Form Cms-672 - Resident Census And Conditions Of Residents Page 6
Download a blank fillable Form Cms-672 - Resident Census And Conditions Of Residents in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Cms-672 - Resident Census And Conditions Of Residents with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7RESIDENT CENSUS AND CONDITIONS OF RESIDENTS
(use with Form CMS-672)
F125: Receiving tracheostomy care: Receiving care involved
F134: Antipsychotic medications: Days entered for N0410A > 0
in maintenance of the airway, the stoma and surrounding skin,
•
Clozapine
•
Haloperidol
and dressings/coverings for the stoma. O0100E2 = checked.
•
Haloperiodal Deconate
F126: Receiving ostomy care: Receiving care for a colostomy,
•
Droperidol
ileostomy, uretrostomy, or other ostomy of the intestinal and/or
•
Loxapine
urinary tract. DO NOT include tracheostomy. H0100C = checked.
•
Thioridazine
•
Molindone
F127: Receiving suctioning: That require use of a mechanical
•
Theothixene
•
Zyprexa
device which provides suction to remove secretions from
the respiratory tract via the oral cavity, nasal passage, or
•
Pimozide
•
Fluphenazine Deconate
tracheostomy. O0100D2 = checked. (Note: O0100D2 does not
include oral suctioning, so residents who receive oral suctioning
•
Fluphenazine
will have to be counted separately.)
•
Quetiapine
•
Risperidone
F128: Receiving injections: That have received one or more
•
Mesoridazine
•
Promazine
injections within the past 7 days. (Exclude injections of Vitamin
B 12.) Review residents where N0300 > 0. Omit from the count
•
Trifluoperazine
•
Chlorprothixene
any resident whose only injection currently is B12.
•
Chlorpromazine
F129: Receiving tube feeding: Who receive all or most of
•
Acetophenazine
their nutritional requirements via a feeding tube that delivers
•
Perphenazine
food/nutritional substances directly into the GI system (e.g.,
nasogastric tube, gastrostomy tube). K0510B2 = checked.
F135: Antianxiety medications (anxiolytics): Days entered for
N0410B > 0
F130: Receiving mechanically altered diets: Receiving a
•
Lorazepam
mechanically altered diet including pureed and/or chopped foods
•
Oxazepam
•
Prazepam
(not only meat). K0510C2 = checked.
•
Diazepam
F131: Receiving rehabilitative services: Receiving care
•
Clonazepam
designed to improve functional ability provided by, or under
•
Hydroxyzine
the direction of a rehabilitation professional (physical therapist,
•
Chlordiazepoxide
occupational therapist, speech-language pathologist). Exclude
•
Halazepam
health rehabilitation for MI and/or ID/DD. Any minutes > 0
•
Alprazolam
entered in O0400.
F136: Antidepressant medications: Days entered for N0410C > 0
F132: Assistive devices with eating: Who are using devices to
•
Aripiprazole
maintain independence and to provide comfort when eating (i.e.,
•
Amoxapine
plates with guards, large handled flatware, large handle mugs,
•
Nortriptyline
extend hand flatware, etc.). O0500C or H > 0.
•
Wellbutrin
•
Trazodone
•
Venlafaxine
F. MEDICATIONS (F133 – F139) - RESIDENTS
•
Amtriptyline
F133: Receiving psychoactive medications: That receive
•
Lithium
medications classified as antipsychotics, anxiolytics,
•
Maprotiline
•
Isocarboxazid
antidepressants, and/or hypnotics. Days entered > 0 for N0410A,
B, C or D.
•
Phenelzine
•
Serzone
Use the following lists to assist you in determining the number
•
Desipramine
of residents receiving psychoactive medications. These lists are
•
Tranylcypromine Paroxetine
not meant to be all inclusive; therefore, a resident receiving
•
Fluoxetine
a psychoactive medication not on this list, should be counted
•
Sertraline
•
Doxepin
under F133 and any other medication category that applies:
F134, F135, F136, and/or F137.
•
Imipramine
•
Protriptyline
Form CMS-672 (05/12)
6
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical