Attachment A OASIS C to OASIS C-1 Comparison

*Uses

DAH

TRF

ROC

SOC

M0014

Branch State

S

A

Branch ID Number

S

M0016

Branch ID Number

S

A

S

M0018

A

S

M0020

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

S

M0020

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

S

R

F

T

D

H

M0080

S

R

F

T

D

H

A

S

R

F

T

D

H

M0090

Discipline of Person Completing
Assessment
Date Assessment Completed

S

R

F

T

D

H

C,Q

This Assessment is Currently Being
Completed for the Following
Reason
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.

S

R

F

T

D

H

M0100

S

R

F

T

D

H

C,Q

S

R

This Assessment is Currently
Being Completed for the Following
Reason:
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.

S

R

M0090
M0100
M0102

OASIS-C to OASIS-C1 Crosswalk

R

M0102

November 2014

DC

S

S

FU

M0018

DAH

M0016

Timepoints

Item Description
CMS Certification Number

DC

Branch State

TRF

M0014

OASIS-C1
Item #
M0010

S

FU

Item Description
CMS Certification Number

ROC

Item #
M0010

Timepoints
SOC

OASIS-C

R

A

Q

Q

Page 1

M0140

Race/Ethnicity

M0150

Current Payment Sources

M0903

Date of Last (Most Recent) Home
Visit
Discharge/Transfer/ Death Date

*Uses

M0110

Episode Timing (Early/Later)

S

R

F

S

M0140

S

S

M0150

Race/Ethnicity: (Mark all that
apply.)
Current Payment Sources: (Mark
all that apply.)
Date of Last (Most Recent) Home
Visit
Discharge/Transfer/ Death Date

C, $,
PRA
A

S

A

T

D

H

M0903

T

D

H

M0906

R

DAH

F

S

DC

FU

R

R

TRF

ROC

S

M0906

Item Description
Date of Referral: Indicate the date
that the written or verbal referral
for initiation or resumption of care
was received by the HHA.

SOC

Episode Timing (Early/Later)

Timepoints

Item #
M0104

S

DAH

FU

M0110

OASIS-C1
DC

Item Description
Date of Referral: Indicate the date
that the written or verbal referral for
initiation or resumption of care was
received by the HHA.

TRF

Item #
M0104

ROC

Timepoints
SOC

OASIS-C

Q

T

D

H

A

T

D

H

Q

M1000

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

S

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

M1005

Inpatient Discharge Date (most
recent)
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

M1005

S

R

A

S

R

M1011

Inpatient Discharge Date (most
recent)
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

M1010

M1012

OASIS-C to OASIS-C1 Crosswalk

F

PRA

DELETED

November 2014

Page 2

M1020

S

R

S

M1024

Primary Diagnosis & Degree of
Symptom Control
Other Diagnoses & Degree of
Symptom Control
Payment Diagnoses

M1030

*Uses

S

R

F

M1021

S

R

F

R

F

M1023

S

R

F

S

R

F

M1025

Primary Diagnosis & Degree of
Symptom Control
Other Diagnoses & Degree of
Symptom Control
Optional Diagnoses

S

R

F

Therapies patient receives at home

S

R

F

M1030

S

R

F

M1032

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

S

R

M1033

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

S

R

$,
PRA
$,
PRA
$,
PRA
$,
PRA
PRA

M1034
M1036

Patient’s Overall Status
Risk Factors

S
S

R
R

M1034
M1036

Patient’s Overall Status
Risk Factors

S
S

R
R

PRA
PRA

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?

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?

M1022

OASIS-C to OASIS-C1 Crosswalk

T

D

November 2014

DAH

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

DC

M1018

R

TRF

ROC

R

S

FU

SOC

S

DAH

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

Timepoints

Item Description
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):

R

DC

M1018

OASIS-C1
Item #
M1017

S

TRF

Item Description
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

Item #
M1016

ROC

Timepoints
SOC

OASIS-C

PRA

PRA

T

D

Q

Page 3

*Uses

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

T

D

Q

T

D

M1056

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

T

D

Q

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

S

R

S

R

$,
PRA
PRA

S

R

PRA

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

S

R

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

Vision (with corrective lenses if the
patient usually wears them):
Ability to hear (with hearing aid or
hearing appliance if normally used):

