74502-6  Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]Patient safety event report - hospital - patient information form - version 1.2: -: Pt: ^Patient: -: AHRQ  

PANEL HIERARCHY  (view this panel in the LForms viewer)

  LOINC#   LOINC Name R/O/C  Cardinality  Ex. UCUM Units 
  74502-6   Patient Safety Event Report - Hospital: Patient Information Form - Version 1.2    
       74081-1   Event ID: R 1..1   
       30947-6   Initial Report Date (HERF Q1): R 1..1  {mm/dd/yyyy} 
       74500-0   At the time of the event what was the patient's age? R 1..1   
       74694-1   Is the patient's ethnicity Hispanic or Latino? R 1..1   
       74693-3   What is the patient's race? R 1..1   
       52797-8   ICD-9-CM or ICD-10-CM principal diagnosis code at discharge (if available): O 0..1   
       74562-0   Was any intervention attempted in order to "rescue" the patient (i.e., to prevent, to minimize, or to reverse harm)? R 1..1   
       74561-2   Which of the following interventions (rescue) were documented? C 1..1   
       74560-4   After any intervention to reduce harm, what was the degree of residual harm to the patient from the incident (and subsequent intervention)? R 1..1   
       74559-6   What is the anticipated duration of the harm to the patient? R 1..1   
       74558-8   Approximately when after discovery of the incident was harm assessed? R 1..1   
       74557-0   Did, or will, the incident result in an increased length of stay? R 1..1   
       74556-2   After the discovery of the incident, was the patient, patient's family, or guardian notified? R 1..1   
 

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Patient safety event report - hospital - patient information form - version 1.2  Pt  ^Patient  AHRQ
  Override Display Name for Form:  Patient Safety Event Report - Hospital: Patient Information Form - Version 1.2
  Long Common Name:  Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]

TERM DEFINITION/DESCRIPTION(S)
  The Patient Information Form (PIF) is used to collect demographic information as well as additional information about the impact of the event on a patient (e.g., level of harm, unplanned interventions). It supplements the Healthcare Event Reporting Form (HERF) in cases where an incident is being reported.
 
 

BASIC ATTRIBUTES
  Class/Type: PANEL.SURVEY.AHRQ/Survey
  Panel Type: Panel
  First Released in Version: 2.48
  Last Updated in Version: 2.54
  Status: Active

PARTS

Part Type    Part No.  Part Name   
Component   LP182389-9  Patient safety event report - hospital - patient information form - version 1.2   [Patient safety event report - hospital - patient information form (PIF) - version 1.2] 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP6985-8  Patient 
Scale   LP7747-1 
Method   LP173651-3  AHRQ   [Agency for Healthcare Research and Quality] 
Fragments for synonyms   LP21059-8  Panel 

RELATED NAMES
  Agency for Healthcare Research and Quality Panel Pt safety event
  AHRQ survey Pnl Panl Random
  Form version PIF v1.2 Survey
  Hosp Pnl SURVEY.AHRQ
  Pan Point in time  

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:54 PM
  Long Common Name: Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  Fully Specified Name: Patient safety event report - hospital - patient information form - version 1.2: -: Pt: ^Patient: -: AHRQ
     
  Component Word Count: 10
  ID: 74951
  # of Panel Elements: 14
  Status (Raw): ACTIVE



Selected information about each LOINC that is part of this panel



74081-1   Patient safety event [AHRQ]Patient safety event [AHRQ]Patient safety event: ID: Pt: ^Event: Nom: AHRQ  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Patient safety event  ID  Pt  ^Event  Nom  AHRQ
  Override Display Name for Form:  Event ID:
  Long Common Name:  Patient safety event [AHRQ]

OBSERVATION ID IN FORM
DE2

ANSWER CARDINALITY
1..1

OBSERVATION REQUIRED IN PANEL
Required

BASIC ATTRIBUTES
  Class/Type: SURVEY.AHRQ/Survey
  First Released in Version: 2.46
  Last Updated in Version: 2.66
  Order vs. Obs.: Observation
  Status: Active

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code.
  LOINC   Long Common Name  
  74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]
  74495-3 Patient safety event report - hospital - healthcare event reporting form (HERF) - version 1.2 [AHRQ]
  74501-8 Patient safety event report - hospital - summary of initial report (SIR) - version 1.2 [AHRQ]
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  74725-3 Patient safety event report - hospital - device or medical AndOr surgical supply, including health information technology (HIT) - version 1.2 [AHRQ]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP173704-0  Patient safety event 
Property   LP6818-1  ID   [Identifier] 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP94957-5  Event 
Scale   LP7750-5  Nom 
Method   LP173651-3  AHRQ   [Agency for Healthcare Research and Quality] 

RELATED NAMES
  Agency for Healthcare Research and Quality Nominal Random
  Ident Point in time Survey
  Identifier Pt safety event SURVEY.AHRQ

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:54 PM
  Long Common Name: Patient safety event [AHRQ]
  Fully Specified Name: Patient safety event: ID: Pt: ^Event: Nom: AHRQ
     
  Component Word Count: 3
  ID: 74390
  Status (Raw): ACTIVE


30947-6   Date form completedDate form completedDate form completed: Date: Pt: Form: Qn:  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Date form completed  Date  Pt  Form  Qn 
  Override Display Name for Form:  Initial Report Date (HERF Q1):
  Long Common Name:  Date form completed
  Short Name:  Date form completed

