1.3.6.1.4.1.19376.1.5.3.1.1.12.2.5
Development Only
The PCC Wiki Content is used only for development of IHE PCC Content. The Normative content of the PCC Technical Framework and the current supplements can be found at https://www.ihe.net/resources/technical_frameworks/#pcc
Physical Function Section
Template ID | 1.3.6.1.4.1.19376.1.5.3.1.1.12.2.5 | |
---|---|---|
General Description | This section reports scores from section G of the Minimum Data Set. | |
LOINC Code | Opt | Description |
46006-3 | R | Physical functioning and structural problems |
Entries | Opt | Description |
1.3.6.1.4.1.19376.1.5.3.1.1.12.3.7 | O | Survey Panel At least one Survey Panel or Survey Observation shall be present. |
1.3.6.1.4.1.19376.1.5.3.1.1.12.3.6 | O | Survey Observations At least one Survey Panel or Survey Observation shall be present. |
<component> <section> <templateId root='1.3.6.1.4.1.19376.1.5.3.1.1.12.2.5'/> <id root=' ' extension=' '/> <code code='46006-3' displayName='Physical functioning and structural problems' codeSystem='2.16.840.1.113883.6.1' codeSystemName='LOINC'/> <text> Text as described above </text> <entry> : <!-- Optional Survey Panel element --> <templateId root='1.3.6.1.4.1.19376.1.5.3.1.1.12.3.7'/> : </entry> <entry> : <!-- Optional Survey Observations element --> <templateId root='1.3.6.1.4.1.19376.1.5.3.1.1.12.3.6'/> : </entry> </section> </component> |
Schematron
<pattern name='Template_1.3.6.1.4.1.19376.1.5.3.1.1.12.2.5'> <rule context='*[cda:templateId/@root="1.3.6.1.4.1.19376.1.5.3.1.1.12.2.5"]'> <!-- Verify that the template id is used on the appropriate type of object --> <assert test='../cda:section'> Error: The Physical Function can only be used on sections. </assert> <!-- Verify the section type code --> <assert test='cda:code[@code = "46006-3"]'> Error: The section type code of a Physical Function must be 46006-3 </assert> <assert test='cda:code[@codeSystem = "2.16.840.1.113883.6.1"]'> Error: The section type code must come from the LOINC code system (2.16.840.1.113883.6.1). </assert> <assert test='.//cda:templateId[@root = "1.3.6.1.4.1.19376.1.5.3.1.1.12.3.7"]'> <!-- Note any missing optional elements --> Note: This Physical Function Section does not contain a(n) Survey Panel Entry. See http://wiki.ihe.net/index.php?title=1.3.6.1.4.1.19376.1.5.3.1.1.12.2.5 </assert> <assert test='.//cda:templateId[@root = "1.3.6.1.4.1.19376.1.5.3.1.1.12.3.6"]'> <!-- Note any missing optional elements --> Note: This Physical Function Section does not contain a(n) Survey Observations Entry. See http://wiki.ihe.net/index.php?title=1.3.6.1.4.1.19376.1.5.3.1.1.12.2.5 </assert> <assert test='.//cda:templateId[@root = "1.3.6.1.4.1.19376.1.5.3.1.1.12.3.6"] or .//cda:templateId[@root = "1.3.6.1.4.1.19376.1.5.3.1.1.12.3.7"]'> At least one Survey Panel or Survey Observation shall be present. See http://www.ihe.net/index.php/1.3.6.1.4.1.19376.1.5.3.1.1.12.2.5 </assert> </rule> </pattern>
Uses
See Templates using the Physical Function Section
Constraints
Survey Panels found in this section shall be identified using the panel codes found in the table below, and shall contain one or more survey observations from that panel.
Survey Observations found in this section shall use the LOINC codes from the table below to express the answer to one or more questions from the Minimum Data Set Section G. The Survey Observations shall not contain a <methodCode> or <targetSiteCode> element, as these are not appropriate to the MDS Survey instrument.
