Resident
Identifier
Date
MINIMUM DATA SET (MDS) - Version
3.0.
RESIDENT ASSESSMENT AND CARE
SCREENING.
Section
A.
Identification
Information.
A0050. Type of
Record.
1. Add new record
Enter Code
Continue to A0100, Facility Provider
Numbers.
2. Modify existing record
Continue to A0100, Facility Provider
Numbers.
3. Inactivate existing record
Skip to X0150, Type of
Provider.
A0100. Facility Provider
Numbers.
A. National Provider Identifier (NPI):
B. CMS Certification Number (CCN):
C. State Provider Number:
A0200. Type of
Provider.
Type of
provider.
Enter Code
1. Nursing home
(SNF/NF).
2. Swing
Bed.
A0310. Type of
Assessment.
A. Federal OBRA Reason for
Assessment.
Enter Code
01. Admission assessment (required by day
14).
02. Quarterly review
assessment.
03. Annual
assessment.
04. Significant change in status
assessment.
05. Significant correction to prior comprehensive
assessment.
06. Significant correction to prior quarterly
assessment.
99. None of the
above.
B. PPS
Assessment.
Enter Code
PPS Scheduled Assessments for a Medicare Part A
Stay.
01. 5-day scheduled
assessment.
02. 14-day scheduled
assessment.
03. 30-day scheduled
assessment.
04. 60-day scheduled
assessment.
05. 90-day scheduled
assessment.
PPS Unscheduled Assessments for a Medicare Part A
Stay.
07. Unscheduled assessment used for PPS (OMRA, significant or clinical change, or significant correction
assessment).
Not PPS
Assessment.
99. None of the
above.
C. PPS Other Medicare Required Assessment -
OMRA.
Enter Code
0.
No...
1. Start of therapy
assessment.
2. End of therapy
assessment.
3. Both Start and End of therapy
assessment.
4. Change of therapy
assessment.
D. Is this a Swing Bed clinical change assessment? Complete only if A0200 =
2.
Enter Code
No...
0.
1.
Yes.
E. Is this assessment the first assessment (OBRA, Scheduled PPS, or Discharge) since the most recent admission/entry or reentry?
Enter Code
No...
0.
1.
Yes.
A0310 continued on next
page.
MDS 3.0 Nursing Home Sections A and GG Corrected Version 1.14.0 DRAFT
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