57039-0
Deprecated Outcome and assessment information set (OASIS) form - version C
Deprecated
Status Information
- Status
- DEPRECATED
Term Description
The OASIS is a core set of screening and assessment elements, including standardized definitions and coding categories that form the foundation of the comprehensive assessment for all clients of home health agencies certified to participate in the Medicare or Medicaid program. OASIS-C is a modification to the Outcome and Assessment Information Set (OASIS) that Home Health Agencies (HHAs) must collect in order to participate in the Medicare program. Implementation of OASIS-C, OMB #0938-0760, is required effective January1, 2010.
Source: Regenstrief LOINC
Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
| LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
|---|---|---|---|---|
| 57039-0 | Deprecated Outcome and assessment information set (OASIS) form - version C | |||
| Indent46456-0 | CMS certification number (CCN) Agency [OASIS] | |||
| Indent46494-1 | Branch State | |||
| Indent46495-8 | Branch ID Number | |||
| Indent44954-6 | National Provider Identifier (NPI) | |||
| Indent46496-6 | Patient ID Number | |||
| Indent46497-4 | Start of care date during assessment period [CMS Assessment] | {mm/dd/yyyy} | ||
| Indent46498-2 | Resumption of care date during assessment period [CMS Assessment] | {mm/dd/yyyy} | ||
| Indent45965-1 | Patient Name | |||
| Indent Indent45392-8 | Patient First (Given) name | |||
| Indent Indent45393-6 | Middle initial | |||
| Indent Indent45394-4 | Patient Last (Family) name | |||
| Indent Indent45395-1 | Patient Name suffix | |||
| Indent46499-0 | Patient State of Residence | |||
| Indent45401-7 | Patient Zip Code | |||
| Indent45397-7 | Medicare Number | |||
| Indent45396-9 | Social Security number [Identifier] | |||
| Indent45400-9 | Medicaid number | |||
| Indent21112-8 | Birth date | {mm/dd/yyyy} | ||
| Indent46098-0 | Gender | |||
| Indent57199-2 | Current payment sources for home care during assessment period [CMS Assessment] | |||
| Indent58105-8 | Other (specify) | |||
| Indent57040-8 | Clinical Record Items during assessment period [CMS Assessment] | |||
| Indent Indent46500-5 | Discipline of Person Completing Assessment | |||
| Indent Indent46501-3 | Date Assessment Completed | {mm/dd/yyyy} | ||
| Indent Indent57200-8 | This Assessment is Currently Being Completed for the Following Reason: | |||
| Indent Indent57201-6 | Date of Physician-ordered Start of Care (Resumption of Care) during assessment period [CMS Assessment] | {mm/dd/yyyy} | ||
| Indent Indent57202-4 | Date of Referral | {mm/dd/yyyy} | ||
| Indent Indent57203-2 | Episode Timing: Is the Medicare home health payment episode for which this assessment will define a case mix group an "early" episode or a "later" episode in the patient's current sequence of adjacent Medicare home health payment episodes? | |||
| Indent57041-6 | Patient history and diagnoses | |||
| Indent Indent57204-0 | From which of the following Inpatient Facilities was the patient discharged during the past 14 days? | 1..7 | ||
| Indent Indent58106-6 | Other (specify) | |||
| Indent Indent86470-2 | Inpatient Discharge Date (most recent) | {mm/dd/yyyy} | ||
| Indent Indent46458-6 | Inpatient Diagnosis | |||
| Indent Indent Indent46504-7 | Inpatient Facility Diagnosis : ICD-9-CM Code | R | 1..6 | |
| Indent Indent57183-6 | Inpatient Procedure | C | ||
| Indent Indent Indent58050-6 | Inpatient Procedure : Procedure Code | R | 0..4 | |
| Indent Indent46459-4 | Diagnoses Requiring Medical or Treatment Change Within Past 14 Days | R | ||
| Indent Indent Indent46507-0 | Changed Medical Regimen Diagnosis : ICD-9-CM Code | |||
| Indent Indent46465-1 | Conditions prior to medical or treatment regimen change or inpatient stay within past 14 days [OASIS] | |||
| Indent Indent46609-4 | Diagnosis and severity index | |||
| Indent Indent Indent86255-7 | Primary diagnosis ICD code | |||
| Indent Indent Indent46512-0 | Primary Diagnosis Symptom Control Rating | |||
| Indent Indent Indent46513-8 | Other diagnosis 1 - ICD code [OASIS] | |||
| Indent Indent Indent46514-6 | Other diagnosis 1: Symptom Control Rating | |||
