Functional Status Assessments (FSA) Integration Profile Supplement

Introduction

This is a draft of the Functional Status Assessment Profile (FSA) supplement to the Patient Care Coordination Technical Framework. This draft is a work in progress, not the official supplement or profile.

Profile Abstract

The Functional Status Assessment Profile (FSA) supports the handoff of assessment information between practictioners during transfers of care.

The Institute of Medicine has determined that the highest risk for medical errors occurs during the handoffs of patient care between practitioners, cross-enterprise or intra-enterprise. Continuity of care requires provision of assessments to be available to the receiving practitioner for critical decision making. The transfer of physician documentation provides much of the medical/physiologic condition information. Transfer of nursing documentation provides human response (psychological, social, emotional, physiological and spiritual) of patient/family to changing conditions. Both types of documentation support continuity of patient care as each patient moves through the continuum. This profile demonstrates the collection and exchange of standardized assessment information as it is exchanged across a variety of residential and care provision settings.

Glossary

Term

Definition

IHE Functional Status Assessments Profile Glossary of Terms

IHE Integration Profiles describe the solution to a specific integration problem, and document the system roles, standards and design details for implementors to develop systems that cooperate to address that problem. IHE Profiles are a convenient way for implementors and users to be sure they're talking about the same solution without having to restate the many technical details that ensure actual interoperability.

Braden Score:The Braden Scale is a summated rating scale made up of six subscales scored from 1-3 or 4, for total scores that range from 6-23. The subscales measure functional capabilities of the patient that contribute to either higher intensity and duration of pressure or lower tissue tolerance for pressure. A lower Braden Scale Score indicates lower levels of functioning and, therefore, higher levers of risk for pressure ulcer development. Reliability and validity research found at [1] Media:Braden.pdf

Continuity of Care Record (CCR): A core data set of the most relevant administrative, demographic, and clinical information facts about a patient’s healthcare, covering one or more encounters. The CCR is Designation E2369-05 of the ASTM (American Society for Testing and Materials, International). More information is available from [2].

Continuity of Care Document(CCD): An HL7 Clinical Document Architecture (CDA) implementation alternative to ASTM ADJE2369 for institutions or organizations committed to HL7 standards. This specification was developed as a collaborative effort between ASTM and HL7. More information is available from [3].

Clinical Document Architecture (CDA): A document markup standard that specifies the structure and semantics of clinical documents for the purpose of exchange. From the perspective of CDA the CCR is a standardized data set that can be used to constrain CDS specifically for summary documents. More information is available from [4].

Functional Status: In the context of the Continuity of Care Records (CCR) functional status describes the patient’s status of normal functioning at the time the Care Record was created.

Functional status includes information concerning

• Ambulatory ability • Mental status or competency • Activities of Daily Living (ADL’s) including bathing, dressing, feeding, grooming • Home/living situation having an effect on the health status of the patient • Ability to care for self • Social activity, including issues with social cognition, participation with friends and acquaintances other than family members • Occupation activity, including activities partly or directly related to working, housework or volunteering, family and home responsibilities or activities related to home and family • Communication ability, including issues with speech, writing or cognition required for communication • Perception, including sight, hearing, taste, skin sensation, kinesthetic sense, proprioception, or balance

Geriatric Depression Scale: While there are many instruments available to measure depression, the Geriatric Depression Scale (GDS), first created by Yesavage et al., (Stanford University) has been tested and used extensively with the older population. It is a brief questionnaire in which participants are asked to respond to the 30 questions by answering yes or no in reference to how they felt on the day of administration. Scores of 0 - 9 are considered normal, 10 - 19 indicate mild depression and 20 - 30 indicate severe depression. The GDS may be used with healthy, medically ill and mild to moderately cognitively impaired older adults. It has been extensively used in community, acute and long-term care settings. As for evidence-based research the GDS was found to have 92% sensitivity and 89% specificity when evaluated against diagnostic criteria per the Hartford Institute for Geriatric Nursing. The validity and reliability of the tool have been supported through both clinical practice and research. More information is available from [5].

Logical Observation Identifiers Names and Codes( LOINC®) A database protocol developed by the Regenstrief Institute for Health Care aimed at standardizing laboratory and clinical code for use in clinical care, outcomes management, and research. LOINC® codes (sometimes in combination with SNOMED-CT codes are used to encode functional status assessments to facilitated health information exchange. Additional information found at [6].

