| 70117-7 | Administrative information - Long term care hospital:-:Pt:^Patient:-:CARE | |
| 54581-4 | Facility provider #s | |
| 52714-3 | Provider type:Type:Pt:Provider:Nom:CARE | |
| 54593-9 | Assessment reference date - observation end date:Date:RptPeriod:^Patient:Qn:CMS Assessment | |
| 52455-3 | Admission date | |
| 69418-2 | Reason for assessment - Long term care hospital - version 1.0:Find:Pt:^Patient:Nom:CARE | |
| 52525-3 | Discharge date | |
| 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 | optional |
| 59362-4 | Race or ethnicity OMB.1997 | |
| 52556-8 | Payment sources:Type:Pt:^Patient:Nom: | |
| 52721-8 | Current payment source.other specified:Find:Pt:^Patient:Nom:CARE | |
| 70118-5 | Hearing, speech, vision - Long term care hospital:-:Pt:^Patient:-:CARE | |
| 69867-0 | Active diagnoses based on review of patient records:Find:Pt:^Patient:Nom:CARE | |
| 70120-1 | Assessment administration - Long term care hospital:-:Pt:^Patient:-:CARE | |