Panel Code | Observation Code | Description | Data Type | Value Set |
---|---|---|---|---|
46007-1 | Panel | ADL self performance or support | ||
45588-1 | Bed mobility - self-performance | CO | 2.16.840.1.113883.6.257.755 | |
45589-9 | Bed mobility - support provided | CO | 2.16.840.1.113883.6.257.768 | |
45590-7 | Transfer - self-performance | CO | 2.16.840.1.113883.6.257.755 | |
45591-5 | Transfer - support provided | CO | 2.16.840.1.113883.6.257.768 | |
45592-3 | Walk in room - self-performance | CO | 2.16.840.1.113883.6.257.755 | |
45593-1 | Walk in room - support provided | CO | 2.16.840.1.113883.6.257.768 | |
45594-9 | Walk in corridor - self-performance | CO | 2.16.840.1.113883.6.257.755 | |
45595-6 | Walk in corridor - support provided | CO | 2.16.840.1.113883.6.257.768 | |
45596-4 | Locomotion on unit - self-performance | CO | 2.16.840.1.113883.6.257.755 | |
45597-2 | Locomotion on unit - support provided | CO | 2.16.840.1.113883.6.257.768 | |
45598-0 | Locomotion off unit - self-performance | CO | 2.16.840.1.113883.6.257.755 | |
45599-8 | Locomotion off unit - support provided | CO | 2.16.840.1.113883.6.257.768 | |
45600-4 | Dressing - self-performance | CO | 2.16.840.1.113883.6.257.755 | |
45601-2 | Dressing - support provided | CO | 2.16.840.1.113883.6.257.768 | |
45602-0 | Eating - self-performance | CO | 2.16.840.1.113883.6.257.755 | |
45603-8 | Eating - support provided | CO | 2.16.840.1.113883.6.257.768 | |
45604-6 | Toilet use - self-performance | CO | 2.16.840.1.113883.6.257.755 | |
45605-3 | Toilet use - support provided | CO | 2.16.840.1.113883.6.257.768 | |
45606-1 | Personal hygiene - self-performance | CO | 2.16.840.1.113883.6.257.755 | |
45607-9 | Personal hygiene - support provided | CO | 2.16.840.1.113883.6.257.768 | |
46008-9 | Panel | Bathing | ||
45608-7 | Bathing - self-performance | CO | 2.16.840.1.113883.6.257.860 | |
45609-5 | Bathing - support provided | CO | 2.16.840.1.113883.6.257.768 | |
46009-7 | Panel | Test for balance | ||
45610-3 | Balance while standing | CO | 2.16.840.1.113883.6.257.876 | |
45523-8 | Balance while sitting | CO | 2.16.840.1.113883.6.257.876 | |
46010-5 | Panel | Functional limitation in range of motion | ||
45524-6 | Range of motion^Neck | CO | 2.16.840.1.113883.6.257.889 | |
45525-3 | Voluntary movement^Neck | CO | 2.16.840.1.113883.6.257.898 | |
45526-1 | Range of motion^Upper Extremity | CO | 2.16.840.1.113883.6.257.889 | |
45527-9 | Voluntary movement^Upper Extremity | CO | 2.16.840.1.113883.6.257.898 | |
45528-7 | Range of motion^Hand | CO | 2.16.840.1.113883.6.257.889 | |
45529-5 | Voluntary movement^Hand | CO | 2.16.840.1.113883.6.257.898 | |
45530-3 | Range of motion^Lower Extremity | CO | 2.16.840.1.113883.6.257.889 | |
45531-1 | Voluntary movement^Lower Extremity | CO | 2.16.840.1.113883.6.257.898 | |
45532-9 | Range of motion^Foot | CO | 2.16.840.1.113883.6.257.889 | |
45533-7 | Voluntary movement^Foot | CO | 2.16.840.1.113883.6.257.898 | |
45534-5 | Other - range of motion | CO | 2.16.840.1.113883.6.257.889 | |
45535-2 | Other - voluntary movement | CO | 2.16.840.1.113883.6.257.898 | |
46011-3 | Panel | Modes of locomotion | ||
45536-0 | Uses cane, walker or crutch | CO | 2.16.840.1.113883.6.257.117 | |
45537-8 | Wheeled self | CO | 2.16.840.1.113883.6.257.117 | |
45538-6 | Other person wheeled | CO | 2.16.840.1.113883.6.257.117 | |
45539-4 | Uses wheelchair for primary locomotion | CO | 2.16.840.1.113883.6.257.117 | |
