1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 SHORT TERM 02 LONG TERM 03 CHRISTIAN SCIENCE 04 PSYCHIATRIC 05 REHABILITATION 06 CHILDRENS' 07 ALCOHOL/DRUG 08 PPS EXEMPT REHABILITATION 09 PPS EXEMPT PSYCHIATRIC 10 PPS EXEMPT ALCOHOL/DRUG CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 01 HOSPITALS CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME VALUES: Y YES * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 5 VALIDATION (ACCRED HOSPITAL + CLIA88 ONLY) 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 VOLUNTARY NON-PROFIT - CHURCH 02 VOLUNTARY NON-PROFIT - PRIVATE 03 VOLUNTARY NON-PROFIT - OTHER 04 PROPRIETARY 05 GOVERNMENT - FEDERAL 06 GOVERNMENT - STATE 07 GOVERNMENT - LOCAL 08 GOV. - HOSP. DIST. OR AUTH. ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE ACCREDITATION EFFECTIVE DATE 6 653 658 C PROV0000 THE EFFECTIVE DATE OF THE CURRENT PERIOD OF ACCREDITATION BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTH CARE ORGANIZATIONS (JCAHO) OR THE AMERICAN OSTEOPATHIC ASSOCIATION (AOA). COBOL NAME: ACCRED-EFF-DT ACCREDITATION EXPIRATION DATE 6 659 664 C PROV0005 THE EXPIRATION DATE OF THE CURRENT PERIOD OF ACCREDITATION BY THE JOINT COMMITTEE ON ACCREDITATION OF HEALTH CARE ORGANIZATIONS (JCAHO) OR THE AMERICAN OSTEOPATHIC ASSOCIATION (AOA). COBOL NAME: ACCRED-EXP-DT ACCREDITATION INDICATOR 1 665 665 C PROV0010 INDICATES IF A HOSPITAL IS ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTH CARE ORGANIZATION (JCAHO) OR THE AMERICAN OSTEOPATHIC ORGANIZATION (AOA). COBOL NAME: ACCRED-STAT VALUES: * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 0 NONE 1 JCAHO 2 AOA ALCOHOL/DRUG UNIT BEDS 3 666 668 N PROV0040 THE NUMBER OF BEDS IN A PPS EXEMPT ALCOHOL/DRUG UNIT OF A HOSPITAL. COBOL NAME: ALCOH-DRG-UNIT-BED-SZ ALCOHOL/DRUG UNIT EFFECTIVE DATE 6 669 674 C PROV0045 THE DATE AN ALCOHOL/DRUG UNIT BECAME EXEMPT FROM THE PROSPECTIVE PAYMENT SYSTEM (PPS). COBOL NAME: ALCOH-DRG-UNIT-EFF-DT ALCOHOL/DRUG UNIT INDICATOR 1 675 675 C PROV0050 INDICATES IF A HOSPITAL HAS A PPS EXEMPT ALCOHOL/DRUG UNIT. COBOL NAME: ALCOH-DRG-UNIT-IND VALUES: Y ALC/DRG UNIT ALCOHOL/DRUG UNIT TERMINATION CODE 1 676 676 C PROV0055 INDICATES THE REASON THAT AN ALCOHOL/DRUG UNIT IS NO LONGER EXEMPT FROM THE PROSPECTIVE PAYMENT SYSTEM. COBOL NAME: ALCOH-DRG-UNIT-TERM-CD VALUES: 0 ACTIVE 1 VOLUNTARY-MERGER OR CLOSURE 2 VOLUNTARY-DISSATISFACTION WITH REIMBURSEMENT 3 RISK OF INVOLUNTARY TERMINATION 4 VOLUNTARY-OTHER 5 FAILURE TO MEET HEALTH/SAFETY 6 FAILURE TO MEET AGREEMENT ALCOHOL/DRUG UNIT TERMINATION DATE 6 677 682 C PROV0060 THE DATE AN ALCOHOL/DRUG UNIT'S EXEMPTION FROM THE PROSPECTIVE PAYMENT SYSTEM IS TERMINATED. COBOL NAME: ALCOH-DRG-UNIT-TERM-DT BEDS - TOTAL 5 683 687 N PROV0740 TOTAL NUMBER OF BEDS IN A FACILITY, INCLUDING THOSE IN NON-PARTICIPATING OR NON-LICENSED AREAS. COBOL NAME: NUM-BEDS BEDS - TOTAL CERTIFIED 5 688 692 N PROV0755 NUMBER OF BEDS IN MEDICARE AND/OR MEDICAID CERTIFIED AREAS WITHIN A FACILITY. COBOL NAME: NUM-CERT-BEDS CANADIAN PROVINCE 2 693 694 C PROV2980 THE CANADIAN PROVINCE WHERE A EMERGENCY HOSPITAL IS LOCATED. COBOL NAME: PROVINCE VALUES: AB ALBERTA BC BRITISH COLUMBIA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 19 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME LB LABRADOR MB MANITOBA NB NEW BRUNSWICK NF NEWFOUNDLAND NS NOVA SCOTIA NT NORTHWEST TERRITORIES ON ONTARIO PE PRINCE EDWARD ISLAND PQ QUEBEC SK SASKATCHEWAN YT YUKON TERRITORY CERTIFIED RN ANESTHETISTS 7.2 695 701 N PROV0760 NUMBER OF FULL-TIME EQUIVALENT CERTIFIED REGISTERED NURSE ANESTHETISTS (CRNA) EMPLOYED BY A HOSPITAL. COBOL NAME: NUM-CERT-RN-ANEST CLIA - HOSP LAB ID #1 10 702 711 C PROV0130 NUMBER ASSIGNED TO A HOSPITAL LABORATORY LICENSED IN ACCORDANCE WITH THE CLINICAL LABORATORY IMPROVEMENT ACT (CLIA). COBOL NAME: CLIA-ID-NUM-A CLIA - HOSP LAB ID #2 10 712 721 C PROV0135 NUMBER ASSIGNED TO A HOSPITAL LABORATORY LICENSED IN ACCORDANCE WITH THE CLINICAL LABORATORY IMPROVEMENT ACT (CLIA). COBOL NAME: CLIA-ID-NUM-B CLIA - HOSP LAB ID #3 10 722 731 C PROV0140 NUMBER ASSIGNED TO A HOSPITAL LABORATORY LICENSED IN ACCORDANCE WITH THE CLINICAL LABORATORY IMPROVEMENT ACT (CLIA). COBOL NAME: CLIA-ID-NUM-C CLIA - HOSP LAB ID #4 10 732 741 C PROV0145 NUMBER ASSIGNED TO A HOSPITAL LABORATORY LICENSED IN ACCORDANCE WITH THE CLINICAL LABORATORY IMPROVEMENT ACT (CLIA). COBOL NAME: CLIA-ID-NUM-D CLIA - HOSP LAB ID #5 10 742 751 C PROV0150 NUMBER ASSIGNED TO A HOSPITAL LABORATORY LICENSED IN ACCORDANCE WITH THE CLINICAL LABORATORY IMPROVEMENT ACT (CLIA). COBOL NAME: CLIA-ID-NUM-E COMPLIANCE: LIFE SAFETY CODE 1 752 752 C PROV0240 INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN RECOMMENDED FOR A PROVIDER. COBOL NAME: COMPL-LSC VALUES: 1 WAIVER RECOMMENDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 20 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COMPLIANCE: SCOPE OF SERVICE 1 753 753 C PROV0280 INDICATES IF A WAIVER OF THE SCOPE OF SERVICES REQUIREMENT HAS BEEN RECOMMENDED FOR A HOSPITAL. COBOL NAME: COMPL-SCOPE-OF-SERV VALUES: 1 WAIVER RECOMMENDED COMPLIANCE: TECHNICAL PERSONNEL 1 754 754 C PROV0285 INDICATES IF A WAIVER OF THE TECHNICAL PERSONNEL REQUIREMENT HAS BEEN RECOMMENDED FOR A HOSPITAL. COBOL NAME: COMPL-TECH-PERSNL VALUES: 1 WAIVER RECOMMENDED COMPLIANCE: 24 HR REGISTERED NURSE 1 755 755 C PROV0290 INDICATES IF A WAIVER OF THE 24 HOUR REGISTERED NURSE REQUIREMENT HAS BEEN RECOMMENDED FOR A HOSPITAL. COBOL NAME: COMPL-24-HR-RN VALUES: 1 WAIVER RECOMMENDED CURRENT SURVEY EVER ACCREDITED 1 756 756 C PROV3545 INDICATES IF THIS PROVIDER WAS AN ACCREDITED HOSPITAL ANYTIME DURING THE CURRENT SURVEY. COBOL NAME: CURRENT-EVER-ACCRED VALUES: N NO Y YES CURRENT SURVEY EVER NON-ACCRED 1 757 757 C PROV3555 INDICATES IF THIS PROVIDER WAS A NON-ACCREDITED HOSPITAL ANYTINE DURING THE CURRENT SURVEY. COBOL NAME: CURRENT-EVER-NON-ACCRED VALUES: N NO Y YES CURRENT SURVEY EVER SWINGBED 1 758 758 C PROV3550 INDICATES IF THIS PROVIDER WAS A SWINGBED HOSPITAL ANYTIME DURING THE CURRENT SURVEY. COBOL NAME: CURRENT-EVER-SWINGBED VALUES: N NO Y YES DATE OF VALIDATION SURVEY 6 759 764 C PROV0450 DATE A VALIDATION SURVEY IS PERFORMED BY THE STATE AGENCY IN A JCAH OR AOA ACCREDITED HOSPITAL. COBOL NAME: DT-VALID-SURVEY DIETITIANS 7.2 765 771 N PROV0820 NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED BY A FACILITY. COBOL NAME: NUM-DIETICIANS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 21 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME INHALATION THERAPISTS 7.2 772 778 N PROV0950 NUMBER OF FULLTIME EQUIVALENT INHALATION THERAPISTS EMPLOYED BY A HOSPITAL. COBOL NAME: NUM-INHAL-THERAPY LICENSED PRACTICAL NURSES 7.2 779 785 N PROV0955 NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL OR VOCATIONAL NURSES EMPLOYED BY A FACILITY. COBOL NAME: NUM-LPN-LVN MEDICAL SCHOOL AFFILIATION 1 786 786 C PROV0645 THE TYPE OF AFFILIATION THAT A HOSPITAL MAY HAVE WITH A MEDICAL SCHOOL. COBOL NAME: MED-SCHL-AFF VALUES: 1 MAJOR 2 LIMITED 3 GRADUATE 4 NO AFFILIATION MEETS 1861 DEFINITION 1 787 787 C PROV0670 INDICATES IF AN EMERGENCY HOSPITAL MEETS THE DEFINITION OF "HOSPITAL" CONTAINED IN SECTION 1861 OF THE SOCIAL SECURITY ACT. COBOL NAME: MEETS-1861 VALUES: Y MEETS 1861(E)(1) OCCUPATIONAL THERAPISTS 7.2 788 794 N PROV1050 THE NUMBER OF FULL TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-OCCUP-THERAPISTS OTHER PERSONNEL 7.2 795 801 N PROV1075 THE NUMBER OF FULL-TIME EQUIVALENT OTHER SALARIED PERSONNEL EMPLOYED BY A FACILITY. COBOL NAME: NUM-OTHER-PERSNL PARTICIPATING CODE (Y,N) 1 802 802 C PROV1575 THIS CODE INDICATES WHETHER A PROVIDER IS PARTICIPATING IN THE MEDICAID OR MEDICARE PROGRAM. COBOL NAME: PARTICIPATING-CD VALUES: N NON-PARTICIPATING PROVIDER Y PARTICIPATING PROVIDER PHYSICAL THERAPISTS 7.2 803 809 N PROV1125 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-PHYS-THERAPY PHYSICIAN ASSISTANTS 7.2 810 816 N PROV1115 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN ASSISTANTS EMPLOYED BY A HOSPITAL OR RURAL HEALTH CLINIC. COBOL NAME: NUM-PHYS-ASSIST * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 22 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PPS PREVIOUS PROVIDER NUMBER 6 817 822 C PROV1520 A PROVIDER NUMBER PREVIOUSLY ASSIGNED TO A PPS EXEMPT PROVIDER OR UNIT. COBOL NAME: OLD-PROV-NUM PROGRAM PARTICIPATION 1 823 823 C PROV1670 INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE, MEDICAID, OR BOTH PROGRAMS. COBOL NAME: PROG-PARTCI VALUES: 1 MEDICARE ONLY 3 MEDICARE AND MEDICAID PSYCHIATRIC UNIT BEDS 3 824 826 N PROV1690 THE NUMBER OF BEDS IN A PPS EXEMPT PSYCHIATRIC UNIT OF A HOSPITAL. COBOL NAME: PSY-UNIT-BED-SZ PSYCHIATRIC UNIT EFFECTIVE DATE 6 827 832 C PROV1695 THE DATE A PSYCHIATRIC UNIT BECAME EXEMPT FROM THE PROSPECTIVE PAYMENT SYSTEM (PPS). COBOL NAME: PSY-UNIT-EFF-DT PSYCHIATRIC UNIT INDICATOR 1 833 833 C PROV1700 INDICATES IF A HOSPITAL HAS A PPS EXEMPT PSYCHIATRIC UNIT. COBOL NAME: PSY-UNIT-IND VALUES: Y PSYCH UNIT PSYCHIATRIC UNIT TERMINATION CODE 1 834 834 C PROV1705 INDICATES THE REASON THAT A PSYCHIATRIC UNIT IS NO LONGER EXEMPT FROM PPS. COBOL NAME: PSY-UNIT-TERM-CD VALUES: 0 ACTIVE 1 VOLUNTARY-MERGER OR CLOSURE 2 VOLUNTARY-DISSATISFIED WITH REIMBURSEMENT 3 RISK OF INVOLUNTARY TERMINATION 4 VOLUNTARY-OTHER 5 FAILURE TO MEET HEALTH/SAFETY 6 FAILURE TO MEET AGREEMENT 7 PROVIDER STATUS CHANGE PSYCHIATRIC UNIT TERMINATION DATE 6 835 840 C PROV1710 THE DATE A PSYCHIATRIC UNIT IS NO LONGER EXEMPT FROM THE PROSPECTIVE PAYMENT SYSTEM. COBOL NAME: PSY-UNIT-TERM-DT REGIONAL OVERRIDE #1 (NUMBER BEDS) 1 841 841 C PROV1545 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-1 VALUES: * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 23 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME Y RECORD HAS BEEN APPROVED REGIONAL OVERRIDE #2 (STAFFING) 1 842 842 C PROV1550 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-2 VALUES: Y RECORD HAS BEEN APPROVED REGIONAL OVERRIDE #3 (NURSE - BED) 1 843 843 C PROV1555 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-3 VALUES: Y RECORD HAS BEEN APPROVED REGISTERED NURSES 7.2 844 850 N PROV1145 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED PROFESSIONAL NURSES EMPLOYED BY A PROVIDER. COBOL NAME: NUM-REG-NURS REGISTERED PHARMACISTS 7.2 851 857 N PROV1100 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED PHARMACISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-PHARMACIST-REG REHABILITATION UNIT BEDS 3 858 860 N PROV1730 THE NUMBER OF BEDS IN A PPS EXEMPT REHABILITATION UNIT OF A HOSPITAL. COBOL NAME: REHAB-UNIT-BED-SZ REHABILITATION UNIT EFFECT DATE 6 861 866 C PROV1735 THE DATE A REHABILITATION UNIT BECAME EXEMPT FROM THE PROSPECTIVE PAYMENT SYSTEM. COBOL NAME: REHAB-UNIT-EFF-DT REHABILITATION UNIT INDICATOR 1 867 867 C PROV1740 INDICATES IF A HOSPITAL HAS A PPS EXEMPT REHABILITATION UNIT. COBOL NAME: REHAB-UNIT-IND VALUES: Y REHAB UNIT REHABILITATION UNIT TERMINAT CODE 1 868 868 C PROV1745 THIS ELEMENT INDICATES THE REASON FOR A HOSPITAL REHABILITATION UNIT'S TERMINATION OF ITS EXCLUSION STATUS UNDER PROSPECTIVE PAYMENT SYSTEM. COBOL NAME: REHAB-UNIT-TERM-CD VALUES: 0 ACTIVE 1 VOLUNTARY-MERGER OR CLOSURE 2 VOLUNTARY-DISSATISFIED WITH REIMBURSEMENT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 24 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 3 RISK OF INVOLUNTARY TERMINATION 4 VOLUNTARY-OTHER 5 FAILURE TO MEET HEALTH/SAFETY 6 FAILURE TO MEET AGREEMENT 7 PROVIDER STATUS CHANGE REHABILITATION UNIT TERMINAT DATE 6 869 874 C PROV1750 THIS ELEMENT IS THE DATE THE HOSPITAL'S PSYCHIATRIC UNIT IS NO LONGER EXCLUDED FROM PROSPECTIVE PAYMENT SYSTEM. COBOL NAME: REHAB-UNIT-TERM-DT RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM RESIDENT PROGRAM APPROVED BY ADA 1 885 885 C PROV1805 INDICATES IF THE RESIDENT PROGRAM AT A HOSPITAL IS APPROVED BY THE AMERICAN DENTAL ASSOCIATION COBOL NAME: RES-PGM-APPR-ADA VALUES: N NOT APPROVED Y APPROVED RESIDENT PROGRAM APPROVED BY AMA 1 886 886 C PROV1810 INDICATES IF THE RESIDENT PROGRAM AT A HOSPITAL IS APPROVED BY THE AMERICAN MEDICAL ASSOCIATION. COBOL NAME: RES-PGM-APPR-AMA VALUES: N NOT APPROVED Y APPROVED RESIDENT PROGRAM APPROVED BY AOA 1 887 887 C PROV1815 INDICATES IF THE RESIDENT PROGRAM AT A HOSPITAL IS APPROVED BY THE AMERICAN OSTEOPATHIC ASSOCIATION. COBOL NAME: RES-PGM-APPR-AOA VALUES: N NOT APPROVED Y APPROVED RESIDENT PROGRAM APPROVED BY OTHER 1 888 888 C PROV1820 INDICATES IF THE RESIDENT PROGRAM AT A HOSPITAL IS APPROVED BY OTHER PROFESSIONAL ORGANIZATIONS. COBOL NAME: RES-PGM-APPR-OTHER VALUES: N NOT APPROVED Y APPROVED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 25 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME RESIDENTS (PHYSICIANS) 7.2 889 895 N PROV1165 THE NUMBER OF FULL-TIME EQUIVALENT RESIDENTS (PHYSICIANS) EMPLOYED BY A HOSPITAL. COBOL NAME: NUM-RESID-PHYS SEPARATE COST ENTITY INDICATOR 1 896 896 C PROV2040 INDICATES IF A HOSPITAL HAS A UNIT IDENTIFIED AS A SEPARATE COST ENTITY. COBOL NAME: SEP-COST-ENTITY-IND VALUES: Y SEPARATE COST ENTITY SRV: ACUTE RENAL DIALYSIS 1 897 897 C PROV2055 INDICATES HOW ACUTE RENAL DIALYSIS SERVICES ARE PROVIDED IN A HOSPITAL. COBOL NAME: SP-ACUTE-REN-DIAL VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: ALCOHOL AND/OR DRUG 1 898 898 C PROV2065 INDICATES HOW ALCOHOL AND/OR DRUG SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-ALCOH-DRUG VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: ANESTHESIA 1 899 899 C PROV2070 INDICATES HOW ANESTHESIA SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-ANESTH VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: BLOOD BANK 1 900 900 C PROV2080 INDICATES HOW BLOOD BANK SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-BLOOD-BANK VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 26 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: BURN CARE UNIT 1 901 901 C PROV2090 INDICATES HOW BURN CARE UNIT SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-BURN-UNIT VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: CHIROPRACTIC 1 902 902 C PROV2100 INDICATES HOW CHIROPRACTIC SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-CHIROPRATIC VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: CORONARY CARE UNIT 1 903 903 C PROV2110 INDICATES HOW CORONARY CARE UNIT SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-CORONARY-CARE VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: DENTAL 1 904 904 C PROV2120 INDICATES HOW DENTAL SERVICES ARE PROVIDED. COBOL NAME: SP-DENTAL VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: DIETARY 1 905 905 C PROV2130 INDICATES HOW DIETARY SERVICES ARE PROVIDED. COBOL NAME: SP-DIETARY VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: EMERGENCY SERVICES(ORGANIZED) 1 906 906 C PROV2140 INDICATES HOW ORGANIZED EMERGENCY SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-EMERG-DEPT VALUES: 0 NOT PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 27 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: HOME CARE UNIT 1 907 907 C PROV2160 INDICATES HOW HOME CARE SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-HOME-CARE-UNIT VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: HOSPICE 1 908 908 C PROV2175 INDICATES HOW HOSPICE SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-HOSPICE VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: INPATIENT SURGICAL 1 909 909 C PROV2190 INDICATES HOW INPATIENT SURGICAL SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-INPAT-SURG VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: INTENSIVE CARE UNIT 1 910 910 C PROV2185 INDICATES HOW INTENSIVE CARE UNIT SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-ICU VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: LABORATORY (ANATOMICAL) 1 911 911 C PROV2205 INDICATES HOW ANATOMICAL LABORATORY SERVICES ARE PROVIDED IN A HOSPITAL. COBOL NAME: SP-LABORATORY-ANATOM VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 28 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: LABORATORY (CLINICAL) 1 912 912 C PROV2210 INDICATES HOW CLINICAL LABORATORY SERVICES ARE PROVIDED IN A HOSPITAL. COBOL NAME: SP-LABORATORY-CLINIC VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: LONG TERM CARE UNIT 1 913 913 C PROV2215 INDICATES HOW