MANUAL v1.20.1 · 2025-10-01MATRIX v1.20.1v4 · 2025-10-01
A

Section A: Identification Information

101 of 101 items loaded.

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A0050

Type of Record

Coding Instructions for A0050, Type of Record

3 governed answer/subitem rowsA0100

Facility Provider Numbers

Item Rationale

3 governed answer/subitem rowsA0100A

Facility National Provider Identifier (NPI)

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.

MDS Item Matrix page 1A0100B

Facility CMS Certification Number (CCN)

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.

MDS Item Matrix page 1A0100C

State provider number

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.

MDS Item Matrix page 1A0200

Type of Provider

DEFINITIONS

2 governed answer/subitem rowsA0310

Type of Assessment

For all Federally required assessments and records as well as all PPS assessments.

2 governed answer/subitem rowsA0310A

Type of assessment: OBRA

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.

MDS Item Matrix page 1A0310B

= 01 and/or A0310H = 1)

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.

MDS Item Matrix page 1A0310E

First assessment since most recent entry

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.

MDS Item Matrix page 1A0310F

D/C Items = ISC Skip Patterns

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.

MDS Item Matrix page 1A0310G

OBRA Quarterly =2 UPD

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.

MDS Item Matrix page 1A0310G1

Interrupted Stay

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.

MDS Item Matrix page 1A0310H

Measures = 1)

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.

MDS Item Matrix page 1A0410

Unit Certification or Licensure Designation

Item Rationale

1 governed answer/subitem rowsA0500

Legal Name of Resident

Item Rationale

Manual page A-12A0500A

Resident first name

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.

MDS Item Matrix page 1A0500B

Resident middle initial

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.

MDS Item Matrix page 1A0500C

Resident last name

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.

MDS Item Matrix page 1A0500D

Resident name suffix

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.

MDS Item Matrix page 1A0600

Social Security and Medicare Numbers

Item Rationale

Manual page A-13A0600A

Social Security Number

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.

MDS Item Matrix page 1A0600B

Medicare number

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.

MDS Item Matrix page 1A0700

Medicaid Number

Item Rationale

Manual page A-14A08010

GenderSex

A0800

Manual page 1A0810

Sex

Item Rationale

Manual page A-15A0900

Birth Date

Item Rationale

Manual page A-15A1005

Ethnicity

Item Rationale

Manual page A-16A1005A

Ethnicity: No, not of Hispanic, Latino/a, or Spanish origin

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.

MDS Item Matrix page 1A1005B

Ethnicity: Yes, Mexican, Mexican American, Chicano/a

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.

MDS Item Matrix page 1A1005C

Ethnicity: Yes, Puerto Rican

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.

MDS Item Matrix page 1A1005D

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.

MDS Item Matrix page 1A1005E

Ethnicity: Yes, another Hispanic, Latino, or Spanish origin

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.

MDS Item Matrix page 1A1005X

Ethnicity: Resident unable to respond

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.

MDS Item Matrix page 1A1005Y

Ethnicity: Resident declines to respond

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.

MDS Item Matrix page 1A1010

Race

Item Rationale

Manual page A-18A1010A

Race: White

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.

MDS Item Matrix page 1A1010B

Race: Black or African American

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.

MDS Item Matrix page 1A1010C

Race: American Indian or Alaska Native

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.

MDS Item Matrix page 1A1010D

Race: Asian Indian

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.

MDS Item Matrix page 1A1010E

Race: Chinese

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.

MDS Item Matrix page 1A1010F

Race: Filipino

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.

MDS Item Matrix page 1A1010G

Race: Japanese

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.

MDS Item Matrix page 1A1010H

Race: Korean

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.

MDS Item Matrix page 1A1010I

Race: Vietnamese

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.

MDS Item Matrix page 1A1010J

Race: Other Asian

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.

MDS Item Matrix page 1A1010K

Race: Native Hawaiian

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.

MDS Item Matrix page 1A1010L

Race: Guamanian or Chamorro

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.

MDS Item Matrix page 1A1010M

Race: Samoan

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.

MDS Item Matrix page 1A1010N

Race: Other Pacific Islander

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.

MDS Item Matrix page 1A1010X

Resident unable to respond

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.

MDS Item Matrix page 1A1010Y

Resident declines to respond

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.

MDS Item Matrix page 1A1010Z

None of the above

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.

MDS Item Matrix page 1A1110

Language

Item Rationale

3 governed answer/subitem rowsA1110A

Language: What is your preferred language?

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.

MDS Item Matrix page 1A1110B

Language: Need or want an interpreter?

