Attachment A OASIS-C to OASIS C-1 crosswalk

OASIS-C to Revised Draft OASIS-C1 – Items, Timepoints & Uses Crosswalk
OASIS-C

OASIS-C1

M0010

CMS Certification
Number

S

M0010

M0014

Branch State

S

M0014

M0016

Branch ID Number

S

M0018

National Provider
Identifier (NPI) physician
who signed plan of care

M0020

CMS Certification Number

DAH

DC

TRF

FU

Item Description

ROC

Item #

Item
Uses
*

Time Points
SOC

Items
DAH

DC

TRF

FU

Item Description

ROC

Item #

Time Points
SOC

Items

S

A

Branch State

S

A

M0016

Branch ID Number

S

A

S

M0018

National Provider
Identifier (NPI) physician
who signed plan of care

S

A

Patient ID Number

S

M0020

Patient ID Number

S

A

M0030

Start of Care Date

S

M0030

Start of Care Date

S

C,Q

M0032

Resumption of Care Date

M0032

Resumption of Care Date

M0040

Patient Name

S

M0040

Patient Name

S

A

M0050

Patient State of
Residence

S

M0050

Patient State of
Residence

S

A

M0060

Patient Zip Code

S

M0060

Patient Zip Code

S

A

M0063

Medicare Number

S

M0063

Medicare Number

S

A

M0064

Social Security Number

S

M0064

Social Security Number

S

A

M0065

Medicaid Number

S

M0065

Medicaid Number

S

A

M0066

Birth Date

S

M0066

Birth Date

S

Q

M0069

Gender

S

M0069

Gender

S

PRA

M0080

Discipline of Person
Completing Assessment

S

R

F

T

D

H

M0080

Discipline of Person
Completing Assessment

S

R

F

T

D

H

A

M0090

Date Assessment
Completed

S

R

F

T

D

H

M0090

Date Assessment
Completed

S

R

F

T

D

H

C,Q

OASIS-C to OASIS-C1 Crosswalk

R

September 2013

R

Q

Page 1

OASIS-C

OASIS-C1

FU

TRF

DC

DAH

DC

S

R

F

T

D

M0102

Date of Physicianordered 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

S

Date of Referral: Indicate
the date that the written or
verbal referral for initiation
or resumption of care was
received by the HHA.
__ __ /__ __ /__ ____ __
month / day / year

M0110
M0140

M0104

Item #

ROC

TRF

This Assessment is
Currently Being
Completed for the
Following Reason

Item
Uses
*

Time Points
SOC

FU

M0100

Item #

Items
DAH

ROC

Time Points
SOC

Items

H

M0100

This Assessment is
Currently Being
Completed for the
Following Reason:

S

R

F

T

D

H

R

M0102

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

S

R

Q

S

R

M0104

Date of Referral: Indicate
the date that the written or
verbal referral for initiation
or resumption of care was
received by the HHA.
__ __ /__ __ /__ _ __ __
month / day / year

S

R

Q

Episode Timing
(Early/Later)

S

R

M0110

Episode Timing
(Early/Later)

S

R

Race/Ethnicity

S

M0140

Race/Ethnicity: (Mark all
that apply.)

S

Item Description

OASIS-C to OASIS-C1 Crosswalk

F

Item Description

September 2013

F

C,Q

C, $,
PRA
A

Page 2

OASIS-C

OASIS-C1

M0906

Discharge/Transfer/
Death Date

T

D

M1000

From which of the following
Inpatient Facilities was
the patient discharged
during the past 14 days?
(Mark all that apply.)

S

M1005

Inpatient Discharge Date
(most recent)

M1010

M1012

DAH

D

DC

T

TRF

Date of Last (Most
Recent) Home Visit

FU

M0903

Item Description

ROC

S

Item #

Item
Uses
*

Time Points
SOC

Current Payment Sources

DC

SOC

M0150

TRF

Item Description

FU

Item #

Items
DAH

Time Points
ROC

Items

M0150

Current Payment
Sources: (Mark all that
apply.)

