| 69417-4 | CMS certification # Fclty | |
| 69417-4 | CMS certification # Fclty | |
| 69417-4 | CMS certification # Fclty | |
| 46494-1 | State location of agency branch:Loc:RptPeriod:Agency:Nom:CMS Assessment | |
| 46494-1 | State location of agency branch:Loc:RptPeriod:Agency:Nom:CMS Assessment | |
| 46494-1 | State location of agency branch:Loc:RptPeriod:Agency:Nom:CMS Assessment | |
| 46495-8 | Branch number:ID:RptPeriod:Agency:Nom:CMS Assessment | |
| 46495-8 | Branch number:ID:RptPeriod:Agency:Nom:CMS Assessment | |
| 46495-8 | Branch number:ID:RptPeriod:Agency:Nom:CMS Assessment | |
| 68468-8 | Attending physician NPI:ID:Pt:Provider:Nom: | |
| 68468-8 | Attending physician NPI:ID:Pt:Provider:Nom: | |
| 68468-8 | Attending physician NPI:ID:Pt:Provider:Nom: | |
| 46496-6 | Agency patient number:ID:RptPeriod:^Patient:Nom:CMS Assessment | |
| 46496-6 | Agency patient number:ID:RptPeriod:^Patient:Nom:CMS Assessment | |
| 46496-6 | Agency patient number:ID:RptPeriod:^Patient:Nom:CMS Assessment | |
| 46497-4 | Start of care date:Date:RptPeriod:^Patient:Qn:CMS Assessment | |
| 46497-4 | Start of care date:Date:RptPeriod:^Patient:Qn:CMS Assessment | |
| 46497-4 | Start of care date:Date:RptPeriod:^Patient:Qn:CMS Assessment | |
| 54503-8 | Legal name of patient:-:Pt:^Patient:-: | |
| 54503-8 | Legal name of patient:-:Pt:^Patient:-: | |
| 54503-8 | Legal name of patient:-:Pt:^Patient:-: | |
| 46499-0 | State of residence | |
| 46499-0 | State of residence | |
| 46499-0 | State of residence | |
| 45401-7 | Postal code | |
| 45401-7 | Postal code | |
| 45401-7 | Postal code | |
| 45397-7 | Medicare or comparable # | |
| 45397-7 | Medicare or comparable # | |
| 45397-7 | Medicare or comparable # | |
| 45396-9 | Social Security # | |
| 45396-9 | Social Security # | |
| 45396-9 | Social Security # | |
| 45400-9 | Medicaid # | |
| 45400-9 | Medicaid # | |
| 45400-9 | Medicaid # | |
| 21112-8 | Birth date | |
| 21112-8 | Birth date | |
| 21112-8 | Birth date | |
| 46098-0 | Sex | |
| 46098-0 | Sex | |
| 46098-0 | Sex | |
| 59362-4 | Race or ethnicity OMB.1997 | |
| 59362-4 | Race or ethnicity OMB.1997 | |
| 59362-4 | Race or ethnicity OMB.1997 | |
| 57199-2 | Current payment sources for home care:Type:RptPeriod:^Patient:Nom:CMS Assessment | |
| 57199-2 | Current payment sources for home care:Type:RptPeriod:^Patient:Nom:CMS Assessment | |
| 57199-2 | Current payment sources for home care:Type:RptPeriod:^Patient:Nom:CMS Assessment | |