HOPE Item Summary
|
Item |
Group |
Type |
Length |
Fixed Start-End |
Description |
| ASMT_SYS_CD | Control | Code | 10 | 1-10 | Assessment system code |
| ITM_SET_SYS_CD | Control | Code | 10 | 11-20 | Item set system code |
| ITM_SBST_CD | Control | Code | 3 | 21-23 | Item subset code |
| ITM_SET_VRSN_CD | Control | Code | 10 | 24-33 | Item set version code |
| SPEC_VRSN_CD | Control | Code | 10 | 34-43 | Specifications version code |
| CRCTN_NUM | Control | Number | 2 | 44-45 | Correction number |
| STATE_CD | Control | Code | 2 | 46-47 | Provider"s state postal code |
| FAC_ID | Control | Text | 16 | 48-63 | Assigned provider submission ID |
| SFTWR_VNDR_ID | Control | Text | 9 | 64-72 | Software vendor federal employer tax ID |
| SFTWR_VNDR_NAME | Control | Text | 30 | 73-102 | Software vendor company name |
| SFTWR_VNDR_EMAIL_ADR | Control | Text | 50 | 103-152 | Software vendor email address |
| SFTWR_PROD_NAME | Control | Text | 50 | 153-202 | Software product name |
| SFTWR_PROD_VRSN_CD | Control | Text | 20 | 203-222 | Software product version code |
| CONTROL_ITEMS_FILLER | Filler | Filler | 190 | 223-412 | Control items filler |
| A0050 | Asmt | Code | 1 | 413-413 | Type of record |
| A0100A | Asmt | Text | 10 | 414-423 | Facility National Provider Identifier (NPI) |
| A0100B | Asmt | Text | 12 | 424-435 | Facility CMS Certification Number (CCN) |
| A0215 | Asmt | Code | 2 | 436-437 | Site of service at admission |
| A0220 | Asmt | Date | 8 | 438-445 | Admission date |
| A0250 | Asmt | Code | 1 | 454-454 | Reason for record |
| A0270 | Asmt | Date | 8 | 456-463 | Discharge date |
| A0500A | Asmt | Text | 12 | 464-475 | Patient first name |
| A0500B | Asmt | Text | 1 | 476-476 | Patient middle initial |
| A0500C | Asmt | Text | 18 | 477-494 | Patient last name |
| A0500D | Asmt | Text | 3 | 495-497 | Patient name suffix |
| A0550 | Asmt | Text | 11 | 670-680 | Patient zip code |
| A0600A | Asmt | Text | 9 | 498-506 | Social Security Number |
| A0600B | Asmt | Text | 12 | 507-518 | Patient Medicare number |
| A0700 | Asmt | Text | 14 | 519-532 | Patient Medicaid number |
| A0800 | Asmt | Code | 1 | 533-533 | Gender |
| A0900 | Asmt | Date | 8 | 534-541 | Birthdate |
| A1005A | Asmt | Checklist | 1 | 737-737 | Ethnicity: No, not Hispanic, Latino/a, Spanish |
| A1005B | Asmt | Checklist | 1 | 738-738 | Ethnicity: Yes, Mex, Mex Amer, Chicano/a |
| A1005C | Asmt | Checklist | 1 | 739-739 | Ethnicity: Yes, Puerto Rican |
| A1005D | Asmt | Checklist | 1 | 740-740 | Ethnicity: Yes, Cuban |
| A1005E | Asmt | Checklist | 1 | 741-741 | Ethnicity: Yes, another Hispanic/Latino/Spanish |
| A1005X | Asmt | Checklist | 1 | 742-742 | Ethnicity: Patient unable to respond |
| A1005Y | Asmt | Checklist | 1 | 743-743 | Ethnicity: Patient declines to respond |
| A1010A | Asmt | Checklist | 1 | 744-744 | Race: White |
| A1010B | Asmt | Checklist | 1 | 745-745 | Race: Black or African American |
