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Identification and background information:  current payment sources - other per diem.

Identification and background information: Responsibility/legal guardian - legal guardian

Identification and background information: Responsibility/legal guardian - other legal oversight

Identification and background information: Responsibility/legal guardian - durable power attorney/health

Identification and background information: Responsibility/legal guardian - durable power attorney/financial

Identification and background information: Responsibility/legal guardian - family member responsible

Identification and background information: Responsibility/legal guardian - patient responsible for self

Identification and background information: Responsibility/legal guardian - none of above

Resident's gender

Resident's birthdate.  If only the year (YYYY) was submitted, the month is defaulted to 01 and the day is defaulted to 01.  If only the month and year are submitted, the day is defaulted to 01.  If this field is null, either no date was submitted or an invalid date was submitted.

Resident' race/ethinicity.

State facility provider number.

Federal facility provider number.

Primary reason for assessment

Special reason for assessment.

Demographic informaiton:  date of entry - date the stay began.

Demographic information:  conditions related to MR/DD status - non-applicable - no MR/DD.

Demographic information:  conditions related to MR/DD status - Down's Syndrome.

Demographic information:  conditions related to MR/DD status - autism.

Demographic information:  conditions related to MR/DD status - MR/DD with organic condition - epilepsy.

Demographic information:  conditions related to MR/DD status - MR/DD with organic condition - other organic condition related to MR/DD.

Demographic information:  conditions related to MR/DD status - MR/DD with organic condition - MR/DD with no organic condition

Demographic information:  date background information was completed.

Demographic information:  admitted form (at entry).

Demographic information:  lived alone (prior to entry)

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