OASIS Data Dictionary - individual assessment
(Excel formatted original source document)
(Data Documentation is sometimes referred to as data dictionaries, file layouts, and data layouts)
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| CASPER Field Name | Field Description | Data Type | Data Length | Code Values |
| AST_BEG_VER_DT | Date of the submission file that contains the version of this assessment | DATE | 8 | |
| AST_END_VER_DT | Date of the submission file that contains the correction or inactivation request of this assessment. | DATE | 8 | |
| AST_MOD_IND | Designates Version of the assessment. C = Current, M = Modified, X = Inactive | VARCHAR2 | 1 | |
| BIRTHDATE_SUBM_IND | Indicates if the full birthdate was submitted or if part of the date was defaulted. S - 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. | VARCHAR2 | 1 | |
| BRANCH_IDENTIFIER | Agency assigned branch id | VARCHAR2 | 10 | |
| CALC_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 | VARCHAR2 | 5 | |
| CALC_HIPPS_VERSION | The version of the HIPPS code calculated | VARCHAR2 | 5 | |
| CORRECTION_NUM | Sequential correction number of assessment | NUMBER | 2 | |
| FAC_INT_ID | This field is used as a key to uniquely identify a facility | NUMBER | 10 | |
| HHA_ASMT_INT_ID | The assessment internal id | NUMBER | 15 | |
| HHA_SUBM_SEQ_NBR | Internal database tracking number for submissions | NUMBER | 10 | |
| LOCK_DATE | The lock-in date for the HHA Assessment | DATE | 8 | |
| M0010_MEDICARE_ID | Agency Medicare Provider Number | VARCHAR2 | 6 | |
| M0012_MEDICAID_ID | Agency Medicaid Provider Number | VARCHAR2 | 15 | |
| M0014_BRANCH_STATE | Branch State | VARCHAR2 | 2 | |
| M0016_BRANCH_ID | Branch ID Number | VARCHAR2 | 10 | |
| M0020_PAT_ID | Patient ID Number | VARCHAR2 | 20 | |
| M0030_SOC_DT | Start of Care Date | DATE | 8 | |
| M0032_ROC_DT | Resumption of Care Date | DATE | 8 | |
| M0032_ROC_DT_NA | Not Applicable | NUMBER | 1 | |
| M0040_PAT_FNAME | Patient First Name | VARCHAR2 | 12 | |
| M0040_PAT_LNAME | Patient Last Name | VARCHAR2 | 18 | |
| M0040_PAT_MI | Patient Middle Initial | VARCHAR2 | 1 | |
| M0040_PAT_SUFFIX | Patient Name Suffix | VARCHAR2 | 3 | |
| M0050_PAT_ST | Patient State of Residence | VARCHAR2 | 2 | |
| M0060_PAT_ZIP | Patient Zip Code | VARCHAR2 | 11 | |
| M0063_MEDICAID_NBR | Medicaid Number | VARCHAR2 | 14 | |
| M0063_MEDICARE_NA | No Medicare. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0063_MEDICARE_NBR | Medicare Number | VARCHAR2 | 12 | |
| M0064_SSN | Social Security Number | VARCHAR2 | 9 | |
| M0064_SSN_UK | Social Security Number Unknown or Not Available. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0065_MEDICAID_NA | No Medicaid. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0065_MEDICAID_NBR | Medicaid Number | VARCHAR2 | 14 | |
| M0066_PAT_BIRTH_DT | Birth Date. If only 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. | DATE | 8 | |
| M0069_PAT_GENDER | Gender. 1 = Male, 2 = Female | NUMBER | 1 | 1=Male, 2=Female |
| M0072_PHYSICIAN_ID | Primary Referring Physician ID. spaces = Unknown | VARCHAR2 | 10 | |
| M0072_PHYSICIAN_UK | Primary Referring Physician Unknown or Not Available. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0080_ASSR_DISCIPL | Discipline of Person Completing Assessment. 01 = RN, 02 = PT, 03 = SLP/ ST, 04 = OT | VARCHAR2 | 2 | 01=RN, 02=PT, 03=SLP/ST, 04=OT |
| M0090_ASMT_CPLT_DT | Date Assessment Completed | DATE | 8 | |
| M0100_ASSMT_REASON | The reason the Assessment is Currently Being Completed. 01 = Start of care - further visits planned, 02 = Start of care - 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 = Discharge from agency 10 = Discharge from agency - no visits completed after start/ resumption of care assessment | VARCHAR2 | 2 | 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=Discharge from agency, 10=Discharge from agency - no visits completed after start/resumption of care assessmentA |
| M0140_ETHNIC_AI_AN | Race/ Ethnicity as Identified by Patient: American Indian or Alaska Native. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0140_ETHNIC_ASIAN | Race/ Ethnicity as Identified by Patient: Asian. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0140_ETHNIC_BLACK | Race/ Ethnicity as Identified by Patient: Black or African-American. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0140_ETHNIC_HISP | Race/ Ethnicity as Identified by Patient: Hispanic or Latino. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0140_ETHNIC_NH_PI | Race/ Ethnicity as Identified by Patient: Native Hawaiian or Pacific Islander. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0140_ETHNIC_UK | Race/ Ethnicity as Identified by Patient: Unknown. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0140_ETHNIC_WHITE | Race/ Ethnicity as Identified by Patient: White. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_MCAIDFFS | Current Payment Sources for Home Care: Medicaid (traditional fee-for-service). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_MCAIDHMO | Current Payment Sources for Home Care: Medicaid (HMO/ managed care). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_MCAREFFS | Current Payment Sources for Home Care: Medicare (traditonal fee-for-service). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_MCAREHMO | Current Payment Sources for Home Care: Medicare (HMO/ managed care). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_NONE | Current Payment Sources for Home Care: None, no charge for current services. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_OTHER | Current Payment Sources for Home Care: Other (specify). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_OTH_GOVT | Current Payment Sources for Home Care: Other Government (eg, CHAMPUS, VA, etc). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_PRIV_HMO | Current Payment Sources for Home Care: Private HMO/ managed care. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_PRIV_INS | Current Payment Sources for Home Care: Private Insurance. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_SELFPAY | Current Payment Sources for Home Care: Self-pay. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_TITLEPGM | Current Payment Sources for Home Care: Title Programs (e.g., Title III, V, or XX). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_UK | Current Payment Sources for Home Care: Unknown. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0150_CPY_WRKCOMP | Current Payment Sources for Home Care: Worker's Compensation. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0160_LTD_FIN_EXP | Financial Factors limiting ability of patient/ family to meet basic health needs: Unable to afford med. expenses not covered by insurance/ Medicare (e.g., copayments). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0160_LTD_FIN_FOOD | Financial Factors limiting ability of patient/ family to meet basic health needs: Unable to afford food. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0160_LTD_FIN_NONE | Financial Factors limiting ability of patient/ family to meet basic health needs: none. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0160_LTD_FIN_OTHR | Financial Factors limiting ability of patient/ family to meet basic health needs: Other (specify). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0160_LTD_FIN_RENT | Financial Factors limiting ability of patient/ family to meet basic health needs: Unable to afford rent/ utility bills. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0160_LTD_FIN_SUPP | Financial Factors limiting ability of patient/ family to meet basic health needs: Unable to afford medicine or medical supplies. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0170_DC_HOSP_14_D | From which of following Inpatient Facilities was patient discharged during past 14 days? Hospital. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0170_DC_N_HM_14_D | From which of following Inpatient Facilities was patient discharged during past 14 days? Nursing Home. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0170_DC_OTHER | From which of following Inpatient Facilities was patient discharged during past 14 days? Other (specify). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0170_DC_REHB_14_D | From which of following Inpatient Facilities was patient discharged during past 14 days? Rehabilitation facility. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0170_NONE_14_DAYS | From which of following Inpatient Facilities was patient discharged during past 14 days? Patient not discharged from inpatient facility. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0175_DC_HSP_14_DA | Inpatient Facility Admitted From during past 14 Days - Hospital | VARCHAR2 | 1 | 0=Not Checked, 1=Checked |
| M0175_DC_NON_14_DA | Inpatient Facility Admitted From during past 14 Days - Not Discharged from an Inpatient Facility | VARCHAR2 | 1 | 0=Not Checked, 1=Checked |
| M0175_DC_ONH_14_DA | Inpatient Facility Admitted From during past 14 Days - Other Nursing Home | VARCHAR2 | 1 | 0=Not Checked, 1=Checked |
| M0175_DC_OTH_14_DA | Inpatient Facility Admitted From during past 14 Days - Other | VARCHAR2 | 1 | 0=Not Checked, 1=Checked |
| M0175_DC_RHB_14_DA | Inpatient Facility Admitted From during past 14 Days - Rehabilitation Facility | VARCHAR2 | 1 | 0=Not Checked, 1=Checked |
| M0175_DC_SNF_14_DA | Inpatient Facility Admitted From during past 14 Days - Skilled Nursing Facility | VARCHAR2 | 1 | 0=Not Checked, 1=Checked |
| M0180_DSCHG_UK | Inpatient Discharge Date (most recent) : Unknown. 0 = No, 1 = Yes | VARCHAR2 | 1 | 0=No, 1=Yes |
| M0180_INP_DSCHG_DT | Inpatient Discharge Date (most recent) | DATE | 8 | |
| M0190_14D_INP1_ICD | Inpatient Diagnoses and ICD code categories: Inpatient Facility Diagnosis ICD code a. | VARCHAR2 | 7 | |
| M0190_14D_INP2_ICD | Inpatient Diagnoses and ICD code categories: Inpatient Facility Diagnosis ICD code b. | VARCHAR2 | 7 | |
| M0200_REG_CHG_14_D | Medical Treatment Regimen Change Within Past 14 days. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0210_CHGREG_ICD1 | List Patient's Medical Diagnosis and ICD code categories (three digits required; five optional), ICD a. | VARCHAR2 | 7 | |
