B1200: Corrective Lenses | MDS Learning Hub

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B1200: Corrective Lenses

Item Rationale

Health-related Quality of Life

• Decreased ability to see can limit the enjoyment of everyday activities and can contribute to social isolation and mood and behavior disorders.

• Many residents who do not have corrective lenses could benefit from them, and others have corrective lenses that are not sufficient.

• Many persons who benefit from and own visual aids do not have them on arrival at the nursing home.

Planning for Care

• Knowing if corrective lenses were used when determining ability to see alloAws better identification of evaluation and management needs.

• Residents with eyeglasses or other visual appliances should be assisted in accessing them. Use and maintenance should be included in care planning.

• Residents who do not have adequate vision without eyeglasses or other visual appliances should be asked about history of corrective lens use.

• Residents who do not have adequate vision, despite using a visual appliance, might benefit from a re-evaluation of the appliance or assessment for new causes of vision impairment.

Steps for Assessment

1. Prior to beginning the assessment, ask the resident whether they use eyeglasses or other vision aids and whether the eyeglasses or vision aids are at the nursing home. Visual aids do not include surgical lens implants.

2. If the resident cannot respond, check with family and care staff about the resident’s use of vision aids during the 7-day look-back period.

3. Observe whether the resident used eyeglasses or other vision aids during reading vision test (B1000).

4. Check the medical record for evidence that the resident used corrective lenses when ability to see was recorded.

5. Ask staff and significant others whether the resident was using corrective lenses when they observed the resident’s ability to see.

Coding Instructions

• Code 0, no: if the resident did not use eyeglasses or other vision aid during the B1000, Vision assessment.

• Code 1, yes: if corrective lenses or other visual aids were used when visual ability was assessed in completing B1000, Vision.

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Section	Title	Intent
A	Identification Information	Obtain key information to uniquely identify each resident, nursing home, type of record, and reasons for assessment.
B	Hearing, Speech, and Vision	Document the resident's ability to hear, understand, and communicate with others, and whether the resident experiences visual, hearing, or speech limitations.
C	Cognitive Patterns	Determine the resident’s attention, orientation, and ability to register and recall information.
D	Mood	Identify signs and symptoms of mood distress.
E	Behavior	Identify behavioral symptoms that may cause distress or are potentially harmful to the resident, or may be distressing or disruptive to facility residents, staff, or the environment.
F	Preferences for Customary Routine and Activities	Obtain information regarding the resident’s preferences for his or her daily routine and activities.
GG	Functional Abilities and Goals	Assess the need for assistance with self-care and mobility activities.
GG	Functional Abilities and Goals - Discharge (End of SNF PPS Stay)	Assess the resident’s functional abilities at the time of discharge, focusing on self-care and mobility activities. This documents the resident's final performance after their skilled nursing facility stay.
H	Bladder and Bowel	Gather information on the use of bowel and bladder appliances, the use of and response to urinary toileting programs, and bowel training programs.
I	Active Diagnoses	Code diseases related to the resident's current functional, cognitive, mood, or behavior status, medical treatments, nursing monitoring, or risk of death.
J	Health Conditions	Document health conditions that impact the resident's functional status and quality of life.
K	Swallowing/Nutritional Status	Assess conditions that could affect the resident’s ability to maintain adequate nutrition and hydration.
L	Oral/Dental Status	Record any oral or dental problems present.
M	Skin Conditions	Document the presence, appearance, and change of pressure ulcers, as well as other skin conditions or lesions.
N	Medications	Record the number of days the resident received injections, insulin, and select medications.
O	Special Treatments, Procedures, and Programs	Identify any special treatments, procedures, and programs that the resident received during specified time periods.
P	Restraints and Alarms	Record the frequency that the resident was restrained by any of the listed devices during the day or night; document whether any listed alarms were used.
Q	Participation in Assessment and Goal Setting	Record the participation of the resident, family, or significant others in the assessment and understanding of the resident's goals.
V	Care Area Assessment (CAA) Summary	Document triggered care areas, and whether or not a care plan was developed for each triggered area; record the location of care area assessment documentation.
X	Correction Request	Request to modify or inactivate a record already present in the QIES ASAP database.
Z	Assessment Administration	Provide billing information and signatures of assessors completing the assessment.

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MDS Item	Short Description
A0050	Type of Record
A0100A	Facility National Provider Identifier (NPI)
A0100B	Facility CMS Certification Number (CCN)
A0100C	State provider number
A0200	Type of provider
A0310A	Type of assessment: OBRA
A0310B	Type of assessment: PPS
A0310E	First assessment since most recent entry
A0310F	Entry/discharge reporting
A0310G	Planned/unplanned discharge
A0310G1	Interrupted Stay
A0310H	SNF Part A PPS Discharge
A0410	Unit Certification or Licensure Designation
A0500A	Resident first name
A0500B	Resident middle initial
A0500C	Resident last name
A0500D	Resident name suffix
A0600A	Social Security Number
A0600B	Medicare number
A0700	Medicaid number
A0800	Gender
A0900	Birthdate
A1005A	Ethnicity: No, not of Hispanic, Latino/a, or Spanish origin
A1005B	Ethnicity: Yes, Mexican, Mexican American, Chicano/a
A1005C	Ethnicity: Yes, Puerto Rican
A1005D	Ethnicity: Yes, Cuban
A1005E	Ethnicity: Yes, another Hispanic, Latino, or Spanish origin
A1005X	Ethnicity: Resident unable to respond
A1005Y	Ethnicity: Resident declines to respond
A1010A	Race: White
A1010B	Race: Black or African American
A1010C	Race: American Indian or Alaska Native
A1010D	Race: Asian Indian
A1010E	Race: Chinese
A1010F	Race: Filipino
A1010G	Race: Japanese
A1010H	Race: Korean
A1010I	Race: Vietnamese
A1010J	Race: Other Asian
A1010K	Race: Native Hawaiian
A1010L	Race: Guamanian or Chamorro
A1010M	Race: Samoan
A1010N	Race: Other Pacific Islander
A1010X	Resident unable to respond
A1010Y	Resident declines to respond
A1010Z	None of the above
A1110A	Language: What is your preferred language?
A1110B	Language: Need or want an interpreter?
A1200	Marital status
A1250A	Transportation (from NACHC©) : Yes, kept from med appts.
A1250B	Transportation (from NACHC©): Yes, kept from non-med appts.
A1250C	Transportation (from NACHC©): No
A1250X	Transportation (from NACHC©): Resident unable to respond
A1250Y	Transportation (from NACHC©): Resident declines to respond
A1300A	Medical record number
A1300B	Room number
A1300C	Name by which resident prefers to be addressed
A1300D	Lifetime occupation(s)
A1500	Resident evaluated by PASRR
A1510A	Level II PASRR conditions: Serious Mental Illness
A1510B	Level II PASRR conditions: Intellectual Disability
A1510C	Level II PASRR conditions: Other related conditions
A1550A	ID/DD status: Down syndrome
A1550B	ID/DD status: Autism
A1550C	ID/DD status: Epilepsy
A1550D	ID/DD status: other organic ID/DD condition
A1550E	ID/DD status: ID/DD with no organic condition
A1550Z	ID/DD status: none of the above
A1600	Entry date (date of admission/reentry in facility)
A1700	Type of entry
A1805	Entered From
A1900	Admission date
A2000	Discharge date
A2105	Discharge Status
A2121	Provision of Current Reconciled Medication List (To Provider)
A2122A	Route of Current Reconciled Medication List Transmission: EHR to provider
A2122B	Route of Current Reconciled Medication List Transmission: HIEO to provider
A2122C	Route of Current Reconciled Medication List Transmission: Verbal to provider
A2122D	Route of Current Reconciled Medication List Transmission: Paper-based to provider
A2122E	Route of Current Reconciled Medication List Transmission: Other Methods to provider
A2123	Provision of Current Reconciled Medication List (To Resident)
A2124A	Route of Current Reconciled Medication List Transmission: EHR to res/fam/caregiver
A2124B	Route of Current Reconciled Medication List Transmission: HIEO to res/fam/caregiver
A2124C	Route of Current Reconciled Medication List Transmission: Verbal to res/fam/caregiver
A2124D	Route of Current Reconciled Medication List Transmission: Paper-based to res/fam/caregiver
A2124E	Route of Current Reconciled Medication List Transmission: Other Methods to res/fam/caregiver
A2200	Previous assessment reference date for significant correction
A2300	Assessment reference date
A2400A	Has resident had Medicare-covered stay
A2400B	Start date of most recent Medicare stay
A2400C	End date of most recent Medicare stay