Minimum Data Set (MDS):The instrument specified by the Centers for Medicare and Medicaid Services (in the United States ) that requires nursing facilities to conduct a comprehensive, accurate, standardized, reproducible assessment of each resident’s functional capacity. Section G Physical Functioning and Structural Problems are included in this demonstration project. Media:SectionG_MDS20.pdf

Minimum Data Set for Long Term Care Version 2.0 (MDS 2.0): A federally mandated (in the United States) standard assessment form that Medicare and/or Medicaid-certified nursing facilities must use to collect demographic and clinical data on nursing home residents. More information is found at[7].

Outcomes and Assessment Information Set (OASIS): A standard core assessment data tool developed to measure the outcomes of adult patients receiving home health services under the Medicare and Medicaid programs in the United States. More information is available from [8].

Pain Scale (Numeric Pain Scale):Patient rates his/her pain from 0 to 10 (or 5 or 20), with 0 representing no pain and 10 (or 5 or 20) representing the worst possible pain. This scale is used for age 5 years and older and is the preferred pain scale for many older healthy adults. Reliable and valid per Herr & Garland, 2001; Ho et al, 1996; Price et al, 1994.

Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT®): A comprehensive clinical terminology, originally created by the College of American Pathologists (CAP) and, as of April 2007, owned, maintained, and distributed by the International Health Terminology Standards Development Organisation (IHTSDO), a non-for-profit association in Denmark. The CAP continues to support SNOMED CT operations under contract to the IHTSDO and provides SNOMED-related products and services as a licensee of the terminology. More information available from [9] or the United States National Library of Medicine at [10]

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Dependencies

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Integration Profile	Dependency	Dependency Type	Purpose
Functional Status Assessment

Profile Name

The Functional Status Assessment Profile (FSA) supports the handoff of assessment information between practictioners during transfers of care.

The Institute of Medicine has determined that the highest risk for medical errors occurs during the handoffs of patient care between practitioners, cross-enterprise or intra-enterprise. Continuity of care requires provision of assessments to be available to the receiving practitioner for critical decision making. The transfer of physician documentation provides much of the medical/physiologic condition information. Transfer of nursing documentation provides human response (psychological, social, emotional, physiological and spiritual) of patient/family to changing conditions. Both types of documentation support continuity of patient care as each patient moves through the continuum. This profile demonstrates the collection and exchange of standardized assessment information as it is exchanged across a variety of residential and care provision settings.

Use Cases

#1 Long-Term Care to Acute Care

Media:Case1DiabeticNH.pdf

Primary Actor(s): Discharge nurse in LTC facility, Admitting nurse in acute care facility

Stakeholder(s): Primary Care Physician, Hospitalist

Use Case Overview: A diabetic nursing home patient is transferring from the LTC environment to an in-patient acute care hospital based on deteriorating functional status assessments.

Use Case Scenario

1. A 76 year old resident/patient of a LTC facility has become increasingly weak, lethargic and has a low-grade fever. Resident refuses to get out of bed and is complaining of chills and the nurse noted reddened area on coccyx during assessment. Resident's glucose level is elevated and the maximum sliding-scale dose indicated in medication order is not controlling blood sugar.
   1. Nurse documents vital signs.
   2. Nurse documents finger-stick glucose measurement.
   3. Nurse documents current functional assessment.
   4. Nurse documents braden score.
   5. Nurse initiates phone collaboration with Primary Care Provider (PCP).
   6. Primary care provider (PCP) reviews patient status information on the electronic health record (EHR).
   7. PCP enters transfer order to acute care facililty via computerized physician order entry (CPOE).
2. The patient's baseline and standardized functional assessment is sent to the acute care hospital via a document exchange server.
   1. Nurse admission coordinator reviews transfer documents via the EHR.
   2. Bed is assigned on medical floor at acute care facility
   3. Notification of pending admission is sent to charge nurse on the medical floor
3. Charge nurse reviews the patient's functional status assessment data, VS, glucose values and braden score from LTC facility.
   1. Based on the information reviewed, Charge nurse adjusts shift assignment based on patients level of care.
4. Patient arrives in medical floor at acute care facility.
   1. Admitting nurse takes patient VS and completes admission assessment in EHR.
   2. EHR evaluates admission assessment data and identifies patient skin integrity problem due to Braden Score and fall risk.
   3. Electronic health record flags need for skin care protocol to clinician.
   4. Skin care protocol and fall risk protocol implemented according to facility protocols.
   5. Acute care physician assesses patient and reviews nurse assessment data in EHR.
5. Patient's medical issues are addressed during course of hospitalization (5 days).
   1. Standard plans of care (POC) initiated in nursing documentation in EHR.
      • Previous baseline functional status included in patient's POC.
      • Expressed as patient goals prior to discharge.
   2. Progress and level of care requirement is continuously monitored by nurse and hospitalist assigned to patient
6. After several days of care, patient ready for discharge as evidenced by blood sugar levels WNL and increased functional status (including ambulation with assistance).
   1. Series of functional assessments and overal progress reviewed by care providers.
   2. Nursing POC updated in EHR to reflect level of care (functional status) and unresolved skin risk.
   3. Acute care physician enters discharge order via CPOE.
   4. PCP notified of transfer back to LTC facility and review of patient status.
7. Long Term Care/Hospital collaborate on discharge plan/transfer.
   1. Patient readied for discharge, EHR documents completed.
   2. EHR discharge documents sent to document exchange server; message sent to LTC to download documents.
   3. Patient returns to LTC.