| M0210_CHGREG_ICD2 | List Patient's Medical Diagnosis and ICD code categories (three digits required; five optional), ICD b. | VARCHAR2 | 7 | |
| M0210_CHGREG_ICD3 | List Patient's Medical Diagnosis and ICD code categories (three digits required; five optional), ICD c. | VARCHAR2 | 7 | |
| M0210_CHGREG_ICD4 | List Patient's Medical Diagnosis and ICD code categories (three digits required; five optional), ICD d. | VARCHAR2 | 7 | |
| M0220_PR_CATH | Conditions Prior to Medical or Treatment Regimen Change or Impatient Stay Within Past 14 days: indwelling/ suprapubic catheter. 0 = No, 1 = Yes, spaces = Unknown | VARCHAR2 | 1 | =Space, 0=No, 1=Yes |
| M0220_PR_DISRUPT | Conditions Prior to Medical or Treatment Regimen Change or Impatient Stay Within Past 14 days: disruptive or socially inappropriate behavior. 0 = No, 1 = Yes, spaces = Unknown | VARCHAR2 | 1 | =Space, 0=No, 1=Yes |
| M0220_PR_IMP_DCSN | Conditions Prior to Medical or Treatment Regimen Change or Impatient Stay Within Past 14 days: impaired decision-making. 0 = No, 1 = Yes, spaces = Unknown | VARCHAR2 | 1 | =Space, 0=No, 1=Yes |
| M0220_PR_INTR_PAIN | Conditions Prior to Medical or Treatment Regimen Change or Impatient Stay Within Past 14 days: intractable pain. 0 = No, 1 = Yes, spaces = Unknown | VARCHAR2 | 1 | =Space, 0=No, 1=Yes |
| M0220_PR_MEM_LOSS | Conditions Prior to Medical or Treatment Regimen Change or Impatient Stay Within Past 14 days: memory loss to the extent that supervision required. 0 = No, 1 = Yes, spaces = Unknown | VARCHAR2 | 1 | =Space, 0=No, 1=Yes |
| M0220_PR_NOCHG_14D | Conditions Prior to Medical or Treatment Regimen Change or Impatient Stay Within Past 14 days: no inpatient facility discharge and no change in medical ot treatment regimen in past 14 days. 0 = No, 1 = Yes | VARCHAR2 | 1 | 0=No, 1=Yes |
| M0220_PR_NONE | Conditions Prior to Medical or Treatment Regimen Change or Impatient Stay Within Past 14 days: None of the above. 0 = No, 1 = Yes, spaces = Unknown | VARCHAR2 | 1 | =Space, 0=No, 1=Yes |
| M0220_PR_UK | Conditions Prior to Medical or Treatment Regimen Change or Impatient Stay Within Past 14 days: Unknown. 0 = No, 1 = Yes | VARCHAR2 | 1 | 0=No, 1=Yes |
| M0220_PR_UR_INCON | Conditions Prior to Medical or Treatment Regimen Change or Impatient Stay Within Past 14 days: Urinary incontinence. 0 = No, 1 = Yes, spaces = Unknown | VARCHAR2 | 1 | =Space, 0=No, 1=Yes |
| M0230_PRI_DGN_ICD | The values available describing the Primary Diagnosis Severity Rating | VARCHAR2 | 400 | |
| M0230_PRI_DGN_SEV | 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 | VARCHAR2 | 2 | 00=Asymptomatic, no treatment needed at this time, 01=Symptoms well controlled with current therapy, 02=Symptoms controlled with difficulty, affecting daily functioning; patient needs ongoing monitoring, 03=Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring, 04=Symptoms poorly controlled, history of rehospitalizations |
| M0240_OTH_DGN1_ICD | Other Diagnosis ICD b. | VARCHAR2 | 7 | |
| M0240_OTH_DGN1_SEV | 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 | VARCHAR2 | 2 | 00=Asymptomatic, no treatment needed at this time, 01=Symptoms well controlled with current therapy, 02=Symptoms controlled with difficulty, affecting daily functioning; patient needs ongoing monitoring, 03=Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring, 04=Symptoms poorly controlled, history of rehospitalizations |
| M0240_OTH_DGN2_ICD | Other Diagnosis ICD c. | VARCHAR2 | 7 | |
| M0240_OTH_DGN2_SEV | 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 | VARCHAR2 | 2 | 00=Asymptomatic, no treatment needed at this time, 01=Symptoms well controlled with current therapy, 02=Symptoms controlled with difficulty, affecting daily functioning; patient needs ongoing monitoring, 03=Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring, 04=Symptoms poorly controlled, history of rehospitalizations |
| M0240_OTH_DGN3_ICD | Other Diagnosis ICD d. | VARCHAR2 | 7 | |
| M0240_OTH_DGN3_SEV | 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 | VARCHAR2 | 2 | 00=Asymptomatic, no treatment needed at this time, 01=Symptoms well controlled with current therapy, 02=Symptoms controlled with difficulty, affecting daily functioning; patient needs ongoing monitoring, 03=Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring, 04=Symptoms poorly controlled, history of rehospitalizations |
| M0240_OTH_DGN4_ICD | Other Diagnosis ICD e. | VARCHAR2 | 7 | |
| M0240_OTH_DGN4_SEV | 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 | VARCHAR2 | 2 | 00=Asymptomatic, no treatment needed at this time, 01=Symptoms well controlled with current therapy, 02=Symptoms controlled with difficulty, affecting daily functioning; patient needs ongoing monitoring, 03=Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring, 04=Symptoms poorly controlled, history of rehospitalizations |
| M0240_OTH_DGN5_ICD | Other Diagnosis ICD f. | VARCHAR2 | 7 | |