H

M0903

Date of Last (Most
Recent) Home Visit

T

D

H

A

H

M0906

Discharge/Transfer/ Death
Date

T

D

H

Q

R

M1000

From which of the following
Inpatient Facilities was the
patient discharged within
the past 14 days? (Mark all
that apply.)

S

R

PRA

S

R

M1005

Inpatient Discharge Date
(most recent)

S

R

A

List each Inpatient
Diagnosis and ICD-10-C M
code at the level of highest
specificity for only those
conditions treated during an
inpatient stay within the last
14 days

S

R

M1011

List each Inpatient
Diagnosis and ICD-10-CM
code at the level of highest
specificity for only those
conditions actively treated
during an inpatient stay
having a discharge date
within the last 14 days (no
V, W, X, Y, or Z codes or
surgical codes)

S

R

List each Inpatient
Procedure and the
associated ICD-9-C M
procedure code relevant to
the plan of care.

S

R

OASIS-C to OASIS-C1 Crosswalk

A

S

F

PRA

DELETED

September 2013

Page 3

OASIS-C

OASIS-C1
Item
Uses
*

PRA

S

R

M1018

Conditions Prior to
Regimen Change or
Inpatient Stay Within Past
14 Days

S

R

PRA

Primary Diagnosis &
Degree of Symptom
Control

S

R

F

M1021

Primary Diagnosis &
Degree of Symptom Control

S

R

F

$,
PRA

M1022

Other Diagnoses &
Degree of Symptom
Control

S

R

F

M1023

Other Diagnoses & Degree
of Symptom Control

S

R

F

$,
PRA

M1024

Payment Diagnoses

S

R

F

M1025

Optional Diagnoses

S

R

F

$,
PRA

M1030

Therapies patient
receives at home

S

R

F

M1030

Therapies patient
receives at home

S

R

F

$,
PRA

M1018

Conditions Prior to
Regimen Change or
Inpatient Stay Within Past
14 Days

M1020

OASIS-C to OASIS-C1 Crosswalk

September 2013

DAH

R

DC

S

TRF

Diagnoses Requiring
Medical or Treatment
Regimen Change Within
Past 14 Days: List the
patient's Medical Diagnoses
and ICD-10-C M codes at
the level of highest
specificity for those
conditions requiring
changed medical or
treatment regimen within
the past 14 days (no
surgical codes):

FU

M1017

Diagnoses Requiring
Medical or Treatment
Regimen Change Within
Past 14 Days: List the
patient's Medical
Diagnoses and ICD-10-C M
codes at the level of
highest specificity for those
conditions requiring
changed medical or
treatment regimen within
the past 14 days (no
surgical codes):

DAH

R

M1016

DC

S

Item Description

TRF

Item Description

Item #

FU

Item #

ROC

Time Points
SOC

Items

ROC

Time Points
SOC

Items

Page 4

OASIS-C

OASIS-C1
Item
Uses
*

S

R

M1034

Patient’s Overall Status

S

R

PRA

S

R

M1036

Risk Factors

S

R

PRA

D

M1041

Influenza Vaccine Data
Collection Period: Does
this episode of care
(SOC/ROC to
Transfer/Discharge) include
any dates on or between
October 1 and March 31?

T

D

Q

T

D

M1046

Influenza Vaccine
Received: did the patient
receive the influenza
vaccine for this year’s flu
season?

T

D

Q

T

D

M1051

Pneumococcal Vaccine:
Has the patient ever
received the pneumococcal
vaccination (PPV)?

T

D

Q

M1034

Patient’s Overall Status

M1036

Risk Factors

M1040

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?

T

M1045

Reason Influenza Vaccine
not received: If the patient
did not receive the
influenza vaccine from your
agency during this episode
of care, state reason:

M1050

Pneumococcal Vaccine:
Did the patient receive
pneumococcal
polysaccharide vaccine
(PPV) from your agency
during this episode of care
(SOC/ROC to
Transfer/Discharge)?

