| SPECIFICATION |
{"test":[{"content":[{"choice":[{"choiceId":5155,"choiceText":"Initial","ien":100118,"legacyValue":0,"sequence":1},{"choiceId":5156,"choiceText":"6 month","ien":100119,"legacyValue":0,"sequence":2},{"choiceId":5157,"choiceText":"Annual","ie
your clothes on?","ien":100023,"legacyValue":2,"sequence":3},{"choiceId":5059,"choiceText":"* Cannot dress yourself and somebody dresses you?","ien":100024,"legacyValue":3,"sequence":4},{"choiceId":5060,"choiceText":"* Are never dressed?","
null,"copyrightText":null,"copyrighted":false,"dllDate":null,"dllVersion":null,"enteredBy":"KEVIN MELDRUM","entryDate":"2020-10-28","fullText":true,"id":264,"lastEditDate":3211203.1108,"lastEditedBy":"KEVIN MELDRUM","legacy":false,"licenseC
urrent":false,"name":"CASE MIX","national":true,"normSample":null,"operational":"Y","printTitle":"Case Mix & Budget Tool","publicationDate":"2016-10-01",
"publisher":"VHA","purpose":null,"reference":null,"requireSignature":false,"requiresLicense":"N","scoringRevision":2,"scoringRoutine":"YTSCMIXG","scoringTag":null,"staffOnly":null,"submitNational":false,"targetPopulation":null,"version":nul
l,"wasOperational":true},"report":{"id":187,"instrument":264,"template":"| HCBS Case Mix & Budget Tool (CASE MIX)|\r\n| Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>\r\n| | Veteran: <.Patient_Name_Last_
First.>| SSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>| \r\n| Type of Evaluation: <*Answer_8580*>\r\n| Anticipated Start Date: <*Answer_8581*>\r\n| Anticipated Lengt
h of Service: <*Answer_8582*>|\r\n| <*Answer_7771*>\r\n| Questions and Answers:|<*Answer_7772*>\r\n| Q15. SPECIAL NURSING\r\n| <*Answer_8550*>\r\n| Q16. NEUROMUSCULAR DIAGNOSIS\"\r\n| <*Answer_8551*>\r\n| COMMENTS\r\n|
<*Answer_8552*>\r\n| SOURCES\r\n| <*Answer_8553*>"},"rule":[{"booleanOperator":"AND","consistencyCheck":null,"id":370,"indexOperator":"Does not equal","indexQuestionId":8547,"indexValue":2,"indexValueDataType":"STRING","instrumentId
":264,"instrumentQuestionId":8547,"instrumentRuleId":476,"messageText":null,"skippedQuestion":[{"id":1932,"instrumentId":264,"questionId":8548,"ruleId":370}],"targetOperator":null,"targetQuestionId":null,"targetValue":null,"targetValueDataT
ype":null}],"scaleGroup":[{"grid1":0,"grid2":7,"grid3":0,"id":316,"instrument":264,"name":"Case Mix","ordInc":1,"ordMax":12,"ordMin":0,"ordTitle":"Case Mix Level","scale":[{"groupId":316,"id":1352,"name":"LEVEL","sequence":1,"xLabel":"Level
"},{"groupId":316,"id":1353,"name":"ADL","sequence":2,"xLabel":"ADLs"}],"sequence":1}],"spec":{"entryChecksum":2969544202,"entrySpec":"{\"name\": \"CASE MIX\", \r\n \"restartDays\": 2, \r\n \"content\":[\r\n {\"id\": \"q8580\", \"type\":
ien":100025,"legacyValue":4,"sequence":5}],"choiceDisplay":82590,"choiceIdentifier":0,"choiceIdentifierIen":42247,"choiceTypeId":15001,"designator":"Q1.","hint":null,"id":8535,"instrument":264,"introDisplay":97350,"introId":2434,"introText"
\"ChoiceQuestion\", \"required\": false, \"inline\": false, \r\n \"text\": \" Type of Evaluation\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5155\", \"text\": \"1. Initial\", \"quickKey\": 1}, \r\n {\"id\": \
"c5156\", \"text\": \"2. 6 month\", \"quickKey\": 2}, \r\n {\"id\": \"c5157\", \"text\": \"3. Annual\", \"quickKey\": 3}, \r\n {\"id\": \"c5158\", \"text\": \"4. Change in level of care\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\":
\"q8581\", \"type\": \"DateQuestion\", \"required\": false, \"inline\": true, \r\n \"text\": \" Anticipated Start Date \", \r\n \"controlWidth\": 120, \"daysBack\": 30, \"daysAhead\": 365}, \r\n {\"id\": \"q8582\", \"typ
e\": \"ChoiceQuestion\", \"required\": false, \"inline\": false, \r\n \"text\": \" Anticipated Length of Service\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5159\", \"text\": \"1. Less than 90 days\", \"quickKey\
": 1}, \r\n {\"id\": \"c5160\", \"text\": \"2. 3 months\", \"quickKey\": 2}, \r\n {\"id\": \"c5161\", \"text\": \"3. 6 months\", \"quickKey\": 3}, \r\n {\"id\": \"c5162\", \"text\": \"4. 12 months\", \"quickKey\": 4}\r\n ]}, \