PLEASE NOTE: Italicized text denotes information in the use case that provides details regarding patient condition and workflow, but will not be included as part of the integration profile.

#2 Home/Ambulatory Care into Acute Care

Media:Case2OrthoSurg_.pdf Media:Case2_Page2_.pdf

Primary Actor(s)

ED Nurse, ED Doctor, Surgeon, Orthopedic nurse in acute care facility, Nurse in rehab facility, Clinical staff in assisted living facility

Secondary Actor(s)

Paramedics, Physical Therapist

Stakeholder(s)

Primary Care Physician, Hospitalist

Use Case Overview

A normally active, older adult in an assisted living community has an accidental fall requiring admission to an acute care facility. Alteration in functional status requires the patient discharge to a nursing home for rehabilitation with the long term goal of returning to assisted living.

Use Case Scenario

1. A 69 year old single male, living in an assisted community, is normally very active and self sufficient and requires only minimal assistance from staff for medication management. While walking outside, the patient falls and breaks his hip. The patient has a large 10 cm hematoma on his side with bruising that extends down his right hip and leg. He has a laceration on his forehead from his glasses breaking durign the fall. The patient is pale, and complaining of severe pain in his right hip. The patient is unable to move and an ambulance is called. Patient is transferred from the assisted living community to the emergency department at an acute care facility. There is no baseline functional assessment data available from the assisted living community.
   1. Nurse charts vital signs
   2. Nurse documents information regarding hematoma and area of brusing on right side
   3. Nurse documents information regarding head laceration and covers wound with 2x2 gauze/tape.
   4. Primary care physician is notified of ambulance transfer to acute care facililty
2. The patient's history from the assisted living community is reviewed with the paramedics before the patient is moved to the ambulance prior to transfer to the acute care facility emergency department.
   1. Paramedics are provided with a brief summary of patient including age, date of birth, medical history, medications and allergies.
3. Patient is brought to emergency department of acute care facility and is assessed by clinical staff. Nurse and physician assigned to patient review accident information and patient history via the electronic health record. The nurse performs a thorough assessment of the patient's current conditionl x-rays and labs are ordered. Patient is medicated for pain prior to the x-ray. ED doctor determines patient has hip fracture and recommends patient be transferred to the orthopedic floor with a surgical consult.
   1. ED nurse charts vital signs and accident information in electronic health record.
   2. ED nurse assesses patient's level of pain using numeric rating scale in the electronic health record.
   3. ED nurse notifies doctor of pain score.
   4. ED doctor assesses patient and reviews history.
   5. ED doctor orders hip x-ray and pain medication in electronic health record
   6. ED doctor writes up admission to ortho floor and orders surgical consult in the electronic health record.
4. Patient transferred to orthopedic floor at acute care facility and has surgical consult.
   1. Admitting nurse takes patient VS and completes admission assessment including numeric pain rating scale in the electronic health record.
   2. The electronic health record evaluates admission assessment data entered by the clinician and flags patient for skin integrity problem and fall risk.
   3. Skin care and fall risk protocol implemented in the electronic health record according to facility protocols.
   4. Surgeon assesses patient condition and recommends total hip replacement surgery.
5. Patient has surgery and returns to orthopedic floor. Nurses continue to monitor patient, dress wounds and assess pain level and medicate as needed. Patient begins physical therapy 1st day post-op.
   1. Standard plans of care initiated in nursing documentation in electronic health record.
      • Previous baseline functional status included in plan of care post total hip replacement.
      • Expressed as patient goals prior to discharge.
   2. Patient's pain level is assessed pre and post medication using numeric rating scale and documented in electronic health record.
   3. Progress and level of care requirement is continuously monitored by nurse and surgeon assigned to patient.
   4. Physical therapist establishes rehabilitation plan and goals post total hip surgery and documents progress in electronic health record.
6. Patient regains strength and is able to transfer and toilet with assistance. Staples have been removed from hip incision and bruising is resolving. Patients level of pain has dropped significantly since admission and is requiring less pain medication.
   1. Skin care protocol is suspended.
   2. Nursing plan of care updated to reflect level of care patient requires.
7. After several days of care post total hip surgery, the patient is progressing, but still not able to function independently (at previous baseline). The surgeon recommends the patient be transferred to a rehabilitation facility for more intense therapy.
   1. Series of functional assessments and overal progress reviewed by care providers.
   2. Plan of care is updated in the electronic health record.
   3. Primary care physician is notified of plan to transfer.
   4. Patient is prepared for discharge to rehabilitation facility with final assessment completed.
8. The patient's baseline and standardized functional assessment is sent to the rehabilitation facility via a document exchange server.
   1. Rehabilitation facility nurse admission coordinator reviews transfer documents.
   2. Bed is assigned on orthopedic floor at rehabilitation facility.
   3. Notification of pending admission is sent to charge nurse on the floor at the rehabilitation facility.
9. Charge nurse reviews patient accident history, functional assessment data, and patient progress from acute care facility. Based on the information reviewed, nurse determines that patient will require assistance transferring, toileting and ambulation and will be at risk for falls.
   1. Rehab facility charge nurse adjusts shift assignment based on patients level of care.
10. Patient regains strength and is able to transfer, toilet and ambulate with minimal assistance after one week and has not required pain medicine the last 3 days. Surgeon recommends patient for transfer back to assisted living facility.
    1. Series of functional assessments and overal progress reviewed by care providers.
    2. Plan of care is updated in EMR system.
    3. Primary care physician is notified of plan to transfer patient back to assisted living facility.
    4. Patient is prepared for discharge to assisted living facility with final assessment completed.
11. The patient's baseline and standardized functional assessment is sent to the assisted living facility via a document exchange server.
    1. Series of functional assessments and overal progress from rehabilitation center is reviewed by assisted living care providers.
12. Assisted living clinical staff review patients hospitalization and rehab history, functional assessment data, and patient progress. Based on the information reviewed, nurse determines that patient will require assistance transferring, toileting and ambulation and will be at risk for falls.
    1. Series of functional assessments and overal progress reviewed by care providers.
    2. Patient's assisted living needs have been updated to reflect fall risk and assistance with ambulation, toileting and transfer in the electronic health record.

