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Thu Nov 16 08:15:13 EST 2017 QIES Workbench Record Layout Report For Job: DUA #16702 MDS2.0 Q1-Q2 1999 ( 166459.1 ) Report Name: DUA #16702 MDS2.0 |
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| Data Type | Offset | Length | DP | Field Name |
|---|---|---|---|---|
| CHAR | 1 | 5 | 0 | (A2) Room Number |
| DATE | 6 | 8 | 0 | (A3A) Assessment Reference Date |
| DATE | 14 | 8 | 0 | (A4A) Reentry Date |
| CHAR | 22 | 1 | 0 | (A4B) Admitted From |
| CHAR | 23 | 1 | 0 | (A5) Marital Status |
| CHAR | 24 | 12 | 0 | (A6) Medical Record Number |
| CHAR | 36 | 1 | 0 | (A7A) Medicaid Per Diem |
| CHAR | 37 | 1 | 0 | (A7B) Medicare Per Diem |
| CHAR | 38 | 1 | 0 | (A7C) Medicare Ancillary Part A |
| CHAR | 39 | 1 | 0 | (A7D) Medicare Ancillary Part B |
| CHAR | 40 | 1 | 0 | (A7E) CHAMPUS Per Diem |
| CHAR | 41 | 1 | 0 | (A7F) VA Per Diem |
| CHAR | 42 | 1 | 0 | (A7G) Self/Family Pay Full Per Diem |
| CHAR | 43 | 1 | 0 | (A7H) Medicaid Resident Liability/Medicare Co-Pay |
| CHAR | 44 | 1 | 0 | (A7I) Private Insurance Per Diem |
| CHAR | 45 | 1 | 0 | (A7J) Other Per Diem |
| CHAR | 46 | 1 | 0 | (A9A) Legal Guardian |
| CHAR | 47 | 1 | 0 | (A9B) Other Legal Oversight |
| CHAR | 48 | 1 | 0 | (A9C) Power of Attorney/Health Care |
| CHAR | 49 | 1 | 0 | (A9D) Power of Attorney/Financial |
| CHAR | 50 | 1 | 0 | (A9E) Family Member Responsible |
| CHAR | 51 | 1 | 0 | (A9F) Patient Responsible for Self |
| CHAR | 52 | 1 | 0 | (A9G) None of Above Legal Guardian |
| CHAR | 53 | 1 | 0 | (A10A) Living Will |
| CHAR | 54 | 1 | 0 | (A10B) Do Not Resuscitate |
| CHAR | 55 | 1 | 0 | (A10C) Do Not Hospitalize |
| CHAR | 56 | 1 | 0 | (A10D) Organ Donation |
| CHAR | 57 | 1 | 0 | (A10E) Autopsy Request |
| CHAR | 58 | 1 | 0 | (A10F) Feeding Restrictions |
| CHAR | 59 | 1 | 0 | (A10G) Medication Restrictions |
| CHAR | 60 | 1 | 0 | (A10H) Other Treatment Restrictions |
| CHAR | 61 | 1 | 0 | (A10I) None of the Above Advanced Directives |
| CHAR | 62 | 1 | 0 | (AA2) Gender |
| DATE | 63 | 8 | 0 | (AA3) Birth Date |
| CHAR | 71 | 1 | 0 | (AA4) Race/Ethnicity |
| CHAR | 72 | 15 | 0 | (AA6A) Facility Medicaid Number |
| CHAR | 87 | 12 | 0 | (AA6B) Facility Medicare Number |
| CHAR | 99 | 2 | 0 | (AA8A) Primary Reason for Assessment |
| CHAR | 101 | 1 | 0 | (AA8B) Assessment Codes for Medicare PPS State |
| DATE | 102 | 8 | 0 | (AB1) Date of Entry |
| CHAR | 110 | 1 | 0 | (AB2) Admitted From |
| CHAR | 111 | 1 | 0 | (AB3) Lived Alone Prior to Entry |
| CHAR | 112 | 5 | 0 | (AB4) ZIP Code of Prior Primary Residence |
| CHAR | 117 | 1 | 0 | (AB5A) Prior Stay in This Nursing Home |
| CHAR | 118 | 1 | 0 | (AB5B) Stay in Other Nursing Home |
| CHAR | 119 | 1 | 0 | (AB5C) Other Residential Facility |
| CHAR | 120 | 1 | 0 | (AB5D) MH/Psychiatric Setting |
| CHAR | 121 | 1 | 0 | (AB5E) MR/DD Setting |
| CHAR | 122 | 1 | 0 | (AB5F) None of Above Residential History |
| CHAR | 123 | 21 | 0 | (AB6) Lifetime Occupation |
| CHAR | 144 | 1 | 0 | (AB7) Education |
| CHAR | 145 | 1 | 0 | (AB8A) Language |
| CHAR | 146 | 9 | 0 | (AB8B) Other Language |
| CHAR | 155 | 1 | 0 | (AB9) Mental Health History |
| CHAR | 156 | 1 | 0 | (AB10A) No MR/DD |
| CHAR | 157 | 1 | 0 | (AB10B) Downs Syndrome |
| CHAR | 158 | 1 | 0 | (AB10C) Autism |
| CHAR | 159 | 1 | 0 | (AB10D) Epilepsy |
| CHAR | 160 | 1 | 0 | (AB10E) Other Organic Condition Related to MR/DD |
| CHAR | 161 | 1 | 0 | (AB10F) MR/DD with No Organic Condition |
| DATE | 162 | 8 | 0 | (AB11) Background Information Completed Date |
| CHAR | 170 | 1 | 0 | (AC1A) Stays Up Late at Night |
| CHAR | 171 | 1 | 0 | (AC1B) Naps Regularly During Day |
| CHAR | 172 | 1 | 0 | (AC1C) Goes Out 1+ Days a Week |
| CHAR | 173 | 1 | 0 | (AC1D) Stays Busy With Hobbies/Reading/Fixed Daily Routine |
| CHAR | 174 | 1 | 0 | (AC1E) Spends Most of Time Alone/Watching TV |
| CHAR | 175 | 1 | 0 | (AC1F) Moves Independently Indoors |
