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