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Skilled Nursing Services
Personal Care
Waiver Process
Enrollment
Providers
Home
About
Services
Adult Day Care
Home Modifications
Home Delivered Meals
Medication Management
Non-Medical Transportation
Nursing Home Transition
Skilled Nursing Services
Personal Care
Waiver Process
Enrollment
Providers
InterRAI
interRAI (1)
CDMS_FormID
phw1
Member_ID
First Name
(Required)
Middle Inital
Jr/Sr
Last Name
(Required)
RAIA10a
RAIA2
1
2
Year
Month
Date
RAIA3d
RAIA10b
RAIA24
1
2
3
4
5
6
RAIA11c
RAIA11a
RAIA11b
RAIA12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
RAIA5a4
RAIA5a1
RAIA5a2
RAIA5a3
RAIA5b
RAIA5c
RAIA6
RAIA13a
1
2
3
4
5
6
7
8
RAIA7a
0
1
RAIA7b
0
1
RAIA7c
0
1
RAIA7d
0
1
RAIA7e
0
1
RAIA7f
0
1
RAIA8
1
2
3
4
5
6
7
RAIA13b
0
1
RAIA13c
0
1
2
RAIA14
0
1
2
3
4
5
RAIA9a
RAIA9b
RAIA9c
RAIA9d
RAIB3
1
2
3
4
RAIB1d
RAIB1a
RAIB1b
RAIB1c
RAIB2a
0
1
RAIB4a
0
1
RAIB4b
0
1
RAIB2b
0
1
RAIB4c
0
1
RAIB2c
0
1
RAIB4d
0
1
RAIB2d
0
1
RAIB4e
0
1
RAIB2e
0
1
RAIB2f
0
1
C1
0
1
2
3
4
5
C3a
0
1
2
C3b
0
1
2
C3c
0
1
2
C4
0
1
C2a
0
1
C2b
0
1
C5
0
1
2
8
C2c
0
1
D1
0
1
2
3
4
D3
0
1
2
3
4
D2
0
1
2
3
4
D4
0
1
2
3
4
E1f
0
1
2
3
E1g
0
1
2
3
E1h
0
1
2
3
E1i
0
1
2
3
E1j
0
1
2
3
E1k
0
1
2
3
E1a
0
1
2
3
E1b
0
1
2
3
E1c
0
1
2
3
E1d
0
1
2
3
E2a
0
1
2
3
8
E1e
0
1
2
3
E2b
0
1
2
3
8
E2c
0
1
2
3
8
E3c
0
1
2
3
E3d
0
1
2
3
E3e
0
1
2
3
E3f
0
1
2
3
E3a
0
1
2
3
E3b
0
1
2
3
F3
0
1
2
F4
0
1
2
3
F1a
0
1
2
3
4
8
F1b
0
1
2
3
4
8
F1c
0
1
2
3
4
8
F1d
0
1
2
3
4
8
F1e
0
1
2
3
4
8
F5
0
1
F1f
0
1
2
3
4
8
F2
0
1
Meal Prep Performance
(Required)
0
1
2
3
4
5
6
8
Meal Prep Capacity
(Required)
0
1
2
3
4
5
6
G1bC
0
1
2
3
4
5
6
G1bP
0
1
2
3
4
5
6
8
G1cC
0
1
2
3
4
5
6
G1cP
0
1
2
3
4
5
6
8
G1dC
0
1
2
3
4
5
6
G1dP
0
1
2
3
4
5
6
8
G2a
0
1
2
3
4
5
6
8
G1eP
0
1
2
3
4
5
6
8
G1eC
0
1
2
3
4
5
6
G2b
0
1
2
3
4
5
6
8
G1fC
0
1
2
3
4
5
6
G1fP
0
1
2
3
4
5
6
8
G1gP
0
1
2
3
4
5
6
8
G1gC
0
1
2
3
4
5
6
G2c
0
1
2
3
4
5
6
8
G1hP
0
1
2
3
4
5
6
8
G1hC
0
1
2
3
4
5
6
G2d
0
1
2
3
4
5
6
8
G2e
0
1
2
3
4
5
6
8
G3d
0
1
2
3
4
5
8
G2f
0
1
2
3
4
5
6
8
G2g
0
1
2
3
4
5
6
8
G2h
0
1
2
3
4
5
6
8
G2i
0
1
2
3
4
5
6
8
G2j
0
1
2
3
4
5
6
8
G4a
0
1
2
3
4
G3a
0
1
2
3
G4b
0
1
2
3
G3b
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
77
88
99
G5a
0
1
G5b
0
1
G6
0
1
2
8
G3c
0
1
2
3
4
5
G7a
0
1
G7b
0
1
H1
0
1
2
3
4
5
8
H3
0
1
2
3
4
5
8
H2
0
1
2
3
H4
0
1
I1c
0
1
2
3
I1d
0
1
2
3
I1e
0
1
2
3
I1f
0
1
2
3
I1g
0
1
2
3
I1h
0
1
2
3
I1i
0
1
2
3
I1j
0
1
2
3
I1a
0
1
2
3
I1b
0
1
2
3
meal_sc_tue
meal_sc_thurs
meal_sc_fri
meal_sc_sun
(Required)
meal_sc_sat
(Required)
meal_sc_wed
meal_sc_desc
G1aS3
meal_sc_mon
(Required)
meal_weekly_total
meal_mon
First Choice
Second Choice
Third Choice
meal_fri
First Choice
Second Choice
Third Choice
meal_adj_weekly_total
meal_tue
First Choice
Second Choice
Third Choice
meal_sc
meal_sun
First Choice
Second Choice
Third Choice
meal_wed
First Choice
Second Choice
Third Choice
meal_sat
First Choice
Second Choice
Third Choice
meal_thurs
First Choice
Second Choice
Third Choice
a1
rb_meal_weekly_total
rb_meal_tues
First Choice
Second Choice
Third Choice
rb_meal_sc
rb_meal_sun
First Choice
Second Choice
Third Choice
rb_meal_fri
First Choice
Second Choice
Third Choice
rb_meal_sat
First Choice
Second Choice
Third Choice
rb_meal_thurs
First Choice
Second Choice
Third Choice
rb_meal_adj_weekly_total
rb_meal_wed
First Choice
Second Choice
Third Choice
rb_meal_mon
First Choice
Second Choice
Third Choice
a2
ph_meal_weekly_total
ph_meal_mon
First Choice
Second Choice
Third Choice
ph_meal_tues
First Choice
Second Choice
Third Choice
ph_meal_wed
First Choice
Second Choice
Third Choice
ph_meal_thurs
First Choice
Second Choice
Third Choice
ph_meal_adj_weekly_total
ph_meal_sc
ph_meal_sun
First Choice
Second Choice
Third Choice
ph_meal_sat
First Choice
Second Choice
Third Choice
ph_meal_fri
First Choice
Second Choice
Third Choice
house_sc_desc
G1bS3
house_weekly_total
house_mon
First Choice
Second Choice
Third Choice
house_sat
First Choice
Second Choice
Third Choice
house_fri