LONG TERM CARE UNIT SERVICES ARE PROVIDED IN A HOSPITAL. COBOL NAME: SP-LTC-UNIT VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: NEONATAL NURSERY 1 914 914 C PROV2235 INDICATES HOW NEONATAL NURSERY SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-NEONATAL-NURS VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: NUCLEAR MEDICINE 1 915 915 C PROV2245 INDICATES HOW NUCLEAR MEDICINE SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-NUCLEAR-MED VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: OBSTETRICS 1 916 916 C PROV2265 INDICATES HOW OBSTETRICS SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-OBSTETRICS VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 29 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: OCCUPATIONAL THERAPY 1 917 917 C PROV2270 INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-OCCUP-THERAPY VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: OPEN HEART SURGERY FACILITY 1 918 918 C PROV2285 INDICATES HOW OPEN HEART SURGERY FACILITY SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-OPEN-HEART-SURG VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: OPERATING ROOMS 1 919 919 C PROV2300 INDICATES HOW OPERATING ROOM SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-OR-ROOMS VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: OPTOMETRIC 1 920 920 C PROV2295 INDICATES HOW OPTOMETRIC SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-OPTOMETRIC VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: ORGAN BANK 1 921 921 C PROV2310 INDICATES HOW ORGAN BANK SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-ORGAN-BANK VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 30 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: ORGAN TRANSPLANT 1 922 922 C PROV2315 INDICATES HOW ORGAN TRANSPLANT SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-ORGAN-TRANS VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: OUTPATIENT 1 923 923 C PROV2350 INDICATES HOW OUTPATIENT SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-OUTPAT VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: OUTPATIENT SURGERY UNIT 1 924 924 C PROV2355 INDICATES HOW OUTPATIENT SURGERY UNIT SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-OUTPAT-SURG VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: PEDIATRIC 1 925 925 C PROV2360 INDICATES HOW PEDIATRIC SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-PEDIATRIC VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: PHARMACY 1 926 926 C PROV2365 INDICATES HOW PHARMACY SERVICES ARE PROVIDED. COBOL NAME: SP-PHARMACY VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: PHYSICAL THERAPY 1 927 927 C PROV2370 INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-PHYSICAL-THERAPY VALUES: 0 NOT PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 31 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: POSTOPERATIVE RECOVERY ROOM 1 928 928 C PROV2410 INDICATES HOW POSTOPERATIVE RECOVERY ROOM SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-POSTOP-REC-RM VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: PSYCHIATRIC 1 929 929 C PROV2415 INDICATES HOW PSYCHIATRIC SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-PSYCHIATRIC VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: RADIOLOGY (DIAGNOSTIC) 1 930 930 C PROV2440 INDICATES HOW DIAGNOSTIC RADIOLOGY SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-RADIOLOGY-DIAG VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: RADIOLOGY (THERAPEUTIC) 1 931 931 C PROV2445 INDICATES HOW THERAPEUTIC RADIOLOGY SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-RADIOLOGY-THERAPY VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: REHABILITATION 1 932 932 C PROV2450 INDICATES HOW REHABILITATION SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-REHABIL VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 32 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: SELF CARE UNIT 1 933 933 C PROV2470 INDICATES HOW SELF CARE UNIT SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-SELF-CARE VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: SHOCK TRAUMA 1 934 934 C PROV2475 INDICATES HOW SHOCK TRAUMA SERVICES ARE PROVIDED BY A HOSPITAL. COBOL NAME: SP-SHOCK-TRAUMA VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: SOCIAL 1 935 935 C PROV2485 INDICATES HOW SOCIAL SERVICES ARE PROVIDED. COBOL NAME: SP-SOCIAL VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT SRV: SPEECH PATHOLOGY 1 936 936 C PROV2505 INDICATES HOW SPEECH PATHOLOGY SERVICES ARE PROVIDED. COBOL NAME: SP-SPEECH-PATH VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SWING BED INDICATOR 1 937 937 C PROV2795 INDICATES IF A HOSPITAL PROVIDES SWING BED SERVICES - BEDS CAN BE USED FOR EITHER HOSPITAL OR LONG TERM CARE SERVICES. COBOL NAME: SWINGBED-IND VALUES: N NO Y YES SWING BED SIZE CODE 1 938 938 C PROV2800 INDICATES THE SIZE OF A HOSPITAL PROVIDING SWING BED SERVICES. COBOL NAME: SWINGBED-SIZE-CD VALUES: 1 49 OR FEWER BEDS 2 50 TO 99 BEDS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 33 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TYPE OF NON-PARTICIPATING PROVIDER 1 939 939 C PROV0690 INDICATES WHETHER A NON-PARTICIPATING HOSPITAL IS FEDERAL OR OTHER THAN FEDERAL. COBOL NAME: NON-PARTICIPATING-TYPE VALUES: E EMERGENCY HOSPITAL NON-FEDERAL F EMERGENCY HOSPITAL FEDERAL PHYSICAL THERAPISTS 7.2 1635 1641 N PROV1120 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-PHYS-THERAPISTS SPEECH PATHOLOGISTS, AUDIOLOGISTS 7.2 1649 1655 N PROV1220 THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS OR AUDIOLOGISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-SPEECH-PATH-AUDIO PHYSICIANS 7.2 1988 1994 N PROV1110 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIANS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-PHYS SRV: RESPIRATORY CARE 1 2035 2035 C PROV2455 INDICATES HOW RESPIRATORY CARE SERVICES ARE PROVIDED. COBOL NAME: SP-RESP-CARE VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY STAFF AND UNDER ARRANGEMENT MEDICAL SOCIAL WORKERS 7.2 2110 2116 N PROV0975 NUMBER OF FULL-TIME EQUIVALENT MEDICAL SOCIAL WORKERS EMPLOYED BY A HOSPITAL OR HOSPICE. COBOL NAME: NUM-MED-SOCIAL-WRKS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 TITLE 18 ONLY 02 TITLE 19 ONLY 03 TITLE 18/19 CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 02 SNF/NF (DUALLY CERTIFIED) CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 FOR PROFIT - INDIVIDUAL 02 FOR PROFIT - PARTNERSHIP 03 FOR PROFIT - CORPORATION 04 NONPROFIT - CHURCH RELATED 05 NONPROFIT - CORPORATION 06 NONPROFIT - OTHER 07 GOVERNMENT - STATE 08 GOVERNMENT - COUNTY 09 GOVERNMENT - CITY 10 GOVERNMENT - CITY/COUNTY 11 GOVERNMENT - HOSPITAL DISTRICT 12 GOVERNMENT - FEDERAL ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE BEDS - TOTAL 5 683 687 N PROV0740 TOTAL NUMBER OF BEDS IN A FACILITY, INCLUDING THOSE IN NON-PARTICIPATING OR NON-LICENSED AREAS. COBOL NAME: NUM-BEDS BEDS - TOTAL CERTIFIED 5 688 692 N PROV0755 NUMBER OF BEDS IN MEDICARE AND/OR MEDICAID CERTIFIED AREAS WITHIN A FACILITY. COBOL NAME: NUM-CERT-BEDS COMPLIANCE: LIFE SAFETY CODE 1 752 752 C PROV0240 INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN RECOMMENDED FOR A PROVIDER. COBOL NAME: COMPL-LSC VALUES: 1 WAIVER RECOMMENDED PROGRAM PARTICIPATION 1 823 823 C PROV1670 INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE, MEDICAID, OR BOTH PROGRAMS. COBOL NAME: PROG-PARTCI VALUES: 1 MEDICARE ONLY 2 MEDICAID ONLY 3 MEDICARE AND MEDICAID * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGIONAL OVERRIDE #1 (NUMBER BEDS) 1 841 841 C PROV1545 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-1 VALUES: Y RECORD HAS BEEN APPROVED REGIONAL OVERRIDE #2 (STAFFING) 1 842 842 C PROV1550 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-2 VALUES: Y RECORD HAS BEEN APPROVED RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM ACTIVITY THERAPISTS - CONTRACT 7.2 940 946 N PROV0695 THE NUMBER OF FULL TIME EQUIVALENT ACTIVITIES THERAPISTS UNDER CONTRACT TO THE FACILITY COBOL NAME: NUM-ACT-THER-CONTRACT ACTIVITY THERAPISTS - FULL TIME 7.2 947 953 N PROV0700 THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES THERAPISTS EMPLOYED FULL TIME BY THE FACILITY COBOL NAME: NUM-ACT-THER-FULL-TIME ACTIVITY THERAPISTS - PART TIME 7.2 954 960 N PROV0705 THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES THERAPISTS EMPLOYED PART-TIME BY THE FACILITY. COBOL NAME: NUM-ACT-THER-PART-TIME ADMINISTRATOR - CONTRACT 7.2 961 967 N PROV0710 THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATORS UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-ADMN-CONTRACT ADMINISTRATOR - FULL TIME 7.2 968 974 N PROV0715 THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATORS EMPLOYED ON A FULL TIME BASIS BY THE FACILITY. COBOL NAME: NUM-ADMN-FULL-TIME ADMINISTRATOR - PART TIME 7.2 975 981 N PROV0720 THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATORS EMPLOYED ON A PART-TIME BASIS BY THE FACILITY. COBOL NAME: NUM-ADMN-PART-TIME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * ADMISSION SUSPENSION DATE 6 982 987 C PROV0030 THE DATE THAT PAYMENTS FOR NEW ADMISSIONS IN A LONG TERM CARE FACILITY WILL BE DENIED IF AN INTERMEDIATE SANCTION IS TAKEN AGAINST THE FACILITY. COBOL NAME: ADMIN-SUSP-DT AIDES/ORDERLIES - CONTRACT 7.2 988 994 N PROV1000 THE NUMBER OF FULL-TIME EQUIVALENT AIDES/ORDERLIES UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-NURSE-AID-CONTRACT AIDES/ORDERLIES - FULL TIME 7.2 995 1001 N PROV1005 THE NUMBER OF FULL-TIME EQUIVALENT AIDES/ORDERLIES EMPLOYED BY THE FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-NURSE-AID-FULL-TIME AIDES/ORDERLIES - PART TIME 7.2 1002 1008 N PROV1010 THE NUMBER OF FULL-TIME EQUIVALENT AIDES/ORDERLIES EMPLOYED BY THE FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-NURSE-AID-PART-TIME BEDS - MEDICARE SNF 4 1009 1012 N PROV1445 NUMBER OF MEDICARE CERTIFIED SNF BEDS IN A FACILITY. COBOL NAME: NUM-T18-SNF-BEDS BEDS - NURSING FACILITY 4 1013 1016 N PROV1455 NUMBER OF MEDICAID CERTIFIED SKILLED NURSING CARE BEDS IN A FACILITY. COBOL NAME: NUM-T19-SNF-BEDS BEDS - SNF/NF 4 1017 1020 N PROV1450 NUMBER OF BEDS CERTIFIED FOR BOTH MEDICARE AND MEDICAID SKILLED NURSING CARE IN A LONG TERM CARE FACILITY. COBOL NAME: NUM-T1819-SNF-BEDS CHRISTIAN SCIENCE INDICATOR 1 1021 1021 C PROV0110 INDICATES IF A PROVIDER IS A CHRISTIAN SCIENCE FACILITY COBOL NAME: CHRISTIAN-SCIENCE-IND VALUES: Y CHRISTIAN SCIENCE COMPLIANCE: BEDS PER ROOM WAIVER 1 1022 1022 C PROV0225 INDICATES IF A WAIVER OF THE BEDS PER ROOM REQUIREMENT HAS BEEN RECOMMENDED FOR A FACILITY. COBOL NAME: COMPL-BEDS-PER-ROOM VALUES: 1 WAIVER RECOMMENDED COMPLIANCE: PATIENT ROOM SIZE 1 1023 1023 C PROV0270 INDICATES IF A WAIVER OF PATIENT ROOM SIZE HAS BEEN RECOMMENDED FOR A FACILITY. COBOL NAME: COMPL-PATIENT-ROOM-SZ VALUES: 1 WAIVER RECOMMENDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 19 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COMPLIANCE: 7 DAY REGISTERED NURSE 1 1024 1024 C PROV0295 INDICATES IF A WAIVER OF THE 7 DAY REGISTERED NURSE REQUIREMENTS HAS BEEN RECOMMENDED FOR A SNF OR NF. COBOL NAME: COMPL-7-DAY-RN VALUES: 1 WAIVER RECOMMENDED DATE OF RO TITLE 19 FINAL REVIEW 6 1025 1030 C PROV0410 THE DATE THE REGIONAL OFFICE COMPLETES ITS REVIEW OF A TITLE 19 (MEDICAID) CERTIFICATION KIT. COBOL NAME: DT-RO-FINAL-REV DENTISTS - CONTRACT 7.2 1031 1037 N PROV0785 THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-DENTIST-CONTRACT DENTISTS - FULL TIME 7.2 1038 1044 N PROV0790 THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-DENTIST-FULL-TIME DENTISTS - PART TIME 7.2 1045 1051 N PROV0795 THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-DENTIST-PART-TIME DIETITIANS - CONTRACT 7.2 1052 1058 N PROV0805 THE NUMBER OF FULL-TIME EQUIVALENT UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-DIET-CONTRACT DIETITIANS - FULL TIME 7.2 1059 1065 N PROV0810 THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-DIET-FULL-TIME DIETITIANS - PART TIME 7.2 1066 1072 N PROV0815 THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-DIET-PART-TIME EXPERIMENTAL RESEARCH CONDUCTED 1 1073 1073 C PROV0465 INDICATES IF A FACILITY USES RESIDENTS TO DEVELOP AND TEST CLINICAL TREATMENTS. COBOL NAME: EXPER-RESEARCH VALUES: N NO Y YES FACILITY PART OF A CCRC 1 1074 1074 C PROV3235 INDICATES IF THE FACILITY IS PART OF A CONTINUING CARE RETIREMENT COMMUNITY (CCRC). COBOL NAME: CCRC-FACIL VALUES: N NO Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 20 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOOD SERVICE - CONTRACT 7.2 1075 1081 N PROV0860 THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE PERSONNEL UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-FOOD-SRV-CONTRACT FOOD SERVICE - FULL TIME 7.2 1082 1088 N PROV0865 THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-FOOD-SRV-FULL-TIME FOOD SERVICE - PART TIME 7.2 1089 1095 N PROV0870 THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-FOOD-SRV-PART-TIME HOUSEKEEPING - CONTRACT 7.2 1096 1102 N PROV0925 THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING PERSONNEL UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-HOUSE-CONTRACT HOUSEKEEPING - FULL TIME 7.2 1103 1109 N PROV0930 THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-HOUSE-FULL-TIME HOUSEKEEPING - PART TIME 7.2 1110 1116 N PROV0935 THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-HOUSE-PART-TIME LPN/LVN - CONTRACT 7.2 1117 1123 N PROV1465 THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/ VOCATIONAL NURSES UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-VOC-NURSE-CONTRACT LPN/LVN - FULL TIME 7.2 1124 1130 N PROV1470 THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/ VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-VOC-NURSE-FULL-TIME LPN/LVN - PART TIME 7.2 1131 1137 N PROV1475 THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/ VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-VOC-NURSE-PART-TIME LTC AGREEMENT BEGINNING DATE 6 1138 1143 C PROV0620 THE BEGINNING DATE OF A CERTIFIED LONG TERM CARE FACILI TY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-BEGIN-DT LTC AGREEMENT ENDING DATE 6 1144 1149 C PROV0625 THE ENDING DATE OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-END-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 21 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME LTC AGREEMENT EXTENSION DATE 6 1150 1155 C PROV0630 THE LAST DATE OF AN EXTENSION OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-EXT-DT LTC CROSS REFERENCE PROVIDER # 6 1156 1161 C PROV0640 THIS CROSS REFERENCE NUMBER IDENTIFIES LTC PROVIDER NUMBERS THAT WERE TERMINATED IN 1985 BECAUSE OF POLICY CHANGES WHICH STATES THAT SNF/ICF DISTINCT PARTS OR DUA LLY CERTIFIED PORTIONS ARE ASSIGNED SINGLE SNF PROV NO. COBOL NAME: LTC-CROSS-REF-PROV-NUM MEDICAL DIRECTOR - CONTRACT 7.2 1162 1168 N PROV0960 NUMBER OF MEDICAL DIRECTORS UNDER CONTRACT. COBOL NAME: NUM-MED-CONTRACT MEDICAL DIRECTOR - FULL TIME 7.2 1169 1175 N PROV0965 THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-MED-FULL-TIME MEDICAL DIRECTOR - PART TIME 7.2 1176 1182 N PROV0970 THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-MED-PART-TIME MENTAL HEALTH SERVICES - CONTRACT 7.2 1183 1189 N PROV0980 THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH SERVICES PERSONNEL UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-MEN-HLTH-CONTRACT MENTAL HEALTH SERVICES - FULL TIME 7.2 1190 1196 N PROV0985 THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-MEN-HLTH-FULL-TIME MENTAL HEALTH SERVICES - PART TIME 7.2 1197 1203 N PROV0990 THE NUMBER OF FULL TIME EQUIVALENT MENTAL HEALTH SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-MEN-HLTH-PART-TIME MULTI-FACILITY ORGANIZATION NAME 38 1204 1241 C PROV0680 THE NAME OF THE MULTI-FACILITY ORGANIZATION THAT OWNS THE FACILITY. COBOL NAME: NAME-MULT-FACL-ORG MULTI-FACILITY ORGANIZATION OWNED 1 1242 1242 C PROV0675 INDICATES IF A FACILITY IS OWNED BY AN ORGANIZATION THAT OWNS (OR LEASES) TWO OR MORE NURSING FACILITIES. COBOL NAME: MULT-FACL-ORG VALUES: N NO Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 22 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME OCCUPATIONAL THERAPIST - CONTRACT 7.2 1243 1249 N PROV1035 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-OCC-THER-CONTRACT OCCUPATIONAL THERAPIST - FULL TIME 7.2 1250 1256 N PROV1040 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-OCC-THER-FULL-TIME OCCUPATIONAL THERAPIST - PART TIME 7.2 1257 1263 N PROV1045 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-OCC-THER-PART-TIME OCCUPATIONAL THERAPY ASST-CONTRACT 7.2 1264 1270 N PROV1020 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY ASSISTANTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-OCC-AID-CONTRACT OCCUPATIONAL THERAPY ASST-FULL 7.2 1271 1277 N PROV1025 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-OCC-AID-FULL-TIME OCCUPATIONAL THERAPY ASST-PART 7.2 1278 1284 N PROV1030 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-OCC-AID-PART-TIME ORGANIZED FAMILY GROUP 1 1285 1285 C PROV1535 INDICATES IF THE FACILITY HAS AN ORGANIZED GROUP OF FAMILY MEMBERS OF RESIDENTS. COBOL NAME: ORG-FAMILY-GRP VALUES: N NO Y YES ORGANIZED RESIDENT GROUP 1 1286 1286 C PROV1540 INDICATES IF THE FACILITY HAS AN ORGANIZED RESIDENTS GROUP. COBOL NAME: ORG-RESID-GRP VALUES: N NO Y YES OTHER - CONTRACT 7.2 1287 1293 N PROV3265 THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED IN ANY OTHER CATEGORIES UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-OTH-CONTRACT OTHER - FULL TIME 7.2 1294 1300 N PROV3245 THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A FULL-TIME BASIS. COBOL NAME: NUM-OTH-FULL-TIME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 23 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME OTHER - PART TIME 7.2 1301 1307 N PROV3255 THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A PART-TIME BASIS. COBOL NAME: NUM-OTH-PART-TIME OTHER PHYSICIAN - CONTRACT 7.2 1308 1314 N PROV1060 THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS UNDER CONTRACT TO A FACILITY COBOL NAME: NUM-OTH-PHY-CONTRACT OTHER PHYSICIAN - FULL TIME 7.2 1315 1321 N PROV1065 THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-OTH-PHY-FULL-TIME OTHER PHYSICIAN - PART TIME 7.2 1322 1328 N PROV1070 THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-OTH-PHY-PART-TIME PHARMACISTS - CONTRACT 7.2 1329 1335 N PROV1085 THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-PHAR-CONTRACT PHARMACISTS - FULL TIME 7.2 1336 1342 N PROV1090 THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-PHAR-FULL-TIME PHARMACISTS - PART TIME 7.2 1343 1349 N PROV1095 THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-PHAR-PART-TIME PHYSICAL THERAPISTS - CONTRACT 7.2 1350 1356 N PROV1430 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-THER-CONTRACT PHYSICAL THERAPISTS - FULL TIME 7.2 1357 1363 N PROV1435 THE NUMBER OF FULL TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-THER-FULL-TIME PHYSICAL THERAPISTS - PART TIME 7.2 1364 1370 N PROV1440 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-THER-PART-TIME PHYSICAL THERAPY ASST - CONTRACT 7.2 1371 1377 N PROV1415 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY ASSISTANTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-THER-AID-CONTRACT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 24 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PHYSICAL THERAPY ASST - FULL TIME 7.2 1378 1384 N PROV1420 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-THER-AID-FULL-TIME PHYSICAL THERAPY ASST - PART TIME 7.2 1385 1391 N PROV1425 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-THER-AID-PART-TIME PHYSICIAN EXTENDER - CONTRACT 7.2 1392 1398 N PROV3270 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-PHYS-EXT-CONTRACT PHYSICIAN EXTENDER - FULL TIME 7.2 1399 1405 N PROV3250 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS EMPLOYED BY THE FACILITY ON A FULL-TIME BASIS. COBOL NAME: NUM-PHYS-EXT-FULL-TIME PHYSICIAN EXTENDER - PART TIME 7.2 1406 1412 N PROV3260 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS EMPLOYED BY THE FACILITY ON A PART-TIME BASIS. COBOL NAME: NUM-PHYS-EXT-PART-TIME PODIATRISTS - CONTRACT 7.2 1413 1419 N PROV1130 THE NUMBER OF FULL TIME EQUIVALENT PODIATRISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-POD-CONTRACT PODIATRISTS - FULL TIME 7.2 1420 1426 N PROV1135 THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED BY A AFCILITY ON A FULL TIME BASIS. COBOL NAME: NUM-POD-FULL-TIME PODIATRISTS - PART TIME 7.2 1427 1433 N PROV1140 THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-POD-PART-TIME PRIOR ADMISSION SUSPENSION DATE 6 1434 1439 C PROV1610 PREVIOUS DATE A SUSPENSION OF ADMISSIONS WAS INVOKED FOR A PROVIDER. COBOL NAME: PRIOR-ADMIN-SUSP-DT PRIOR LTC END DATE 6 1440 1445 C PROV1630 THE LAST DATE OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT FOR A PRIOR SURVEY. COBOL NAME: PRIOR-LTC-END-DT PRIOR LTC EXTENSION DATE 6 1446 1451 C PROV1635 THE LAST DATE OF AN EXTENSION OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT FOR A PRIOR SURVEY. COBOL NAME: PRIOR-LTC-EXT-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 25 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR RESCIND SUSPENSION DATE 6 1452 1457 C PROV1640 THE EFFECTIVE DATE OF A PREVIOUS SUSPENSION OF ADMISSIONS TO A LTC FACILITY. COBOL NAME: PRIOR-RESC-SUSP-DT PROVIDER BASED FACILITY 1 1458 1458 C PROV1675 INDICATES IF A LONG TERM CARE FACILITY IS PROVIDER BASED. COBOL NAME: PROV-BASED-FACILITY VALUES: N NOT HOSPITAL BASED Y HOSPITAL BASED REGISTERED NURSE - CONTRACT 7.2 1459 1465 N PROV1150 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-REG-NURSE-CONTRACT REGISTERED NURSE - FULL TIME 7.2 1466 1472 N PROV1155 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-REG-NURSE-FULL-TIME REGISTERED NURSE - PART TIME 7.2 1473 1479 N PROV1160 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-REG-NURSE-PART-TIME RESCIND SUSPENSION DATE 6 1480 1485 C PROV1825 DATE THAT THE SUPENSION OF PAYMENTS FOR NEW ADMISSIONS TO A LONG TERM CARE FACILITY (LTC) IS RESCINDED. COBOL NAME: RESC-SUSP-DT SOCIAL WORKER - CONTRACT 7.2 1486 1492 N PROV1170 THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-SOCIAL-CONTRACT SOCIAL WORKER - FULL TIME 7.2 1493 1499 N PROV1175 THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-SOCIAL-FULL-TIME SOCIAL WORKER - PART TIME 7.2 1500 1506 N PROV1180 THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-SOCIAL-PART-TIME SPECIAL CARE BEDS-AIDS 3 1507 1509 N PROV0725 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH AIDS. COBOL NAME: NUM-AIDS-BEDS SPECIAL CARE BEDS-ALZHEIMERS 3 1510 1512 N PROV0730 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH ALZEHEIMERS. COBOL NAME: NUM-ALZHEIMERS-BEDS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 26 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL CARE BEDS-DIALYSIS 3 1513 1515 N PROV0800 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS NEEDING DIALYSIS. COBOL NAME: NUM-DIAL-BEDS SPECIAL CARE BEDS-DISABLED CHILD 3 1516 1518 N PROV0855 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR DEISCABLED CHILDREN. COBOL NAME: NUM-DIS-CHILD-BEDS SPECIAL CARE BEDS-HEAD TRAUMA 3 1519 1521 N PROV0905 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILTY FOR RESIDENTS WITH HEAD TRAUMA. COBOL NAME: NUM-HEAD-TRAUMA-BEDS SPECIAL CARE BEDS-HOSPICE 3 1522 1524 N PROV0920 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY A FACILITY FOR RESIDENTS NEEDING HOSPICE SERVICES. COBOL NAME: NUM-HOSPICE-BEDS SPECIAL CARE BEDS-HUNTINGTONS 3 1525 1527 N PROV0940 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH HUNTINGTON'S DISEASE COBOL NAME: NUM-HUNTING-DIS-BEDS SPECIAL CARE BEDS-SPEC REHAB 3 1528 1530 N PROV1205 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH SPECIALIZED REHAB NEEDS. COBOL NAME: NUM-SPEC-REHAB-BEDS SPECIAL CARE BEDS-VENTILATOR 3 1531 1533 N PROV1460 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH VENTILATOR/ RESIPIRATORY CARE NEEDS. COBOL NAME: NUM-VENT-RESP-BEDS SPEECH PATHOLOGIST - CONTRACT 7.2 1534 1540 N PROV1190 THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-SPCH-PATH-CONTRACT SPEECH PATHOLOGIST - FULL TIME 7.2 1541 1547 N PROV1195 THE NUMBER OF FULL-TIME EQUIVALENT SPPECH PATHOLOGISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-SPCH-PATH-FULL-TIME SPEECH PATHOLOGIST - PART TIME 7.2 1548 1554 N PROV1200 THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-SPCH-PATH-PART-TIME SRV: ACTIVITIES-OFFSITE-RESIDENTS 1 1555 1555 C PROV3390 INDICATES IF ACTIVITIES SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-ACT-THER-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 27 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: ACTIVITIES-ONSITE-NON RES 1 1556 1556 C PROV3385 INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS. COBOL NAME: SP-ACT-THER-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: ACTIVITIES-ONSITE-RESIDENTS 1 1557 1557 C PROV3380 INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-ACT-THER-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: BLOOD ADMIN-OFFSITE-RESIDENTS 1 1558 1558 C PROV3525 INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-ADM-BLOOD-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: BLOOD ADMIN-ONSITE-NONRES 1 1559 1559 C PROV3520 INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS. COBOL NAME: SP-ADM-BLOOD-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: BLOOD ADMIN-ONSITE-RESIDENTS 1 1560 1560 C PROV3515 INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-ADM-BLOOD-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: CLINICAL LAB-OFFSITE-RESIDENT 1 1561 1561 C PROV3495 INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-CLIN-LAB-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: CLINICAL LAB-ONSITE-NON RES 1 1562 1562 C PROV3490 INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-CLIN-LAB-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 28 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: CLINICAL LAB-ONSITE-RESIDENTS 1 1563 1563 C PROV3485 INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-CLIN-LAB-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DENTAL-OFFSITE-RESIDENTS 1 1564 1564 C PROV3435 INDICATES IF DENTAL SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-DENTAL-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DENTAL-ONSITE-NON RESIDENTS 1 1565 1565 C PROV3430 INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-DENTAL-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DENTAL-ONSITE-RESIDENTS 1 1566 1566 C PROV3425 INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-DENTAL-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DIETARY-OFFSITE-RESIDENTS 1 1567 1567 C PROV3345 INDICATES IF DIETARY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-DIETARY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DIETARY-ONSITE-NON RESIDENTS 1 1568 1568 C PROV3340 INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-DIETARY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DIETARY-ONSITE-RESIDENTS 1 1569 1569 C PROV3335 INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-DIETARY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 29 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: HOUSEKEEPING ONSITE-NON RES 1 1570 1570 C PROV3535 INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-HOUSE-KP-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: HOUSEKEEPING-OFFSITE-RES 1 1571 1571 C PROV3540 INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-HOUSE-KP-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: HOUSEKEEPING-ONSITE-RESIDENTS 1 1572 1572 C PROV3530 INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-HOUSE-KP-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: MENTAL HEALTH-OFFSITE-RES 1 1573 1573 C PROV3465 INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-MEN-HLTH-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: MENTAL HEALTH-ONSITE-NON RES 1 1574 1574 C PROV3460 INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-MEN-HLTH-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: MENTAL HEALTH-ONSITE-RESID 1 1575 1575 C PROV3455 INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-MEN-HLTH-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: NURSING-OFFSITE-RESIDENTS 1 1576 1576 C PROV3315 INDICATES IF NURSING SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-NURSING-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 30 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: NURSING-ONSITE-NON RESIDENTS 1 1577 1577 C PROV3310 INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-NURSING-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: NURSING-ONSITE-RESIDENTS 1 1578 1578 C PROV3305 INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-NURSING-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: OCCUP THER-OFFSITE-RESIDENTS 1 1579 1579 C PROV3360 INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-OCC-THER-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: OCCUP THER-ONSITE-NON RESID 1 1580 1580 C PROV3355 INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-OCC-THER-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: OCCUP THER-ONSITE-RESIDENTS 1 1581 1581 C PROV3350 INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-OCC-THER-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHARMACY-OFFSITE-RESIDENTS 1 1582 1582 C PROV3330 INDICATES IF PHARMACY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHARMACY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHARMACY-ONSITE-NON RESIDENTS 1 1583 1583 C PROV3325 INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHARMACY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 31 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: PHARMACY-ONSITE-RESIDENTS 1 1584 1584 C PROV3320 INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHARMACY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS EXTENDER-OFFSITE-RESID 1 1585 1585 C PROV3300 INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHYS-EXT-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS EXTENDER-ONSITE-NON RES 1 1586 1586 C PROV3295 INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHYS-EXT-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS EXTENDER-ONSITE-RESIDENT 1 1587 1587 C PROV3290 INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHYS-EXT-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS THER-OFFSITE-RESIDENTS 1 1588 1588 C PROV3375 INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHYS-THER-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS THER-ONSITE-NON RESIDENT 1 1589 1589 C PROV3370 INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHYS-THER-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS THER-ONSITE-RESIDENTS 1 1590 1590 C PROV3365 INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHYS-THER-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 32 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: PHYSICIAN-OFFSITE-RESIDENTS 1 1591 1591 C PROV3285 INDICATES IF PHYSICIAN SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHYS-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYSICIAN-ONSITE-NON RESIDENT 1 1592 1592 C PROV3280 INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHYS-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYSICIAN-ONSITE-RESIDENTS 1 1593 1593 C PROV3275 INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHYS-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PODIATRY-OFFSITE-RESIDENTS 1 1594 1594 C PROV3450 INDICATES IF PODIATRY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PODIATRY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PODIATRY-ONSITE-NON RESIDENTS 1 1595 1595 C PROV3445 INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PODIATRY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PODIATRY-ONSITE-RESIDENTS 1 1596 1596 C PROV3440 INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PODIATRY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SOCIAL WORK-OFFSITE-RESIDENTS 1 1597 1597 C PROV3405 INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-MED-SOC-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 33 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: SOCIAL WORK-ONSITE-NON RESID 1 1598 1598 C PROV3400 INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-MED-SOC-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SOCIAL WORK-ONSITE-RESIDENTS 1 1599 1599 C PROV3395 INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-MED-SOC-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SPEECH PATH-OFFSITE-RESIDEN 1 1600 1600 C PROV3420 INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-SPEECH-PH-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SPEECH PATH-ONSITE-NON RESID 1 1601 1601 C PROV3415 INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-SPEECH-PH-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SPEECH PATH-ONSITE-RESIDENTS 1 1602 1602 C PROV3410 INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-SPEECH-PH-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: VOCATIONAL-OFFSITE-RESIDENTS 1 1603 1603 C PROV3480 INDICATES IF VOCATIONAL SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-VOC-GUID-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: VOCATIONAL-ONSITE-NON RESID 1 1604 1604 C PROV3475 INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-VOC-GUID-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 34 SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: VOCATIONAL-ONSITE-RESIDENTS 1 1605 1605 C PROV3470 INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-VOC-GUID-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: XRAY-OFFSITE-RESIDENTS 1 1606 1606 C PROV3510 INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-DIAG-XRAY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: XRAY-ONSITE-NON RESIDENTS 1 1607 1607 C PROV3505 INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-DIAG-XRAY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: XRAY-ONSITE-RESIDENTS 1 1608 1608 C PROV3500 INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-DIAG-XRAY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 TITLE 18 ONLY 02 TITLE 19 ONLY 03 TITLE 18/19 CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 03 SNF/NF (DISTINCT PART) CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 FOR PROFIT - INDIVIDUAL 02 FOR PROFIT - PARTNERSHIP 03 FOR PROFIT - CORPORATION 04 NONPROFIT - CHURCH RELATED 05 NONPROFIT - CORPORATION 06 NONPROFIT - OTHER 07 GOVERNMENT - STATE 08 GOVERNMENT - COUNTY 09 GOVERNMENT - CITY 10 GOVERNMENT - CITY/COUNTY 11 GOVERNMENT - HOSPITAL DISTRICT 12 GOVERNMENT - FEDERAL ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE BEDS - TOTAL 5 683 687 N PROV0740 TOTAL NUMBER OF BEDS IN A FACILITY, INCLUDING THOSE IN NON-PARTICIPATING OR NON-LICENSED AREAS. COBOL NAME: NUM-BEDS BEDS - TOTAL CERTIFIED 5 688 692 N PROV0755 NUMBER OF BEDS IN MEDICARE AND/OR MEDICAID CERTIFIED AREAS WITHIN A FACILITY. COBOL NAME: NUM-CERT-BEDS COMPLIANCE: LIFE SAFETY CODE 1 752 752 C PROV0240 INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN RECOMMENDED FOR A PROVIDER. COBOL NAME: COMPL-LSC VALUES: 1 WAIVER RECOMMENDED PROGRAM PARTICIPATION 1 823 823 C PROV1670 INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE, MEDICAID, OR BOTH PROGRAMS. COBOL NAME: PROG-PARTCI VALUES: 1 MEDICARE ONLY 2 MEDICAID ONLY 3 MEDICARE AND MEDICAID * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGIONAL OVERRIDE #1 (NUMBER BEDS) 1 841 841 C PROV1545 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-1 VALUES: Y RECORD HAS BEEN APPROVED REGIONAL OVERRIDE #2 (STAFFING) 1 842 842 C PROV1550 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-2 VALUES: Y RECORD HAS BEEN APPROVED RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM ACTIVITY THERAPISTS - CONTRACT 7.2 940 946 N PROV0695 THE NUMBER OF FULL TIME EQUIVALENT ACTIVITIES THERAPISTS UNDER CONTRACT TO THE FACILITY COBOL NAME: NUM-ACT-THER-CONTRACT ACTIVITY THERAPISTS - FULL TIME 7.2 947 953 N PROV0700 THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES THERAPISTS EMPLOYED FULL TIME BY THE FACILITY COBOL NAME: NUM-ACT-THER-FULL-TIME ACTIVITY THERAPISTS - PART TIME 7.2 954 960 N PROV0705 THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES THERAPISTS EMPLOYED PART-TIME BY THE FACILITY. COBOL NAME: NUM-ACT-THER-PART-TIME ADMINISTRATOR - CONTRACT 7.2 961 967 N PROV0710 THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATORS UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-ADMN-CONTRACT ADMINISTRATOR - FULL TIME 7.2 968 974 N PROV0715 THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATORS EMPLOYED ON A FULL TIME BASIS BY THE FACILITY. COBOL NAME: NUM-ADMN-FULL-TIME ADMINISTRATOR - PART TIME 7.2 975 981 N PROV0720 THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATORS EMPLOYED ON A PART-TIME BASIS BY THE FACILITY. COBOL NAME: NUM-ADMN-PART-TIME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * ADMISSION SUSPENSION DATE 6 982 987 C PROV0030 THE DATE THAT PAYMENTS FOR NEW ADMISSIONS IN A LONG TERM CARE FACILITY WILL BE DENIED IF AN INTERMEDIATE SANCTION IS TAKEN AGAINST THE FACILITY. COBOL NAME: ADMIN-SUSP-DT AIDES/ORDERLIES - CONTRACT 7.2 988 994 N PROV1000 THE NUMBER OF FULL-TIME EQUIVALENT AIDES/ORDERLIES UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-NURSE-AID-CONTRACT AIDES/ORDERLIES - FULL TIME 7.2 995 1001 N PROV1005 THE NUMBER OF FULL-TIME EQUIVALENT AIDES/ORDERLIES EMPLOYED BY THE FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-NURSE-AID-FULL-TIME AIDES/ORDERLIES - PART TIME 7.2 1002 1008 N PROV1010 THE NUMBER OF FULL-TIME EQUIVALENT AIDES/ORDERLIES EMPLOYED BY THE FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-NURSE-AID-PART-TIME BEDS - MEDICARE SNF 4 1009 1012 N PROV1445 NUMBER OF MEDICARE CERTIFIED SNF BEDS IN A FACILITY. COBOL NAME: NUM-T18-SNF-BEDS BEDS - NURSING FACILITY 4 1013 1016 N PROV1455 NUMBER OF MEDICAID CERTIFIED SKILLED NURSING CARE BEDS IN A FACILITY. COBOL NAME: NUM-T19-SNF-BEDS BEDS - SNF/NF 4 1017 1020 N PROV1450 NUMBER OF BEDS CERTIFIED FOR BOTH MEDICARE AND MEDICAID SKILLED NURSING CARE IN A LONG TERM CARE FACILITY. COBOL NAME: NUM-T1819-SNF-BEDS CHRISTIAN SCIENCE INDICATOR 1 1021 1021 C PROV0110 INDICATES IF A PROVIDER IS A CHRISTIAN SCIENCE FACILITY COBOL NAME: CHRISTIAN-SCIENCE-IND VALUES: Y CHRISTIAN SCIENCE COMPLIANCE: BEDS PER ROOM WAIVER 1 1022 1022 C PROV0225 INDICATES IF A WAIVER OF THE BEDS PER ROOM REQUIREMENT HAS BEEN RECOMMENDED FOR A FACILITY. COBOL NAME: COMPL-BEDS-PER-ROOM VALUES: 1 WAIVER RECOMMENDED COMPLIANCE: PATIENT ROOM SIZE 1 1023 1023 C PROV0270 INDICATES IF A WAIVER OF PATIENT ROOM SIZE HAS BEEN RECOMMENDED FOR A FACILITY. COBOL NAME: COMPL-PATIENT-ROOM-SZ VALUES: 1 WAIVER RECOMMENDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 19 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COMPLIANCE: 7 DAY REGISTERED NURSE 1 1024 1024 C PROV0295 INDICATES IF A WAIVER OF THE 7 DAY REGISTERED NURSE REQUIREMENTS HAS BEEN RECOMMENDED FOR A SNF OR NF. COBOL NAME: COMPL-7-DAY-RN VALUES: 1 WAIVER RECOMMENDED DATE OF RO TITLE 19 FINAL REVIEW 6 1025 1030 C PROV0410 THE DATE THE REGIONAL OFFICE COMPLETES ITS REVIEW OF A TITLE 19 (MEDICAID) CERTIFICATION KIT. COBOL NAME: DT-RO-FINAL-REV DENTISTS - CONTRACT 7.2 1031 1037 N PROV0785 THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-DENTIST-CONTRACT DENTISTS - FULL TIME 7.2 1038 1044 N PROV0790 THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-DENTIST-FULL-TIME DENTISTS - PART TIME 7.2 1045 1051 N PROV0795 THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-DENTIST-PART-TIME DIETITIANS - CONTRACT 7.2 1052 1058 N PROV0805 THE NUMBER OF FULL-TIME EQUIVALENT UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-DIET-CONTRACT DIETITIANS - FULL TIME 7.2 1059 1065 N PROV0810 THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-DIET-FULL-TIME DIETITIANS - PART TIME 7.2 1066 1072 N PROV0815 THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-DIET-PART-TIME EXPERIMENTAL RESEARCH CONDUCTED 1 1073 1073 C PROV0465 INDICATES IF A FACILITY USES RESIDENTS TO DEVELOP AND TEST CLINICAL TREATMENTS. COBOL NAME: EXPER-RESEARCH VALUES: N NO Y YES FACILITY PART OF A CCRC 1 1074 1074 C PROV3235 INDICATES IF THE FACILITY IS PART OF A CONTINUING CARE RETIREMENT COMMUNITY (CCRC). COBOL NAME: CCRC-FACIL VALUES: N NO Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 20 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOOD SERVICE - CONTRACT 7.2 1075 1081 N PROV0860 THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE PERSONNEL UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-FOOD-SRV-CONTRACT FOOD SERVICE - FULL TIME 7.2 1082 1088 N PROV0865 THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-FOOD-SRV-FULL-TIME FOOD SERVICE - PART TIME 7.2 1089 1095 N PROV0870 THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-FOOD-SRV-PART-TIME HOUSEKEEPING - CONTRACT 7.2 1096 1102 N PROV0925 THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING PERSONNEL UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-HOUSE-CONTRACT HOUSEKEEPING - FULL TIME 7.2 1103 1109 N PROV0930 THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-HOUSE-FULL-TIME HOUSEKEEPING - PART TIME 7.2 1110 1116 N PROV0935 THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-HOUSE-PART-TIME LPN/LVN - CONTRACT 7.2 1117 1123 N PROV1465 THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/ VOCATIONAL NURSES UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-VOC-NURSE-CONTRACT LPN/LVN - FULL TIME 7.2 1124 1130 N PROV1470 THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/ VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-VOC-NURSE-FULL-TIME LPN/LVN - PART TIME 7.2 1131 1137 N PROV1475 THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/ VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-VOC-NURSE-PART-TIME LTC AGREEMENT BEGINNING DATE 6 1138 1143 C PROV0620 THE BEGINNING DATE OF A CERTIFIED LONG TERM CARE FACILI TY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-BEGIN-DT LTC AGREEMENT ENDING DATE 6 1144 1149 C PROV0625 THE ENDING DATE OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-END-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 21 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME LTC AGREEMENT EXTENSION DATE 6 1150 1155 C PROV0630 THE LAST DATE OF AN EXTENSION OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-EXT-DT LTC CROSS REFERENCE PROVIDER # 6 1156 1161 C PROV0640 THIS CROSS REFERENCE NUMBER IDENTIFIES LTC PROVIDER NUMBERS THAT WERE TERMINATED IN 1985 BECAUSE OF POLICY CHANGES WHICH STATES THAT SNF/ICF DISTINCT PARTS OR DUA LLY CERTIFIED PORTIONS ARE ASSIGNED SINGLE SNF PROV NO. COBOL NAME: LTC-CROSS-REF-PROV-NUM MEDICAL DIRECTOR - CONTRACT 7.2 1162 1168 N PROV0960 NUMBER OF MEDICAL DIRECTORS UNDER CONTRACT. COBOL NAME: NUM-MED-CONTRACT MEDICAL DIRECTOR - FULL TIME 7.2 1169 1175 N PROV0965 THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-MED-FULL-TIME MEDICAL DIRECTOR - PART TIME 7.2 1176 1182 N PROV0970 THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-MED-PART-TIME MENTAL HEALTH SERVICES - CONTRACT 7.2 1183 1189 N PROV0980 THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH SERVICES PERSONNEL UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-MEN-HLTH-CONTRACT MENTAL HEALTH SERVICES - FULL TIME 7.2 1190 1196 N PROV0985 THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-MEN-HLTH-FULL-TIME MENTAL HEALTH SERVICES - PART TIME 7.2 1197 1203 N PROV0990 THE NUMBER OF FULL TIME EQUIVALENT MENTAL HEALTH SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-MEN-HLTH-PART-TIME MULTI-FACILITY ORGANIZATION NAME 38 1204 1241 C PROV0680 THE NAME OF THE MULTI-FACILITY ORGANIZATION THAT OWNS THE FACILITY. COBOL NAME: NAME-MULT-FACL-ORG MULTI-FACILITY ORGANIZATION OWNED 1 1242 1242 C PROV0675 INDICATES IF A FACILITY IS OWNED BY AN ORGANIZATION THAT OWNS (OR LEASES) TWO OR MORE NURSING FACILITIES. COBOL NAME: MULT-FACL-ORG VALUES: N NO Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 22 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME OCCUPATIONAL THERAPIST - CONTRACT 7.2 1243 1249 N PROV1035 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-OCC-THER-CONTRACT OCCUPATIONAL THERAPIST - FULL TIME 7.2 1250 1256 N PROV1040 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-OCC-THER-FULL-TIME OCCUPATIONAL THERAPIST - PART TIME 7.2 1257 1263 N PROV1045 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-OCC-THER-PART-TIME OCCUPATIONAL THERAPY ASST-CONTRACT 7.2 1264 1270 N PROV1020 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY ASSISTANTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-OCC-AID-CONTRACT OCCUPATIONAL THERAPY ASST-FULL 7.2 1271 1277 N PROV1025 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-OCC-AID-FULL-TIME OCCUPATIONAL THERAPY ASST-PART 7.2 1278 1284 N PROV1030 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-OCC-AID-PART-TIME ORGANIZED FAMILY GROUP 1 1285 1285 C PROV1535 INDICATES IF THE FACILITY HAS AN ORGANIZED GROUP OF FAMILY MEMBERS OF RESIDENTS. COBOL NAME: ORG-FAMILY-GRP VALUES: N NO Y YES ORGANIZED RESIDENT GROUP 1 1286 1286 C PROV1540 INDICATES IF THE FACILITY HAS AN ORGANIZED RESIDENTS GROUP. COBOL NAME: ORG-RESID-GRP VALUES: N NO Y YES OTHER - CONTRACT 7.2 1287 1293 N PROV3265 THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED IN ANY OTHER CATEGORIES UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-OTH-CONTRACT OTHER - FULL TIME 7.2 1294 1300 N PROV3245 THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A FULL-TIME BASIS. COBOL NAME: NUM-OTH-FULL-TIME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 23 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME OTHER - PART TIME 7.2 1301 1307 N PROV3255 THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A PART-TIME BASIS. COBOL NAME: NUM-OTH-PART-TIME OTHER PHYSICIAN - CONTRACT 7.2 1308 1314 N PROV1060 THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS UNDER CONTRACT TO A FACILITY COBOL NAME: NUM-OTH-PHY-CONTRACT OTHER PHYSICIAN - FULL TIME 7.2 1315 1321 N PROV1065 THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-OTH-PHY-FULL-TIME OTHER PHYSICIAN - PART TIME 7.2 1322 1328 N PROV1070 THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-OTH-PHY-PART-TIME PHARMACISTS - CONTRACT 7.2 1329 1335 N PROV1085 THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-PHAR-CONTRACT PHARMACISTS - FULL TIME 7.2 1336 1342 N PROV1090 THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-PHAR-FULL-TIME PHARMACISTS - PART TIME 7.2 1343 1349 N PROV1095 THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-PHAR-PART-TIME PHYSICAL THERAPISTS - CONTRACT 7.2 1350 1356 N PROV1430 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-THER-CONTRACT PHYSICAL THERAPISTS - FULL TIME 7.2 1357 1363 N PROV1435 THE NUMBER OF FULL TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-THER-FULL-TIME PHYSICAL THERAPISTS - PART TIME 7.2 1364 1370 N PROV1440 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-THER-PART-TIME PHYSICAL THERAPY ASST - CONTRACT 7.2 1371 1377 N PROV1415 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY ASSISTANTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-THER-AID-CONTRACT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 24 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PHYSICAL THERAPY ASST - FULL TIME 7.2 1378 1384 N PROV1420 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-THER-AID-FULL-TIME PHYSICAL THERAPY ASST - PART TIME 7.2 1385 1391 N PROV1425 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-THER-AID-PART-TIME PHYSICIAN EXTENDER - CONTRACT 7.2 1392 1398 N PROV3270 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-PHYS-EXT-CONTRACT PHYSICIAN EXTENDER - FULL TIME 7.2 1399 1405 N PROV3250 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS EMPLOYED BY THE FACILITY ON A FULL-TIME BASIS. COBOL NAME: NUM-PHYS-EXT-FULL-TIME PHYSICIAN EXTENDER - PART TIME 7.2 1406 1412 N PROV3260 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS EMPLOYED BY THE FACILITY ON A PART-TIME BASIS. COBOL NAME: NUM-PHYS-EXT-PART-TIME PODIATRISTS - CONTRACT 7.2 1413 1419 N PROV1130 THE NUMBER OF FULL TIME EQUIVALENT PODIATRISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-POD-CONTRACT PODIATRISTS - FULL TIME 7.2 1420 1426 N PROV1135 THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED BY A AFCILITY ON A FULL TIME BASIS. COBOL NAME: NUM-POD-FULL-TIME PODIATRISTS - PART TIME 7.2 1427 1433 N PROV1140 THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-POD-PART-TIME PRIOR ADMISSION SUSPENSION DATE 6 1434 1439 C PROV1610 PREVIOUS DATE A SUSPENSION OF ADMISSIONS WAS INVOKED FOR A PROVIDER. COBOL NAME: PRIOR-ADMIN-SUSP-DT PRIOR LTC END DATE 6 1440 1445 C PROV1630 THE LAST DATE OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT FOR A PRIOR SURVEY. COBOL NAME: PRIOR-LTC-END-DT PRIOR LTC EXTENSION DATE 6 1446 1451 C PROV1635 THE LAST DATE OF AN EXTENSION OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT FOR A PRIOR SURVEY. COBOL NAME: PRIOR-LTC-EXT-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 25 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR RESCIND SUSPENSION DATE 6 1452 1457 C PROV1640 THE EFFECTIVE DATE OF A PREVIOUS SUSPENSION OF ADMISSIONS TO A LTC FACILITY. COBOL NAME: PRIOR-RESC-SUSP-DT PROVIDER BASED FACILITY 1 1458 1458 C PROV1675 INDICATES IF A LONG TERM CARE FACILITY IS PROVIDER BASED. COBOL NAME: PROV-BASED-FACILITY VALUES: N NOT HOSPITAL BASED Y HOSPITAL BASED REGISTERED NURSE - CONTRACT 7.2 1459 1465 N PROV1150 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-REG-NURSE-CONTRACT REGISTERED NURSE - FULL TIME 7.2 1466 1472 N PROV1155 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-REG-NURSE-FULL-TIME REGISTERED NURSE - PART TIME 7.2 1473 1479 N PROV1160 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-REG-NURSE-PART-TIME RESCIND SUSPENSION DATE 6 1480 1485 C PROV1825 DATE THAT THE SUPENSION OF PAYMENTS FOR NEW ADMISSIONS TO A LONG TERM CARE FACILITY (LTC) IS RESCINDED. COBOL NAME: RESC-SUSP-DT SOCIAL WORKER - CONTRACT 7.2 1486 1492 N PROV1170 THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-SOCIAL-CONTRACT SOCIAL WORKER - FULL TIME 7.2 1493 1499 N PROV1175 THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-SOCIAL-FULL-TIME SOCIAL WORKER - PART TIME 7.2 1500 1506 N PROV1180 THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-SOCIAL-PART-TIME SPECIAL CARE BEDS-AIDS 3 1507 1509 N PROV0725 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH AIDS. COBOL NAME: NUM-AIDS-BEDS SPECIAL CARE BEDS-ALZHEIMERS 3 1510 1512 N PROV0730 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH ALZEHEIMERS. COBOL NAME: NUM-ALZHEIMERS-BEDS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 26 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL CARE BEDS-DIALYSIS 3 1513 1515 N PROV0800 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS NEEDING DIALYSIS. COBOL NAME: NUM-DIAL-BEDS SPECIAL CARE BEDS-DISABLED CHILD 3 1516 1518 N PROV0855 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR DEISCABLED CHILDREN. COBOL NAME: NUM-DIS-CHILD-BEDS SPECIAL CARE BEDS-HEAD TRAUMA 3 1519 1521 N PROV0905 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILTY FOR RESIDENTS WITH HEAD TRAUMA. COBOL NAME: NUM-HEAD-TRAUMA-BEDS SPECIAL CARE BEDS-HOSPICE 3 1522 1524 N PROV0920 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY A FACILITY FOR RESIDENTS NEEDING HOSPICE SERVICES. COBOL NAME: NUM-HOSPICE-BEDS SPECIAL CARE BEDS-HUNTINGTONS 3 1525 1527 N PROV0940 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH HUNTINGTON'S DISEASE COBOL NAME: NUM-HUNTING-DIS-BEDS SPECIAL CARE BEDS-SPEC REHAB 3 1528 1530 N PROV1205 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH SPECIALIZED REHAB NEEDS. COBOL NAME: NUM-SPEC-REHAB-BEDS SPECIAL CARE BEDS-VENTILATOR 3 1531 1533 N PROV1460 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH VENTILATOR/ RESIPIRATORY CARE NEEDS. COBOL NAME: NUM-VENT-RESP-BEDS SPEECH PATHOLOGIST - CONTRACT 7.2 1534 1540 N PROV1190 THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-SPCH-PATH-CONTRACT SPEECH PATHOLOGIST - FULL TIME 7.2 1541 1547 N PROV1195 THE NUMBER OF FULL-TIME EQUIVALENT SPPECH PATHOLOGISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-SPCH-PATH-FULL-TIME SPEECH PATHOLOGIST - PART TIME 7.2 1548 1554 N PROV1200 THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-SPCH-PATH-PART-TIME SRV: ACTIVITIES-OFFSITE-RESIDENTS 1 1555 1555 C PROV3390 INDICATES IF ACTIVITIES SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-ACT-THER-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 27 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: ACTIVITIES-ONSITE-NON RES 1 1556 1556 C PROV3385 INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS. COBOL NAME: SP-ACT-THER-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: ACTIVITIES-ONSITE-RESIDENTS 1 1557 1557 C PROV3380 INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-ACT-THER-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: BLOOD ADMIN-OFFSITE-RESIDENTS 1 1558 1558 C PROV3525 INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-ADM-BLOOD-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: BLOOD ADMIN-ONSITE-NONRES 1 1559 1559 C PROV3520 INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS. COBOL NAME: SP-ADM-BLOOD-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: BLOOD ADMIN-ONSITE-RESIDENTS 1 1560 1560 C PROV3515 INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-ADM-BLOOD-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: CLINICAL LAB-OFFSITE-RESIDENT 1 1561 1561 C PROV3495 INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-CLIN-LAB-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: CLINICAL LAB-ONSITE-NON RES 1 1562 1562 C PROV3490 INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-CLIN-LAB-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 28 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: CLINICAL LAB-ONSITE-RESIDENTS 1 1563 1563 C PROV3485 INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-CLIN-LAB-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DENTAL-OFFSITE-RESIDENTS 1 1564 1564 C PROV3435 INDICATES IF DENTAL SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-DENTAL-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DENTAL-ONSITE-NON RESIDENTS 1 1565 1565 C PROV3430 INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-DENTAL-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DENTAL-ONSITE-RESIDENTS 1 1566 1566 C PROV3425 INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-DENTAL-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DIETARY-OFFSITE-RESIDENTS 1 1567 1567 C PROV3345 INDICATES IF DIETARY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-DIETARY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DIETARY-ONSITE-NON RESIDENTS 1 1568 1568 C PROV3340 INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-DIETARY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DIETARY-ONSITE-RESIDENTS 1 1569 1569 C PROV3335 INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-DIETARY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 29 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: HOUSEKEEPING ONSITE-NON RES 1 1570 1570 C PROV3535 INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-HOUSE-KP-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: HOUSEKEEPING-OFFSITE-RES 1 1571 1571 C PROV3540 INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-HOUSE-KP-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: HOUSEKEEPING-ONSITE-RESIDENTS 1 1572 1572 C PROV3530 INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-HOUSE-KP-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: MENTAL HEALTH-OFFSITE-RES 1 1573 1573 C PROV3465 INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-MEN-HLTH-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: MENTAL HEALTH-ONSITE-NON RES 1 1574 1574 C PROV3460 INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-MEN-HLTH-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: MENTAL HEALTH-ONSITE-RESID 1 1575 1575 C PROV3455 INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-MEN-HLTH-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: NURSING-OFFSITE-RESIDENTS 1 1576 1576 C PROV3315 INDICATES IF NURSING SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-NURSING-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 30 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: NURSING-ONSITE-NON RESIDENTS 1 1577 1577 C PROV3310 INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-NURSING-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: NURSING-ONSITE-RESIDENTS 1 1578 1578 C PROV3305 INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-NURSING-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: OCCUP THER-OFFSITE-RESIDENTS 1 1579 1579 C PROV3360 INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-OCC-THER-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: OCCUP THER-ONSITE-NON RESID 1 1580 1580 C PROV3355 INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-OCC-THER-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: OCCUP THER-ONSITE-RESIDENTS 1 1581 1581 C PROV3350 INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-OCC-THER-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHARMACY-OFFSITE-RESIDENTS 1 1582 1582 C PROV3330 INDICATES IF PHARMACY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHARMACY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHARMACY-ONSITE-NON RESIDENTS 1 1583 1583 C PROV3325 INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHARMACY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 31 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: PHARMACY-ONSITE-RESIDENTS 1 1584 1584 C PROV3320 INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHARMACY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS EXTENDER-OFFSITE-RESID 1 1585 1585 C PROV3300 INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHYS-EXT-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS EXTENDER-ONSITE-NON RES 1 1586 1586 C PROV3295 INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHYS-EXT-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS EXTENDER-ONSITE-RESIDENT 1 1587 1587 C PROV3290 INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHYS-EXT-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS THER-OFFSITE-RESIDENTS 1 1588 1588 C PROV3375 INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHYS-THER-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS THER-ONSITE-NON RESIDENT 1 1589 1589 C PROV3370 INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHYS-THER-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS THER-ONSITE-RESIDENTS 1 1590 1590 C PROV3365 INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHYS-THER-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 32 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: PHYSICIAN-OFFSITE-RESIDENTS 1 1591 1591 C PROV3285 INDICATES IF PHYSICIAN SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHYS-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYSICIAN-ONSITE-NON RESIDENT 1 1592 1592 C PROV3280 INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHYS-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYSICIAN-ONSITE-RESIDENTS 1 1593 1593 C PROV3275 INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHYS-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PODIATRY-OFFSITE-RESIDENTS 1 1594 1594 C PROV3450 INDICATES IF PODIATRY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PODIATRY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PODIATRY-ONSITE-NON RESIDENTS 1 1595 1595 C PROV3445 INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PODIATRY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PODIATRY-ONSITE-RESIDENTS 1 1596 1596 C PROV3440 INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PODIATRY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SOCIAL WORK-OFFSITE-RESIDENTS 1 1597 1597 C PROV3405 INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-MED-SOC-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 33 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: SOCIAL WORK-ONSITE-NON RESID 1 1598 1598 C PROV3400 INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-MED-SOC-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SOCIAL WORK-ONSITE-RESIDENTS 1 1599 1599 C PROV3395 INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-MED-SOC-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SPEECH PATH-OFFSITE-RESIDEN 1 1600 1600 C PROV3420 INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-SPEECH-PH-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SPEECH PATH-ONSITE-NON RESID 1 1601 1601 C PROV3415 INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-SPEECH-PH-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SPEECH PATH-ONSITE-RESIDENTS 1 1602 1602 C PROV3410 INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-SPEECH-PH-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: VOCATIONAL-OFFSITE-RESIDENTS 1 1603 1603 C PROV3480 INDICATES IF VOCATIONAL SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-VOC-GUID-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: VOCATIONAL-ONSITE-NON RESID 1 1604 1604 C PROV3475 INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-VOC-GUID-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 34 SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: VOCATIONAL-ONSITE-RESIDENTS 1 1605 1605 C PROV3470 INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-VOC-GUID-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: XRAY-OFFSITE-RESIDENTS 1 1606 1606 C PROV3510 INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-DIAG-XRAY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: XRAY-ONSITE-NON RESIDENTS 1 1607 1607 C PROV3505 INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-DIAG-XRAY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: XRAY-ONSITE-RESIDENTS 1 1608 1608 C PROV3500 INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-DIAG-XRAY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 TITLE 18 ONLY 02 TITLE 19 ONLY 03 TITLE 18/19 CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 04 SKILLED NURSING FACILITIES CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 FOR PROFIT - INDIVIDUAL 02 FOR PROFIT - PARTNERSHIP 03 FOR PROFIT - CORPORATION 04 NONPROFIT - CHURCH RELATED 05 NONPROFIT - CORPORATION 06 NONPROFIT - OTHER 07 GOVERNMENT - STATE 08 GOVERNMENT - COUNTY 09 GOVERNMENT - CITY 10 GOVERNMENT - CITY/COUNTY 11 GOVERNMENT - HOSPITAL DISTRICT 12 GOVERNMENT - FEDERAL ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE BEDS - TOTAL 5 683 687 N PROV0740 TOTAL NUMBER OF BEDS IN A FACILITY, INCLUDING THOSE IN NON-PARTICIPATING OR NON-LICENSED AREAS. COBOL NAME: NUM-BEDS BEDS - TOTAL CERTIFIED 5 688 692 N PROV0755 NUMBER OF BEDS IN MEDICARE AND/OR MEDICAID CERTIFIED AREAS WITHIN A FACILITY. COBOL NAME: NUM-CERT-BEDS COMPLIANCE: LIFE SAFETY CODE 1 752 752 C PROV0240 INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN RECOMMENDED FOR A PROVIDER. COBOL NAME: COMPL-LSC VALUES: 1 WAIVER RECOMMENDED PROGRAM PARTICIPATION 1 823 823 C PROV1670 INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE, MEDICAID, OR BOTH PROGRAMS. COBOL NAME: PROG-PARTCI VALUES: 1 MEDICARE ONLY 2 MEDICAID ONLY 3 MEDICARE AND MEDICAID * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGIONAL OVERRIDE #1 (NUMBER BEDS) 1 841 841 C PROV1545 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-1 VALUES: Y RECORD HAS BEEN APPROVED REGIONAL OVERRIDE #2 (STAFFING) 1 842 842 C PROV1550 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-2 VALUES: Y RECORD HAS BEEN APPROVED RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM ACTIVITY THERAPISTS - CONTRACT 7.2 940 946 N PROV0695 THE NUMBER OF FULL TIME EQUIVALENT ACTIVITIES THERAPISTS UNDER CONTRACT TO THE FACILITY COBOL NAME: NUM-ACT-THER-CONTRACT ACTIVITY THERAPISTS - FULL TIME 7.2 947 953 N PROV0700 THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES THERAPISTS EMPLOYED FULL TIME BY THE FACILITY COBOL NAME: NUM-ACT-THER-FULL-TIME ACTIVITY THERAPISTS - PART TIME 7.2 954 960 N PROV0705 THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES THERAPISTS EMPLOYED PART-TIME BY THE FACILITY. COBOL NAME: NUM-ACT-THER-PART-TIME ADMINISTRATOR - CONTRACT 7.2 961 967 N PROV0710 THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATORS UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-ADMN-CONTRACT ADMINISTRATOR - FULL TIME 7.2 968 974 N PROV0715 THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATORS EMPLOYED ON A FULL TIME BASIS BY THE