September 2013

DAH
PRA

DC

R

TRF

S

Risk for Hospitalization:
Which of the following signs
or symptoms characterize
this patient as at risk for
hospitalization? (Mark all
that apply.)

FU

ROC

Risk for Hospitalization:
Which of the following signs
or symptoms characterize
this patient as at risk for
hospitalization? (Mark all
that apply.)

M1032

DAH

M1033

Item Description

DC

R

TRF

S

FU

Item Description

SOC

Time Points

Item #

Item #

OASIS-C to OASIS-C1 Crosswalk

Items

ROC

Time Points
SOC

Items

Page 5

OASIS-C

OASIS-C1

Vision (with corrective
lenses if the patient usually
wears them):

S

R

M1210

Ability to hear (with
hearing aid or hearing
appliance if normally used):

S

M1220

Understanding of Verbal
Content in patient's own
language (with hearing aid
or device if used):

S

OASIS-C to OASIS-C1 Crosswalk

T

D

DAH

M1200

DC

R

TRF

S

FU

Patient Living Situation
Which of the following best
describes the patient's
residential circumstance
and availability of
assistance? (Check one
box only.)

D

ROC

M1100

T

Item
Uses
*

Time Points
SOC

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:

Items
DAH

M1055

DC

Item Description

TRF

Item #

FU

ROC

Time Points
SOC

Items

Item #

Item Description

M1056

Reason PPV not received:
If patient has never
received the pneumococcal
vaccination (PPV), state
reason:

M1100

Patient Living Situation
Which of the following best
describes the patient's
residential circumstance
and availability of
assistance? (Check one
box only.)

S

R

M1200

Vision (with corrective
lenses if the patient usually
wears them):

S

R

R

M1210

Ability to Hear (with
hearing aid or hearing
appliance if normally used):

S

R

PRA

R

M1220

Understanding of Verbal
Content in patient's own
language (with hearing aid
or device if used):

S

R

PRA

F

September 2013

Q

Q,
PRA

F

$,
PRA

Page 6

OASIS-C

OASIS-C1

R

M1240

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)?

S

R

M1240

Has this patient had a
formal Pain Assessment
using a standardized,
validated pain assessment
tool (appropriate to the
patient’s ability to
communicate the severity of
pain)?

S

R

M1242

Frequency of Pain
Interfering with patient's
activity or movement:

S

R

M1242

Frequency of Pain
Interfering with patient's
activity or movement:

S

R

M1300

Pressure Ulcer
Assessment: Was this
patient assessed for Risk of
Developing Pressure
Ulcers?

S

R

M1300

Pressure Ulcer
Assessment: Was this
patient assessed for Risk of
Developing Pressure
Ulcers?

S

R

Q

M1302

Does this patient have a
Risk of Developing
Pressure Ulcers

S

R

M1302

Does this patient have a
Risk of Developing
Pressure Ulcers

S

R

Q,
PRA

M1306

Does this patient have at
least one Unhealed
Pressure Ulcer at Stage II
or Higher or designated as
"unstageable"?

S

R

M1306

Does this patient have at
least one Unhealed
Pressure Ulcer at Stage II
or Higher or designated as
"unstageable"? (Excludes
Stage I pressure ulcers and
healed Stage II pressure
ulcers )

S

R

F

F

D

D

September 2013

D

DAH

S

DC

Speech and Oral (Verbal)
Expression of Language
(in patient's own language):

TRF

M1230

D

FU

ROC

R

OASIS-C to OASIS-C1 Crosswalk

SOC

S

DAH

Speech and Oral (Verbal)
Expression of Language
(in patient's own language):

Item
Uses
*

Time Points

Item Description

DC

M1230

Items
Item #

TRF

Item Description

FU

Item #

ROC

Time Points
SOC

Items

Q,
PRA
Q

F

F

D

D

Q, $,
PRA

C,Q,
PRA

Page 7

OASIS-C

OASIS-C1

S

R

F

D

M1307

The Oldest Stage II
Pressure Ulcer that is
present at discharge:
(Excludes healed Stage II
Pressure Ulcers)