| Indent Indent Indent46515-3 | Other diagnosis 2 - ICD code [OASIS] | |||
| Indent Indent Indent46516-1 | Other diagnosis 2: Symptom Control Rating | |||
| Indent Indent Indent46517-9 | Other diagnosis 3 - ICD code [OASIS] | |||
| Indent Indent Indent46518-7 | Other diagnosis 3: Symptom Control Rating | |||
| Indent Indent Indent46519-5 | Other diagnosis 4 - ICD code [OASIS] | |||
| Indent Indent Indent46520-3 | Other diagnosis 4: Symptom Control Rating | |||
| Indent Indent Indent46521-1 | Other diagnosis 5 - ICD code [OASIS] | |||
| Indent Indent Indent46522-9 | Other diagnosis 5: Symptom Control Rating | |||
| Indent Indent58051-4 | Payment diagnosis [OASIS-C] | R | ||
| Indent Indent Indent49561-4 | Payment diagnosis [identifier] | R | 0..12 | |
| Indent Indent46466-9 | Therapies the patient receives at home | 1..3 | ||
| Indent Indent57319-6 | Risk for Hospitalization: Which of the following signs or symptoms characterize this patient as at risk for hospitalization? | 1..6 | ||
| Indent Indent57206-5 | Overall Status:Which description best fits the patient's overall status? | 1..1 | ||
| Indent Indent57207-3 | Risk factors, either present or past, likely to affect current health status and/or outcome | 1..5 | ||
| Indent Indent57208-1 | Influenza vaccination received in Reporting Period [CMS Assessment] | |||
| Indent Indent55020-2 | Reason influenza virus vaccine not received during assessment period [CMS Assessment] | |||
| Indent Indent57210-7 | Pneumococcal Vaccine: Did the patient receive pneumococcal polysaccharide vaccine (PPV) from your agency during this episode of care (SOC/ROC to Transfer/Discharge)? | |||
| Indent Indent57211-5 | Reason PPV not received: If patient did not receive the pneumococcal polysaccharide vaccine (PPV) from your agency during this episode of care (SOC/ROC to Transfer/Discharge), state reason: | |||
| Indent57043-2 | Patient Living Situation: Which of the following best describes the patient's residential circumstance and availability of assistance? | |||
| Indent Indent57212-3 | Patient lives alone during assessment period [CMS Assessment] | |||
| Indent Indent57213-1 | Patient lives with other person during assessment period [CMS Assessment] | |||
| Indent Indent57214-9 | Patient lives in congregated situtation during assessment period [CMS Assessment] | |||
| Indent57042-4 | Sensory status during assessment period [CMS Assessment] | |||
| Indent Indent57215-6 | Vision (with corrective lenses if the patient usually wears them): | |||
| Indent Indent57216-4 | Ability to hear (with hearing aid or hearing appliance if normally used): | |||
| Indent Indent57217-2 | Understanding of verbal content in patient's own language (with hearing aid or device if used) | |||
| Indent Indent57218-0 | Speech and oral (verbal) expression of language (in patient's own language) | |||
| Indent Indent57219-8 | Has this patient had a formal Pain Assessment using a standardized, validated pain assessment tool (appropriate to the patient's ability to communicate the severity of pain)? | |||
| Indent Indent57220-6 | Frequency of pain interfering with patient's activity or movement: | |||
| Indent57044-0 | Integumentary status | |||
| Indent Indent57221-4 | Pressure Ulcer Assessment: Was this patient assessed for Risk of Developing Pressure Ulcers? | |||
| Indent Indent57280-0 | Does this patient have a Risk of Developing Pressure Ulcers? | |||
| Indent Indent57307-1 | Does this patient have at lease one Unhealed Pressure Ulcer at Stage II or Higher or designated as "unstageable" | |||
| Indent Indent57222-2 | Oldest non-epithelialized stage II pressure ulcer that is present at discharge | |||
| Indent Indent58052-2 | Date pressure injury.oldest non-epithelialized stage 2 first identified [CMS Assessment] | {mm/dd/yyyy} | ||
| Indent Indent58102-5 | Current number of unhealed (non-epithelialized) pressure ulcers at each stage | |||
| Indent Indent Indent57186-9 | Number currently present | |||
| Indent Indent Indent Indent55124-2 | Stage II: Partial thickness loss of dermis presenting as a shallow open ulcer with red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. | {#} | ||
