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pdfAttachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 1
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Patient Name:
__ __ __ __ __ __ __ __ __ __ __ __
__
(MI)
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
X
X
February 26, 2009
X
X
M0018
X
M0066
M0069
X
M0065
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
M0064
X
__ __ __ __ __ __ __ __ __ __
• UK - Unknown or Not Available
X
M0064 (M0064) Social Security Number:
• UK – Unknown or Not Available
M0065 (M0065) Medicaid Number:
• NA – No Medicaid
M0066 (M0066) Birth Date: month/day/year
M0069 (M0069) Gender:
• 1 - Male
• 2 - Female
M0072 (M0072) Primary Referring Physician ID: (UPIN#)
X
Medicare Number: __ __ __ __ __ __ __ __ __ __ __ __
(including suffix)
• NA – No Medicare
Social Security Number: __ __ __ - __ __ - __ __ __ __
• UK – Unknown or Not Available
Medicaid Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __
• NA – No Medicaid
Birth Date: month/day/year
Gender:
• 1 - Male
• 2 - Female
National Provider Identifier (NPI) for the attending
physician who has signed the plan of care:
__ __ __ __ __ __ __ __ __ __
• UK – Unknown or Not Available
X
M0063
X
Patient Zip Code: __ __ __ __ __ __ __ __ __
(including suffix)
(Suffix)
X
M0060
X
M0063 (M0063) Medicare Number:
• NA – No Medicare
M0050
(Last)
Patient State of Residence: __ __
X
M0060 (M0060) Patient Zip Code:
__ __ __
X
M0050 (M0050) Patient State of Residence:
X
X
(First)
Harmony
M0040
DAH
Start of Care Date: month/ day /year
Resumption of Care Date: month/day/year/ NA
X
X
M0030
M0032
X
Logic
X
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
DC
Patient ID Number:
__ __ __ __ __ __ __ __ __ __
TRF
X
Branch ID Number:
FU
X
Branch State: __ __
X
CMS Certification Number __ __ __ __ __ __
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
M0020
X
M0030 (M0030) Start of Care Date: month/ day /year
M0032 (M0032) Resumption of Care Date:
month/day/year/ NA
M0040 (M0040) Patient Name: First/MI/Last/Suffix
M0016
X
M0020 (M0020) Patient ID Number:
M0014
X
M0016 (M0016) Branch ID Number:
DROPPED
on OASIS-C
X
M0014 (M0014) Branch State:
M0010
X
M0012 (M0012) Agency Medicaid Provider Number
OASIS-C
Item #
X
M0010 (M0010) Agency Medicare Provider Number
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 2
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
FU
TRF
DC
DAH
X
X
X
X
X
X
X
X
X
X
Harmony
ROC
February 26, 2009
X
X
X
X
X
Date Assessment Completed:
month/day/year
X
X
X
X
X
X
X
M0090
X
Current Payment Sources for Home Care: (Mark all
that apply.)
• 0 - None; no charge for current services
• 1 - Medicare (traditional fee-for-service)
• 2 - Medicare (HMO/managed care/Advantage
plan)
• 3 - Medicaid (traditional fee-for-service)
• 4 - Medicaid (HMO/managed care)
• 5 - Workers' compensation
• 6 - Title programs (e.g., Title III, V, or XX)
• 7 - Other government (e.g., TriCare, VA, etc.)
• 8 - Private insurance
• 9 - Private HMO/managed care
• 10 - Self-pay
• 11 - Other (specify)
• UK - Unknown
Discipline of Person Completing Assessment:
• 1-RN • 2-PT • 3-SLP/ST • 4-OT
X
M0150
SOC
DAH
DC
TRF
FU
X
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
Race/Ethnicity:
(Mark all that apply.)
• 1 - American Indian or Alaska Native
• 2 - Asian
• 3 - Black or African-American
• 4 - Hispanic or Latino
• 5 - Native Hawaiian or Pacific Islander
• 6 - White
M0080
Logic
OASIS-C Version 12.1 2-24-2009
Item Text
M0140
X
• 3 - Medicaid (traditional fee-for-service)
• 4 - Medicaid (HMO/managed care)
• 5 - Workers' compensation
• 6 - Title programs (e.g., Title III, V, or XX)
• 7 - Other government (e.g., CHAMPUS, VA, etc.)
• 8 - Private insurance
• 9 - Private HMO/managed care
• 10 - Self-pay
• 11 - Other (specify)
• UK - Unknown
M0080 (M0080) Discipline of Person Completing
Assessment:
• 1-RN • 2-PT • 3-SLP/ST • 4-OT
M0090 (M0090) Date Assessment Completed:
month/day /year
OASIS-C
Item #
X
M0140 (M0140) Race/Ethnicity (as identified by patient):
(Mark all that apply.)
• 1 - American Indian or Alaska Native
• 2 - Asian
• 3 - Black or African-American
• 4 - Hispanic or Latino
• 5 - Native Hawaiian or Pacific Islander
• 6 - White
• UK - Unknown
M0150 (M0150) Current Payment Sources for Home Care:
(Mark all that apply.)
• 0 - None; no charge for current services
• 1 - Medicare (traditional fee-for-service)
• 2 - Medicare (HMO/managed care)
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 3
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
TRF
DC
DAH
X
X
X
X
X
Harmony
FU
X
February 26, 2009
X
M0104
ROC
M0102
X
This Assessment is Currently Being Completed for
the Following Reason:
Start/Resumption of Care
1 – Start of care—further visits planned
3 – Resumption of care (after inpatient stay)
Follow-Up
4 – Recertification (follow-up) reassessment [ Go
to M0110 ]
5 – Other follow-up [ Go to M0110 ]
Transfer to an Inpatient Facility
6 – Transferred to an inpatient facility—patient not
discharged from agency [ Go to M1040 ]
7 – Transferred to an inpatient facility—patient
discharged from agency [ Go to M1040 ]
Discharge from Agency — Not to an Inpatient
Facility
8 – Death at home [ Go to M0906 ]
9 – Discharge from agency [ Go to M1032 ]
Date of Physician-ordered Start of Care
(Resumption of Care): If the physician indicated a
specific start of care (resumption of care) date when
the patient was referred for home health services,
record the date specified.
__ __ /__ __ /__ __ __ __
month / day / year
(Go to M0110, if date entered)
NA –No specific SOC date ordered by physician
Date of Referral: Indicate the date that the written
or documented orders from the physician or
physician designee for initiation or resumption of
care were received by the HHA.
__ __ /__ __ /__ __ __ __
month / day / year
X
M0100
X
OASIS-C Version 12.1 2-24-2009
Item Text
X
X
X
X
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
X
New on
OASISC
X
M0100 (M0100) This Assessment is Currently Being
Completed for the Following Reason:
Start/Resumption of Care
1 – Start of care—further visits planned
3 – Resumption of care (after inpatient stay)
Follow-Up
4 – Recertification (follow-up) reassessment [ Go
to M0110 ]
5 – Other follow-up [ Go to M0110 ]
Transfer to an Inpatient Facility
6 – Transferred to an inpatient facility—patient not
discharged from agency [ Go to M0830 ]
7 – Transferred to an inpatient facility—patient
discharged from agency [ Go to M0830 ]
Discharge from Agency — Not to an Inpatient
Facility
8 – Death at home [ Go to M0906 ]
9 – Discharge from agency [ Go to M0200 ]
New on
OASISC
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Logic
01, 03, 04, 05
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 4
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
X
X
X
CARE
X
X
X
X
February 26, 2009
Harmony
X
From which of the following Inpatient Facilities was
the patient discharged during the past 14 days?
(Mark all that apply.)
1 - Long-term nursing facility
2 - Skilled nursing facility (SNF / TCU)
3 - Hospital emergency department
4 - Short-stay acute hospital (IPPS)
5 - Long-term care hospital (LTCH)
6 - Inpatient rehabilitation hospital or unit (IRF)
7 - Psychiatric hospital or unit
8 - Other (specify)
NA - Patient was not discharged from an inpatient
facility [Go to M1016 ]
Inpatient Discharge Date (most recent):
month/day/year
• UK - Unknown
DAH
X
M1000
DC
FU
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?
• 1 - Early
• 2 - Later
• UK - Unknown
• NA - Not Applicable: No Medicare case mix
group to be defined by this assessment.
TRF
ROC
M0110
X
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
X
OASIS-C
Item #
M1005
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
X
M0180 (M0180) Inpatient Discharge Date (most recent):
month/day/year
• UK - Unknown
X
M0110 (M0110) 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?
• 1 - Early
• 2 - Later
• UK - Unknown
• NA - Not Applicable: No Medicare case mix
group to be defined by this assessment.
At follow-up go to M0230
M0175 (M0175) From which of the following Inpatient
Facilities was the patient discharged during the past
14 days? (Mark all that apply.)
• 1 - Hospital
• 2 - Rehabilitation facility
• 3 - Skilled nursing facility
• 4 - Other nursing home
• 5 - Other (specify)
• NA - Patient was not discharged from an inpatient
facility [If NA, go to M0200 ]
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Logic
1,2
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 5
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
February 26, 2009
DAH
X
X
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
DROPPED
on OASIS-C
(incorporated
as NA in
M1016)
DC
NA - Not applicable
UK - Unknown
__ __ . __ __
__ __ . __ __
__ __ . __ __
__ __ . __ __
TRF
________________________________
________________________________
________________________________
________________________________
FU
List each Inpatient Procedure and the associated
ICD-9-CM procedure code relevant to the plan of
care.
Inpatient Procedure
Procedure Code
a.
b.
c.
d.
M0200 (M0200) Medical or Treatment Regimen Change
Within Past 14 Days: Has this patient experienced
a change in medical or treatment regimen (e.g.,
medication, treatment, or service change due to
new or additional diagnosis, etc.) within the last 14
days?
• 0 - No [ If No, go to M0220; if No at Discharge,
go to M0250 ]
• 1 - Yes
__ __ __ . __ __
__ __ __ . __ __
__ __ __ . __ __
__ __ __ . __ __
__ __ __ . __ __
__ __ __ . __ __
X
M1012
New on
OASISC
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
X
a.
b.
c.
d.
e.
f.
ROC
List each Inpatient Diagnosis and ICD-9-CM code at
the level of highest specificity for only those
conditions treated during an inpatient stay within the
last 14 days (no E codes, or V codes):
Inpatient Facility Diagnosis
ICD-9-CM Code
X
M1010
X
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
OASIS-C
Item #
X
X
M0190 (M0190) List each Inpatient Diagnosis and ICD 9
CM code at the level of highest specificity for only
those conditions treated during an inpatient stay
within the last 14 days (no surgical, E codes, or V
codes):
Inpatient Facility Diagnosis ICD-9-CM
a. (__ __ __ • __ __)
b. (__ __ __ • __ __)
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 6
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
February 26, 2009
DAH
NA - Not applicable (no medical or treatment
regimen changes within the past 14 days)
Conditions Prior to Medical or Treatment Regimen
Change or Inpatient Stay Within Past 14 Days: If
this patient experienced an inpatient facility
discharge or change in medical or treatment
regimen within the past 14 days, indicate any
conditions which existed prior to the inpatient stay
or change in medical or treatment regimen. (Mark
all that apply.)
1 - Urinary incontinence
2 - Indwelling/suprapubic catheter
3 - Intractable pain
4 - Impaired decision-making
5 - Disruptive or socially inappropriate behavior
6 - Memory loss to the extent that supervision
required
7 - None of the above
NA - No inpatient facility discharge and no change
in medical or treatment regimen in past 14 days
UK - Unknown
DC
__ __ __ . __ __
__ __ __ . __ __
__ __ __ . __ __
__ __ __ . __ __
__ __ __ . __ __
__ __ __ . __ __
TRF
X
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
M1018
X
M0220 (M0220) Conditions Prior to Medical or Treatment
Regimen Change or Inpatient Stay Within Past 14
Days: If this patient experienced an inpatient facility
discharge or change in medical or treatment
regimen within the past 14 days, indicate any
conditions which existed prior to the inpatient stay or
change in medical or treatment regimen. (Mark all
that apply.)
• 1 - Urinary incontinence
• 2 - Indwelling/suprapubic catheter
• 3 - Intractable pain
• 4 - Impaired decision-making
• 5 - Disruptive or socially inappropriate behavior
• 6 - Memory loss to the extent that supervision
required
• 7 - None of the above
• NA - No inpatient facility discharge and no change
in medical or treatment regimen in past 14 days
• UK - Unknown
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
FU
a.
b.
c.
d.
e.
f.
ICD-9-CM
Code
X
X
Changed Medical Regimen Diagnosis
X
Diagnoses Requiring Medical or Treatment
Regimen Change Within Past 14 Days: List the
patient's Medical Diagnoses and ICD-9-CM codes
at the level of highest specificity for those conditions
requiring changed medical or treatment regimen
within the past 14 days. (no surgical, E codes, or V
codes):
ROC
M1016
X
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
X
X
M0210 (M0210) List the patient's Medical Diagnoses and
ICD 9 CM codes at the level of highest specificity for
those conditions requiring changed medical or
treatment regimen (no surgical, E codes, or V
codes)::
Changed Medical Regimen Diagnosis ICD-9-CM
a. (__ __ __ • __ __)
b. (__ __ __ • __ __)
c. (__ __ __ • __ __)
d. (__ __ __ • __ __)
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 7
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
X
TRF
FU
February 26, 2009
X
X
M1020, Diagnoses, Symptom Control, and Payment
1022, 1024 Diagnoses: List each diagnosis for which the
patient is receiving home care (Column 1) and
enter its ICD-9-CM code at the level of highest
specificity (no surgical/procedure codes) (Column
2). Diagnoses are listed in the order that best reflect
the seriousness of each condition and support the
disciplines and services provided. Rate the degree
of symptom control for each condition (Column 2).