D

M1308

Current Number of
Unhealed Pressure Ulcers
at Each Stage or
Unstageable: (Enter “0” if
none; Excludes Stage I
pressure ulcers and healed
Stage II pressure ulcers )

M1309

Worsening in Pressure
Ulcer Status since
SOC/ROC

M1310

Pressure Ulcer Length

S

R

D

DELETED

M1312

Pressure Ulcer Width

S

R

D

DELETED

M1314

Pressure Ulcer Depth

S

R

D

DELETED

M1320

Status Most Problematic
(Observable) Pressure
Ulcer

S

R

D

OASIS-C to OASIS-C1 Crosswalk

M1320

Status of Most
Problematic Pressure
Ulcer that is Observable:
(Excludes pressure ulcer
that cannot be staged due
to a non-removable
dressing/device).

September 2013

S

S

R

R

F

DAH

DC

TRF

FU

Item Description

ROC

Item #

Item
Uses
*

Time Points
SOC

Current Number
Unhealed (nonepithelialized) Pressure
Ulcers at Stages II-IV (or
unstageable)

Items
DAH

M1308

DC

The Oldest Nonepithelialized Stage II
Pressure Ulcer that is
present at discharge

TRF

M1307

FU

Item Description

ROC

Item #

Time Points
SOC

Items

D

Q,
PRA

D

Q, $,
PRA

D

PQ

D

C,
PRA

Page 8

OASIS-C

OASIS-C1

D

M1322

Current Number of Stage I
Pressure Ulcers: 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.

S

R

F

D

$,
PRA

M1324

Stage Most Problematic
(Observable) Pressure
Ulcer

S

R

F

D

M1324

Stage of Most
Problematic Unhealed
Pressure Ulcer that is
Stageable: (Excludes
pressure ulcer that cannot
be staged due to a nonremovable dressing/device,
coverage of wound bed by
slough and/or eschar, or
suspected deep tissue
injury).

S

R

F

D

Q, $,
PRA

M1330

Does this patient have a
Stasis Ulcer?

S

R

F

D

M1330

Does this patient have a
Stasis Ulcer?

S

R

F

D

$,
PRA

M1332

Current Number
(Observable) Stasis
Ulcer(s)

S

R

F

D

M1332

Current Number of Stasis
Ulcer(s) that are
Observable

S

R

F

D

$,
PRA

M1334

Status Most Problematic
(Observable) Stasis Ulcer

S

R

F

D

M1334

Status of Most
Problematic Stasis Ulcer
that is Observable

S

R

F

D

$,
PRA

September 2013

DAH

F

DC

FU

R

TRF

ROC

S

OASIS-C to OASIS-C1 Crosswalk

SOC

Current Number of Stage
I Pressure Ulcers: 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.

Item
Uses
*

Time Points

Item Description

DAH

FU

M1322

Items
Item #

DC

Item Description

TRF

Item #

ROC

Time Points
SOC

Items

Page 9

OASIS-C

OASIS-C1
Item
Uses
*

D

M1340

Does this patient have a
Surgical Wound?

S

R

F

D

C,Q,
PRA

M1342

Status Most Problematic
(Observable) Surgical
Wound

S

R

F

D

M1342

Status of Most
Problematic Surgical
Wound that is Observable

S

R

F

D

Q, $
PRA

M1350

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?

S

R

F

D

M1350

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?

S

R

M1400

When is the patient
dyspneic or noticeably
Short of Breath?

S

R

F

D

M1400

When is the patient
dyspneic or noticeably
Short of Breath?

S

R

M1410

Respiratory Treatments
utilized at home: (Mark all
that apply.)

S

R

D

M1410

Respiratory Treatments
utilized at home: (Mark all
that apply.)

S

R

OASIS-C to OASIS-C1 Crosswalk

September 2013

DELETED
D

DELETED

DELETED
F

DAH

F

Item Description

DC

FU

R

Item #

TRF

ROC

S

DAH

Does this patient have a
Surgical Wound?

