-3808
Property | Specification |
Data System | MDS |
Data Specs | V1.15.0 |
Edit Type | Format |
Severity | Warning |
Edit Text | When this Section S item is required by a State, it should equal one of the valid values indicated in the data specifications for that item. Note that for numeric items, signed numbers (with a leading plus or minus sign) should not be submitted. |
Version Notes |
Item List | |
Item ID | Description |
S0101 | Admitted from Community |
S0102 | Admitted from NH or SB |
S0111 | Lived Alone |
S0115 | Spouse Location |
S0120 | Prior Residence ZIP Code |
S0122 | Prior Residence State |
S0123 | Prior Residence County |
S0125 | Prior Residence Town Code |
S0130 | Highest Education Completed |
S0140 | Physician License Number |
S0141 | Physician Name |
S0150 | State Resident ID |
S0160 | Specialty unit |
S0161A | Requires specialized unit: dementia/Alzheimer |
S0161B | Requires specialized unit: behavioral health |
S0161C | Requires specialized unit: TBI |
S0161D | Requires specialized unit: ventilator |
S0161Z | Requires specialized unit: none of the above |
S0165A | Specialty services: Dementia/Alzheimers |
S0165B | Specialty services: Behavioral Health |
S0165C | Specialty services: Traumatic Brain Injury |
S0165D | Specialty services: Ventilator |
S0165E | Specialty services: On-Site Dialysis |
S0165Z | Specialty services: None of the Above |
S0170A | Advanced directive: Guardian |
S0170B | Advanced directive: DPOA-HC |
S0170C | Advanced directive: Living will |
S0170D | Advanced directive: Do not resuscitate |
S0170E | Advanced directive: Do not hospitalize |
S0170F | Advanced directive: Do not intubate |
S0170G | Advanced directive: Feeding restrictions |
S0170H | Advanced directive: Other treatment restrictions |
S0170Z | Advanced directive: None of the above |
S0171A | Resident healthcare proxy exists |
S0171B | Resident healthcare proxy invoked |
S0172A | Goal discussion: documentation received |
S0172B | Goal discussion: hospital |
S0172C | Goal discussion: previous NH |
S0172D | Goal discussion: Home without home health services |
S0172E | Goal discussion: Home with home health services |
S0172F | Goal discussion: PCP office |
S0172G | Goal discussion: Other |
S0172H | Goal discussion: Not occur reason |
S0173 | Documentation of goals of care discussion |
S0174 | Resident has Advanced Directive |
S0175 | Resident has POA for Health Care |
S0180 | Discharged to Community |
S0183 | Discharged prior to admission assessment |
S0500 | Level of Care |
S0501 | CCNH RHNS Level of Care |
S0510 | PASRR Screening Complete |
S0511 | PASRR Date |
S0512 | PASRR Level 1 |
S0513 | PASRR Screening Outcome |
S0520 | Reason for Admission |
S0600A | Meets criteria: requires ventilator 10+ hours |
S0600B | Meets criteria: requires ventilator 16+ hours |
S0600C | Meets criteria: Traumatic Brain Injury-Tier I |
S0600D | Meets criteria: Traumatic Brain Injury-Tier II |
S0600E | Meets criteria: Traumatic Brain Injury-Tier III |
S0600Z | Meets criteria: none of the above |
S1000 | Local Health Department Reporting |
S1001 | State Health Department Reporting |
S1100A | Disease: Clostridium Difficile |
S1100B | Disease: MRSA |
S1100C | Disease: VRE |
S1100D | Disease: VISA |
S1100E | Disease: VRSA |
S1100F | Disease: Other MDRO |
S1100F1 | Disease: MDRO Name1 |
S1100F2 | Disease: MDRO Name2 |
S1100G | Disease: Tuberculosis |
S1100H | Disease: Herpes Zoster |
S1100I | Disease: Scabies |
S1100J | Disease: CRE |
S1100Z | Disease: None of the Above |