r\n {\"id\": \"i2434\", \"type\": \"IntroText\", \r\n \"text\": \" \"\r\n }, \r\n {\"id\": \"q8535\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"Q1. DRESSING<br \/> How well are you
able to manage dressing? By dressing, we mean\r\n laying out the clothes and<br \/> putting them on, including shoes, and fastening\r\n clothes. Would you say that you:\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choice
s\":[\r\n {\"id\": \"c5056\", \"text\": \"0. Can dress without help of any kind?\", \"quickKey\": 0}, \r\n {\"id\": \"c5057\", \"text\": \"1. Need and get minimal supervision or reminding?\", \"quickKey\": 1}, \r\n {\"id\": \"c5
058\", \"text\": \"2. * Need some help from another person to put your clothes on?\", \"quickKey\": 2},
\r\n {\"id\": \"c5059\", \"text\": \"3. * Cannot dress yourself and somebody dresses you?\", \"quickKey\": 3}, \r\n {\"id\": \"c5060\", \"text\": \"4. * Are never dressed?\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q8536\", \"t
:" ","max":0,"min":0,"questionDisplay":97350,"questionId":8535,"questionText":"DRESSING|\r\nHow well are you able to manage dressing? By dressing, we mean laying out the clothes and|\r\nputting them on, including shoes, and fastening clot
ype\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"Q2. GROOMING<br \/> Now I have some questions about how you manage with grooming\r\n activities like combing your hair,<br \/> putting on makeup, shaving,
and\r\n brushing your teeth. Would you say that you:\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5061\", \"text\": \"0. Can comb your hair, wash your face, shave or brush your teeth with
out help of\r\n any kind?\", \"quickKey\": 0}, \r\n {\"id\": \"c5062\", \"text\": \"1. Need and get supervision or reminding or grooming activities?\", \"quickKey\": 1}, \r\n {\"id\": \"c5063\", \"text\": \"2. * Needs and get daily
help from another person?\", \"quickKey\": 2}, \r\n {\"id\": \"c5064\", \"text\": \"3. * Are completely groomed by somebody else?\", \"quickKey\": 3}\r\n ]}, \r\n {\"id\": \"q8537\", \"type\": \"ChoiceQuestion\", \"required\": true,
\"inline\": false, \r\n \"text\": \"Q3. BATHING<br \/> How well can you bathe or shower yourself? (Bathing or\r\n showering by yourself means running<br \/> the water, taking the bath or shower\r\n without any help, and washing all part
s of the body, including<br \/> our hair\r\n and face.) Would you say that you:\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5065\", \"text\": \"0. Can bathe or shower without any help?\",
\"quickKey\": 0}, \r\n {\"id\": \"c5066\", \"text\": \"1. Need and get minimal supervision or reminding?\", \"quickKey\": 1}, \r\n {\"id\": \"c5067\", \"text\": \"2. Need and get supervision only?\", \"quickKey\": 2}, \r\n {\"i
d\": \"c5068\", \"text\": \"3. Need and get help getting in and out of the tub?\", \"quickKey\": 3}, \r\n {\"id\": \"c5069\", \"text\": \"4. * Need and get help washing and drying your body?\", \"quickKey\": 4}, \r\n {\"id\": \"c507
0\", \"text\": \"5. * Cannot bathe or shower, need complete help?\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8538\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"Q4. EATING<br \/> How well c
an you manage eating by yourself? Eating by yourself\r\n means drinking and eating without<br \/> help from anybody else, but you can use\r\n special utensils and straws. It also means cutting most foods<br \/> on your own.\r\n Would you sa
hes. Would you say that you:","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":10},{"choice":[{"choiceId":5061,"choiceText":"Can comb your hair, wash your face, shave or brush your teeth without help of any kind?",
y that you:\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5071\", \"text\": \"0. Can eat without help of any kind?\", \"quickKey\": 0}, \r\n {\"id\": \"c5072\", \"text\": \"1. Need and
get minimal reminding or supervision?\", \"quickKey\": 1}, \r\n {\"id\": \"c5073\", \"text\": \"2. * Need and get help in cutting food, buttering bread or arranging food?\", \"quickKey\": 2}, \r\n {\"id\": \"c5074\", \"text\": \"3.