Item Description

DC

M1340

Item #

TRF

SOC

Time Points

FU

Items

ROC

Time Points
SOC

Items

C,
PRA

Q, $,
PRA

PRA

Page 10

OASIS-C

OASIS-C1

DAH

DC

T

D

M1500

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
the time of or at any time
since the previous OASIS
assessment?

T

D

Q

D

M1510

Heart Failure Follow-up: If
patient has been diagnosed
with heart failure and has
exhibited symptoms
indicative of heart failure at
the time of or at any time
since the previous OASIS
assessment, what action(s)
has (have) been taken to
respond? (Mark all that
apply.)

T

D

Q

D

M1600

Has this patient been
treated for a Urinary Tract
Infection in the past 14
days?

S

R

D

Q,
PRA

D

M1610

Urinary Incontinence or
Urinary Catheter
Presence

S

R

D

Q, $,
PRA

M1500

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?

M1510

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.)

T

M1600

Has this patient been
treated for a Urinary Tract
Infection in the past 14
days?

S

R

M1610

Urinary Incontinence or
Urinary Catheter
Presence

S

R

September 2013

FU

TRF

ROC

SOC

DAH

DC

Item Description

Item Description

OASIS-C to OASIS-C1 Crosswalk

Item
Uses
*

Time Points

Item #

Item #

F

Items

TRF

FU

ROC

Time Points
SOC

Items

F

Page 11

OASIS-C

OASIS-C1

S

R

S

R

F

D

M1620

Bowel Incontinence
Frequency

S

R

F

M1630

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?

S

R

F

M1630

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?

S

R

F

M1700

Cognitive Functioning:
Patient's current (day of
assessment) level of
alertness, orientation,
comprehension,
concentration, and
immediate memory for
simple commands.

S

R

D

M1700

Cognitive Functioning:
Patient's current (day of
assessment) level of
alertness, orientation,
comprehension,
concentration, and
immediate memory for
simple commands.

S

R

D

Q,
PRA

M1710

When Confused
(Reported or Observed
Within the Last 14 Days)

S

R

D

M1710

When Confused
(Reported or Observed
Within the Last 14 Days)

S

R

D

Q,
PRA

M1720

When Anxious (Reported
or Observed Within the
Last 14 Days)

S

R

D

M1720

When Anxious (Reported
or Observed Within the
Last 14 Days)

S

R

D

Q,
PRA

September 2013

DAH

When does Urinary
Incontinence occur?

DC

M1615

Item Description

TRF

D

Item #

FU

Bowel Incontinence
Frequency

OASIS-C to OASIS-C1 Crosswalk

ROC

M1620

Item
Uses
*

Time Points
SOC

R

Items
DAH

S

DC

When does Urinary
Incontinence occur?

Item Description

TRF

M1615

Item #

FU

ROC

Time Points
SOC

Items

D

Q,
PRA

D

Q, $,
PRA
$,
PRA

Page 12

OASIS-C

OASIS-C1

M1745

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.

S

R

M1750

Is this patient receiving
Psychiatric Nursing
Services at home provided
by a qualified psychiatric
nurse?

S

R

OASIS-C to OASIS-C1 Crosswalk

R

D

M1740

Cognitive, behavioral, and
psychiatric symptoms that
are demonstrated at least
once a week (Reported or
Observed): (Mark all that
apply.)

S

R

D

Q,
PRA

D

M1745

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.

S

R

D

Q,
PRA

M1750

Is this patient receiving
Psychiatric Nursing
Services at home provided
by a qualified psychiatric
nurse?

S

R

September 2013

DAH

R

S

DC

S

Depression Screening:
Has the patient been
screened for depression,
using a standardized,
validated depression
screening tool?

Item Description

TRF

Cognitive, behavioral,
and psychiatric
symptoms that are
demonstrated at least once
a week (Reported or
Observed): (Mark all that
apply.)

M1730

Item #

FU

M1740

ROC

R

Item
Uses
*

Time Points
SOC

S

Items
DAH

Depression Screening:
Has the patient been
screened for depression,
using a standardized
depression screening tool?

