| 54582-2 | Provider type:Type:Pt:Provider:Nom:MDSv3 | |
| 54503-8 | Legal name of patient:-:Pt:^Patient:-: | |
| 46098-0 | Sex | |
| 21112-8 | Birth date | |
| 45396-9 | Social Security # | |
| 54502-0 | Assessment &or tracking type:-:Pt:^Patient:-: | |
| 75794-8 | Assessment reference date:-:Pt:^Patient:Set:MDSv3 | |
| 54593-9 | Assessment reference date - observation end date:Date:RptPeriod:^Patient:Qn:CMS Assessment | |
| 58199-1 | Reasons for modification:-:Pt:^Patient:-:MDSv3 | |
| 58206-4 | Reasons for inactivation:-:Pt:^Patient:-:MDSv3 | |