| 52494-2 | Observational Assessment of Cognitive Status at 2 day Assessment Period |
| 52501-4 | Pain Effect on Function during last 2 days |
| 52596-4 | Memory/recall ability during 2 day assessment period |
| 52597-2 | Unable to assess memory/recall ability during 2 day assessment period .specified reason |
| 52598-0 | Physical behavioral symptoms directed toward others during 2 day assessment period (qualitative) |
| 52599-8 | Verbal behavioral symptoms directed towards others during 2 day assessment period (qualitative) |
| 52600-4 | Other disruptive or dangerous behavioral symptoms not directed towards others, including self-injurious behaviors during 2 day assessment period (qualitative) |
| 52604-6 | Pain presence during last 2 days (qualitative) |
| 52605-3 | Pain has made it hard to sleep during last 2 days (qualitative) |
| 52606-1 | Limited activities because of pain during last 2 days (qualitative) |
| 52611-1 | Bladder - frequency of incontinence during 2 day assessment period (qualitative) |
| 52612-9 | Bowel - frequency of incontinence during 2 day assessment period (qualitative) |
| 52627-7 | Weight-bearing restrictions during 2 day assessment period Upper extremity - left (qualitative) |
| 52628-5 | Weight-bearing restrictions during 2 day assessment period Upper extremity - right (qualitative) |
| 52629-3 | Weight-bearing restrictions during 2 day assessment period Lower extremity - left (qualitative) |
| 52630-1 | Weight-bearing restrictions during 2 day assessment period Lower extremity - right (qualitative) |
| 52632-7 | Grip strength during 2 day assessment period Hand - left (qualitative) |
| 52633-5 | Grip strength during 2 day assessment period Hand - right (qualitative) |
| 52635-0 | Respiratory status with oxygen therapy during 2 day assessment period (qualitative) |
| 52636-8 | Respiratory status without oxygen therapy during 2 day assessment period (qualitative) |
| 52638-4 | Mobility endurance - able to walk or wheel 50 feet during 2 day assessment period (qualitative) |
| 52639-2 | Sitting endurance - able to tolerate sitting for 15 minutes during 2 day assessment period (qualitative) |
| 52642-6 | Eating during 2 day assessment period (qualitative) |
| 52643-4 | Tube feeding during 2 day assessment period (qualitative) |
| 52644-2 | Oral hygiene during 2 day assessment period (qualitative) |
| 52645-9 | Toilet hygiene during 2 day assessment period (qualitative) |
| 52646-7 | Upper body dressing during 2 day assessment period (qualitative) |
| 52647-5 | Lower body dressing during 2 day assessment period (qualitative) |
| 52648-3 | Lying to sitting on side of bed during 2 day assessment period (qualitative) |
| 52649-1 | Sit to stand during 2 day assessment period (qualitative) |
| 52650-9 | Chair-bed to chair transfer during 2 day assessment period (qualitative) |
| 52651-7 | Toilet transfer during 2 day assessment period (qualitative) |
| 52652-5 | Primarily uses wheelchair for mobility during 2 day assessment period (qualitative) |
| 52653-3 | Walk 150 ft (45 m) during 2 day assessment period (qualitative) |
| 52654-1 | Walk 100 ft (30 m) during 2 day assessment period (qualitative) |
| 52655-8 | Walk 50 ft (15 m) during 2 day assessment period (qualitative) |
| 52656-6 | Walk 10 ft (3 m) during 2 day assessment period (qualitative) |
| 52657-4 | Wheel 150 ft (45 m) during 2 day assessment period (qualitative) |
| 52658-2 | Wheel 100 ft (30 m) during 2 day assessment period (qualitative) |
| 52659-0 | Wheel 50 ft (15 m) during 2 day assessment period (qualitative) |
| 52660-8 | Wheel 10 ft (3 m) during 2 day assessment period (qualitative) |
| 52661-6 | Wash upper body during 2 day assessment period (qualitative) |
| 52662-4 | Shower/bathe self during 2 day assessment period (qualitative) |
| 52663-2 | Roll left and right during 2 day assessment period (qualitative) |
| 52664-0 | Sit to lying during 2 day assessment period (qualitative) |
| 52665-7 | Picking up objects during 2 day assessment period (qualitative) |
| 52666-5 | Putting on/taking off footwear during 2 day assessment period (qualitative) |
| 52667-3 | One step (curb) during two day assessment period (qualitative) |
| 52668-1 | Walk 50 feet with two turns during two day assessment period (qualitative) |
| 52669-9 | 12 steps-interior during two day assessment period (qualitative) |
| 52670-7 | Four steps-exterior during two day assessment period (qualitative) |
| 52671-5 | Walking 10 feet on uneven surfaces during two day assessment period (qualitative) |
| 52672-3 | Car transfer during two day assessment period (qualitative) |
| 52673-1 | Wheel short ramp during two day assessment period (qualitative) |
| 52674-9 | Wheel long ramp during two day assessment period (qualitative) |
| 52675-6 | Telephone-answering during two day assessment period (qualitative) |
| 52676-4 | Telephone-placing call during two day assessment period (qualitative) |
| 52677-2 | Medication management-oral medications during two day assessment period (qualitative) |
| 52678-0 | Medication management-inhalant/mist medications during two day assessment period (qualitative) |
| 52679-8 | Medication management-injectable medications during two day assessment period (qualitative) |
| 52680-6 | Make light meal during two day assessment period (qualitative) |
| 52681-4 | Wipe down surface during two day assessment period (qualitative) |
| 52682-2 | Light shopping during two day assessment period (qualitative) |
| 52683-0 | Laundry during two day assessment period (qualitative) |
| 52684-8 | Use public transportation during 2 day assessment period (qualitative) |
| 52738-2 | Inattention during 2 day assessment period (qualitative) |
| 52739-0 | Disorganized thinking during 2 day assessment period (qualitative) |
| 52740-8 | Altered level of consciousness/alertness during 2 day assessment period (qualitative) |
| 52741-6 | Psychomotor retardation during 2 day assessment period (qualitative) |
| 52742-4 | Pain severity during last 2 days (qualitative) |
| 52805-9 | Major treatments used within 2 days interim period panel |
| 52806-7 | Major treatments used within 2 days interim period |