* Need and get some personal help with feeding or someone needs to be sure\r\n that you don't choke?\", \"quickKey\": 3}, \r\n {\"id\": \"c5075\", \"text\": \"4. * Need to be fed completely or tube feeding or IV feeding?\", \"quickKey\"
: 4}\r\n ]}, \r\n {\"id\": \"q8539\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"Q5. BED MOBILITY<br \/> How well can you manage sitting up or moving around in\r\n bed? Would you say that yo
u:\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5076\", \"text\": \"0. Can move in bed without any help?\", \"quickKey\": 0}, \r\n {\"id\": \"c5077\", \"text\": \"1. Need and get help
sometimes to sit up?\", \"quickKey\": 1}, \r\n {\"id\": \"c5078\", \"text\": \"2. * Always need and get help to sit up?\", \"quickKey\": 2},
\r\n {\"id\": \"c5079\", \"text\": \"3. * Always need and get help to be turned or change positions?\", \"quickKey\": 3}\r\n ]}, \r\n {\"id\": \"q8540\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \
"text\": \"Q6. TRANSFERRING<br \/> How well can you get in and out of a bed or chair? Would\r\n you say that you:\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5080\", \"text\": \"0. Can ge
t in and out of a bed or chair without help of any kind?\", \"quickKey\": 0}, \r\n {\"id\": \"c5081\", \"text\": \"1. Need somebody to be there to guide you but can move in and out of a bed or\r\n chair?\", \"quickKey\": 1}, \r\n {\
"id\": \"c5082\", \"text\": \"2. * Need one other person to help you?\", \"quickKey\": 2}, \r\n {\"id\": \"c5083\", \"text\": \"3. * Need two other people or a mechanical aid to help you?\", \"quickKey\": 3}, \r\n {\"id\": \"c5084\"
"ien":100026,"legacyValue":0,"sequence":1},{"choiceId":5062,"choiceText":"Need and get supervision or reminding or grooming activities?","ien":100027,"legacyValue":1,"sequence":2},{"choiceId":5063,"choiceText":"* Needs and get daily help fr
, \"text\": \"4. * Never get out of a bed or chair?\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q8541\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"Q7. WALKING<br \/> How well are you able t
o walk around, either without any help\r\n or with a cane or walker, but not<br \/> including a wheelchair? (If asked,\r\n clarify that independence in walking refers to the ability to walk<br \/> short\r\n distances around the house. Indep
endence in walking does not include climbing\r\n stairs.) <br \/> Would you say that you:\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5085\", \"text\": \"0. Walk without help of any kind?
