Type of Provider on Existing Record to Be Modified/Inactivated
modified/inactivated)
2 governed answer/subitem rowsX0200Name of Resident on Existing Record to Be Modified/Inactivated
modified/inactivated)
Manual page X-3X0200ACorrection: 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 19X0200CCorrection: 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 19X03010GenderSex (A08010 on existing
record to be modified/inactivated)
Manual page 2X0310Sex (A0810 on existing record to be modified/inactivated)
Coding Instructions for X0310, Sex
Manual page X-3X0400Birth Date on Existing Record to Be Modified/Inactivated
modified/inactivated)
Manual page X-4X0500Social Security Number on Existing Record to Be Modified/Inactivated
modified/inactivated)
Manual page X-4X0600Type of Assessment/Tracking (A0310 on existing record
to be modified/inactivated) (cont.)
2 governed answer/subitem rowsX0600ACorrection: OBRA reason for assessment
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 19X0600BCorrection: PPS reason for assessment
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 19X0600FCorrection: entry/discharge reporting
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 19X0600HCorrection: SNF Part A PPS Discharge
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 19X0700Date on Existing Record to Be Modified/Inactivated
Complete one only
Manual page X-7X0700ACorrection: assessment reference date
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 19X0700BCorrection: discharge date
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 19X0700CCorrection: entry date
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 19X0800Correction Attestation Section
The items in this section indicate the number of times a record accepted into iQIES has been
Manual page X-8X0900Reasons for Modification
The items in this section indicate the possible reasons for the modification request of the record
Manual page X-9X0900ACorrection: modification reasons - transcription error
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 20X0900BCorrection: modification reasons - data entry error
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 20X0900CCorrection: modification reasons error
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 20X0900DCorrection: modification reasons - item coding error
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 20X0900ZCorrection: modification reasons - other error
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 20X1050Reasons for Inactivation
The items in this section indicate the possible reasons for the inactivation request. Check all that
Manual page X-10X1050ACorrection: inactivation reasons - event did not occur
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 20X1050ZCorrection: inactivation reasons - other reason
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 20X1100RN Assessment Coordinator Attestation of Completion
(cont.)
Manual page X-12X1100ACorrection: attestor 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 20X1100BCorrection: attestor 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 20X1100CCorrection: attestor title
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 20X1100DCorrection: attestor signature
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 20X1100ECorrection: attestation date
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 20