S1200A | Primary/secondary SMI dx: schizophrenia |
S1200B | Primary/secondary SMI dx: delusional disorder |
S1200C | Primary/secondary SMI dx: schizoaffective disorder |
S1200D | Primary/secondary SMI dx: psychotic disorder NOS |
S1200E | Primary/secondary SMI dx: bipolar disorder I |
S1200F | Primary/secondary SMI dx: bipolar disorder II |
S1200G | Primary/secondary SMI dx: cyclothymic disorder |
S1200H | Primary/secondary SMI dx: bipolar disorder NOS |
S1200I | Primary/secondary SMI dx: major depress recurrent |
S2000 | Capable of self-administration of medications |
S2001 | Wishes to self-medicate |
S2010 | Refused meds 3 days |
S2011 | Staff support for meds 3 days |
S2015 | Refused meds occasionally 30 days |
S2016 | Refused meds frequently 30 days |
S2040 | Behavior Management Program |
S2050 | Resists grooming/hygiene |
S2060A | Resident centered care: Oasis |
S2060B | Resident centered care: habilitation therapy |
S2060C | Resident centered care: hand in hand |
S2060D | Resident centered care: consistent assignment |
S2060E | Resident centered care: other |
S2060Z | Resident centered care: none of the above |
S3100A | Contractures: Hand |
S3100B | Contractures: Wrist |
S3100C | Contractures: Elbow |
S3100D | Contractures: Shoulder |
S3100E | Contractures: Neck |
S3100F | Contractures: Ankle |
S3100G | Contractures: Knee |
S3100H | Contractures: Hip |
S3100Z | Contractures: Other |
S3200A | Dominant Side |
S3200B | Use of dominant hand/arm |
S3300 | Weight-based Equipment Need |
S3305A | Lifting device for weight |
S3305B | Wheelchair or mobility device for weight |
S3305C | Bed for weight |
S3305D | Seating for weight |
S3305E | More than 2 staff for weight |
S3305Y | Other for weight |
S4000A | Harm: Self Injury/Self-injurious attempt |
S4000B | Harm: Attempt was to kill self |
S4000C | Harm: Considered injuring self |
S4000D | Harm: Self-injury caregiver concern |
S4010A | Hourly Interval Observation |
S4010B | 15- Min. Interval Observation |
S4010C | 5- Min. Interval Observation |
S4010D | Constant Observation for < 1 hr |
S4010E | Constant Observation for > 1 hr |
S4500 | Substance Abuse: Alcoholic Drinks |
S4510A | Substance Abuse: Inhalants |
S4510B | Substance Abuse: Hallucinogens |
S4510C | Substance Abuse: Cocaine and Crack |
S4510D | Substance Abuse: Stimulants |
S4510E | Substance Abuse: Opiates |
S4510F | Substance Abuse: Cannabis |
S5000 | Number of New Pressure Ulcers |
S5005 | New Pressure Ulcer setting |
S5010A1 | Pressure ulcer 1 location |
S5010A2 | Pressure ulcer 1 status |
S5010B1 | Pressure ulcer 2 location |
S5010B2 | Pressure ulcer 2 status |
S5010C1 | Pressure ulcer 3 location |
S5010C2 | Pressure ulcer 3 status |
S5010D1 | Pressure ulcer 4 location |
S5010D2 | Pressure ulcer 4 status |
S5010E1 | Pressure ulcer 5 location |
S5010E2 | Pressure ulcer 5 status |
S5010F1 | Pressure ulcer 6 location |
S5010F2 | Pressure ulcer 6 status |
S5010G1 | Pressure ulcer 7 location |
S5010G2 | Pressure ulcer 7 status |
S5010H1 | Pressure ulcer 8 location |
S5010H2 | Pressure ulcer 8 status |
S5010I1 | Pressure ulcer 9 location |
S5010I2 | Pressure ulcer 9 status |
S6000 | Parenteral/IV feeding in NH |
S6005 | IV meds in NH |
S6010 | Oxygen Therapy in NH |
S6020A | Vent/resp specialized RN expertise |
S6020B | Vent/resp specialized CNA training needed |
S6020C | Vent/resp specialized therapy (PT,OT,RT) expertise |
S6020D | Vent/resp specialized equipment |
S6020Y | Vent/resp Other |
S6020Z | Vent/resp None of the Above |