| M0240_OTH_DGN5_SEV | 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 | VARCHAR2 | 2 | 00=Asymptomatic, no treatment needed at this time, 01=Symptoms well controlled with current therapy, 02=Symptoms controlled with difficulty, affecting daily functioning; patient needs ongoing monitoring, 03=Symptoms poorly controlled, patient needs frequent adjustment in treatment and dose monitoring, 04=Symptoms poorly controlled, history of rehospitalizations |
| M0250_THH_ENT_NUTR | Enteral nutrition (nasogastric, gastrostomy, jejunostomy, or any other artificial entry into alimentary canal). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0250_THH_IV_INFUS | Intravenous or infusion therapy (excludes TPN). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0250_THH_NONE_ABV | None of the above. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0250_THH_PAR_NUTR | Parentheral nutrition (TPN or lipids). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0260_OVRALL_PROGN | Overall Prognosis: Best description of patient's overall prognosis for recovery from this episode of illness. 00 - Poor, 01 - Good/ Fair, UK - Unknown | VARCHAR2 | 2 | 00=Poor: little or no recovery is expected and/or further decline is imminent, 01=Good/Fair: partial to full recovery is expected, UK=Unknown |
| M0270_REHAB_PROGN | Rehabilitative Prognosis: Best description of patient's prognosis for functional status. 00 - Guarded, 01 - Good, UK - Unknown | VARCHAR2 | 2 | 00=Guarded: minimal improvement in functional status is expected; decline is possible, 01=Good: marked improvement in functional status is expected, UK=Unknown |
| M0280_LIFE_EXPECT | Life expectancy (physician documentation is not required). 0 - Life expectancy is greater than 6 months, 1 - Life expectancy is 6 months of fewer | VARCHAR2 | 2 | 00=Life expectancy is greater than 6 months, 01=Life expectancy is 6 months or fewer |
| M0290_RSK_ALCOHOL | High Risk Factors characterizing this patient: Alcoholism. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0290_RSK_DRUGS | High Risk Factors characterizing this patient: Drug Dependency. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0290_RSK_NONE | High Risk Factors characterizing this patient: None of the above. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0290_RSK_OBESITY | High Risk Factors characterizing this patient: Obesity. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0290_RSK_SMOKING | High Risk Factors characterizing this patient: Heavy Smoking. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0290_RSK_UK | High Risk Factors characterizing this patient: Unknown. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0300_CURR_RESIDEN | 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 | VARCHAR2 | 2 | 01=Patient owned or rented residence (house, apartment, or mobile home owned or rented by patient/couple/significant other), 02=Family member residence, 03=Boarding home or rented room, 04=Board and care or assisted living facility, 05=Other (specify) |
| M0310_STR_DOORWAYS | Stuctural Barriers: Narrow or obstructed doorways. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0310_STR_MST_ISTR | Structural Barriers: Stairs inside which must be used by patient. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0310_STR_NONE | Structural Barriers: None. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0310_STR_OPT_ISTR | Structural Barriers: Stairs inside home which are used optionally. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0310_STR_OUTSTAIR | Structural Barriers: Stairs leading from inside to outside house. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0320_SAF_APPLIANC | Safey Hazards: unsafe gas/ electric appliance. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0320_SAF_COOLING | Safety Hazards: inadequate cooling. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0320_SAF_FIRE_SAF | Safety Hazards: lack of fire safety devices. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0320_SAF_FLOOR | Safety Hazards: inadequate floor, roof, or windows. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0320_SAF_FLOORCOV | Safety Hazards: unsafe floor coverings. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0320_SAF_HAZ_MAT | Safety Hazards: improperly stored hazardous materials. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0320_SAF_HEATING | Safety Hazards: inadequate heating. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0320_SAF_LIGHTING | Safety Hazards: inadequate lighting. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0320_SAF_NONE | Safety Hazards: none. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0320_SAF_OTHER | Safety Hazards: other (specify). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0320_SAF_PAINT | Safety Hazards: lead-based paint. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0320_SAF_RAILINGS | Safety Hazards: inadequate stair railings. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_BAD_H2O | Sanitation Hazards: contaminated water. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_BUGS_ROD | Sanitation Hazards: insects/ rodents present. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_COOK_FAC | Sanitation Hazards: no cooking facilities. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_FOOD_STR | Sanitation Hazards: inadequate/ improper food storage. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_LIVING_A | Sanitation Hazards: cluttered/ soiled living area. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_NONE | Sanitation Hazards: none. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_NO_H2O | Sanitation Hazards: no running water. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_NO_TOILT | Sanitation Hazards: no toileting facilities. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_OTHER | Sanitation Hazards: other (specify). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_OUT_TOIL | Sanitation Hazards: outdoor toileting facilities only. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_REFRIGER | Sanitation Hazards: no food refrigeration. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_SEW_DISP | Sanitation Hazards: inadequate sewage disposal. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0330_SAN_TRASH | Sanitation Hazards: no scheduled trash pickup. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0340_LIV_ALONE | Patient lives alone. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0340_LIV_FRIEND | Patient lives with friend. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0340_LIV_OTHER | Patient lives with other than above. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0340_LIV_OTH_FAM | Patient lives with other family member. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0340_LIV_PD_HELP | Patient lives with paid help. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0340_LIV_SPOUSE | Patient lives with spouse or significant other. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0350_AP_HM_RES | Assisting person(s): person residing in the home (excluding paid help). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0350_AP_NONE | Assisting person(s): None of the above. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0350_AP_PD_HELP | Assisting person(s): paid help. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0350_AP_REL_FRND | Assisting person(s): relatives, friends, or neighbors living outside the home. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0350_AP_UK | Assisting person(s): unknown. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0360_PRI_CAREGVR | 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 | VARCHAR2 | 2 | =Space, 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 |
| M0370_FREQ_PRM_AST | 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 | VARCHAR2 | 2 | =Space, 01=Several times during day and night, 02=Several times during 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 |
| M0380_CA_ADL | 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 | VARCHAR2 | 1 | |
| M0380_CA_ENVIRON | 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 | VARCHAR2 | 1 | |
| M0380_CA_FIN_LEGAL | 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 | VARCHAR2 | 1 | |
| M0380_CA_HLTH_CARE | 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 | VARCHAR2 | 1 | |
| M0380_CA_IADL | 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 | VARCHAR2 | 1 | |
| M0380_CA_MEDICAL | 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 | VARCHAR2 | 1 | |
| M0380_CA_PSYCHSOC | 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 | VARCHAR2 | 1 | |
| M0380_CA_UK | 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 | VARCHAR2 | 1 | |
| M0390_VISION | Vision with corrective lenses if the patient usually wears them. 00=Normal Vision, 01=Partially Impaired, 02=Severely Impaired | VARCHAR2 | 2 | 00=Normal vision; sees adequately in most situations; can see medication labels, newsprint., 01=Partially impaired: cannot see medication labels or newsprint, but can see obstacles in path, and the surrounding layout; can count fingers at arm"s length., 02=Severly impaired; cannot locate object without hearing or touching them or patient nonresponsive. |
| 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 | VARCHAR2 | 2 | 00=No observable impairment. Able to hear and understand complex or detailed instructions and extended or abstract conversation., 01=With minimal difficulty, able to hear and understand most multi-step instructions and ordinary conversation. May need occasional repetition, extra time, or louder voice., 02=Has moderate difficulty hearing and understanding simple, one-step instructions and brief conversation; needs frequent prompting or assistance., 03=Has severe difficulty hearing and understanding simple greetings and short comments. Requires multiple repetitions, restatements, demonstrations, additional time., 04=Unable to hear and understand familiar words or common expressions consistently, or patient nonresponsive. |