First Choice
Second Choice
Third Choice
house_tue
First Choice
Second Choice
Third Choice
house_thurs
First Choice
Second Choice
Third Choice
house_wed
First Choice
Second Choice
Third Choice
house_adj_weekly_total
house_sc
house_sun
First Choice
Second Choice
Third Choice
house_sc_sun
house_sc_tue
house_sc_thurs
house_sc_sat
house_sc_mon
house_sc_fri
house_sc_wed
a3
rb_house_weekly_total
rb_house_mon
First Choice
Second Choice
Third Choice
rb_house_tues
First Choice
Second Choice
Third Choice
rb_house_wed
First Choice
Second Choice
Third Choice
rb_house_thurs
First Choice
Second Choice
Third Choice
rb_house_fri
First Choice
Second Choice
Third Choice
rb_house_sat
First Choice
Second Choice
Third Choice
rb_house_sun
First Choice
Second Choice
Third Choice
rb_house_adj_weekly_total
rb_house_sc
rb_house_adj_weekly_total
a4
ph_house_sat
First Choice
Second Choice
Third Choice
ph_house_weekly_total
ph_house_sun
First Choice
Second Choice
Third Choice
ph_house_tues
First Choice
Second Choice
Third Choice
ph_house_wed
First Choice
Second Choice
Third Choice
ph_house_thurs
First Choice
Second Choice
Third Choice
ph_house_fri
First Choice
Second Choice
Third Choice
ph_house_sc
ph_house_adj_weekly_total
ph_house_adj_weekly_total
ph_house_mon
First Choice
Second Choice
Third Choice
finance_sc_desc
G1cS3
finance_sc_sun
finance_tue
First Choice
Second Choice
Third Choice
finance_sc
finance_adj_weekly_total
finance_sat
First Choice
Second Choice
Third Choice
finance_mon
First Choice
Second Choice
Third Choice
finance_fri
First Choice
Second Choice
Third Choice
finance_thurs
First Choice
Second Choice
Third Choice
finance_wed
First Choice
Second Choice
Third Choice
finance_sun
First Choice
Second Choice
Third Choice
finance_weekly_total
finance_sc_thurs
finance_sc_tue
finance_sc_sat
finance_sc_mon
finance_sc_fri
finance_sc_wed
a5
rb_finance_weekly_total
rb_finance_mon
First Choice
Second Choice
Third Choice
rb_finance_adj_weekly_total
rb_finance_sun
First Choice
Second Choice
Third Choice
rb_finance_sat
First Choice
Second Choice
Third Choice
rb_finance_fri
First Choice
Second Choice
Third Choice
rb_finance_thurs
First Choice
Second Choice
Third Choice
rb_finance_wed
First Choice
Second Choice
Third Choice
rb_finance_tues
First Choice
Second Choice
Third Choice
rb_finance_sc
rb_finance_adj_weekly_total
a6
ph_finance_sat
First Choice
Second Choice
Third Choice
ph_finance_weekly_total
ph_finance_sun
First Choice
Second Choice
Third Choice
ph_finance_adj_weekly_total
ph_finance_thurs
First Choice
Second Choice
Third Choice
ph_finance_sc
ph_finance_wed
First Choice
Second Choice
Third Choice
ph_finance_tues
First Choice
Second Choice
Third Choice
ph_finance_mon
First Choice
Second Choice
Third Choice
ph_finance_fri
First Choice
Second Choice
Third Choice
ph_finance_adj_weekly_total
meds_sc_desc
G1dS3
meds_sc_sun
meds_weekly_total
meds_sc
meds_sun
First Choice
Second Choice
Third Choice
meds_mon
First Choice
Second Choice
Third Choice
meds_sat
First Choice
Second Choice
Third Choice
meds_adj_weekly_total
meds_thurs
First Choice
Second Choice
Third Choice
meds_wed
First Choice
Second Choice
Third Choice
meds_tue
First Choice
Second Choice
Third Choice
meds_fri
First Choice
Second Choice
Third Choice
meds_sc_thurs
meds_sc_tue
meds_sc_sat
meds_sc_mon
meds_sc_wed
meds_sc_fri
a7
rb_meds_weekly_total
rb_meds_tues
First Choice
Second Choice
Third Choice
rb_meds_thurs
First Choice
Second Choice
Third Choice
rb_meds_fri
First Choice
Second Choice
Third Choice
rb_meds_sat
First Choice
Second Choice
Third Choice
rb_meds_sun
First Choice
Second Choice
Third Choice
rb_meds_sc
rb_meds_adj_weekly_total
rb_meds_wed
First Choice
Second Choice
Third Choice
rb_meds_mon
First Choice
Second Choice
Third Choice
a8
ph_meds_weekly_total
ph_meds_sat
First Choice
Second Choice
Third Choice
ph_meds_mon
First Choice
Second Choice
Third Choice
ph_meds_sun
First Choice
Second Choice
Third Choice
ph_meds_tues
First Choice
Second Choice
Third Choice
ph_meds_wed
First Choice
Second Choice
Third Choice
ph_meds_thurs
First Choice
Second Choice
Third Choice
ph_meds_adj_weekly_total
ph_meds_sc
ph_meds_fri
First Choice
Second Choice
Third Choice
phone_sc_desc
G1eS3
phone_sc_sun
phone_weekly_total
phone_sc
phone_tue
First Choice
Second Choice
Third Choice
phone_sun
First Choice
Second Choice
Third Choice
phone_sat
First Choice
Second Choice
Third Choice
phone_fri
First Choice
Second Choice
Third Choice
phone_adj_weekly_total
phone_thurs
First Choice
Second Choice
Third Choice
phone_wed
First Choice
Second Choice
Third Choice
phone_mon
First Choice
Second Choice
Third Choice
phone_sc_tue
phone_sc_sat
phone_sc_mon
phone_sc_thurs
phone_sc_fri
phone_sc_wed
a9
rb_1_weekly_total
rb_1_adj_weekly_total
rb_1_sc
rb_1_sat
First Choice
Second Choice
Third Choice
rb_1_mon
First Choice
Second Choice
Third Choice
rb_1_wed
First Choice
Second Choice
Third Choice
rb_1_thurs
First Choice
Second Choice
Third Choice
rb_1_fri
First Choice
Second Choice
Third Choice
rb_1_sun
First Choice
Second Choice
Third Choice
rb_1_tues
First Choice
Second Choice
Third Choice
a10
ph_1_sat
First Choice
Second Choice
Third Choice
ph_1_weekly_total
ph_1_mon
First Choice
Second Choice
Third Choice
ph_1_wed
First Choice
Second Choice
Third Choice
ph_1_thurs
First Choice
Second Choice
Third Choice
ph_1_tues
First Choice
Second Choice
Third Choice
ph_1_fri
First Choice
Second Choice
Third Choice
ph_1_sun
First Choice
Second Choice
Third Choice
ph_1_sc
ph_1_adj_weekly_total
stairs_sc_desc
G1fS3
stairs_sc_sun
stairs_weekly_total
stairs_sc_thurs
stairs_sc_tue
stairs_tue
First Choice
Second Choice
Third Choice
stairs_mon
First Choice
Second Choice
Third Choice
stairs_wed
First Choice
Second Choice
Third Choice
stairs_sun
First Choice
Second Choice
Third Choice
stairs_thurs
First Choice
Second Choice
Third Choice
stairs_fri
First Choice
Second Choice
Third Choice
stairs_adj_weekly_total
stairs_sc
stairs_sat
First Choice
Second Choice
Third Choice
stairs_sc_mon
stairs_sc_sat
stairs_sc_wed
stairs_sc_fri
a11
rb_2_weekly_total
rb_2_sat
First Choice
Second Choice
Third Choice
rb_2_sun
First Choice
Second Choice
Third Choice
rb_2_fri
First Choice
Second Choice
Third Choice
rb_2_sc
rb_2_adj_weekly_total
rb_2_mon
First Choice
Second Choice
Third Choice
rb_2_tues
First Choice
Second Choice
Third Choice
rb_2_wed
First Choice
Second Choice
Third Choice
rb_2_thurs
First Choice
Second Choice
Third Choice
a12
ph_2_sat
First Choice
Second Choice
Third Choice
ph_2_weekly_total
ph_2_adj_weekly_total
ph_2_sc
ph_2_sun
First Choice
Second Choice
Third Choice
ph_2_mon
First Choice
Second Choice
Third Choice
ph_2_tues
First Choice
Second Choice
Third Choice
ph_2_wed
First Choice
Second Choice
Third Choice
ph_2_thurs
First Choice
Second Choice
Third Choice
ph_2_fri
First Choice
Second Choice
Third Choice
shopping_sc_desc
shopping_weekly_total
shopping_mon
First Choice
Second Choice
Third Choice
shopping_sc_sun
shopping_sc_sat
shopping_sat
First Choice
Second Choice
Third Choice
shopping_sc_fri
shopping_fri
First Choice
Second Choice
Third Choice
shopping_sc_thurs
shopping_thurs
First Choice
Second Choice
Third Choice
shopping_sc_wed
shopping_wed
First Choice
Second Choice
Third Choice
shopping_sc
shopping_adj_weekly_total
shopping_sc_mon
G1gS3
shopping_sun
First Choice
Second Choice
Third Choice
shopping_tue
First Choice
Second Choice
Third Choice
shopping_sc_tue
a13
rb_3_weekly_total
rb_3_thurs
First Choice
Second Choice
Third Choice
rb_3_mon
First Choice
Second Choice
Third Choice
rb_3_tues
First Choice
Second Choice
Third Choice
rb_3_wed
First Choice
Second Choice
Third Choice
rb_3_sat
First Choice
Second Choice
Third Choice
rb_3_fri
First Choice
Second Choice
Third Choice
rb_3_sun
First Choice
Second Choice
Third Choice
rb_3_sc
rb_3_adj_weekly_total
a14
ph_3_weekly_total
ph_3_sat
First Choice
Second Choice
Third Choice
ph_3_tues
First Choice
Second Choice
Third Choice
ph_3_sun
First Choice
Second Choice
Third Choice
ph_3_adj_weekly_total
