Updated research request forms and data security approval requirement effective 4/24/23
Emergent care: unknown.
Emergent Care Reason: cardiac problems.
Emergent Care Reason: GI bleeding, obstruction.
Emergent Care Reason: hypo/ hyperglycemia, diabetes out of control.
Emergent Care Reason: improper medication administration, medication side effects, toxicity, anphylaxis.
Emergent Care Reason: injury caused by fall or accident at home.
Emergent Care Reason: nausea, dehydration, malnutrition, constipation, impaction.
Emergent Care Reason: other than above.
Emergent Care Reason: respiratory problems.
Emergent Care Reason: reason unknown.
Emergent Care Reason: wound infection, deteriorating wound status, new lesion/ ulcer.
Inpatient facility to which the patient has been admitted.
Where the patient is after discharge.
After discharge, does patient receive health, personal, or support services or assistance: yes, other community resources.
After discharge, does patient receive health, personal, or support services or assistance: yes, family or friends.
After discharge, does patient receive health, personal, or support services or assistance: no assistance or services.
Reason admitted to acute care hospital.
Reason for hospitalization: chemotherapy.
Reason for hospitalization: deep vein thrombosis, pulmonary embolus.
Reason for hospitalization: exacerbation of CHF, fluid overload, heart failure.
Reason for hospitalization: GI bleeding, obstruction.
Reason for hospitalization: Hypo/ hyperglycemia, diabetes out of control.
Reason for hospitalization: improper medication administration, medication side effects, toxicity, anaphylaxis.
Reason for hospitalization: injury caused by fall or accident at home.
Reason for hospitalization: IV catheter-related infection.
Reason for hospitalization: myocardial infarction, stroke.
Reason for hospitalization: Other than above.
Reason for hospitalization: psychotic episode.
Reason for hospitalization: respiratory problems.
Reason for hospitalization: scheduled surgical procedure.
Reason for hospitalization: uncontrolled pain.
Reason for hospitalization: urinary tract infection.
Reason for hospitalization: wound or tube site infection, deteriorating wound status, new lesion/ ulcer.
Reason(s) for admission to nursing home: hospice care.
Reason(s) for admission to nursing home: other.
Reason(s) for admission to nursing home: permanent placement.
Reason(s) for admission to nursing home: respite care.
Reason(s) for admission to nursing home: therapy services.
Reason(s) for admission to nursing home: unknown.
Reason(s) for admission to nursing home: unsafe for care at home.
Date of last home visit (most recent)
Discharge/ transfer/ death date
Skin condition: ulcers - stasis ulcer. This field indicates the highest stage indicator of a stasis ulcer in the last 7 days. A stasis ulcer is an open lesion caused by poor circulation in the lower extremities.
Skin condition: history of resolved ulcers. This field indicates if the resident had an ulcer that was resolved or cured in the lat 90 days.
Skin condition: other skin problems or lesions present in last 7 days - abrasions/bruises.
Skin condition: other skin problems or lesions present in last 7 days - rashes - e.g., intertrigo, eczema, etc.
Skin condition: other skin problems or lesions present in last 7 days - skin desensitized to pain or pressure.
Skin condition: other skin problems or lesions present in last 7 days - skin tears or cuts (other than surgery).
Skin condition: other skin problems or lesions present in last 7 days - none of above.
Skin condition: skin treatments in last 7 days - other preventative/protective skin care other than to feet.