OBSERVATION ID IN FORM
DE30

ANSWER CARDINALITY
1..1

OBSERVATION REQUIRED IN PANEL
Required

BASIC ATTRIBUTES
  Class/Type: ADMIN/Clinical
  First Released in Version: 2.04
  Last Updated in Version: 2.61
  Order vs. Obs.: Observation
  Status: Active

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code.
  LOINC   Long Common Name  
  46611-0 Mental residual functional capacity (RFC) assessment form
  55140-8 Vaccine Adverse Event Reporting System (VAERS) panel
  60687-1 Test of Infant Motor Performance Version 5.1
  69412-5 Continuity Assessment Record and Evaluation (CARE) tool - Long term care hospital (LTCH) - version 1.0
  74080-3 Patient safety event report - hospital - medication or other substance - version 1.2 [AHRQ]
  74495-3 Patient safety event report - hospital - healthcare event reporting form (HERF) - version 1.2 [AHRQ]
  74501-8 Patient safety event report - hospital - summary of initial report (SIR) - version 1.2 [AHRQ]
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  74725-3 Patient safety event report - hospital - device or medical AndOr surgical supply, including health information technology (HIT) - version 1.2 [AHRQ]
  85645-0 Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 3.00 [CMS Assessment]
  85662-5 Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Planned Discharge - version 3.00 [CMS Assessment]
  85668-2 Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Unplanned Discharge - version 3.00 [CMS Assessment]
  85671-6 Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Expired - version 3.00 [CMS Assessment]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP72361-6  Date form completed 
Property   LP182451-7  Date 
Time   LP6960-1  Pt   [Point in time (spot)] 
System   LP29994-8  Form 
Scale   LP7753-9  Qn 

LANGUAGE VARIANTS
  Chinese (CHINA)  (From: Regenstrief-generated full translation based on part translation provided by Lin Zhang, A LOINC volunteer from China)
 
  表单完成日期:日期:时间点:表单:定量型:表单完成日期:日期:时间点:表单:定量型:
  Italian (ITALY)  (From: Regenstrief-generated full translation based on part translation provided by Consiglio Nazionale delle Ricerche)
 
  Data completamento form:Data:Pt:Modulo:Qn:Data completamento form:Data:Pt:Modulo:Qn:
  Portuguese (BRAZIL)  (From: HL7 Brazil Institute)
 
  Data formulário preenchido:TmStp:Pt:Forma:Qn:Data formulário preenchido:TmStp:Pt:Forma:Qn:
  Russian (RUSSIAN FEDERATION)  (From: Regenstrief-generated full translation based on part translation provided by Yaroslavl State Medical Academy)
 
  Дата форма заполнение:Дата:ТчкВрм:Форма:Колич:Дата форма заполнение:Дата:ТчкВрм:Форма:Колич:
  Spanish (ARGENTINA)  (From: Conceptum Medical Terminology Center)
 
  fecha de formulario completo:marca de tiempo:fecha y hora:punto en el tiempo:forma:cuantitativo:fecha de formulario completo:marca de tiempo:fecha y hora:punto en el tiempo:forma:cuantitativo:

RELATED NAMES
  ADMIN Quan Random
  Point in time Quant  
  QNT Quantitative  

EXAMPLE UNITS
  Unit  Source Type
  {mm/dd/yyyy}  EXAMPLE UCUM UNITS 

UNITS (INTERNAL DETAILS)
  Source Type:  EXAMPLE UCUM UNITS 
  Unit:  {mm/dd/yyyy} 

RELATED CODES
Code System Code Code Text Code Version
   CMS LCDS   Z0500B     3.00 

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:54 PM
  Attachment Units Required: N
  Long Common Name: Date form completed
  Shortname: Date form completed
  Fully Specified Name: Date form completed: Date: Pt: Form: Qn:
     
  Component Word Count: 3
  ID: 22884
  Status (Raw): ACTIVE


74500-0   Age at time of event [AHRQ]Age at time of event [AHRQ]Age at time of event: Find: Pt: ^Patient: Nom: AHRQ  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Age at time of event  Find  Pt  ^Patient  Nom  AHRQ
  Long Common Name:  Age at time of event [AHRQ]

OBSERVATION ID IN FORM
DE45

ANSWER CARDINALITY
1..1

FORM CODING INSTRUCTIONS
Check one:

OBSERVATION REQUIRED IN PANEL
Required

BASIC ATTRIBUTES
  Class/Type: SURVEY.AHRQ/Survey
  First Released in Version: 2.48
  Last Updated in Version: 2.48
  Order vs. Obs.: Observation
  Status: Active

NORMATIVE ANSWER LIST    (LL2814-3)  
 
Source: 
  SEQ#        Answer        Code         Answer ID    
  1       Neonate (0-28 days)       a       LA20736-7  
  2       Infant (>28 days <1 year)       b       LA20737-5  
  3       Child (1-12 years)       c       LA20738-3  
  4       Adolescent (13-17 years)       d       LA20739-1  
  5       Adult (18-64 years)       e       LA20740-9  
  6       Mature adult (65-74 years)       f       LA20741-7  
  7       Older adult (75-84 years)       g       LA20742-5  
  8       Aged adult (85+ years)       h       LA20743-3  
  9       Unknown
http://snomed.info/sct ©: 261665006 Unknown (qualifier value)    
  i       LA4489-6  