Choose one value that represents the degree of
symptom control appropriate for each diagnosis: V
codes (for M1020 or M1022) or E codes (for M1022
only) may be used. ICD-9-CM sequencing
requirements must be followed if multiple coding is
indicated for any diagnoses. If a V code is reported
in place of a case mix diagnosis, then optional item
M1024 Payment Diagnoses (Columns 3 and 4) may
be completed. A case mix diagnosis is a diagnosis
that determines the Medicare PPS case mix group.
Do not assign symptom control ratings for V or E
codes.
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
X
M0230 M0230/240/246 Diagnoses, Severity Index, and
Payment Diagnoses: List each diagnosis for which
the patient is receiving home care (Column 1) and
enter its ICD-9-CM code at the level of highest
specificity (no surgical/procedure codes) (Column 2)
. Rate each condition (Column 2) using the severity
index. (Choose one value that represents the most
severe rating appropriate for each diagnosis.) V
codes (for M0230 or M0240) or E codes (for M0240
only) may be used. ICD-9-CM sequencing
requirements must be followed if multiple coding is
indicated for any diagnoses. If a V code is reported
in place of a case mix diagnosis, then optional item
M0246 Payment Diagnoses (Columns 3 and 4) may
be completed. A case mix diagnosis is a diagnosis
that determines the Medicare PPS case mix group.
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
valid ICD9
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 8
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
February 26, 2009
TRF
M1020, Code each row according to the following directions
1022, 1024 for each column:
Column 1: Enter the description of the diagnosis.
cont.
Column 2: Enter the ICD-9-CM code for the
diagnosis described in Column 1; Rate the degree
of symptom control for the condition listed in
Column 1 using the following scale:
0 - Asymptomatic, no treatment needed at this time
1 - Symptoms well controlled with current therapy
2 - Symptoms controlled with difficulty, affecting
daily functioning; patient needs ongoing monitoring
3 - Symptoms poorly controlled; patient needs
frequent adjustment in treatment &dose monitoring
4 - Symptoms poorly controlled; history of rehospitalizations
- Note that in Column 2 the rating for symptom
control of each diagnosis should not be used
to determine the sequencing of the diagnoses listed
in Column 1. These are separate items and
sequencing may not coincide. Sequencing of
diagnoses should reflect the seriousness of each
condition and support the disciplines and services
provided.
Column 3: (OPTIONAL) If a V code is assigned to
any row in Column 2, in place of a case mix
diagnosis, it may be necessary to complete optional
item M1024 Payment Diagnoses (Columns 3 and
4). See OASIS C Guidance Manual.
Column 4: (OPTIONAL) If a V code in Column 2 is
reported in place of a case mix diagnosis that
requires multiple diagnosis codes under ICD-9-CM
coding guidelines, enter the diagnosis descriptions
and the ICD-9-CM codes in the same row in
Columns 3 and 4. For example, if the case mix
diagnosis is a manifestation code, record the
diagnosis description and ICD-9-CM code for the
underlying condition in Column 3 of that row and the
diagnosis description and ICD-9-CM code for the
manifestation in Column 4 of that row. Otherwise,
leave Column 4 blank in that row.
FU
OASIS-C Version 12.1 2-24-2009
Item Text
ROC
OASIS-C
Item #
SOC
DAH
DC
TRF
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
FU
M230, Code each row as follows:
cont.
Column 1: Enter the description of the diagnosis.
Column 2: Enter the ICD-9-CM code for the
diagnosis described in Column 1;
Rate the severity of the condition listed in Column 1
using the following scale:
0 - Asymptomatic, no treatment needed at this time
1 - Symptoms well controlled with current therapy
2 - Symptoms controlled with difficulty, affecting
daily functioning; patient needs ongoing monitoring
3 - Symptoms poorly controlled; patient needs
frequent adjustment in treatment and dose
monitoring
4 - Symptoms poorly controlled; history of rehospitalizations
Column 3: (OPTIONAL) If a V code reported in any
row in Column 2 is reported in place of a case mix
diagnosis, list the appropriate case mix diagnosis
(the description and the ICD-9-CM code) in the
same row in Column 3. Otherwise, leave Column
3blank in that row.
Column 4: (OPTIONAL) If a V code in Column 2 is
reported in place of a case mix diagnosis that
requires multiple diagnosis codes under ICD-9-CM
coding guidelines, enter the diagnosis descriptions
and the ICD-9-CM codes in the same row in
Columns 3 and 4. For example, if the case mix
diagnosis is a manifestation code, record the
diagnosis description and ICD-9-CM code for the
underlying condition in Column 3 of that row and the
diagnosis description and ICD-9-CM code for the
manifestation in Column 4 of that row. Otherwise,
leave Column 4 blank in that row.
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 9
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
X
Column 3 - Complete if a V code is assigned under
certain circumstances to Column 2
in place of a case mix diagnosis. - Description/ICD9-CM
Column 4 - Complete only if the V code in Column 2
is reported in place of a case mix
diagnosis that is a multiple coding situation (e.g., a
manifestation code).- Description/ICD-9-CM
M0246 see M0230
X
$
1,2,3
X
X
X
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
X
X
M0250 (M0250) Therapies the patient receives at home:
(Mark all that apply.)
1 - Intravenous or infusion therapy (excludes TPN)
2 - Parenteral nutrition (TPN or lipids)
3 - Enteral nutrition (nasogastric, gastrostomy,
jejunostomy, or any other artificial entry into the
alimentary canal)
4 - None of the above
$
valid ICD9
M1020, See above
1022, 1024
cont.
M1030
Therapies the patient receives at home: (Mark all
that apply.)
1 - Intravenous or infusion therapy (excludes TPN)
2 - Parenteral nutrition (TPN or lipids)
3 - Enteral nutrition (nasogastric, gastrostomy,
jejunostomy, or any other artificial entry into the
alimentary canal)
4 - None of the above
February 26, 2009
Harmony
X
X
X
X
X
Column 2 - ICD-9-CM and symptom control rating
for each condition
(Note that the sequencing of these ratings may not
match the sequencing of the diagnoses.)
ICD-9-CM / Symptom Control Rating
DAH
X
X
Column 1 - Diagnoses - (Sequencing of diagnoses
should reflect the seriousness of each
condition and support the disciplines and services
provided.) - Description
DC
FU
X
X
M1020, COLUMN HEADINGS for (M1020) Primary
1022, 1024 Diagnosis, (M1022) Other Diagnoses, &
cont.
(M1024) Payment Diagnoses (OPTIONAL)
TRF
ROC
X
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
M0240 see M0230
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
valid ICD9
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 10
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
X
X
X
M1032
X
February 26, 2009
Harmony
X
X
DROPPED
on OASIS-C
DAH
X
DC
X
TRF
ROC
Risk for Hospitalization: Which of the following
signs or symptoms characterize this patient as at
risk for hospitalization? (Mark all that apply.)
1 - Recent decline in mental, emotional, or
behavioral status
2 - Multiple hospitalizations (2 or more) in the past
12 months
3 - History of falls (2 or more falls - or any fall with
an injury - in the past year)
4 - Taking five or more medications
5 - Frailty indicators, e.g., weight loss, selfreported exhaustion
6 - Other
7 - None of the above
FU
SOC
DAH
DC
TRF
FU
OASIS-C Version 12.1 2-24-2009
Item Text
DROPPED
on OASIS-C
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
OASIS-C
Item #
DROPPED
on OASIS-C
X
M0260 (M0260) Overall Prognosis: BEST description of
patient's overall prognosis for recovery from this
episode of illness.
• 0 - Poor: little or no recovery is expected and/or
further decline is imminent
• 1 - Good/Fair: partial to full recovery is expected
• UK – Unknown
M0270 (M0270) Rehabilitative Prognosis: BEST
description of patient's prognosis for functional
status.
• 0 - Guarded: minimal improvement in functional
status is expected; decline is possible
• 1 - Good: marked improvement in functional
status is expected
• UK - Unknown
M0280 (M0280) Life Expectancy: (Physician documentation
is not required.)
• 0 - Life expectancy is greater than 6 months
• 1 - Life expectancy is 6 months or fewer
New on
OASISC
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 11
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
X
X
X
NQF
X
X
February 26, 2009
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
M1040
ROC
New on
OASISC
X
• 1 - Heavy smoking
• 2 - Obesity
• 3 - Alcohol dependency
• 4 - Drug dependency
• 5 - None of the above
• UK - Unknown
X
M1036
X
M0290 (M0290) High Risk Factors characterizing this
patient: (Mark all that apply.)
Overall Status: Which description best fits the
patient’s overall status? (Check one)
0 - The patient is stable with no heightened risk(s)
for serious complications and death (beyond those
typical of the patient’s age).
1 - The patient is temporarily facing high health
risk(s) but is likely to return to being stable without
heightened risk(s) for serious complications and
death (beyond those typical of the patient’s age).
2 - The patient is likely to remain in fragile health
and have ongoing high risk(s) of serious
complications and death.
3 - The patient has serious progressive conditions
that could lead to death within a year.
UK - The patient’s situation is unknown or unclear.
Risk Factors, either present or past, likely to affect
current health status and/or outcome: (Mark all that
apply.)
1 - Smoking
2 - Obesity
3 - Alcohol dependency
4 - Drug dependency
5 - None of the above
UK – Unknown
M1038 - Guidelines for Physician Notification MOVED TO ITEM M2250
Influenza Vaccine: Did the patient receive the
influenza vaccine from your agency for this year’s
influenza season (October 1 through March 31)
during this episode of care?
0 - No
1 - Yes [ Go to M1050 ]
NA - Does not apply because entire episode of
care (SOC/ROC to Transfer/Discharge) is outside
this influenza season. [ Go to M1050 ]
DC
M1034
FU
New on
OASISC
X
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
DAH
TRF
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 12
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
NQF
NQF
X
NQF
Harmony
X
DAH
X
February 26, 2009
DC
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
X
M1055
X
New on
OASISC
X
M1050
TRF
New on
OASISC
Reason Influenza Vaccine not received: If the
patient did not receive the influenza vaccine from
your agency during this episode of care, state
reason:
1 - Received from another health care provider
(e.g., physician)
2 - Received from your agency previously during
this year’s flu season
3 - Offered and declined
4 - Assessed and determined to have medical
contraindication(s)
5 - Not indicated; patient does not meet age/
condition guidelines for influenza vaccine
6 - Inability to obtain vaccine due to declared
shortage
7 - None of the above
Pneumococcal Vaccine: Did the patient receive
pneumococcal polysaccharide vaccine (PPV) from
your agency during this episode of care (SOC/ROC
to Transfer/Discharge)?
0 - No
1 - Yes [ Go to M1246 at TRN; Go to M1100 at DC ]
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:
1 - Patient has received PPV in the past
2 - Offered and declined
3 - Assessed and determined to have medical
contraindication(s)
4 - Not indicated; patient does not meet
age/condition guidelines for PPV
5 - None of the above
FU
M1045
ROC
New on
OASISC
DC
OASIS-C Version 12.1 2-24-2009
Item Text
FU
OASIS-C
Item #
SOC
DAH
TRF
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 13
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
ROC
SOC
DAH
DC
TRF
FU
OASIS-C Version 12.1 2-24-2009
Item Text
X
X
DROPPED
on OASIS-C
X
X
X
DROPPED
on OASIS-C
-
X
X
X
DROPPED
on OASIS-C
X
X
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
OASIS-C
Item #
DROPPED
on OASIS-C
X
M0300 (M0300) Current Residence:
• 1 - Patient's owned or rented residence (house,
apartment, or mobile home owned or rented by
patient/couple/significant other)
• 2 - Family member's residence
• 3 - Boarding home or rented room
• 4 - Board and care or assisted living facility
• 5 - Other (specify)
M0340 (M0340) Patient Lives With: (Mark all that apply.)
• 1 - Lives alone
• 2 - With spouse or significant other
• 3 - With other family member
• 4 - With a friend
• 5 - With paid help (other than home care agency
staff)
• 6 - With other than above
M0350 (M0350) Assisting Person(s) Other than Home Care
Agency Staff: (Mark all that apply.)
• 1 - Relatives, friends, or neighbors living outside
the home
• 2 - Person residing in the home (EXCLUDING
paid help)
• 3 - Paid help
• 4 - None of the above [ If None of the above, go
to M0390 ]
• UK - Unknown [ If Unknown, go to M0390 ]
M0360 (M0360) Primary Caregiver taking lead
responsibility for providing or managing the patient's
care, providing the most frequent assistance, etc.
(other than home care agency staff):
• 0 - No one person [ If No one person, go to
M0390 ]
• 1 - Spouse or significant other
• 2 - Daughter or son
• 3 - Other family member
• 4 - Friend or neighbor or community or church
member
• 5 - Paid help
• UK - Unknown [ If Unknown, go to M0390 ]
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
February 26, 2009
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 14
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
ROC
X
X
X
X
February 26, 2009
SOC
DAH
DC
TRF
FU
OASIS-C Version 12.1 2-24-2009
Item Text
DROPPED
on OASIS-C
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
OASIS-C
Item #
DROPPED
on OASIS-C
X
M0370 (M0370) How Often does the patient receive
assistance from the primary caregiver?