| CHAR | 176 | 1 | 0 | (AC1G) Use of Tobacco Products at Least Daily |
| CHAR | 177 | 1 | 0 | (AC1H) None of Above Cycle of Daily Events |
| CHAR | 178 | 1 | 0 | (AC1I) Distinct Food Preferences |
| CHAR | 179 | 1 | 0 | (AC1J) Eats Between Meals |
| CHAR | 180 | 1 | 0 | (AC1K) Use of Alcoholic Beverages at Least Weekly |
| CHAR | 181 | 1 | 0 | (AC1L) None of Above Eating Patterns |
| CHAR | 182 | 1 | 0 | (AC1M) In Bedclothes Much of Day |
| CHAR | 183 | 1 | 0 | (AC1N) Wakens to Toilet Most Nights |
| CHAR | 184 | 1 | 0 | (AC1O) Has Irregular Bowel Movement Pattern |
| CHAR | 185 | 1 | 0 | (AC1P) Showers for Bathing |
| CHAR | 186 | 1 | 0 | (AC1Q) Bathing in PM |
| CHAR | 187 | 1 | 0 | (AC1R) None of Above ADL Patterns |
| CHAR | 188 | 1 | 0 | (AC1S) Daily Contact with Relatives/Close Friends |
| CHAR | 189 | 1 | 0 | (AC1T) Usually Attends Church/Temple/Synagogue |
| CHAR | 190 | 1 | 0 | (AC1U) Finds Strength in Faith |
| CHAR | 191 | 1 | 0 | (AC1V) Daily Animal Companion/Presence |
| CHAR | 192 | 1 | 0 | (AC1W) Involved in Group Activities |
| CHAR | 193 | 1 | 0 | (AC1X) None of Above Involvement Patterns |
| CHAR | 194 | 1 | 0 | (AC1Y) Unknown Customary Routine |
| CHAR | 195 | 1 | 0 | (B1) Comatose |
| CHAR | 196 | 1 | 0 | (B2A) Short Term Memory |
| CHAR | 197 | 1 | 0 | (B2B) Long Term Memory |
| CHAR | 198 | 1 | 0 | (B3A) Current Season |
| CHAR | 199 | 1 | 0 | (B3B) Location of Own Room |
| CHAR | 200 | 1 | 0 | (B3C) Staff Names/Faces |
| CHAR | 201 | 1 | 0 | (B3D) That He/She is in Nursing Home |
| CHAR | 202 | 1 | 0 | (B3E) None of Above are Recalled |
| CHAR | 203 | 1 | 0 | (B4) Daily Decision Making Skills |
| CHAR | 204 | 1 | 0 | (B5A) Easily Distracted |
| CHAR | 205 | 1 | 0 | (B5B) Altered Perception |
| CHAR | 206 | 1 | 0 | (B5C) Disorganized Speech |
| CHAR | 207 | 1 | 0 | (B5D) Restlessness |
| CHAR | 208 | 1 | 0 | (B5E) Lethargy |
| CHAR | 209 | 1 | 0 | (B5F) Varied Mental Function |
| CHAR | 210 | 1 | 0 | (B6) Change in Cognitive Status |
| CHAR | 211 | 1 | 0 | (C1) Hearing |
| CHAR | 212 | 1 | 0 | (C2A) Hearing Aid Present and Used |
| CHAR | 213 | 1 | 0 | (C2B) Hearing Aid Present and Not Used Regularly |
| CHAR | 214 | 1 | 0 | (C2C) Other Receptive Communication Techniques Used |
| CHAR | 215 | 1 | 0 | (C2D) None of Above Communication Devices |
| CHAR | 216 | 1 | 0 | (C3A) Speech |
| CHAR | 217 | 1 | 0 | (C3B) Writing Messages to Express Needs |
| CHAR | 218 | 1 | 0 | (C3C) American Sign Language/Braille |
| CHAR | 219 | 1 | 0 | (C3D) Signs/Gestures/Sounds |
| CHAR | 220 | 1 | 0 | (C3E) Communication Board |
| CHAR | 221 | 1 | 0 | (C3F) Other Mode of Expression |
| CHAR | 222 | 1 | 0 | (C3G) None of Above Modes of Expression |
| CHAR | 223 | 1 | 0 | (C4) Making Self Understood |
| CHAR | 224 | 1 | 0 | (C5) Speech Clarity |
| CHAR | 225 | 1 | 0 | (C6) Ability to Understand Others |
| CHAR | 226 | 1 | 0 | (C7) Change in Communication/Hearing |
| CHAR | 227 | 1 | 0 | (D1) Vision |
| CHAR | 228 | 1 | 0 | (D2A) Side Vision Problems |
| CHAR | 229 | 1 | 0 | (D2B) Experiences Seeing Halos/Rings Around Light/Flashes of Light |
| CHAR | 230 | 1 | 0 | (D2C) None of Above Visual Limitations |
| CHAR | 231 | 1 | 0 | (D3) Visual Appliances |
| CHAR | 232 | 1 | 0 | (E1A) Negative Statements |
| CHAR | 233 | 1 | 0 | (E1B) Repetitive Questions |
| CHAR | 234 | 1 | 0 | (E1C) Repetitive Verbalizations |
| CHAR | 235 | 1 | 0 | (E1D) Persistent Anger |
| CHAR | 236 | 1 | 0 | (E1E) Self Depreciation |
| CHAR | 237 | 1 | 0 | (E1F) Unrealistic Fears |
| CHAR | 238 | 1 | 0 | (E1G) States Something Terrible About to Happen |
| CHAR | 239 | 1 | 0 | (E1H) Repetitive Health Complaints |
| CHAR | 240 | 1 | 0 | (E1I) Repetitive Anxious Complaints |
| CHAR | 241 | 1 | 0 | (E1J) Unpleasant Mood |
| CHAR | 242 | 1 | 0 | (E1K) Insomnia |
| CHAR | 243 | 1 | 0 | (E1L) Sad Facial Expressions |
| CHAR | 244 | 1 | 0 | (E1M) Crying |
| CHAR | 245 | 1 | 0 | (E1N) Repetitive Physical Movements |
| CHAR | 246 | 1 | 0 | (E1O) Withdrawal |