SURVEY QUESTION
Text: At the time of the event what was the patient's age?
Source: PIF.Q1

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code.
  LOINC   Long Common Name  
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP182401-2  Age at time of event 
Property   LP6813-2  Find   [Finding] 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP6985-8  Patient 
Scale   LP7750-5  Nom 
Method   LP173651-3  AHRQ   [Agency for Healthcare Research and Quality] 

RELATED NAMES
  Agency for Healthcare Research and Quality Nominal Survey
  Finding Point in time SURVEY.AHRQ
  Findings Random  

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:54 PM
  Long Common Name: Age at time of event [AHRQ]
  Fully Specified Name: Age at time of event: Find: Pt: ^Patient: Nom: AHRQ
     
  Component Word Count: 5
  ID: 74949
  Status (Raw): ACTIVE


74694-1   Ethnicity [AHRQ]Ethnicity [AHRQ]Ethnicity: Type: Pt: ^Patient: Nom: AHRQ  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Ethnicity  Type  Pt  ^Patient  Nom  AHRQ
  Long Common Name:  Ethnicity [AHRQ]

OBSERVATION ID IN FORM
DE48

ANSWER CARDINALITY
1..1

FORM CODING INSTRUCTIONS
Check one:

OBSERVATION REQUIRED IN PANEL
Required

BASIC ATTRIBUTES
  Class/Type: SURVEY.AHRQ/Survey
  First Released in Version: 2.48
  Last Updated in Version: 2.48
  Order vs. Obs.: Observation
  Status: Active

HL7 ATTRIBUTES
  HL7 Field ID: PID-22

NORMATIVE ANSWER LIST    (LL2815-0)  
 
Source: 
  SEQ#        Answer        Code         Answer ID    
  1       Hispanic or Latino       a       LA6214-6  
  2       Not Hispanic or Latino       b       LA19555-4  
  3       Unknown
http://snomed.info/sct ©: 261665006 Unknown (qualifier value)    
  c       LA4489-6  

SURVEY QUESTION
Text: Is the patient's ethnicity Hispanic or Latino?
Source: PIF.Q2

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code.
  LOINC   Long Common Name  
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP72553-8  Ethnicity 
Property   LP6886-8  Type 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP6985-8  Patient 
Scale   LP7750-5  Nom 
Method   LP173651-3  AHRQ   [Agency for Healthcare Research and Quality] 

RELATED NAMES
  Agency for Healthcare Research and Quality Random Typ
  Nominal Survey  
  Point in time SURVEY.AHRQ  

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:54 PM
  Long Common Name: Ethnicity [AHRQ]
  Fully Specified Name: Ethnicity: Type: Pt: ^Patient: Nom: AHRQ
     
  Component Word Count: 1
  ID: 75223
  Status (Raw): ACTIVE


74693-3   Race [AHRQ]Race [AHRQ]Race: Type: Pt: ^Patient: Nom: AHRQ  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Race  Type  Pt  ^Patient  Nom  AHRQ
  Long Common Name:  Race [AHRQ]

OBSERVATION ID IN FORM
DE51

ANSWER CARDINALITY
1..1

FORM CODING INSTRUCTIONS
Check one:

OBSERVATION REQUIRED IN PANEL
Required

BASIC ATTRIBUTES
  Class/Type: SURVEY.AHRQ/Survey
  First Released in Version: 2.48
  Last Updated in Version: 2.48
  Order vs. Obs.: Observation
  Status: Active

HL7 ATTRIBUTES
  HL7 Field ID: PID-10

NORMATIVE ANSWER LIST    (LL2816-8)  
 
Source: 
  SEQ#        Answer        Code         Answer ID    
  1       American Indian or Alaska Native       a       LA6155-1  
  2       Asian       b       LA6156-9  
  3       Black or African American       c       LA10610-6  
  4       Native Hawaiian or Other Pacific Islander       d       LA10611-4  
  5       White       e       LA4457-3  
  6       More than one race       f       LA20744-1  
  7       Unknown
http://snomed.info/sct ©: 261665006 Unknown (qualifier value)    
  g       LA4489-6  

SURVEY QUESTION
Text: What is the patient's race?
Source: PIF.Q3

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code.
  LOINC   Long Common Name  
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP71009-2  Race 
Property   LP6886-8  Type 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP6985-8  Patient 
Scale   LP7750-5  Nom 
Method   LP173651-3  AHRQ   [Agency for Healthcare Research and Quality] 

RELATED NAMES
  Agency for Healthcare Research and Quality Point in time SURVEY.AHRQ
  Ethnicity Random Typ
  Nominal Survey  

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:54 PM
  Long Common Name: Race [AHRQ]
  Fully Specified Name: Race: Type: Pt: ^Patient: Nom: AHRQ
     