• 1 - Several times during day and night
• 2 - Several times during day
• 3 - Once daily
• 4 - Three or more times per week
• 5 - One to two times per week
• 6 - Less often than weekly
• UK - Unknown
M0380 (M0380) Type of Primary Caregiver Assistance:
(Mark all that apply.)
• 1 - ADL assistance (e.g., bathing, dressing,
toileting, bowel/bladder, eating/feeding)
• 2 - IADL assistance (e.g., meds, meals,
housekeeping, laundry, telephone, shopping,
finances)
• 3 - Environmental support (housing, home
maintenance)
• 4 - Psychosocial support (socialization,
companionship, recreation)
• 5 - Advocates or facilitates patient's participation
in appropriate medical care
• 6 - Financial agent, power of attorney, or
conservator of finance
• 7 - Health care agent, conservator of person, or
medical power of attorney
• UK - Unknown
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 15
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
X
X
February 26, 2009
X
M1200
X
Patient Living Situation: Which of the following best
describes the patient's residential circumstance and
availability of assistance? (Check one box only).
MATRIX
ROWS: Living Arrangement
a Patient lives alone • 01 • 02 • 03 • 04 • 05
b Patient lives with other person(s) in the home • 06
• 07 • 08 • 09 • 10
c Patient lives in congregate situation (e.g., assisted
living) • 11 • 12 • 13 • 14 • 15
BY COLUMNS: Availability of Assistance:
- Around the clock 01-06-11
- Regular daytime 02-07-12
- Regular nighttime 03-08-13
- Occasional / short-term assistance 04-09-14
- No assistance available 05-10-15
Vision (with corrective lenses if the patient usually
wears them):
0 - Normal vision: sees adequately in most
situations; can see medication labels, newsprint.
1 - Partially impaired: cannot see medication
labels or newsprint, but can see obstacles in path,
and the surrounding layout; can count fingers at
arm's length.
2 - Severely impaired: cannot locate objects
without hearing or touching them or patient
nonresponsive.
ROC
M1100
X
X
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
$
01,02
X
M0390 (M0390) Vision with corrective lenses if the patient
usually wears them:
• 0 - Normal vision: sees adequately in most
situations; can see medication labels, newsprint.
• 1 - Partially impaired: cannot see medication
labels or newsprint, but can see obstacles in path,
and the surrounding layout; can count fingers at
arm's length.
• 2 - Severely impaired: cannot locate objects
without hearing or touching them or patient
nonresponsive.
OASIS-C Version 12.1 2-24-2009
Item Text
X
New on
OASISC
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 16
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
CARE
February 26, 2009
X
Understanding of Verbal Content in patient's own
language (with hearing aid or device if used):
0 - Understands: clear comprehension without
cues or repetitions.
1 - Usually Understands: understands most
conversations, but misses some part/intent of
message. Requires cues at times to understand.
2 - Sometimes Understands: understands only
basic conversations or simple, direct phrases.
Frequently requires cues to understand.
3 - Rarely/Never Understands
UK - Unable to assess understanding.
X
M1220
ROC
Ability to hear (with hearing aid or hearing appliance
if normally used):
0 - Adequate: hears normal conversation without
difficulty.
1 - Mildly to Moderately Impaired: difficulty hearing
in some environments or speaker may need to
increase volume or speak distinctly.
2 - Severely Impaired: absence of useful hearing.
UK - Unable to assess hearing.
X
M1210
X
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
OASIS-C
Item #
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
X
M0400 (M0400) Hearing and Ability to Understand Spoken
Language in patient's own language (with hearing
aids if the patient usually uses them):
• 0 - No observable impairment. Able to hear and
understand complex or detailed instructions and
extended or abstract conversation.
• 1 - With minimal difficulty, able to hear and
understand most multi-step instructions and
ordinary conversation. May need occasional
repetition, extra time, or louder voice.
• 2 - Has moderate difficulty hearing and
understanding simple, one-step instructions and
brief conversation; needs frequent prompting or
assistance.
• 3 - Has severe difficulty hearing and
understanding simple greetings and short
comments. Requires multiple repetitions,
restatements, demonstrations, additional time.
• 4 - Unable to hear and understand familiar words
or common expressions consistently, or patient
nonresponsive.
New on
OASISC
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 17
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
X
February 26, 2009
X
X
M1240
2 - Expresses simple ideas or needs with
moderate difficulty (needs prompting or assistance,
errors in word choice, organization or speech
intelligibility). Speaks in phrases or short
sentences.
3 - Has severe difficulty expressing basic ideas or
needs and requires maximal assistance or guessing
by listener. Speech limited to single words or short
phrases.
4 - Unable to express basic needs even with
maximal prompting or assistance but is not
comatose or unresponsive (e.g., speech is
nonsensical or unintelligible).
5 - Patient nonresponsive or unable to speak.
Has this patient had a formal Pain Assessment
using a standardized pain assessment tool
(appropriate to the patient’s ability to communicate
the severity of pain)?
• 0 - No standardized assessment conducted
• 1 - Yes, and it does not indicate severe pain
• 2 - Yes, and it indicates severe pain
X
Speech and Oral (Verbal) Expression of Language
(in patient's own language):
0 - Expresses complex ideas, feelings, and needs
clearly, completely, and easily in all situations with
no observable impairment.
1 - Minimal difficulty in expressing ideas and needs
(may take extra time; makes occasional errors in
word choice, grammar or speech intelligibility;
needs minimal prompting or assistance)
ROC
M1230
X
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
X
M0410 (M0410) Speech and Oral (Verbal) Expression of
Language (in patient's own language):
• 0 - Expresses complex ideas, feelings, and needs
clearly, completely, and easily in all situations with
no observable impairment.
• 1 - Minimal difficulty in expressing ideas and
needs (may take extra time; makes occasional
errors in word choice, grammar or speech
intelligibility; needs minimal prompting or
assistance).
• 2 - Expresses simple ideas or needs with
moderate difficulty (needs prompting or assistance,
errors in word choice, organization or speech
intelligibility). Speaks in phrases or short
sentences.
• 3 - Has severe difficulty expressing basic ideas or
needs and requires maximal assistance or guessing
by listener. Speech limited to single words or short
phrases.
• 4 - Unable to express basic needs even with
maximal prompting or assistance but is not
comatose or unresponsive (e.g., speech is
nonsensical or unintelligible).
• 5 - Patient nonresponsive or unable to speak.
New on
OASISC
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 18
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
February 26, 2009
X
M1300
X
New on
OASISC
Harmony
X
X
M1246
(M1244 Pain Intervention in Plan of Care - MOVED
TO M2250)
Pain Intervention: Since the previous OASIS
assessment, were pain management steps to
monitor and mitigate pain BOTH included in the
physician-ordered plan of care AND implemented?
0 - No
1 - Yes
NA - Formal assessment did not indicate pain
since the last OASIS assessment
Pressure Ulcer Assessment: Was this patient
assessed for Risk of Developing Pressure Ulcers?
0 - No assessment conducted [ Go to M1306 ]
1 - Yes, based on an evaluation of clinical factors,
e.g., mobility, incontinence, nutrition, etc., without
use of standardized tool
2 - Yes, using a standardized tool, e.g., Braden,
Norton, other
DAH
X
X
X
DC
FU
X
TRF
ROC
X
X
X
X
New on
OASISC
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
Frequency of Pain Interfering with patient's activity
or movement:
0 - Patient has no pain
1 - Patient has pain that does not interfere with
activity or movement
2 - Less often than daily
3 - Daily, but not constantly
4 - All of the time
X
M1242
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
OASIS-C
Item #
DROPPED
on OASIS-C
X
M0430 (M0430) Intractable Pain: Is the patient
experiencing pain that is not easily relieved, occurs
at least daily, and affects the patient's sleep,
appetite, physical or emotional energy,
concentration, personal relationships, emotions, or
ability or desire to perform physical activity?
• 0 - No
• 1 - Yes
X
M0420 (M0420) Frequency of Pain interfering with patient's
activity or movement:
• 0 - Patient has no pain or pain does not interfere
with activity or movement
• 1 - Less often than daily
• 2 - Daily, but not constantly
• 3 - All of the time
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
2,3
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 19
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
X
Harmony
DC
X
DAH
TRF
FU
X
X
PU
FRAMEWORK
X
February 26, 2009
X
M1307
X
M1306
X
Pressure Ulcer Prevention: Since the previous
OASIS assessment, were pressure ulcer prevention
intervention(s) BOTH included in the physicianordered plan of care AND implemented?
0 - No
1 - Yes
NA - Formal assessment indicates the patient was
not at risk of pressure ulcers since the last OASIS
assessment
Does this patient have at least one unhealed (nonepithelialized) Pressure Ulcer at Stage II or higher
or designated as "not stageable"?
0 - No [ Go to M1322 at SOC/ROC/DC; Go to
M1324 at FU ]
1 - Yes
Date of Onset of Oldest Stage II Pressure Ulcer:
0 - Present at SOC/ROC
1 - Identified since most recent SOC/ROC
__ __ /__ __ /__ __ __ __
month / day / yea
ROC
M1304
X
Does this patient have a Risk of Developing
Pressure Ulcers?
0 - No [ Go to M1306 ]
1 - Yes
(former M1304 Pressure Ulcer Prevention in Plan of
Care - MOVED TO M2250)
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
X
New on
OASISC
Logic
X
M0445 (M0445) Does this patient have a Pressure Ulcer?
• 0 - No [ If No, go to M0468 ]
• 1 - Yes
M1302
X
New on
OASISC
New on
OASISC
OASIS-C Version 12.1 2-24-2009
Item Text
X
New on
OASISC
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 20
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
X
MDS
X
X
February 26, 2009
FU
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
X
Pressure Ulcer Length: Longest length “head-to-toe”
| ___ | ___ | . | ___ | (cm)
X
M1310
ROC
Current Number of Unhealed (non-epithelialized)
Pressure Ulcers at Each Stage (2 - 4):
(MATRIX)
(Enter “0” if none; enter “4” if “4 or more”; enter “UK”
for rows d.1 – d.3 if “Unknown”)
ROWS:
Stage description - unhealed pressure ulcers
a.
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.
b.
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.
c.
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.
d.1
Unstageable: Known or likely but not
stageable due to non-removable dressing or device
d.2 Unstageable: Known or likely but not
stageable due to coverage of wound bed by slough
and/or eschar.
d.3 Unstageable: Suspected deep tissue injury in
evolution.
BY COLUMNS:
Number Present
Number of these that were present on admission
(most recent SOC / ROC)
Directions for M1310 and M1312: If the patient has
one or more unhealed (non-epithelialized) Stage III
or IV pressure ulcers, identify the pressure ulcer
with the largest surface dimension (length x width)
and record in centimeters:
X
M1308
X
OASIS-C Version 12.1 2-24-2009
Item Text
X
X
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
X
New on
OASISC
X
M0450 (M0450 b-e) Current Number of Pressure Ulcers at
b-e
Each Stage: (Circle one response for each stage.)
Pressure Ulcer Stages - Number of Pressure
(M0450 Ulcers
a:
b) Stage 2: Partial thickness skin loss involving
see epidermis and/or dermis. The ulcer is superficial
below) and presents clinically as an abrasion, blister, or
shallow crater. 0 1 2 3 4 or more
c) Stage 3: Full-thickness skin loss involving
damage or necrosis of subcutaneous tissue which
may extend down to, but not through, underlying
fascia. The ulcer presents clinically as a deep
crater with or without undermining of adjacent
tissue. 0 1 2 3 4 or more
d) Stage 4: Full-thickness skin loss with extensive
destruction, tissue necrosis, or damage to muscle,
bone, or supporting structures (e.g., tendon, joint
capsule, etc.) 0 1 2 3 4 or more
e) In addition to the above, is there at least one
pressure ulcer that cannot be observed due to the
presence of eschar or a nonremovable dressing,
including casts?
• 0 - No
• 1 - Yes
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
3,4
NRS: 1,2,3,4
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 21
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
X
X
X
X
X
X
X
X
X
MDS
X
PU FRAME
WORK
X
x
x
x
Intact skin with non-blanchable redness of a
localized area usually over a bony prominence. The
area may be painful, firm, soft, warmer or cooler as
compared to adjacent tissue.
• 0 • 1 • 2 • 3 • 4 or more
X
M1322
$
01,02,03,04
M0460
x
x
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
M1324
x
(M0460) Stage of Most Problematic (Observable)
Pressure Ulcer:
• 1 - Stage 1
• 2 - Stage 2
• 3 - Stage 3
• 4 - Stage 4
• NA - No observable pressure ulcer
Stage of Most Problematic (Observable) Pressure
Ulcer:
• 1 - Stage I [Go to M1330 at SOC/ROC/FU ]
• 2 - Stage II
• 3 - Stage III
• 4 - Stage IV
• NA - No observable pressure ulcer [Go to M1330
at SOC/ROC/FU ]
February 26, 2009
Harmony
X
x
x
a) Stage 1: Nonblanchable erythema of intact skin;
the heralding of skin ulceration. In darkerpigmented skin, warmth, edema, hardness, or
discolored skin may be indicators.
0, 1, 2, 3, 4 or more
[At follow-up, skip to M0470 if patient has no
pressure ulcers]
$
NRS:
01,02,03,04
x
(M0450
b-e:
see
above)
x
• 1 - Fully granulating
• 2 - Early/partial granulation
• 3 - Not healing
• NA - No observable pressure ulcer
M0450a (M0450) Current Number of Pressure Ulcers at
(stage 1) Each Stage: (Circle one response for each stage.)
