| SPECIFICATION |
{"test":[{"content":[{"choice":[{"choiceId":6173,"choiceText":"No","ien":109856,"legacyValue":0,"sequence":1},{"choiceId":6174,"choiceText":"Yes","ien":109857,"legacyValue":1,"sequence":2}],"choiceDisplay":81351,"choiceIdentifier":0,"choice
ow, scoring should be based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9559,"questionText":"Prior history of falls within 3 months|\r\nAny unintentional change in position resulting in coming to rest on
el of function<br \/> Pain often affects an individual's\r\n desire or ability to move or pain can be a factor in depression or compliance\r\n with safety recommendations.\", \r\n \"intro\": \"Required Core Elements<br \/> Information ma
y be gathered from medical record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n
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\r\n {\"id\": \"q9566\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"10. Cognitive impairment<br \/> Could include patients with dementia, Alzheimer's\r\n or stroke patients or patients who are
confused, use poor judgment, have\r\n decreased comprehension, impulsivity, memory deficits. Consider patients ability\r\n to adhere to the plan of care.<br \/>\", \r\n \"intro\": \"Required Core Elements<br \/> Information may be gathe
red from medical record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id
\": \"c6173\", \"text\": \"0. No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}]\r\n}","instrument":345,"lastUpdate":"2026-04-21T08:00:09","specIen":197},"verify":["601.71:345","601.72:9557
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the ground or at a lower level","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","restrictFrom":null,"sequence":30},{"choice":[{"choiceId":6173,"choiceText":"No","ien":109856,"legacyValue":0,"sequence":1},{"choiceId":6174,"c
.91:16343"]}],"xchg":{"date":3260402.132543,"description":"Fix line breaks MAHC-10","name":"YS*5.01*246 MAHC-10","source":"LEE@CAMP MASTER","version":1.02}}
hoiceText":"Yes","ien":109857,"legacyValue":1,"sequence":2}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42508,"choiceTypeId":15274,"designator":"4.","hint":null,"id":9625,"instrument":345,"introDisplay":81371,"introId"
:2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols listed below, scoring should be based on your clinical judgment.","m
ax":0,"min":0,"questionDisplay":81372,"questionId":9560,"questionText":"Incontinence|\r\nInability to make it to the bathroom or commode in timely manner|\r\nIncludes frequency, urgency, and\/or nocturia.","required":true,"responseTypeId":1
,"responseTypeText":"MCHOICE","restrictFrom":null,"sequence":40},{"choice":[{"choiceId":6173,"choiceText":"No","ien":109856,"legacyValue":0,"sequence":1},{"choiceId":6174,"choiceText":"Yes","ien":109857,"legacyValue":1,"sequence":2}],"choic
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thered from medical record, assessment and if applicable, the patient\/caregiver. |
\r\nBeyond protocols listed below, scoring should be based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9561,"questionText":"Visual Impairment|\r\nIncludes but not limited to, macular degeneration, diabet
ic retinopathies, visual field loss, age\r\nrelated changes, decline in visual acuity, accommodation, glare tolerance, depth perception, and\r\nnight vision or not wearing prescribed glasses or having the correct prescription.|","required":
IdentifierIen":42508,"choiceTypeId":15274,"designator":"1.","hint":null,"id":9622,"instrument":345,"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medical record, assessment and i
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1,"sequence":2}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42508,"choiceTypeId":15274,"designator":"6.","hint":null,"id":9627,"instrument":345,"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r
\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols listed below, scoring should be based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"quest
ionId":9562,"questionText":"Impaired functional mobility|\r\nMay include patients who need help with IADLS or ADLS or have gait or transfer problems,\r\narthritis, pain, fear of falling, foot problems, impaired sensation, impaired coordinat
ion or improper\r\nuse of assistive devices.|","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","restrictFrom":null,"sequence":60},{"choice":[{"choiceId":6173,"choiceText":"No","ien":109856,"legacyValue":0,"sequence":1},{"cho