PLEASE NOTE: Italicized text denotes information in the use case that provides details regarding patient condition and workflow, but will not be included as part of the integration profile.

#3 Behavioral

Media:Case3_MentalH.pdf

Primary Actor(s)

Psychiatric nurse, Attending physician/hospitalist, Home health nurse

Stakeholder(s)

Primary Care Physician, Outpatient psychiatrist

Use Case Overview

A recently widowed 75 year old woman is admitted to an adult inpatient floor of a behavior health hospital for depression post suicide attempt

Use Case Overview

1. A 75 year old woman who lives alone and has become increasingly withdrawn since the sudden death of her husband 6 weeks ago took several days worth of medication at one time from her pill pack. A neighbor found her in her home confused and immediately took her to her psychiatrists office. Patient was diagnosed as depressed by her psychiatrist, and was a direct admission from her doctor's office to an adult inpatient floor in a behavioral health facility.
   
2. Psychiatrist notes patient issue regarding depression into electonic health record notes.
3. Patient screened by adult inpatient admission nurse using the geriatric depression scale. Her initial score was 26, indicating severe depression. Patient information was entered into the electronic health record. Patient states that she has a hard time getting going each day and is afraid of how she will survive without her husband. She has lost her appetite and is unhappy with her life without her husband.
   1. Nurse documents geriatric depression scale results in the electronic health record.
   2. Nurse documents patient's feelings and concerns in progress notes in the electronic health record.
   3. Nurse initiates plan of care for management of depression.
4. Psychiatrist reviews the patient's progress and visits patient. Psychiatrist orders anti-depressant and mood stabilizer medications via CPOE.
5. Social work evaluates the patient for her social support and financial status. The patient has no limitations in activity of daily living. She has a housekeeper come in monthly to clean and does her own grocery shopping and laundry weekly. Her nearest relative is over 1,000 miles away and her only support network are friends and neighbors that are also frail and elderly. The social worker also collaborates with the nurse regarding the signs of depression and the geriatric depression scale score. The plan of care is initiated and discharge planning begins.
6. Daily, nursing gives patient medication and assesses the patient's depression status using the geriatric depression scale. Various support therapy sessions provided to patient to improve mood and outlook for the future.
   1. Nurse documents administration of medication.
   2. Nurse documents depression assessment.
   3. Nurse documents patient's response to therapies.
   4. Nurse documents udpate to the plan of care.
7. After 5 days, patient is progressing well and responding to therapy. Most recent geriatric depression scale score documented in the electronic health record is 15, indicating mild depression.
   1. Nurse documents administration of medication.
   2. Nurse documents depression assessment.
   3. Nurse documents patient's response to therapies.
   4. Nurse documents udpate to the plan of care.
8. Patient care conference is done with patient, nurse, social worker and physician. Based on progress, patient will be discharged to home with home health visits.
   
   1. Patient's plan of care is updated.
   2. Physician enters discharge to home order with home health services into the electronic health record.
9. Patient is discharged home with home health referral.
10. Home health nurse reviews patient status electronically and prepares for visit to patient home.