| A1010C | Asmt | Checklist | 1 | 746-746 | Race: American Indian or Alaska Native |
| A1010D | Asmt | Checklist | 1 | 747-747 | Race: Asian Indian |
| A1010E | Asmt | Checklist | 1 | 748-748 | Race: Chinese |
| A1010F | Asmt | Checklist | 1 | 749-749 | Race: Filipino |
| A1010G | Asmt | Checklist | 1 | 750-750 | Race: Japanese |
| A1010H | Asmt | Checklist | 1 | 751-751 | Race: Korean |
| A1010I | Asmt | Checklist | 1 | 752-752 | Race: Vietnamese |
| A1010J | Asmt | Checklist | 1 | 753-753 | Race: Other Asian |
| A1010K | Asmt | Checklist | 1 | 754-754 | Race: Native Hawaiian |
| A1010L | Asmt | Checklist | 1 | 755-755 | Race: Guamanian or Chamorro |
| A1010M | Asmt | Checklist | 1 | 756-756 | Race: Samoan |
| A1010N | Asmt | Checklist | 1 | 757-757 | Race: Other Pacific Islander |
| A1010X | Asmt | Checklist | 1 | 758-758 | Race: Patient unable to respond |
| A1010Y | Asmt | Checklist | 1 | 759-759 | Race: Patient declines to respond |
| A1010Z | Asmt | Checklist | 1 | 760-760 | Race: None of the above |
| A1110A | Asmt | Text | 15 | 761-775 | Preferred language |
| A1110B | Asmt | Code | 1 | 776-776 | Does the patient need or want an interpreter |
| A1400A | Asmt | Checklist | 1 | 681-681 | Payer: Medicare (FFS) |
| A1400B | Asmt | Checklist | 1 | 682-682 | Payer: Medicare (managed care/Part C/Mcr Advant.) |
| A1400C | Asmt | Checklist | 1 | 683-683 | Payer: Medicaid (FFS) |
| A1400D | Asmt | Checklist | 1 | 684-684 | Payer: Medicaid (managed care) |
| A1400G | Asmt | Checklist | 1 | 685-685 | Payer: Other Government |
| A1400H | Asmt | Checklist | 1 | 686-686 | Payer: Private insurance/Medigap |
| A1400I | Asmt | Checklist | 1 | 687-687 | Payer: Private managed care |
| A1400J | Asmt | Checklist | 1 | 688-688 | Payer: Self-pay |
| A1400K | Asmt | Checklist | 1 | 689-689 | Payer: No payor source |
| A1400X | Asmt | Checklist | 1 | 690-690 | Payer: Unknown |
| A1400Y | Asmt | Checklist | 1 | 691-691 | Payer: Other |
| A1805 | Asmt | Code | 2 | 777-778 | Admitted from |
| A1905 | Asmt | Code | 1 | 779-779 | Living Arrangements |
| A1910 | Asmt | Code | 1 | 780-780 | Availability of Assistance |
| A2115 | Asmt | Code | 1 | 548-548 | Reason for discharge |
| F2000A | Asmt | Code | 1 | 550-550 | Was ptnt/rsp prty asked about CPR |
| F2000B | Asmt | Date | 8 | 551-558 | Date ptnt/rsp prty asked about CPR |
| F2100A | Asmt | Code | 1 | 559-559 | Was ptnt/rsp prty asked treatments oth than CPR |
| F2100B | Asmt | Date | 8 | 560-567 | Date ptnt/rsp prty asked treatments oth than CPR |
| F2200A | Asmt | Code | 1 | 568-568 | Was ptnt/rsp prty asked hospitalization |
| F2200B | Asmt | Date | 8 | 569-576 | Date ptnt/rsp prty asked hospitalization |
| F3000A | Asmt | Code | 1 | 577-577 | Was ptnt/crgvr asked sprtual/exstntial cncrns |
| F3000B | Asmt | Date | 8 | 578-585 | Date ptnt/crgvr asked sprtual/exstntial cncrns |
| I0010 | Asmt | Code | 2 | 586-587 | Principal diagnosis |
| I0100 | Asmt | Checklist | 1 | 781-781 | Cancer |
