Minimum Data Set (Mds) - Resident Assessment And Care Screening Page 2
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9Resident
Identifier
Date
Section
A.
Identification
Information.
A0310. Type of Assessment -
Continued.
F. Entry/discharge reporting
Enter Code
01. Entry tracking
record.
10. Discharge assessment-return not
anticipated.
11. Discharge assessment-return
anticipated.
12. Death in facility tracking
record.
99. None of the
above.
G. Type of
discharge.
- Complete only if A0310F = 10 or
11.
Enter Code
1.
Planned...
Unplanned.
2.
H. Is this a SNF PPS Part A Discharge (End of Stay)
Assessment?.
Enter Code
0.
No...
Yes.
1.
A0410. Unit Certification or Licensure
Designation.
1. Unit is neither Medicare nor Medicaid certified and MDS data is not required by the
State.
Enter Code
2. Unit is neither Medicare nor Medicaid certified but MDS data is required by the
State.
3. Unit is Medicare and/or Medicaid
certified.
A0500. Legal Name of
Resident.
A. First name:
B. Middle initial:
C. Last name:
D. Suffix:
A0600. Social Security and Medicare
Numbers.
A. Social Security Number:
_
_
B. Medicare number (or comparable railroad insurance number):
A0700. Medicaid Number - Enter "+" if pending, "N" if not a Medicaid
recipient.
A0800.
Gender.
Enter Code
Male.
1.
2.
Female.
A0900. Birth
Date.
_
_
Month
Day
Year
A1000.
Race/Ethnicity.
Check all that
apply.
A. American Indian or Alaska
Native.
B.
Asian.
C. Black or African
American.
D. Hispanic or
Latino.
E. Native Hawaiian or Other Pacific
Islander.
F.
White.
MMDS 3.0 Nursing Home Sections A and GG Corrected Version 1.14.0 DRAFT
Page 2 of 9
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