\", \"quickKey\": 0}, \r\n {\"id\": \"c5086\", \"text\": \"1. Can walk with help of a cane, walker, crutch, or push wheelchair?\", \"quickKey\": 1}, \r\n {\"id\": \"c5087\", \"text\": \"2. * Need and get help from one person to help
you walk?\", \"quickKey\": 2}, \r\n {\"id\": \"c5088\", \"text\": \"3. * Need and get help from two people to help you walk?\", \"quickKey\": 3}, \r\n {\"id\": \"c5089\", \"text\": \"4. * Cannot walk at all?\", \"quickKey\": 4}\r\n
]}, \r\n {\"id\": \"q8542\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"Q8. BEHAVIOR\", \r\n \"intro\": \" \",\r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5090\",
\"text\": \"0. Behavior requires no intervention.\", \"quickKey\": 0}, \r\n {\"id\": \"c5091\", \"text\": \"1. Needs and receives occasional staff intervention in the form of cues\r\n because the person is anxious, irritable, lethargic
or demanding. Person responds to cues.\", \"quickKey\": 1}, \r\n {\"id\": \"c5092\", \"text\": \"2. * Needs and receives regular staff intervention in the form of redirection\r\n because the person has episodes of disorientation, halluc
inates, wanders, is withdrawn or exhibits similar\r\n behaviors. Person may be resistive but responds to redirection.\", \"quickKey\": 2}, \r\n {\"id\": \"c5093\", \"text\": \"3. * Needs and receives behavior management and staff interv
ention because\r\n person exhibits disruptive behavior such as verbally abusing others, wandering into private areas,\r\n removing or destroying property, or acts in a sexually aggressive manner. Person may be resistant to redirection.\",\r
om another person?","ien":100028,"legacyValue":2,"sequence":3},{"choiceId":5064,"choiceText":"* Are completely groomed by somebody else?","ien":100029,"legacyValue":3,"sequence":4}],"choiceDisplay":82590,"choiceIdentifier":0,"choiceIdentifi
\n \"quickKey\": 3}, \r\n {\"id\": \"c5094\", \"text\": \"4. * Needs and receives behavior management and staff intervention because person is\r\n physically abusive to self and others. Person may physically resist redirection.\", \"qui
ckKey\": 4}\r\n ]}, \r\n {\"id\": \"q8543\", \"type\": \"ChoiceQuestion\", \"required\": false, \"inline\": false, \r\n \"text\": \"Q9. COMMUNICATION<br \/> How effective are you at making yourself understood?\r\n Would you say that
on a regular basis you are:\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[
\r\n {\"id\": \"c5095\", \"text\": \"0. Understood?\", \"quickKey\": 0}, \r\n {\"id\": \"c5096\", \"text\": \"1. Usually Understood?\", \"quickKey\": 1}, \r\n {\"id\": \"c5097\", \"text\": \"2. Sometimes Understood?\", \"quickKe
y\": 2}, \r\n {\"id\": \"c5098\", \"text\": \"3. Rarely\/Never Understood?\", \"quickKey\": 3}\r\n ]}, \r\n {\"id\": \"q8544\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"Q10. TOILETING<
br \/> How well can you manage using the toilet? (Using the toilet\r\n independently includes<br \/> adjusting clothing, getting to and on the toilet,\r\n and cleaning one's self. If reminders<br \/> are needed to use the toilet this\r\n co
unts as some help.) Would you say that you:\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5099\", \"text\": \"0. Can use the toilet without help, including adjusting clothing?\", \"quickKey
\": 0}, \r\n {\"id\": \"c5100\", \"text\": \"1. * Need some help to get to and on the toilet but don't have accidents?\", \"quickKey\": 1}, \r\n {\"id\": \"c5101\", \"text\": \"2. * Have accidents sometimes, but not more than once a
week?\", \"quickKey\": 2}, \r\n {\"id\": \"c5102\", \"text\": \"3. * Only have accidents at night?\", \"quickKey\": 3}, \r\n {\"id\": \"c5103\", \"text\": \"4. * Have accidents more than once a week?\", \"quickKey\": 4}, \r\n {