DAH
X
Status of Most Problematic (Observable) Pressure
Ulcer:
0 - Re-epithelialized
1 - Fully granulating
2 - Early/partial granulation
3 - Not healing
NA - No observable pressure ulcer
Current Number of Stage I Pressure Ulcers:
DC
X
X
M1320
OASIS-C Version 12.1 2-24-2009
Item Text
TRF
ROC
X
M0464 (M0464) Status of Most Problematic (Observable)
Pressure Ulcer:
OASIS-C
Item #
FU
SOC
Pressure Ulcer Depth: Depth of the same pressure
ulcer; from visible surface to the deepest area
| ___ | ___ | . | ___ | (cm)
DAH
M1314
DC
New on
OASISC
TRF
Pressure Ulcer Width: Width of the same pressure
ulcer, greatest width measured at right angles to
length
| ___ | ___ | . | ___ | (cm
FU
M1312
SOC
New on
OASISC
OASIS-B1
Item Text
ROC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 22
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
X
X
X
DC
X
x
x
x
x
x
February 26, 2009
TRF
DROPPED
on OASIS-C
(incorporated
as response
#2 in M1330)
X
$
NRS: 0,1
• 1 - One
• 2 - Two
• 3 - Three
• 4 - Four or more
X
Current Number of (Observable) Stasis Ulcer(s):
FU
M1332
X
Does this patient have a Stasis Ulcer?
• 0 - No [ Go to M1340 ]
• 1 - Yes, patient has one or more (observable)
stasis ulcers
• 2 - Stasis ulcer known or likely but not observable
due to non-removable dressing [ Go to M1340 ]
X
M1330
ROC
Logic
0,1
(Item on RFA
1, 3 only)
used only for
skip logic
checks
$
NRS: 02,03,04
(Item also
used for skip
logic check for
M0476)
X
Pressure Ulcer Intervention: Since the previous
OASIS assessment, were pressure ulcers treated
with dressings used that support the principles of
moist wound healing?
0 - No
1 - Yes
2 - Dressings that support the principles of moist
wound healing not indicated for this patient’s
pressure ulcers
NA - Patient had no Stage II or higher unhealed
pressure ulcers since previous OASIS assessment
X
x
x
x
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
x
M0470 (M0470) Current Number of Observable Stasis
Ulcer(s):
0 - Zero
1 - One
2 - Two
3 - Three
4 - Four or more
M0474 (M0474) Does this patient have at least one Stasis
Ulcer that Cannot be Observed due to the presence
of a nonremovable dressing?
• 0 - No
• 1 - Yes
OASIS-C Version 12.1 2-24-2009
Item Text
M1326
New on
OASISC
M0468 (M0468) Does this patient have a Stasis Ulcer?
0 - No [If No, go to M0482]
1 - Yes
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 23
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
X
M1340
x
x
x
x
x
x
DROPPED
on OASIS-C
00,01,02,03,04 (skip check
(Item only on
can be
RFA 1, 3)
performed
used only for with M1340)
skip logic
check
DROPPED
on OASIS-C
(incorporated
as response
#2 in M1340)
Does this patient have a Surgical Wound?
• 0 - No [ Go to M1350 ]
• 1 - Yes, patient has at least one (observable)
surgical wound
• 2 - Surgical wound known or likely but not
observable due to non-removable dressing [ Go to
M1350 ]
February 26, 2009
Harmony
X
X
x
x
Logic
0,1
(Item on RFA
1, 3 only)
used only for
skip logic
checks
Logic
DAH
X
X
DC
FU
X
TRF
ROC
X
Status of Most Problematic (Observable) Stasis
Ulcer:
• 1 - Fully granulating
• 2 - Early/partial granulation
• 3 - Not healing
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
OASIS-C Version 12.1 2-24-2009
Item Text
X
1 - Fully granulating
2 - Early/partial granulation
3 - Not healing
NA - No observable stasis ulcer
M0482 (M0482) Does this patient have a Surgical Wound?
0 - No [If No, go to M0490]
1 - Yes
M0484 (M0484) Current Number of (Observable) Surgical
Wounds: (If a wound is partially closed but has
more than one opening, consider each opening as a
separate wound.)
• 0 - Zero
• 1 - One
• 2 - Two
• 3 - Three
• 4 - Four or more
M0486 (M0486) Does this patient have at least one
Surgical Wound that Cannot be Observed due to
the presence of a nonremovable dressing?
• 0 - No
• 1 - Yes
M1334
x
x
x
x
M0476 (M0476) Status of Most Problematic (Observable)
Stasis Ulcer:
OASIS-C
Item #
SOC
[At follow-up, skip to M0488 if patient has no stasis
ulcers]
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
02,03
NRS: 01, 02,
03
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 24
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
X
X
X
X
X
February 26, 2009
X
M1400
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?
0 - No
1 - Yes
(M1360 Diabetic Foot Care on Plan of Care MOVED TO 2250)
Diabetic Foot Care Plan Follow-up: Since the
previous OASIS assessment, were orders for
patient/caregiver education and regular monitoring
for the presence of lesions on the lower extremities
BOTH included in the physician-ordered plan of
care AND implemented?
0 - No
1 - Yes
NA - Patient does not have diagnosis of diabetes
OR patient is bi-lateral amputee
When is the patient dyspneic or noticeably Short of
Breath?
0 - Patient is not short of breath
1 - When walking more than 20 feet, climbing stairs
2 - With moderate exertion (e.g., while dressing,
using commode or bedpan, walking distances less
than 20 feet)
3 - With minimal exertion (e.g., while eating, talking,
or performing other ADLs) or with agitation
4 - At rest (during day or night)
Harmony
X
X
M1350
DAH
X
X
DC
FU
X
TRF
ROC
X
x
x
x
X
$
02,03,04
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
Status of Most Problematic (Observable) Surgical
Wound:
0 - Re-epithelialized
1 - Fully granulating
2 - Early/partial granulation
3 - Not healing
M1365
New on
OASISC
X
x
x
x
x
• 0 - No [ If No, go to M0490 ]
• 1 - Yes
Logic
0,1
used only for
skip logic
check
OASIS-C Version 12.1 2-24-2009
Item Text
M1342
x
x
x
x
1 - Fully granulating
2 - Early/partial granulation
3 - Not healing
NA - No observable surgical wound
M0440 (M0440) Does this patient have a Skin Lesion or an
Open Wound? This excludes "OSTOMIES."
M0490 (M0490) When is the patient dyspneic or noticeably
Short of Breath?
0 - Never, patient is not short of breath
1 - When walking more than 20 feet, climbing stairs
2 - With moderate exertion (e.g., while dressing,
using commode or bedpan, walking distances less
than 20 feet)
3 - With minimal exertion (e.g., while eating, talking,
or performing other ADLs) or with agitation
4 - At rest (during day or night)
OASIS-C
Item #
SOC
M0488 (M0488) [At follow-up, skip to M0490 if patient has
no surgical wounds]
Status of Most Problematic (Observable) Surgical
Wound:
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
2,3
NRS: 2,3
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 25
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
X
X
X
X
X
February 26, 2009
TRF
M1510
FU
M1500
X
Respiratory Treatments utilized at home: (Mark all
that apply.)
1 - Oxygen (intermittent or continuous)
2 - Ventilator (continually or at night)
3 - Continuous / Bi-level positive airway pressure
4 - None of the above
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 any point since the previous
OASIS assessment?
0 - No [ Go to M1732 at TRN; Go to M1600 at DC ]
1 - Yes
2 - Not assessed [Go to M1732 at TRN; Go to
M1600 at DC ]
NA - Patient does not have diagnosis of heart
failure [Go to M1732 at TRN; Go to M1600 at DC ]
Heart Failure Follow-up: If patient has been
diagnosed with heart failure and has exhibited
symptoms indicative of heart failure since the
previous OASIS assessment, what action(s) has
(have) been taken to respond? (Mark all that apply.)
0 - No action taken
1 - Patient’s physician (or other primary care
practitioner) contacted the same day
2 - Patient advised to get emergency treatment
(e.g., call 911 or go to emergency room)
3 - Implement physician-ordered patient-specific
established parameters for treatment
4 - Patient education or other clinical interventions
5 - Obtained change in care plan orders (e.g.,
increased monitoring by agency, change in visit
frequency, telehealth, etc.)
ROC
M1410
X
OASIS-C Version 12.1 2-24-2009
Item Text
x
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
New on
OASISC
x
M0500 (M0500) Respiratory Treatments utilized at home:
(Mark all that apply.)
• 1 - Oxygen (intermittent or continuous)
• 2 - Ventilator (continually or at night)
• 3 - Continuous positive airway pressure
• 4 - None of the above
New on
OASISC
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 26
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
X
X
X
X
X
X
X
X
X
FU
X
x
x
x
ROC
x
x
x
February 26, 2009
X
x
x
x
M1620
1 - Patient is incontinent
2 - Patient requires a urinary catheter (i.e.,
external, indwelling, intermittent, suprapubic)
[ Go to M1620 ]
When does Urinary Incontinence occur?
0 - Timed-voiding defers incontinence
1 - Occasional stress incontinence
2 - During the night only
3 - During the day only
4 - During the day and night
Bowel Incontinence Frequency:
0 - Very rarely or never has bowel incontinence
1 - Less than once weekly
2 - One to three times weekly
3 - Four to six times weekly
4 - On a daily basis
5 - More often than once daily
NA - Patient has ostomy for bowel elimination
UK - Unknown
X
M1610
X
Has this patient been treated for a Urinary Tract
Infection in the past 14 days?
0 - No
1 - Yes
NA - Patient on prophylactic treatment
UK - Unknown
Urinary Incontinence or Urinary Catheter
Presence:
0 - No incontinence or catheter (includes anuria or
ostomy for urinary drainage) [ Go to M1620 ]
X
M1600
x
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
x
$
02,03,04, 05
NRS: 04, 05
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
OASIS-C
Item #
M1615
x
2 - During the day and night
M0540 (M0540) Bowel Incontinence Frequency:
0 - Very rarely or never has bowel incontinence
1 - Less than once weekly
2 - One to three times weekly
3 - Four to six times weekly
4 - On a daily basis
5 - More often than once daily
NA - Patient has ostomy for bowel elimination
UK - Unknown
$
NRS: 2
x
1 - During the night only
x
M0510 (M0510) Has this patient been treated for a Urinary
Tract Infection in the past 14 days?
• 0 - No
• 1 - Yes
• NA - Patient on prophylactic treatment
• UK - Unknown
M0520 (M0520) Urinary Incontinence or Urinary Catheter
Presence:
0 - No incontinence or catheter (includes anuria or
ostomy for urinary drainage)
[If No, go to M0540]
1 - Patient is incontinent
2 - Patient requires a urinary catheter (i.e., external,
indwelling, intermittent, suprapubic)
[Go to M0540]
M0530 (M0530) When does Urinary Incontinence occur?
0 - Timed-voiding defers incontinence
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 27
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
X
X
X
DC
FU
X
TRF
ROC
x
x
February 26, 2009
X
Ostomy for Bowel Elimination: 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?
0 - Patient does not have an ostomy for bowel
elimination.
1 - Patient's ostomy was not related to an inpatient
stay and did not necessitate change in medical or
treatment regimen.
2 - The ostomy was related to an inpatient stay or
did necessitate change in medical or treatment
regimen.
Cognitive Functioning: Patient's current (day of
assessment) level of alertness, orientation,
comprehension, concentration, and immediate
memory for simple commands.
0 - Alert/oriented, able to focus and shift attention,
comprehends and recalls task directions
independently.
1 - Requires prompting (cuing, repetition,
reminders) only under stressful or unfamiliar
conditions.
2 - Requires assistance and some direction in
specific situations (e.g., on all tasks involving
shifting of attention), or consistently requires low
stimulus environment due to distractibility.
3 - Requires considerable assistance in routine
situations. Is not alert and oriented or is unable to
shift attention and recall directions more than half
the time.
4 - Totally dependent due to disturbances such as
constant disorientation, coma, persistent vegetative
state, or delirium.
X
M1630
x
x
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
x
OASIS-C
Item #
M1700
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
M0550 (M0550) Ostomy for Bowel Elimination: 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?
0 - Patient does not have an ostomy for bowel
elimination.
1 - Patient's ostomy was not related to an inpatient
stay and did not necessitate change in medical or
treatment regimen.
2 - The ostomy was related to an inpatient stay or
did necessitate change in medical or treatment
regimen.
M0560 (M0560) Cognitive Functioning: (Patient's current
level of alertness, orientation, comprehension,
concentration, and immediate memory for simple
commands.)
• 0 - Alert/oriented, able to focus and shift attention,
comprehends and recalls task directions
independently.
• 1 - Requires prompting (cuing, repetition,
reminders) only under stressful or unfamiliar
conditions.
• 2 - Requires assistance and some direction in
specific situations (e.g., on all tasks involving
shifting of attention), or consistently requires low
stimulus environment due to distractibility.
• 3 - Requires considerable assistance in routine
situations. Is not alert and oriented or is unable to
shift attention and recall directions more than half
the time.
• 4 - Totally dependent due to disturbances such as
constant disorientation, coma, persistent vegetative
state, or delirium.