  Component Word Count: 1
  ID: 75222
  Status (Raw): ACTIVE


52797-8   Diagnosis ICD code [Identifier]Diagnosis ICD code [Identifier]Diagnosis ICD code: Prid: Pt: ^Patient: Nom:  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Diagnosis ICD code  Prid  Pt  ^Patient  Nom 
  Override Display Name for Form:  ICD-9-CM or ICD-10-CM principal diagnosis code at discharge (if available):
  Long Common Name:  Diagnosis ICD code [Identifier]
  Short Name:  Dx ICD code

OBSERVATION ID IN FORM
DE54

ANSWER CARDINALITY
0..1

OBSERVATION REQUIRED IN PANEL
Optional

BASIC ATTRIBUTES
  Class/Type: CLIN/Clinical
  First Released in Version: 2.26
  Last Updated in Version: 2.63
  Order vs. Obs.: Both
  Status: Active.
Change Reason: Changed CLASS from SURVEY.MDS to CLIN.

EXAMPLE ANSWER LIST    (LL4547-7)  
 
Externally Defined: Y
Source: Centers for Disease Control and Prevention
Link to external list: http://www.cdc.gov/nchs/icd.htm

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code and, if applicable, override LOINC answer lists that are associated with this LOINC term in the context of that panel. Override lists are used when the panel requires a different answer list and/or answer list link type than the default answer list associated with this LOINC.
  LOINC   Long Common Name   Answer List Id Answer List Type   # of answers
  52743-2 Continuity Assessment Record and Evaluation (CARE) tool - Acute Care
  52744-0 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Admission
  52745-7 Continuity Assessment Record and Evaluation (CARE) tool - Post Acute Care (PAC) - Discharge
  52746-5 Continuity Assessment Record and Evaluation (CARE) tool - Interim
  52747-3 Continuity Assessment Record and Evaluation (CARE) tool - Expired
  52748-1 Continuity Assessment Record and Evaluation (CARE) tool - Home Health Admission
  62949-3 PhenX domain - Gastrointestinal
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  83265-9 Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.4 [CMS Assessment]
  85645-0 Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 3.00 [CMS Assessment]
  86522-0 MDS v3.0 - RAI v1.14.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
  86856-2 MDS v3.0 - RAI v1.14.1 - Nursing home PPS (NP) and Nursing home quarterly (NQ) item set [CMS Assessment]
  86871-1 MDS v3.0 - RAI v1.14.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
  86872-9 MDS v3.0 - RAI v1.14.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
  86873-7 MDS v3.0 - RAI v1.14.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
  86876-0 MDS v3.0 - RAI v1.14.1 - Swing bed PPS (SP) item set [CMS Assessment]
  87414-9 Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 1.5 [CMS Assessment]
  87509-6 Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) - Admission - version 4.00 [CMS Assessment]
  87825-6 National Trauma Data Standard - version 2018 set
  88282-9 MDS v3.0 - RAI v1.15.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
  88283-7 MDS v3.0 - RAI v1.15.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
  88284-5 MDS v3.0 - RAI v1.15.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
  88285-2 MDS v3.0 - RAI v1.15.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
  88287-8 MDS v3.0 - RAI v1.15.1 - Nursing home PPS (NP) item set [CMS Assessment]
  88288-6 MDS v3.0 - RAI v1.15.1 - Swing bed PPS (SP) item set [CMS Assessment]
  88292-8 MDS v3.0 - RAI v1.15.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
  88329-8 Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 2.0 [CMS Assessment] LL1892-0 NORMATIVE 1
  88945-1 MDS v3.0 - RAI v1.16.1 - Nursing home discharge (ND) and Swing bed discharge (SD) item set [CMS Assessment]
  88946-9 MDS v3.0 - RAI v1.16.1 - Nursing home OMRA start of therapy and discharge (NSD) and Swing bed OMRA start of therapy and discharge (SSD) item set [CMS Assessment]
  88947-7 MDS v3.0 - RAI v1.16.1 - Nursing home OMRA-discharge (NOD) and Swing bed OMRA-discharge (SOD) item set [CMS Assessment]
  88949-3 MDS v3.0 - RAI v1.16.1 - Nursing home PPS (NP) item set [CMS Assessment]
  88950-1 MDS v3.0 - RAI v1.16.1 - Swing bed PPS (SP) item set [CMS Assessment]
  88954-3 MDS v3.0 - RAI v1.16.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
  88955-0 MDS v3.0 - RAI v1.16.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
  89724-9 Minimum Data Set (MDS) for Public Health Emergency Operations Centers (EOC) [CDC Emergency Operations Centers]
  89963-3 Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) - version 3.0 [CMS Assessment] LL1892-0 NORMATIVE 1
  90473-0 MDS v3.0 - RAI v1.17.1 - Nursing home comprehensive (NC) item set [CMS Assessment]
  90474-8 MDS v3.0 - RAI v1.17.1 - Nursing home PPS (NP) item set [CMS Assessment]
  90475-5 MDS v3.0 - RAI v1.17.1 - Nursing home quarterly (NQ) item set [CMS Assessment]
  90476-3 MDS v3.0 - RAI v1.17.1 - Swing bed PPS (SP) item set [CMS Assessment]
  90477-1 MDS v3.0 - RAI v1.17.1 - Nursing home discharge (ND) item set [CMS Assessment]
  90480-5 MDS v3.0 - RAI v1.17.1 - Interim Payment Assessment (IPA) item set [CMS Assessment]
  91552-0 MDS v3.0 - RAI v1.17.1 - Swing bed discharge (SD) item set [CMS Assessment]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP74726-8  Diagnosis ICD code 
Property   LP6850-4  Prid   [Presence or Identity] 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP6985-8  Patient 
Scale   LP7750-5  Nom 
Fragments for synonyms   LP57597-4  ICD 