| CHAR | 247 | 1 | 0 | (E1P) Reduced Social Interaction |
| CHAR | 248 | 1 | 0 | (E2) Mood Persistance |
| CHAR | 249 | 1 | 0 | (E3) Change in Mood |
| CHAR | 250 | 1 | 0 | (E4AA) Wandering Frequency |
| CHAR | 251 | 1 | 0 | (E4AB) Wandering Alterability |
| CHAR | 252 | 1 | 0 | (E4BA) Verbally Abusive Frequency |
| CHAR | 253 | 1 | 0 | (E4BB) Verbally Abusive Alterability |
| CHAR | 254 | 1 | 0 | (E4CA) Physcially Abusive Frequency |
| CHAR | 255 | 1 | 0 | (E4CB) Physically Abusive Alterability |
| CHAR | 256 | 1 | 0 | (E4DA) Socially Inappropriate Behavior Frequency |
| CHAR | 257 | 1 | 0 | (E4DB) Socially Inappropriate Behavior Alterability |
| CHAR | 258 | 1 | 0 | (E4EA) Resists Care Frequency |
| CHAR | 259 | 1 | 0 | (E4EB) Resists Care Alterability |
| CHAR | 260 | 1 | 0 | (E5) Change in Behavioral Symptoms |
| CHAR | 261 | 1 | 0 | (F1A) At Ease Interacting with Others |
| CHAR | 262 | 1 | 0 | (F1B) At Ease Doing Planned Activities |
| CHAR | 263 | 1 | 0 | (F1C) At Ease Doing Self-Initiated Activities |
| CHAR | 264 | 1 | 0 | (F1D) Establishes Own Goals |
| CHAR | 265 | 1 | 0 | (F1E) Pursues Involvement in Life of Facility |
| CHAR | 266 | 1 | 0 | (F1F) Accepts Invitations Into Most Group Activities |
| CHAR | 267 | 1 | 0 | (F1G) None of Above Sense of Initiative |
| CHAR | 268 | 1 | 0 | (F2A) Covert/Open Conflict with Staff |
| CHAR | 269 | 1 | 0 | (F2B) Unhappy With Roommate |
| CHAR | 270 | 1 | 0 | (F2C) Unhappy With Residents Other Than Roommate |
| CHAR | 271 | 1 | 0 | (F2D) Openly Express Conflict with Family/Friends |
| CHAR | 272 | 1 | 0 | (F2E) Absense of Personal Contact with Family/Friends |
| CHAR | 273 | 1 | 0 | (F2F) Recent Loss of Close Family Member/Friend |
| CHAR | 274 | 1 | 0 | (F2G) Does Not Adjust Well Easily to Change in Routine |
| CHAR | 275 | 1 | 0 | (F2H) None of Above Unsettled Relationships |
| CHAR | 276 | 1 | 0 | (F3A) Strong Identifications with Past Roles |
| CHAR | 277 | 1 | 0 | (F3B) Expresses Sadness/Anger Over Lost Roles |
| CHAR | 278 | 1 | 0 | (F3C) Perceived Daily Routine is Very Different from Prior Pattern in Community |
| CHAR | 279 | 1 | 0 | (F3D) None of Above Past Roles |
| CHAR | 280 | 1 | 0 | (G1AA) Bed Mobility Self Performance |
| CHAR | 281 | 1 | 0 | (G1AB) Bed Mobility Support Provided |
| CHAR | 282 | 1 | 0 | (G1BA) Transfer Self Performance |
| CHAR | 283 | 1 | 0 | (G1BB) Transfer Support Provided |
| CHAR | 284 | 1 | 0 | (G1CA) Walk In Room Self Performance |
| CHAR | 285 | 1 | 0 | (G1CB) Walk in Room Support Provided |
| CHAR | 286 | 1 | 0 | (G1DA) Walk In Corridor Self Performance |
| CHAR | 287 | 1 | 0 | (G1DB) Walk in Corridor Support Provided |
| CHAR | 288 | 1 | 0 | (G1EA) Locomotion on Unit Self Performance |
| CHAR | 289 | 1 | 0 | (G1EB) Locomotion on Unit Support Provided |
| CHAR | 290 | 1 | 0 | (G1FA) Locomotion off Unit Self Performance |
| CHAR | 291 | 1 | 0 | (G1FB) Locomotion off Unit Support Provided |
| CHAR | 292 | 1 | 0 | (G1GA) Dressing Self Performance |
| CHAR | 293 | 1 | 0 | (G1GB) Dressing Support Provided |
| CHAR | 294 | 1 | 0 | (G1HA) Eating Self Performance |
| CHAR | 295 | 1 | 0 | (G1HB) Eating Support Provided |
| CHAR | 296 | 1 | 0 | (G1IA) Toilet Use Self Performance |
| CHAR | 297 | 1 | 0 | (G1IB) Toilet Use Support Provided |
| CHAR | 298 | 1 | 0 | (G1JA) Personal Hygiene Self Performance |
| CHAR | 299 | 1 | 0 | (G1JB) Personal Hygiene Support Provided |
| CHAR | 300 | 1 | 0 | (G2A) Bathing Self Performance |
| CHAR | 301 | 1 | 0 | (G2B) Bathing Support |
| CHAR | 302 | 1 | 0 | (G3A) Balance while Standing |
| CHAR | 303 | 1 | 0 | (G3B) Balance while Sitting |
| CHAR | 304 | 1 | 0 | (G4AA) Neck Range of Motion |
| CHAR | 305 | 1 | 0 | (G4AB) Neck Voluntary Movement |
| CHAR | 306 | 1 | 0 | (G4BA) Arm Range of Motion |
| CHAR | 307 | 1 | 0 | (G4BB) Arm Voluntary Movement |
| CHAR | 308 | 1 | 0 | (G4CA) Hand Range of Motion |
| CHAR | 309 | 1 | 0 | (G4CB) Hand Voluntary Movement |