MDS Item	Short Description
B0100	Comatose
B0200	Hearing
B0300	Hearing aid
B0600	Speech clarity
B0700	Makes self understood
B0800	Ability to understand others
B1000	Vision
B1200	Corrective lenses
B1300	Health Literacy

MDS Item	Short Description
C0100	BIMS: should resident interview be conducted
C0200	BIMS res interview: repetition of three words
C0300A	BIMS res interview: able to report correct year
C0300B	BIMS res interview: able to report correct month
C0300C	BIMS res interview: able report correct day of week
C0400A	BIMS res interview: able to recall "sock"
C0400B	BIMS res interview: able to recall "blue"
C0400C	BIMS res interview: able to recall "bed"
C0500	BIMS res interview: summary score
C0600	Staff assessment mental status: conduct assessment
C0700	Staff assessment mental status: short-term memory OK
C0800	Staff assessment mental status: long-term memory OK
C0900A	Staff assessment mental status: recall current season
C0900B	Staff assessment mental status: recall location of room
C0900C	Staff assessment mental status: recall staff names/faces
C0900D	Staff assessment mental status: recall in nursing home
C0900Z	Staff assessment mental status: none of above recalled
C1000	Cognitive skills for daily decision making
C1310A	Acute Onset Mental Status Change
C1310B	Signs of delirium: inattention
C1310C	Signs of delirium: disorganized thinking
C1310D	Signs of delirium: altered level of consciousness

MDS Item	Short Description
D0100	PHQ: should resident mood interview be conducted
D0150A1	PHQ res: little interest or pleasure - presence
D0150A2	PHQ res: little interest or pleasure - frequency
D0150B1	PHQ res: feeling down, depressed - presence
D0150B2	PHQ res: feeling down, depressed - frequency
D0150C1	PHQ res: trouble with sleep - presence
D0150C2	PHQ res: trouble with sleep - frequency
D0150D1	PHQ res: feeling tired/little energy - presence
D0150D2	PHQ res: feeling tired/little energy - frequency
D0150E1	PHQ res: poor appetite or overeating - presence
D0150E2	PHQ res: poor appetite or overeating - frequency
D0150F1	PHQ res: feeling bad about self - presence
D0150F2	PHQ res: feeling bad about self - frequency
D0150G1	PHQ res: trouble concentrating - presence
D0150G2	PHQ res: trouble concentrating - frequency
D0150H1	PHQ res: slow, fidgety, restless - presence
D0150H2	PHQ res: slow, fidgety, restless - frequency
D0150I1	PHQ res: thoughts better off dead - presence
D0150I2	PHQ res: thoughts better off dead - frequency
D0160	PHQ res: total mood severity score
D0500A1	PHQ staff: little interest or pleasure - presence
D0500A2	PHQ staff: little interest or pleasure - frequency
D0500B1	PHQ staff: feeling down, depressed - presence
D0500B2	PHQ staff: feeling down, depressed - frequency
D0500C1	PHQ staff: trouble with sleep - presence
D0500C2	PHQ staff: trouble with sleep - frequency
D0500D1	PHQ staff: feeling tired/little energy - presence
D0500D2	PHQ staff: feeling tired/little energy - frequency
D0500E1	PHQ staff: poor appetite or overeating - presence
D0500E2	PHQ staff: poor appetite or overeating - frequency
D0500F1	PHQ staff: feeling bad about self - presence
D0500F2	PHQ staff: feeling bad about self - frequency
D0500G1	PHQ staff: trouble concentrating - presence
D0500G2	PHQ staff: trouble concentrating -
D0500H1	PHQ staff: slow, fidgety, restless - presence
D0500H2	PHQ staff: slow, fidgety, restless - frequency
D0500I1	PHQ staff: thoughts better off dead - presence
D0500I2	PHQ staff: thoughts better off dead - frequency
D0500J1	PHQ staff: short-tempered - presence
D0500J2	PHQ staff: short-tempered - frequency
D0600	PHQ staff: total mood severity score
D0700	Social Isolation