LANGUAGE VARIANTS
  Chinese (CHINA)  (From: Regenstrief-generated full translation based on part translation provided by Lin Zhang, A LOINC volunteer from China)
 
  诊断 ICD 代码:存在与否或特征标识:时间点:^患者:名义型:诊断 ICD 代码:存在与否或特征标识:时间点:^患者:名义型:
  Italian (ITALY)  (From: Regenstrief-generated full translation based on part translation provided by Consiglio Nazionale delle Ricerche)
 
  Diagnosi, codice ICD:Prid:Pt:^Paziente:Nom:Diagnosi, codice ICD:Prid:Pt:^Paziente:Nom:
  Spanish (SPAIN)  (From: Regenstrief-generated full translation based on part translation provided by the Clinical Laboratory Committee of SERVICIO EXTREMEÑO DE SALUD, with the support of BITAC MAP.)
 
  Código CIE del diagnóstico:Presencia o identidad:Punto temporal:^paciente:Nom:Código CIE del diagnóstico:Presencia o identidad:Punto temporal:^paciente:Nom:

RELATED NAMES
  CLIN Identity or presence Point in time
  Dx International Classification of Diseases Random
  Dx ICD code Nominal  

RELATED CODES
Code System Code Code Text Code Version
   CMS IRF-PAI   22     1.5 
   CMS IRF-PAI   22A     1.5 
   CMS IRF-PAI   22A     2.0 
   CMS IRF-PAI   22A,     3.0 
   CMS IRF-PAI   22B     2.0 
   CMS IRF-PAI   22B     3.0 
   CMS IRF-PAI   22B     1.5 
   CMS IRF-PAI   22C     2.0 
   CMS IRF-PAI   22C     1.5 
   CMS IRF-PAI   22C     3.0 
   CMS LCDS   I0050A     3.00 
   CMS LCDS   I0050A     4.00 
   CMS MDS   I0020A     1.16.1 
   CMS MDS   I0020B     1.17.1 
   CMS MDS   I8000     1.14.1 
   CMS MDS   I8000A     1.14.1 
   CMS MDS   I8000A-I8000J     1.17.1 
   CMS MDS   I8000A-I8000J     1.15.1 
   CMS MDS   I8000A-I8000J     1.16.1 
   CMS MDS   I8000B     1.14.1 
   CMS MDS   I8000C     1.14.1 
   CMS MDS   I8000D     1.14.1 
   CMS MDS   I8000E     1.14.1 
   CMS MDS   I8000F     1.14.1 
   CMS MDS   I8000G     1.14.1 
   CMS MDS   I8000H     1.14.1 
   CMS MDS   I8000I     1.14.1 
   CMS MDS   I8000J     1.14.1 

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:54 PM
  Attachment Units Required: N
  Long Common Name: Diagnosis ICD code [Identifier]
  Shortname: Dx ICD code
  Fully Specified Name: Diagnosis ICD code: Prid: Pt: ^Patient: Nom:
     
  Component Word Count: 3
  ID: 46937
  Status (Raw): ACTIVE


74562-0   Rescue intervention was attempted [AHRQ]Rescue intervention was attempted [AHRQ]Rescue intervention was attempted: Find: Pt: ^Patient: Ord: AHRQ  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Rescue intervention was attempted  Find  Pt  ^Patient  Ord  AHRQ
  Long Common Name:  Rescue intervention was attempted [AHRQ]

TERM DEFINITION/DESCRIPTION(S)
  Determination if intervention was attempted to rescue the patient.
 
 

OBSERVATION ID IN FORM
DE63

ANSWER CARDINALITY
1..1

FORM CODING INSTRUCTIONS
Check one:

OBSERVATION REQUIRED IN PANEL
Required

BASIC ATTRIBUTES
  Class/Type: SURVEY.AHRQ/Survey
  First Released in Version: 2.48
  Last Updated in Version: 2.48
  Order vs. Obs.: Observation
  Status: Active

NORMATIVE ANSWER LIST    (LL2817-6)  
 
Source: 
  SEQ#        Answer        Code         Answer ID    
  1       Yes
http://snomed.info/sct ©: 373066001 Yes (qualifier value)    
  a       LA33-6  
  2       No
http://snomed.info/sct ©: 373067005 No (qualifier value)    
  b       LA32-8  
  3       Unknown
http://snomed.info/sct ©: 261665006 Unknown (qualifier value)    
  c       LA4489-6  

SURVEY QUESTION
Text: Was any intervention attempted in order to "rescue" the patient (i.e., to prevent, to minimize, or to reverse harm)?
Source: PIF.Q5

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code.
  LOINC   Long Common Name  
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP182441-8  Rescue intervention was attempted 
Property   LP6813-2  Find   [Finding] 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP6985-8  Patient 
Scale   LP7751-3  Ord 
Method   LP173651-3  AHRQ   [Agency for Healthcare Research and Quality] 

