| 46456-0 | CMS certification number:ID:Pt:Agency:Nom:OASIS | |
| 46494-1 | State location of agency branch:Loc:RptPeriod:Agency:Nom:CMS Assessment | |
| 46495-8 | Branch number:ID:RptPeriod:Agency:Nom:CMS Assessment | |
| 44954-6 | Physician managing NPI | |
| 46496-6 | Agency patient number:ID:RptPeriod:^Patient:Nom:CMS Assessment | |
| 46497-4 | Start of care date:Date:RptPeriod:^Patient:Qn:CMS Assessment | |
| 45965-1 | Name:-:Pt:^Patient:Set: | |
| 46499-0 | State of residence | |
| 45401-7 | Postal code | |
| 45397-7 | Medicare or comparable # | |
| 45396-9 | Social Security # | |
| 45400-9 | Medicaid # | |
| 21112-8 | Birth date | |
| 46098-0 | Sex | |
| 57199-2 | Current payment sources for home care:Type:RptPeriod:^Patient:Nom:CMS Assessment | |
| 58105-8 | Current payment sources for home care.other specified:Find:Pt:^Patient:Nom:OASIS-C | |
| 57040-8 | Clinical record items:-:RptPeriod:^Patient:-:CMS Assessment | |
| 69324-2 | Patient history and diagnosis - start of care, resumption of care:-:Pt:^Patient:-:OASIS-C | |
| 57043-2 | Living arrangements:-:Pt:^Patient:-: | |
| 57042-4 | Sensory status:-:RptPeriod:^Patient:-:CMS Assessment | |
| 57044-0 | Integumentary status:-:Pt:^Patient:-: | |
| 52510-5 | Respiratory status:-:Pt:^Patient:-: | |
| 57046-5 | Elimination status:-:Pt:^Patient:-: | |
| 69334-1 | Neuro & emotional & behavioral status - start of care:-:Pt:^Patient:-:OASIS-C | |
| 57048-1 | ADL & IADLs:-:Pt:^Patient:-: | |
| 52471-0 | Medications:-:Pt:^Patient:-: | |
| 57049-9 | Care management:-:RptPeriod:^Patient:-:CMS Assessment | |
| 57050-7 | Therapy need and plan of care:-:RptPeriod:^Patient:-:CMS Assessment | |
| 57190-1 | Outcome and assessment information set (OASIS) form - version C - Start of care:-:Pt:^Patient:-: | |