iceId":6174,"choiceText":"Yes","ien":109857,"legacyValue":1,"sequence":2}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42508,"choiceTypeId":15274,"designator":"7.","hint":null,"id":9628,"instrument":345,"introDisplay":8
1371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols listed below, scoring should be based on your clinical
judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9563,"questionText":"Environmental hazards|\r\nMay include but not limited to, poor illumination, equipment tubing, inappropriate footwear, pets,\r\nhard to reach items, floor
surfaces that are uneven or cluttered, or outdoor entry and exits.|","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","restrictFrom":null,"sequence":70},{"choice":[{"choiceId":6173,"choiceText":"No","ien":109856,"legacyValue
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f applicable, the patient\/caregiver. |\r\nBeyond protocols listed below, scoring should be based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9557,"questionText":"Age 65+","required":true,"responseTypeI
t":345,"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols listed below, scoring should be
based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9564,"questionText":"Poly Pharmacy (4 or more prescriptions - any type)|\r\nAll PRESCRIPTIONS including prescriptions for OTC meds. Drugs highly associa
ted with fall risk\r\ninclude but not limited to, sedatives, anti-depressants, tranquilizers, narcotics, antihypertensives,\r\ncardiac meds, corticosteroids, anti-anxiety drugs, anticholinergic drugs, and hypoglycemic drugs.|| ","required":
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1,"sequence":2}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42508,"choiceTypeId":15274,"designator":"9.","hint":null,"id":9630,"instrument":
345,"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols listed below, scoring should be ba
sed on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9565,"questionText":"Pain affecting level of function|\r\nPain often affects an individual's desire or ability to move or pain can be a factor in depressio
n or\r\ncompliance with safety recommendations.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","restrictFrom":null,"sequence":90},{"choice":[{"choiceId":6173,"choiceText":"No","ien":109856,"legacyValue":0,"sequence":1},{"c
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":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols listed below, scoring should be based on your clini
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cal judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9566,"questionText":"Cognitive impairment|\r\nCould include patients with dementia, Alzheimer's or stroke patients or patients who are\r\nconfused, use poor judgment, have
decreased comprehension, impulsivity, memory deficits.\r\nConsider patients ability to adhere to the plan of care.|","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","restrictFrom":null,"sequence":100}],"display":[{"alignment
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lWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":8,"fontUnderlined":false,"id":81372,"left":2,"mask":null}],"info":{"author":"Missouri Alliance for HOME CARE","auxDate":null,"auxVersion":null,"copyrightText":null,"copyr
ighted":false,"dllDate":null,"dllVersion":null,"enteredBy":null,"entryDate":"2025-02-28","fullText":true,"id":345,"interpretiveText":"A score of 4 or more is considered at risk for falling.","lastEditDate":3250228.1742,"lastEditedBy":null,"
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souri Alliance for Home Care. (n.d.). Missouri Alliance for Home Care 10-Question Fall Risk Assessment Tool. Retrieved from https:\/\/www.homecaremissouri.org","requireSignature":true,"requiresLicense":"N","scoringRevision":1,"scoringRoutin
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for Home Care - 10 questions (MAHC-10)\r\n| \r\n| Date Given: <.Date_Given.>\r\n| Clinician: <.Staff_Ordered_By.>\r\n| Location: <.Location.>\r\n| \r\n| Veteran: <.Patient_Name_Last_First.>\r\n| SSN: <.Patient_SSN.>\r\n| DO
hoiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42508,"choiceTypeId":15274,"designator":"2.","hint":null,"id":9623,"instrument":345,"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may b