45540-2 | No modes of locomotion | CO | 2.16.840.1.113883.6.257.117 | |
46012-1 | Panel | Modes of transfer | ||
45541-0 | Bedfast all or most of the time | CO | 2.16.840.1.113883.6.257.117 | |
45542-8 | Bed rails for bed mobility or transfer | CO | 2.16.840.1.113883.6.257.117 | |
45543-6 | Lifted manually | CO | 2.16.840.1.113883.6.257.117 | |
45544-4 | Lifted mechanically | CO | 2.16.840.1.113883.6.257.117 | |
45545-1 | Transfer aid | CO | 2.16.840.1.113883.6.257.117 | |
45546-9 | No mode of transfer | CO | 2.16.840.1.113883.6.257.117 | |
No Panel | 45611-1 | Task segmentation | CO | 2.16.840.1.113883.6.257.117 |
46013-9 | Panel | ADL functional rehabilitation potential | ||
45612-9 | Resident sees increased independence capability | CO | 2.16.840.1.113883.6.257.117 | |
45613-7 | Staff sees increased independence capability | CO | 2.16.840.1.113883.6.257.117 | |
45614-5 | Resident slow performing tasks or activity | CO | 2.16.840.1.113883.6.257.117 | |
45615-2 | Difference in morning to evening activities of daily living | CO | 2.16.840.1.113883.6.257.117 | |
45616-0 | Activities of daily living rehabilitation potential - none of above | CO | 2.16.840.1.113883.6.257.117 | |
45617-8 | Change in activities of daily living function | CO | 2.16.840.1.113883.6.257.464 |
The coded orginal values used in the observations above are described in more detail in the table below.
Explanation | Coded Value |
---|---|
2.16.840.1.113883.6.257.755 | |
INDEPENDENT-No help or oversight -OR- Help/oversight provided only 1 or 2 times during last 7 days | 0 |
SUPERVISION-Oversight, encouragement or cueing provided 3 or more times during last7 days -OR- Supervision (3 or more times) plus physical assistance provided only 1 or 2 times during last 7 days | 1 |
LIMITED ASSISTANCE-Resident highly involved in activity; received physical help in guided maneuvering of limbs or other nonweight bearing assistance 3 or more times - OR-More help provided only 1 or 2 times during last 7 days | 2 |
EXTENSIVE ASSISTANCE-While resident performed part of activity, over last 7-day period, help of following type(s) provided 3 or more times: - Weight-bearing support - Full staff performance during part (but not all) of last 7 days | 3 |
TOTAL DEPENDENCE-Full staff performance of activity during entire 7 days | 4 |
ACTIVITY DID NOT OCCUR during entire 7 days | 8 |
2.16.840.1.113883.6.257.768 | |
No setup or physical help from staff | 0 |
Setup help only | 1 |
One person physical assist | 2 |
ADL activity itself did not occur during entire 7 days | 8 |
2.16.840.1.113883.6.257.860 | |
Independent-No help provided | 0 |
Supervision-Oversight help only | 1 |
Physical help limited to transfer only | 2 |
Physical help in part of bathing activity | 3 |
Total dependence | 4 |
Activity itself did not occur during entire 7 days | 8 |
2.16.840.1.113883.6.257.876 | |
Maintained position as required in test | 0 |
Unsteady, but able to rebalance self without physical support | 1 |
Partial physical support during test; or stands (sits) but does not follow directions for test | 2 |
Not able to attempt test without physical help | 3 |
2.16.840.1.113883.6.257.889 | |
No limitation | 0 |
Limitation on one side | 1 |
Limitation on both sides | 2 |
2.16.840.1.113883.6.257.898 | |
No loss | 0 |
Partial loss | 1 |
Full loss | 2 |
2.16.840.1.113883.6.257.117 | |
No | 0 |
Yes | 1 |
UTD | - |
2.16.840.1.113883.6.257.464 | |
No change | 0 |
Improved | 1 |
Deteriorated | 2 |