| 45405-8 | Ability to understand others (qualitative) |
| 45406-6 | Change in communication/hearing (qualitative) |
| 45407-4 | Vision (qualitative) |
| 45409-0 | Codes for assessments required for Medicare PPS or the State |
| 45410-8 | Admitted from (at entry) Facility |
| 45411-6 | Lived alone prior to admission (qualitative) |
| 45412-4 | History of prior stay at this nursing home (qualitative) |
| 45413-2 | History of stay in other nursing home (qualitative) |
| 45414-0 | History of stay in other residential facility (qualitative) |
| 45415-7 | History of stay at mental health/psychiatric setting (qualitative) |
| 45416-5 | History of stay in mental retardation and developmental disabilities setting (qualitative) |
| 45417-3 | None of the listed prior residential settings (qualitative) |
| 45418-1 | Lifetime occupations |
| 45419-9 | Language.other |
| 45420-7 | Mental health history (qualitative) |
| 45421-5 | No mental retardation and developmental disabilities (qualitative) |
| 45422-3 | Down's syndrome (qualitative) |
| 45423-1 | Autism (qualitative) |
| 45424-9 | Epilepsy (qualitative) |
| 45425-6 | Other organic condition related to mental retardation and developmental disabilities (qualitative) |
| 45426-4 | Mental retardation and developmental disabilities with no organic condition (qualitative) |
| 45427-2 | Date background information form completed |
| 45428-0 | Stays up late at night (qualitative) |
| 45429-8 | Naps regularly during day (qualitative) |
| 45430-6 | Goes out 1 or more days a week (qualitative) |
| 45431-4 | Stays busy with hobbies, reading or fixed daily routine (qualitative) |
| 45432-2 | Spends most time alone or watching TV (qualitative) |
| 45433-0 | Moves independently indoors (qualitative) |
| 45434-8 | Use of tobacco products at least daily (qualitative) |
| 45435-5 | None of the listed cycle of daily events (qualitative) |
| 45436-3 | Distinct food preferences (qualitative) |
| 45437-1 | Eats between meals all or most days (qualitative) |
| 45438-9 | Use of alcohol at least weekly (qualitative) |
| 45439-7 | None of the listed eating patterns (qualitative) |
| 45440-5 | In bedclothes much of day (qualitative) |
| 45441-3 | Wakens to toilet all or most nights (qualitative) |
| 45442-1 | Has irregular bowel movement pattern (qualitative) |
| 45443-9 | Showers for bathing (qualitative) |
| 45444-7 | Bathing in PM (qualitative) |
| 45445-4 | None of the listed additional ADL patterns (qualitative) |
| 45446-2 | Daily contact with relatives/close friends (qualitative) |
| 45447-0 | Usually attends church, temple, etc. (qualitative) |
| 45448-8 | Finds strength in faith (qualitative) |
| 45449-6 | Daily animal companion/presence (qualitative) |
| 45450-4 | Involved in group activities (qualitative) |
| 45451-2 | None of the listed involvement patterns (qualitative) |
| 45452-0 | Unknown customary routine - resident/family unable to provide information (qualitative) |
| 45453-8 | Date of last day of MDS observation period |
| 45454-6 | Original or corrected copy of form # (qualitative) |
| 45455-3 | Date of reentry to facility |
| 45456-1 | Medicaid per diem (qualitative) |
| 45457-9 | Medicare per diem (qualitative) |
| 45458-7 | Medicare ancillary part A (qualitative) |
| 45459-5 | Medicare ancillary part B (qualitative) |
| 45460-3 | CHAMPUS Per Diem (qualitative) |
| 45461-1 | VA Per Diem (qualitative) |
| 45462-9 | Self or family pays for full per diem (qualitative) |
| 45463-7 | Medicaid resident liability or Medicare copayment (qualitative) |
| 45464-5 | Private insurance per diem (qualitative) |
| 45465-2 | Other per diem (qualitative) |
| 45466-0 | Legal guardian (qualitative) |
| 45467-8 | Other legal oversight (qualitative) |
| 45468-6 | Health care durable power attorney (qualitative) |
| 45469-4 | Financial durable power attorney (qualitative) |
| 45470-2 | Family member responsible (qualitative) |
| 45471-0 | Patient responsible for self (qualitative) |
| 45472-8 | Responsibility - none of above (qualitative) |
| 45474-4 | Advance directive - do not resuscitate (qualitative) |
| 45475-1 | Advance directive - do not hospitalize (qualitative) |
| 45476-9 | Advance directive - organ donation (qualitative) |
| 45477-7 | Advance directive - autopsy request (qualitative) |
| 45478-5 | Advance directive - feeding restrictions (qualitative) |
| 45479-3 | Advance directive - medication restrictions (qualitative) |
| 45480-1 | Advance directive - other treatment restrictions (qualitative) |
| 45481-9 | Advance directive - none (qualitative) |
| 45483-5 | Short-term memory OK (qualitative) |
| 45484-3 | Long-term memory OK (qualitative) |
| 45485-0 | Can recall current season (qualitative) |
| 45486-8 | Can recall location of own room (qualitative) |
| 45487-6 | Can recall staff names/faces (qualitative) |
| 45488-4 | Can recall that he or she is in nursing home (qualitative) |
| 45489-2 | Memory/recall - none of above are recalled (qualitative) |
| 45490-0 | Cognitive skills for daily decision making (qualitative) |
| 45491-8 | Easily distracted (qualitative) |
| 45492-6 | Periods of altered perception or awareness of surroundings (qualitative) |
| 45493-4 | Episodes of disorganized speech (qualitative) |
| 45494-2 | Periods of restlessness (qualitative) |
| 45495-9 | Periods of lethargy (qualitative) |
| 45496-7 | Mental function varies over the course of the day (qualitative) |
| 45497-5 | Change in cognitive status (qualitative) |
| 45498-3 | Hearing (qualitative) |
| 45499-1 | Hearing aid present and used (qualitative) |
| 45500-6 | Hearing aid present and not used regularly (qualitative) |
| 45501-4 | Other receptive communication techniques used (qualitative) |
| 45502-2 | No communication device (qualitative) |
| 45503-0 | Uses speech (qualitative) |
| 45504-8 | Uses written messages to express or clarify needs (qualitative) |
| 45505-5 | Uses American sign language or Braille (qualitative) |
| 45506-3 | Uses signs/gestures/sounds (qualitative) |
| 45507-1 | Uses communication board (qualitative) |