| I0600 | Asmt | Checklist | 1 | 782-782 | Heart Failure |
| I0900 | Asmt | Checklist | 1 | 783-783 | Peripheral Disease (PVD or PAD) |
| I0950 | Asmt | Checklist | 1 | 784-784 | Cardiovascular (excluding heart failure) |
| I1101 | Asmt | Checklist | 1 | 785-785 | Liver disease (e.g., cirrhosis) |
| I6202 | Asmt | Checklist | 1 | 794-794 | Chronic Obstructive Pulmonary Disease (COPD) |
| I2102 | Asmt | Checklist | 1 | 787-787 | Sepsis |
| I2900 | Asmt | Checklist | 1 | 788-788 | Diabetes Mellitus (DM) |
| I2910 | Asmt | Checklist | 1 | 789-789 | Neuropathy |
| I4501 | Asmt | Checklist | 1 | 790-790 | Stroke |
| I4801 | Asmt | Checklist | 1 | 791-791 | Dementia (including Alzheimer’s disease) |
| I5150 | Asmt | Checklist | 1 | 792-792 | Neurological Conditions |
| I5401 | Asmt | Checklist | 1 | 793-793 | Seizure Disorder |
| I1510 | Asmt | Checklist | 1 | 786-786 | Renal disease |
| I8005 | Asmt | Checklist | 1 | 795-795 | Other Medical Condition |
| J0050 | Asmt | Code | 1 | 796-796 | Death is Imminent |
| J0900A | Asmt | Code | 1 | 588-588 | Was patient screened for pain |
| J0900B | Asmt | Date | 8 | 589-596 | Date of first screening for pain |
| J0900C | Asmt | Code | 1 | 597-597 | Patient"s pain severity was |
| J0900D | Asmt | Code | 1 | 598-598 | Type of standardized pain tool used |
| J0905 | Asmt | Code | 1 | 692-692 | Is pain an active problem for the patient? |
| J0910A | Asmt | Code | 1 | 599-599 | Was comprehensive pain assessment done |
| J0910B | Asmt | Date | 8 | 600-607 | Date of comprehensive pain assessment |
| J0910C1 | Asmt | Code | 1 | 608-608 | Pain asmt included: location |
| J0910C2 | Asmt | Code | 1 | 609-609 | Pain asmt included: severity |
| J0910C3 | Asmt | Code | 1 | 610-610 | Pain asmt included: character |
| J0910C4 | Asmt | Code | 1 | 611-611 | Pain asmt included: duration |
| J0910C5 | Asmt | Code | 1 | 612-612 | Pain asmt included: frequency |
| J0910C6 | Asmt | Code | 1 | 613-613 | Pain asmt included: what relieves/worsens |
| J0910C7 | Asmt | Code | 1 | 614-614 | Pain asmt included: effect function/quality life |
| J0910C9 | Asmt | Code | 1 | 615-615 | Pain asmt included: none of the above |
| J0915 | Asmt | Code | 1 | 797-797 | Neuropathic Pain |
| J2030A | Asmt | Code | 1 | 616-616 | Was patient screened for shortness of breath |
| J2030B | Asmt | Date | 8 | 617-624 | Date of first screening for shortness of breath |
| J2030C | Asmt | Code | 1 | 625-625 | Did screening indicate pt had shortness of breath |
| J2040A | Asmt | Code | 1 | 626-626 | Was treatment for shortness of breath initiated |
| J2040B | Asmt | Date | 8 | 627-634 | Date treatment for shortness of breath initiated |
| J2050A | Asmt | Code | 1 | 798-798 | Was symptom impact screening completed |
| J2050B | Asmt | Date | 8 | 799-806 | Date of symptom impact screening |
| J2051A | Asmt | Code | 1 | 807-807 | Symptom Impact - Pain |
| J2051B | Asmt | Code | 1 | 808-808 | Symptom Impact - Shortness of breath |
| J2051C | Asmt | Code | 1 | 809-809 | Symptom Impact - Anxiety |