ph_3_sc
ph_3_fri
First Choice
Second Choice
Third Choice
ph_3_thurs
First Choice
Second Choice
Third Choice
ph_3_wed
First Choice
Second Choice
Third Choice
ph_3_mon
First Choice
Second Choice
Third Choice
trans_sc_desc
G1hS3
trans_weekly_total
trans_mon
First Choice
Second Choice
Third Choice
trans_sat
First Choice
Second Choice
Third Choice
trans_wed
First Choice
Second Choice
Third Choice
trans_fri
First Choice
Second Choice
Third Choice
trans_sc
trans_thurs
First Choice
Second Choice
Third Choice
trans_adj_weekly_total
trans_sun
First Choice
Second Choice
Third Choice
trans_tue
First Choice
Second Choice
Third Choice
trans_sc_sun
trans_sc_tue
trans_sc_thurs
trans_sc_mon
trans_sc_sat
trans_sc_fri
trans_sc_wed
rb_trans_sc_desc
rb_4_weekly_total
rb_4_tues
First Choice
Second Choice
Third Choice
rb_4_mon
First Choice
Second Choice
Third Choice
rb_4_wed
First Choice
Second Choice
Third Choice
rb_4_thurs
First Choice
Second Choice
Third Choice
rb_4_fri
First Choice
Second Choice
Third Choice
rb_4_sat
First Choice
Second Choice
Third Choice
rb_4_sun
First Choice
Second Choice
Third Choice
rb_4_sc
rb_4_adj_weekly_total
ph_trans_sc_desc
ph_4_weekly_total
ph_4_sat
First Choice
Second Choice
Third Choice
ph_4_thurs
First Choice
Second Choice
Third Choice
ph_4_wed
First Choice
Second Choice
Third Choice
ph_4_tues
First Choice
Second Choice
Third Choice
ph_4_adj_weekly_total
ph_4_fri
First Choice
Second Choice
Third Choice
ph_4_sc
ph_4_sun
First Choice
Second Choice
Third Choice
ph_4_mon
First Choice
Second Choice
Third Choice
bath_sc_desc
G2aS3
bath_sc_sun
bath_weekly_total
bath_sc_thurs
bath_sc_tue
bath_tue
First Choice
Second Choice
Third Choice
bath_fri
First Choice
Second Choice
Third Choice
bath_sat
First Choice
Second Choice
Third Choice
bath_wed
First Choice
Second Choice
Third Choice
bath_thurs
First Choice
Second Choice
Third Choice
bath_mon
First Choice
Second Choice
Third Choice
bath_adj_weekly_total
bath_sun
First Choice
Second Choice
Third Choice
bath_sc
bath_sc_sat
bath_sc_mon
bath_sc_wed
bath_sc_fri
rb_bath_sc_desc
rb_5_weekly_total
rb_5_mon
First Choice
Second Choice
Third Choice
rb_5_tues
First Choice
Second Choice
Third Choice
rb_5_wed
First Choice
Second Choice
Third Choice
rb_5_thurs
First Choice
Second Choice
Third Choice
rb_5_fri
First Choice
Second Choice
Third Choice
rb_5_sat
First Choice
Second Choice
Third Choice
rb_5_sun
First Choice
Second Choice
Third Choice
rb_5_sc
rb_5_adj_weekly_total
ph_bath_sc_desc
ph_5_sat
First Choice
Second Choice
Third Choice
ph_5_weekly_total
ph_5_mon
First Choice
Second Choice
Third Choice
ph_5_tues
First Choice
Second Choice
Third Choice
ph_5_wed
First Choice
Second Choice
Third Choice
ph_5_thurs
First Choice
Second Choice
Third Choice
ph_5_fri
First Choice
Second Choice
Third Choice
ph_5_sun
First Choice
Second Choice
Third Choice
ph_5_adj_weekly_total
ph_5_sc
hyg_sc_desc
G2bS3
hyg_sc_sun
hyg_sc_thurs
hyg_sc_tue
hyg_mon
First Choice
Second Choice
Third Choice
hyg_tue
First Choice
Second Choice
Third Choice
hyg_wed
First Choice
Second Choice
Third Choice
hyg_thurs
First Choice
Second Choice
Third Choice
hyg_adj_weekly_total
hyg_sc
hyg_sun
First Choice
Second Choice
Third Choice
hyg_sat
First Choice
Second Choice
Third Choice
hyg_fri
First Choice
Second Choice
Third Choice
hyg_weekly_total
hyg_sc_mon
hyg_sc_sat
hyg_sc_wed
hyg_sc_fri
rb_hyg_sc_desc
rb_6_weekly_total
rb_6_adj_weekly_total
rb_6_wed
First Choice
Second Choice
Third Choice
rb_6_fri
First Choice
Second Choice
Third Choice
rb_6_sat
First Choice
Second Choice
Third Choice
rb_6_sc
rb_6_sun
First Choice
Second Choice
Third Choice
rb_6_tues
First Choice
Second Choice
Third Choice
rb_6_mon
First Choice
Second Choice
Third Choice
rb_6_thurs
First Choice
Second Choice
Third Choice
ph_hyg_sc_desc
ph_6_sat
First Choice
Second Choice
Third Choice
ph_6_weekly_total
ph_6_sun
First Choice
Second Choice
Third Choice
ph_6_tues
First Choice
Second Choice
Third Choice
ph_6_wed
First Choice
Second Choice
Third Choice
