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This field indicates the most recent inpatient discharge date is unknown.

This field indicates the most recent inpatient discharge date.

This field lists the inpatient diagnosis and ICD code 1 for conditions treated during an inpatient stay within the past 14 days.

This field lists the inpatient diagnosis and ICD code 2 for conditions treated during an inpatient stay within the past 14 days.

This field lists the inpatient diagnosis and ICD code 3 for conditions treated during an inpatient stay within the past 14 days.

This field lists the inpatient diagnosis and ICD code 4 for conditions treated during an inpatient stay within the past 14 days.

This field lists the inpatient diagnosis and ICD code 5 for conditions treated during an inpatient stay within the past 14 days.

This field lists the inpatient diagnosis and ICD code 6 for conditions treated during an inpatient stay within the past 14 days.

This field is checked if the inpatient procedure and associated ICD code is unknown for the plan of care.

This field is checked if there is no inpatient procedure and associated ICD code for the plan of care.

This field lists the inpatient ICD and procedure 1 relevant to the plan of care.

This field lists the inpatient ICD and procedure 2 relevant to the plan of care.

This field lists the inpatient ICD and procedure 3 relevant to the plan of care.

This field lists the inpatient ICD and procedure 4 relevant to the plan of care.

This field lists the patient's medical diagnoses and ICD code 1 for those conditions requiring changed medical or treatment regimen within the past 14 days.

This field lists the patient's medical diagnoses and ICD code 2 for those conditions requiring changed medical or treatment regimen within the past 14 days.

This field lists the patient's medical diagnoses and ICD code 3 for those conditions requiring changed medical or treatment regimen within the past 14 days.

This field lists the patient's medical diagnoses and ICD code 4 for those conditions requiring changed medical or treatment regimen within the past 14 days.

This field lists the patient's medical diagnoses and ICD code 5 for those conditions requiring changed medical or treatment regimen within the past 14 days.

This field lists the patient's medical diagnoses and ICD code 6 for those conditions requiring changed medical or treatment regimen within the past 14 days.

This field is checked if there have been no medical or treatment regimen changes within the past 14 days.

This field is checked if the patient had indwelling/suprapubic catheter prior to the inpatient stay or change in medical or treatment regimen within the past 14 days.

This field is checked if the patient had disruptive or socially inappropriate behavior prior to the inpatient stay or change in medical or treatment regimen within the past 14 days.

This field is checked if the patient had impaired decision-making prior to the inpatient stay or change in medical or treatment regimen within the past 14 days.

This field is checked if the patient had intractable pain prior to the inpatient stay or change in medical or treatment regimen within the past 14 days.

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