MDS Item	Short Description
E0100A	Psychosis: hallucinations
E0100B	Psychosis: delusions
E0100Z	Psychosis: none of the above
E0200A	Physical behavioral symptoms directed toward others
E0200B	Verbal behavioral symptoms directed toward others
E0200C	Other behavioral symptoms not directed toward others
E0300	Overall presence of behavioral symptoms
E0500A	Behavioral symptoms put res at risk for illness/injury
E0500B	Behavioral symptoms interfere with resident care
E0500C	Behavioral symptoms interfere with social activities
E0600A	Behavioral symptoms put others at risk for injury
E0600B	Behavioral symptoms intrude on privacy of others
E0600C	Behavioral symptoms disrupt care or living environment
E0800	Rejection of care: presence and frequency
E0900	Wandering: presence and frequency
E1000A	Wandering: risk of getting to dangerous place
E1000B	Wandering: intrude on privacy of others
E1100	Change in behavior or other symptoms

MDS Item	Short Description
F0300	Conduct res interview for daily/activity preferences
F0400A	Res interview: choose clothes to wear
F0400B	Res interview: take care of personal belongings
F0400C	Res interview: choose tub, bath, shower, sponge
F0400D	Res interview: have snacks between meals
F0400E	Res interview: choose own bedtime
F0400F	Res interview: discuss care with family/friend
F0400G	Res interview: use phone in private
F0400H	Res interview: lock things to keep them safe
F0500A	Res interview: have books, newspaper, mags to read
F0500B	Res interview: listen to music
F0500C	Res interview: be around animals/pets
F0500D	Res interview: keep up with news
F0500E	Res interview: do things with groups of people
F0500F	Res interview: do favorite activities
F0500G	Res interview: go outside when good weather
F0500H	Res interview: participate in religious practices
F0600	Primary respondent: daily/activities prefs
F0700	Conduct staff assessment for daily/activity prefs
F0800A	Staff assessment: choosing clothes to wear
F0800B	Staff assessment: caring for personal belongings
F0800C	Staff assessment: receiving tub bath
F0800D	Staff assessment: receiving shower
F0800E	Staff assessment: receiving bed bath
F0800F	Staff assessment: receiving sponge bath
F0800G	Staff assessment: snacks between meals
F0800H	Staff assessment: staying up past 8PM
F0800I	Staff assessment: discuss care with family/other
F0800J	Staff assessment: use phone in private
F0800K	Staff assessment: place to lock personal things
F0800L	Staff assessment: reading books, newspapers, mags
F0800M	Staff assessment: listening to music
F0800N	Staff assessment: being around animals/pets
F0800O	Staff assessment: keeping up with news
F0800P	Staff assessment: doing things with groups
F0800Q	Staff assessment: participating in favorite activities
F0800R	Staff assessment: spend time away from nursing home
F0800S	Staff assessment: spend time outdoors
F0800T	Staff assessment: participating in religious activities
F0800Z	Staff assessment: none of above activities

MDS Item	Short Description
GG0100A	Self-Care: Prior Function
GG0100B	Indoor Mobility (Ambulation): Prior Function
GG0100C	Stairs: Prior Function
GG0100D	Functional Cognition: Prior Function
GG0110A	Manual wheelchair
GG0110B	Motorized wheelchair and/or scooter
GG0110C	Mechanical lift
GG0110D	Walker
GG0110E	Orthotics/Prosthetics
GG0110Z	None of the above
GG0115A	ROM limitation: upper extremity
GG0115B	ROM limitation: lower extremity
GG0120A	Mobility devices: cane/crutch
GG0120B	Mobility devices: walker
GG0120C	Mobility devices: wheelchair (manual or electric)
GG0120D	Mobility devices: limb prosthesis
GG0120Z	Mobility devices: none of the above
GG0130A1	Eating (Admission Performance)
GG0130A3	Eating (Discharge Performance)
GG0130A5	Eating (OBRA/Interim Performance)
GG0130B1	Oral Hygiene (Admission Performance)
GG0130B3	Oral Hygiene (Discharge Performance)
GG0130B5	Oral Hygiene (OBRA/Interim Performance)
GG0130C1	Toileting Hygiene (Admission Performance)
GG0130C3	Toileting Hygiene (Discharge Performance)
GG0130C5	Toileting Hygiene (OBRA/Interim Performance)
GG0130E1	Shower/bathe self (Admission Performance)
GG0130E3	Shower/bathe self (Discharge Performance)
GG0130E5	Shower/bathe self (OBRA/Interim Performance)
GG0130F1	Upper body dressing (Admission Performance)
GG0130F3	Upper body dressing (Discharge Performance)
GG0130F5	Upper body dressing (OBRA/Interim Performance)
GG0130G1	Lower body dressing (Admission Performance)
GG0130G3	Lower body dressing (Discharge Performance)
GG0130G5	Lower body dressing (OBRA/Interim Performance)
GG0130H1	Putting on/taking off footwear (Admission Performance)
GG0130H3	Putting on/taking off footwear (Discharge Performance)
GG0130H5	Putting on/taking off footwear(OBRA/Interim Performance)
GG0130I1	Personal Hygiene (Admission Performance)
GG0130I3	Personal Hygiene (Discharge Performance)
GG0130I5	Personal Hygiene (OBRA/Interim Performance)
GG0170A1	Roll left and right (Admission Performance)
GG0170A3	Roll left and right (Discharge Performance)
GG0170A5	Roll left and right (OBRA/Interim Performance)
GG0170B1	Sit to lying (Admission Performance)
GG0170B3	Sit to lying (Discharge Performance)
GG0170B5	Sit to lying (OBRA/Interim Performance)
GG0170C1	Lying to sitting on bed side (Admission Performance)
GG0170C3	Lying to sitting on bed side (Discharge Performance)
GG0170C5	Lying to sitting on bed side (OBRA/Interim Performance)
GG0170D1	Sit to stand (Admission Performance)
GG0170D3	Sit to stand (Discharge Performance)
GG0170D5	Sit to stand (OBRA/Interim Performance)
GG0170E1	Chair/bed-to-chair transfer (Admission Performance)
GG0170E3	Chair/bed-to-chair transfer (Discharge Performance)
GG0170E5	Chair/bed-to-chair transfer (OBRA/Interim Performance)
GG0170F1	Toilet transfer (Admission Performance)
GG0170F3	Toilet transfer (Discharge Performance)
GG0170F5	Toilet transfer (OBRA/Interim Performance)
GG0170FF1	Tub/Shower Transfer (Admission Performance)
GG0170FF3	Tub/Shower Transfer (Discharge Performance)
GG0170FF5	Tub/Shower Transfer (OBRA/Interim Performance)
GG0170G1	Car Transfer (Admission Performance)
GG0170G3	Car Transfer (Discharge Performance)
GG0170I1	Walk 10 feet (Admission Performance)
GG0170I3	Walk 10 feet (Discharge Performance)
GG0170I5	Walk 10 feet (OBRA/Interim Performance)
GG0170J1	Walk 50 feet with two turns (Admission Performance)
GG0170J3	Walk 50 feet with two turns (Discharge Performance)
GG0170J5	Walk 50 feet with two turns (OBRA/Interim Performance)
GG0170K1	Walk 150 feet (Admission Performance)
GG0170K3	Walk 150 feet (Discharge Performance)
GG0170K5	Walk 150 feet (OBRA/Interim Performance)
GG0170L1	Walking 10 feet on uneven surfaces (Admission Performance)
GG0170L3	Walking 10 feet on uneven surfaces (Discharge Performance)
GG0170M1	1 step (curb) (Admission Performance)
GG0170M3	1 step (curb) (Discharge Performance)
GG0170N1	4 steps (Admission Performance)
GG0170N3	4 steps (Discharge Performance)
GG0170O1	12 steps (Admission Performance)
GG0170O3	12 steps (Discharge Performance)
GG0170P1	Picking up object (Admission Performance)
GG0170P3	Picking up object (Discharge Performance)
GG0170Q1	Use of wheelchair/scooter (Admission Performance)
GG0170Q3	Use of wheelchair/scooter (Discharge Performance)
GG0170Q5	Use of wheelchair/scooter (OBRA/Interim Performance)
GG0170R1	Wheel 50 feet with two turns (Admission Performance)
GG0170R3	Wheel 50 feet with two turns (Discharge Performance)
GG0170R5	Wheel 50 feet with two turns (OBRA/Interim Performance)
GG0170RR1	Type wheelchair/scooter used (Admission Performance)
GG0170RR3	Type wheelchair/scooter used (Discharge Performance)
GG0170RR5	Type wheelchair/scooter used (OBRA/Interim Performance)
GG0170S1	Wheel 150 feet (Admission Performance)
GG0170S3	Wheel 150 feet (Discharge Performance)
GG0170S5	Wheel 150 feet (OBRA/Interim Performance)
GG0170SS1	Type wheelchair/scooter used (Admission Performance)
GG0170SS3	Type wheelchair/scooter used (Discharge Performance)
GG0170SS5	Type wheelchair/scooter used (OBRA/Interim Performance)