| M0410_SPEECH | Speech and oral (verbal) expression of language in patient's own language. 00=Espresses complex feelings and needs clearly, 01=Minimal difficulty, 02=Moderate difficulty, 03=Severe difficulty, 04=Unable to express basic needs, 05=Patient unresponsive | VARCHAR2 | 2 | 00=Expresses complex ideas, feelings, and needs clearly, completely, and easily in all situations with no observable impairment., 01=Minimal difficulty in expressing ideas and needs (may take extra time; makes occasional errors in word choice, grammar or speech intelligibility; needs minimal prompting or assistance)., 02=Expresses simple ideas or needs with moderate difficulty (needs prompting or assistance, errors in word choice, organization or speech intelligibility). Speaks in phrases or short sentences., 03=Has severe difficulty expressing basic ideas or needs and requires maximal assistance or guessing by listener. Speech limited to single words or short phrases., 04=Unable to express basic needs even with maximal prompting or assistance but is not comatose or unresponsive (e.g., speech is nonsensical or unintelligible)., 05=Patient unresponsive or unable to speak. |
| M0420_FREQ_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 | VARCHAR2 | 2 | 00=Patient has no pain or pain does not interfere with activity or movement, 01=Less often than daily, 02=Daily, but not constantly, 03=All of the time |
| M0430_INTRACT_PAIN | Intractable pain. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0440_LES_OPEN_WND | Does patient have skin lesion or open wound? 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0445_PRESS_ULCER | Does patient have pressure ulcer? 0 = No, 1 = Yes, space = M0440 = No | VARCHAR2 | 1 | =Space, 0=No, 1=Yes |
| M0450_NBR_PRU_STG1 | Pressure Ulcer Stage 1. 00=zero, 01=one, 02=two, 03=three, 04=Four or more, space = M0440 = no | VARCHAR2 | 2 | =Space, 00=Zero, 01=One, 02=Two, 03=Three, 04=Four or more |
| M0450_NBR_PRU_STG2 | Pressure Ulcer Stage 2. 00=zero, 01=one, 02=two, 03=three, 04=Four or more, space = M0440 = no | VARCHAR2 | 2 | =Space, 00=Zero, 01=One, 02=Two, 03=Three, 04=Four or more |
| M0450_NBR_PRU_STG3 | Pressure Ulcer Stage 3. 00=zero, 01=one, 02=two, 03=three, 04=Four or more, space = M0440 = no | VARCHAR2 | 2 | =Space, 00=Zero, 01=One, 02=Two, 03=Three, 04=Four or more |
| M0450_NBR_PRU_STG4 | Pressure Ulcer Stage 4. 00=zero, 01=one, 02=two, 03=three, 04=Four or more, space = M0440 = no | VARCHAR2 | 2 | =Space, 00=Zero, 01=One, 02=Two, 03=Three, 04=Four or more |
| M0450_UNOBS_PRSULC | 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 | VARCHAR2 | 1 | =Space, 00=Zero, 01=One, 02=Two, 03=Three, 04=Four or more |
| M0460_STG_PRBL_PRU | 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 | VARCHAR2 | 2 | =Space, 01=Stage 1, 02=Stage 2, 03=Stage 3, 04=Stage 4, NA=NA - No observable pressure ulcer |
| M0464_STA_PRBL_PRU | Status of most problematic pressure ulcer. 01=Fully granulating, 02=Early/ partial granulation, 03=Not healing, NA=No observable pressure ulcer, Space = M0440 = no | VARCHAR2 | 2 | =Space, 01=Fully granulating, 02=Early/partial granulation, 03=Not healing, NA=NA - No observable ulcer/wound |
| M0468_STASIS_ULCER | Does patient have stasis ulcer? 0=no, 1=yes, space = M0440 no | VARCHAR2 | 1 | =Space, 0=No, 1=Yes |
| M0470_NBR_STAS_ULC | Current number of observable stasis ulcers. 00=zero, 01=one, 02=two, 03=three, 04=Four or more, Space = M0440 no or M0468 no | VARCHAR2 | 2 | =Space, 00=Zero, 01=One, 02=Two, 03=Three, 04=Four or more |
| M0474_UNOBS_STAULC | 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 | VARCHAR2 | 1 | 0=No, 1=Yes |
| M0476_STA_PRB_STAU | 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 | VARCHAR2 | 2 | =Space, 01=Fully granulating, 02=Early/partial granulation, 03=Not healing, NA=NA - No observable ulcer/wound |
| M0482_SURG_WOUND | Does patient have a surgical wound? 0=no, 1=yes, space = M0440 no | VARCHAR2 | 1 | =Space, 0=No, 1=Yes |
| M0484_NBR_SURGWND | Current number of observable surgical wounds. 00=zero, 01=one, 02=two, 03=three, 04=four or more, Space = M0440 no or M0482 no | VARCHAR2 | 2 | =Space, 00=Zero, 01=One, 02=Two, 03=Three, 04=Four or more |
| M0486_UNOBS_SRGWND | 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 | VARCHAR2 | 1 | =Space, 0=No, 1=Yes |
| M0488_STA_PRB_SWND | Status of most problematic surgical wound. 01=Fully granulating, 02=Early/ partial granulation, 03=Not healing, NA=No observable surgical wound, Space = M0440 no or M0482 no | VARCHAR2 | 2 | =Space, 01=Fully granulating, 02=Early/partial granulation, 03=Not healing, NA=NA - No observable ulcer/wound |
| M0490_WHEN_DYSPNIC | 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) | VARCHAR2 | 2 | 01=When walking more than 20 feet, climbing stairs, 02=With moderate exertion (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), 00=Never, patient is not short of breath |
| M0500_RESPTX_AIRPR | Respiratory Treatments utilized at home: continuous positive airway pressure. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0500_RESPTX_NONE | Respiratory Treatments utilized at home: none of the above. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0500_RESPTX_OXYGN | Respiratory Treatments utilized at home: oxygen (intermittent or continuous). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0500_RESPTX_VENT | Respiratory Treatments utilized at home: ventilator (continually or at night). 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0510_UTI | Patient has been treated for Urinary Tract Infection in past 14 days. 00=no, 01=yes, NA= Patient on prophylactic treatment, UK=Unknown | VARCHAR2 | 2 | 00=No, 01=Yes, NA=NA - Patient on prophylactic treatment, UK=Unknown |
