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Oral/nutritional status: oral problems - chewing problem.
Oral/nutritional status: oral problems - swallowing problem.
Oral/nutritional status: oral problems - mouth pain
Oral/nutritional status: oral problems - none of above.
Oral/nutritional status: height and weight - height (inches).
Oral/nutritional status: height and weight - weight (pounds).
Oral/nutritional status: height and weight - weight gain - 5% or more in 30 days; 10% or more in 180 days.
Oral/nutritional status: nutritional problems - complains about taste of many foods.
Oral/nutritional status: nutritional problems - regular complaints of hunger.
Oral/nutritional status: nutritional problems - leaves 25% or more food uneaten at most meals.
Oral/nutritional status: nutritional problems - none of above.
Oral/nutritional status: nutritional approaches in last 7 days - mechanically altered diet.
Oral/nutritional status: nutritional approaches in last 7 days - syringe (oral feeding).
Oral/nutritional status: nutritional approaches in last 7 days - therpaeutic diet.
Oral/nutritional status: nutritional approaches in last 7 days - dietary supplement between meals.
Oral/nutritional status: nutritional approaches in last 7 days - plate guard, stabilized utensil, etc.
Oral/nutritional status: nutritional approaches in last 7 days - plate guard, stabilized utensil, etc.
Oral/nutritional status: nutritional approaches in last 7 days - on a planned weight change program.
Oral/nutritional status: nutritional approaches in last 7 days - none of above.
Oral/dental status: oral status and disease prevention - debris in mouth before bed.
Oral/dental status: oral status and disease prevention - has dentures or removable bridge.
Oral/dental status: oral status and disease prevention - some/all natural teeth lost.
Oral/dental status: oral status and disease prevention - broken, loose, or carious teeth.
Oral/dental status: oral status and disease prevention - inflamed/bleeding gums, oral abscesses, etc.
Oral/dental status: oral status and disease prevention - daily cleaning teeth/dentures or mouth care.
Oral/dental status: oral status and disease prevention - none of above.
Agency Medicare provider number. The CMS Certification Number (CCN).
Agency Medicaid provider number.
Branch state.
Branch ID number.
Start of care date.
Resumption of care date.
Resumption of care date is not applicable.
Patient's state of residence.
Patient's ZIP code.
Patient has no Medicare number.
Patient's Social Security number is unknown or not available.
Patient has no Medicaid number.
Patient's birthdate. 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.
Resident's gender
Primary referring physician identification
Primary referring physician is unknown or not available.
Discipline of person completing assessment.
The date the assessment was completed.
The reason the assessment is currently being completed.
Medicare home health payment episode for which this assessment will define a case mix group an "early" episode or a "later" episode. Effective August 2008.
Race/ethnicity as identified by patient: American Indian or Alaska native.
Race/ethnicity as identified by patient: Asian.
Race/ethnicity as identified by patient: Black or African-American.
Race/ethnicity as identified by patient: Hispanic or Latino.