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
01,02
NRS: 01,02
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 28
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
X
X
Harmony
X
February 26, 2009
DAH
X
When Anxious (Reported or Observed Within the
Last 14 Days):
0 - None of the time
1 - Less often than daily
2 - Daily, but not constantly
3 - All of the time
NA - Patient nonresponsive
DC
X
M1720
TRF
When Confused (Reported or Observed Within the
Last 14 Days):
0 - Never
1 - In new or complex situations only
2 - On awakening or at night only
3 - During the day and evening, but not constantly
4 - Constantly
NA - Patient nonresponsive
FU
ROC
M1710
X
x
x
OASIS-C Version 12.1 2-24-2009
Item Text
x
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
• 0 - None of the time
• 1 - Less often than daily
• 2 - Daily, but not constantly
• 3 - All of the time
• NA - Patient nonresponsive
x
• 0 - Never
• 1 - In new or complex situations only
• 2 - On awakening or at night only
• 3 - During the day and evening, but not constantly
• 4 - Constantly
• NA - Patient nonresponsive
M0580 (M0580) When Anxious (Reported or Observed):
OASIS-C
Item #
SOC
M0570 (M0570) When Confused (Reported or Observed):
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 29
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
CARE
February 26, 2009
DC
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
TRF
2 - Yes, with a different standardized assessmentand the patient meets criteria for further evaluation
for depression.
3 - Yes, patient was screened with a different
standardized assessment-and the patient does not
meet criteria for further evaluation for depression.
FU
Depression Screening: Has the patient been
screened for depression, using a standardized
depression screening tool?
0 - No
1 - Yes, patient was screened using the
PHQ-2© scale. (Instructions for this two-question
tool: Ask patient: “Over the last two weeks, how
often have you been bothered by any of the
following problems”)
(Matrix)
ROWS:
a) Little interest or pleasure in doing things
b) Feeling down, depressed, or hopeless?
by COLUMNS:
- Not at all (0 - 1 day) (0)
- Several days (2 - 6 days) (1)
- More than half of the days (7 – 11 days) (2)
- Nearly every day (12 – 14 days) (3)
- N/A - Unable to respond
X
M1730
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
New on
OASISC
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 30
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
X
February 26, 2009
DC
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
X
x
x
M1734 - Depression Intervention on Plan of Care MOVED to M2250
TRF
Depression Intervention Implementation: Since the
previous OASIS assessment, were intervention(s)
for depression (such as medication, referral for
treatment and/or a monitoring plan) BOTH included
in the physician-ordered plan of care AND
implemented?
0 - No
1 - Yes
NA - Formal assessment indicates patient did not
meet criteria for depression AND patient did not
have diagnosis of depression since the last OASIS
assessment
FU
M1732
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
DROPPED
on OASIS-C
x
M0590 (M0590) Depressive Feelings Reported or
Observed in Patient: (Mark all that apply.)
• 1 - Depressed mood (e.g., feeling sad, tearful)
• 2 - Sense of failure or self reproach
• 3 - Hopelessness
• 4 - Recurrent thoughts of death
• 5 - Thoughts of suicide
• 6 - None of the above feelings observed or
reported
OASIS-C
Item #
SOC
New on
OASISC
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 31
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
X
Harmony
X
DAH
X
X
DC
X
TRF
X
FU
ROC
X
x
x
X
x
x
February 26, 2009
X
Cognitive, behavioral, and psychiatric symptoms
that are demonstrated at least once a week
(Reported or Observed): (Mark all that apply.)
1 - Memory deficit: failure to recognize familiar
persons/places, inability to recall events of past 24
hours, significant memory loss so that supervision is
required
2 - Impaired decision-making: failure to perform
usual ADLs or IADLs, inability to appropriately stop
activities, jeopardizes safety through actions
3 - Verbal disruption: yelling, threatening,
excessive profanity, sexual references, etc.
4 - Physical aggression: aggressive or combative
to self and others (e.g., hits self, throws objects,
punches, dangerous maneuvers with wheelchair or
other objects)
5 - Disruptive, infantile, or socially inappropriate
behavior (excludes verbal actions)
6 - Delusional, hallucinatory, or paranoid behavior
7 - None of the above behaviors demonstrated
Frequency of Disruptive Behavior Symptoms
(Reported or Observed) Any physical, verbal, or
other disruptive/dangerous symptoms that are
injurious to self or others or jeopardize personal
safety.
0 - Never
1 - Less than once a month
2 - Once a month
3 - Several times each month
4 - Several times a week
5 - At least daily
Is this patient receiving Psychiatric Nursing
Services at home provided by a qualified psychiatric
nurse?
0 – No
1 - Yes
x
M1740
SOC
DAH
DC
TRF
FU
x
OASIS-C Version 12.1 2-24-2009
Item Text
M1750
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
OASIS-C
Item #
M1745
x
M0630 (M0630) Is this patient receiving Psychiatric Nursing
Services at home provided by a qualified psychiatric
nurse?
• 0 - No
• 1 - Yes
x
M0610 (M0610) Behaviors Demonstrated at Least Once a
Week (Reported or Observed): (Mark all that
apply.)
• 1 - Memory deficit: failure to recognize familiar
persons/places, inability to recall events of past 24
hours, significant memory loss so that supervision is
required
• 2 - Impaired decision-making: failure to perform
usual ADLs or IADLs, inability to appropriately stop
activities, jeopardizes safety through actions
• 3 - Verbal disruption: yelling, threatening,
excessive profanity, sexual references, etc.
• 4 - Physical aggression: aggressive or combative
to self and others (e.g., hits self, throws objects,
punches, dangerous maneuvers with wheelchair or
other objects)
• 5 - Disruptive, infantile, or socially inappropriate
behavior (excludes verbal actions)
• 6 - Delusional, hallucinatory, or paranoid behavior
• 7 - None of the above behaviors demonstrated
M0620 (M0620) Frequency of Behavior Problems
(Reported or Observed) (e.g., wandering episodes,
self abuse, verbal disruption, physical aggression,
etc.):
• 0 - Never
• 1 - Less than once a month
• 2 - Once a month
• 3 - Several times each month
• 4 - Several times a week
• 5 - At least daily
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 32
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
X
February 26, 2009
TRF
x
(current only)
0 - Able to groom self unaided, with or without the
use of assistive devices or adapted methods.
1 - Grooming utensils must be placed within reach
before able to complete grooming activities.
2 - Someone must assist the patient to groom self.
3 - Patient depends entirely upon someone else for
grooming needs.
FU
Grooming: Current ability to tend safely to personal
hygiene needs (i.e., washing face and hands, hair
care, shaving or make up, teeth or denture care,
fingernail care).
X
M1800
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
Current
0 - Able to groom self unaided, with or without the
use of assistive devices or adapted methods.
1 - Grooming utensils must be placed within reach
before able to complete grooming activities.
2 - Someone must assist the patient to groom self.
3 - Patient depends entirely upon someone else for
grooming needs
x
M0640 (M0640) Grooming: Ability to tend to personal
hygiene needs (i.e., washing face and hands, hair
care, shaving or make up, teeth or denture care,
fingernail care).
Prior
0 - Able to groom self unaided, with or without the
use of assistive devices or adapted methods.
1 - Grooming utensils must be placed within reach
before able to complete grooming activities.
2 - Someone must assist the patient to groom self.
3 - Patient depends entirely upon someone else for
grooming needs
UK - Unknown
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 33
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
2 - Someone must help the patient put on upper
body clothing.
3 - Patient depends entirely upon another person to
dress the upper body.
February 26, 2009
X
0 - Able to get clothes out of closets and drawers,
put them on and remove them from the upper body
without assistance.
1 - Able to dress upper body without assistance if
clothing is laid out or handed to the patient.
Harmony
Current Ability to Dress Upper Body safely (with or
without dressing aids) including undergarments,
pullovers, front-opening shirts and blouses,
managing zippers, buttons, and snaps:
DAH
X
DC
FU
X
TRF
ROC
X
M1810
OASIS-C Version 12.1 2-24-2009
Item Text
x
(current only)
x
(current only)
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
Current
0 - Able to get clothes out of closets and drawers,
put them on and remove them
from the upper body without assistance.
1 - Able to dress upper body without assistance if
clothing is laid out or handed
to the patient.
2 - Someone must help the patient put on upper
body clothing.
3 - Patient depends entirely upon another person to
dress the upper body.
x
Prior
0 - Able to get clothes out of closets and drawers,
put them on and remove them from the upper body
without assistance.
1 - Able to dress upper body without assistance if
clothing is laid out or handed to the patient.
2 - Someone must help the patient put on upper
body clothing.
3 - Patient depends entirely upon another person to
dress the upper body.
UK - Unknown
OASIS-C
Item #
SOC
M0650 (M0650) Ability to Dress Upper Body (with or
without dressing aids)
including undergarments, pullovers, front-opening
shirts and blouses,
managing zippers, buttons, and snaps:
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
(current)
01,02,03
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 34
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
February 26, 2009
X
0 - Able to obtain, put on, and remove clothing and
shoes without assistance.
1 - Able to dress lower body without assistance if
clothing and shoes are laid out or handed to the
patient.
2 - Someone must help the patient put on
undergarments, slacks, socks or nylons, and shoes.
3 - Patient depends entirely upon another person to
dress lower body.
Harmony
Current Ability to Dress Lower Body safely (with or
without dressing aids) including undergarments,
slacks, socks or nylons, shoes:
DAH
X
DC
FU
X
TRF
ROC
X
M1820
OASIS-C Version 12.1 2-24-2009
Item Text
x
(current only)
x
(current only)
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
Current
0 - Able to obtain, put on, and remove clothing and
shoes without assistance.
1 - Able to dress lower body without assistance if
clothing and shoes are laid out or handed to the
patient.
2 - Someone must help the patient put on
undergarments, slacks, socks or nylons, and shoes.
3 - Patient depends entirely upon another person to
dress lower body.
x
Prior
0 - Able to obtain, put on, and remove clothing and
shoes without assistance.
1 - Able to dress lower body without assistance if
clothing and shoes are laid out or handed to the
patient.
2 - Someone must help the patient put on
undergarments, slacks, socks or nylons, and shoes.
3 - Patient depends entirely upon another person to
dress lower body.
UK - Unknown
OASIS-C
Item #
SOC
M0660 (M0660) Ability to Dress Lower Body (with or
without dressing aids) including undergarments,
slacks, socks or nylons, shoes:
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
(current)
01,02,03
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 35
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
0 - Able to bathe self in shower or tub independently, including getting in and out of tub/shower.
1 - With the use of devices, is able to bathe self in
shower or tub independently, including getting in
and out of the tub/shower.
2 - Able to bathe in shower or tub with the
intermittent assistance of another person:
(a) for intermittent supervision or encouragement
or reminders, OR
(b) to get in and out of the shower or tub, OR
(c) for washing difficult to reach areas.
3 - Able to participate in bathing self in shower or
tub, but requires presence of another person
throughout the bath for assistance or supervision.
4 - Unable to use the shower or tub, but able to
bathe self independently, with or without the use of
devices, at the sink, in chair, or on commode.
5 - Unable to use the shower or tub, but able to
participate in bathing self in bed, at the sink, in
bedside chair, or on commode, with the assistance
or supervision of another person throughout the
bath.
6 - Unable to participate effectively in bathing and
is bathed totally by another person.
February 26, 2009
X
x
(current only)
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
(current only)
5 - Unable to effectively participate in bathing and is
totally bathed by another person.
x
4 - Unable to use the shower or tub and is bathed in
bed or bedside chair.
x
Current
0 - Able to bathe self in shower or tub
independently.
1 - With the use of devices, is able to bathe self in
shower or tub independently.
2 - Able to bathe in shower or tub with the
assistance of another person:
(a) for intermittent supervision or encouragement
or reminders, OR
(b) to get in and out of the shower or tub, OR
(c) for washing difficult to reach areas.
3 - Participates in bathing self in shower or tub, but
requires presence of another person throughout the
bath for assistance or supervision.
Harmony
0 - Able to bathe self in shower or tub independently.
1 - With the use of devices, is able to bathe self in shower or tub
independently.
2 - Able to bathe in shower or tub with the assistance of another
person:
(a) for intermittent supervision or encouragement or reminders,
OR (b) to get in and out of the shower or tub, OR (c) for washing
difficult to reach areas.
3 - Participates in bathing self in shower or tub, but requires
presence of another person throughout the bath for assistance or
supervision.
4 - Unable to use the shower or tub and is bathed in bed or
bedside chair.
5 - Unable to effectively participate in bathing and is totally
bathed by another person.
UK - Unknown
DAH
DC
X
TRF
FU
Bathing: Current ability to wash entire body safely.
Excludes grooming (washing face and hands only).
X
M1830
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
M0670 (M0670) Bathing: Ability to wash entire body.
Excludes grooming (washing face and hands only).
Prior
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
(current)
02,03,04,05
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 36
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
February 26, 2009
X
0 - Able to get to and from the toilet and transfer
independently with or without a device.
1 - When reminded, assisted, or supervised by
another person, able to get to and from the toilet
and transfer.
2 - Unable to get to and from the toilet but is able to
use a bedside commode (with or without
assistance).
3 - Unable to get to and from the toilet or bedside
commode but is able to use a bedpan/urinal
independently.
4 - Is totally dependent in toileting.
Harmony
Toilet Transferring: Current ability to get to and
from the toilet or bedside commode safely and
transfer on and off toilet/commode.
DAH
X
DC
FU
X
TRF
ROC
X
M1840
OASIS-C Version 12.1 2-24-2009
Item Text
x
(current only)
x
(current only)
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
Current
0 - Able to get to and from the toilet independently
with or without a device.