S

R

S

R

M1210

M1220

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

S

R

M1220

M1230

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

S

R

OASIS-C to OASIS-C1 Crosswalk

DAH

DC

M1051

Item #
M1046

F

D

M1230

November 2014

FU

D

D

R

M1210

ROC

T

T

S

M1200

SOC

DAH

FU

TRF

M1100

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

Timepoints

DC

M1055

OASIS-C1

TRF

M1050

Item Description
Reason Influenza Vaccine not
received: If the patient did not
receive the influenza vaccine from
your agency during this episode of
care, state reason:
Pneumococcal Vaccine: Did the
patient receive pneumococcal
polysaccharide vaccine (PPV) from
your agency during this episode of
care (SOC/ROC to
Transfer/Discharge)?

ROC

Item #
M1045

Timepoints
SOC

OASIS-C

T

D

Q

Q,
PRA

F

D

Q,
PRA

Page 4

Does this patient have a Risk of
Developing Pressure Ulcers
Does this patient have at least one
Unhealed Pressure Ulcer at Stage
II or Higher or designated as
"unstageable"?

S

R

M1302

S

R

M1302
M1306

M1307

The Oldest Non-epithelialized
Stage II Pressure Ulcer that is
present at discharge

M1308

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

S

R

F

F

D

M1306

D

M1307

D

M1308

M1309

Does this patient have a Risk of
Developing Pressure Ulcers
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 )
The Oldest Stage II Pressure
Ulcer that is present at discharge:
(Excludes healed Stage II
Pressure Ulcers)
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 )

M1310

Pressure Ulcer Length

S

R

D

Worsening in Pressure Ulcer
Status since SOC/ROC
DELETED

M1312

Pressure Ulcer Width

S

R

D

DELETED

OASIS-C to OASIS-C1 Crosswalk

November 2014

R

F

S

R

S

R

S

R

S

R

F

F

D

D

*Uses

M1300

S

DAH

R

M1242

R

DC

S

M1300

D

S

TRF

F

FU

R

Item Description
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)?
Frequency of Pain Interfering with
patient's activity or movement:
Pressure Ulcer Assessment: Was
this patient assessed for Risk of
Developing Pressure Ulcers?

ROC

S

Item #
M1240

Timepoints
SOC

Frequency of Pain Interfering with
patient's activity or movement:
Pressure Ulcer Assessment: Was
this patient assessed for Risk of
Developing Pressure Ulcers?

R

DAH

M1242

S

DC

Item Description
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)?

TRF

Item #
M1240

FU

OASIS-C1

ROC

Timepoints
SOC

OASIS-C

Q

Q,
$,PRA
Q
Q,
PRA
C,Q,
PRA

D

Q,
PRA

D

Q, $,
PRA

D

PQ

Page 5

R

F

D

M1322

S

R

R

F

D

M1324

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

M1324

Stage Most Problematic
(Observable) Pressure Ulcer

S

S

M1330

Does this patient have a Stasis
Ulcer?
Current Number (Observable)
Stasis Ulcer(s)
Status Most Problematic
(Observable) Stasis Ulcer
Does this patient have a Surgical
Wound?
Status Most Problematic
(Observable) Surgical Wound

S

R

F

D

M1330

S

R

F

D

M1332

S

R

F

D

M1334

S

R

F

D

M1340

S

R

F

D

M1342

Does this patient have a Stasis
Ulcer?
Current Number of Stasis Ulcer(s)
that are Observable
Status of Most Problematic Stasis
Ulcer that is Observable
Does this patient have a Surgical
Wound?
Status of Most Problematic
Surgical Wound that is
Observable

November 2014

*Uses

S

DAH

R

OASIS-C to OASIS-C1 Crosswalk

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

DC

S

M1342

M1320

TRF

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.

