| 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 | |
| 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 | |
| 69372-1 | What is the highest level of school this patient has completed:Find:Pt:^Patient:Ord:CARE | |
| 54505-3 | Language:-:Pt:^Patient:-: | |
| 45404-1 | Marital status | |
| 11340-7 | Hx of Occupation | |
| 52556-8 | Payment sources:Type:Pt:^Patient:Nom: | |
| 52721-8 | Current payment source.other specified:Find:Pt:^Patient:Nom:CARE | |
| 52722-6 | Admitted from:Type:Pt:Facility:Nom:CARE | |
| 52723-4 | Admitted from.other specified:Type:Pt:Facility:Nom:CARE | |
| 69411-7 | Medical services received in past 2Mo - Long term care hospital:Find:2Mo:^Patient:Nom:CARE | |
| 52724-2 | Primary diagnosis code from previous setting:Prid:Pt:^Patient:Nom:CARE | |
| 86255-7 | Primary Dx ICD code | |
| 70118-5 | Hearing, speech, vision - Long term care hospital:-:Pt:^Patient:-:CARE | |
| 70114-4 | Functional status - usual performance - Long term care hospital:-:Pt:^Patient:-:CARE | |
| 70116-9 | Bowel and bladder - Long term care hospital:-:Pt:^Patient:-:CARE | |
| 69867-0 | Active diagnoses based on review of patient records:Find:Pt:^Patient:Nom:CARE | |
| 70115-1 | Swallowing - nutritional status - Long term care hospital:-:Pt:^Patient:-:CARE | |
| 70112-8 | Skin conditions - Long term care hospital:-:Pt:^Patient:-:CARE | |
| 70120-1 | Assessment administration - Long term care hospital:-:Pt:^Patient:-:CARE | |