ph_6_thurs
First Choice
Second Choice
Third Choice
ph_6_fri
First Choice
Second Choice
Third Choice
ph_6_adj_weekly_total
ph_6_mon
First Choice
Second Choice
Third Choice
ph_6_sc
ubod_sc_desc
G2cS3
ubod_weekly_total
ubod_sc_sun
ubod_adj_weekly_total
ubod_fri
First Choice
Second Choice
Third Choice
ubod_sun
First Choice
Second Choice
Third Choice
ubod_sat
First Choice
Second Choice
Third Choice
ubod_sc
ubod_thurs
First Choice
Second Choice
Third Choice
ubod_wed
First Choice
Second Choice
Third Choice
ubod_tue
First Choice
Second Choice
Third Choice
ubod_mon
First Choice
Second Choice
Third Choice
ubod_sc_thurs
ubod_sc_tue
ubod_sc_mon
ubod_sc_sat
ubod_sc_fri
ubod_sc_wed
rb_ubod_sc_desc
rb_7_weekly_total
rb_7_tues
First Choice
Second Choice
Third Choice
rb_7_adj_weekly_total
rb_7_mon
First Choice
Second Choice
Third Choice
rb_7_sc
rb_7_sun
First Choice
Second Choice
Third Choice
rb_7_sat
First Choice
Second Choice
Third Choice
rb_7_fri
First Choice
Second Choice
Third Choice
rb_7_thurs
First Choice
Second Choice
Third Choice
rb_7_wed
First Choice
Second Choice
Third Choice
ph_ubod_sc_desc
ph_7_sat
First Choice
Second Choice
Third Choice
ph_7_weekly_total
ph_7_mon
First Choice
Second Choice
Third Choice
ph_7_tues
First Choice
Second Choice
Third Choice
ph_7_wed
First Choice
Second Choice
Third Choice
ph_7_thurs
First Choice
Second Choice
Third Choice
ph_7_fri
First Choice
Second Choice
Third Choice
ph_7_sun
First Choice
Second Choice
Third Choice
ph_7_sc
ph_7_adj_weekly_total
lbod_sc_desc
G2dS3
lbod_sc_sun
lbod_weekly_total
lbod_adj_weekly_total
lbod_sc
lbod_sun
First Choice
Second Choice
Third Choice
lbod_mon
First Choice
Second Choice
Third Choice
lbod_fri
First Choice
Second Choice
Third Choice
lbod_tue
First Choice
Second Choice
Third Choice
lbod_wed
First Choice
Second Choice
Third Choice
lbod_sat
First Choice
Second Choice
Third Choice
lbod_thurs
First Choice
Second Choice
Third Choice
lbod_sc_tue
lbod_sc_thurs
lbod_sc_mon
lbod_sc_sat
lbod_sc_fri
lbod_sc_wed
rb_lbod_sc_desc
rb_8_weekly_total
rb_8_adj_weekly_total
rb_8_sc
rb_8_sun
First Choice
Second Choice
Third Choice
rb_8_sat
First Choice
Second Choice
Third Choice
rb_8_fri
First Choice
Second Choice
Third Choice
rb_8_thurs
First Choice
Second Choice
Third Choice
rb_8_wed
First Choice
Second Choice
Third Choice
rb_8_tues
First Choice
Second Choice
Third Choice
rb_8_mon
First Choice
Second Choice
Third Choice
ph_lbod_sc_desc
ph_8_weekly_total
ph_8_sat
First Choice
Second Choice
Third Choice
ph_8_thurs
First Choice
Second Choice
Third Choice
ph_8_wed
First Choice
Second Choice
Third Choice
ph_8_mon
First Choice
Second Choice
Third Choice
ph_8_adj_weekly_total
ph_8_fri
First Choice
Second Choice
Third Choice
ph_8_sun
First Choice
Second Choice
Third Choice
ph_8_sc
ph_8_tues
First Choice
Second Choice
Third Choice
walk_sc_desc
walk_mon
First Choice
Second Choice
Third Choice
walk_sc
walk_tue
First Choice
Second Choice
Third Choice
walk_wed
First Choice
Second Choice
Third Choice
walk_adj_weekly_total
walk_fri
First Choice
Second Choice
Third Choice
walk_thurs
First Choice
Second Choice
Third Choice
walk_sat
First Choice
Second Choice
Third Choice
walk_sun
First Choice
Second Choice
Third Choice
G2eS3a
walk_sc_thurs
walk_weekly_total
walk_sc_sat
walk_sc_tue
walk_sc_mon
walk_sc_sun
walk_sc_fri
walk_sc_wed
rb_walk_sc_desc
rb_9_weekly_total
rb_9_thurs
First Choice
Second Choice
Third Choice
rb_9_tues
First Choice
Second Choice
Third Choice
rb_9_sun
First Choice
Second Choice
Third Choice
rb_9_sat
First Choice
Second Choice
Third Choice
rb_9_fri
First Choice
Second Choice
Third Choice
rb_9_wed
First Choice
Second Choice
Third Choice
rb_9_mon
First Choice
Second Choice
Third Choice
rb_9_sc
rb_9_adj_weekly_total
ph_walk_sc_desc
ph_9_weekly_total
ph_9_sat
First Choice
Second Choice
Third Choice
ph_9_mon
First Choice
Second Choice
Third Choice
ph_9_tues
First Choice
Second Choice
Third Choice
ph_9_sun
First Choice
Second Choice
Third Choice
ph_9_thurs
First Choice