| CHAR | 310 | 1 | 0 | (G4DA) Leg Range of Motion |
| CHAR | 311 | 1 | 0 | (G4DB) Leg Voluntary Movement |
| CHAR | 312 | 1 | 0 | (G4EA) Foot Range of Motion |
| CHAR | 313 | 1 | 0 | (G4EB) Foot Voluntary Movement |
| CHAR | 314 | 1 | 0 | (G4FA) Other Limitation of Range of Motion |
| CHAR | 315 | 1 | 0 | (G4FB) Other Limitation of Voluntary Movement |
| CHAR | 316 | 1 | 0 | (G5A) Cane/Walker/Crutch |
| CHAR | 317 | 1 | 0 | (G5B) Wheeled Self |
| CHAR | 318 | 1 | 0 | (G5C) Other Person Wheeled |
| CHAR | 319 | 1 | 0 | (G5D) Wheelchair Primary Mode of Locomotion |
| CHAR | 320 | 1 | 0 | (G5E) None of Above Modes of Locomotion |
| CHAR | 321 | 1 | 0 | (G6A) Bedfast All/Most of Time |
| CHAR | 322 | 1 | 0 | (G6B) Bed Rails Used for Bed Mobility/Transfer |
| CHAR | 323 | 1 | 0 | (G6C) Lifted Manually |
| CHAR | 324 | 1 | 0 | (G6D) Lifted Mechanically |
| CHAR | 325 | 1 | 0 | (G6E) Transfer Aid |
| CHAR | 326 | 1 | 0 | (G6F) None of Above Modes of Transfer |
| CHAR | 327 | 1 | 0 | (G7) Task Segmentation |
| CHAR | 328 | 1 | 0 | (G8A) Resident Believes he/she Capable of Increased Independence |
| CHAR | 329 | 1 | 0 | (G8B) Staff Believes Resident is Capable of Increased Independence |
| CHAR | 330 | 1 | 0 | (G8C) Resident Able to Perform Tasks/Activity but is Slow |
| CHAR | 331 | 1 | 0 | (G8D) Difference in ADL Performance Morning to Evening |
| CHAR | 332 | 1 | 0 | (G8E) None of Above Rehabilitation Potential |
| CHAR | 333 | 1 | 0 | (G9) Change in ADL Function |
| CHAR | 334 | 1 | 0 | (H1A) Bowel Continence |
| CHAR | 335 | 1 | 0 | (H1B) Bladder Continence |
| CHAR | 336 | 1 | 0 | (H2A) Bowel Elimination Pattern Regular |
| CHAR | 337 | 1 | 0 | (H2B) Constipation |
| CHAR | 338 | 1 | 0 | (H2C) Diarrhea |
| CHAR | 339 | 1 | 0 | (H2D) Fecal Impaction |
| CHAR | 340 | 1 | 0 | (H2E) None of Above Bowel Elimination Pattern |
| CHAR | 341 | 1 | 0 | (H3A) Any Scheduled Toileting Plan |
| CHAR | 342 | 1 | 0 | (H3B) Bladder Retraining Program |
| CHAR | 343 | 1 | 0 | (H3C) External Condom Catheter |
| CHAR | 344 | 1 | 0 | (H3D) Indwelling Catheter |
| CHAR | 345 | 1 | 0 | (H3E) Intermittent Catheter |
| CHAR | 346 | 1 | 0 | (H3F) Did Not Use Toilet Room/Commode/Urinal |
| CHAR | 347 | 1 | 0 | (H3G) Pads/Briefs Used |
| CHAR | 348 | 1 | 0 | (H3H) Enemas/Irrigation |
| CHAR | 349 | 1 | 0 | (H3I) Ostomy Present |
| CHAR | 350 | 1 | 0 | (H3J) None of Above Appliances and Programs |
| CHAR | 351 | 1 | 0 | (H4) Change in Urinary Continence |
| CHAR | 352 | 1 | 0 | (I1A) Diabetes Mellitus |
| CHAR | 353 | 1 | 0 | (I1AA) Seizure Disorder |
| CHAR | 354 | 1 | 0 | (I1B) Hyperthyroidism |
| CHAR | 355 | 1 | 0 | (I1BB) Transient Ischemic Attack |
| CHAR | 356 | 1 | 0 | (I1C) Hypothyroidism |
| CHAR | 357 | 1 | 0 | (I1CC) Traumatic Brain Injury |
| CHAR | 358 | 1 | 0 | (I1D) Arteriosclerotic Heart Disease |
| CHAR | 359 | 1 | 0 | (I1DD) Anxiety Disorder |
| CHAR | 360 | 1 | 0 | (I1E) Cardiac Dysrhythmias |
| CHAR | 361 | 1 | 0 | (I1EE) Depression |
| CHAR | 362 | 1 | 0 | (I1F) Congestive Heart Failure |
| CHAR | 363 | 1 | 0 | (I1FF) Manic Depression Bipolar Disease |
| CHAR | 364 | 1 | 0 | (I1G) Deep Vein Thrombosis |
| CHAR | 365 | 1 | 0 | (I1GG) Schizophrenia |
| CHAR | 366 | 1 | 0 | (I1H) Hypertension |
| CHAR | 367 | 1 | 0 | (I1HH) Asthma |
| CHAR | 368 | 1 | 0 | (I1I) Hypotension |
| CHAR | 369 | 1 | 0 | (I1II) Emphysema/COPD |
| CHAR | 370 | 1 | 0 | (I1J) Peripheral Vascular Disease |
| CHAR | 371 | 1 | 0 | (I1JJ) Cataracts |
| CHAR | 372 | 1 | 0 | (I1K) Other Cardiovascular Disease |
| CHAR | 373 | 1 | 0 | (I1KK) Diabetic Retinopathy |
| CHAR | 374 | 1 | 0 | (I1L) Arthritis |
| CHAR | 375 | 1 | 0 | (I1LL) Glaucoma |
| CHAR | 376 | 1 | 0 | (I1M) Hip Fracture |
| CHAR | 377 | 1 | 0 | (I1MM) Macular Degeneration |
| CHAR | 378 | 1 | 0 | (I1N) Missing Limb |
| CHAR | 379 | 1 | 0 | (I1NN) Allergies |
| CHAR | 380 | 1 | 0 | (I1O) Osteoporosis |
| CHAR | 381 | 1 | 0 | (I1OO) Anemia |