| Indent Indent Indent Indent55125-9 | Stage III: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscles are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. | {#} | ||
| Indent Indent Indent Indent55126-7 | Stage IV: Full thickness tissue loss with visible bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling. | {#} | ||
| Indent Indent Indent Indent54893-3 | Unstageable: Known or likely but unstageable due to non-removable dressing or device | {#} | ||
| Indent Indent Indent Indent54946-9 | Unstageable: Known or likely but unstageable due to coverage of wound bed by slough and/or eschar. | {#} | ||
| Indent Indent Indent Indent54950-1 | Unstageable: Suspected deep tissue injury in evolution. | {#} | ||
| Indent Indent Indent57187-7 | Number of those listed in Column 1 that were present on admission (most recent SOC/ROC) | |||
| Indent Indent Indent Indent54886-7 | Stage II: Partial thickness loss of dermis presenting as a shallow open ulcer with red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. | {#} | ||
| Indent Indent Indent Indent54887-5 | Stage III: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscles are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. | {#} | ||
| Indent Indent Indent Indent54890-9 | Stage IV: Full thickness tissue loss with visible bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling. | {#} | ||
| Indent Indent Indent Indent54894-1 | Unstageable: Known or likely but unstageable due to non-removable dressing or device | {#} | ||
| Indent Indent Indent Indent54947-7 | Unstageable: Known or likely but unstageable due to coverage of wound bed by slough and/or eschar. | {#} | ||
| Indent Indent Indent Indent54951-9 | Unstageable: Suspected deep tissue injury in evolution. | {#} | ||
| Indent Indent57188-5 | Stage III and IV pressure ulcer with the largest surface dimension (length x width) | |||
| Indent Indent Indent57226-3 | Pressure Ulcer Length: Longest length "head to toe" | cm | ||
| Indent Indent Indent52729-1 | Pressure Ulcer Width: Width of the same pressure ulcer; greatest width perpendicular to the length | cm | ||
| Indent Indent Indent57228-9 | Pressure Ulcer Depth: Depth of the same pressure ulcer; from visible surface to the depth of the deepest area | cm | ||
| Indent Indent57229-7 | Status of most problematic (observable) pressure ulcer: | |||
| Indent Indent46536-9 | Current Number of Stage I Pressure Ulcers: | {#} | ||
| Indent Indent57231-3 | Status of most problematic unhealed (observable) pressure ulcer: | |||
| Indent Indent57232-1 | Does the patient have a Stasis Ulcer? | |||
| Indent Indent57233-9 | Current Number of (Observable) Stasis Ulcer(s): | {#} | ||
| Indent Indent57234-7 | Status of most problematic (observable) stasis ulcer: | |||
| Indent Indent57235-4 | Does this patient have a Surgical Wound? | |||
| Indent Indent57236-2 | Status of most problematic (observable) surgical wound: | |||
| Indent Indent46534-4 | Does this patient have a Skin Lesion or Open Wound (excluding bowel ostomy), other than those described above, that is receiving intervention by the home health agency? | |||
| Indent52510-5 | Respiratory status | |||
| Indent Indent57237-0 | When is the patient dyspneic or noticeably Short of Breath? | |||
| Indent Indent57238-8 | Respiratory treatments utilized at home: | 1..3 | ||
| Indent57045-7 | Cardiac status | |||
| Indent Indent57239-6 | Symptoms in Heart Failure Patients: If patient has been diagnosed with heart failure, did the patient exhibit symptoms indicated by clinical heart failure guidelines (including dyspnea, orthopnea, edema, or weight gain) at the time of or at any time since the most recent SOC/ROC assessment? | |||
| Indent Indent57240-4 | Heart failure follow-up during assessment period [CMS Assessment] | 1..5 | ||
| Indent57046-5 | Elimination status | |||
| Indent Indent46553-4 | Urinary incontinence or urinary catheter present during assessment period [CMS Assessment] | |||
| Indent Indent46587-2 | Bowel incontinence frequency during assessment period [CMS Assessment] | |||
