| 58198-3 | Type of record:Type:RptPeriod:^Patient:Nom:CMS Assessment | |
| 54581-4 | Facility provider #s | |
| 54582-2 | Provider type:Type:Pt:Provider:Nom:MDSv3 | |
| 54502-0 | Assessment &or tracking type:-:Pt:^Patient:-: | |
| 54896-6 | Submission requirement:Find:Pt:^Patient:Ord:MDSv3 | |
| 54503-8 | Legal name of patient:-:Pt:^Patient:-: | |
| 45966-9 | Social Security & Medicare numbers:-:Pt:^Patient:-: | |
| 45400-9 | Medicaid # | |
| 46098-0 | Sex | |
| 21112-8 | Birth date | |
| 59362-4 | Race or ethnicity OMB.1997 | |
| 54505-3 | Language:-:Pt:^Patient:-: | |
| 45404-1 | Marital status | |
| 54506-1 | Optional resident items:-:Pt:^Patient:-: | |
| 54589-7 | Preadmission Screening and Resident Review (PASRR):Find:RptPeriod:^Patient:Ord:CMS Assessment | |
| 71441-0 | Level II Preadmission Screening and Resident Review (PASRR):Find:RptPeriod:^Patient:Nom:CMS Assessment | |
| 71454-3 | Conditions related to intellectual disability and developmental disability status:-:Pt:^Patient:-:MDSv3 | |
| 50786-3 | Date of entry:TmStp:Pt:^Patient:Qn: | |
| 54590-5 | Entry type:Type:RptPeriod:^Patient:Nom:CMS Assessment | |
| 85398-6 | Admitted from:Type:Pt:Facility:Nom: | |
| 52525-3 | Discharge date | |
| 55128-3 | Discharge disposition:Type:Pt:^Patient:Nom: | |
| 54592-1 | Previous assessment reference date for significant correction:Date:RptPeriod:^Patient:Qn:CMS Assessment | |
| 54593-9 | Assessment reference date - observation end date:Date:RptPeriod:^Patient:Qn:CMS Assessment | |
| 54507-9 | Medicare stay:-:RptPeriod:^Patient:-:CMS Assessment | |