DC

M1730

TRF

Item Description

FU

Item #

ROC

Time Points
SOC

Items

Q,
PRA

PRA

Page 13

OASIS-C

OASIS-C1

S

R

M1810

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:

S

R

F

D

M1810

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:

S

R

M1820

Current Ability to Dress
Lower Body safely (with or
without dressing aids)
including undergarments,
slacks, socks or nylons,
shoes:

S

R

F

D

M1820

Current Ability to Dress
Lower Body safely (with or
without dressing aids)
including undergarments,
slacks, socks or nylons,
shoes:

S

M1830

Bathing: Current ability to
wash entire body safely.
Excludes grooming
(washing face, washing
hands, and shampooing
hair).

S

R

F

D

M1830

Bathing: Current ability to
wash entire body safely.
Excludes grooming
(washing face, washing
hands, and shampooing
hair).

S

September 2013

DAH

Grooming: Current ability
to tend safely to personal
hygiene needs (specifically:
washing face and hands,
hair care, shaving or make
up, teeth or denture care, or
fingernail care).

DC

M1800

TRF

D

FU

ROC

R

OASIS-C to OASIS-C1 Crosswalk

SOC

S

DAH

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).

Item
Uses
*

Time Points

Item Description

DC

M1800

Items
Item #

TRF

Item Description

FU

Item #

ROC

Time Points
SOC

Items

D

Q,
PRA

F

D

Q, $,
PRA

R

F

D

Q, $,
PRA

R

F

D

Q, $,
PRA

Page 14

OASIS-C

OASIS-C1

D

M1840

Toilet Transferring:
Current ability to get to and
from the toilet or bedside
commode safely and
transfer on and off
toilet/commode.

S

R

F

M1845

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,
includes cleaning area
around stoma, but not
managing equipment.

S

R

D

M1845

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,
includes cleaning area
around stoma, but not
managing equipment.

S

R

M1850

Transferring: Current
ability to move safely from
bed to chair, or ability to
turn and position self in bed
if patient is bedfast.

S

R

F

D

M1850

Transferring: Current
ability to move safely from
bed to chair, or ability to
turn and position self in bed
if patient is bedfast.

S

R

M1860

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.

S

R

F

D

M1860

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.

S

R

September 2013

DAH

F

DC

FU

R

TRF

ROC

S

OASIS-C to OASIS-C1 Crosswalk

SOC

Toilet Transferring:
Current ability to get to and
from the toilet or bedside
commode safely and
transfer on and off
toilet/commode.

Item
Uses
*

Time Points

Item Description

DAH

FU

M1840

Items
Item #

DC

Item Description

TRF

Item #

ROC

Time Points
SOC

Items

D

Q, $,
PRA

D

Q,
PRA

F

D

Q, $,
PRA

F

D

Q, $,
PRA

Page 15

OASIS-C

OASIS-C1

S

R

D

Q,
PRA

M1880

Current Ability to Plan and
Prepare Light Meals (e.g.,
cereal, sandwich) or reheat
delivered meals safely:

S

R

D

M1880

Current Ability to Plan and
Prepare Light Meals (for
example: cereal, sandwich)
or reheat delivered meals
safely:

S

R

D

Q,
PRA

M1890

Ability to Use Telephone:
Current ability to answer
the phone safely, including
dialing numbers, and
effectively using the
telephone to communicate.

S

R

D

M1890

Ability to Use Telephone:
Current ability to answer the
phone safely, including
dialing numbers, and
effectively using the
telephone to communicate.

S

R

D

Q,
PRA

M1900

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.

S

R

M1900

Prior Functioning
ADL/IADL: Indicate the
patient’s usual ability with
everyday activities prior to
his /her most recent illness,
exacerbation, or injury.
Check only one box in each
row.

S

R

September 2013

DAH

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.

DC

M1870

TRF

D

FU

ROC

R

OASIS-C to OASIS-C1 Crosswalk

SOC

S

DAH

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.