| Indent Indent46588-0 | Does this patient have an ostomy for bowel elimination that (within the last 14 days): a) was related to an inpatient facility stay, or b) necessitated a change in medical or treatment regimen? | |||
| Indent57047-3 | Neuro and emotional and behavioral status - SOC or ROC | |||
| Indent Indent46589-8 | Cognitive functioning during assessment period [CMS Assessment] | |||
| Indent Indent58104-1 | When confused (reported or observed within the last 14 days) | |||
| Indent Indent86495-9 | When Anxious (Reported or Observed Within the Last 14 Days) | |||
| Indent Indent57242-0 | Depression Screening: Has the patient been screened for depression, using a standardized depression screening tool? | |||
| Indent Indent Indent58120-7 | Patient Health Questionnaire 2 item (PHQ-2) [PHQ.CMS] | |||
| Indent Indent Indent Indent44250-9 | Little interest or pleasure in doing things | |||
| Indent Indent Indent Indent44255-8 | Feeling down, depressed, or hopeless | |||
| Indent Indent46473-5 | Cognitive, behavorial, and psychiatric symptoms that are demonstrated at least once a week (Reported or Observed): | |||
| Indent Indent46592-2 | Frequency of disruptive behavior symptoms (reported or observed) | |||
| Indent Indent46593-0 | Is this patient receiving Psychiatric Nursing Services at home provided by a qualified psychiatric nurse? | |||
| Indent57048-1 | ADL and IADLs | |||
| Indent Indent46595-5 | Grooming: | |||
| Indent Indent46597-1 | Ability to dress upper body: | |||
| Indent Indent46599-7 | Ability to dress lower body: | |||
| Indent Indent57243-8 | Bathing: | |||
| Indent Indent57244-6 | Toileting transferring: | |||
| Indent Indent57245-3 | Toileting hygiene: | |||
| Indent Indent57246-1 | Transferring: | |||
| Indent Indent57247-9 | Ambulation/Locomotion: | |||
| Indent Indent57248-7 | Feeding or eating: | |||
| Indent Indent57249-5 | Ability to plan or prepare light meals | |||
| Indent Indent46569-0 | Ability to use telephone: | |||
| Indent Indent58121-5 | Prior Functioning ADL/IADL during assessment period [CMS Assessment] | |||
| Indent Indent Indent85070-1 | Self-care (specifically: grooming, dressing, bathing, and toileting hygiene) | |||
| Indent Indent Indent86185-6 | Ambulation | |||
| Indent Indent Indent86186-4 | Transfer | |||
| Indent Indent Indent86187-2 | Household tasks (specifically: light meal preparation, laundry, shopping, and phone use.) | |||
| Indent Indent57254-5 | Has this patient had a multi-factor Fall Risk Assessment (such as falls history, use of multiple medications, mental impairment, toileting frequency, general mobility/transferring impairment, environmental hazards)? | |||
| Indent52471-0 | Medications | |||
| Indent Indent57255-2 | Drug regimen review identified potential medication issues during assessment period [CMS Assessment] | |||
| Indent Indent57281-8 | Medication follow-up during assessment period [CMS Assessment] | |||
| Indent Indent57256-0 | Medication intervention since admission/reentry during assessment period [CMS Assessment] | |||
| Indent Indent57257-8 | Patient/caregiver received high risk drug education during assessment period [CMS Assessment] | |||
| Indent Indent57195-0 | Patient/Caregiver Drug Education Intervention: At the time of, or at any time since the most recent SOC/ROC assessment, was the patient/caregiver instructed by agency staff or other health care provider to monitor the effectiveness of drug therapy, adverse drug reactions, and significant side effects, and how and when to report problems that may occur? | |||
| Indent Indent57285-9 | Management of oral medications: | |||
| Indent Indent57284-2 | Management of injectable medications: | |||
| Indent Indent57196-8 | Prior medication management during assessment period [CMS Assessment] | |||
| Indent Indent Indent57258-6 | Oral medications | |||
| Indent Indent Indent57259-4 | Injectable medications | |||
| Indent57049-9 | Care management during assessment period [CMS Assessment] | |||
| Indent Indent57306-3 | Types and sources of assistance during assessment period [CMS Assessment] | |||
| Indent Indent Indent57260-2 | Non-agency caregiver ability and willingness to assist with ADL during assessment period [CMS Assessment] | |||