MDS Item	Short Description
H0100A	Appliances: indwelling catheter
H0100B	Appliances: external catheter
H0100C	Appliances: ostomy
H0100D	Appliances: intermittent catheterization
H0100Z	Appliances: none of the above
H0200A	Urinary toileting program: has been attempted
H0200B	Urinary toileting program: response
H0200C	Urinary toileting program: current program/trial
H0300	Urinary continence
H0400	Bowel continence
H0500	Bowel toileting program being used
H0600	Constipation

MDS Item	Short Description
I0020	Indicate the resident’s primary medical condition category
I0020B	ICD Code 1 - 13
I0100	Cancer (with or without metastasis)
I0200	Anemia
I0300	Atrial fibrillation and other dysrhythmias
I0400	Coronary artery disease (CAD)
I0500	Deep venous thrombosis (DVT), PE, or PTE
I0600	Heart failure
I0700	Hypertension
I0800	Orthostatic hypotension
I0900	Peripheral vascular disease (PVD) or PAD
I1100	Cirrhosis
I1200	Gastroesophageal reflux disease (GERD) or ulcer
I1300	Ulcerative colitis, Crohn's, inflammatory bowel disease
I1400	Benign prostatic hyperplasia (BPH)
I1500	Renal insufficiency, renal failure, ESRD
I1550	Neurogenic bladder
I1650	Obstructive uropathy
I1700	Multidrug-resistant organism (MDRO)
I2000	Pneumonia
I2100	Septicemia
I2200	Tuberculosis
I2300	Urinary tract infection (UTI) (LAST 30 DAYS)
I2400	Viral hepatitis (includes type A, B, C, D, and E)
I2500	Wound infection (other than foot)
I2900	Diabetes mellitus (DM)
I3100	Hyponatremia
I3200	Hyperkalemia
I3300	Hyperlipidemia (e.g., hypercholesterolemia)
I3400	Thyroid disorder
I3700	Arthritis
I3800	Osteoporosis
I3900	Hip fracture
I4000	Other fracture
I4200	Alzheimer's disease
I4300	Aphasia
I4400	Cerebral palsy
I4500	Cerebrovascular accident (CVA), TIA, or stroke
I4800	Non-Alzheimer's Dementia
I4900	Hemiplegia or hemiparesis
I5000	Paraplegia
I5100	Quadriplegia
I5200	Multiple sclerosis
I5250	Huntington's disease
I5300	Parkinson's disease
I5350	Tourette's syndrome
I5400	Seizure disorder or epilepsy
I5500	Traumatic brain injury (TBI)
I5600	Malnutrition (protein, calorie), risk of malnutrition
I5700	Anxiety disorder
I5800	Depression (other than bipolar)
I5900	Bipolar Disorder
I5950	Psychotic disorder (other than schizophrenia)
I6000	Schizophrenia
I6100	Post-traumatic stress disorder (PTSD)
I6200	Asthma, COPD, or chronic lung disease
I6300	Respiratory failure
I6500	Cataracts, glaucoma, or macular degeneration
I7900	None of above active diagnoses within last 7 days
I8000A	Additional active ICD diagnosis 1
I8000B	Additional active ICD diagnosis 2
I8000C	Additional active ICD diagnosis 3
I8000D	Additional active ICD diagnosis 4
I8000E	Additional active ICD diagnosis 5
I8000F	Additional active ICD diagnosis 6
I8000G	Additional active ICD diagnosis 7
I8000I	Additional active ICD diagnosis 9
I8000J	Additional active ICD diagnosis 10