    1. Home health nurse reviews geriatric depression scale ratings from hospital and history of patient stay and underlying issues.
11. Home health nurse visits patient at home.
    1. Nurse assesses patient using the geriatric depression scale and enters into the electronic health record.
    2. Nurse assesses patient using oasis and enters into the electronic health record.
12. Outpatient psychiatrist reviews patient's progress from home health and follows up with patient.
    1. Psychiatrist reviews geriatric depression scale rating since returning home in electronic health record.
    2. Psychiatrist reviews home health Oasis assessment information in electronic health record.

PLEASE NOTE: Italicized text denotes information in the use case that provides details regarding patient condition and workflow, but will not be included as part of the integration profile.

Actors/Transaction

There are two actors in this profile, the Content Creator and the Content Consumer. Content is created by a Content Creator and is to be consumed by a Content Consumer. The sharing or transmission of content from one actor to the other is addressed by the appropriate use of IHE profiles described below, and is out of scope of this profile. A Document Source or a Portable Media Creator may embody the Content Creator Actor. A Document Consumer, a Document Recipient or a Portable Media Importer may embody the Content Consumer Actor. The sharing or transmission of content or updates from one actor to the other is addressed by the use of appropriate IHE profiles described by section 3.7 Content Bindings with XDS, XDM and XDR found in the Patient Care Coordination Technical Framework

{{{1}}} Actor Diagram

Options

{{{1}}} Options

Actor	Option	Section
Content Consumer	View Option (1) Document Import Option (1) Section Import Option (1) Discrete Data Import Option (1)	PCC TF-1: 2.13.1 PCC TF-1: 2.13.2 PCC TF-1: 2.13.3 PCC TF-1: 2.13.4
Content Creator	Referral Option (1) Discharge Summary Option (1)	PCC TF-1: 2.13.5 PCC TF-1: 2.13.6

Note ¹: The Actor shall support at least one of these options.

Grouping

Content Bindings with XDS, XDM and XDR

It is expected that the transfers of care will occur in an environment where the physician offices and hospitals have a coordinated infrastructure that serves the information sharing needs of this community of care. Several mechanisms are supported by IHE profiles:

• A registry/repository-based infrastructure is defined by the IHE Cross Enterprise Document Sharing (XDS) and other IHE Integration Profiles such as patient identification (PIX & PDQ), and notification of availability of documents (NAV).
• A media-based infrastructure is defined by the IHE Cross Enterprise Document Media Interchange (XDM) profile.
• A reliable messaging-based infrastructure is defined by the IHE Cross Enterprise Document Reliable Interchange (XDR) profile.
• All of these infrastructures support Security and privacy through the use of the Consistent Time (CT) and Audit Trail and Node Authentication (ATNA) profiles.

For more details on these profiles, see the IHE IT Infrastructure Technical Framework.

Content profiles may impose additional requirements on the transactions used when grouped with actors from other IHE Profiles.

Cross Enterprise Document Sharing, Media Interchange and Reliable Messages

Actors from the ITI XDS, XDM and XDR profiles embody the Content Creator and Content Consumer sharing function of this profile. A Content Creator or Content Consumer must be grouped with appropriate actors from the XDS, XDM or XDR profiles, and the metadata sent in the document sharing or interchange messages has specific relationships to the content of the clinical document described in the content profile.