| Indent Indent Indent57261-0 | Non-agency caregiver ability and willingness to assist with IADL during assessment period [CMS Assessment] | |||
| Indent Indent Indent57262-8 | Non-agency caregiver ability and willingness to assist with medication administration during assessment period [CMS Assessment] | |||
| Indent Indent Indent57263-6 | Medical procedures/treatments | |||
| Indent Indent Indent57264-4 | Non-agency caregiver ability and willingness to assist with management of equipment during assessment period [CMS Assessment] | |||
| Indent Indent Indent57265-1 | Non-agency caregiver ability and willingness to assist with supervision and safety during assessment period [CMS Assessment] | |||
| Indent Indent Indent57266-9 | Advocacy or facilitation | |||
| Indent Indent57267-7 | How Often does the patient receive ADL or IADL assistance from any caregiver(s) (other than home health agency staff)? | |||
| Indent57050-7 | Therapy need and plan of care during assessment period [CMS Assessment] | |||
| Indent Indent57268-5 | Therapy need during assessment period [CMS Assessment] | {#} | ||
| Indent Indent57197-6 | Plan of Care Synopsis: | |||
| Indent Indent Indent57269-3 | Plan of care includes patient-specific parameters for notifying physician of changes during assessment period [CMS Assessment] | |||
| Indent Indent Indent57270-1 | Plan of care includes diabetic foot care during assessment period [CMS Assessment] | |||
| Indent Indent Indent57271-9 | Plan of care includes fall prevention interventions during assessment period [CMS Assessment] | |||
| Indent Indent Indent57272-7 | Depression intervention(s) | |||
| Indent Indent Indent57273-5 | Intervention(s) to monitor and mitigate pain | |||
| Indent Indent Indent57274-3 | Intervention(s) to prevent pressure ulcers | |||
| Indent Indent Indent57275-0 | Plan of care includes pressure injury treatment - moist healing during assessment period [CMS Assessment] | |||
| Indent57052-3 | Emergent care during assessment period [CMS Assessment] | |||
| Indent Indent57276-8 | Emergent care utilized during assessment period [CMS Assessment] | |||
| Indent Indent57277-6 | Reason For Emergent Care: For what reason(s) did the patient receive emergent care (with or without hospitalization)? | 1..19 | ||
| Indent57051-5 | Data items collected at inpatient facility admission or agency discharge only | |||
| Indent Indent57198-4 | Intervention Synopsis: | |||
| Indent Indent Indent57270-1 | Diabetic foot care including monitoring for the presence of skin lesions on the lower extremities and patient/caregiver education on proper foot care | |||
| Indent Indent Indent57271-9 | Falls prevention interventions | |||
| Indent Indent Indent57272-7 | Depression intervention(s) such as medication, referral for other treatment, or a monitoring plan for current treatment | |||
| Indent Indent Indent57273-5 | Intervention(s) to monitor and mitigate pain | |||
| Indent Indent Indent57274-3 | Plan of care includes intervention to prevent pressure injuries during assessment period [CMS Assessment] | |||
| Indent Indent Indent57275-0 | Pressure ulcer treatment based on principles of moist wound healing | |||
| Indent Indent46578-1 | To which Inpatient Facility has the patient been admitted? | |||
| Indent Indent55128-3 | Discharge disposition | |||
| Indent Indent57279-2 | For what reason(s) did the patient require hospitalization? | 1..20 | ||
| Indent Indent46477-6 | For what Reason(s) was the patient Admitted to a Nursing Home? | |||
| Indent Indent46581-5 | Date of last (most recent) home visit: | {mm/dd/yyyy} | ||
| Indent Indent46582-3 | Discharge/Transfer/Death Date: | {mm/dd/yyyy} |
Fully-Specified Name
- Component
- Outcome and assessment information set (OASIS) form - version C
- Property
- -
- Time
- Pt
- System
- ^Patient
- Scale
- -
- Method
Basic Attributes
- Class
- PANEL.SURVEY.OASIS
- Type
- Surveys
- First Released
- Version 2.29
- Last Updated
- Version 2.73
- Change Reason
- Release 2.73: Status: LOINC will keep most current version and one prior version of CMS assessments active and discourage all older versions.;
- Panel Type
- Panel
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