M1340

D

FU

M1322

M1334

ROC

R

M1332

SOC

S

D

DAH

Status Most Problematic
(Observable) Pressure Ulcer

Timepoints

Item Description
DELETED

R

DC

M1320

OASIS-C1
Item #

S

TRF

Item Description
Pressure Ulcer Depth

FU

Item #
M1314

ROC

Timepoints
SOC

OASIS-C

D

C,
PRA

F

D

$,
PRA

R

F

D

Q, $,
PRA

S

R

F

D

S

R

F

D

S

R

F

D

S

R

F

D

S

R

F

D

$,
PRA
$,
PRA
$,
PRA
C,Q,
PRA
Q, $
PRA

Page 6

M1410

S

R

F

D

*Uses

R

DAH

S

D

When is the patient dyspneic or
noticeably Short of Breath?
Respiratory Treatments utilized at
home: (Mark all that apply.)

DC

M1400

R

TRF

D

S

FU

R

ROC

S

M1410

SOC

F

Item Description
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?

D

DAH

R

Item #
M1350

DC

S

F

TRF

FU

When is the patient dyspneic or
noticeably Short of Breath?
Respiratory Treatments utilized at
home: (Mark all that apply.)

R

DELETED

M1400

S

Timepoints

DELETED

Item Description
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?

OASIS-C1

DELETED

Item #
M1350

ROC

Timepoints
SOC

OASIS-C

C,
PRA

Q,
$,PRA
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?

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

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

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

M1600

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

S

R

D

M1600

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

S

R

D

Q,
PRA

M1610

Urinary Incontinence or Urinary
Catheter Presence

S

R

D

M1610

Urinary Incontinence or Urinary
Catheter Presence

S

R

D

Q, $,
PRA

OASIS-C to OASIS-C1 Crosswalk

F

November 2014

F

Page 7

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

D
D

*Uses

F

R

DAH

R

M1620

S

DC

FU

S

Item #
M1615

TRF

Item Description
When does Urinary Incontinence
occur?
Bowel Incontinence Frequency

ROC

F

D

Timepoints
SOC

F

D

DAH

R

R

OASIS-C1
DC

S

S

TRF

FU

M1620

Item Description
When does Urinary Incontinence
occur?
Bowel Incontinence Frequency

ROC

Item #
M1615

Timepoints
SOC

OASIS-C

Q,
PRA
Q,
$,PRA
$,
PRA

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

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

S

R

D

Q,
PRA

M1720

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

S

R

D

M1720

S

R

D

Q,
PRA

M1730

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

S

R

When Confused (Reported or
Observed Within the Last 14
Days)
When Anxious (Reported or
Observed Within the Last 14
Days)
Depression Screening: Has the
patient been screened for
depression, using a standardized,
validated depression screening
tool?

S

R

M1740

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

S

R

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

S

R

OASIS-C to OASIS-C1 Crosswalk

M1730

D

M1740

November 2014

Q,
PRA

D

Q,
PRA

Page 8

Current Ability to Dress Upper
Body safely (with or without
dressing aids) including
undergarments, pullovers, frontopening shirts and blouses,
managing zippers, buttons, and
snaps:
Current Ability to Dress Lower
Body safely (with or without
dressing aids) including
undergarments, slacks, socks or
nylons, shoes:

S

R

S

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

S

M1820

M1830

OASIS-C to OASIS-C1 Crosswalk

M1800

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).

S

R

F

D

M1810

S

R

R

F

D

M1820

Current Ability to Dress Upper
Body safely (with or without
dressing aids) including
undergarments, pullovers, frontopening shirts and blouses,
managing zippers, buttons, and
snaps:
Current Ability to Dress Lower
Body safely (with or without
dressing aids) including
undergarments, slacks, socks or
nylons, shoes:

S

R

F

D

M1830

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

S

November 2014

*Uses

M1810

D

D

DAH

R

DC

S

R

R

TRF

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).

S

S

FU

M1800

M1750

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

ROC

R

Item #
M1745

Timepoints
SOC

S

D

DAH

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

R

OASIS-C1
DC

M1750

S

TRF

Item Description
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.

FU

Item #
M1745

ROC

Timepoints
SOC

OASIS-C

Q,
PRA

PRA

D

Q,
PRA

F

D

Q, $,
PRA

R

F

D

Q, $,
PRA

R

F

D

Q, $,
PRA

Page 9

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

M1870

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.

S

R

OASIS-C to OASIS-C1 Crosswalk

M1845

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

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

D

M1870

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.

