| 52525-3 | Discharge date | |
| 45453-8 | Date of last day of MDS observation period:Date:Pt:^Patient:Qn:MDS | |
| 45453-8 | Date of last day of MDS observation period:Date:Pt:^Patient:Qn:MDS | |
| 45453-8 | Date of last day of MDS observation period:Date:Pt:^Patient:Qn:MDS | |
| 45453-8 | Date of last day of MDS observation period:Date:Pt:^Patient:Qn:MDS | |
| 50786-3 | Date of entry:TmStp:Pt:^Patient:Qn: | |
| 45454-6 | Original or corrected copy of form:Num:Pt:^Patient:Ord:MDS | |
| 45454-6 | Original or corrected copy of form:Num:Pt:^Patient:Ord:MDS | |
| 45454-6 | Original or corrected copy of form:Num:Pt:^Patient:Ord:MDS | |
| 45454-6 | Original or corrected copy of form:Num:Pt:^Patient:Ord:MDS | |
| 58200-7 | Correction number:Num:RptPeriod:^Patient:Qn:CMS Assessment | |