RELATED NAMES
  Agency for Healthcare Research and Quality QL Screen
  Finding Qual Survey
  Findings Qualitative SURVEY.AHRQ
  Ordinal Random  
  Point in time Rescue intervention attempted  

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:55 PM
  Long Common Name: Rescue intervention was attempted [AHRQ]
  Fully Specified Name: Rescue intervention was attempted: Find: Pt: ^Patient: Ord: AHRQ
     
  Component Word Count: 4
  ID: 75091
  Status (Raw): ACTIVE


74561-2   Documented rescue interventions [AHRQ]Documented rescue interventions [AHRQ]Documented rescue interventions: Type: Pt: ^Patient: Nom: AHRQ  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Documented rescue interventions  Type  Pt  ^Patient  Nom  AHRQ
  Long Common Name:  Documented rescue interventions [AHRQ]

TERM DEFINITION/DESCRIPTION(S)
  Determination of the interventions performed in order to rescue the patient.
 
 

OBSERVATION ID IN FORM
DE66

ANSWER CARDINALITY
1..1

FORM CODING INSTRUCTIONS
Check all that apply:

OBSERVATION REQUIRED IN PANEL
Conditional

BASIC ATTRIBUTES
  Class/Type: SURVEY.AHRQ/Survey
  First Released in Version: 2.48
  Last Updated in Version: 2.48
  Order vs. Obs.: Observation
  Status: Active

NORMATIVE ANSWER LIST    (LL2818-4)  
 
Source: 
  SEQ#        Answer        Code         Answer ID    
  1       Transfer, including transfer to a higher level care area within facility, transfer to another facility, or hospital admission (from outpatient)       a       LA20745-8  
  2       Monitoring, including observation, physiological examination, laboratory testing, phlebotomy, and/or imaging studies       b       LA20746-6  
  3       Medication therapy, including administration of antidote, change in pre-incident dose or route       c       LA21144-3  
  4       Surgical/procedural intervention       d       LA21145-0  
  5       Respiratory support (e.g., ventilation, tracheotomy)       e       LA21146-8  
  6       Blood transfusion       f       LA21147-6  
  7       Counseling or psychotherapy       g       LA21148-4  
  8       Unknown
http://snomed.info/sct ©: 261665006 Unknown (qualifier value)    
  h       LA4489-6  
  9       Other intervention: PLEASE SPECIFY       i       LA21149-2  

SURVEY QUESTION
Text: Which of the following interventions (rescue) were documented?
Source: PIF.Q6

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code.
  LOINC   Long Common Name  
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP182394-9  Documented rescue interventions 
Property   LP6886-8  Type 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP6985-8  Patient 
Scale   LP7750-5  Nom 
Method   LP173651-3  AHRQ   [Agency for Healthcare Research and Quality] 

RELATED NAMES
  Agency for Healthcare Research and Quality Random Typ
  Nominal Survey  
  Point in time SURVEY.AHRQ  

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:55 PM
  Long Common Name: Documented rescue interventions [AHRQ]
  Fully Specified Name: Documented rescue interventions: Type: Pt: ^Patient: Nom: AHRQ
     
  Component Word Count: 3
  ID: 75090
  Status (Raw): ACTIVE


74560-4   Extent of harm to the patient [AHRQ]Extent of harm to the patient [AHRQ]Extent of harm to the patient: Find: Pt: ^Patient: Nom: AHRQ  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Extent of harm to the patient  Find  Pt  ^Patient  Nom  AHRQ
  Long Common Name:  Extent of harm to the patient [AHRQ]

TERM DEFINITION/DESCRIPTION(S)
  The extent of harm to the patient after discovery of the incident and any attempts to minimize adverse consequences.
 
 

OBSERVATION ID IN FORM
DE55

ANSWER CARDINALITY
1..1

FORM CODING INSTRUCTIONS
Check first applicable:

OBSERVATION REQUIRED IN PANEL
Required

BASIC ATTRIBUTES
  Class/Type: SURVEY.AHRQ/Survey
  First Released in Version: 2.48
  Last Updated in Version: 2.48
  Order vs. Obs.: Observation
  Status: Active

NORMATIVE ANSWER LIST    (LL2819-2)  
 
Source: 
  SEQ#        Answer        Code         Answer ID    
  1       Death: Dead at time of assessment.       a       LA20747-4  
  2       Severe harm: Bodily or psychological injury (including pain or disfigurement) that interferes significantly with functional ability or quality of life.       b       LA20748-2  
  3       Moderate harm: Bodily or psychological injury adversely affecting functional ability or quality of life, but not at the level of severe harm.       c       LA20749-0  
  4       Mild harm: Bodily or psychological injury resulting in minimal symptoms or loss of function, or injury limited to additional treatment, monitoring, and/or increased length of stay.       d       LA21150-0  
  5       No harm: Event reached patient, but no harm was evident.       e       LA21151-8  
  6       Unknown
http://snomed.info/sct ©: 261665006 Unknown (qualifier value)    
  f       LA4489-6  

SURVEY QUESTION
Text: After any intervention to reduce harm, what was the degree of residual harm to the patient from the incident (and subsequent intervention)?
Source: PIF.Q7