Item
Uses
*

Time Points

Item Description

DC

M1870

Items
Item #

TRF

Item Description

FU

Item #

ROC

Time Points
SOC

Items

PRA

Page 16

OASIS-C

OASIS-C1

OASIS-C to OASIS-C1 Crosswalk

R

Q

S

R

M2000

Drug Regimen Review:
Does a complete drug
regimen review indicate
potential clinically significant
medication issues (for
example: adverse drug
reactions, ineffective drug
therapy, significant side
effects, drug interactions,
duplicate therapy,
omissions, dosage errors,
or noncompliance [nonadherence])?

S

R

C

S

R

M2002

Medication Follow-up:
Was a physician or the
physician-designee
contacted within one
calendar day to resolve
clinically significant
medication issues, including
reconciliation?

S

R

Q

September 2013

DAH

S

DC

Has this patient had a multifactor Falls Risk
Assessment using a
standardized, validated
assessment tool?

TRF

M1910

FU

Medication Follow-up:
Was a physician or the
physician-designee
contacted within one
calendar day to resolve
clinically significant
medication issues,
including reconciliation?

ROC

M2002

SOC

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?

R

DAH

M2000

S

DC

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)?

Item Description

TRF

M1910

Item
Uses
*

Time Points

Item #

FU

Item Description

Items

ROC

Item #

Time Points
SOC

Items

Page 17

OASIS-C

OASIS-C1

OASIS-C to OASIS-C1 Crosswalk

S

R

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?

September 2013

S

R

T

D

DAH

M2010

DC

Medication Intervention: If
there were any clinically
significant medication
issues at the time of, or at
any time since the previous
OASIS assessment, was a
physician or the physiciandesignee contacted within
one calendar day to resolve
any identified clinically
significant medication
issues, including
reconciliation?

TRF

M2004

FU

Item Description

ROC

D

Item #

Item
Uses
*

Time Points
SOC

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?

T

Items
DAH

M2010

DC

Medication Intervention:
If there were any clinically
significant medication
issues since the previous
OASIS assessment, was a
physician or the physiciandesignee contacted within
one calendar day of the
assessment to resolve
clinically significant
medication issues,
including reconciliation?

TRF

M2004

FU

Item Description

ROC

Item #

Time Points
SOC

Items

Q

Q,
PRA

Page 18

OASIS-C

OASIS-C1

OASIS-C to OASIS-C1 Crosswalk

Patient/Caregiver Drug
Education Intervention: At
the time of, or at any time
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, adverse drug
reactions, and significant
side effects, and how and
when to report problems
that may occur?

D

M2020

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.)

September 2013

S

R

DAH

M2015

FU

D

ROC

T

DC

R

Item Description

TRF

S

Item #

Item
Uses
*

Time Points
SOC

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.)

DAH

M2020

DC

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?

Items

TRF

M2015

FU

Item Description

ROC

Item #

Time Points
SOC

Items

T

D

Q

D

Q,
PRA

Page 19

OASIS-C

OASIS-C1

S

R

M2100

Types of Assistance
Needed and
Sources/Availability:
Determine the level of
caregiver ability and
willingness to provide
assistance for the following
activities, if assistance is
needed. (Check only one
box in each row.)

S

R

OASIS-C to OASIS-C1 Crosswalk

D

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.

S

R

F

M2040

Prior Medication
Management: Indicate the
patient’s usual ability with
managing oral and
injectable medications prior
to his/her most recent
illness, exacerbation or
injury. Check only one box
in each row.

S

R

M2102

Types and Sources of
Assistance: Determine the
ability and willingness of
non-agency caregivers
(such as family members,
friends, or privately paid
caregivers) to provide
assistance for the following
activities, if assistance is
needed. Excludes all care
by your agency staff.
(Check only one box in
each row.)

S

R

September 2013

D

DAH

Prior Medication
Management Ability:
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.

M2030

DC

M2040

D

TRF

F

Item Description

FU

R

Item #

ROC

S

Item
Uses
*

Time Points
SOC

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.

