Coding Instructions

for X1100A, Attesting Individual’s First Name
•
Enter the first name of the facility staff member attesting to the completion of the
corrected information. Start entry with the leftmost box.
Coding Instructions for X1100B, Attesting Individual’s Last Name
•
Enter the last name of the facility staff member attesting to the completion of the
corrected information. Start entry with the leftmost box.
Coding Instructions for X1100C, Attesting Individual’s Title
•
Enter the title of the facility staff member attesting to the completion of the corrected
information on the line provided.
Coding Instructions for X1100D, Signature
•
The attesting individual must sign the correction request here, certifying the completion
of the corrected information. The entire correction request should be completed and
signed within 14 days of detecting an error in a record accepted into iQIES. The
correction request, including the signature of the attesting facility staff, must be kept with
the modified or inactivated MDS record and retained in the resident’s medical record or
electronic medical record.
X1100: RN Assessment Coordinator Attestation of Completion
(cont.)
Coding Instructions for X1100E, Attestation Date
•
Enter the date the attesting facility staff member attested to the completion of the
corrected information.
•
Do not leave any boxes blank. For a one-digit month or day, place a zero in the first box.
For example, January 2, 2011, should be entered as:
Coding Tip for X1100, RN Assessment Coordinator Attestation of
Completion
•
If an inactivation is being completed, Z0400 must also be completed.
0
1
0
2
2
0
1
1
SECTION Z: ASSESSMENT ADMINISTRATION
Intent: The intent of the items in this section is to provide billing information and signatures of
persons completing the assessment.