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code.
  LOINC   Long Common Name  
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP182396-4  Extent of harm to the patient 
Property   LP6813-2  Find   [Finding] 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP6985-8  Patient 
Scale   LP7750-5  Nom 
Method   LP173651-3  AHRQ   [Agency for Healthcare Research and Quality] 

RELATED NAMES
  Agency for Healthcare Research and Quality Nominal Survey
  Finding Point in time SURVEY.AHRQ
  Findings Random  

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:55 PM
  Long Common Name: Extent of harm to the patient [AHRQ]
  Fully Specified Name: Extent of harm to the patient: Find: Pt: ^Patient: Nom: AHRQ
     
  Component Word Count: 6
  ID: 75089
  Status (Raw): ACTIVE


74559-6   Anticipated duration of harm to the patient [AHRQ]Anticipated duration of harm to the patient [AHRQ]Anticipated duration of harm to the patient: Find: Pt: ^Patient: Ord: AHRQ  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Anticipated duration of harm to the patient  Find  Pt  ^Patient  Ord  AHRQ
  Long Common Name:  Anticipated duration of harm to the patient [AHRQ]

TERM DEFINITION/DESCRIPTION(S)
  Determination of the anticipated duration of the harm to the patient.
 
 

OBSERVATION ID IN FORM
DE59

ANSWER CARDINALITY
1..1

FORM CODING INSTRUCTIONS
Check one:

OBSERVATION REQUIRED IN PANEL
Required

BASIC ATTRIBUTES
  Class/Type: SURVEY.AHRQ/Survey
  First Released in Version: 2.48
  Last Updated in Version: 2.48
  Order vs. Obs.: Observation
  Status: Active

NORMATIVE ANSWER LIST    (LL2820-0)  
 
Source: 
  SEQ#        Answer        Code         Answer ID    
  1       Permanent: not expected to revert to approximately normal (i.e., patient's baseline)       a       LA20750-8  
  2       Temporary: expected to revert to approximately normal (i.e., patient's baseline)       b       LA20751-6  
  3       Unknown
http://snomed.info/sct ©: 261665006 Unknown (qualifier value)    
  c       LA4489-6  

SURVEY QUESTION
Text: What is the anticipated duration of the harm to the patient?
Source: PIF.Q8

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code.
  LOINC   Long Common Name  
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP182442-6  Anticipated duration of harm to the patient 
Property   LP6813-2  Find   [Finding] 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP6985-8  Patient 
Scale   LP7751-3  Ord 
Method   LP173651-3  AHRQ   [Agency for Healthcare Research and Quality] 

RELATED NAMES
  Agency for Healthcare Research and Quality Point in time Screen
  Durat QL Survey
  Finding Qual SURVEY.AHRQ
  Findings Qualitative  
  Ordinal Random  

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:55 PM
  Long Common Name: Anticipated duration of harm to the patient [AHRQ]
  Fully Specified Name: Anticipated duration of harm to the patient: Find: Pt: ^Patient: Ord: AHRQ
     
  Component Word Count: 7
  ID: 75088
  Status (Raw): ACTIVE


74558-8   Timing of harm assessment [AHRQ]Timing of harm assessment [AHRQ]Timing of harm assessment: Find: Pt: ^Patient: Ord: AHRQ  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Timing of harm assessment  Find  Pt  ^Patient  Ord  AHRQ
  Long Common Name:  Timing of harm assessment [AHRQ]

TERM DEFINITION/DESCRIPTION(S)
  Determination of approximately when after the discovery of the incident the harm was assessed.
 
 

OBSERVATION ID IN FORM
DE60

ANSWER CARDINALITY
1..1

FORM CODING INSTRUCTIONS
Check one:

OBSERVATION REQUIRED IN PANEL
Required

BASIC ATTRIBUTES
  Class/Type: SURVEY.AHRQ/Survey
  First Released in Version: 2.48
  Last Updated in Version: 2.48
  Order vs. Obs.: Observation
  Status: Active

NORMATIVE ANSWER LIST    (LL2821-8)  
 
Source: 
  SEQ#        Answer        Code         Answer ID    
  1       Within 24 hours       a       LA20752-4  
  2       After 24 hours but before 3 days       b       LA20753-2  
  3       Three days or later       c       LA20754-0  
  4       Unknown
http://snomed.info/sct ©: 261665006 Unknown (qualifier value)    
  d       LA4489-6  

SURVEY QUESTION
Text: Approximately when after discovery of the incident was harm assessed?
Source: PIF.Q9

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code.
  LOINC   Long Common Name  
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP182399-8  Timing of harm assessment 
Property   LP6813-2  Find   [Finding] 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP6985-8  Patient 
Scale   LP7751-3  Ord 
Method   LP173651-3  AHRQ   [Agency for Healthcare Research and Quality] 

RELATED NAMES
  Agency for Healthcare Research and Quality QL Survey
  Finding Qual SURVEY.AHRQ
  Findings Qualitative  
  Ordinal Random  
  Point in time Screen  

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:55 PM
  Long Common Name: Timing of harm assessment [AHRQ]
  Fully Specified Name: Timing of harm assessment: Find: Pt: ^Patient: Ord: AHRQ
     
  Component Word Count: 4
  ID: 75087
  Status (Raw): ACTIVE


74557-0   Increased length of stay due to incident [AHRQ]Increased length of stay due to incident [AHRQ]Increased length of stay due to incident: Find: Pt: ^Patient: Ord: AHRQ  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Increased length of stay due to incident  Find  Pt  ^Patient  Ord  AHRQ
  Long Common Name:  Increased length of stay due to incident [AHRQ]

TERM DEFINITION/DESCRIPTION(S)
  Determination if the incident resulted in an increased length of stay.
 