S

R

November 2014

D

*Uses

M1860

D

F

DAH

R

R

R

DC

S

S

S

TRF

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

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

FU

M1850

Item #
M1840

ROC

R

D

Timepoints
SOC

S

F

DAH

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.

R

OASIS-C1
DC

M1845

S

TRF

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

FU

Item #
M1840

ROC

Timepoints
SOC

OASIS-C

Q, $,
PRA

D

Q,
PRA

F

D

Q, $,
PRA

F

D

Q, $,
PRA

D

Q,
PRA

Page 10

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

M1910

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)?

M2000

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?

*Uses

R

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

PRA

S

R

M1910

Has this patient had a multi-factor
Falls Risk Assessment using a
standardized, validated
assessment tool?

S

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 [non-adherence])?

S

R

C

November 2014

D

D

DAH

S

DC

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

R

TRF

M1890

D

S

FU

ROC

R

OASIS-C to OASIS-C1 Crosswalk

SOC

S

D

DAH

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

Timepoints

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

R

DC

M1890

OASIS-C1
Item #
M1880

S

TRF

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

FU

Item #
M1880

ROC

Timepoints
SOC

OASIS-C

Q,
PRA

Q,
PRA

Page 11

OASIS-C to OASIS-C1 Crosswalk

S

R

November 2014

S

R

D

*Uses

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

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?

R

TRF

M2004

S

FU

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

ROC

D

Item #
M2002

Timepoints
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

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?

R

OASIS-C1

TRF

M2004

S

FU

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

ROC

Item #
M2002

Timepoints
SOC

OASIS-C

Q

Q

Q,
PRA

Page 12

OASIS-C to OASIS-C1 Crosswalk

F

R

D

M2030

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

November 2014

F

*Uses

S

D

DAH

R

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.)

T

DC

S

M2020

TRF

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.

D

FU

M2030

ROC

R

Item Description
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?

SOC

S

Timepoints

Item #
M2015

D

DAH

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.)

T

OASIS-C1
DC

M2020

TRF

Item Description
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?

FU

Item #
M2015

ROC

Timepoints
SOC

OASIS-C

Q

D

Q,
PRA

D

$.
PRA

Page 13

S

R

OASIS-C to OASIS-C1 Crosswalk

F

R

D

M2110

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

S

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

S

R

November 2014

D

F

*Uses

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.)

S

DAH

M2200

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.)

DC

R

M2102

R

TRF

S

D

S

FU

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

ROC

M2110

SOC

R

Item Description
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.

DAH

S

Timepoints

Item #
M2040

DC

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.)

R

TRF

M2100

S

FU

Item Description
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.

OASIS-C1

DELETED

Item #
M2040

ROC

Timepoints
SOC

OASIS-C

PRA

PRA

PRA

$,
PRA

Page 14

*Uses

DAH

DC

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 physicianordered plan of care AND
implemented?

T

D

Q

To which Inpatient Facility has the
patient been admitted?
Discharge Disposition: Where is
the patient after discharge from
your agency? (Choose only one
answer.)
Reason for Hospitalization: For
what reason(s) did the patient
require hospitalization? (Mark all
that apply.)

T

D

M2410

T

D

Q

D

M2420

To which Inpatient Facility has the
patient been admitted?
Discharge Disposition: Where is
the patient after discharge from
your agency? (Choose only one
answer.)
Reason for Hospitalization: For
what reason(s) did the patient
require hospitalization? (Mark all
that apply.)

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

R

T

M2430

November 2014

S

R

FU

TRF

ROC

SOC

DAH

DC

T

M2300

S

FU

TRF

ROC

Timepoints

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

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

M2430

OASIS-C1
Item #
M2250

Item #
M2250

M2420

Timepoints
SOC

OASIS-C

Q,
PRA

D

T

Q

Page 15

110

91

76

33

18

59

5

*Uses

5

DAH

61

DC

19

TRF

32

Item Description
DELETED

FU

DAH

80

Item #

ROC

DC

95

T

Timepoints
SOC

TRF

TOTALS:

FU

114

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

OASIS-C1

ROC

Item #
M2440

Timepoints
SOC

OASIS-C

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

OASIS-C to OASIS-C1 Crosswalk

November 2014

Page 16