J0100A	Pain: received scheduled pain med regimen
J0100B	Pain: received PRN pain medications
J0100C	Pain: received non-medication intervention
J0200	Should pain assessment interview be conducted
J0300	Res pain interview: presence
J0410	Res pain interview: frequency
J0510	Pain Effect on Sleep
J0520	Pain Interference with Therapy Activities
J0530	Pain Interference with Day-to-Day Activities
J0600A	Res pain interview: intensity rating scale
J0600B	Res pain interview: verbal descriptor scale
J0700	Should staff assessment for pain be conducted
J0800A	Staff pain assessment: non-verbal sounds
J0800B	Staff pain assessment: vocal complaints of pain
J0800C	Staff pain assessment: facial expressions
J0800D	Staff pain assessment: protective movements/postures
J0800Z	Staff pain assessment: none of these signs observed
J0850	Staff pain assessment: frequency of pain
J1100A	Short breath/trouble breathing: with exertion
J1100B	Short breath/trouble breathing: sitting at rest
J1100C	Short breath/trouble breathing: lying flat
J1100Z	Short breath/trouble breathing: none of above
J1300	Current tobacco use
J1400	Prognosis: life expectancy of less than 6 months
J1550A	Problem conditions: fever
J1550B	Problem conditions: vomiting
J1550C	Problem conditions: dehydrated
J1550D	Problem conditions: internal bleeding
J1550Z	Problem conditions: none of the above
J1700A	Fall history: fall during month before admission
J1700B	Fall history: fall 2-6 months before admission
J1700C	Fall history: fracture from fall 6 month pre admit
J1800	Falls since admit/prior assessment: any falls
J1900A	Falls since admit/prior assessment: no injury
J1900B	Falls since admit/prior assessment: injury (not major)
J1900C	Falls since admit/prior assessment: major injury
J2000	Prior Surgery
J2100	Recent Surgery Requiring Active SNF Care
J2300	Knee Replacement - partial or total
J2310	Hip Replacement - partial or total
J2320	Ankle Replacement - partial or total
J2330	Shoulder Replacement - partial or total
J2400	Spinal surgery - spinal cord or major spinal nerves
J2410	Spinal surgery - fusion of spinal bones
J2420	Spinal surgery - lamina, discs, or facets
J2499	Spinal surgery - other
J2500	Ortho surgery - repair fractures of shoulder or arm
J2510	Ortho surgery - repair fractures of pelvis, hip, leg, knee, or ankle
J2520	Ortho surgery - repair but not replace joints
J2530	Ortho surgery - repair other bones
J2599	Ortho surgery - other
J2600	Neuro surgery - brain, surrounding tissue or blood vessels
J2610	Neuro surgery - peripheral and autonomic nervous system - open and percutaneous
J2620	Neuro surgery - insertion or removal of spinal and brain neurostimulators, electrodes, catheters, and CSF drainage devices
J2699	Neuro surgery - Other
J2700	Cardiopulmonary surgery - heart or major blood vessels - open and percutaneous procedures
J2710	Cardiopulmonary surgery - respiratory system, including lungs, bronchi, trachea, larynx, or vocal cords – open and endoscopic
J2799	Cardiopulmonary surgery - Other
J2800	Genitourinary surgery - genital systems
J2810	Genitourinary surgery - the kidneys, ureter, adrenals, and bladder—open, laparoscopic
J2899	Other major genitourinary surgery
J2900	Major surgery - tendons, ligament, or muscles
J2910	Major surgery - the GI tract and abdominal contents from the esophagus to the anus, the biliary tree, gall bladder, liver, pancreas, spleen—open or laparoscopic
J2920	Major surgery - endocrine organs (such as thyroid, parathyroid), neck, lymph nodes, and thymus—open
J2930	Major surgery - the breast
J2940	Major surgery - repair of deep ulcers, internal brachytherapy, bone marrow, or stem cell harvest or transplant
J5000	Major surgery - Other surgery not listed above

K0100A	Swallow disorder: loss liquids/solids from mouth
K0100B	Swallow disorder: holds food in mouth/cheeks
K0100C	Swallow disorder: cough/choke with meals/meds
K0100D	Swallow disorder: difficulty or pain swallowing
K0100Z	Swallow disorder: none of the above
K0200A	Height (in inches)
K0200B	Weight (in pounds)
K0300	Weight loss
K0310	Weight gain
K0520A1	Nutritional approaches: Parenteral/IV Feeding - Adm
K0520A2	Nutritional approaches: Parenteral/IV Feeding - Not a Res
K0520A3	Nutritional approaches: Parenteral/IV Feeding - While a Res
K0520A4	Nutritional approaches: Parenteral/IV Feeding - At Discharge
K0520B1	Nutritional approaches: Feeding Tube - Adm
K0520B2	Nutritional approaches: Feeding Tube - Not a Res
K0520B3	Nutritional approaches: Feeding Tube - While a Res
K0520B4	Nutritional approaches: Feeding Tube - At Discharge
K0520C1	Nutritional approaches: Mechanically Altered Diet - Adm
K0520C3	Nutritional approaches: Mechanically Altered Diet - While a Res
K0520C4	Nutritional approaches: Mechanically Altered Diet - At Discharge
K0520D1	Nutritional approaches: Therapeutic Diet - Adm
K0520D3	Nutritional approaches: Therapeutic Diet - While a Res
K0520D4	Nutritional approaches: Therapeutic Diet - At Discharge
K0520Z1	Nutritional approaches: None of the above - Adm
K0520Z2	Nutritional approaches: None of the above - Not a Res
K0520Z3	Nutritional approaches: None of the above - While a Res
K0520Z4	Nutritional approaches: None of the above - At Discharge
K0710A2	Prop calories parenteral/tube feed: while a resident
K0710A3	Prop calories parenteral/tube feed: 7 days
K0710B2	Avg fluid intake per day IV/ tube: while a resident
K0710B3	Avg fluid intake per day IV/tube: 7 days

L0200A	Dental: broken or loosely fitting denture
L0200B	Dental: no natural teeth or tooth fragment(s)
L0200C	Dental: abnormal mouth tissue
L0200D	Dental: cavity or broken natural teeth
L0200E	Dental: inflamed/bleeding gums or loose teeth
L0200F	Dental: pain, discomfort, difficulty chewing
L0200G	Dental: unable to examine
L0200Z	Dental: none of the above