B: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>\r\n| \r\n| MAHC-10 Total = <-MAHC-10 Total->\r\n|\r\n| A score of 4 or more is considered at risk for falling. \r\n| \r\n|Questions and Answers:\r\n| \
r\n| 1. Age 65+\r\n| <*Answer_9557*>\r\n| 2. Diagnosis (3 or more co-existing)\r\n| Includes only documented medical diagnoses
\r\n| <*Answer_9558*>\r\n| 3. Prior history of falls within 3 months\r\n| Any unintentional change in position resulting in \r\n| coming to rest on the ground or at a lower level\r\n| <*Answer_9559*>\r\n| 4. In
continence\r\n| Inability to make it to the bathroom or commode \r\n| in timely manner. Includes frequency, urgency, and\/or \r\n| nocturia.\r\n| <*Answer_9560*>\r\n| 5. Visual Impairment\r\n| Includes but
not limited to, macular degeneration, \r\n| diabetic retinopathies, visual field loss, age related \r\n| changes, decline in visual acuity, accommodation, glare \r\n| tolerance, depth perception, and night vision or not \r
\n| wearing prescribed glasses or having the correct prescription.\r\n| <*Answer_9561*>\r\n| 6. Impaired functional mobility\r\n| May include patients who need help with IADLS or ADLS or \r\n| have gait or transfe
r problems, arthritis, pain, fear of \r\n| falling, foot problems, impaired sensation, impaired \r\n| coordination or improper use of assistive devices.\r\n| <*Answer_9562*>\r\n| 7. Environmental hazards\r\n| May
include but not limited to, poor illumination, \r\n| equipment tubing, inappropriate footwear, pets, hard to reach \r\n| items, floor surfaces that are uneven or cluttered, or \r\n| outdoor entry and exits.\r\n| <*An
swer_9563*>\r\n| 8. Poly Pharmacy (4 or more prescriptions - any type)\r\n| All PRESCRIPTIONS including prescriptions for OTC meds. Drugs \r\n| highly associated with fall risk include but not limited to, \r\n| sedative
s, anti-depressants, tranquilizers, narcotics, \r\n| antihypertensives, cardiac meds, corticosteroids, anti-anxiety \r\n| drugs, anticholinergic drugs, and hypoglycemic drugs. \r\n| <*Answer_9564*>\r\n| 9. Pain affectin
e gathered from medical record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols listed below, scoring should be based on your clinical judgment.","max":0,"min":0,"questionDisplay":81372,"questionId":9558,"questi
g level of function\r\n| Pain often affects an individual's desire or ability to move \r\n| or pain can be a factor in depression or compliance with safety | recommendations.\r\n| <*Answer_9565*>\r\n| 10. Cognitive
impairment\r\n| Could include patients with dementia, Alzheimer's or stroke \r\n| patients or patients who are confused, use poor judgment, \r\n| have decreased comprehension, impulsivity, memory deficits.\r\n| Cons
ider patients ability to adhere to the plan of care.\r\n| <*Answer_9566*>\r\n| \r\n|Information contained in this note is based on a self-report assessment \r\n|and is not sufficient to use alone for diagnostic purposes. Assessment \
r\n|results should be verified for accuracy and used in conjunction with \r\n|other diagnostic activities."},"scaleGroup":[{"grid1":0,"grid2":0,"grid3":0,"id":418,"instrument":345,"name":"MAHC-10 Total","ordInc":1,"ordMax":10,"ordMin":0,"or
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targetText":"Yes","value":1},{"id":16336,"questionId":9563,"scaleId":1606,"targetText":"No","value":0},{"id":16337,"questionId":9563,"scaleId":1606,"targetText":
"Yes","value":1},{"id":16338,"questionId":9564,"scaleId":1606,"targetText":"No","value":0},{"id":16339,"questionId":9564,"scaleId":1606,"targetText":"Yes","value":1},{"id":16340,"questionId":9565,"scaleId":1606,"targetText":"No","value":0},
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id\": \"i2616\", \"type\": \"IntroText\", \r\n \"text\": \"Required Core Elements<br \/> Information may be gathered from medical record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed belo
w, scoring should be based on your clinical judgment.\"\r\n }, \r\n {\"id\": \"q9557\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"1. Age 65+\", \r\n \"intro\": \"Required Core Elements<
br \/> Information may be gathered from medical record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n
\"choices\":[\r\n {\"id\": \"c6173\", \"text\": \"0. No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9558\", \"type\": \"ChoiceQuestion\", \"required\": true,