| J2051D | Asmt | Code | 1 | 810-810 | Symptom Impact - Nausea |
| J2051E | Asmt | Code | 1 | 811-811 | Symptom Impact - Vomiting |
| J2051F | Asmt | Code | 1 | 812-812 | Symptom Impact - Diarrhea |
| J2051G | Asmt | Code | 1 | 813-813 | Symptom Impact - Constipation |
| J2051H | Asmt | Code | 1 | 814-814 | Symptom Impact - Agitation |
| J2052A | Asmt | Code | 1 | 815-815 | Was in-person SFV completed |
| J2052B | Asmt | Date | 8 | 816-823 | Date of in-person SFV |
| J2052C | Asmt | Code | 1 | 824-824 | Reason SFV Not Completed |
| J2053A | Asmt | Code | 1 | 825-825 | SFV Symptom Impact Since Screen - Pain |
| J2053B | Asmt | Code | 1 | 826-826 | SFV Symptom Impact Since Screen - Shortness breath |
| J2053C | Asmt | Code | 1 | 827-827 | SFV Symptom Impact Since Screen - Anxiety |
| J2053D | Asmt | Code | 1 | 828-828 | SFV Symptom Impact Since Screen - Nausea |
| J2053E | Asmt | Code | 1 | 829-829 | SFV Symptom Impact Since Screen - Vomiting |
| J2053F | Asmt | Code | 1 | 830-830 | SFV Symptom Impact Since Screen - Diarrhea |
| J2053G | Asmt | Code | 1 | 831-831 | SFV Symptom Impact Since Screen - Constipation |
| J2053H | Asmt | Code | 1 | 832-832 | SFV Symptom Impact Since Screen - Agitation |
| M1190 | Asmt | Code | 1 | 833-833 | Patient has one or more skin conditions |
| M1195A | Asmt | Checklist | 1 | 834-834 | Skin Condition - Diabetic foot ulcer(s) |
| M1195B | Asmt | Checklist | 1 | 835-835 | Skin Condition - Open lesion(s) |
| M1195C | Asmt | Checklist | 1 | 836-836 | Skin Condition - Pressure Ulcer(s)/Injuries |
| M1195D | Asmt | Checklist | 1 | 837-837 | Skin Condition - Rash(es) |
| M1195E | Asmt | Checklist | 1 | 838-838 | Skin Condition - Skin tear(s) |
| M1195F | Asmt | Checklist | 1 | 839-839 | Skin Condition - Surgical wound(s) |
| M1195G | Asmt | Checklist | 1 | 840-840 | Skin Condition - Ulcers (not diabetic or pressure) |
| M1195H | Asmt | Checklist | 1 | 841-841 | Skin Condition - Moisture Associated Skin Damage |
| M1195Z | Asmt | Checklist | 1 | 842-842 | Skin Condition - None of the above |
| M1200A | Asmt | Checklist | 1 | 843-843 | Treatments - Pressure reducing device for chair |
| M1200B | Asmt | Checklist | 1 | 844-844 | Treatments - Pressure reducing device for bed |
| M1200C | Asmt | Checklist | 1 | 845-845 | Treatments - Turning/repositioning program |
| M1200D | Asmt | Checklist | 1 | 846-846 | Treatments - Nutrition or hydration intervention |
| M1200E | Asmt | Checklist | 1 | 847-847 | Treatments - Pressure ulcer/injury care |
| M1200F | Asmt | Checklist | 1 | 848-848 | Treatments - Surgical wound care |
| M1200G | Asmt | Checklist | 1 | 849-849 | Treatments - Apply nonsurgical dressings-not feet |
| M1200H | Asmt | Checklist | 1 | 850-850 | Treatments - Apply ointments/meds (not feet) |
| M1200I | Asmt | Checklist | 1 | 851-851 | Treatments - Application of dressings to feet |
| M1200J | Asmt | Checklist | 1 | 852-852 | Treatments - Incontinence Management |