Items
DAH

FU

M2030

DC

Item Description

TRF

Item #

ROC

Time Points
SOC

Items

$.
PRA

PRA

D

PRA

Page 20

OASIS-C

OASIS-C1

Plan of Care Synopsis:
(Check only one box in
each row.) Does the
physician-ordered plan of
care include the following:

S

R

OASIS-C to OASIS-C1 Crosswalk

R

M2200

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 speechlanguage pathology visits
combined)? (Enter zero
[ “000” ] if no therapy
visits indicated.)

S

R

M2250

Plan of Care Synopsis:
(Check only one box in
each row.) Does the
physician-ordered plan of
care include the following:

S

R

September 2013

F

DAH

M2250

F

S

DC

R

How Often does the patient
receive ADL or IADL
assistance from any
caregiver(s) (other than
home health agency staff)?

DELETED

S

M2110

TRF

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 speechlanguage pathology visits
combined)? (Enter zero
[ “000” ] if no therapy
visits indicated.)

Item Description

FU

M2200

D

Item #

ROC

R

Item
Uses
*

Time Points
SOC

S

Items
DAH

How Often does the
patient receive ADL or
IADL assistance from any
caregiver(s) (other than
home health agency staff)?

DC

M2110

TRF

Item Description

FU

Item #

ROC

Time Points
SOC

Items

PRA

$,
PRA

Q,
PRA

Page 21

OASIS-C

OASIS-C1
Item
Uses
*
DAH

DC

T

D

M2300

Emergent Care: At the
time of or at any time since
the previous OASIS
assessment has the patient
utilized a hospital
emergency department
(includes
holding/observation status)?

T

D

Q

T

D

M2310

Reason for Emergent
Care: For what reason(s)
did the patient seek and/or
receive emergent care (with
or without hospitalization)?

T

D

Q

Intervention Synopsis:
Since the previous OASIS
assessment, were the
following interventions
BOTH included in the
physician-ordered plan of
care AND implemented?

T

D

M2400

Intervention Synopsis:
(Check only one box in
each row.) At the time of or
at any time since the
previous OASIS
assessment, were the
following interventions
BOTH included in the
physician-ordered plan of
care AND implemented?

T

D

Q

To which Inpatient Facility
has the patient been
admitted?

T

D

M2410

To which Inpatient Facility
has the patient been
admitted?

T

D

Q

Item Description

M2300

Emergent Care: Since the
last time OASIS data were
collected, has the patient
utilized a hospital
emergency department
(includes holding/
observation)?

M2310

Reason for Emergent
Care: For what reason(s)
did the patient receive
emergent care (with or
without hospitalization)?

M2400

M2410

OASIS-C to OASIS-C1 Crosswalk

September 2013

FU

Item Description

Item #

FU

Item #

TRF

ROC

SOC

Time Points

DC

DAH

Items

TRF

ROC

Time Points
SOC

Items

Page 22

OASIS-C

OASIS-C1

M2420

Discharge Disposition:
Where is the patient after
discharge from your
agency? (Choose only
one answer.)

M2430

Reason for
Hospitalization: For what
reason(s) did the patient
require hospitalization?
(Mark all that apply.)

T

M2440

For what Reason(s) was
the patient Admitted to a
Nursing Home? (Mark all
that apply.)

T

114

TOTALS:

D

95

80

32

19

M2420

Discharge Disposition:
Where is the patient after
discharge from your
agency? (Choose only
one answer.)

M2430

Reason for
Hospitalization: For what
reason(s) did the patient
require hospitalization?
(Mark all that apply.)

DAH

DC

TRF

FU

Item Description

ROC

Item #

Item
Uses
*

Time Points
SOC

Items
DAH

DC

TRF

FU

Item Description

ROC

Item #

Time Points
SOC

Items

D

T

Q

DELETED

62

5

110

91

76

32

18

56

5

*Item Uses
A = Administrative
C =Consistency Check
Q = Quality Measure
PQ = Potential Quality Measure
PRA = Potential Quality Measure Risk Adjustment
$ = Payment

OASIS-C to OASIS-C1 Crosswalk

September 2013

Page 23