1 - When reminded, assisted, or supervised by
another person,
able to get to and from the toilet.
2 - Unable to get to and from the toilet but is able to
use a bedside commode
(with or without assistance).
3 - Unable to get to and from the toilet or bedside
commode but is able to use a bedpan/urinal
independently.
4 - Is totally dependent in toileting.
x
Prior
0 - Able to get to and from the toilet independently
with or without a device.
1 - When reminded, assisted, or supervised by
another person, able to get to and from the toilet.
2 - Unable to get to and from the toilet but is able to
use a bedside commode (with or without
assistance).
3 - Unable to get to and from the toilet or bedside
commode but is able to use a bedpan/urinal
independently.
4 - Is totally dependent in toileting.
UK - Unknown
OASIS-C
Item #
SOC
M0680 (M0680) Toileting: Ability to get to and from the
toilet or bedside commode.
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
(current)
02,03,04
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 37
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
X
DAH
X
February 26, 2009
X
Toileting Hygiene: Current ability to maintain
perineal hygiene safely, adjust clothes and/or
incontinence pads before and after using toilet,
commode, bedpan, urinal. If managing ostomy,
include cleaning area around stoma, but not
managing equipment.
0 - Able to manage toileting hygiene and clothing
management without assistance.
1 - Able to manage toileting hygiene and clothing
management without assistance if
supplies/implements are laid out for the patient.
2 - Someone must help the patient to maintain
toileting hygiene and/or adjust clothing.
3 - Patient depends entirely upon another person to
maintain toileting hygiene.
DC
ROC
M1845
TRF
OASIS-C Version 12.1 2-24-2009
Item Text
FU
OASIS-C
Item #
SOC
DAH
DC
TRF
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
FU
New on
OASISC
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 38
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
X
February 26, 2009
X
x
(current only)
x
(current only)
0 - Able to independently transfer.
1 - Able to transfer with minimal human assistance
or with use of an assistive device.
2 - Able to bear weight and pivot during the transfer
process but unable to transfer self.
3 - Unable to transfer self and is unable to bear
weight or pivot when transferred by another person.
4 - Bedfast, unable to transfer but is able to turn
and position self in bed.
5 - Bedfast, unable to transfer and is unable to turn
and position self.
FU
Transferring: Current ability to move safely from
bed to chair, or ability to turn and position self in bed
if patient is bedfast.
X
M1850
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
Current
• 0 - Able to independently transfer.
• 1 - Transfers with minimal human assistance or
with use of an assistive device.
• 2 - Unable to transfer self but is able to bear
weight and pivot during the transfer process.
• 3 - Unable to transfer self and is unable to bear
weight or pivot when transferred by another person.
• 4 - Bedfast, unable to transfer but is able to turn
and position self in bed.
• 5 - Bedfast, unable to transfer and is unable to
turn and position self.
x
M0690 (M0690) Transferring: Ability to move from bed to
chair, on and off toilet or commode, into and out of
tub or shower, and ability to turn and position self in
bed if patient is bedfast.
Prior
• 0 - Able to independently transfer.
• 1 - Transfers with minimal human assistance or
with use of an assistive device.
• 2 - Unable to transfer self but is able to bear
weight and pivot during the transfer process.
• 3 - Unable to transfer self and is unable to bear
weight or pivot when transferred by another person.
• 4 - Bedfast, unable to transfer but is able to turn
and position self in bed.
• 5 - Bedfast, unable to transfer and is unable to
turn and position self.
• UK - Unknown
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
(current)
02,03,04, 05
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 39
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
February 26, 2009
X
0 - Able to independently walk on even and uneven
surfaces and negotiate stairs with or without railings
(i.e., needs no human assistance or assistive
device).
1 - With the use of a one-handed device (e.g. cane,
single crutch, hemi-walker), able to independently
walk on even and uneven surfaces and negotiate
stairs with or without railings.
2 - Requires use of a two-handed device (e.g.,
walker or crutches) to walk alone on a level surface
and/or requires human supervision or assistance to
negotiate stairs or steps or uneven surfaces.
3 - Able to walk only with the supervision or
assistance of another person at all times.
4 - Chairfast, unable to ambulate but is able to
wheel self independently.
5 - Chairfast, unable to ambulate and is unable to
wheel self.
6 - Bedfast, unable to ambulate or be up in a chair
Harmony
Ambulation/Locomotion: Current ability to walk
safely, once in a standing position, or use a
wheelchair, once in a seated position, on a variety
of surfaces.
DAH
X
DC
FU
X
TRF
ROC
M1860
OASIS-C Version 12.1 2-24-2009
Item Text
X
x
(current only)
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
2 - Able to walk only with the supervision or
assistance of another person at all times.
3 - Chairfast, unable to ambulate but is able to
wheel self independently.
4 - Chairfast, unable to ambulate and is unable to
wheel self.
5 - Bedfast, unable to ambulate or be up in a chair.
x
Current
0 - Able to independently walk on even and uneven
surfaces and climb stairs with or without railings
(i.e., needs no human assistance or assistive
device).
1 - Requires use of a device (e.g., cane, walker) to
walk alone or requires human supervision or
assistance to negotiate stairs or steps or uneven
surfaces.
x
(current only)
Prior
0 - Able to independently walk on even and uneven
surfaces and climb stairs with or without railings (i.e.,
needs no human assistance or assistive device).
1 - Requires use of a device (e.g., cane, walker) to walk
alone or requires human supervision or assistance to
negotiate stairs or steps or uneven surfaces.
2 - Able to walk only with the supervision or assistance of
another person at all times.
3 - Chairfast, unable to ambulate but is able to wheel self
independently.
4 - Chairfast, unable to ambulate and is unable to wheel
self.
5 - Bedfast, unable to ambulate or be up in a chair.
UK - Unknown
OASIS-C
Item #
SOC
M0700 (M0700) Ambulation/Locomotion: Ability to SAFELY
walk, once in a standing position, or use a
wheelchair, once in a seated position, on a variety
of surfaces.
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
(current)
01,02,03,04,05
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 40
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
X
February 26, 2009
TRF
x
(current only)
0 - Able to independently feed self.
1 - Able to feed self independently but requires:
(a) meal set-up; OR
(b) intermittent assistance or supervision from
another person; OR
(c) a liquid, pureed or ground meat diet.
2 - Unable to feed self and must be assisted or
supervised throughout the meal/snack.
3 - Able to take in nutrients orally and receives
supplemental nutrients through a nasogastric tube
or gastrostomy.
4 - Unable to take in nutrients orally and is fed
nutrients through a nasogastric tube
or gastrostomy.
5 - Unable to take in nutrients orally or by tube
feeding.
FU
Feeding or Eating: Current ability to feed self meals
and snacks safely. Note: This refers only to the
process of eating, chewing, and swallowing, not
preparing the food to be eaten.
X
M1870
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
Current
0 - Able to independently feed self.
1 - Able to feed self independently but requires:
(a) meal set-up; OR
(b) intermittent assistance or supervision from
another person; OR
(c) a liquid, pureed or ground meat diet.
2 - Unable to feed self and must be assisted or
supervised throughout the meal/snack.
3 - Able to take in nutrients orally and receives
supplemental nutrients through a nasogastric tube
or gastrostomy.
4 - Unable to take in nutrients orally and is fed
nutrients through a nasogastric tube
or gastrostomy.
5 - Unable to take in nutrients orally or by tube
feeding.
x
M0710 (M0710) Feeding or Eating: Ability to feed self
meals and snacks. Note: This refers only to the
process of eating, chewing, and swallowing, not
preparing the food to be eaten.
Prior
0 - Able to independently feed self.
1 - Able to feed self independently but requires:
(a) meal set-up; OR
(b) intermittent assistance or supervision from
another person; OR
(c) a liquid, pureed or ground meat diet.
2 - Unable to feed self and must be assisted or
supervised throughout the meal/snack.
3 - Able to take in nutrients orally and receives
supplemental nutrients through a nasogastric tube
or gastrostomy.
4 - Unable to take in nutrients orally and is fed
nutrients through a nasogastric tube or gastrostomy.
5 - Unable to take in nutrients orally or by tube
feeding.
UK - Unknown
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 41
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
X
FU
ROC
X
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
Current Ability to Plan and Prepare Light Meals
(e.g., cereal, sandwich) or reheat delivered meals
safely:
February 26, 2009
CARE
0 - (a) Able to independently plan and prepare all
light meals for self or reheat delivered meals; OR
(b) Is physically, cognitively, and mentally able
to prepare light meals on a regular basis but has not
routinely performed light meal preparation in the
past (i.e., prior to this home care admission).
1 - Unable to prepare light meals on a regular basis
due to physical, cognitive, or mental limitations.
2 - Unable to prepare any light meals or reheat any
delivered meals.
(former M1880 Change in Mobility - MOVED TO
M1900)
(former M1890 Change in Self-care Ability MOVED TO M1900)
(former M1920 Change in Ability to Perform Routine
Household Tasks - MOVED to M1900)
X
x
(current only)
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
Current
0 - (a) Able to independently plan and prepare all
light meals for self or reheat delivered meals; OR
(b) Is physically, cognitively, and mentally able to
prepare light meals on a regular basis but has not
routinely performed light meal preparation in the
past (i.e., prior to this home care admission).
1 - Unable to prepare light meals on a regular basis
due to physical, cognitive, or mental limitations.
2 - Unable to prepare any light meals or reheat any
delivered meals.
OASIS-C
Item #
M1880
x
M0720 (M0720) Planning and Preparing Light Meals (e.g.,
cereal, sandwich) or reheat delivered meals:
Prior
0 - (a) Able to independently plan and prepare all
light meals for self or reheat delivered meals; OR
(b) Is physically, cognitively, and mentally able to
prepare light meals on a regular basis but has not
routinely performed light meal preparation in the
past (i.e., prior to this home care admission).
1 - Unable to prepare light meals on a regular basis
due to physical, cognitive, or mental limitations.
2 - Unable to prepare any light meals or reheat any
delivered meals.
UK - Unknown
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 42
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
X
Prior Functioning ADL/IADL: Indicate the patient’s
usual ability with everyday activities prior to this
current illness, exacerbation, or injury. Check only
one box in each row.
February 26, 2009
CARE
MATRIX:
ROWS - Functional Area
a. Self-Care (e.g., grooming, dressing, and
bathing)
b. Ambulation
c. Transfer
d. Household tasks (e.g., light meal preparation,
laundry, shopping )
by COLUMNS
Independent
Needed Some Help
Dependent
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
ROC
M1900
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
New on
OASISC
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 43
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
x
(current only)
February 26, 2009
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
Current
• 0 - Able to independently drive a regular or
adapted car; OR uses a regular or handicapaccessible public bus.
• 1 - Able to ride in a car only when driven by
another person; OR able to use a bus or handicap
van only when assisted or accompanied by another
person.
• 2 - Unable to ride in a car, taxi, bus, or van, and
requires transportation by ambulance.
OASIS-C
Item #
DROPPED
on OASIS-C
x
M0730 (M0730) Transportation: Physical and mental ability
to safely use a car, taxi, or public transportation
(bus, train, subway).
Prior
• 0 - Able to independently drive a regular or
adapted car; OR uses a regular or handicapaccessible public bus.
• 1 - Able to ride in a car only when driven by
another person; OR able to use a bus or handicap
van only when assisted or accompanied by another
person.
• 2 - Unable to ride in a car, taxi, bus, or van, and
requires transportation by ambulance.
• UK - Unknown
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 44
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
x
(current only)
February 26, 2009
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
Current
• 0 - (a) Able to independently take care of all
laundry tasks; OR
(b) Physically, cognitively, and mentally able to do
laundry and access facilities, but has not routinely
performed laundry tasks in the past (i.e., prior to this
home care admission).
• 1 - Able to do only light laundry, such as minor
hand wash or light washer loads. Due to physical,
cognitive, or mental limitations, needs assistance
with heavy laundry such as carrying large loads of
laundry.
• 2 - Unable to do any laundry due to physical
limitation or needs continual supervision and
assistance due to cognitive or mental limitation.
OASIS-C
Item #
DROPPED
on OASIS-C
x
M0740 (M0740) Laundry: Ability to do own laundry to
carry laundry to and from washing machine, to use
washer and dryer, to wash small items by hand.
Prior
• 0 - (a) Able to independently take care of all
laundry tasks; OR
(b) Physically, cognitively, and mentally able to do
laundry and access facilities, but has not routinely
performed laundry tasks in the past (i.e., prior to this
home care admission).
• 1 - Able to do only light laundry, such as minor
hand wash or light washer loads. Due to physical,
cognitive, or mental limitations, needs assistance
with heavy laundry such as carrying large loads of
laundry.
• 2 - Unable to do any laundry due to physical
limitation or needs continual supervision and
assistance due to cognitive or mental limitation.
• UK - Unknown
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 45
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
x
(current only)
February 26, 2009
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
OASIS-C
Item #
DROPPED
on OASIS-C
x
M0750 (M0750) Housekeeping: Ability to safely and
effectively perform light housekeeping and heavier
cleaning tasks.
Prior
• 0 - (a) Able to independently perform all
housekeeping tasks; OR
(b) Physically, cognitively, and mentally able to
perform all housekeeping tasks but has not routinely
participated in housekeeping tasks in the past (i.e.,
prior to this home care admission).