Second Choice
Third Choice
ph_9_wed
First Choice
Second Choice
Third Choice
ph_9_sc
ph_9_adj_weekly_total
ph_9_fri
First Choice
Second Choice
Third Choice
loco_sc_desc
loco_sc_sun
loco_weekly_total
loco_fri
First Choice
Second Choice
Third Choice
loco_sc
loco_thurs
First Choice
Second Choice
Third Choice
loco_wed
First Choice
Second Choice
Third Choice
loco_tue
First Choice
Second Choice
Third Choice
loco_mon
First Choice
Second Choice
Third Choice
loco_adj_weekly_total
loco_sun
First Choice
Second Choice
Third Choice
loco_sat
First Choice
Second Choice
Third Choice
loco_sc_mon
loco_sc_tue
loco_sc_sat
loco_sc_thurs
loco_sc_fri
loco_sc_wed
G2fS3a
desc1
rb_10_weekly_total
rb_10_wed
First Choice
Second Choice
Third Choice
rb_10_adj_weekly_total
rb_10_mon
First Choice
Second Choice
Third Choice
rb_10_thurs
First Choice
Second Choice
Third Choice
rb_10_fri
First Choice
Second Choice
Third Choice
rb_10_sat
First Choice
Second Choice
Third Choice
rb_10_sun
First Choice
Second Choice
Third Choice
rb_10_sc
rb_10_tues
First Choice
Second Choice
Third Choice
desc2
ph_10_sat
First Choice
Second Choice
Third Choice
ph_10_weekly_total
ph_10_tues
First Choice
Second Choice
Third Choice
ph_10_sun
First Choice
Second Choice
Third Choice
ph_10_wed
First Choice
Second Choice
Third Choice
ph_10_thurs
First Choice
Second Choice
Third Choice
ph_10_fri
First Choice
Second Choice
Third Choice
ph_10_adj_weekly_total
ph_10_sc
ph_10_mon
First Choice
Second Choice
Third Choice
trans_toilet_sc_desc
trans_toilet_weekly_total
trans_toilet_sc_thurs
trans_toilet_sc_tue
trans_toilet_sc_sun
trans_toilet_mon
First Choice
Second Choice
Third Choice
trans_toilet_sc
trans_toilet_adj_weekly_total
trans_toilet_sun
First Choice
Second Choice
Third Choice
trans_toilet_tue
First Choice
Second Choice
Third Choice
trans_toilet_sat
First Choice
Second Choice
Third Choice
trans_toilet_fri
First Choice
Second Choice
Third Choice
trans_toilet_wed
First Choice
Second Choice
Third Choice
trans_toilet_thurs
First Choice
Second Choice
Third Choice
trans_toilet_sc_mon
trans_toilet_sc_wed
trans_toilet_sc_fri
trans_toilet_sc_sat
G2gS3a
desc3
rb_11_weekly_total
rb_11_mon
First Choice
Second Choice
Third Choice
rb_11_tues
First Choice
Second Choice
Third Choice
rb_11_sun
First Choice
Second Choice
Third Choice
rb_11_sc
rb_11_thurs
First Choice
Second Choice
Third Choice
rb_11_adj_weekly_total
rb_11_wed
First Choice
Second Choice
Third Choice
rb_11_sat
First Choice
Second Choice
Third Choice
rb_11_fri
First Choice
Second Choice
Third Choice
desc4
ph_11_weekly_total
ph_11_sat
First Choice
Second Choice
Third Choice
ph_11_tues
First Choice
Second Choice
Third Choice
ph_11_mon
First Choice
Second Choice
Third Choice
ph_11_thurs
First Choice
Second Choice
Third Choice
ph_11_wed
First Choice
Second Choice
Third Choice
ph_11_sun
First Choice
Second Choice
Third Choice
ph_11_adj_weekly_total
ph_11_sc
ph_11_fri
First Choice
Second Choice
Third Choice
toiletuse_sc_desc
toiletuse_weekly_total
toiletuse_adj_weekly_total
toiletuse_tue
First Choice
Second Choice
Third Choice
toiletuse_wed
First Choice
Second Choice
Third Choice
toiletuse_sat
First Choice
Second Choice
Third Choice
toiletuse_fri
First Choice
Second Choice
Third Choice
toiletuse_mon
First Choice
Second Choice
Third Choice
toiletuse_thurs
First Choice
Second Choice
Third Choice
toiletuse_sun
First Choice
Second Choice
Third Choice
toiletuse_sc
toiletuse_sc_sun
G2hS3a
toiletuse_sc_tue
toiletuse_sc_thurs
toiletuse_sc_mon
toiletuse_sc_sat
toiletuse_sc_fri
toiletuse_sc_wed
desc5
rb_12_weekly_total
rb_12_thurs
First Choice
Second Choice
Third Choice
rb_12_sun
First Choice
Second Choice
Third Choice
rb_12_sat
First Choice
Second Choice
Third Choice
rb_12_fri
First Choice
Second Choice
Third Choice
rb_12_tues
First Choice
Second Choice
Third Choice
rb_12_wed
First Choice
Second Choice
Third Choice
rb_12_mon
First Choice
Second Choice
Third Choice
rb_12_sc
rb_12_adj_weekly_total
desc6
ph_12_weekly_total
ph_12_sat
First Choice