Notification of Document Availability (NAV)

A Document Source should provide the capability to issue a Send Notification Transaction per the ITI Notification of Document Availability (NAV) Integration Profile in order to notify one or more Document Consumer(s) of the availability of one or more documents for retrieval. One of the Acknowledgement Request options may be used to request from a Document Consumer that an acknowledgement should be returned when it has received and processed the notification. A Document Consumer should provide the capability to receive a Receive Notification Transaction per the NAV Integration Profile in order to be notified by Document Sources of the availability of one or more documents for retrieval. The Send Acknowledgement option may be used to issue a Send Acknowledgement to a Document Source that the notification was received and processed.

Document Digital Signature (DSG)

When a Content Creator Actor needs to digitally sign a document in a submission set, it may support the Digital Signature (DSG) Content Profile as a Document Source. When a Content Consumer Actor needs to verify a Digital Signature, it may retrieve the digital signature document and may perform the verification against the signed document content.

Content Modules

Content modules describe the content of a payload found in an IHE transaction. Content profiles are transaction neutral. They do not have dependencies upon the transaction that they appear in.

Process Flow

Functional Status Assessment Process Flow

More text about process flow

Actor Definitions

Actor

Definition

Transaction Definitions

Transaction

Definition

Volume II

Functional Status Assessment Content

Standards

CDAR2

Clinical Document Architecture, Release 2, 2005 HL7

CRS

Implementation Guide for CDA Release 2 – Level 1 and 2 – Care Record Summary (US realm), 2006, HL7.

CCD

ASTM/HL7 Continuity of Care Document (Draft)

LOINC

Logical Observation Identifiers Names and Codes

SNOMED

Systemized Nomenclature for Medicine

LOINC Codes for Selected Instruments

Media:LOINCified Braden Scale.pdf

Media:LOINCified Geriatric Depression Scale - 30 Item.pdf

Media:LOINCified MDS.pdf

Details about the Nursing Home Minimum Data Set (MDS), which must be completed by Nursing Homes, can be found here

Media:LOINCified OASIS.pdf

Details about the Outcome and Assessment Information Set (OASIS), which must be completed by Home Health Agencies, can be found here

Media:LOINC-PainAssessmentPanel.pdf: A 13 Item Pain Scale

Media:LOINC-PainVisualAnalogScale.pdf: The Visual Analog Pain Scale. Responses can be an integer, ratio, real number, or range and may optionally include relational operators from the set <=, <, >, and >=.

Semantic Mapping of Contents of LOINC-ified Instruments to SNOMED Concepts

Media:LOINCified MDS to SNOMED Mappings.xls

This mapping was funded by DHHS/ASPE (The Office of the Assistant to the Secretary for Planning and Evaluation within the Department of Health and Human Services)

The plan is for these mappings to be loaded to the UMLS' Metathesaurus. Although these mappings have been validated by MDS experts, they have not been validated by SNOMED experts. The expectation is that these mappings will continue to be validated and updated by appropriate stakeholders.

Media:SNOMED_Braden_Mapping.pdf

Data Element Index

FSA Data Elements

Data Elements	Other Reference	LOINC Section or CDA Element
Numerical Pain Rating Scale
Braden Scale
MDS Section G
Geriatric Depression Scale

Document Specification

{{{1}}} Constraints

Data Element	Opt	Section	Template ID
Numerical Pain Rating Scale	R		1.3.6.1.4.1.19376.1.5.3.1.3.X
Braden Scale	R		1.3.6.1.4.1.19376.1.5.3.1.3.Y
MDS Section G	R		1.3.6.1.4.1.19376.1.5.3.1.3.Z
Geriatric Depression Scale	R		1.3.6.1.4.1.19376.1.5.3.1.3.Q

Section Template 1

TemplateID	1.3.6.1.4.1.19376.1.5.3.1.3.X
Parent Template	1.3.6.1.4.1.19376.1.5.3.1.3.Y
General Description	This section shall ...
LOINC Code	Opt	Description
#####-#	R	Description
Entries	Opt	Description
1.3.6.1.4.1.19376.1.5.3.1.4.A	O	Description
Sub-sections	Opt	Description
1.3.6.1.4.1.19376.1.5.3.1.3.D	R	Description

Header Template 1

<entry>An XML Example</entry>

entry

Description of the entry element.

Entry Template 1

<entry>An XML Example</entry>

entry

Description of the entry element.