
| CHAR | 2 | (M0800) Prior Management of Injectable Medications | Prior ability to prepare and take injectable medications. 00 = Able to independently take the correct medication and proper dosage at the correct times, 01 = Able to take injectable medication at correct times if: (a) individual syringes are prepared in advance by another person, OR (b) given daily reminders, 02 = Unable to take injectable medications unless administered by someone else, NA = No injectable medications prescribed, UK = Unknown. |
| CHAR | 2 | (M0810) Patient Management of Equipment | Patient management of equipment. 00 = Patient manages all tasks related to equipment completely independently, 01 = If someone else sets up equipment, patient is able to manage all other aspects of equipment, 02 = Patient requires considerable assistance from another person to manage equipment, but independently completes portions of the task, 03 = Patient is only able to monitor equipment and must call someone else to manage the equipment, 04 = Patient is completely dependent on someone else to manage all equipment, NA = No equipment used. |
| CHAR | 2 | (M0820) Caregiver Management of Equipment | Caregiver management of equipment. 00 = Caregiver manages all tasks related to equipment completely independently, 01 = If someone else sets up equipment, caregiver is able to manage all other aspects, 02 = Caregiver requires considerable assistance from another person to manage equipment, but independently completes significant portions of task, 03 = Caregiver is only able to complete small portions of task, 04 = Caregiver is completely dependent on someone else to manage all equipment, NA = No caregiver. UK = Unknown. |
| CHAR | 2 | (M0825) Therapy Need | (M0825) Therapy need. 00 = No, 01 = Yes, NA = Not applicable. |
| NUM | 3 | (M0826) Number of Therapy Visits | Number of therapy visits indicated for current payment episode. |
| NUM | 1 | (M0826) Therapy Need Not Applicable | Therapy visits not applicable. |
| NUM | 1 | (M0830) Doctors Office Emergency Visit | Emergent care: doctor's office emergency visit/house call. 0 = No, 1 = Yes. |
| NUM | 1 | (M0830) Hospital Emergency Room | Emergent care: hospital emergency room. 00 = No, 01 = Yes, NA = Not applicable. |
| NUM | 1 | (M0830) No Emergent Care Services | Emergent care: no emergent care services. 0 = No, 1 = Yes. |
| NUM | 1 | (M0830) Outpatient Department Emergency | Emergent care: outpatient department/clinic emergency. 0 = No, 1 = Yes. |
| NUM | 1 | (M0830) Unknown Emergent Care | Emergent care: unknown. 0 = No, 1 = Yes. |
| CHAR | 1 | (M0840) Cardiac Problems | Emergent care reason: cardiac problems. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0840) GI Bleeding, Obstruction | Emergent care reason: GI bleeding, obstruction. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0840) Hypo/Hyperglycemia, Diabetes Out of Control | Emergent care reason: hypo/hyperglycemia, diabetes out of control. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0840) Improper Medication Administration | Emergent care reason: improper medication administration, medication side effects, toxicity, anaphylaxis. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0840) Injury Caused by Fall/Accident | Emergent care reason: injury caused by fall or accident at home. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0840) Nausea/Dehydration/Malnutrition/Constipaton/Impaction | Emergent care reason: nausea, dehydration, malnutrition, constipation, impaction. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0840) Other than Above Reasons for Emergent Care | Emergent care reason: other than above. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0840) Respiratory Problems | Emergent care reason: respiratory problems. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0840) Unknown Emergent Care Reason | Emergent care reason: reason unknown. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0840) Wound Infection | Emergent care reason: wound infection, deteriorating wound status, new lesion/ulcer. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 2 | (M0855) Inpatient Facility Where Admitted | Inpatient facility to which the patient has been admitted. 01 = Hospital, 02 = Rehabilitation facility, 03 = Nursing home, 04 = Hospice, NA = No inpatient facility admission. |
| CHAR | 2 | (M0870) Discharge Disposition | Where the patient is after discharge. 01 = Patient remained in the community, 02 = Patient transferred to a noninstitutional hospice, 03 = Unknown because patient moved to geographical location not served by this agency, UK = Other unknown. |
| CHAR | 1 | (M0880) Assistance/Services Provided By Community Resources | After discharge, does patient receive health, personal, or support services or assistance: yes, other community resources. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0880) Assistance/Services Provided by Family/Friends | After discharge, does patient receive health, personal, or support services or assistance: yes, family or friends. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0880) No Assistance/Services Received | After discharge, does patient receive health, personal, or support services or assistance: no assistance or services. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 2 | (M0890) Reason Admitted to Hospital | Reason admitted to acute care hospital. 01 = Hospitalization for emergent, 02 = Hospitalization for urgent, 03 = Hospitalization for elective, UK = Unknown. |
| CHAR | 1 | (M0895) Chemotherapy | Reason for hospitalization: chemotherapy. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Deep Vein Thrombosis/Pulmonary Embolus | Reason for hospitalization: deep vein thrombosis, pulmonary embolus. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Exacerbation of CHF/Fluid Overload/Heart Failure | Reason for hospitalization: exacerbation of CHF, fluid overload, heart failure. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) GI Bleeding, Obstruction | Reason for hospitalization: GI bleeding, obstruction. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Hypo/Hyperglycemia, Diabetes Out of Control | Reason for hospitalization: Hypo/hyperglycemia, diabetes out of control. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) IV Catheter-Related Infection | Reason for hospitalization: IV catheter-related infection. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Improper Medication Administration | Reason for hospitalization: improper medication administration, medication side effects, toxicity, anaphylaxis. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Injury Caused by Fall/Accident | Reason for hospitalization: injury caused by fall or accident at home. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Myocardial Infarction/Stroke | Reason for hospitalization: myocardial infarction, stroke. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Other Than Above Reason for Hospitalization | Reason for hospitalization: other than above. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Psychotic Episode | Reason for hospitalization: psychotic episode. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Respiratory Problems | Reason for hospitalization: respiratory problems. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Scheduled Surgical Procedure | Reason for hospitalization: scheduled surgical procedure. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Uncontrolled Pain | Reason for hospitalization: uncontrolled pain. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Urinary Tract Infection | Reason for hospitalization: urinary tract infection. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0895) Wound or Tube Site Infection | Reason for hospitalization: wound or tube site infection, deteriorating wound status, new lesion/ulcer. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0900) Hospice Care | Reason(s) for admission to nursing home: hospice care. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0900) Other Reason Admitted to Nursing Home | Reason(s) for admission to nursing home: other. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0900) Permanent Placement | Reason(s) for admission to nursing home: permanent placement. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0900) Respite Care | Reason(s) for admission to nursing home: respite care. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0900) Therapy Services | Reason(s) for admission to nursing home: therapy services. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0900) Unknown Reason Admitted to Nursing Home | Reason(s) for admission to nursing home: unknown. 0 = No, 1 = Yes, Space = Unknown. |
| CHAR | 1 | (M0900) Unsafe for Care at Home | Reason(s) for admission to nursing home: unsafe for care at home. 0 = No, 1 = Yes, Space = Unknown. |
| DATE | 8 | (M0903) Date of Last Home Visit | Date of last home visit (most recent). |
| DATE | 8 | (M0906) Discharge/Transfer/Death Date | Discharge/transfer/death date. |