M0100A	Risk determination: has ulcer, scar, or dressing
M0100B	Risk determination: formal assessment
M0100C	Risk determination: clinical assessment
M0100Z	Risk determination: none of the above
M0150	Is resident at risk of developing pressure ulcer
M0210	Resident has Stage 1 or higher pressure ulcers
M0300A1	Stage 1 pressure ulcers: number present
M0300B1	Stage 2 pressure ulcers: number present
M0300B2	Stage 2 pressure ulcers: number at admit/reentry
M0300C1	Stage 3 pressure ulcers: number present
M0300C2	Stage 3 pressure ulcers: number at admit/reentry
M0300D1	Stage 4 pressure ulcers: number present
M0300D2	Stage 4 pressure ulcers: number at admit/reentry
M0300E1	Unstaged due to dressing: number present
M0300E2	Unstaged due to dressing: number at admit/reentry
M0300F1	Unstaged slough/eschar: number present
M0300F2	Unstaged slough/eschar: number at admit/reentry
M0300G1	Unstageable - deep tissue: number present
M0300G2	Unstageable - deep tissue: number at admit/reentry
M1030	Number of venous and arterial ulcers
M1040A	Other skin problems: infection of the foot
M1040B	Other skin problems: diabetic foot ulcer(s)
M1040C	Other skin problems: other open lesion(s) on the foot
M1040D	Other skin problems: lesions not ulcers, rashes, cuts
M1040E	Other skin problems: surgical wound(s)
M1040F	Other skin problems: burns (second or third degree)
M1040G	Skin tear(s)
M1040H	Moisture Associated Skin Damage (MASD)
M1040Z	Other skin problems: none of the above
M1200A	Skin/ulcer treatments: pressure reducing device for chair
M1200B	Skin/ulcer treatments: pressure reducing device for bed
M1200C	Skin/ulcer treatments: turning/repositioning
M1200D	Skin/ulcer treatments: nutrition/hydration
M1200E	Skin/ulcer treatments: pressure ulcer/injury care
M1200F	Skin/ulcer treatments: surgical wound care
M1200G	Skin/ulcer treatments: application of dressings
M1200H	Skin/ulcer treatments: apply ointments/medications
M1200I	Skin/ulcer treatments: apply dressings to feet
M1200Z	Skin/ulcer treatments: none of the above

N0300	Number of days injectable medications received
N0350A	Insulin: insulin injections
N0350B	Insulin: orders for insulin
N0415A1	High-Risk Drug Classes: Antipsychotic: Has received
N0415A2	High-Risk Drug Classes: Antipsychotic: Indication noted
N0415B1	High-Risk Drug Classes: Antianxiety: Has received
N0415B2	High-Risk Drug Classes: Antianxiety: Indication noted
N0415C1	High-Risk Drug Classes: Antidepressant: Has received
N0415C2	High-Risk Drug Classes: Antidepressant: Indication noted
N0415D1	High-Risk Drug Classes: Hypnotic: Has received
N0415D2	High-Risk Drug Classes: Hypnotic: Indication noted
N0415E1	High-Risk Drug Classes: Anticoagulant: Has received
N0415E2	High-Risk Drug Classes: Anticoagulant: Indication noted
N0415F1	High-Risk Drug Classes: Antibiotic: Has received
N0415F2	High-Risk Drug Classes: Antibiotic: Indication noted
N0415G1	High-Risk Drug Classes: Diuretic: Has received
N0415G2	High-Risk Drug Classes: Diuretic: Indication noted
N0415H1	High-Risk Drug Classes: Opioid: Has received
N0415H2	High-Risk Drug Classes: Opioid: Indication noted
N0415I1	High-Risk Drug Classes: Antiplatelet: Has received
N0415I2	High-Risk Drug Classes: Antiplatelet: Indication noted
N0415J1	High-Risk Drug Classes: Hypoglycemic: Has received
N0415J2	High-Risk Drug Classes: Hypoglycemic: Indication noted
N0415K1	High-Risk Drug Classes: Anti-convulsants: Has received
N0415K2	High-Risk Drug Classes: Anti-convulsants: Indication noted
N0415Z1	High-Risk Drug Classes: None of Above: Has Received
N0450A	Resident received antipsychotic medications
N0450B	GDR attempted
N0450C	Date of last attempted GDR
N0450D	Physician documented GDR
N0450E	Date physician documented GDR
N2001	Drug Regimen Review
N2003	Medication Follow-up
N2005	Medication Intervention