| M0520_UR_INCONT | Urinary incontinence or unrinary catheter presence. 00=No incontinence or catheter, 01=Patient is incontinent, 02=Patient requires a urinary catheter | VARCHAR2 | 2 | 00=No incontinence or catheter (includes anuria or ostomy for urinary drainage), 01=Patient is incontinent, 02=Patient requires a urinary catheter (i.e., external, indwelling, intermittent, suprapubic) |
| M0530_UR_INCONT_OC | When does urinary incontinence occur. 00=Timed-voiding defers incontinence, 01=During the night only, 02=During the day and night, Space = M0520 contains 00 or 02. | VARCHAR2 | 2 | 00=Timed-voiding defers incontinence, 01=During the night only, 02=During the day and night |
| M0540_BWL_INCONT | 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 | VARCHAR2 | 2 | 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=NA - Patient has ostomy for bowel elimination, UK=Unknown |
| M0550_OSTOMY | 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 | VARCHAR2 | 2 | 00=Patient does not have an ostomy for bowel elimination., 01=Patient 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 or treatment regimen. |
| M0560_COG_FUNCTION | 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 direction, coma, persistent vegetative state, or delirium | VARCHAR2 | 2 | 00=Alert/oriented, able to focus and shift attention, comprehends and recalls task directions independently., 01=Requires prompting (cuing, repetition, reminders) only under stressful or unfamiliar conditions., 02=Requires assistance and some direction in specific situations (e.g., on all tasks involving shifting of attention), 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. |
| M0570_WHEN_CONFUSD | 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 | VARCHAR2 | 2 | 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=NA - Patient nonresponsive |
| 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 | VARCHAR2 | 2 | 00=None of the time, 01=Less often than daily, 02=Daily, but not constantly, 03=All of the time, NA=NA - Patient nonresponsive |
| M0590_DP_DEATH | Depressive feelings: recurrent thoughts of death. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0590_DP_HOPELESS | Depressive feelings: hopelessness. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0590_DP_MOOD | Depressive feelings: depressed mood. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0590_DP_NONE | Depressive feelings: none of the above. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0590_DP_SENS_FAIL | Depressive feelings: sense of failure or self reproach. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0590_DP_SUICIDE | Depressive feelings: thoughts of suicide. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0600_BEH_AGITAT | Patient Behaviors: agitation. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0600_BEH_APPWT_C | Patient Behaviors: recent change in appetite or weight. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0600_BEH_DIM_INT | Patient Behaviors: diminished interest in most activities. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0600_BEH_INDECIS | Patient Behaviors: indecisiveness, lack of concentration. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0600_BEH_NONE | Patient Behaviors: None of the above behaviors. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0600_BEH_SLEEP_D | Patient Behaviors: sleep disturbances. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0600_BEH_SUICIDE | Patient Behaviors: a suicide attempt. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0610_BD_DELUSIONS | Behaviors Demonstrated at least once a week: delusional, hallucinatory, paranoid behavior. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0610_BD_IMP_DCSN | Behaviors Demonstrated at least once a week: impaired decision-making. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0610_BD_MEM_DFICT | Behaviors Demonstrated at least once a week: memory deficit. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0610_BD_NONE | Behaviors Demonstrated at least once a week: none of the above. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0610_BD_PHYSICAL | Behaviors Demonstrated at least once a week: physical aggression. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0610_BD_SOC_INAPP | Behaviors Demonstrated at least once a week: disruptive, infantile, or socially inappropriate behavior. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0610_BD_VERBAL | Behaviors Demonstrated at least once a week: verbal disruption. 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0620_BEH_PROB_FRQ | 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 | VARCHAR2 | 2 | 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 |