| CHAR | 382 | 1 | 0 | (I1P) Pathological Bone Fracture |
| CHAR | 383 | 1 | 0 | (I1PP) Cancer |
| CHAR | 384 | 1 | 0 | (I1Q)Alzheimers Disease |
| CHAR | 385 | 1 | 0 | (I1QQ) Renal Failure |
| CHAR | 386 | 1 | 0 | (I1R) Aphasia |
| CHAR | 387 | 1 | 0 | (I1RR) None of Above Diseases |
| CHAR | 388 | 1 | 0 | (I1S) Cerebral Palsy |
| CHAR | 389 | 1 | 0 | (I1T) Cerebrovascular Accident/Stroke |
| CHAR | 390 | 1 | 0 | (I1U) Dementia Other than Alzheimers Disease |
| CHAR | 391 | 1 | 0 | (I1V) Hemiplegia/Hemiparesis |
| CHAR | 392 | 1 | 0 | (I1W) Multiple Sclerosis |
| CHAR | 393 | 1 | 0 | (I1X) Paraplegia |
| CHAR | 394 | 1 | 0 | (I1Y) Parkinsons Disease |
| CHAR | 395 | 1 | 0 | (I1Z) Quadriplegia |
| CHAR | 396 | 1 | 0 | (I2A) Antibiotic Resistant Infection |
| CHAR | 397 | 1 | 0 | (I2B) Clostridium Difficile |
| CHAR | 398 | 1 | 0 | (I2C) Conjunctivitis |
| CHAR | 399 | 1 | 0 | (I2D) HIV Infection |
| CHAR | 400 | 1 | 0 | (I2E) Pneumonia |
| CHAR | 401 | 1 | 0 | (I2F) Respiratory Infection |
| CHAR | 402 | 1 | 0 | (I2G) Septicemia |
| CHAR | 403 | 1 | 0 | (I2H) Sexually Transmitted Diseases |
| CHAR | 404 | 1 | 0 | (I2I) Tuberculosis |
| CHAR | 405 | 1 | 0 | (I2J) Urinary Tract Infection |
| CHAR | 406 | 1 | 0 | (I2K) Viral Hepititis |
| CHAR | 407 | 1 | 0 | (I2L) Wound Infection |
| CHAR | 408 | 1 | 0 | (I2M) None of Above Infections |
| CHAR | 409 | 7 | 0 | (I3A) Other Diagnosis/ICD-9 Codes |
| CHAR | 416 | 7 | 0 | (I3B) Other Diagnosis/ICD-9 Codes |
| CHAR | 423 | 7 | 0 | (I3C) Other Diagnosis/ICD-9 Codes |
| CHAR | 430 | 7 | 0 | (I3D) Other Diagnosis/ICD-9 Codes |
| CHAR | 437 | 7 | 0 | (I3E) Other Diagnosis/ICD-9 Codes |
| CHAR | 444 | 1 | 0 | (J1A) Weight Gain/Loss of 3+ Pounds |
| CHAR | 445 | 1 | 0 | (J1B) Inability to Lie Flat Due to Shortness of Breath |
| CHAR | 446 | 1 | 0 | (J1C) Dehydrated/Output Exceeds Input |
| CHAR | 447 | 1 | 0 | (J1D) Insufficient Fluid |
| CHAR | 448 | 1 | 0 | (J1E) Delusions |
| CHAR | 449 | 1 | 0 | (J1F) Dizziness/Vertigo |
| CHAR | 450 | 1 | 0 | (J1G) Edema |
| CHAR | 451 | 1 | 0 | (J1H) Fever |
| CHAR | 452 | 1 | 0 | (J1I) Hallucinations |
| CHAR | 453 | 1 | 0 | (J1J) Internal Bleeding |
| CHAR | 454 | 1 | 0 | (J1K) Recurrent Lung Aspirations |
| CHAR | 455 | 1 | 0 | (J1L) Shortness of Breath |
| CHAR | 456 | 1 | 0 | (J1M) Syncope/Fainting |
| CHAR | 457 | 1 | 0 | (J1N) Unsteady Gait |
| CHAR | 458 | 1 | 0 | (J1O) Vomiting |
| CHAR | 459 | 1 | 0 | (J1P) None of Above Problem Conditions |
| CHAR | 460 | 1 | 0 | (J2A) Pain Frequency |
| CHAR | 461 | 1 | 0 | (J2B) Pain Intensity |
| CHAR | 462 | 1 | 0 | (J3A) Back Pain |
| CHAR | 463 | 1 | 0 | (J3B) Bone Pain |
| CHAR | 464 | 1 | 0 | (J3C) Chest Pain while Doing Usual Activities |
| CHAR | 465 | 1 | 0 | (J3D) Headache |
| CHAR | 466 | 1 | 0 | (J3E) Hip Pain |
| CHAR | 467 | 1 | 0 | (J3F) Incisional Pain |
| CHAR | 468 | 1 | 0 | (J3G) Joint Pain |
| CHAR | 469 | 1 | 0 | (J3H) Soft Tissue Pain |
| CHAR | 470 | 1 | 0 | (J3I) Stomach Pain |
| CHAR | 471 | 1 | 0 | (J3J) Other Pain Site |
| CHAR | 472 | 1 | 0 | (J4A) Fell in Past 30 Days |
| CHAR | 473 | 1 | 0 | (J4B) Fell in Past 31-180 Days |
| CHAR | 474 | 1 | 0 | (J4C) Hip Fracture in Last 180 Days |
| CHAR | 475 | 1 | 0 | (J4D) Other Fracture in Last 180 Days |
| CHAR | 476 | 1 | 0 | (J4E) None of Above Accidents |
| CHAR | 477 | 1 | 0 | (J5A) Conditions/Disease Make Residents Mood/Behavior Unstable |
| CHAR | 478 | 1 | 0 | (J5B) Resident Experiencing Episode of Recurrent/Chronic Problem |
| CHAR | 479 | 1 | 0 | (J5C) End Stage Disease |
| CHAR | 480 | 1 | 0 | (J5D) None of Above Stability of Conditions |
| CHAR | 481 | 1 | 0 | (K1A) Chewing Problem |
| CHAR | 482 | 1 | 0 | (K1B) Swallowing Problem |
| CHAR | 483 | 1 | 0 | (K1C) Mouth Pain |
| CHAR | 484 | 1 | 0 | (K1D) None of Above Oral Problems |
| CHAR | 485 | 2 | 0 | (K2A) Height |
| CHAR | 487 | 3 | 0 | (K2B) Weight |
| CHAR | 490 | 1 | 0 | (K3A) Weight Loss |
| CHAR | 491 | 1 | 0 | (K3B) Weight Gain |