O0110A1a	Treatment: Chemotherapy - On Adm
O0110A1b	Treatment: Chemotherapy - While a Res
O0110A1c	Treatment: Chemotherapy - At Discharge
O0110A2a	Treatment: Chemotherapy - IV - On Adm
O0110A2c	Treatment: Chemotherapy - IV - At Discharge
O0110A3a	Treatment: Chemotherapy - Oral - On Adm
O0110A3c	Treatment: Chemotherapy - Oral - At Discharge.
O0110A10a	Treatment: Chemotherapy - Other - On Adm
O0110A10c	Treatment: Chemotherapy - Other - At Discharge
O0110B1a	Treatment: Radiation - On Adm
O0110B1b	Treatment: Radiation - While a Resident
O0110B1c	Treatment: Radiation - At Discharge
O0110C1a	Treatment: Oxygen Therapy - On Adm
O0110C1b	Treatment: Oxygen Therapy - While a Res
O0110C1c	Treatment: Oxygen Therapy - At Discharge
O0110C2a	Treatment: Oxygen Therapy - Continuous - On Adm
O0110C2c	Treatment: Oxygen Therapy - Continuous - At Discharge
O0110C3a	Treatment: Oxygen Therapy - Intermittent - On Adm
O0110C3c	Treatment: Oxygen Therapy - Intermittent - At Discharge
O0110C4a	Treatment: Oxygen Therapy - High- concentration - On Adm
O0110C4c	Treatment: Oxygen Therapy - High- concentration - At Discharge
O0110D1a	Treatment: Suctioning - On Adm
O0110D1b	Treatment: Suctioning - While a Res
O0110D1c	Treatment: Suctioning - At Discharge
O0110D2a	Treatment: Suctioning - Scheduled - Adm
O0110D2c	Treatment: Suctioning - Scheduled - At Discharge
O0110D3a	Treatment: Suctioning - As Needed - Adm
O0110D3c	Treatment: Suctioning - As Needed - At Discharge
O0110E1a	Treatment: Tracheostomy care - Adm
O0110E1b	Treatment: Tracheostomy care - While a Resident
O0110E1c	Treatment: Tracheostomy care - At Discharge
O0110F1a	Treatment: Invasive Mechanical Ventilator - Adm
O0110F1b	Treatment: Invasive Mechanical Ventilator - While a Res
O0110F1c	Treatment: Invasive Mechanical Ventilator - At Discharge
O0110G1a	Treatment: Non-Invasive Mechanic Ventilator - On Adm
O0110G1b	Treatment: Non-Invasive Mechanic Ventilator - While a Res
O0110G1c	Treatment: Non-Invasive Mechanic Ventilator - At Discharge
O0110G2a	Treatment: Non-Invasive Mechanic Ventilator - BiPAP - On Adm
O0110G2c	Treatment: Non-Invasive Mechanic Ventilator - BiPAP - At Discharge
O0110G3a	Treatment: Non-Invasive Mechanic Ventilator - CPAP - On Adm
O0110G3c	Treatment: Non-Invasive Mechanic Ventilator - CPAP - At Discharge
O0110H1a	Treatment: IV Medications - On Adm
O0110H1b	Treatment: IV Medications - While a Res
O0110H1c	Treatment: IV Medications - At Discharge
O0110H2a	Treatment: IV Medications - Vasoactive Med - On Adm
O0110H2c	Treatment: IV Medications - Vasoactive Med - At Discharge
O0110H3a	Treatment: IV Medications - Antibiotics - On Adm
O0110H3c	Treatment: IV Medications - Antibiotics - At Discharge
O0110H4a	Treatment: IV Medications - Anticoagulant - On Adm
O0110H4c	Treatment: IV Medications - Anticoagulant - At Discharge
O0110H10a	Treatment: IV Medications - Other - On Adm
O0110H10c	Treatment: IV Medications - Other - At Discharge
O0110I1a	Treatment: Transfusions - On Adm
O0110I1b	Treatment: Transfusions - While a Res
O0110I1c	Treatment: Transfusions - At Discharge
O0110J1a	Treatment: Dialysis - On Adm
O0110J1b	Treatment: Dialysis - while a Resident
O0110J1c	Treatment: Dialysis - At Discharge
O0110J2a	Treatment: Dialysis - Hemodialysis - On Adm
O0110J2c	Treatment: Dialysis - Hemodialysis - At Discharge
O0110J3a	Treatment: Dialysis - Peritoneal - On Adm
O0110J3c	Treatment: Dialysis - Peritoneal - At Discharge
O0110K1b	Treatment: Hospice - While a Res
O0110M1b	Treatment: isolate/quarantine - While a Res
O0110O1a	Treatment: IV Access - On Adm
O0110O1b	Treatment: IV Access - While a Res
O0110O1c	Treatment: IV Access - At Discharge
O0110O2a	Treatment: IV Access - Peripheral - On Adm
O0110O2c	Treatment: IV Access - Peripheral - At Discharge
O0110O3a	Treatment: IV Access - Midline - On Adm
O0110O3c	Treatment: IV Access - Midline - At Discharge
O0110O4a	Treatment: IV Access - Central - On Adm
O0110O4c	Treatment: IV Access - Central - At Discharge
O0110Z1a	Treatment: None of the above - On Adm
O0110Z1b	Treatment: None of the above - While a Res
O0110Z1c	Treatment: None of the above - At Discharge
O0250A	Was influenza vaccine received
O0250B	Date influenza vaccine received
O0250C	If influenza vaccine not received, state reason
O0300A	Is pneumococcal vaccination up to date
O0300B	If pneumococcal vaccination not received, state reason
O0350	Resident’s COVID-19 vaccination is up to date
O0400A1	Speech-language/audiology: individual minutes
O0400A2	Speech-language/audiology: concurrent minutes
O0400A3	Speech-language/audiology: group minutes
O0400A3A	Speech-language/audiology: co-treatment minutes
O0400A4	Speech-language/audiology: number of days
O0400A5	Speech-language/audiology: start date
O0400A6	Speech-language/audiology: end date
O0400B1	Occupational therapy: individual minutes
O0400B2	Occupational therapy: concurrent minutes
O0400B3	Occupational therapy: group minutes
O0400B3A	Occupational therapy: co-treatment minutes
O0400B4	Occupational therapy: number of days
O0400B5	Occupational therapy: start date
O0400B6	Occupational therapy: end date
O0400C1	Physical therapy: individual minutes
O0400C2	Physical therapy: concurrent minutes
O0400C3	Physical therapy: group minutes
O0400C3A	Physical therapy: co-treatment minutes
O0400C4	Physical therapy: number of days
O0400C5	Physical therapy: start date
O0400C6	Physical therapy: end date
O0400D1	Respiratory therapy: number of minutes
O0400D2	Respiratory therapy: number of days
O0400E1	Psychological therapy: number of minutes
O0400E2	Psychological therapy: number of days
O0400F1	Recreational therapy: number of minutes
O0400F2	Recreational therapy: number of days
O0420	Distinct calendar days of therapy (7 look back)
O0425A1	SLP and Audiology Services: Individual Minutes
O0425A2	SLP and Audiology Services: Concurrent Minutes
O0425A3	SLP and Audiology Services: Group Minutes
O0425A4	SLP and Audiology Services: Co-treatment Minutes
O0425A5	SLP and Audiology Services: Days
O0425B1	Occupational Therapy: Individual Minutes
O0425B2	Occupational Therapy: Concurrent Minutes
O0425B3	Occupational Therapy: Group Minutes
O0425B4	Occupational Therapy: Co-treatment Minutes
O0425B5	Occupational Therapy: Days
O0425C1	Physical Therapy: Individual Minutes
O0425C2	Physical Therapy: Concurrent Minutes
O0425C3	Physical Therapy: Group Minutes
O0425C4	Physical Therapy: Co-treatment Minutes
O0425C5	Physical Therapy: Days
O0430	Distinct Calendar Days of Part A Therapy
O0500A	Range of motion (passive): number of days
O0500B	Range of motion (active): number of days
O0500C	Splint or brace assistance: number of days
O0500D	Bed mobility training: number of days
O0500E	Transfer training: number of days
O0500F	Walking training: number of days
O0500G	Dressing and/or grooming training: number of days
O0500H	Eating and/or swallowing training: number of days
O0500I	Amputation/prosthesis training: number of days
O0500J	Communication training: number of days

P0100A	Restraints used in bed: bed rail
P0100B	Restraints used in bed: trunk restraint
P0100C	Restraints used in bed: limb restraint
P0100D	Restraints used in bed: other
P0100E	Restraints in chair/out of bed: trunk restraint
P0100F	Restraints in chair/out of bed: limb restraint
P0100G	Restraints in chair/out of bed: chair stops rising
P0100H	Restraints in chair/out of bed: other
P0200A	Bed alarm
P0200B	Chair alarm
P0200C	Floor mat alarm
P0200D	Motion sensor alarm
P0200E	Wander/elopement alarm
P0200F	Other alarm

Q0110A	Asmt and Goal Participation: Resident
Q0110B	Asmt and Goal Participation: Family
Q0110C	Asmt and Goal Participation: Significant other
Q0110D	Asmt and Goal Participation: Legal guardian
Q0110E	Asmt and Goal Participation: Other legally authorized representative
Q0110Z	Asmt and Goal Participation: None of the above.
Q0310A	Resident's overall goal for discharge
Q0310B	Information source for Q0310A
Q0400A	Active discharge plan for return to community
Q0490	Resident's preference to avoid being asked
Q0500B	Do you want to talk about returning to community
Q0500C	Information source for Q500B
Q0550A	Reasking resident preference
Q0550C	Information source for Q0550A
Q0610A	Referral been made to local contact agency
Q0620	Reason Referral to Local Contact Agency Not Made