Second Choice
Third Choice
ph_12_mon
First Choice
Second Choice
Third Choice
ph_12_sun
First Choice
Second Choice
Third Choice
ph_12_fri
First Choice
Second Choice
Third Choice
ph_12_thurs
First Choice
Second Choice
Third Choice
ph_12_wed
First Choice
Second Choice
Third Choice
ph_12_tues
First Choice
Second Choice
Third Choice
ph_12_sc
ph_12_adj_weekly_total
bed_sc_desc
G2iS3a
bed_sc_sun
bed_weekly_total
bed_sc_tue
bed_sc_thurs
bed_sun
First Choice
Second Choice
Third Choice
bed_sc
bed_thurs
First Choice
Second Choice
Third Choice
bed_adj_weekly_total
bed_wed
First Choice
Second Choice
Third Choice
bed_sat
First Choice
Second Choice
Third Choice
bed_tue
First Choice
Second Choice
Third Choice
bed_mon
First Choice
Second Choice
Third Choice
bed_fri
First Choice
Second Choice
Third Choice
bed_sc_sat
bed_sc_mon
bed_sc_wed
bed_sc_fri
desc7
rb_13_weekly_total
rb_13_wed
First Choice
Second Choice
Third Choice
rb_13_tues
First Choice
Second Choice
Third Choice
rb_13_mon
First Choice
Second Choice
Third Choice
rb_13_thurs
First Choice
Second Choice
Third Choice
rb_13_fri
First Choice
Second Choice
Third Choice
rb_13_sat
First Choice
Second Choice
Third Choice
rb_13_sun
First Choice
Second Choice
Third Choice
rb_13_sc
rb_13_adj_weekly_total
desc8
ph_13_sat
First Choice
Second Choice
Third Choice
ph_13_weekly_total
ph_13_mon
First Choice
Second Choice
Third Choice
ph_13_thurs
First Choice
Second Choice
Third Choice
ph_13_tues
First Choice
Second Choice
Third Choice
ph_13_wed
First Choice
Second Choice
Third Choice
ph_13_fri
First Choice
Second Choice
Third Choice
ph_13_sun
First Choice
Second Choice
Third Choice
ph_13_adj_weekly_total
ph_13_sc
eat_sc_desc
eat_sc_mon
eat_sc_thurs
G2jS3a
eat_sc_tue
eat_weekly_total
eat_mon
First Choice
Second Choice
Third Choice
eat_sat
First Choice
Second Choice
Third Choice
eat_sun
First Choice
Second Choice
Third Choice
eat_wed
First Choice
Second Choice
Third Choice
eat_adj_weekly_total
eat_tue
First Choice
Second Choice
Third Choice
eat_sc
eat_fri
First Choice
Second Choice
Third Choice
eat_thurs
First Choice
Second Choice
Third Choice
eat_sc_fri
eat_sc_sun
eat_sc_sat
eat_sc_wed
desc9
rb_14_weekly_total
rb_14_tues
First Choice
Second Choice
Third Choice
rb_14_wed
First Choice
Second Choice
Third Choice
rb_14_thurs
First Choice
Second Choice
Third Choice
rb_14_fri
First Choice
Second Choice
Third Choice
rb_14_sat
First Choice
Second Choice
Third Choice
rb_14_sun
First Choice
Second Choice
Third Choice
rb_14_sc
rb_14_adj_weekly_total
rb_14_mon
First Choice
Second Choice
Third Choice
desc10
ph_14_sat
First Choice
Second Choice
Third Choice
ph_14_weekly_total
ph_14_wed
First Choice
Second Choice
Third Choice
ph_14_thurs
First Choice
Second Choice
Third Choice
ph_14_sun
First Choice
Second Choice
Third Choice
ph_14_sc
ph_14_adj_weekly_total
ph_14_fri
First Choice
Second Choice
Third Choice
ph_14_tues
First Choice
Second Choice
Third Choice
ph_14_mon
First Choice
Second Choice
Third Choice
additional 1
cis_mon
cis_thurs
cis_weekly_total
cis_sun
cis_sat
cis_fri
cis_adj_weekly_total
cis_tue
cis_wed
additional 3
ifs_weekly_total
ifs_mon
ifs_tue
ifs_wed
ifs_thurs
ifs_fri
ifs_adj_weekly_total
ifs_sat
ifs_sun
test_tuesday
test_sat
test_fri
test_sun
test_wed
test_weekly_total
test_adj_weekly_total
test_sc_weekly_total
test_monday
test_thurs
rb_test_adj_weekly_total
rb_test_wed
rb_test_sat
rb_test_tuesday
rb_test_sun
rb_test_fri
test_rb_weekly_total
rb_test_thurs
rb_test_weekly_total
rb_test_monday
ph_test_wed
ph_test_sat
ph_test_fri
ph_test_sun
ph_test_tuesday
ph_test_adj_weekly_total
ph_test_monday
ph_test_thurs
ph_test_weekly_total
test_ph_weekly_total
additional 2
ars_mon
ars_adj_weekly_total
ars_weekly_total
ars_tue
ars_wed
ars_thurs
ars_fri
ars_sat
ars_sun
additional 2_rb
ars_weekly_total_rb
ars_weekly_total_rb
ars_sun_rb
ars_fri_rb
ars_mon_rb
ars_tue_rb
ars_wed_rb
ars_thurs_rb
ars_sat_rb
additional 2_md
ars_sun_md
ars_weekly_total_md
ars_adj_weekly_total_md
ars_mon_md
ars_sat_md
ars_fri_md
ars_thurs_md
