Form Cms-672 - Resident Census And Conditions Of Residents Page 4
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7RESIDENT CENSUS AND CONDITIONS OF RESIDENTS
(use with Form CMS-672)
F100: Bedfast all or most of time: Who are bedfast all or most
A. BOWEL/BLADDER STATUS (F94 – F99)
of the time (e.g., in bed or geriatric chair/recliner) includes
RESIDENTS
bedfast with bathroom privileges.
F94: With an indwelling or an external catheter:
Whose urinary bladder is constantly drained by a catheter (e.g.,
F101: In a chair all or most of time: Who depend on a chair for
an indwelling catheter, a suprapubic catheter or nephrostomy
mobility includes those residents who can stand with assistance to
tube) or who wears an appliance that is applied over the penis and
pivot from bed to wheelchair or to otherwise transfer. The resident
connected to a drainage bag to collect urine from the bladder (e.g.,
cannot take steps without extensive or constant weight-bearing
condom catheter or similar appliance). H0100A or B = checked.
support from others and is not bedfast all or most of the time.
G0300A or E = 2 OR G0600C = checked.
F95: Of the total number of residents with catheters:
Who had a catheter present on admission/entry or reentry.
F102: Independently ambulatory: Who require no help or
H0100A or B = checked. To complete this field use only the
oversight; or help or oversight was provided only 1 or 2 times
counts from the first assessment since the most recent admission/
during the past 7 days. Do not include residents who use a cane,
entry or reentry (OBRA or Scheduled PPS, i.e., A0310A = 01
walker or crutch. G0110C1 or G0110D1 = 0 or 7 and G0110C2 or
OR A0310B = 01 or 06 OR A0310E = 1 for each resident).
G0110D2 = 0 or 1 AND G0600A and G0600B = not checked.
F96: Occasionally or frequently incontinent of bladder:
F103: Ambulation with assistance or assistive devices:
Who have an incontinent episode two or more times per week.
Who require oversight, cueing, physical assistance or who use a
Do not include residents with an indwelling or external catheter.
cane, walker, or crutch. Count the use of lower leg splints, orthotics,
H0100A and B = not checked AND H0300 =1, 2, or 3.
and braces as assistive devices. G0110C1 or G0110D1 = 1, 2, or
3 AND G0110C2 or G0110D2 = 1, 2 or 3 OR G0600A and/or
F97: Occasionally or frequently incontinent of bowel:
G0600B = checked.
Who have a loss of bowel control two or more times per week.
H0400 = 2 or 3.
F104: Physically restrained: For whom restraints were used.
Restraints include any manual or physical method or mechanical
F98: On urinary toileting program: With a systematically
device, material or equipment attached or adjacent to the
implemented, individualized urinary toileting program
resident’s body in such a way that the individual cannot remove
(i.e. bladder rehabilitation/retraining, prompted voiding,
easily and it restricts freedom of movement or normal access
habit training/scheduled voiding) to decrease or prevent
to one’s body. Do not include devices such as braces which are
urinary incontinence or minimizing or avoiding the negative
used for medical/clinical reasons. P0100A through H = 1 or 2.
consequences of incontinence (e.g., pelvic floor exercises).
Count all residents on urinary training programs including those
F105: Of total number of restrained residents: On admission/
who are incontinent. H0200A = 1 OR H200C = 1 OR H0300 =
entry or reentry with an order for restraint(s). P0100A through
1, 2 or 3.
H = 1 or 2. To complete this field use only the counts from the
first assessment since the most recent admission/entry or reentry
F99: On bowel toileting program: With a systematically
(OBRA or Scheduled PPS, i.e., A0310A = 01 OR A0310B = 01
implemented, individualized bowel toileting program to decrease
or 06 OR A0310E = 1 for each resident).
or prevent bowel incontinence or minimizing or avoiding the
negative consequences of incontinence (e.g., use of adequate
F106: With contractures: With a restriction of full passive
fluid intake, fiber in the diet, exercise, and scheduled times
range of motion of any joint due to deformity, disuse, pain, etc.,
to attempt bowel movement). Count all residents on toileting
includes loss of range of motion in neck, fingers, wrists, elbows,
programs including those who are incontinent. H0400 = 2 or 3
shoulders, hips, knees and ankles. G0400A and/or B = 1 or 2.
OR H0500 OR H0600 = 1.
F107: Of the total number with contractures, those who
had a contracture(s) on admission: To complete this field use
B. MOBILITY (F100 – F107) - RESIDENTS
only the counts from the first assessment since the most recent
Total for F100 – F103 should = the number in Block F78,
admission/entry or reentry (OBRA or Scheduled PPS, i.e.,
Total Residents. Algorithm to force mutual exclusivity: Test
A0310A = 01 OR A0310B = 01 or 06 OR A0310E = 1 for each
for each resident. If F100 = 1 then add 1 to F100, and go to
resident). (neck contractures not included in MDS data).
the next resident; If F101 = 1 then add 1 to F101 and go to the
next resident; If F103 = 1 then add 1 to F103 and go to the next
resident; If F102 = 1 then add 1 and go to the next resident.
Form CMS-672 (05/12)
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