V0100A	Prior OBRA reason for assessment
V0100B	Prior PPS reason for assessment
V0100C	Prior assessment reference date
V0100D	Prior assessment BIMS summary score
V0100E	Prior assessment PHQ res: total mood severity score
V0100F	Prior assessment PHQ staff: total mood score
V0200A01A	CAA-Delirium: triggered
V0200A01B	CAA-Delirium: plan
V0200A02A	CAA-Cognitive loss/dementia: triggered
V0200A02B	CAA-Cognitive loss/dementia: plan
V0200A03A	CAA-Visual function: triggered
V0200A03B	CAA-Visual function: plan
V0200A04A	CAA-Communication: triggered
V0200A04B	CAA-Communication: plan
V0200A05A	CAA-ADL functional/rehab potential: triggered
V0200A05B	CAA-ADL functional/rehab potential: plan
V0200A06A	CAA-Urinary incontinence/indwelling catheter: triggered
V0200A06B	CAA-Urinary incontinence/indwelling catheter: plan
V0200A07A	CAA-Psychosocial well-being: triggered
V0200A07B	CAA-Psychosocial well-being: plan
V0200A08A	CAA-Mood state: triggered
V0200A08B	CAA-Mood state: plan
V0200A09A	CAA-Behavioral symptoms: triggered
V0200A09B	CAA-Behavioral symptoms: plan
V0200A10A	CAA-Activities: triggered
V0200A10B	CAA-Activities: plan
V0200A11A	CAA-Falls: triggered
V0200A11B	CAA-Falls: plan
V0200A12A	CAA-Nutritional status: triggered
V0200A12B	CAA-Nutritional status: plan
V0200A13A	CAA-Feeding tubes: triggered
V0200A13B	CAA-Feeding tubes: plan
V0200A14A	CAA-Dehydration/fluid maintenance: triggered
V0200A14B	CAA-Dehydration/fluid maintenance: plan
V0200A15A	CAA-Dental care: triggered
V0200A15B	CAA-Dental care: plan
V0200A16A	CAA-Pressure ulcer: triggered
V0200A16B	CAA-Pressure ulcer: plan
V0200A17A	CAA-Psychotropic drug use: triggered
V0200A17B	CAA-Psychotropic drug use: plan
V0200A18A	CAA-Physical restraints: triggered
V0200A18B	CAA-Physical restraints: plan
V0200A19A	CAA-Pain: triggered
V0200A19B	CAA-Pain: plan
V0200A20A	CAA-Return to community referral: triggered
V0200A20B	CAA-Return to community referral: plan
V0200B1	CAA-Assessment process RN signature
V0200B2	CAA-Assessment process signature date
V0200C1	CAA-Care planning signature
V0200C2	CAA-Care planning signature date

X0150	Correction: type of provider
X0200A	Correction: resident first name
X0200C	Correction: resident last name
X0300	Correction: resident gender
X0400	Correction: resident birth date
X0500	Correction: resident social security number
X0600A	Correction: OBRA reason for assessment
X0600B	Correction: PPS reason for assessment
X0600F	Correction: entry/discharge reporting
X0600H	Correction: SNF Part A PPS Discharge
X0700A	Correction: assessment reference date
X0700B	Correction: discharge date
X0700C	Correction: entry date
X0800	Correction: correction number
X0900A	Correction: modification reasons - transcription error
X0900B	Correction: modification reasons - data entry error
X0900C	Correction: modification reasons - software error
X0900D	Correction: modification reasons - item coding error
X0900Z	Correction: modification reasons - other error
X1050A	Correction: inactivation reasons - event did not occur
X1050Z	Correction: inactivation reasons - other reason
X1100A	Correction: attestor first name
X1100B	Correction: attestor last name
X1100C	Correction: attestor title
X1100D	Correction: attestor signature
X1100E	Correction: attestation date

Z0100A	Medicare Part A: HIPPS code
Z0100B	Medicare Part A: Version code
Z0200A	State Medicaid Billing: Case Mix group
Z0200B	State Medicaid Billing: Version code
Z0250A	Alt State Medicaid Billing: Case Mix group
Z0250B	Alt State Medicaid Billing: Version Code
Z0300A	Insurance Billing: Billing Code
Z0300B	Insurance Billing: Billing Version
Z0400A	Attestation signature, title, sections, date
Z0400B	Attestation signature, title, sections, date
Z0400C	Attestation signature, title, sections, date
Z0400D	Attestation signature, title, sections, date
Z0400E	Attestation signature, title, sections, date
Z0400F	Attestation signature, title, sections, date
Z0400G	Attestation signature, title, sections, date
Z0400H	Attestation signature, title, sections, date
Z0400I	Attestation signature, title, sections, date
Z0400J	Attestation signature, title, sections, date
Z0400K	Attestation signature, title, sections, date
Z0400L	Attestation signature, title, sections, date
Z0500A	Signature of RN assessment coordinator
Z0500B	Date RN signed assessment as complete

MDS Item Matrix for Administrative Processing

Section A Administrative Processing - Supporting Item (+)

Section A Administrative Processing - State Optional (s)

Section A Administrative Processing - Non-Submitted Item (-)

Section A Administrative Processing - Required Item (X)

Section B Administrative Processing - Supporting Item (+)

Section B Administrative Processing - State Optional (s)

Section B Administrative Processing - Non-Submitted Item (-)

Section B Administrative Processing - Required Item (X)

Section C Administrative Processing - Supporting Item (+)

Section C Administrative Processing - State Optional (s)

Section C Administrative Processing - Non-Submitted Item (-)

Section C Administrative Processing - Required Item (X)

MDS Item Matrix for PDPM (Patient Driven Payment Model)

Section A: Identification Information
Section B: Hearing, Speech, and Vision

Section A PDPM (Patient Driven Payment Model) - Supporting Item (+)

Section A PDPM (Patient Driven Payment Model) - State Optional (s)

Section A PDPM (Patient Driven Payment Model) - Non-Submitted Item (-)

Section A PDPM (Patient Driven Payment Model) - Required Item (X)

All Section A: Identification Information PDPM (Patient Driven Payment Model)

Section B PDPM (Patient Driven Payment Model) - Supporting Item (+)

Section B PDPM (Patient Driven Payment Model) - State Optional (s)

Section B PDPM (Patient Driven Payment Model) - Non-Submitted Item (-)

Section B PDPM (Patient Driven Payment Model) - Required Item (X)

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