X1100: RN Assessment Coordinator Attestation of Completion

X1100: RN Assessment Coordinator Attestation of Completion

The items in this section identify the RN coordinator attesting to the correction request and the date of the attestation.

Coding Instructions for X1100A, Attesting Individual’s First Name

Enter the first name of the facility staff member attesting to the completion of the corrected information. Start entry with the leftmost box.

Coding Instructions for X1100B, Attesting Individual’s Last Name

Enter the last name of the facility staff member attesting to the completion of the corrected information. Start entry with the leftmost box.

Coding Instructions for X1100C, Attesting Individual’s Title

Enter the title of the facility staff member attesting to the completion of the corrected information on the line provided.

Coding Instructions for X1100D, Signature

The attesting individual must sign the correction request here, certifying the completion of the corrected information. The entire correction request should be completed and signed within 14 days of detecting an error in a record accepted into iQIES. The correction request, including the signature of the attesting facility staff, must be kept with the modified or inactivated MDS record and retained in the resident’s medical record or electronic medical record.

Coding Instructions for X1100E, Attestation Date

Enter the date the attesting facility staff member attested to the completion of the corrected information.

Do not leave any boxes blank. For a one-digit month or day, place a zero in the first box. For example, January 2, 2011, should be entered as:

Coding Tip for X1100, RN Assessment Coordinator Attestation of Completion

If an inactivation is being completed, Z0400 must also be completed.