S6022A | Vent/resp days licensed nurse: hourly intervals |
S6022B | Vent/resp days licensed nurse: 15-minute intervals |
S6022C | Vent/resp days licensed nurse: 5-minute intervals |
S6023A | Vent/resp days CNA: hourly intervals |
S6023B | Vent/resp days CNA: 15-minute intervals |
S6023C | Vent/resp days CNA: 5-minute intervals |
S6024A | Vent/resp days RT: hourly intervals |
S6024B | Vent/resp days RT: 15-minute intervals |
S6024C | Vent/resp days RT: 5-minute intervals |
S6050 | Isolation precautions needed |
S6051A | Isolation Precaution: Airborne |
S6051B | Isolation Precaution: Contact |
S6051C | Isolation Precaution: Droplet |
S6051D | Isolation Precaution: Protective |
S6100A | Vaccination: Varicella |
S6100B | Vaccination: Tetanus, diphtheria (Td) |
S6100C | Vaccination: Tetanus, diphtheria, pertussis (Tdap) |
S6100D | Vaccination: Measles, Mumps, Rubella (MMR) |
S6100E | Vaccination: Other |
S6100F1 | Vaccination: Other Name 1 |
S6100F2 | Vaccination: Other Name 2 |
S6100F3 | Vaccination: Other Name 3 |
S6100Z | Vaccination: None of the above |
S6200 | Number of Hospital Stays |
S6205 | Number of Observation Stays |
S6210 | Number of ER visits |
S6220 | Alzheimer"s/Dementia Special Care Unit |
S6230 | Has resident received antipsychotic |
S6232 | Is resident currently receiving antipsychotic |
S6234 | Attempt to reduce amount of antipsychotic |
S6236 | Was reduction in antipsychotic maintained |
S7000 | Dental Care |
S8000A1 | Medicare - Primary Payor |
S8000A2 | Medicare - Secondary Payor |
S8000A3 | Medicare Payor |
S8000B1 | Medicare Part A - Primary Payor |
S8000B2 | Medicare Part A - Secondary Payor |
S8000B3 | Medicare Part A Payor |
S8000C1 | Medicare Part B - Primary Payor |
S8000C2 | Medicare Part B - Secondary Payor |
S8000C3 | Medicare Part B Payor |
S8000D1 | Medicare Part C - Primary Payor |
S8000D2 | Medicare Part C - Secondary Payor |
S8000D3 | Medicare Part C Payor |
S8000E1 | Medicare per diem - Primary Payor |
S8000E2 | Medicare per diem - Secondary Payor |
S8000E3 | Medicare per diem Payor |
S8000Z | Medicare not a payment source |
S8010A1 | In-state Medicaid - Primary Payor |
S8010A2 | In-state Medicaid - Secondary Payor |
S8010A3 | In-state Medicaid payor |
S8010B1 | Out-of-state Medicaid - Primary Payor |
S8010B2 | Out-of-state Medicaid - Secondary Payor |
S8010B3 | Out-of-state Medicaid Payor |
S8010C1 | Medicaid per diem - Primary Payor |
S8010C2 | Medicaid per diem - Secondary Payor |
S8010C3 | Medicaid per diem Payor |
S8010D1 | Medicaid managed care per diem - Primary Payor |
S8010D2 | Medicaid managed care per diem - Secondary Payor |
S8010D3 | Medicaid managed care per diem Payor |
S8010E1 | Medicaid per diem (not MC) - Primary Payor |
S8010E2 | Medicaid per diem (not MC) - Secondary Payor |
S8010E3 | Medicaid per diem (not MC) Payor |
S8010F | Medicaid per diem type |
S8010F1 | Medicaid Resident Liability - Primary Payor |
S8010F2 | Medicaid Resident Liability - Secondary Payor |
S8010F3 | Medicaid Resident Liability Payor |
S8010G | Medicaid state source |
S8010G1 | Medicare Co-Pay - Primary Payor |
S8010G2 | Medicare Co-pay - Secondary Payor |
S8010G3 | Medicare Co-pay Payor |
S8010H1 | Picture Date reporting |
S8010H2 | Medicaid Other - Secondary Payor |
S8010H3 | Medicaid Other Payor |
S8010I1 | Medicaid Pending - Primary Payor |
S8010I2 | Medicaid Pending - Secondary Payor |
S8010I3 | Medicaid Pending Payor |
S8010Z | Medicaid not a payment source |
S8020A1 | Private - Primary Payor |
S8020A2 | Private - Secondary Payor |