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.

MDS Item Matrix page 1A1200

Marital Status

Item Rationale

Manual page A-24A1255

Transportation

Transportation item has been derived from the national PRAPARE® social drivers of health assessment tool (2016), which was

4 governed answer/subitem rowsA1300

Optional Resident Items

Item Rationale

Manual page A-28A1300A

Medical record number

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.

MDS Item Matrix page 1A1300B

Room number

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.

MDS Item Matrix page 1A1300C

Name by which resident prefers to be addressed

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.

MDS Item Matrix page 1A1300D

Lifetime occupation(s)

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.

MDS Item Matrix page 1A1500

Preadmission Screening and Resident Review (PASRR)

(cont.)

2 governed answer/subitem rowsA1510

Level II Preadmission Screening and Resident Review

(PASRR) Conditions

Manual page A-32A1510A

Level II PASRR conditions: Serious Mental Illness

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.

MDS Item Matrix page 1A1510B

PDPM Level II PASRR conditions: Intellectual Disability

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.

MDS Item Matrix page 2A1510C

Level II PASRR conditions: Other related conditions

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.

MDS Item Matrix page 2A1550

Conditions Related to Intellectual

Disability/Developmental Disability (ID/DD)

Manual page A-34A1550A

ID/DD status: Down syndrome

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.

MDS Item Matrix page 2A1550B

ID/DD status: Autism

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.

MDS Item Matrix page 2A1550C

ID/DD status: Epilepsy

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.

MDS Item Matrix page 2A1550D

ID/DD status: other organic ID/DD condition

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.

MDS Item Matrix page 2A1550E

ID/DD status: ID/DD with no organic condition

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.

MDS Item Matrix page 2A1550Z

ID/DD status: none of the above

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.

MDS Item Matrix page 2A1600

Entry Date

Item Rationale

Manual page A-35A1700

Type of Entry

Item Rationale

2 governed answer/subitem rowsA1805

Entered From

Item Rationale

10 governed answer/subitem rowsA1900

Admission Date (Date this episode of care in this facility

began) (cont.)

Manual page A-40A2000

Discharge Date

Item Rationale

Manual page A-41A2105

Discharge Status

Item Rationale

12 governed answer/subitem rowsA2121

Provision of Current Reconciled Medication List to Subsequent Provider

Subsequent Provider at Discharge (cont.)

1 governed answer/subitem rowsA2122

Route of Current Reconciled Medication List

Transmission to Subsequent Provider (cont.)

3 governed answer/subitem rowsA2122A

Route of Current Reconciled Medication List Transmission: EHR to provider

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.

MDS Item Matrix page 2A2122B

Route of Current Reconciled Medication List Transmission: HIEO to provider

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.

MDS Item Matrix page 2A2122C

Route of Current Reconciled Medication List Transmission: Verbal to provider

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.

MDS Item Matrix page 2A2122D

Route of Current Reconciled Medication List Transmission: Paper-based to provider

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.

MDS Item Matrix page 2A2122E

Route of Current Reconciled Medication List Transmission: Other Methods to provider

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.

MDS Item Matrix page 2A2123

Provision of Current Reconciled Medication List to Resident, Family, or Caregiver

Resident at Discharge (cont.)

2 governed answer/subitem rowsA2124

Route of Current Reconciled Medication List Transmission

to Resident (cont.)

Manual page A-54A2124A

Route of Current Reconciled Medication List Transmission: EHR to res/fam/caregiver

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.

MDS Item Matrix page 2A2124B

Route of Current Reconciled Medication List Transmission: HIEO to res/fam/caregiver

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.

MDS Item Matrix page 2A2124C

Route of Current Reconciled Medication List Transmission: Verbal to res/fam/caregiver

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.

MDS Item Matrix page 2A2124D

Route of Current Reconciled Medication List Transmission: Paper-based to res/fam/caregiver

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.

MDS Item Matrix page 2A2124E

Route of Current Reconciled Medication List Transmission: Other Methods to res/fam/caregiver

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.

MDS Item Matrix page 2A2200

Previous Assessment Reference Date for Significant

Correction

Manual page A-55A2300

Assessment Reference Date

Item Rationale

Manual page A-55A2400

Medicare Stay

Item Rationale

2 governed answer/subitem rowsA2400A

Has resident had Medicare-covered stay

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.

MDS Item Matrix page 2A2400B

Start date of most recent Medicare stay

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.

MDS Item Matrix page 2A2400C

End date of most recent Medicare stay

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.

MDS Item Matrix page 2