A0050

Type of Record

x Applies ›

A0100

Facility Provider Numbers

x Applies ›

A0200

Type of Provider

x Applies ›

A0310

Type of Assessment

x Applies ›

A0410

Unit Certification or Licensure Designation

x Applies ›

A0500

Legal Name of Resident

x Applies ›

A0600

Social Security and Medicare Numbers

x Applies ›

A0700

Medicaid Number

x Applies ›

A0810

Sex

x Applies ›

A0900

Birth Date

x Applies ›

A1005

Ethnicity

x Applies ›

A1010

Race

x Applies ›

A1200

Marital Status

x Applies ›

A1300

Optional Resident Items

x Applies ›

A1600

Entry Date

x Applies ›

A1700

Type of Entry

x Applies ›

A1805

Entered From

x Applies ›

A1900

Admission Date (Date this episode of care in this facility

x Applies ›

A2000

Discharge Date

x Applies ›

A2105

Discharge Status

x Applies ›

A2400

Medicare Stay

x Applies ›

X1100

RN Assessment Coordinator Attestation of Completion

- Not submitted to iQIES ›

Z0400

Signatures of Persons Completing the Assessment or

- Not submitted to iQIES ›