ars_wed_md
ars_tue_md
additional 4
test_weekly_ftotal
test_adj_weekly_ftotal
test_sc_weekly_ftotal
I1k
0
1
2
3
I1l
0
1
2
3
I2aICD3
I2aDC
I2aDIAG
I2aICD1
I2aICD2
I1m
0
1
2
3
I1n
0
1
2
3
I1o
0
1
2
3
I1p
0
1
2
3
I1q
0
1
2
3
I1r
0
1
2
3
I1s
0
1
2
3
I1t
0
1
2
3
I1u
0
1
2
3
J4
0
1
2
3
J1
0
1
2
3
J2
0
1
J5
0
1
2
3
4
J3a
0
1
2
3
4
J6a
0
1
2
3
J3b
0
1
2
3
4
J3c
0
1
2
3
4
J3d
0
1
2
3
4
J3e
0
1
2
3
4
J3f
0
1
2
3
4
J6b
0
1
2
3
4
J3g
0
1
2
3
4
J3h
0
1
2
3
4
J3i
0
1
2
3
4
J6c
0
1
2
3
J3j
0
1
2
3
4
J3k
0
1
2
3
4
J3l
0
1
2
3
4
J6d
0
1
J3m
0
1
2
3
4
J3n
0
1
2
3
4
J6e
0
1
2
3
4
5
J3o
0
1
2
3
4
J3p
0
1
2
3
4
J3q
0
1
2
3
4
J3r
0
1
2
3
4
J3s
0
1
2
3
4
J3t
0
1
2
3
4
J3u
0
1
2
3
4
J9a
0
1
2
J7a
0
1
J7b
0
1
J9b
0
1
2
3
J7c
0
1
J8
0
1
2
3
8
K1b
K1a
K2a
0
1
K2b
0
1
K2c
0
1
K2d
0
1
K3
0
1
2
3
4
5
6
7
8
9
K4a
0
1
K4b
0
1
K4c
0
1
K4d
0
1
L5
0
1
L1
0
1
2
3
4
5
L6
0
1
L2
0
1
L7
0
1
2
3
4
L3
0
1
L4
0
1
M1g1b
M1g1g
M1g1c
GTTS - DROPS
GM - GRAMS
L - LITERS
MCG - MICRORAM
MEQ - milli equivalent
MG-milligram
ML-milliliter
oz-Ounce
Puffs
%
units
OTH (other)
M1g1a
M1g1d
Q1H
Q2H
Q3H
Q4H
Q6H
Q8H
Daily
BED
BID
TID
QID
5D
Q2D
Q3D
Weekly
2W
3W
4W
5W
6W
1M
2M
OTH
M1g1f
0 - No
1 - Yes
M1g1e
0 - No
1 - Yes
M1g2c
GTTS - DROPS
GM - GRAMS
L - LITERS
MCG - MICRORAM
MEQ - milli equivalent
MG-milligram
ML-milliliter
oz-Ounce
Puffs
%
units
OTH (other)
M1g2d
REC
ET
SL
PO
TOP
TD
IM
IH
EYE
IV
NAS
Sub-Q
OTH
M1g2a
M1g2f
0 - No
1 - Yes
M1g2b
M1g2g
M1g2e
Q1H
Q2H
Q3H
Q4H
Q6H
Q8H
Daily
BED
BID
TID
QID
5D
Q2D
Q3D
Weekly
2W
3W
4W
5W
6W
1M
2M
OTH
M1g3c
GTTS - DROPS
GM - GRAMS
L - LITERS
MCG - MICRORAM
MEQ - milli equivalent
MG-milligram
ML-milliliter
oz-Ounce
Puffs
%
units
OTH (other)
M1g3e
Q1H
Q2H
Q3H
Q4H
Q6H
Q8H
Daily
BED
BID
TID
QID
5D
Q2D
Q3D
Weekly
2W
3W
4W
5W
6W
1M
2M
OTH
M1g3g
M1g3b
M1g3f
0 - No
1 - Yes
M1g3d
REC
ET
SL
PO
TOP
TD
IM
IH
EYE
IV
NAS
Sub-Q
OTH
M1g3a
M1g4a
M1g4f
0 - No
1 - Yes
M1g4d
REC
ET
SL
PO
TOP
TD
IM
IH
EYE
IV
NAS
Sub-Q
OTH
M1g4g
M1g4c
GTTS - DROPS
GM - GRAMS
L - LITERS
MCG - MICRORAM
MEQ - milli equivalent
MG-milligram
ML-milliliter
oz-Ounce
Puffs
%
units
OTH (other)
M1g4b
M1g4e
Q1H
Q2H
Q3H
Q4H
Q6H
Q8H
Daily
BED
BID
TID
QID
5D
Q2D
Q3D
Weekly
2W
3W
4W
5W
6W
1M
2M
OTH
M1g5c
GTTS - DROPS
GM - GRAMS
L - LITERS
MCG - MICRORAM
MEQ - milli equivalent
MG-milligram
ML-milliliter
oz-Ounce
Puffs
%
units
OTH (other)
M1g5d
REC
ET
SL
PO
TOP
TD
IM
IH
EYE
IV
NAS
Sub-Q
OTH
M1g5b
M1g5g
M1g5e
Q1H
Q2H
Q3H
Q4H
Q6H
Q8H
Daily
BED
BID
TID
QID
5D
Q2D
Q3D
Weekly
2W
3W
4W
5W
6W
1M
2M
OTH
M1g5a
M1g5f
0 - No
1 - Yes
M2
0
1
M3
0
1
2
8
N1a
0
1
N1b
0
1
N3aWEEK
N3aDAY
N1c
0
1
N3bDAY
N3bWEEK
N1d
0
1
N3cWEEK
N3cDAY
N1e
0
1
N3dDAY
N1f
0
1
N3eDAY
N3eWEEK
N1g
0
1
N3fWEEK
N3fDAY
N1h
0
1
N3gDAY
N3gWEEK
N3hDAY
N3hWEEK
N4a
N4b
N2a
0
1
2
3
N4c
N2b
0
1
2
3
N5
0
1
N2c
0
1
2
3
N2d
0
1
2
3
N2e
0
1
2
3
N2f
0
1
2
3
N2g
0
1
2
3
N2h
0
1
2
3
N2i
0
1
2
3
N2j
0
1
2
3
N2k
0
1
2
3
N2l
0
1
2
3
N2m
0
1
2
3
N2n
0
1
2
3
O1
0
1
P1a
1
2
3
4
5
6
7
8
9
P1a2
1
2
3
4
5
6
7
8
9
P1c2
0
1
8
P1c
0
1
8
P1d2
0
1
8
P1d
0
1
8
P2a
0
1
P2b
0
1
P2c
0
1
P1b2
0
1
2
8
P1b
0
1
2
8
P3
P4
0
1
Q2
0
1
Q1a
0
1
Q3a
0
1
Q3b
0
1
Q1b
0
1
Q3c
0
1
Q1c
0
1
Q4
0
1
Q1d
0
1
Q1e
0
1
R1
0
1
R3
R4
R2
0
1
2
R5
0
1
2
3
4
8
S1Date
S1Month
S1
S1Day
S2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
T2Day
T2Month
T2Year
T2Date
T1
DueDateDate
AssessmentType
I-Initial
R-Reassessment
SC-Significant change
DueDateDay
DueDateYear
DueDateMonth
RequestDateDate
RequestDateDay
RequestDateMonth
RequestDateYear
AssessmentLateReason
I: Inaccurate contact information given at time of referral
P: Participant/participant family member requests a delay
E: Emergency declaration by government entity
A: Assessor unavailable within required timeframe
AC: Assessor cancellation
OT: Other
OtherReasonAssessmentLate
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VB
CNC Revision
CLEARSPACE_1
end_eval_1
end_eval_1
end_eval_4
end_eval_5
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end_eval_8
CNC Revision
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