
File HBHC_PATIENT(631) Data List
| NAME |
EVALUATION DATE |
MARITAL STATUS @ EVALUATION |
LIVING ARRANGEMENTS @ EVAL |
LAST AGENCY PROVIDING CARE |
TYPE OF LAST CARE AGENCY |
ADMIT/REJECT ACTION |
REJECT/WITHDRAW REASON |
REJECT/WITHDRAW DISPOSITION |
DATE |
PRIMARY DIAGNOSIS @ ADMISSION |
VISION @ ADMISSION |
STATE CODE |
HEARING @ ADMISSION |
EXPRESSIVE COMMUNICATION @ ADM |
RECEPTIVE COMMUNICATION @ ADM |
BATHING @ ADMISSION |
DRESSING @ ADMISSION |
TOILET USAGE @ ADMISSION |
TRANSFERRING @ ADMISSION |
EATING @ ADMISSION |
WALKING @ ADMISSION |
BOWEL CONTINENCE @ ADMISSION |
COUNTY CODE |
BLADDER CONTINENCE @ ADMISSION |
MOBILITY @ ADMISSION |
ADAPTIVE TASKS @ ADMISSION |
BEHAVIOR PROBLEMS @ ADMISSION |
DISORIENTATION @ ADMISSION |
MOOD DISTURBANCE @ ADMISSION |
CAREGIVER LIMITATIONS @ ADM |
PERSON COMPLETING EVL/ADM FORM |
DATE EVAL/ADM FORM COMPLETED |
DISCHARGE DATE |
ZIP CODE |
ELIGIBILITY @ DISCHARGE |
MARITAL STATUS @ DISCHARGE |
LIVING ARRANGEMENTS @ D/C |
DISCHARGE STATUS |
TRANSFER DESTINATION |
TYPE OF DESTINATION AGENCY |
PRIMARY DIAGNOSIS @ DISCHARGE |
VISION @ DISCHARGE |
HEARING @ DISCHARGE |
EXPRESSIVE COMMUNICATION @ D/C |
ELIGIBILITY @ EVALUATION |
RECEPTIVE COMMUNICATION @ D/C |
BATHING @ DISCHARGE |
DRESSING @ DISCHARGE |
TOILET USAGE @ DISCHARGE |
TRANSFERRING @ DISCHARGE |
EATING @ DISCHARGE |
WALKING @ DISCHARGE |
BOWEL CONTINENCE @ DISCHARGE |
BLADDER CONTINENCE @ DISCHARGE |
MOBILITY @ DISCHARGE |
BIRTH YEAR |
ADAPTIVE TASKS @ DISCHARGE |
BEHAVIOR PROBLEMS @ DISCHARGE |
DISORIENTATION @ DISCHARGE |
MOOD DISTURBANCE @ DISCHARGE |
CAREGIVER LIMITATIONS @ D/C |
PERSON COMPLETING D/C FORM |
DATE DISCHARGE FORM COMPLETED |
CASE MANAGER |
SECONDARY DIAGNOSES @ ADM |
CAUSE OF DEATH |
PERIOD OF SERVICE |
SECONDARY DIAGNOSES @ D/C |
FORM 3 TRANSMIT STATUS |
FORM 5 TRANSMIT STATUS |
FORM 3 FILED IN HBHC(634) DATE |
FORM 3 BATCH INITIAL MM MSG # |
FORM 3 MAIL MESSAGE DATE |
FORM 5 FILED IN HBHC(634) DATE |
FORM 5 BATCH INITIAL MM MSG # |
FORM 5 MAIL MESSAGE DATE |
FORM 3 TRANSMIT FLAG EDIT DATE |
SEX |
FORM 3 TRANSMIT FLAG EDIT DUZ |
FORM 5 TRANSMIT FLAG EDIT DATE |
FORM 5 TRANSMIT FLAG EDIT DUZ |
FORM 3 RE-TRANS BATCH MM MSG # |
FORM 3 RE-TRANSMIT DATE |
FORM 5 RE-TRANS BATCH MM MSG # |
FORM 5 RE-TRANSMIT DATE |
REFERRED WHILE INPATIENT |
MEDICAL FOSTER HOME PATIENT |
MEDICAL FOSTER HOME NAME |
RACE |
RACECOMP |
RATE PAID |
PARENT SITE |