| CHAR | 492 | 1 | 0 | (K4A) Complains About the Taste of Many Foods |
| CHAR | 493 | 1 | 0 | (K4B) Regular Complaints of Hunger |
| CHAR | 494 | 1 | 0 | (K4C) Leaves 25 percent or more Food Uneaten at Most Meals |
| CHAR | 495 | 1 | 0 | (K4D) None of Above Nutritional Problems |
| CHAR | 496 | 1 | 0 | (K5A) Parenteral IV |
| CHAR | 497 | 1 | 0 | (K5B) Feeding Tube |
| CHAR | 498 | 1 | 0 | (K5C) Mechanically Altered Diet |
| CHAR | 499 | 1 | 0 | (K5D) Syringe Oral Feeding |
| CHAR | 500 | 1 | 0 | (K5E) Therapeutic Diet |
| CHAR | 501 | 1 | 0 | (K5F) Dietary Supplement Between Meals |
| CHAR | 502 | 1 | 0 | (K5G) Plate Guard, Stabilized Built-Up Utensil, Etc |
| CHAR | 503 | 1 | 0 | (K5H) On a Planned Weight Change Program |
| CHAR | 504 | 1 | 0 | (K5I) None of Above Nutritional Approaches |
| CHAR | 505 | 1 | 0 | (K6A) Calories Received in Last 7 Days |
| CHAR | 506 | 1 | 0 | (K6B) Fluid Intake Per Day |
| CHAR | 507 | 1 | 0 | (L1A) Debris Present in Mouth Prior to Going to Bed |
| CHAR | 508 | 1 | 0 | (L1B) Has Dentures/Removable Bridge |
| CHAR | 509 | 1 | 0 | (L1C) Some/All Natural Teeth Lost |
| CHAR | 510 | 1 | 0 | (L1D) Broken/Loose/Carious Teeth |
| CHAR | 511 | 1 | 0 | (L1E) Inflamed/Swollen/Bleeding Gums |
| CHAR | 512 | 1 | 0 | (L1F) Daily Cleaning of Teeth/Dentures |
| CHAR | 513 | 1 | 0 | (L1G) None of Above Oral Status |
| CHAR | 514 | 1 | 0 | (M1A) Stage 1 Ulcers |
| CHAR | 515 | 1 | 0 | (M1B) Stage 2 Ulcers |
| CHAR | 516 | 1 | 0 | (M1C) Stage 3 Ulcers |
| CHAR | 517 | 1 | 0 | (M1D) Stage 4 Ulcers |
| CHAR | 518 | 1 | 0 | (M2A) Pressure Ulcers |
| CHAR | 519 | 1 | 0 | (M2B) Stasis Ulcers |
| CHAR | 520 | 1 | 0 | (M3) History of Resolved Ulcers |
| CHAR | 521 | 1 | 0 | (M4A) Abrasions/Bruises |
| CHAR | 522 | 1 | 0 | (M4B) Burns 2nd/3rd Degree |
| CHAR | 523 | 1 | 0 | (M4C) Open Lesions Other Than Ulcers/Rashes/Cuts |
| CHAR | 524 | 1 | 0 | (M4D) Rashes |
| CHAR | 525 | 1 | 0 | (M4E) Skin Desensitized to Pain/Pressure |
| CHAR | 526 | 1 | 0 | (M4F) Skin Tears/Cuts |
| CHAR | 527 | 1 | 0 | (M4G) Surgical Wounds |
| CHAR | 528 | 1 | 0 | (M4H) None of Above Skin Problems |
| CHAR | 529 | 1 | 0 | (M5A) Pressure Relieving Devices for Chair |
| CHAR | 530 | 1 | 0 | (M5B) Pressure Relieving Devices for Bed |
| CHAR | 531 | 1 | 0 | (M5C) Turning/Repositioning Program |
| CHAR | 532 | 1 | 0 | (M5D) Nutrition/Hydration Intervention to Manage Skin Problems |
| CHAR | 533 | 1 | 0 | (M5E) Ulcer Care |
| CHAR | 534 | 1 | 0 | (M5F) Surgical Wound Care |
| CHAR | 535 | 1 | 0 | (M5G) Application of Dressings |
| CHAR | 536 | 1 | 0 | (M5H) Application of Ointments/Medications |
| CHAR | 537 | 1 | 0 | (M5I) Other Preventative or Protective Skin Care |
| CHAR | 538 | 1 | 0 | (M5J) None of Above Skin Treatments |
| CHAR | 539 | 1 | 0 | (M6A) Resident Has 1 or More Foot Problems |
| CHAR | 540 | 1 | 0 | (M6B) Infection of Foot |
| CHAR | 541 | 1 | 0 | (M6C) Open Lesions on Foot |
| CHAR | 542 | 1 | 0 | (M6D) Nails/Calluses Trimmed on Foot |
| CHAR | 543 | 1 | 0 | (M6E) Received Preventative/Protective Foot Care |
| CHAR | 544 | 1 | 0 | (M6F) Application of Dressings to Foot |
| CHAR | 545 | 1 | 0 | (M6G) None of Above Foot Problems |
| CHAR | 546 | 1 | 0 | (N1A) Morning |
| CHAR | 547 | 1 | 0 | (N1B) Afternoon |
| CHAR | 548 | 1 | 0 | (N1C) Evening |
| CHAR | 549 | 1 | 0 | (N1D) None of Above Time Awake |
| CHAR | 550 | 1 | 0 | (N2) Time Involved in Activities |
| CHAR | 551 | 1 | 0 | (N3A) Prefers Own Room |
| CHAR | 552 | 1 | 0 | (N3B) Prefers Day/Activity Room |
| CHAR | 553 | 1 | 0 | (N3C) Prefers Inside NH/Off Unit |
| CHAR | 554 | 1 | 0 | (N3D) Prefers Outside Activity |
| CHAR | 555 | 1 | 0 | (N3E) None of Above Preferred Activity Settings |
| CHAR | 556 | 1 | 0 | (N4A) Cards/Other Games |
| CHAR | 557 | 1 | 0 | (N4B) Crafts/Arts |
| CHAR | 558 | 1 | 0 | (N4C) Exercises/Sports |
| CHAR | 559 | 1 | 0 | (N4D) Music |
| CHAR | 560 | 1 | 0 | (N4E) Reading/Writing |