| M0630_REC_PSYCH | Is patient receiving psychiatric nursing services at home provided by a qualified psychiatric nurse? 0 = No, 1 = Yes | NUMBER | 1 | 0=No, 1=Yes |
| M0640_CU_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 with 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 | VARCHAR2 | 2 | 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 |
| M0640_PR_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 with 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 | VARCHAR2 | 2 | 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 |
| M0650_CU_DRESS_UPR | 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, UK=Unknown | VARCHAR2 | 2 | 00=Able to get clothes out of closets and drawers, put them on and remove them from the upper body without assistance., 01=Able to dress upper body without assistance if clothing is laid out or handed to the 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 |
| M0650_PR_DRESS_UPR | 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 | VARCHAR2 | 2 | 00=Able to get clothes out of closets and drawers, put them on and remove them from the upper body without assistance., 01=Able to dress upper body without assistance if clothing is laid out or handed to the 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 |
| M0660_CU_DRESS_LOW | 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, UK=Unkown | VARCHAR2 | 2 | 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=Paitent depends entirely upon another person to dress lower body., UK=Unknown |
| M0660_PR_DRESS_LOW | 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 | VARCHAR2 | 2 | 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=Paitent depends entirely upon another person to dress lower body., UK=Unknown |
| M0670_CU_BATHING | Current abilty to wash entire body. 00=Able to bath self in shower or tub independently. 01=With the use of devices, is able to bath self in shower or tub independently, 02=Able to bath 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 | VARCHAR2 | 2 | 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/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 the 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 |
| M0670_PR_BATHING | Prior ability to wash entire body. 00=Able to bath self in shower or tub independently. 01=With the use of devices, is able to bath self in shower or tub independently, 02=Able to bath in shower or tub with the assistance of another person; d) for intermittent supervision or encouragement or reminders, or d) to get in and out of the shower or tub, or f) 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 | VARCHAR2 | 2 | 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/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 the 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 |
| M0680_CU_TOILETING | Current ability to get to and from toilet or bedside commode. 00=Able to get to and from the toilet indepently 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 | VARCHAR2 | 2 | 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 |
| M0680_PR_TOILETING | Prior ability to get to and from toilet or bedside commode. 00=Able to get to and from the toilet indepently 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 | VARCHAR2 | 2 | 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 |
| M0690_CU_TRANSFER | 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, UK=Unknown | VARCHAR2 | 2 | 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 the 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 |
| M0690_PR_TRANSFER | 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 | VARCHAR2 | 2 | 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 the 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 |
| M0700_CU_AMBULATN | Current ambulation/ locomotion ability. 00 - Able to independently walk on even and uneven surfaces and climb stairs. 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 | VARCHAR2 | 2 | 00=Able to independently walk on even and uneven surfaces and climb stairs with or without railings (i.e., needs no human assistance or assistive device)., 01=Requires use of a device (e.g., cane, walker) to walk alone or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces., 02=Able to walk only with the 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 |
| M0700_PR_AMBULATN | Prior ambulation/ locomotion ability. 00 - Able to independently walk on even and uneven surfaces and climb stairs. 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 | VARCHAR2 | 2 | 00=Able to independently walk on even and uneven surfaces and climb stairs with or without railings (i.e., needs no human assistance or assistive device)., 01=Requires use of a device (e.g., cane, walker) to walk alone or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces., 02=Able to walk only with the 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 |
| M0710_CU_FEEDING | 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.UK - Unknown. | VARCHAR2 | 2 | 00=Able to independently feed self., 01=Able to feed self independently but requires: (a) meal set-up; 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=Un |