S8020A3 | Private Payor |
S8020B1 | Private per diem - Primary Payor |
S8020B2 | Private per diem - Secondary Payor |
S8020B3 | Private per diem Payor |
S8020C1 | Private LTC insurance policy - Primary Payor |
S8020C2 | Private LTC insurance policy - Secondary Payor |
S8020C3 | Private LTC insurance policy |
S8020Z | Private insurance not a payment source |
S8030A1 | Self-pay - Primary Payor |
S8030A2 | Self-pay - Secondary Payor |
S8030A3 | Self-pay Payor |
S8030B1 | Family pay - Primary Payor |
S8030B2 | Family pay - Secondary Payor |
S8030B3 | Family pay Payor |
S8030C | Self or Family pay for full per diem |
S8030Z | Self or Family not a payment source |
S8040A1 | State Run Medical Assistance - Primary Payor |
S8040A2 | State Run Medical Assistance - Secondary Payor |
S8040A3 | State Run Medical Assistance Payor |
S8040B1 | Tricare per diem - Primary Payor |
S8040B2 | Tricare per diem - Secondary Payor |
S8040B3 | Tricare per diem Payor |
S8040C1 | VA per diem - Primary Payor |
S8040C2 | VA per diem - Secondary Payor |
S8040C3 | VA per diem Payor |
S8040D1 | Other Public - Primary Payor |
S8040D2 | Other Public - Secondary Payor |
S8040D3 | Other Public Payor |
S8040Z | Other government not a payment source |
S8050A1 | Other - Primary Payor |
S8050A2 | Other - Secondary Payor |
S8050A3 | Other Payor |
S8050B | Other Payor Name 1 |
S8050C | Other Payor Name 2 |
S8050D | Other Payor Name 3 |
S8055 | Primary payor |
S8099 | Payor: None of the Above |
S8500 | Medicaid begin date |
S8510A | Medicaid Therapeutic bed-hold days since last asmt |
S8510B | Medicaid Therapeutic bed-hold days - YTD |
S8512A | Medicaid hospital bed-hold days since last asmt |
S8512B | Medicaid hospital bed-hold days - YTD |
S8520A | Medicaid Leave Days Type 1 |
S8520B | Leave Days for Medicaid begin date 1 |
S8520C | Leave Days for Medicaid end date 1 |
S8521A | Medicaid Leave Days Type 2 |
S8521B | Leave Days for Medicaid begin date 2 |
S8521C | Leave Days for Medicaid end date 2 |
S9000 | IL Skills Training |
S9001 | IL IDPH Subpart S criteria |
S9002A | IL IDPH Subpart S: Schizophrenia |
S9002B | IL IDPH Subpart S: Delusional disorder |
S9002C | IL IDPH Subpart S: Schizoaffective disorder |
S9002D | IL IDPH Subpart S:Psychotic disorder not specified |
S9002E | IL IDPH Subpart S: Bipolar I mixed, manic, & depr |
S9002F | IL IDPH Subpart S: Bipolar disorder II |
S9002G | IL IDPH Subpart S: Cyclothymic disorder |
S9002H | IL IDPH Subpart S: Bipolar disorder not specified |
S9002I | IL IDPH Subpart S: Major depression, recurrent |
S9003 | IL IDPH Subpart S: Ancillary |
S9020 | FL FRAES number |
S9040A | CA POLST |
S9040B | CA POLST Section A |
S9040C | CA POLST Section B |
S9040C1 | CA POLST Section B (revised) |
S9040D | CA POLST Section C |
S9040D1 | CA POLST Section C (revised) |
S9040E | CA POLST D physician signature |
S9040F | CA POLST D resident signature |
S9040G | CA POLST D discussed with patient or decisionmaker |
S9040H | CA POLST advanced directive |
S9060 | NY Medicaid add-on eligibility |
S9080A | PA MA CASE-MIX |
S9080B | PA MA CASE-MIX Date |
S9080C | PA MA CASE-MIX Access Card Number |
S9080D | PA MA CASE-MIX MA NF Effective Date |
S9080E | PA MA CASE-MIX Day One MA |
S9100A | VA Room & Board Payment Assessment Reference Date |
S9100B | VA Room & Board Payment Entry Date |
S9100C | VA Medicaid Room & Board initial date |
S9120 | CT Approved LTC |
S9140 | Completed LAPOST |
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Generated: 03/11/2015 04:34:37 PM