\"id\": \"c5104\", \"text\": \"5. * Have bowel movements in your clothes more than once a week?\", \"quickKey\": 5}, \r\n {\"id\": \"c5105\", \"text\": \"6. * Wet your pants and have bowel movements in your clothes very often?\", \"quic
erIen":42248,"choiceTypeId":15002,"designator":"Q2.","hint":null,"id":8536,"instrument":264,"introDisplay":97350,"introId":2434,"introText":" ","max":0,"min":0,"questionDisplay":97350,"questionId":8536,"questionText":"GROOMING|
kKey\": 6}, \r\n {\"id\": \"c5106\", \"text\": \"7. * Are enrolled in VA Bowel and Bladder Program?\", \"quickKey\": 7}\r\n ]}, \r\n {\"id\": \"q8545\", \"type\": \"ChoiceQuestion\", \"required\": false, \"inline\": false, \r\n \
"text\": \"Q11. MDS HC 2.0\/CPS Cognitive Skill for Daily Decision Making\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5107\", \"text\": \"0. Independent - decisions consistent\/reasonable
.\", \"quickKey\": 0}, \r\n {\"id\": \"c5108\", \"text\": \"1. Modified Independence - some difficulty in new situations only.\", \"quickKey\": 1}, \r\n {\"id\": \"c5109\", \"text\": \"2. Moderately Impaired - decisions poor; cues\/
supervision required.\", \"quickKey\": 2}, \r\n {\"id\": \"c5110\", \"text\": \"3. Severely Impaired - never\/rarely made decisions.\", \"quickKey\": 3}\r\n ]}, \r\n {\"id\": \"q8546\", \"type\": \"ChoiceQuestion\", \"required\": fa
lse, \"inline\": false, \r\n \"text\": \"Q12. MDS 2.0\/CPS: Short Term Memory (recall of what was learned or known)\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5111\", \"text\": \"0. S
hort-term memory okay- seems\/appears to recall after 5 minutes\", \"quickKey\": 0}, \r\n {\"id\": \"c5112\", \"text\": \"1. Memory problem\", \"quickKey\": 1}\r\n ]}, \r\n {\"id\": \"q8547\", \"type\": \"ChoiceQuestion\", \"require
d\": true, \"inline\": false, \r\n \"text\": \"Q13. SPECIAL TREATMENTS\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5113\", \"text\": \"0. No TX\", \"quickKey\": 0}, {\"id\": \"c
5114\", \"text\": \"1. Tube Feedings\", \"quickKey\": 1}, \r\n {\"id\": \"c5115\", \"text\": \"2. One or more TX such as:\", \"quickKey\": 2}\r\n ]}, \r\n {\"id\": \"q8548\", \"type\": \"CheckQuestion\", \"required\": false, \"inlin
e\": false, \r\n \"text\": \"Q13a. Check all that apply:\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5116\", \"text\": \"1. Intravenous Fluid\", \"quickKey\": 1}, \r\n {\"id\": \"c
5117\", \"text\": \"2. Intravenous Medications\", \"quickKey\": 2}, \r\n {\"id\": \"c5118\", \"text\": \"3. Drainage Tubes\", \"quickKey\": 3},
\r\nNow I have some questions about how you manage with grooming activities like combing your hair,| putting on makeup, shaving, and brushing your teeth. Would you say that you:","required":true,"responseTypeId":1,"responseTypeText":"MCHOIC
\r\n {\"id\": \"c5119\", \"text\": \"4. Symptom Control for Terminal Illness\", \"quickKey\": 4}, \r\n {\"id\": \"c5120\", \"text\": \"5. Isolation Precautions\", \"quickKey\": 5}, \r\n {\"id\": \"c5121\", \"text\": \"6. Hyperal
imentation\/Hickman Catheter\", \"quickKey\": 6}, \r\n {\"id\": \"c5122\", \"text\": \"7. Oxygen & Respiratory Therapy\", \"quickKey\": 7}, \r\n {\"id\": \"c5123\", \"text\": \"8. Ostomies & Catheters\", \"quickKey\": 8}, \r\n {
\"id\": \"c5124\", \"text\": \"9. Wound Care\/Decubiti\", \"quickKey\": 9}, \r\n {\"id\": \"c5125\", \"text\": \"10. Skin Care\", \"quickKey\": 10}, \r\n {\"id\": \"c5126\", \"text\": \"11. Other\", \"quickKey\": 11}\r\n ]}, \r\n
{\"id\": \"q8549\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"Q14. CLINICAL MONITORING\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5127\",
\"text\": \"0. Less than once a day\", \"quickKey\": 0}, \r\n {\"id\": \"c5128\", \"text\": \"1. 1-2 shifts a day\", \"quickKey\": 1}, \r\n {\"id\": \"c5129\", \"text\": \"2. All shifts\", \"quickKey\": 2}\r\n ]}, \r\n {\"id\":