| CHAR | 561 | 1 | 0 | (N4F) Spiritual/Religious Activities |
| CHAR | 562 | 1 | 0 | (N4G) Trips/Shopping |
| CHAR | 563 | 1 | 0 | (N4H) Walking/Wheeling Outdoors |
| CHAR | 564 | 1 | 0 | (N4I) Watching TV |
| CHAR | 565 | 1 | 0 | (N4J) Gardening or Plants |
| CHAR | 566 | 1 | 0 | (N4K) Talking or Conversing |
| CHAR | 567 | 1 | 0 | (N4L) Helping Others |
| CHAR | 568 | 1 | 0 | (N4M) None of Above Activity Preferences |
| CHAR | 569 | 1 | 0 | (N5A) Type of Activities Currently Involved In |
| CHAR | 570 | 1 | 0 | (N5B) Extent of Involvement |
| CHAR | 571 | 2 | 0 | (O1) Number of Medications |
| CHAR | 573 | 1 | 0 | (O2) New Medications |
| CHAR | 574 | 1 | 0 | (O3) Injections |
| CHAR | 575 | 1 | 0 | (O4A) Antipsychotic |
| CHAR | 576 | 1 | 0 | (O4B) Antianxiety |
| CHAR | 577 | 1 | 0 | (O4C) Antidepressant |
| CHAR | 578 | 1 | 0 | (O4D) Hypnotic |
| CHAR | 579 | 1 | 0 | (O4E) Diuretic |
| CHAR | 580 | 1 | 0 | (P1AA) Chemotherapy |
| CHAR | 581 | 1 | 0 | (P1AB) Dialysis |
| CHAR | 582 | 1 | 0 | (P1AC) IV Medication |
| CHAR | 583 | 1 | 0 | (P1AD) Intake/Output |
| CHAR | 584 | 1 | 0 | (P1AE) Monitoring Acute Medical Condition |
| CHAR | 585 | 1 | 0 | (P1AF) Ostomy Care |
| CHAR | 586 | 1 | 0 | (P1AG) Oxygen Therapy |
| CHAR | 587 | 1 | 0 | (P1AH) Radiation |
| CHAR | 588 | 1 | 0 | (P1AI) Suctioning |
| CHAR | 589 | 1 | 0 | (P1AJ) Tracheostomy Care |
| CHAR | 590 | 1 | 0 | (P1AK) Transfusions |
| CHAR | 591 | 1 | 0 | (P1AL) Ventilator/Respirator |
| CHAR | 592 | 1 | 0 | (P1AM) Alcohol/Drug Treatment Program |
| CHAR | 593 | 1 | 0 | (P1AN) Alzheimers/Dementia Special Care Unit |
| CHAR | 594 | 1 | 0 | (P1AO) Hospice Care |
| CHAR | 595 | 1 | 0 | (P1AP) Pediatric Unit |
| CHAR | 596 | 1 | 0 | (P1AQ) Respite Care |
| CHAR | 597 | 1 | 0 | (P1AR) Training in Community Skills |
| CHAR | 598 | 1 | 0 | (P1AS) None of Above Special Treatments |
| CHAR | 599 | 1 | 0 | (P1BAA) Speech Therapy Days |
| CHAR | 600 | 4 | 0 | (P1BAB) Speech Therapy Minutes |
| CHAR | 604 | 1 | 0 | (P1BBA) Occupational Therapy Days |
| CHAR | 605 | 4 | 0 | (P1BBB) Occupational Therapy Minutes |
| CHAR | 609 | 1 | 0 | (P1BCA) Physical Therapy Days |
| CHAR | 610 | 4 | 0 | (P1BCB) Physical Therapy Minutes |
| CHAR | 614 | 1 | 0 | (P1BDA) Respiratory Therapy Days |
| CHAR | 615 | 4 | 0 | (P1BDB) Respiratory Therapy Minutes |
| CHAR | 619 | 1 | 0 | (P1BEA) Psychological Therapy Days |
| CHAR | 620 | 4 | 0 | (P1BEB) Psychological Therapy Minutes |
| CHAR | 624 | 1 | 0 | (P2A) Special Behavior Symptom Evaluation Program |
| CHAR | 625 | 1 | 0 | (P2B) Evaluation by Licensed Mental Health Specialist |
| CHAR | 626 | 1 | 0 | (P2C) Group Therapy |
| CHAR | 627 | 1 | 0 | (P2D) Resident-Specific Deliberate Changes in Environment |
| CHAR | 628 | 1 | 0 | (P2E) Reorientation |
| CHAR | 629 | 1 | 0 | (P2F) None of Above Intervention Programs |
| CHAR | 630 | 1 | 0 | (P3A) Passive Range of Motion |
| CHAR | 631 | 1 | 0 | (P3B) Active Range of Motion |
| CHAR | 632 | 1 | 0 | (P3C) Splint or Brace Assistance |
| CHAR | 633 | 1 | 0 | (P3D) Bed Mobility |
| CHAR | 634 | 1 | 0 | (P3E) Transfer |
| CHAR | 635 | 1 | 0 | (P3F) Walking |
| CHAR | 636 | 1 | 0 | (P3G) Dressing/Grooming |
| CHAR | 637 | 1 | 0 | (P3H) Eating/Swallowing |
| CHAR | 638 | 1 | 0 | (P3I) Amputation/Prosthesis Care |
| CHAR | 639 | 1 | 0 | (P3J) Communication |
| CHAR | 640 | 1 | 0 | (P3K) Other Nursing Rehabilitation |
| CHAR | 641 | 1 | 0 | (P4A) Full Bed Rails |
| CHAR | 642 | 1 | 0 | (P4B) Other Side Rails |
| CHAR | 643 | 1 | 0 | (P4C) Trunk Restraint |
| CHAR | 644 | 1 | 0 | (P4D) Limb Restraint |
| CHAR | 645 | 1 | 0 | (P4E) Chair Prevents Rising |
| CHAR | 646 | 2 | 0 | (P5) Hospital Stays |
| CHAR | 648 | 2 | 0 | (P6) Emergency Room Visits |
| CHAR | 650 | 2 | 0 | (P7) Physician Visits |
| CHAR | 652 | 2 | 0 | (P8) Physicians Orders |
| CHAR | 654 | 1 | 0 | (P9) Abnormal Lab Values |
| CHAR | 655 | 1 | 0 | (Q1A) Resident Wishes to Return to Community |
