MPAF Data and Supporting Regulations in 42 CFR Sections 413.337, 413.343, 424.32 and 483.20

Resident Identifier
P1.

Numeric Identifier

SPECIAL b. THERAPIES - Record the number of days and total minutes each of the
following therapies was administered (for at least 15 minutes a day) in the last 7
TREATMENTS,
calendar days (Enter 0 if none or less than 15 min. daily)
PROCE[Note — count only post admission therapies]
DAYS
MIN
DURES, AND (A) = # of days administered for 15 minutes or more
PROGRAMS (B) = total # of minutes provided in last 7 days
(A)
(B)

P8. PHYSICIAN
ORDERS

Q1. DISCHARGE a. Resident expresses/indicates preference to return to the community
POTENTIAL
0. No
1. Yes

a. Speech - language pathology and audiology services

c. Stay projected to be of a short duration—discharge projected
within 90 days (do not include expected discharge due to death)
0. No
2. Within 31-90 days
1. Within 30 days
3. Discharge status uncertain

b. Occupational therapy
c. Physical therapy
d. Respiratory therapy

Q2.

e. Psychological therapy (by any licensed mental health
professional)

P3. NURSING
REHABILITATION/
RESTORATIVE CARE

Record the NUMBER OF DAYS each of the following rehabilitation or
restorative techniques or practices was provided to the residents for
more than or equal to 15 minutes per day in the last 7 days
(ENTER 0 if none or less than15 min. daily.)
a. Range of motion (passive)

f. Walking

b. Range of motion (active)

g. Dressing or grooming

c. Splint or brace assistance

P4.

h. Eating or swallowing

TRAINING AND SKILL
PRACTICE IN:

i. Amputation/prosthesis care

d. Bed mobility

j. Communication

e. Transfer

k. Other

DEVICES Use the following codes for last 7 days:
AND
0. Not used
RESTRAINTS
1. Used less than daily
2. Used daily
Bed rails
a. —Full bed rails on all open sides of bed

OVERALL Resident’s overall level of self sufficiency has changed significantly as
CHANGE IN compared to status of 90 days ago (or since last assessment if less
CARE NEEDS than 90 days)
0. No change 1. Improved—receives
2. Deteriorated—receives
fewer supports, needs
more support
less restrictive level of
care
R2. SIGNATURE OF PERSON COORDINATING THE ASSESSMENT:

a. Signature of RN Assessment Coordinator (sign on above line)
b. Date RN Assessment Coordinator
signed as complete
Month
Day
Year
T1.
Skip unless this is a Medicare 5 day or Medicare readmission/return
SPECIAL
TREATMENTS assessment
AND
b. ORDERED THERAPIES—Has physician ordered any of the
PROCEfollowing therapies to begin in FIRST 14 days of stay—physical
DURES
therapy, occupational therapy, or speech pathology service?
0. No
1. Yes

c. Through day15, provide an estimate of the number of days when
at least 1 therapy service can be expected to have been delivered.
d. Through day15, provide an estimate of the number of
therapy minutes (across the therapies) that can be
expected to be delivered.

b. —Other types of side rails used (e.g., half rail, one side)
c. Trunk restraint
d. Limb restraint
e. Chair prevents rising
P7. PHYSICIAN In the LAST 14 DAYS (or since admission if less than 14 days in
facility) how many days has the physician (or authorized assistant or
VISITS
practitioner) examined the resident? (Enter 0 if none)

OMB 0938-0739 expiration date 12/31/2002

In the LAST 14 DAYS (or since admission if less than 14 days in
facility) how many days has the physician (or authorized assistant or
practitioner) changed the resident’s orders? Do not include order
renewals without change. (Enter 0 if none)

T3.

CASE MIX
GROUP

Medicare

State

MDS 2.0 PPS July 2002