✓
Checked
Condition applies under the item instruction.
Manual page Q-1DiraChart MDS item reference
Q0110ESection Qv1.20.1Manual page Q-1
Asmt and Goal Participation: Other legally authorized representative
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 Q-1Item-specific instructions
Coding Guidance
Review what the item asks, how to choose the response, and what should be verified before submission.
Steps for Assessment
1. Review the clinical record for documentation that the
resident, family member and/or significant other, and guardian or legally authorized
representative participated in the assessment process.
2. Ask the resident, the family member or significant other (when applicable), and the guardian
or legally authorized representative (when applicable) if they actively participated in the
assessment process.
3. Ask staff members who completed the assessment whether or not the resident, family or
significant other, or guardian or legally authorized representative participated in the
assessment process.
Coding Instructions
for Q0110, Participation in Assessment and Goal
Setting
Record the participation of all those who participated in the assessment process. Check all that
apply.
•
Code A, Resident: if the resident actively participated in the assessment process.
•
Code B, Family: if a member of the resident’s family actively participated in the
assessment process.
•
Code C, Significant other: if a significant other of the resident actively participated
in the assessment process.
•
Code D, Legal guardian: if a legal guardian actively participated in the assessment
process.
DEFINITIONS
FAMILY OR
SIGNIFICANT OTHER
A spousal, kinship (e.g.,
sibling, child, parent,
nephew), or in-law
relationship; a partner,
housemate, primary
community caregiver or
close friend. Significant other
does not include staff at the
nursing home.
GUARDIAN/LEGALLY
AUTHORIZED
REPRESENTATIVE
A person who is authorized,
under applicable law, to
make decisions for the
resident, including giving
and withholding consent for
medical treatment.
Q0110: Participation in Assessment and Goal Setting (cont.)
•
Code E, Other legally authorized representative: if a legally authorized
representative actively participated in the assessment process.
•
Code Z, None of the above: if none of the above actively participated in the
assessment process.
Coding Tips
•
While family, significant others, or, if necessary, the guardian or legally authorized
representative can be involved, the response selected must reflect the resident’s
perspective if they are able to express it, even if the opinion of family member/significant
other or guardian/legally authorized representative differs.
•
Significant other does not include nursing home staff.
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