| CHAR | 656 | 1 | 0 | (Q1B) Resident Supported by Someone Positive Toward Discharge |
| CHAR | 657 | 1 | 0 | (Q1C) Discharge within 90 Days |
| CHAR | 658 | 1 | 0 | (Q2) Change in Care Needs |
| CHAR | 659 | 1 | 0 | (R1A) Resident Participated in Assessment |
| CHAR | 660 | 1 | 0 | (R1B) Family Participation in Assessment |
| CHAR | 661 | 1 | 0 | (R1C) Significant Other Participation in Assessment |
| DATE | 662 | 8 | 0 | (R2B) Date Assessment Complete |
| CHAR | 670 | 1 | 0 | (R3A) Resident Discharge Disposition Code |
| CHAR | 671 | 1 | 0 | (R3B) State Code |
| DATE | 672 | 8 | 0 | (R4) Discharge Date |
| CHAR | 680 | 1 | 0 | (T1AA) Recreation Therapy Days |
| CHAR | 681 | 4 | 0 | (T1AB) Recreation Therapy Minutes |
| CHAR | 685 | 1 | 0 | (T1B) Ordered Therapies |
| CHAR | 686 | 2 | 0 | (T1C) Therapy Days |
| CHAR | 688 | 4 | 0 | (T1D) Therapy Minutes |
| CHAR | 692 | 1 | 0 | (T2A) Furthest Distance Walked |
| CHAR | 693 | 1 | 0 | (T2B) Time Walked |
| CHAR | 694 | 1 | 0 | (T2C) Self Performance in Walking |
| CHAR | 695 | 1 | 0 | (T2D) Walking Support Provided |
| CHAR | 696 | 1 | 0 | (T2E) Parallel Bars Used by Resident |
| CHAR | 697 | 5 | 0 | (T3) Medicare Calculated RUG |
| CHAR | 702 | 1 | 0 | (VA01A) Delirium Triggered |
| CHAR | 703 | 1 | 0 | (VA01B) Delirium Care Planning Decision |
| CHAR | 704 | 1 | 0 | (VA02A) Cognitive Loss Triggered |
| CHAR | 705 | 1 | 0 | (VA02B) Cognitive Loss Care Planning Decision |
| CHAR | 706 | 1 | 0 | (VA03A) Visual Function Triggered |
| CHAR | 707 | 1 | 0 | (VA03B) Visual Function Care Planning Decision |
| CHAR | 708 | 1 | 0 | (VA04A) Communication Triggered |
| CHAR | 709 | 1 | 0 | (VA04B) Communication Care Planning Decision |
| CHAR | 710 | 1 | 0 | (VA05A) ADL Functional Potential Triggered |
| CHAR | 711 | 1 | 0 | (VA05B) ADL Functional Potential Care Planning Decision |
| CHAR | 712 | 1 | 0 | (VA06A) Urinary Incontinence Triggered |
| CHAR | 713 | 1 | 0 | (VA06B) Urinary Incontinence Care Planning Decision |
| CHAR | 714 | 1 | 0 | (VA07A) Psychosocial Well-being Triggered |
| CHAR | 715 | 1 | 0 | (VA07B) Psychosocial Well-being Care Planning Decision |
| CHAR | 716 | 1 | 0 | (VA08A) Mood State Triggered |
| CHAR | 717 | 1 | 0 | (VA08B) Mood State Care Planning Decision |
| CHAR | 718 | 1 | 0 | (VA09A) Behavioral Symptoms Triggered |
| CHAR | 719 | 1 | 0 | (VA09B) Behavioral Symptoms Care Planning Decision |
| CHAR | 720 | 1 | 0 | (VA10A) Activities Triggered |
| CHAR | 721 | 1 | 0 | (VA10B) Activities Care Planning Decision |
| CHAR | 722 | 1 | 0 | (VA11A) Falls Triggered |
| CHAR | 723 | 1 | 0 | (VA11B) Falls Care Planning Decision |
| CHAR | 724 | 1 | 0 | (VA12A) Nutritional Status Triggered |
| CHAR | 725 | 1 | 0 | (VA12B) Nutritional Status Care Planning Decision |
| CHAR | 726 | 1 | 0 | (VA13A) Feeding Tubes Triggered |
| CHAR | 727 | 1 | 0 | (VA13B) Feeding Tubes Care Planning Decision |
| CHAR | 728 | 1 | 0 | (VA14A) Dehydration Triggered |
| CHAR | 729 | 1 | 0 | (VA14B) Dehydration Care Planning Decision |
| CHAR | 730 | 1 | 0 | (VA15A) Dental Care Triggered |
| CHAR | 731 | 1 | 0 | (VA15B) Dental Care Care Planning Decision |
| CHAR | 732 | 1 | 0 | (VA16A) Pressure Ulcers Triggered |
| CHAR | 733 | 1 | 0 | (VA16B) Pressure Ulcers Care Planning Decision |
| CHAR | 734 | 1 | 0 | (VA17A) Psychotropic Drug Use Triggered |
| CHAR | 735 | 1 | 0 | (VA17B) Psychotropic Drug Use Care Planning Decision |
| CHAR | 736 | 1 | 0 | (VA18A) Physical Restraints Triggered |
| CHAR | 737 | 1 | 0 | (VA18B) Physical Restraints Care Planning Decision |
| DATE | 738 | 8 | 0 | (VB2) RAP Date |
| DATE | 746 | 8 | 0 | (VB4) Care Planning Decision Date |
| CHAR | 754 | 10 | 0 | (W1) National Provider ID |
| CHAR | 764 | 1 | 0 | (W2A) Influenza vaccine received in facility |
| CHAR | 765 | 1 | 0 | (W2B) Reason influenza vaccine not received |
| CHAR | 766 | 1 | 0 | (W3A) Resident up to date with PPV status |
| CHAR | 767 | 1 | 0 | (W3B) Reason PPV not received |