 

OBSERVATION ID IN FORM
DE69

ANSWER CARDINALITY
1..1

FORM CODING INSTRUCTIONS
Check one:

OBSERVATION REQUIRED IN PANEL
Required

BASIC ATTRIBUTES
  Class/Type: SURVEY.AHRQ/Survey
  First Released in Version: 2.48
  Last Updated in Version: 2.48
  Order vs. Obs.: Observation
  Status: Active

NORMATIVE ANSWER LIST    (LL2822-6)  
 
Source: 
  SEQ#        Answer        Code         Answer ID    
  1       Yes
http://snomed.info/sct ©: 373066001 Yes (qualifier value)    
  a       LA33-6  
  2       No (or not anticipated)       b       LA20755-7  
  3       Unknown
http://snomed.info/sct ©: 261665006 Unknown (qualifier value)    
  c       LA4489-6  

SURVEY QUESTION
Text: Did, or will, the incident result in an increased length of stay?
Source: PIF.Q10

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code.
  LOINC   Long Common Name  
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP182398-0  Increased length of stay due to incident 
Property   LP6813-2  Find   [Finding] 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP6985-8  Patient 
Scale   LP7751-3  Ord 
Method   LP173651-3  AHRQ   [Agency for Healthcare Research and Quality] 

RELATED NAMES
  Agency for Healthcare Research and Quality Point in time Screen
  Finding QL Survey
  Findings Qual SURVEY.AHRQ
  Len Qualitative  
  Ordinal Random  

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:55 PM
  Long Common Name: Increased length of stay due to incident [AHRQ]
  Fully Specified Name: Increased length of stay due to incident: Find: Pt: ^Patient: Ord: AHRQ
     
  Component Word Count: 7
  ID: 75086
  Status (Raw): ACTIVE


74556-2   Family or guardian was notified [AHRQ]Family or guardian was notified [AHRQ]Family or guardian was notified: Find: Pt: ^Patient: Ord: AHRQ  

NAME
  Fully Specified Name: 
Component   Property   Time   System   Scale   Method
Family or guardian was notified  Find  Pt  ^Patient  Ord  AHRQ
  Long Common Name:  Family or guardian was notified [AHRQ]

TERM DEFINITION/DESCRIPTION(S)
  Determination if the patient, patient's family or guardian was notified of an incident.
 
 

OBSERVATION ID IN FORM
DE72

ANSWER CARDINALITY
1..1

FORM CODING INSTRUCTIONS
Check one:

OBSERVATION REQUIRED IN PANEL
Required

BASIC ATTRIBUTES
  Class/Type: SURVEY.AHRQ/Survey
  First Released in Version: 2.48
  Last Updated in Version: 2.48
  Order vs. Obs.: Observation
  Status: Active

NORMATIVE ANSWER LIST    (LL2817-6)  
 
Source: 
  SEQ#        Answer        Code         Answer ID    
  1       Yes
http://snomed.info/sct ©: 373066001 Yes (qualifier value)    
  a       LA33-6  
  2       No
http://snomed.info/sct ©: 373067005 No (qualifier value)    
  b       LA32-8  
  3       Unknown
http://snomed.info/sct ©: 261665006 Unknown (qualifier value)    
  c       LA4489-6  

SURVEY QUESTION
Text: After the discovery of the incident, was the patient, patient's family, or guardian notified?
Source: PIF.Q11

MEMBER OF THESE PANELS     
  This section provides information about panels that contain this LOINC code.
  LOINC   Long Common Name  
  74502-6 Patient safety event report - hospital - patient information form (PIF) - version 1.2 [AHRQ]
  

PARTS

Part Type    Part No.  Part Name   
Component   LP182397-2  Family or guardian was notified 
Property   LP6813-2  Find   [Finding] 
Time   LP6960-1  Pt   [Point in time (spot)] 
Super System   LP6985-8  Patient 
Scale   LP7751-3  Ord 
Method   LP173651-3  AHRQ   [Agency for Healthcare Research and Quality] 

RELATED NAMES
  Agency for Healthcare Research and Quality QL Survey
  Finding Qual SURVEY.AHRQ
  Findings Qualitative  
  Ordinal Random  
  Point in time Screen  

CHANGE HISTORY
  Change Type: MIN

INTERNAL FIELDS
  Detail Page Created On: 6/26/2019 2:47:55 PM
  Long Common Name: Family or guardian was notified [AHRQ]
  Fully Specified Name: Family or guardian was notified: Find: Pt: ^Patient: Ord: AHRQ
     
  Component Word Count: 5
  ID: 75085
  Status (Raw): ACTIVE

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  Code System: http://snomed.info/sct
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