• 1 - Able to perform only light housekeeping (e.g.,
dusting, wiping kitchen counters) tasks
independently.
• 2 - Able to perform housekeeping tasks with
intermittent assistance or supervision from another
person.
• 3 - Unable to consistently perform any
housekeeping tasks unless assisted by another
person throughout the process.
• 4 - Unable to effectively participate in any
housekeeping tasks.
• UK - Unknown
Current
• 0 - (a) Able to independently perform all
housekeeping tasks; OR
(b) Physically, cognitively, and mentally able to
perform all housekeeping tasks but has not routinely
participated in housekeeping tasks in the past (i.e.,
prior to this home care admission).
• 1 - Able to perform only light housekeeping (e.g.,
dusting, wiping kitchen counters) tasks
independently.
• 2 - Able to perform housekeeping tasks with
intermittent assistance or supervision from another
person.
• 3 - Unable to consistently perform any
housekeeping tasks unless assisted by another
person throughout the process.
• 4 - Unable to effectively participate in any
housekeeping tasks.
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 46
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
x
(current only)
February 26, 2009
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
OASIS-C
Item #
DROPPED
on OASIS-C
x
M0760 (M0760) Shopping: Ability to plan for, select, and
purchase items in a store and to carry them home or
arrange delivery.
Prior
• 0 - (a) Able to plan for shopping needs and
independently perform shopping tasks, including
carrying packages; OR
(b) Physically, cognitively, and mentally able to
take care of shopping, but has not done shopping in
the past (i.e., prior to this home care admission).
• 1 - Able to go shopping, but needs some
assistance:
(a) By self is able to do only light shopping and
carry small packages, but needs someone to do
occasional major shopping; OR
(b) Unable to go shopping alone, but can go with
someone to assist.
• 2 - Unable to go shopping, but is able to identify
items needed, place orders, and arrange home
delivery.
• 3 - Needs someone to do all shopping & errands.
• UK - Unknown
Current
• 0 - (a) Able to plan for shopping needs and
independently perform shopping tasks, including
carrying packages; OR
(b) Physically, cognitively, and mentally able to
take care of shopping, but has not done shopping in
the past (i.e., prior to this home care admission).
• 1 - Able to go shopping, but needs some
assistance:
(a) By self is able to do only light shopping and
carry small packages, but needs someone to do
occasional major shopping; OR
(b) Unable to go shopping alone, but can go with
someone to assist.
• 2 - Unable to go shopping, but is able to identify
items needed, place orders, and arrange home
delivery.
• 3 - Needs someone to do all shopping & errands.
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 47
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
February 26, 2009
X
x
(current only)
0 - Able to dial numbers and answer calls
appropriately and as desired.
1 - Able to use a specially adapted telephone (i.e.,
large numbers on the dial, teletype phone for the
deaf) and call essential numbers.
2 - Able to answer the telephone and carry on a
normal conversation but has difficulty with placing
calls.
3 - Able to answer the telephone only some of the
time or is able to carry on only a limited
conversation.
4 - Unable to answer the telephone at all but can
listen if assisted with equipment.
5 - Totally unable to use the telephone.
NA - Patient does not have a telephone.
Harmony
Ability to Use Telephone: Current ability to answer
the phone safely, including dialing numbers, and
effectively using the telephone to communicate.
DAH
DC
TRF
X
FU
ROC
X
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
Current
• 0 - Able to dial numbers and answer calls
appropriately and as desired.
• 1 - Able to use a specially adapted telephone (i.e.,
large numbers on the dial, teletype phone for the
deaf) and call essential numbers.
• 2 - Able to answer the telephone and carry on a
normal conversation but has difficulty with placing
calls.
• 3 - Able to answer the telephone only some of the
time or is able to carry on only a limited
conversation.
• 4 - Unable to answer the telephone at all but can
listen if assisted with equipment.
• 5 - Totally unable to use the telephone.
• NA - Patient does not have a telephone.
OASIS-C
Item #
M1890
x
M0770 (M0770) Ability to Use Telephone: Ability to answer
the phone, dial numbers, and effectively use the
telephone to communicate.
Prior
• 0 - Able to dial numbers and answer calls
appropriately and as desired.
• 1 - Able to use a specially adapted telephone (i.e.,
large numbers on the dial, teletype phone for the
deaf) and call essential numbers.
• 2 - Able to answer the telephone and carry on a
normal conversation but has difficulty with placing
calls.
• 3 - Able to answer the telephone only some of the
time or is able to carry on only a limited
conversation.
• 4 - Unable to answer the telephone at all but can
listen if assisted with equipment.
• 5 - Totally unable to use the telephone.
• NA - Patient does not have a telephone.
• UK - Unknown
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 48
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
X
February 26, 2009
DC
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
X
M2000
TRF
New on
OASISC
FU
M1920
X
New on
OASISC
(M1940 - Falls Risk Intervention in Plan of Care MOVED to M2250)
Falls Risk Intervention: Since the previous OASIS
assessment, were fall prevention steps BOTH
included in the physician-ordered plan of care AND
implemented?
0 - No
1 - Yes
NA - A multi-factor Fall Risk Assessment
(including factors such as falls history, use of
multiple medications, mental impairment, toileting
frequency, general mobility/transferring impairment,
environmental hazards) indicates the patient was
not at risk for falls since the last OASIS assessment
Drug Regimen Review: Does a complete drug
regimen review indicate potential clinically
significant medication issues, e.g., drug reactions,
ineffective drug therapy, side effects, drug
interactions, duplicate therapy, omissions, dosage
errors, or noncompliance?
0 - Not assessed/reviewed [ Go to M2010 ]
1 - No problems found during review [ Go to
M2010 ]
2 - Problems found during review
NA - Patient is not taking any medications [ Go to
M2040 ]
X
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)?
0 - No multi-factor falls risk assessment
conducted.
1 - Yes, and it does not indicate a risk for falls. [
Go to M2000 at SOC/ROC ]
2 - Yes, and it indicates a risk for falls.
ROC
M1910
X
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
New on
OASISC
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 49
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
X
Harmony
X
DAH
DC
February 26, 2009
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
X
M2015
TRF
New on
OASISC
FU
M2010
X
New on
OASISC
X
M2004
ROC
New on
OASISC
Medication Follow-up: Was a physician or the
physician-designee contacted within one calendar
day to resolve clinically significant medication
issues, including reconciliation?
0 - No
1 - Yes
Medication Intervention: If there were any clinically
significant medication issues since the previous
OASIS assessment, was a physician or the
physician-designee contacted within one calendar
day of the assessment to resolve clinically
significant medication issues, including
reconciliation?
0 - No
1 - Yes
NA - No clinically significant medication issues
identified since the previous OASIS assessment
Patient/Caregiver High Risk Drug Education: Has
the patient/caregiver received instruction on special
precautions for all high-risk medications (such as
hypoglycemics, anticoagulants, etc.) and how and
when to report problems that may occur?
0 - No
1 - Yes
NA - Patient not taking any high risk drugs OR
patient/caregiver fully knowledgeable about special
precautions associated with all high-risk
medications
Patient/Caregiver Drug Education Intervention:
Since the previous OASIS assessment, was the
patient/caregiver instructed by agency staff or other
health care provider to monitor the effectiveness of
drug therapy, drug reactions, and side effects, and
how and when to report problems that may occur?
0 - No
1 - Yes
NA - Patient not taking any drugs
X
M2002
X
New on
OASISC
DC
OASIS-C Version 12.1 2-24-2009
Item Text
FU
OASIS-C
Item #
SOC
DAH
TRF
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 50
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
X
February 26, 2009
DC
3 - Unable to take medication unless administered
by another person.
NA - No oral medications prescribed.
TRF
x
(current only)
0 - Able to independently take the correct oral
medication(s) and proper dosage(s) at the correct
times.
1 - Able to take medication(s) at the correct times if:
(a) individual dosages are prepared in advance
by another person; OR
(b) another person develops a drug diary or chart.
2 - Able to take medication(s) at the correct times if
given reminders by another person at the
appropriate times
FU
Management of Oral Medications:
Patient's current ability to prepare and take all oral
medications reliably and safely, including
administration of the correct dosage at the
appropriate times/intervals. Excludes injectable and
IV medications. (NOTE: This refers to ability, not
compliance or willingness.)
X
M2020
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
DAH
DC
TRF
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
FU
2 - Unable to take medication unless administered
by someone else.
NA - No oral medications prescribed.
x
Current
0 - Able to independently take the correct oral
medication(s) and proper dosage(s) at the correct
times.
1 - Able to take medication(s) at the correct times if:
(a) individual dosages are prepared in advance
by another person; OR
(b) given daily reminders; OR
(c) someone develops a drug diary or chart.
x
M0780 (M0780) Management of Oral Medications:
Patient's ability to prepare and take all prescribed
oral medications reliably and safely, including
administration of the correct dosage at the
appropriate times/intervals. Excludes injectable and
IV medications. (NOTE: This refers to ability, not
compliance or willingness.)
Prior
0 - Able to independently take the correct oral
medication(s) and proper dosage(s) at the correct
times.
1 - Able to take medication(s) at the correct times if:
(a) individual dosages are prepared in advance
by another person; OR
(b) given daily reminders; OR
(c) someone develops a drug diary or chart.
2 - Unable to take medication unless administered
by someone else.
NA - No oral medications prescribed.
UK - Unknown
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 51
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
x
(current only)
February 26, 2009
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
OASIS-C
Item #
DROPPED
on OASIS-C
x
M0790 (M0790) Management of Inhalant/Mist Medications:
Patient's ability to prepare and take all prescribed
inhalant/mist medications (nebulizers, metered dose
devices) reliably and safely, including administration
of the correct dosage at the appropriate
times/intervals. Excludes all other forms of
medication (oral tablets, injectable and IV
medications).
Prior Current
• 0 - Able to independently take the correct
medication and proper dosage at the correct times.
• 1 - Able to take medication at the correct times if:
(a) individual dosages are prepared in advance
by another person, OR
(b) given daily reminders.
• 2 - Unable to take medication unless administered
by someone else.
• NA - No inhalant/mist medications prescribed.
• UK - Unknown
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 52
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
X
X
February 26, 2009
FU
0 - Able to independently take the correct
medication(s) and proper dosage(s) at the correct
times.
1 - Able to take injectable medication(s) at the
correct times if:
(a) individual syringes are prepared in advance
by another person; OR
(b) another person develops a drug diary or chart.
2 - Able to take medication(s) at the correct times if
given reminders by another person based on the
frequency of the injection
3 - Unable to take injectable medication unless
administered by another person.
NA - No injectable medications prescribed.
X
Management of Injectable Medications: Patient's
current ability to prepare and take all prescribed
injectable medications reliably and safely, including
administration of correct dosage at the appropriate
times/intervals. Excludes IV medications.
ROC
M2030
X
OASIS-C Version 12.1 2-24-2009
Item Text
x
(current only)
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
x
(current only)
2 - Unable to take injectable medications unless
administered by someone else.
NA - No injectable medications prescribed.
x
Current
0 - Able to independently take the correct
medication and proper dosage
at the correct times.
1 - Able to take injectable medication at correct
times if:
(a) individual syringes are prepared in advance
by another person, OR
(b) given daily reminders.
x
Prior
0 - Able to independently take the correct
medication and proper dosage at the correct times.
1 - Able to take injectable medication at correct
times if:
(a) individual syringes are prepared in advance
by another person, OR
(b) given daily reminders.
2 - Unable to take injectable medications unless
administered by someone else.
NA - No injectable medications prescribed.
UK - Unknown
OASIS-C
Item #
SOC
M0800 (M0800) Management of Injectable Medications:
Patient's ability to prepare and take all prescribed
injectable medications reliably and safely, including
administration of correct dosage at the appropriate
times/intervals. Excludes IV medications.
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
$
0,1,2,NA
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 53
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
CARE
February 26, 2009
DAH
x
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
DROPPED
on OASIS-C
(see M2110,
row "e")
x
M0810 (M0810) Patient Management of Equipment
(includes ONLY oxygen, IV/infusion therapy,
enteral/parenteral nutrition equipment or supplies):
Patient's ability to set up, monitor and change
equipment reliably and safely, add appropriate fluids
or medication, clean/store/dispose of equipment or
supplies using proper technique. (NOTE: This
refers to ability, not compliance or willingness.)
• 0 - Patient manages all tasks related to equipment
completely independently.
• 1 - If someone else sets up equipment (i.e., fills
portable oxygen tank, provides patient with
prepared solutions), patient is able to manage all
other aspects of equipment.
• 2 - Patient requires considerable assistance from
another person to manage equipment, but
independently completes portions of the task.
• 3 - Patient is only able to monitor equipment (e.g.,
liter flow, fluid in bag) and must call someone else to
manage the equipment.
• 4 - Patient is completely dependent on someone
else to manage all equipment.
• NA - No equipment of this type used in care [ If
NA, go to M0826 ]
DC
by COLUMNS
- Independent
- Needed Some Help
- Dependent
- Not Applicable
TRF
MATRIX:
ROWS - Functional Area
a. Oral medications
b. Injectable medications
FU
Prior Medication Management: Indicate the
patient’s usual ability with managing oral and
injectable medications prior to this current illness,
exacerbation, or injury. Check only one box in each
row.