\"q8550\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"Q15. SPECIAL NURSING<br \/> In order to code this item \\u0022yes,\\u0022 the person\r\n must receive either tube feeding only,<br \/> or a
combination of other special\r\n treatment (2 in Q13) and clinical monitoring (2 in Q14)\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5130\", \"text\": \"1. Yes\", \"quickKey\": 1}, \r\n
{\"id\": \"c5131\", \"text\": \"2. No\", \"quickKey\": 2}\r\n ]}, \r\n {\"id\": \"i2454\", \"type\": \"IntroText\", \r\n \"text\": \"<em>NEURODIAGNOSIS (ICD-10 Codes)<\/em><br \/> <br \/>Diseases of the nervous system\r\n exclu
ding sense organs<br \/> G00-99, excluding G30.9 and G47<br \/>Cerebrovascular\r\n Disease<br \/> I60-I69<br \/>Fracture of the skull<\/br > S02.0XXA<br \/>Spinal Cord\r\n Injury without
evidence of spinal bone injury<\/br> S14.101A-S14.104A<br \/>Injury\r\n to nerve roots and spinal plexusM<br \/> S14.2XXA<br \/>Neoplasms of the brain and\r\n spine<br \/> C41.2, C41.4,
E","sequence":20},{"choice":[{"choiceId":5065,"choiceText":"Can bathe or shower without any help?","ien":100030,"legacyValue":0,"sequence":1},{"choiceId":5066,"choiceText":"Need and get minimal supervision or reminding?","ien":100031,"legac
C71.0-71.9, C79.31, C74.49, C79.32,<br \/> D16.6, D16.8,\r\n D33.2-D33.9, D42.0, D42.1, D42.9, D49.6\"\r\n }, \r\n {\"id\": \"q8551\", \"type\": \"ChoiceQuestion\", \"required\": false, \"inline\": false, \r\n \"t
ext\": \"Q16. NEUROMUSCULAR DIAGNOSIS\", \r\n \"intro\": \"NEURODIAGNOSIS (ICD-10 Codes)<br \/> <br \/>Diseases of the nervous system\r\n excluding sense organs (G00-99, excluding G30.9 and G47)<br \/>Cerebrovascular\r\n Disease (I60
-I69)<br \/>Fracture of the skull (S02.0XXA)<br \/>Spinal Cord\r\n Injury without evidence of spinal bone injury (S14.101A-S14.104A)<br \/>Injury\r\n to nerve roots and spinal plexus (S14.2XXA)<br \/>Neoplasms of the brain and\r\n spine
(C41.2, C41.4, C71.0-71.9, C79.31, C74.49, C79.32, D16.6, D16.8,\r\n D33.2-D33.9, D42.0, D42.1, D42.9, D49.6)\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5132\", \"text\": \"1. Yes\", \"quickKey\": 1}, \r\n {\"
id\": \"c5133\", \"text\": \"2. No\", \"quickKey\": 2}\r\n ]}, \r\n {\"id\": \"q8552\", \"type\": \"MemoQuestion\", \"required\": false, \r\n \"text\": \"COMMENTS. on Functional Strengths\/ADLs\/Community Supports Plan\/Supervision\r
\n Implications\", \r\n \"intro\": \" \", \r\n \"controlWidth\": 658}, \r\n {\"id\": \"q8553\", \"type\": \"CheckQuestion\", \"required\": false, \"inline\": false, \r\n \"text\": \"SOURCES. Please select the sources of informa
tion that were used to determine the\r\n patient's ability to manage <br \/>their activities of daily living (dressing,
\r\n grooming, bathing, eating, walking, toileting, transferring, and bed mobility). \r\n <br \/>Check all that apply:\", \r\n \"intro\": \" \", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5134\", \"text\": \"1. P
erson\", \"quickKey\": 1}, \r\n {\"id\": \"c5135\", \"text\": \"2. Informant\", \"quickKey\": 2}, \r\n {\"id\": \"c5136\", \"text\": \"3. Medical Record\", \"quickKey\": 3}, \r\n {\"id\": \"c5137\", \"text\": \"4. Observation\",
\"quickKey\": 4}\r\n ]}], \r\n \"rules\":[\r\n {\"question\": \"q8547\", \"operator\": \"NE\", \"value\": \"c5115\", \r\n \"skips\":[\"q8548\"]}]\r\n}","instrument":264,"lastUpdate":"2021-12-02T13:52:49","specIen":131},"verify":["60
yValue":1,"sequence":2},{"choiceId":5067,"choiceText":"Need and get supervision only?","ien":100032,"legacyValue":2,"sequence":3},{"choiceId":5068,"choiceText":"Need and get help getting in and out of the tub?","ien":100033,"legacyValue":3,
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