| 58198-3 | Type of record:Type:RptPeriod:^Patient:Nom:CMS Assessment | |
| 54581-4 | Facility provider #s | |
| 85632-8 | Facility type:Type:RptPeriod:Facility:Nom:CMS Assessment | |
| 90521-6 | Optional state assessment:-:RptPeriod:^Patient:-:CMS Assessment | |
| 90489-6 | MDS v3.0 - RAI v1.17.2 - Type of assessment:-:RptPeriod:^Patient:-:CMS Assessment | |
| 86526-1 | Unit certification or licensure designation:Type:RptPeriod:Facility:Nom:CMS Assessment | |
| 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 | |
| 59362-4 | Race or ethnicity OMB.1997 | |
| 54505-3 | Language:-:Pt:^Patient:-: | |
| 45404-1 | Marital status | |
| 54506-1 | Optional resident items:-:Pt:^Patient:-: | |
| 86528-7 | Most recent admission &or entry or reentry into this facility:-:RptPeriod:^Patient:-:CMS Assessment | |
| 52455-3 | Admission date | |
| 52525-3 | Discharge date | |
| 55128-3 | Discharge disposition:Type:Pt:^Patient:Nom: | |
| 54593-9 | Assessment reference date - observation end date:Date:RptPeriod:^Patient:Qn:CMS Assessment | |
| 54507-9 | Medicare stay:-:RptPeriod:^Patient:-:CMS Assessment | |