X
M2040
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
X
OASIS-C
Item #
SOC
New on
OASISC
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 54
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
x
February 26, 2009
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
TRF
FU
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
OASIS-C
Item #
DROPPED
on OASIS-C
(see M2110,
row "e")
x
M0820 (M0820) Caregiver Management of Equipment
(includes ONLY oxygen, IV/infusion equipment,
enteral/parenteral nutrition, ventilator therapy
equipment or supplies): Caregiver’s ability to set
up, monitor, and change equipment reliably and
safely, add appropriate fluids or medication,
clean/store/dispose of equipment or supplies using
proper technique. (NOTE: This refers to ability, not
compliance or willingness.)
• 0 - Caregiver manages all tasks related to
equipment completely independently.
• 1 - If someone else sets up equipment, caregiver
is able to manage all other aspects.
• 2 - Caregiver requires considerable assistance
from another person to manage equipment, but
independently completes significant portions of task.
• 3 - Caregiver is only able to complete small
portions of task (e.g., administer nebulizer
treatment, clean/store/dispose of equipment or
supplies).
• 4 - Caregiver is completely dependent on
someone else to manage all equipment.
• NA - No caregiver
• UK - Unknown
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 55
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
DC
TRF
FU
X
X
February 26, 2009
X
M2200
X
How Often does the patient receive ADL or IADL
assistance from any caregiver(s) (other than home
health agency staff)?
1 - At least daily
2 - Three or more times per week
3 - One to two times per week
4 - Received, but less often than weekly
5 - No assistance received
UK - Unknown* [*at discharge, omit Unknown
response.]
Therapy Need: In the home health plan of care for
the Medicare payment episode for which this
assessment will define a case mix group, what is
the indicated need for therapy visits (total of
reasonable and necessary physical, occupational,
and speech-language pathology visits combined)?
(Enter zero [ “000” ] if no therapy visits indicated.)
(__ __ __) Number of therapy visits indicated (total
of physical, occupational and speech-language
pathology combined).
NA - Not Applicable: No case mix group defined
by this assessment.
ROC
M2110
X
x
x
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
$
(000-999)
x
M0826 (M0826) Therapy Need: In the home health plan of
care for the Medicare payment episode for which
this assessment will define a case mix group, what
is the indicated need for therapy visits (total of
reasonable and necessary physical, occupational,
and speech-language pathology visits combined)?
(Enter zero [“000”] if no therapy visits indicated.)
(__ __ __) Number of therapy visits indicated (total
of physical, occupational and speech-language
pathology combined).
• NA - Not Applicable: No case mix group defined
by this assessment.
OASIS-C Version 12.1 2-24-2009
Item Text
X
New on
OASISC
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 56
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
X
Harmony
X
February 26, 2009
DAH
Plan of Care Synopsis: (Check only one box in
each row.) Does the physician-ordered plan of care
include the following:
MATRIX:
ROWS - Plan / Intervention
a. Patient-specific parameters for notifying physician
of changes in vital signs or other clinical findings
COLUMNS = no, yes, NA - Physician has chosen
not to establish patient-specific parameters
for this patient. Agency will use standardized clinical guidelines accessible for all
care providers to reference
b. Diabetic foot care including monitoring for the
presence of skin lesions on the lower extremities
and patient/caregiver education on proper foot care
COLUMNS = no, yes, NA - Patient is not diabetic
or is bilateral amputee
c. Falls prevention interventions
COLUMNS = no, yes, NA - Patient is not
assessed to be at risk for falls
d. Depression intervention(s) such as medication,
referral for other treatment, or a monitoring plan for
current treatment
COLUMNS = no, yes, NA - Patient has no
diagnosis or symptoms of depression
e. Intervention(s) to monitor and mitigate pain
COLUMNS = no, yes, NA - No pain identified
f. Intervention(s) to prevent pressure ulcers
COLUMNS = no, yes, NA - Patient is not
assessed to be at risk for pressure ulcers
g. Pressure ulcer treatment based on principles of
moist wound healing OR order for treatment based
on moist wound healing has been requested from
physician
COLUMNS = no, yes, NA - Patient has no
pressure ulcers with need for moist wound healing
DC
ROC
M2250
TRF
OASIS-C Version 12.1 2-24-2009
Item Text
FU
OASIS-C
Item #
SOC
DAH
DC
TRF
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
FU
New on
OASISC
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 57
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
X
February 26, 2009
Harmony
X
UK - Unknown [ Go to M2400 ]
Reason for Emergent Care: For what reason(s) did
the patient receive emergent care (with or without
hospitalization)? (Mark all that apply.)
1 - Improper medication administration, medication
side effects, toxicity, anaphylaxis
2 - Injury caused by fall
3 - Respiratory infection (e.g. pneumonia,
bronchitis)
4 - Other respiratory problem
5 - Heart failure (e.g., fluid overload)
6 - Cardiac dysrhythmia (irregular heartbeat)
7 - Myocardial infarction or chest pain
8 - Other heart disease
9 - Stroke (CVA) or TIA
10 - Hypo/Hyperglycemia, diabetes out of control
11 - GI bleeding, obstruction, constipation,
impaction
12 - Dehydration, malnutrition
13 - Urinary tract infection
14 - IV catheter-related infection or complication
15 - Wound infection or deterioration
16 - Uncontrolled pain
17 - Acute mental/behavioral health problem
18 - Deep vein thrombosis, pulmonary embolus
19 - Other than above reasons
UK - Reason unknown
DAH
DC
X
X
X
X
X
TRF
FU
Emergent Care: Since the last time OASIS data
were collected, has the patient utilized a hospital
emergency department (includes
holding/observation )
0 - No [ Go to M2400 ]
1 - Yes, used hospital emergency department
WITHOUT hospital admission
2 - Yes, used hospital emergency department
WITH hospital admission
M2310
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
OASIS-C
Item #
M2300
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
TRF
• 2 - Doctor's office emergency visit/house call
• 3 - Outpatient department/clinic emergency
(includes urgicenter sites)
• UK - Unknown [ If UK, go to M0855 ]
M0840 (M0840) Emergent Care Reason: For what
reason(s) did the patient/family seek emergent
care? (Mark all that apply.)
• 1 - Improper medication administration,
medication side effects, toxicity, anaphylaxis
• 2 - Nausea, dehydration, malnutrition,
constipation, impaction
• 3 - Injury caused by fall or accident at home
• 4 - Respiratory problems (e.g., shortness of
breath, respiratory infection, tracheobronchial
obstruction)
• 5 - Wound infection, deteriorating wound status,
new lesion/ulcer
• 6 - Cardiac problems (e.g., fluid overload,
exacerbation of CHF, chest pain)
• 7 - Hypo/Hyperglycemia, diabetes out of control
• 8 - GI bleeding, obstruction
• 9 - Other than above reasons
• UK - Reason unknown
FU
M0830 (M0830) Emergent Care: Since the last time OASIS
data were collected, has the patient utilized any of
the following services for emergent care (other than
home care agency services)? (Mark all that apply.)
• 0 - No emergent care services [ If no emergent
care, go to M0855 ]
• 1 - Hospital emergency room (includes 23-hour
holding)
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 58
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
Harmony
DAH
February 26, 2009
X
DROPPED
on OASIS-C
(see M2410)
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
UK - Other unknown
[Go to M0903 ]
X
X
• 2 - Patient transferred to a noninstitutional hospice
[ Go to M0903 ]
• 3 - Unknown because patient moved to a
geographic location not served by this agency [ Go
to M0903 ]
• UK - Other unknown [ Go to M0903 ]
M0880 (M0880) After discharge, does the patient receive
health, personal, or support Services or Assistance?
(Mark all that apply.)
• 1 - No assistance or services received
• 2 - Yes, assistance or services provided by family
or friends
• 3 - Yes, assistance or services provided by other
community resources (e.g., meals-on-wheels, home
health services, homemaker assistance,
transportation assistance, assisted living, board and
care)
DC
Discharge Disposition: Where is the patient after
discharge from your agency? (Choose only one
answer.)
1 - Patient remained in the community (without
formal assistive services)
2 - Patient remained in the community (with formal
assistive services)
3 - Patient transferred to a noninstitutional hospice
4 - Unknown because patient moved to a
geographic location not served by this agency
X
M2410
TRF
To which Inpatient Facility has the patient been
admitted?
1 - Hospital [ Go to M2420 ]
2 - Rehabilitation facility [ Go to M0903 ]
3 - Nursing home [ Go to M2430 ]
4 - Hospice [ Go to M0903 ]
NA - No inpatient facility admission
FU
M2400
X
X
M0870 (M0870) Discharge Disposition: Where is the
patient after discharge from your agency? (Choose
only one answer.)
• 1 - Patient remained in the community (not in
hospital, nursing home, or rehab facility)
OASIS-C Version 12.1 2-24-2009
Item Text
ROC
OASIS-C
Item #
SOC
DAH
DC
TRF
FU
M0855 (M0855) To which Inpatient Facility has the patient
been admitted?
1 - Hospital [ Go to M0890 ]
2 - Rehabilitation facility [ Go to M0903 ]
3 - Nursing home [ Go to M0900 ]
4 - Hospice [ Go to M0903 ]
NA - No inpatient facility admission
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 59
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
February 26, 2009
X
X
Reason for Hospitalization: For what reason(s) did
the patient require hospitalization? (Mark all that
apply.)
1 - Improper medication administration, medication
side effects, toxicity, anaphylaxis
2 - Injury caused by fall
3 - Respiratory infection (e.g. pneumonia,
bronchitis)
4 - Other respiratory problem
5 - Heart failure (e.g., fluid overload)
6 - Cardiac dysrhythmia (irregular heartbeat)
7 - Myocardial infarction or chest pain
8 - Other heart disease
9 - Stroke (CVA) or TIA
10 - Hypo/Hyperglycemia, diabetes out of control
11 - GI bleeding, obstruction, constipation,
impaction
12 - Dehydration, malnutrition
13 - Urinary tract infection
14 - IV catheter-related infection or complication
15 - Wound infection or deterioration
16 - Uncontrolled pain
17 - Acute mental/behavioral health problem
18 - Deep vein thrombosis, pulmonary embolus
19 - Scheduled treatment or procedure
20 - Other than above reasons
UK - Reason unknown
[ Go to M0903 ]
Harmony
M2420
DAH
DROPPED
on OASIS-C
DC
TRF
FU
ROC
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
OASIS-C
Item #
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
TRF
• 1 - Improper medication administration,
medication side effects, toxicity, anaphylaxis
• 2 - Injury caused by fall or accident at home
• 3 - Respiratory problems (SOB, infection,
obstruction)
• 4 - Wound or tube site infection, deteriorating
wound status, new lesion/ulcer
• 5 - Hypo/Hyperglycemia, diabetes out of control
• 6 - GI bleeding, obstruction
• 7 - Exacerbation of CHF, fluid overload, heart
failure
• 8 - Myocardial infarction, stroke
• 9 - Chemotherapy
• 10 - Scheduled surgical procedure
• 11 - Urinary tract infection
• 12 - IV catheter-related infection
• 13 - Deep vein thrombosis, pulmonary embolus
• 14 - Uncontrolled pain
• 15 - Psychotic episode
• 16 - Other than above reasons
FU
M0890 (M0890) If the patient was admitted to an acute care
Hospital, for what Reason was he/she admitted?
• 1 - Hospitalization for emergent (unscheduled)
care
• 2 - Hospitalization for urgent (scheduled within 24
hours of admission) care
• 3 - Hospitalization for elective (scheduled more
than 24 hours before admission) care
• UK – Unknown
M0895 (M0895) Reason for Hospitalization: (Mark all that
apply.)
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
Attachment A - Comparison of OASIS-B1 (Current Version) to OASIS-C version 12.1 (Proposed Data Collection)
Page 60
OASIS B1
OASIS-C Version 12.1 2-24-2009
Collection Timepoints
DAH
X
X
X
X
X
Harmony
DC
X
X
X
X
X
February 26, 2009
TRF
X
X
M0906
FU
M0903
For what Reason(s) was the patient Admitted to a
Nursing Home? (Mark all that apply.)
1 - Therapy services
2 - Respite care
3 - Hospice care
4 - Permanent placement
5 - Unsafe for care at home
6 - Other
UK - Unknown
[ Go to M0903 ]
Date of Last (Most Recent) Home Visit:
__ __ /__ __ / __ __ __ __
month / day /
year
Discharge/Transfer/Death Date: Enter the date of
the discharge, transfer, or death (at home) of the
patient.
__ __ /__ __ / __ __ __ __
month / day /
year
ROC
M2430
OASIS-C Version 12.1 2-24-2009
Item Text
SOC
DAH
DC
OASIS-C
Item #
X
Form# CMS–R–245 (OMB# 0938–0760) – OASIS C
TRF
M0903 (M0903) Date of Last (Most Recent) Home Visit:
__ __ /__ __ / __ __ __ __
month day
year
M0906 (M0906) Discharge/Transfer/Death Date: Enter the
date of the discharge, transfer, or death (at home) of
the patient.
__ __ /__ __ / __ __ __ __
month day
year
FU
M0900 (M0900) For what Reason(s) was the patient
Admitted to a Nursing Home? (Mark all that apply.)
• 1 - Therapy services
• 2 - Respite care
• 3 - Hospice care
• 4 - Permanent placement
• 5 - Unsafe for care at home
• 6 - Other
• UK - Unknown
ROC
OASIS-B1
Item Text
SOC
OASIS
B1
Item #
Collection Timepoints
OASIS-B1
Responses
used for
payment
| File Type | application/pdf |
| File Title | OASIS B1 |
| Author | Abt |
| File Modified | 2009-02-26 |
| File Created | 2009-02-26 |