Steps for Assessment
: Interview Instructions
1. Ask the resident to select the category or categories that
most closely correspond to the resident’s race from the list
in A1010, Race.
2. Racial 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 racial 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 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 A1010,
Race 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
RACE
AMERICAN INDIAN OR
ALASKAN NATIVE
A person having origins in any
of the original peoples of North
and South America (including
Central America), and who
maintains tribal affiliation or
community attachment.
ASIAN
A person having origins in any
of the original peoples of the Far
East, Southeast Asia, or the
Indian subcontinent including,
for example, Cambodia, China,
India, Japan, Korea, Malaysia,
Pakistan, the Philippine Islands,
Thailand, Vietnam.
BLACK OR AFRICAN
AMERICAN
A person having origins in any
of the black racial groups of
Africa. Terms such as “Haitian”
or “Negro” can be used in
addition to “Black” or “African
American.”
NATIVE HAWAIIAN OR
OTHER PACIFIC
ISLANDER
A person having origins in any
of the original peoples of
Hawaii, Guam, Samoa, or other
Pacific Islands.
WHITE
A person having origins in any
of the original peoples of
Europe, the Middle East, or
North Africa.
A1010: Race (cont.)