| M1200Z | Asmt | Checklist | 1 | 853-853 | Treatments - None of the above |
| N0500A | Asmt | Code | 1 | 635-635 | Was scheduled opioid initiated or continued |
| N0500B | Asmt | Date | 8 | 636-643 | Date scheduled opioid initiated or continued |
| N0510A | Asmt | Code | 1 | 644-644 | Was PRN opioid initiated or continued |
| N0510B | Asmt | Date | 8 | 645-652 | Date PRN opioid initiated or continued |
| N0520A | Asmt | Code | 1 | 653-653 | Was bowel regimen initiated or continued |
| N0520B | Asmt | Date | 8 | 654-661 | Date bowel regimen initiated or continued |
| Z0350 | Asmt | Date | 8 | 854-861 | Date Assessment Was Completed |
| Z0500B | Asmt | Date | 8 | 662-669 | Date of signature verifying record completion |
| ITEM_FILLER_001 | Filler | Filler | 44 | 693-736 | Reserved for legacy HIS items |
| ITEM_FILLER_002 | Filler | Filler | 8 | 446-453 | Reserved for legacy HIS items |
| ITEM_FILLER_003 | Filler | Filler | 6 | 542-547 | Reserved for legacy HIS items |
| ITEM_FILLER_004 | Filler | Filler | 1 | 455-455 | Reserved for legacy HIS items |
| ITEM_FILLER_005 | Filler | Filler | 1 | 549-549 | Reserved for legacy HIS items |
| ASMT_ITEMS_FILLER | Filler | Filler | 7853 | 862-8714 | Assessment items filler |
| ASSESSMENT_ID | Calc | Number | 15 | 8715-8729 | Assessment internal ID |
| ORIGINAL_ASSESSMENT_ID | Calc | Number | 15 | 8730-8744 | Original assessment ID |
| RESIDENT_INTERNAL_ID | Calc | Number | 10 | 8745-8754 | Resident internal ID |
| TARGET_DATE | Calc | Date | 8 | 8755-8762 | Target date |
| PROVIDER_INTERNAL_ID | Calc | Number | 10 | 8763-8772 | Provider internal ID |
| SUBMISSION_ID | Calc | Number | 15 | 8773-8787 | Submission ID |
| SUBMISSION_DATE | Calc | Date | 8 | 8788-8795 | Submission date |
| SUBMISSION_COMPLETE_DATE | Calc | Date | 8 | 8796-8803 | Submission processing completion date |
| SUBMITTING_USER_ID | Calc | Text | 30 | 8804-8833 | Submitter user ID |
| RESIDENT_MATCH_CRITERIA | Calc | Number | 2 | 8834-8835 | Resident matching criteria |
| RESIDENT_AGE | Calc | Number | 3 | 8836-8838 | Age of resident on the target date |
| BIRTHDATE_SUBMIT_CODE | Calc | Code | 1 | 8839-8839 | Birth date submit code |
| C_CCN_NUM | Calc | Text | 12 | 8840-8851 | Calculated Facility CMS Certification Number (CCN) |
| C_HICN_MBI_IND | Calc | Text | 1 | 8852-8852 | Calculated HICN MBI Indicator |
| C_SSNRI_TRNSLTN_HICN_TXT | Calc | Text | 12 | 8853-8864 | SSNRI Translation HICN Text |
| C_SSNRI_TRNSLTN_MBI_TXT | Calc | Text | 12 | 8865-8876 | SSNRI Translation MBI Text |
| CALCULATED_ITEMS_FILLER | Filler | Filler | 463 | 8877-9339 | Calculated items filler |
| DATA_END_INDICATOR | Calc | Code | 1 | 9340-9340 | End of data terminator code |
| CR | Calc | Code | 1 | 9341-9341 | Carriage return (ASCII 013) |
| LF | Calc | Code | 1 | 9342-9342 | Line feed character (ASCII 010) |
NOTICE: These materials are in the public domain and cannot be copyrighted.
Generated: 09/30/2024 02:43:05 PM