\"inline\": false, \r\n \"text\": \"2. Diagnosis (3 or more co-existing)<br \/> Includes only documented medical\r\n diagnoses\", \r\n \"intro\": \"Required Core Elements<br \/> Information may be gathered from medical record,\r\n ass
essment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6173\", \"text\": \"0. No
\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9559\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"3. Prior history of fall
s within 3 months<br \/> Any unintentional change in\r\n position resulting in coming to rest on the ground or at a lower level\", \r\n \"intro\": \"Required Core Elements<br \/> Information may be gathered from medical record,\r\n asses
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sment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6173\", \"text\": \"0. No\"
, \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9560\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"4. Incontinence<br \/> Ina
bility to make it to the bathroom or commode in timely\r\n manner<br \/> Includes frequency, urgency, and\/or nocturia.\", \r\n \"intro\": \"Required Core Elements<br \/> Information may be gathered from medical record,\r\n assessment an
d if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6173\", \"text\": \"0. No\", \"quic
kKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9561\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"5. Visual Impairment<br \/> Includ
es but not limited to, macular degeneration,\r\n diabetic retinopathies, visual field loss, age related changes, decline in
\r\n visual acuity, accommodation, glare tolerance, depth perception, and night\r\n vision or not wearing prescribed glasses or having the correct prescription.<br\r\n \/>\", \r\n \"intro\": \"Required Core Elements<br \/> Information ma
y be gathered from medical record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n
{\"id\": \"c6173\", \"text\": \"0. No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9562\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r
\n \"text\": \"6. Impaired functional mobility<br \/> May include patients who need help with\r\n IADLS or ADLS or have gait or transfer problems, arthritis, pain, fear of\r\n falling, foot problems, impaired sensation, impaired coordina
,"id":9624,"instrument":345,"introDisplay":81371,"introId":2616,"introText":"Required Core Elements|\r\nInformation may be gathered from medical record, assessment and if applicable, the patient\/caregiver. |\r\nBeyond protocols listed bel
tion or improper\r\n use of assistive devices.<br \/>\", \r\n \"intro\": \"Required Core Elements<br \/> Information may be gathered from medical record,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols
\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6173\", \"text\": \"0. No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"q
uickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9563\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"7. Environmental hazards<br \/> May include but not limited to, poor illumination,\r\n equipment tub
ing, inappropriate footwear, pets, hard to reach items, floor\r\n surfaces that are uneven or cluttered, or outdoor entry and exits.<br \/>\", \r\n \"intro\": \"Required Core Elements<br \/> Information may be gathered from medical recor
d,\r\n assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6173\", \"text\
": \"0. No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9564\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"8. Poly Pharma
cy (4 or more prescriptions - any type)<br \/> All PRESCRIPTIONS\r\n including prescriptions for OTC meds. Drugs highly associated with fall risk\r\n include but not limited to, sedatives, anti-depressants, tranquilizers,\r\n narcotics, ant
ihypertensives, cardiac meds, corticosteroids, anti-anxiety drugs,\r\n anticholinergic drugs, and hypoglycemic drugs.<br \/><br \/> \", \r\n \"intro\": \"Required Core Elements<br \/> Information may be gathered from medical record,\r\n
assessment and if applicable, the patient\/caregiver. <br \/> Beyond protocols\r\n listed below, scoring should be based on your clinical judgment.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6173\", \"text\": \"0.
No\", \"quickKey\": 0}, \r\n {\"id\": \"c6174\", \"text\": \"1. Yes\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q9565\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"9. Pain affecting lev
|
