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Checked
Condition applies under the item instruction.
Manual page A-16DiraChart MDS item reference
A1005DSection Av1.20.1Manual page A-16
Ethnicity: Yes, Cuban
This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.
Quick coding
Answer Codes
Use the item-specific response choices below when structured codes apply.
Response format: Check all that apply
—
Not checked
Condition does not apply under the item instruction.
Manual page A-16Item-specific instructions
Coding Guidance
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Steps for Assessment
: Interview
Instructions
1. Ask the resident to select the category or categories that most closely correspond to their
ethnicity from the list in A1005.
2. Ethnic category definitions are provided only if requested in order to answer the item.
3. Respondents should be offered the option of selecting one or more ethnic designations.
4. If the resident declines to respond, code Y, Resident declines to respond, and do not code
based on other resources (family, significant other, or guardian/legally authorized
representative or medical records).
5. If the resident is unable to respond, the assessor may ask a family member, significant other,
and/or guardian/legally authorized representative.
6. Only use medical record documentation to code A1005, Ethnicity if the resident is unable to
respond and no family member, significant other, and/or guardian/legally authorized
representative provides a response for this item.
DEFINITION
ETHNICITY
HISPANIC OR LATINO/A
A person of Cuban, Mexican,
Puerto Rican, South or Central
American or other Spanish
culture or origin regardless of
race. The term “Spanish Origin”
can be used in addition to
Hispanic or Latino/a.
A1005: Ethnicity (cont.)
Coding Instructions
Check all that apply.
•
If the resident provides a response, check the box(es) indicating the ethnic category or
categories identified by the resident.
•
Code X, Resident unable to respond: if the resident is unable to respond.
— In the cases where the resident is unable to respond and the response is determined
via family, significant other, or legally authorized representative input or medical
record documentation, check all boxes that apply, including X. Resident unable to
respond.
— If the resident is unable to respond and no other resources (family, significant other,
or legally authorized representative or medical records) provided the necessary
information, code A1005 as X. Resident unable to respond.
•
Code Y, Resident declines to respond: if the resident declines to respond.
— When the resident declines to respond, code only Y. Resident declines to respond.
— When the resident declines to respond do not code based on other resources (family,
significant other, or legally authorized representative or medical records).
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