FACILITY. COBOL NAME: NUM-ADMN-FULL-TIME ADMINISTRATOR - PART TIME 7.2 975 981 N PROV0720 THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATORS EMPLOYED ON A PART-TIME BASIS BY THE FACILITY. COBOL NAME: NUM-ADMN-PART-TIME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * ADMISSION SUSPENSION DATE 6 982 987 C PROV0030 THE DATE THAT PAYMENTS FOR NEW ADMISSIONS IN A LONG TERM CARE FACILITY WILL BE DENIED IF AN INTERMEDIATE SANCTION IS TAKEN AGAINST THE FACILITY. COBOL NAME: ADMIN-SUSP-DT AIDES/ORDERLIES - CONTRACT 7.2 988 994 N PROV1000 THE NUMBER OF FULL-TIME EQUIVALENT AIDES/ORDERLIES UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-NURSE-AID-CONTRACT AIDES/ORDERLIES - FULL TIME 7.2 995 1001 N PROV1005 THE NUMBER OF FULL-TIME EQUIVALENT AIDES/ORDERLIES EMPLOYED BY THE FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-NURSE-AID-FULL-TIME AIDES/ORDERLIES - PART TIME 7.2 1002 1008 N PROV1010 THE NUMBER OF FULL-TIME EQUIVALENT AIDES/ORDERLIES EMPLOYED BY THE FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-NURSE-AID-PART-TIME BEDS - MEDICARE SNF 4 1009 1012 N PROV1445 NUMBER OF MEDICARE CERTIFIED SNF BEDS IN A FACILITY. COBOL NAME: NUM-T18-SNF-BEDS BEDS - NURSING FACILITY 4 1013 1016 N PROV1455 NUMBER OF MEDICAID CERTIFIED SKILLED NURSING CARE BEDS IN A FACILITY. COBOL NAME: NUM-T19-SNF-BEDS BEDS - SNF/NF 4 1017 1020 N PROV1450 NUMBER OF BEDS CERTIFIED FOR BOTH MEDICARE AND MEDICAID SKILLED NURSING CARE IN A LONG TERM CARE FACILITY. COBOL NAME: NUM-T1819-SNF-BEDS CHRISTIAN SCIENCE INDICATOR 1 1021 1021 C PROV0110 INDICATES IF A PROVIDER IS A CHRISTIAN SCIENCE FACILITY COBOL NAME: CHRISTIAN-SCIENCE-IND VALUES: Y CHRISTIAN SCIENCE COMPLIANCE: BEDS PER ROOM WAIVER 1 1022 1022 C PROV0225 INDICATES IF A WAIVER OF THE BEDS PER ROOM REQUIREMENT HAS BEEN RECOMMENDED FOR A FACILITY. COBOL NAME: COMPL-BEDS-PER-ROOM VALUES: 1 WAIVER RECOMMENDED COMPLIANCE: PATIENT ROOM SIZE 1 1023 1023 C PROV0270 INDICATES IF A WAIVER OF PATIENT ROOM SIZE HAS BEEN RECOMMENDED FOR A FACILITY. COBOL NAME: COMPL-PATIENT-ROOM-SZ VALUES: 1 WAIVER RECOMMENDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 19 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COMPLIANCE: 7 DAY REGISTERED NURSE 1 1024 1024 C PROV0295 INDICATES IF A WAIVER OF THE 7 DAY REGISTERED NURSE REQUIREMENTS HAS BEEN RECOMMENDED FOR A SNF OR NF. COBOL NAME: COMPL-7-DAY-RN VALUES: 1 WAIVER RECOMMENDED DATE OF RO TITLE 19 FINAL REVIEW 6 1025 1030 C PROV0410 THE DATE THE REGIONAL OFFICE COMPLETES ITS REVIEW OF A TITLE 19 (MEDICAID) CERTIFICATION KIT. COBOL NAME: DT-RO-FINAL-REV DENTISTS - CONTRACT 7.2 1031 1037 N PROV0785 THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-DENTIST-CONTRACT DENTISTS - FULL TIME 7.2 1038 1044 N PROV0790 THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-DENTIST-FULL-TIME DENTISTS - PART TIME 7.2 1045 1051 N PROV0795 THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-DENTIST-PART-TIME DIETITIANS - CONTRACT 7.2 1052 1058 N PROV0805 THE NUMBER OF FULL-TIME EQUIVALENT UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-DIET-CONTRACT DIETITIANS - FULL TIME 7.2 1059 1065 N PROV0810 THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-DIET-FULL-TIME DIETITIANS - PART TIME 7.2 1066 1072 N PROV0815 THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-DIET-PART-TIME EXPERIMENTAL RESEARCH CONDUCTED 1 1073 1073 C PROV0465 INDICATES IF A FACILITY USES RESIDENTS TO DEVELOP AND TEST CLINICAL TREATMENTS. COBOL NAME: EXPER-RESEARCH VALUES: N NO Y YES FACILITY PART OF A CCRC 1 1074 1074 C PROV3235 INDICATES IF THE FACILITY IS PART OF A CONTINUING CARE RETIREMENT COMMUNITY (CCRC). COBOL NAME: CCRC-FACIL VALUES: N NO Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 20 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOOD SERVICE - CONTRACT 7.2 1075 1081 N PROV0860 THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE PERSONNEL UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-FOOD-SRV-CONTRACT FOOD SERVICE - FULL TIME 7.2 1082 1088 N PROV0865 THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-FOOD-SRV-FULL-TIME FOOD SERVICE - PART TIME 7.2 1089 1095 N PROV0870 THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-FOOD-SRV-PART-TIME HOUSEKEEPING - CONTRACT 7.2 1096 1102 N PROV0925 THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING PERSONNEL UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-HOUSE-CONTRACT HOUSEKEEPING - FULL TIME 7.2 1103 1109 N PROV0930 THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-HOUSE-FULL-TIME HOUSEKEEPING - PART TIME 7.2 1110 1116 N PROV0935 THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-HOUSE-PART-TIME LPN/LVN - CONTRACT 7.2 1117 1123 N PROV1465 THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/ VOCATIONAL NURSES UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-VOC-NURSE-CONTRACT LPN/LVN - FULL TIME 7.2 1124 1130 N PROV1470 THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/ VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-VOC-NURSE-FULL-TIME LPN/LVN - PART TIME 7.2 1131 1137 N PROV1475 THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/ VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-VOC-NURSE-PART-TIME LTC AGREEMENT BEGINNING DATE 6 1138 1143 C PROV0620 THE BEGINNING DATE OF A CERTIFIED LONG TERM CARE FACILI TY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-BEGIN-DT LTC AGREEMENT ENDING DATE 6 1144 1149 C PROV0625 THE ENDING DATE OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-END-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 21 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME LTC AGREEMENT EXTENSION DATE 6 1150 1155 C PROV0630 THE LAST DATE OF AN EXTENSION OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-EXT-DT LTC CROSS REFERENCE PROVIDER # 6 1156 1161 C PROV0640 THIS CROSS REFERENCE NUMBER IDENTIFIES LTC PROVIDER NUMBERS THAT WERE TERMINATED IN 1985 BECAUSE OF POLICY CHANGES WHICH STATES THAT SNF/ICF DISTINCT PARTS OR DUA LLY CERTIFIED PORTIONS ARE ASSIGNED SINGLE SNF PROV NO. COBOL NAME: LTC-CROSS-REF-PROV-NUM MEDICAL DIRECTOR - CONTRACT 7.2 1162 1168 N PROV0960 NUMBER OF MEDICAL DIRECTORS UNDER CONTRACT. COBOL NAME: NUM-MED-CONTRACT MEDICAL DIRECTOR - FULL TIME 7.2 1169 1175 N PROV0965 THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-MED-FULL-TIME MEDICAL DIRECTOR - PART TIME 7.2 1176 1182 N PROV0970 THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-MED-PART-TIME MENTAL HEALTH SERVICES - CONTRACT 7.2 1183 1189 N PROV0980 THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH SERVICES PERSONNEL UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-MEN-HLTH-CONTRACT MENTAL HEALTH SERVICES - FULL TIME 7.2 1190 1196 N PROV0985 THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-MEN-HLTH-FULL-TIME MENTAL HEALTH SERVICES - PART TIME 7.2 1197 1203 N PROV0990 THE NUMBER OF FULL TIME EQUIVALENT MENTAL HEALTH SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-MEN-HLTH-PART-TIME MULTI-FACILITY ORGANIZATION NAME 38 1204 1241 C PROV0680 THE NAME OF THE MULTI-FACILITY ORGANIZATION THAT OWNS THE FACILITY. COBOL NAME: NAME-MULT-FACL-ORG MULTI-FACILITY ORGANIZATION OWNED 1 1242 1242 C PROV0675 INDICATES IF A FACILITY IS OWNED BY AN ORGANIZATION THAT OWNS (OR LEASES) TWO OR MORE NURSING FACILITIES. COBOL NAME: MULT-FACL-ORG VALUES: N NO Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 22 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME OCCUPATIONAL THERAPIST - CONTRACT 7.2 1243 1249 N PROV1035 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-OCC-THER-CONTRACT OCCUPATIONAL THERAPIST - FULL TIME 7.2 1250 1256 N PROV1040 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-OCC-THER-FULL-TIME OCCUPATIONAL THERAPIST - PART TIME 7.2 1257 1263 N PROV1045 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-OCC-THER-PART-TIME OCCUPATIONAL THERAPY ASST-CONTRACT 7.2 1264 1270 N PROV1020 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY ASSISTANTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-OCC-AID-CONTRACT OCCUPATIONAL THERAPY ASST-FULL 7.2 1271 1277 N PROV1025 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-OCC-AID-FULL-TIME OCCUPATIONAL THERAPY ASST-PART 7.2 1278 1284 N PROV1030 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-OCC-AID-PART-TIME ORGANIZED FAMILY GROUP 1 1285 1285 C PROV1535 INDICATES IF THE FACILITY HAS AN ORGANIZED GROUP OF FAMILY MEMBERS OF RESIDENTS. COBOL NAME: ORG-FAMILY-GRP VALUES: N NO Y YES ORGANIZED RESIDENT GROUP 1 1286 1286 C PROV1540 INDICATES IF THE FACILITY HAS AN ORGANIZED RESIDENTS GROUP. COBOL NAME: ORG-RESID-GRP VALUES: N NO Y YES OTHER - CONTRACT 7.2 1287 1293 N PROV3265 THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED IN ANY OTHER CATEGORIES UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-OTH-CONTRACT OTHER - FULL TIME 7.2 1294 1300 N PROV3245 THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A FULL-TIME BASIS. COBOL NAME: NUM-OTH-FULL-TIME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 23 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME OTHER - PART TIME 7.2 1301 1307 N PROV3255 THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A PART-TIME BASIS. COBOL NAME: NUM-OTH-PART-TIME OTHER PHYSICIAN - CONTRACT 7.2 1308 1314 N PROV1060 THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS UNDER CONTRACT TO A FACILITY COBOL NAME: NUM-OTH-PHY-CONTRACT OTHER PHYSICIAN - FULL TIME 7.2 1315 1321 N PROV1065 THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-OTH-PHY-FULL-TIME OTHER PHYSICIAN - PART TIME 7.2 1322 1328 N PROV1070 THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-OTH-PHY-PART-TIME PHARMACISTS - CONTRACT 7.2 1329 1335 N PROV1085 THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-PHAR-CONTRACT PHARMACISTS - FULL TIME 7.2 1336 1342 N PROV1090 THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-PHAR-FULL-TIME PHARMACISTS - PART TIME 7.2 1343 1349 N PROV1095 THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-PHAR-PART-TIME PHYSICAL THERAPISTS - CONTRACT 7.2 1350 1356 N PROV1430 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-THER-CONTRACT PHYSICAL THERAPISTS - FULL TIME 7.2 1357 1363 N PROV1435 THE NUMBER OF FULL TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-THER-FULL-TIME PHYSICAL THERAPISTS - PART TIME 7.2 1364 1370 N PROV1440 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-THER-PART-TIME PHYSICAL THERAPY ASST - CONTRACT 7.2 1371 1377 N PROV1415 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY ASSISTANTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-THER-AID-CONTRACT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 24 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PHYSICAL THERAPY ASST - FULL TIME 7.2 1378 1384 N PROV1420 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-THER-AID-FULL-TIME PHYSICAL THERAPY ASST - PART TIME 7.2 1385 1391 N PROV1425 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-THER-AID-PART-TIME PHYSICIAN EXTENDER - CONTRACT 7.2 1392 1398 N PROV3270 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-PHYS-EXT-CONTRACT PHYSICIAN EXTENDER - FULL TIME 7.2 1399 1405 N PROV3250 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS EMPLOYED BY THE FACILITY ON A FULL-TIME BASIS. COBOL NAME: NUM-PHYS-EXT-FULL-TIME PHYSICIAN EXTENDER - PART TIME 7.2 1406 1412 N PROV3260 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS EMPLOYED BY THE FACILITY ON A PART-TIME BASIS. COBOL NAME: NUM-PHYS-EXT-PART-TIME PODIATRISTS - CONTRACT 7.2 1413 1419 N PROV1130 THE NUMBER OF FULL TIME EQUIVALENT PODIATRISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-POD-CONTRACT PODIATRISTS - FULL TIME 7.2 1420 1426 N PROV1135 THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED BY A AFCILITY ON A FULL TIME BASIS. COBOL NAME: NUM-POD-FULL-TIME PODIATRISTS - PART TIME 7.2 1427 1433 N PROV1140 THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-POD-PART-TIME PRIOR ADMISSION SUSPENSION DATE 6 1434 1439 C PROV1610 PREVIOUS DATE A SUSPENSION OF ADMISSIONS WAS INVOKED FOR A PROVIDER. COBOL NAME: PRIOR-ADMIN-SUSP-DT PRIOR LTC END DATE 6 1440 1445 C PROV1630 THE LAST DATE OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT FOR A PRIOR SURVEY. COBOL NAME: PRIOR-LTC-END-DT PRIOR LTC EXTENSION DATE 6 1446 1451 C PROV1635 THE LAST DATE OF AN EXTENSION OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT FOR A PRIOR SURVEY. COBOL NAME: PRIOR-LTC-EXT-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 25 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR RESCIND SUSPENSION DATE 6 1452 1457 C PROV1640 THE EFFECTIVE DATE OF A PREVIOUS SUSPENSION OF ADMISSIONS TO A LTC FACILITY. COBOL NAME: PRIOR-RESC-SUSP-DT PROVIDER BASED FACILITY 1 1458 1458 C PROV1675 INDICATES IF A LONG TERM CARE FACILITY IS PROVIDER BASED. COBOL NAME: PROV-BASED-FACILITY VALUES: N NOT HOSPITAL BASED Y HOSPITAL BASED REGISTERED NURSE - CONTRACT 7.2 1459 1465 N PROV1150 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-REG-NURSE-CONTRACT REGISTERED NURSE - FULL TIME 7.2 1466 1472 N PROV1155 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-REG-NURSE-FULL-TIME REGISTERED NURSE - PART TIME 7.2 1473 1479 N PROV1160 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-REG-NURSE-PART-TIME RESCIND SUSPENSION DATE 6 1480 1485 C PROV1825 DATE THAT THE SUPENSION OF PAYMENTS FOR NEW ADMISSIONS TO A LONG TERM CARE FACILITY (LTC) IS RESCINDED. COBOL NAME: RESC-SUSP-DT SOCIAL WORKER - CONTRACT 7.2 1486 1492 N PROV1170 THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-SOCIAL-CONTRACT SOCIAL WORKER - FULL TIME 7.2 1493 1499 N PROV1175 THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-SOCIAL-FULL-TIME SOCIAL WORKER - PART TIME 7.2 1500 1506 N PROV1180 THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-SOCIAL-PART-TIME SPECIAL CARE BEDS-AIDS 3 1507 1509 N PROV0725 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH AIDS. COBOL NAME: NUM-AIDS-BEDS SPECIAL CARE BEDS-ALZHEIMERS 3 1510 1512 N PROV0730 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH ALZEHEIMERS. COBOL NAME: NUM-ALZHEIMERS-BEDS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 26 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL CARE BEDS-DIALYSIS 3 1513 1515 N PROV0800 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS NEEDING DIALYSIS. COBOL NAME: NUM-DIAL-BEDS SPECIAL CARE BEDS-DISABLED CHILD 3 1516 1518 N PROV0855 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR DEISCABLED CHILDREN. COBOL NAME: NUM-DIS-CHILD-BEDS SPECIAL CARE BEDS-HEAD TRAUMA 3 1519 1521 N PROV0905 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILTY FOR RESIDENTS WITH HEAD TRAUMA. COBOL NAME: NUM-HEAD-TRAUMA-BEDS SPECIAL CARE BEDS-HOSPICE 3 1522 1524 N PROV0920 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY A FACILITY FOR RESIDENTS NEEDING HOSPICE SERVICES. COBOL NAME: NUM-HOSPICE-BEDS SPECIAL CARE BEDS-HUNTINGTONS 3 1525 1527 N PROV0940 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH HUNTINGTON'S DISEASE COBOL NAME: NUM-HUNTING-DIS-BEDS SPECIAL CARE BEDS-SPEC REHAB 3 1528 1530 N PROV1205 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH SPECIALIZED REHAB NEEDS. COBOL NAME: NUM-SPEC-REHAB-BEDS SPECIAL CARE BEDS-VENTILATOR 3 1531 1533 N PROV1460 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH VENTILATOR/ RESIPIRATORY CARE NEEDS. COBOL NAME: NUM-VENT-RESP-BEDS SPEECH PATHOLOGIST - CONTRACT 7.2 1534 1540 N PROV1190 THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-SPCH-PATH-CONTRACT SPEECH PATHOLOGIST - FULL TIME 7.2 1541 1547 N PROV1195 THE NUMBER OF FULL-TIME EQUIVALENT SPPECH PATHOLOGISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-SPCH-PATH-FULL-TIME SPEECH PATHOLOGIST - PART TIME 7.2 1548 1554 N PROV1200 THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-SPCH-PATH-PART-TIME SRV: ACTIVITIES-OFFSITE-RESIDENTS 1 1555 1555 C PROV3390 INDICATES IF ACTIVITIES SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-ACT-THER-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 27 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: ACTIVITIES-ONSITE-NON RES 1 1556 1556 C PROV3385 INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS. COBOL NAME: SP-ACT-THER-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: ACTIVITIES-ONSITE-RESIDENTS 1 1557 1557 C PROV3380 INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-ACT-THER-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: BLOOD ADMIN-OFFSITE-RESIDENTS 1 1558 1558 C PROV3525 INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-ADM-BLOOD-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: BLOOD ADMIN-ONSITE-NONRES 1 1559 1559 C PROV3520 INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS. COBOL NAME: SP-ADM-BLOOD-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: BLOOD ADMIN-ONSITE-RESIDENTS 1 1560 1560 C PROV3515 INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-ADM-BLOOD-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: CLINICAL LAB-OFFSITE-RESIDENT 1 1561 1561 C PROV3495 INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-CLIN-LAB-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: CLINICAL LAB-ONSITE-NON RES 1 1562 1562 C PROV3490 INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-CLIN-LAB-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 28 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: CLINICAL LAB-ONSITE-RESIDENTS 1 1563 1563 C PROV3485 INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-CLIN-LAB-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DENTAL-OFFSITE-RESIDENTS 1 1564 1564 C PROV3435 INDICATES IF DENTAL SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-DENTAL-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DENTAL-ONSITE-NON RESIDENTS 1 1565 1565 C PROV3430 INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-DENTAL-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DENTAL-ONSITE-RESIDENTS 1 1566 1566 C PROV3425 INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-DENTAL-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DIETARY-OFFSITE-RESIDENTS 1 1567 1567 C PROV3345 INDICATES IF DIETARY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-DIETARY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DIETARY-ONSITE-NON RESIDENTS 1 1568 1568 C PROV3340 INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-DIETARY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DIETARY-ONSITE-RESIDENTS 1 1569 1569 C PROV3335 INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-DIETARY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 29 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: HOUSEKEEPING ONSITE-NON RES 1 1570 1570 C PROV3535 INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-HOUSE-KP-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: HOUSEKEEPING-OFFSITE-RES 1 1571 1571 C PROV3540 INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-HOUSE-KP-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: HOUSEKEEPING-ONSITE-RESIDENTS 1 1572 1572 C PROV3530 INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-HOUSE-KP-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: MENTAL HEALTH-OFFSITE-RES 1 1573 1573 C PROV3465 INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-MEN-HLTH-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: MENTAL HEALTH-ONSITE-NON RES 1 1574 1574 C PROV3460 INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-MEN-HLTH-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: MENTAL HEALTH-ONSITE-RESID 1 1575 1575 C PROV3455 INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-MEN-HLTH-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: NURSING-OFFSITE-RESIDENTS 1 1576 1576 C PROV3315 INDICATES IF NURSING SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-NURSING-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 30 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: NURSING-ONSITE-NON RESIDENTS 1 1577 1577 C PROV3310 INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-NURSING-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: NURSING-ONSITE-RESIDENTS 1 1578 1578 C PROV3305 INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-NURSING-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: OCCUP THER-OFFSITE-RESIDENTS 1 1579 1579 C PROV3360 INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-OCC-THER-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: OCCUP THER-ONSITE-NON RESID 1 1580 1580 C PROV3355 INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-OCC-THER-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: OCCUP THER-ONSITE-RESIDENTS 1 1581 1581 C PROV3350 INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-OCC-THER-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHARMACY-OFFSITE-RESIDENTS 1 1582 1582 C PROV3330 INDICATES IF PHARMACY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHARMACY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHARMACY-ONSITE-NON RESIDENTS 1 1583 1583 C PROV3325 INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHARMACY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 31 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: PHARMACY-ONSITE-RESIDENTS 1 1584 1584 C PROV3320 INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHARMACY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS EXTENDER-OFFSITE-RESID 1 1585 1585 C PROV3300 INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHYS-EXT-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS EXTENDER-ONSITE-NON RES 1 1586 1586 C PROV3295 INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHYS-EXT-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS EXTENDER-ONSITE-RESIDENT 1 1587 1587 C PROV3290 INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHYS-EXT-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS THER-OFFSITE-RESIDENTS 1 1588 1588 C PROV3375 INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHYS-THER-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS THER-ONSITE-NON RESIDENT 1 1589 1589 C PROV3370 INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHYS-THER-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS THER-ONSITE-RESIDENTS 1 1590 1590 C PROV3365 INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHYS-THER-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 32 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: PHYSICIAN-OFFSITE-RESIDENTS 1 1591 1591 C PROV3285 INDICATES IF PHYSICIAN SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHYS-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYSICIAN-ONSITE-NON RESIDENT 1 1592 1592 C PROV3280 INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHYS-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYSICIAN-ONSITE-RESIDENTS 1 1593 1593 C PROV3275 INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHYS-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PODIATRY-OFFSITE-RESIDENTS 1 1594 1594 C PROV3450 INDICATES IF PODIATRY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PODIATRY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PODIATRY-ONSITE-NON RESIDENTS 1 1595 1595 C PROV3445 INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PODIATRY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PODIATRY-ONSITE-RESIDENTS 1 1596 1596 C PROV3440 INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PODIATRY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SOCIAL WORK-OFFSITE-RESIDENTS 1 1597 1597 C PROV3405 INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-MED-SOC-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 33 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: SOCIAL WORK-ONSITE-NON RESID 1 1598 1598 C PROV3400 INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-MED-SOC-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SOCIAL WORK-ONSITE-RESIDENTS 1 1599 1599 C PROV3395 INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-MED-SOC-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SPEECH PATH-OFFSITE-RESIDEN 1 1600 1600 C PROV3420 INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-SPEECH-PH-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SPEECH PATH-ONSITE-NON RESID 1 1601 1601 C PROV3415 INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-SPEECH-PH-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SPEECH PATH-ONSITE-RESIDENTS 1 1602 1602 C PROV3410 INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-SPEECH-PH-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: VOCATIONAL-OFFSITE-RESIDENTS 1 1603 1603 C PROV3480 INDICATES IF VOCATIONAL SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-VOC-GUID-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: VOCATIONAL-ONSITE-NON RESID 1 1604 1604 C PROV3475 INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-VOC-GUID-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 34 SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: VOCATIONAL-ONSITE-RESIDENTS 1 1605 1605 C PROV3470 INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-VOC-GUID-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: XRAY-OFFSITE-RESIDENTS 1 1606 1606 C PROV3510 INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-DIAG-XRAY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: XRAY-ONSITE-NON RESIDENTS 1 1607 1607 C PROV3505 INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-DIAG-XRAY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: XRAY-ONSITE-RESIDENTS 1 1608 1608 C PROV3500 INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-DIAG-XRAY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 HOME HEALTH AGENCY CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 05 HOME HEALTH AGENCIES CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00040 BLUE CROSS (CALIFORNIA) 00121 HEALTH CARE SERVICE CORPORATION 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00180 BLUE CROSS (MAINE) 00290 BLUE CROSS (NEW MEXICO) 00362 BLUE CROSS (INDEPENDENCE) 00380 BLUE CROSS (SOUTH CAROLINA) 00450 BLUE CROSS (WISCONSIN) 51051 AETNA (PETALUMA) 51100 AETNA (CLEARWATER) 51390 AETNA (FORT WASHINGTON) 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 VOL. NON-PROF. - RELIGIOUS AFF. 02 VOLUNTARY NON-PROFIT - PRIVATE 03 VOLUNTARY NON-PROFIT - OTHER 04 PROPRIETARY 05 GOVERNMENT - STATE/COUNTY 06 GOVERNMENT - COMB. GOVT & VOL. 07 GOVERNMENT - LOCAL ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE ACCREDITATION EXPIRATION DATE 6 659 664 C PROV0005 THE EXPIRATION DATE OF THE CURRENT PERIOD OF ACCREDITATION BY THE JOINT COMMITTEE ON ACCREDITATION OF HEALTH CARE ORGANIZATIONS (JCAHO) OR THE AMERICAN OSTEOPATHIC ASSOCIATION (AOA). COBOL NAME: ACCRED-EXP-DT DIETITIANS 7.2 765 771 N PROV0820 NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED BY A FACILITY. COBOL NAME: NUM-DIETICIANS LICENSED PRACTICAL NURSES 7.2 779 785 N PROV0955 NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL OR VOCATIONAL NURSES EMPLOYED BY A FACILITY. COBOL NAME: NUM-LPN-LVN OCCUPATIONAL THERAPISTS 7.2 788 794 N PROV1050 THE NUMBER OF FULL TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-OCCUP-THERAPISTS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME OTHER PERSONNEL 7.2 795 801 N PROV1075 THE NUMBER OF FULL-TIME EQUIVALENT OTHER SALARIED PERSONNEL EMPLOYED BY A FACILITY. COBOL NAME: NUM-OTHER-PERSNL PROGRAM PARTICIPATION 1 823 823 C PROV1670 INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE, MEDICAID, OR BOTH PROGRAMS. COBOL NAME: PROG-PARTCI VALUES: 1 MEDICARE ONLY 2 MEDICAID ONLY 3 MEDICARE AND MEDICAID REGIONAL OVERRIDE #2 (STAFFING) 1 842 842 C PROV1550 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-2 VALUES: Y RECORD HAS BEEN APPROVED REGISTERED NURSES 7.2 844 850 N PROV1145 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED PROFESSIONAL NURSES EMPLOYED BY A PROVIDER. COBOL NAME: NUM-REG-NURS REGISTERED PHARMACISTS 7.2 851 857 N PROV1100 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED PHARMACISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-PHARMACIST-REG RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM SRV: OCCUPATIONAL THERAPY 1 917 917 C PROV2270 INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-OCCUP-THERAPY VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: PHARMACY 1 926 926 C PROV2365 INDICATES HOW PHARMACY SERVICES ARE PROVIDED. COBOL NAME: SP-PHARMACY VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: PHYSICAL THERAPY 1 927 927 C PROV2370 INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-PHYSICAL-THERAPY VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION AIDE TRAINING/COMPETENCY PROGRAMS 1 1609 1609 C PROV0555 INDICATES HOW THE AGENCY PROVIDES HOME HEALTH AIDE TRAINING AND COMPETENCY EVALUATION PROGRAMS. COBOL NAME: HHA-PROVIDES-DIRECT VALUES: 1 AIDE TRAINING 2 COMPETENCY EVALUATION PROG. 3 BOTH 4 NEITHER BRANCH OPERATION INDICATOR 1 1610 1610 C PROV1525 INDICATES IF THE AGENCY OPERATES ANY BRANCHES. COBOL NAME: OPERS-BRANCHES VALUES: N NO Y YES BRANCHES 2 1611 1612 N PROV0745 THE NUMBER OF BRANCHES OPERATED BY THE AGENCY. COBOL NAME: NUM-BRANCHES CHANGE OF OWNERSHIP INDICATOR 1 1613 1613 C PROV0105 INDICATES IF A HOME HEALTH AGENCY HAS UNDERGONE A CHANGE OF OWNERSHIP SINCE THE LAST SURVEY. COBOL NAME: CHOW-IND VALUES: N NO Y YES HHA QUALIFIED FOR OPT 1 1614 1614 C PROV0560 INDICATES IF A HOME HEALTH AGENCY IS QUALIFIED TO PROVIDE OUTPATIENT PHYSICAL THERAPY/SPEECH SERVICES. COBOL NAME: HHA-QUAL-FOR-OPT VALUES: N NO Y YES HOME HEALTH AIDES 7.2 1615 1621 N PROV0910 NUMBER OF FULL-TIME EQUIVALENT HOME HEALTH AIDES EMPLOYED BY A HOME HEALTH AGENCY OR HOSPICE. COBOL NAME: NUM-HOME-HEALTH-AIDES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME HOSPICE INDICATOR 1 1622 1622 C PROV0665 INDICATES IF THE HOME HEALTH AGENCY ALSO PARTICIPATES IN THE MEDICARE PROGRAM AS A HOSPICE. COBOL NAME: MEDICARE-CERT-HOSPICE VALUES: N NO Y YES MEDICARE HOSPICE PROVIDER NUMBER 6 1623 1628 C PROV0570 IF THE AGENCY ALSO PARTICIPATES IN THE MEDICARE PROGRAM AS A HOSPICE, THE HOSPICE PROVIDER NUMBER. COBOL NAME: HOSPICE-PROV-NUM MEDICARE/MEDICAID PROVIDER NUMBER 6 1629 1634 C PROV0650 IF THE AGENCY IS BASED IN ANOTHER MEDICARE OR MEDICAID FACILITY, THE PROVIDER NUMBER OF THAT FACILITY. COBOL NAME: MEDICAID-CARE-VEND-NUM PHYSICAL THERAPISTS 7.2 1635 1641 N PROV1120 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-PHYS-THERAPISTS SOCIAL WORKERS 7.2 1642 1648 N PROV1185 THE NUMBER OF FULL TIME EQUIVALENT SOCIAL WORKERS EMPLOYED BY THE AGENCY. COBOL NAME: NUM-SOCIAL-WRKS SPEECH PATHOLOGISTS, AUDIOLOGISTS 7.2 1649 1655 N PROV1220 THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS OR AUDIOLOGISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-SPEECH-PATH-AUDIO SRV: APPLIANCE AND EQUIPMENT 1 1656 1656 C PROV2075 INDICATES HOW APPLIANCE AND EQUIPMENT SERVICES ARE PROVIDED BY A HOME HEALTH AGENCY. COBOL NAME: SP-APPLIANCE-EQUIP VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: HOME HEALTH AIDE/HOMEMAKER 1 1657 1657 C PROV2155 INDICATES HOW HOME HEALTH AIDE SERVICES ARE PROVIDED BY A HOME HEALTH AGENCY. COBOL NAME: SP-HH-AIDE-HOMEMAKER VALUES: 0 NOT PROVIDED 1 PROVIDED BY AGENCY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 19 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: INTERNS AND RESIDENTS 1 1658 1658 C PROV2195 INDICATES HOW INTERN AND RESIDENT SERVICES ARE PROVIDED BY A HOME HEALTH AGENCY. COBOL NAME: SP-INTERNS-RESIDENTS VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: MEDICAL SOCIAL 1 1659 1659 C PROV2220 INDICATES HOW MEDICAL SOCIAL SERVICES ARE PROVIDED COBOL NAME: SP-MEDICAL-SOCIAL VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: NURSING 1 1660 1660 C PROV2250 INDICATES HOW NURSING SERVICES ARE PROVIDED. COBOL NAME: SP-NURSING VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION 7 COMBINATION SRV: NUTRITIONAL GUIDANCE 1 1661 1661 C PROV2255 INDICATES HOW NUTRITIONAL GUIDANCE SERVICES ARE PROVIDED. COBOL NAME: SP-NUTRITION-GUIDANCE VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: OTHER 1 1662 1662 C PROV2340 INDICATES HOW OTHER (NOT SPECIFIED) SERVICES ARE PROVIDED. COBOL NAME: SP-OTHER VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: SPEECH THERAPY 1 1663 1663 C PROV2520 INDICATES HOW SPEECH THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-SPEECH-THERAPY VALUES: 0 NOT PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 20 HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: VOCATIONAL GUIDANCE 1 1664 1664 C PROV2535 INDICATES HOW VOCATIONAL GUIDANCE SERVICES ARE PROVIDED COBOL NAME: SP-VOCAT-GUIDANCE VALUES: 0 NOT PROVIDED 1 PROVIDED BY AGENCY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SUBUNIT INDICATOR 1 1665 1665 C PROV2725 INDICATES IF THE AGENCY IS A SUBUNIT OF ANOTHER AGENCY. COBOL NAME: SUBUNIT-IND VALUES: N NO Y YES SUBUNIT OPERATION INDICATOR 1 1666 1666 C PROV1530 INDICATES IF THE AGENCY OPERATES ANY SUBUNITS. COBOL NAME: OPERS-SUBUNITS VALUES: N NO Y YES SUBUNITS 2 1667 1668 N PROV1240 THE NUMBER OF SUBUNITS OPERATED BY THE AGENCY. COBOL NAME: NUM-SUBUNITS SRV: LABORATORY 1 2065 2065 C PROV2200 INDICATES HOW LABORATORY SERVICES ARE PROVIDED. COBOL NAME: SP-LABORATORY VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 LABORATORY CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 06 MEDICARE LABORATORIES CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00510 BLUE SHIELD (ALABAMA) 00520 BLUE SHIELD (ARKANSAS) 00528 BLUE SHIELD (ARKANSAS/LOUISIANA) 00542 BLUE SHIELD (CALIFORNIA) 00550 BLUE SHIELD (COLORADO) 00570 BLUE SHIELD (DELAWARE) 00580 BLUE SHIELD (DISTRICT OF COLUMBIA) 00590 BLUE SHIELD (FLORIDA) 00621 BLUE SHIELD (ILLINOIS) 00630 BLUE SHIELD (INDIANA) 00640 BLUE SHIELD (IOWA) 00650 BLUE SHIELD (KANSAS) 00655 BLUE SHIELD (KANSAS/NEBRASKA) 00660 BLUE SHIELD (KENTUCKY) 00690 BLUE SHIELD (MARYLAND) 00700 BLUE SHIELD (MASSACHUSETTS) 00710 BLUE SHIELD (MICHIGAN) 00720 BLUE SHIELD (MINNESOTA) 00740 BLUE SHIELD (KANSAS CITY) 00751 BLUE SHIELD (MONTANA) 00770 BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780 BLUE SHIELD (TRI-STATE) 00801 BLUE SHIELD (BUFFALO) 00803 BLUE SHIELD (EMPIRE) 00820 BLUE SHIELD (NORTH DAKOTA) 00825 BLUE SHIELD (NORTH DAKOTA/WYOMING) 00860 BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865 BLUE SHIELD (PENNSYLVANIA) 00870 BLUE SHIELD (RHODE ISLAND) 00880 BLUE SHIELD (SOUTH CAROLINA) 00900 BLUE SHIELD (TEXAS) 00910 BLUE SHIELD (UTAH) 00930 BLUE SHIELD (WASHINGTON) 00951 WISCONSIN PHYSICIANS SERVICE 00973 BLUE SHIELD (PUERTO RICO) 00974 BLUE SHIELD (VIRGIN ISLANDS) 01010 AETNA (PEORIA) 01020 AETNA (ALASKA) 01030 AETNA (ARIZONA) 01040 AETNA (GEORGIA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 01120 AETNA (HAWAII) 01290 AETNA (NEVADA) 01360 AETNA (NEW MEXICO) 01370 AETNA (OKLAHOMA) 01380 AETNA (OREGON) 02050 OCCIDENTAL (CALIFORNIA) 05130 EQICOR (IDAHO) 05440 EQICOR (TENNESSEE) 05535 EQICOR (NORTH CAROLINA) 10071 TRAVELERS (RRB) 10230 TRAVELERS (CONNECTICUT) 10240 TRAVELERS (MINNESOTA) 10250 TRAVELERS (MISSISSIPPI) 10490 TRAVELERS (VIRGINIA) 10492 TRAVELERS - VIRGINIA SPECIAL PROJECT 11260 GENERAL AMERICAN 14330 GROUP HEALTH INC (NEW YORK) 16360 NATIONWIDE (OHIO) 16510 NATIONWIDE (WEST VIRGINIA) 21200 MASSACHUSETTS/MAINE * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 VOL. NON-PROF. - RELIGIOUS AFF. 02 VOLUNTARY NON-PROFIT - PRIVATE 03 VOLUNTARY NON-PROFIT - OTHER 04 PROPRIETARY 05 GOVERNMENT - CITY 06 GOVERNMENT - COUNTY 07 GOVERNMENT - STATE 08 GOVERNMENT - FEDERAL 09 GOVERNMENT - OTHER 10 OTHER (SURVEYED PRIOR TO 040491) 11 UNKNOWN (PRIOR TO 040491 SURVEYS) ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE CALENDAR YEAR TEST VOLUME 2 1669 1670 C PROV2615 THE NUMBER OF TESTS PERFORMED BY A LAB FOR THE PRE- VIOUS CALENDAR YEAR FOR ALL SPECIALTIES AND SUB- SPECIALTIES COBOL NAME: SPEC-CALENDAR-YEAR CLIA LAB PROGRAM STATUS 1 1671 1671 C PROV0615 THE TYPE OF LABORATORY, I.E. HOSPITAL OR INDEPEDENT, AND THE PROGRAM(S) (MEDICARE, CLIA) IN WHICH THE LAB PARTICIPATES COBOL NAME: LAB-PROGRAM-STATUS VALUES: 1 INDEPENDENT MEDICARE LAB 3 INDEPENDENT MEDICARE/CLIA LAB * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CYTOTECHNOLOGISTS-PROF EXAM 3 1672 1674 N PROV0775 NUMBER OF CYTOTECHNOLOGISTS QUALIFIED UNDER CFR 405.1437(B)(3) WHICH REQUIRES SATISFACTORY GRADES IN PROFICIENCY EXAMINATIONS. COBOL NAME: NUM-CYTOTECHS-3 CYTOTECHNOLOGISTS-2 YR COLL 3 1675 1677 N PROV0765 NUMBER OF CYTOTECHNOLOGISTS QUALIFIED UNDER CFR 493.1437(B)(1) WHICH REQUIRES TWO YEARS OF COLLEGE, TWELVE MONTHS OF CYTOTECHNOLOGY TRAINING AND SIX MONTHS OF FORMAL TRAINING. COBOL NAME: NUM-CYTOTECHS-1 CYTOTECHNOLOGISTS-6 MO TRAIN 3 1678 1680 N PROV0770 # OF CYTOTECHNOLOGISTS QUALIFIED UNDER CFR CFR 493.1437(B)(2) WHICH REQUIRES THAT PRIOR TO 1/1/69, THE CYTOTECH IS A HS GRAD WITH 6 MTHS TRNG IN CYTOTECH, AND 2 YRS FULLTIME SUPERVISORY EXPER IN CYTOTECHNOLOGY COBOL NAME: NUM-CYTOTECHS-2 GENERAL SUPERVISOR - CYTOTECH 3 1681 1683 N PROV0880 THE NUMBER OF LAB GENERAL SUPERVISORS, QUALIFIED UNDER CFR 493.1427(B)(5), WHO HAVE FOUR YEARS EXPERIENCE AS CYTOTECHNOLOGISTS. COBOL NAME: NUM-GN-SUP-CYTOTECH GENERAL SUPERVISOR - GRANDFATHERED 3 1684 1686 N PROV0885 THE NUMBER OF LAB GENERAL SUPERVISORS QUALIFIED PRIOR TO 7/1/71 WITH AT LEAST 15 YEARS FULL-TIME EXPERIENCE PRIOR TO 1/1/68. (SEE CFR 493.1427(B)(6). COBOL NAME: NUM-GN-SUP-GRFATHER GENERAL SUPERVISOR - MD/DOCTORATE 3 1687 1689 N PROV0895 THE NUMBER OF LAB GENERAL SUPERVISORS, QUALIFIED UNDER CFR 493.1427(B)(2) WHO ARE PHYSICIANS OR HAVE DOCTORAL DEGREES IN A CLINICAL, PHYSICAL OR BIOLOGICAL SCIENCE AND 2 YEARS EXPERIENCE IN A LABORATORY. COBOL NAME: NUM-GN-SUP-PHYS-DOCT GENERAL SUPERVISOR - QUALIFIED DIR 3 1690 1692 N PROV0900 THE NUMBER OF GENERAL SUPERVISORS QUALIFIED UNDER CFR 493.1427(B)(1) WHO MAY ALSO SERVE AS THE LABORATORY DIRECTOR COBOL NAME: NUM-GN-SUP-QUALIF GENERAL SUPERVISOR - 6 YRS EXP 3 1693 1695 N PROV0875 THE NUMBER OF LAB GENERAL SUPERVISORS, QUALIFIED UNDER CFR 493.1427(B)(4), WHO ARE LAB TECHNOLOGISTS WITH AT LEAST 6 YRS FULL-TIME LAB EXPERIENCE. COBOL NAME: NUM-GN-SUP-CLT-PLUS6 GENERAL SUPERVISOR-MASTERS DEGREE 3 1696 1698 N PROV0890 THE NUMBER OF LAB GENERAL SUPERVISORS QUALIFIED UNDER CFR 493.1427(B)32) WHO POSSESS MASTER'S DEGREES IN A CHEMICAL, PHYSICAL OR BIOLOGICAL SCIENCE AND HAVE AT LEAST 4 YEARS LAB EXPERIENCE. COBOL NAME: NUM-GN-SUP-MST-DEGREE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME IMMUNOHEMATOLOGY TEST FOR TRANSFUS 1 1699 1699 C PROV2085 INDICATES IF A LABORATORY PERFORMS IMMUNOHEMATOLOGY TESTS FOR TRANSFUSION PURPOSES COBOL NAME: SP-BLOOD-BANK-IMMUN VALUES: N NO Y YES LAB DIRECTORS - DOCTORATES 3 1700 1702 N PROV0830 THE NUMBER OF LAB DIRECTORS QUALIFIED UNDER CFR 493.1415(B)(4), WHICH REQUIRES DOCTORAL DEGREES AND BOARD CERTIFICATION OR 4 OR MORE YEARS EXPERIENCE IN AN APPROVED CLINICAL LABORATORY. COBOL NAME: NUM-DIR-DOCT-DEGREE LAB DIRECTORS - GRANDFATHERED 3 1703 1705 N PROV0835 THE NUMBER OF LAB DIRECTORS QUALIFIED UNDER CFR 493.1415(B)(5) WHO QUALIFIED PRIOR TO JULY 1, 1971, UNDER THE GRANDFATHER CLAUSE. COBOL NAME: NUM-DIR-GRFATHER LAB DIRECTORS - MD PATHOLOGISTS 3 1706 1708 N PROV0840 THE NUMBER OF LAB DIRECTORS QUALIFIED UNDER CFR 493.1415(B)(1) WHO ARE PHYSICIANS BOARD CERTIFIED IN ANATOMICAL AND/OR CLINICAL PATHOLOGY OR POSSESS EQUIVALENT QUALIFICATIONS. COBOL NAME: NUM-DIR-PATHOLOGIST LAB DIRECTORS - MD SPECIALTY 3 1709 1711 N PROV0845 THE NUMBER OF LAB DIRECTORS QUALIFIED UNDER CFR 493.1415(B)(2), WHO ARE PHYSICIANS BOARD CERTIFIED IN ONE OF THE LAB SPECIALTIES OR WHO HAVE 4 YEARS OF FT EXPERIENCE IN A LAB, INCLUDING 2 YEARS SPECIALIZED TRNG COBOL NAME: NUM-DIR-PHYS-BOARD LAB DIRECTORS - ORAL PATHOLOGY 3 1712 1714 N PROV0825 NUMBER OF LABORATORY DIRECTORS WHO ARE BOARD CERTIFIED IN ORAL PATHOLOGY OR_WHO POSSESS EQUIVALENT QUALIFICATIONS._SEE CFR 493.1415(B)(3) COBOL NAME: NUM-DIR-DENTIST LAB DIRECTORS - STATE DEEMED 3 1715 1717 N PROV0850 NUMBER OF DIRECTORS THAT QUALIFY UNDER STATE LAW TO DIRECT THE LABORATORY (CFR 493.1415(B)(6)). COBOL NAME: NUM-DIR-STATE-DEEMED TECH SUPER - BA/BS CHEMISTRY 3 1718 1720 N PROV1275 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(S) TO PERFORM CHEMISTRY TESTS, WHO ARE DIRECTORS WITH A BS IN CHEMICAL SCIENCE AND 6 YEARS RELATED EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-CHEM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 19 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TECH SUPER - BA/BS HEMATOLOGY 3 1721 1723 N PROV1285 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER_CFR 493.1421(O) TO PERFORM HEMATOLOGY TESTS, WHO ARE DIRECTORS WITH A BS IN BIOLOGY, IMMUNOLOGY OR MICRO- BIOLOGY, AND HAVE 6 YEARS EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-HEM TECH SUPER - BA/BS IMMUNOHEM 3 1724 1726 N PROV1290 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(R) TO PERFORM BLOOD GROUPING TESTS, WHO ARE DIRECTORS WITH A BS IN BIOLOGY, IMMUNOLOGY OR MICRO- BIOLOGY, AND 6 YEARS EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-IMHE TECH SUPER - BA/BS IMMUNOLOGY 3 1727 1729 N PROV1295 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(P) TO PERFORM DIAGNOSTIC IMMUNOLOGY TESTS, WHO ARE DIRECTORS WITH A BS IN BIOLOGY, CHEMISTRY, IMMU- NOLOGY OR MICROBIOLOGY, AND HAVE 6 YEARS EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-IMM TECH SUPER - BA/BS MICROBIO 3 1730 1732 N PROV1300 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(N) TO PERFORM MICROBIOLOGY TESTS WHO ARE DIRECTORS WITH A BS IN BIOLOGY AND 6 YEARS MICROBIOLOGY EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-MICR TECH SUPER - BA/BS RADIOBIO 3 1733 1735 N PROV1305 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(Q) TO PERFORM RADIOBIOASSAY TESTS WHO ARE DIRECTORS WITH A BS IN CHEMICAL, PHYSICAL OR BIOLOGICAL SCIENCE AND HAVE 6 YEARS EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-RADI TECH SUPER - BA/BS SPEC EXP 3 1736 1738 N PROV1280 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(T) TO PERFORM SPECIFIC LAB TESTS WHO ARE DIRECTORS WITH A BS IN MEDICAL TECHNOLOGY AND HAVE 6 YEARS SPECIALIZED EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-EXP TECH SUPER - CLINICAL CHEMISTRY 3 1739 1741 N PROV1310 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(D) TO PERFORM TESTS IN CHEM UNDER THE SUP OF A BOARD CERT MD OR HAVE EQUIV QUALIFS OR HAVE DOCT/MAST DEGREE IN CHEM AND 4 YRS EXP IN CLINICAL CHEMISTRY COBOL NAME: NUM-TECH-SUP-CHEMISTRY TECH SUPER - CYTOGENETICS 3 1742 1744 N PROV1315 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(K) TO PERFORM IN CLINICAL CYTOGENETICS WHO ARE DIRECTORS WITH A DOCTORAL DEGREE IN BIOLOGY OR PHYSICIANS AND HAVE 4 YEARS EXPERIENCE IN GENETICS COBOL NAME: NUM-TECH-SUP-CYTOGEN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 20 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TECH SUPER - CYTOLOGY 3 1745 1747 N PROV1320 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(F) TO PERFORM CYTOLOGY TESTS UNDER THE SUPERVISION OF A BOARD CERTIFIED PHYSICIAN OR WHO POSSESS EQUIVALENT QUALIFICATIONS COBOL NAME: NUM-TECH-SUP-CYTOLOGY TECH SUPER - DIAGNOSTIC IMMUN 3 1748 1750 N PROV1345 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(C) TO PERFORM TESTS IN DIAGNOSTIC IMMUN- OLOGY UNDER THE SUP OF A BOARD CERT MD OR HAVE EQUIV QUALIFS OR HAVE DOCT/MAST DEGREE IN RELATED SCIENCES COBOL NAME: NUM-TECH-SUP-IMMUNOL TECH SUPER - HEMATOLOGY 3 1751 1753 N PROV1330 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(E) TO PERFORM HEMATOLOGY TESTS UNDER SUPERVISION OF A BOARD CERT MD OR WHO POSSESS BS OR MS DEGREES IN RELATED SCIENCES AND 4 YRS HEMATOLOGY EXPER. COBOL NAME: NUM-TECH-SUP-HEMATOLOGY TECH SUPER - HISTO PATHOLOGY 3 1754 1756 N PROV1325 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(G) TO PERFORM TESTS IN HISTOPATHOLOGY UNDER THE SUPERVISION OF A BOARD CERTIFIED MD OR WHO POSSESS EQUIVALENT QUALIFICATIONS COBOL NAME: NUM-TECH-SUP-DERMATOLGY TECH SUPER - HISTOCOMPATIBILITY 3 1757 1759 N PROV1335 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(J)TO PERFORM TESTS IN HISTO UNDER SUP OF MD OR WHO POSSESS DOCT DEGREES OR ARE MD'S WITH 4 YRS EXP IN IMMUNOLOGY INCLUDING 2 YRS OF HISTO TESTING COBOL NAME: NUM-TECH-SUP-HISTOCOM TECH SUPER - IMMUNOHEMATOLOGY 3 1760 1762 N PROV1340 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(L) TO PERFORM TESTS IN IMMUNOHEMATOLOGY UNDER SUP OF A BOARD CERT MD OR HAVE EQUIV QUALIFS OR ARE PHYSICIANS WITH 2 YRS EXP IN IMMUNOHEMATOLOGY COBOL NAME: NUM-TECH-SUP-IMMUNOHEM TECH SUPER - MICROBIOLOGY 3 1763 1765 N PROV1350 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(B) TO PERFORM MICRO TESTS UNDER SUPERV OF A BOARD CERT MD, OR WHO HOLD DOCTORAL OR MASTER DEGREES IN MICRO AND HAVE 4 YRS EXP IN CLINICAL MICROBIOLOGY COBOL NAME: NUM-TECH-SUP-MICROBIO TECH SUPER - ORAL PATHOLOGY 3 1766 1768 N PROV1355 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(H) TO PERFORM TESTS IN ORAL PATHOLOGY UNDER SUPERVISION OF A BOARD CERT MD OR WHO HAVE EQUIVALENT QUALIFICATIONS COBOL NAME: NUM-TECH-SUP-ORAL-PATH * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 21 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TECH SUPER - PATHOLOGIST 3 1769 1771 N PROV1360 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(A) TO PERFORM ALL BUT HISTOCOMPATIBILITY AND CLINICAL CYTOGENETICS WHO ARE MD'S CERT IN BOTH ANATOMICAL AND CLINICAL PATH OR HAVE EQUIV QUALIFICATNS COBOL NAME: NUM-TECH-SUP-PATHOLOGY TECH SUPER - PHS EXAM 3 1772 1774 N PROV1365 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(M) WITH SATISFACTORY GRADES IN EXAMINATIONS CONDUCTED BY THE PUBLIC HEALTH SERVICE. COBOL NAME: NUM-TECH-SUP-PHS-EXAM TECH SUPER - RADIOBIOASSAY 3 1775 1777 N PROV1370 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(I) WHO ARE BOARD CERT MD'S OR WHO HAVE A DOCTORATE/MASTERS/BACH DEGREE IN RELATED SCIENCES OR ARE PHYSICIANS WITH 4 YEARS EXP IN RADIOBIOASSAY COBOL NAME: NUM-TECH-SUP-RADIOBIO TECHNICIAN TRAINEES 3 1778 1780 N PROV1375 THE NUMBER OF TECHNICIAN TRAINEES IN LABORATORIES WHO ARE HIGH SCHOOL GRADUATES AND WHO ARE RECEIVING THE REQUIRED 2 YEARS LAB EXPERIENCE AND ARE PARTICIPATING IN A STRUCTURED TRAINING PROGRAM.(CFR 493.1402) COBOL NAME: NUM-TECH-TRAINEES TECHNICIANS - GRANDFATHERED 3 1781 1783 N PROV1245 THE NUMBER OF TECHNICIANS QUALIFIED UNDER CFR 493.1441(B)(5) WHO WAS PERFORMING THE DUTIES OF A LAB TECHNICIAN BETWEEN 7/1/61 & 1/1/68 AND HAS AT LEAST 5 YEARS EXPERIENCE PRIOR TO 1/1/68. COBOL NAME: NUM-TECH-GRFATHER TECHNICIANS - MILITARY 3 1784 1786 N PROV1260 THE NUMBER OF TECHNICIANS QUALIFIED UNDER CFR 493.1441(B)(4) WHO COMPLETED AN OFFICIAL MILITARY MEDICAL LABORATORY PROCEDURES COURSE OF AT LEAST 50 WEEKS DURATION. COBOL NAME: NUM-TECH-MILITARY TECHNICIANS - PROFICIENCY EXAM 3 1787 1789 N PROV1265 THE NUMBER OF TECHNICIANS QUALIFIED UNDER CFR 493.1441(B)(6) WHO ACHIEVED A SATISFACTORY GRADE IN AN APPROVED PROFICIENCY EXAMINATION PRIOR TO 12/31/77. COBOL NAME: NUM-TECH-PES-EXAM TECHNICIANS-AA PLUS 60 CREDIT HRS 3 1790 1792 N PROV1380 THE NUMBER OF LABORATORY TECHNICIANS WHO HAVE COMPLETED EITHER 60 HOURS OF ACADEMIC CREDIT OR HAVE ASSOCIATE DEGREES IN A COURSE OF STUDY THAT INCLUDES MEDICAL LABORATORY TECHNIQUES (CFR 493.1441(B)(1). COBOL NAME: NUM-TECH-60-CREDITS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 22 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TECHNICIANS-HIGH SCH + EXPERIENCE 3 1793 1795 N PROV1255 THE NUMBER OF TECHNICIANS QUALIFIED UNDER CFR 493.1441(B)(3) WHO ARE HIGH SCHOOL GRADUATES AND HAVE TWO YEARS OF PERTINENT LABORATORY EXPERIENCE. COBOL NAME: NUM-TECH-HS-AND-2YR TECHNICIANS-HIGH SCH + TRAINING 3 1796 1798 N PROV1250 THE NUMBER OF TECHNICIANS QUALIFIED UNDER CFR 493.1441(B)(2) WHO COMPLETED HIGH SCHOOL AND ONE YEAR IN A TECHNICIAN TRAINING PROGRAM. COBOL NAME: NUM-TECH-HS-AND-1YR TECHNOLOGIST - BACHELORS DEGREE 3 1799 1801 N PROV1385 THE NUMBER OF LAB TECHNOLOGISTS WHO HAVE EARNED BACHELOR'S DEGREES IN CHEMICAL, BIOLOGICAL, OR PHYSICAL SCIENCE AND HAVE ONE YEAR EXPERIENCE/TRAINING IN RELATED SPECIALTY (CFR 493.1433(B)(3)). COBOL NAME: NUM-TECHNOLO-BS-BA TECHNOLOGIST - BS MED TECH 3 1802 1804 N PROV1390 THE NUMBER OF TECHNOLOGISTS WHO HAVE EARNED BACHELOR'S DEGREES IN MEDICAL TECHNOLOGY (CFR 493.1433(B)(1)). COBOL NAME: NUM-TECHNOLO-BS-MT TECHNOLOGIST - GRANDFATHERED 3 1805 1807 N PROV1395 THE NUMBER OF TECHNOLOGISTS WHO QUALIFIED PRIOR TO JULY 1, 1971 & WHO WERE PERFORMING AS TECHNOLOGISTS BETWEEN 7/1/61 & 1/1/68 & HAVE AT LEAST TEN YEARS LAB EXPERIENCE PRIOR TO 1/1/68 (CFR 493.1433(B)(5)). COBOL NAME: NUM-TECHNOLO-GRFATHER TECHNOLOGIST - PROFICIENCY EXAM 3 1808 1810 N PROV1400 THE NUMBER OF TECHNOLOGISTS WHO HAVE ACHIEVED A SATISFACTORY GRADE IN A PROFICIENCY EXAM APPROVED BY THE SECRETARY (CFR 493.1433(B)(6)). COBOL NAME: NUM-TECHNOLO-PES-EXAM TECHNOLOGIST - 90 HRS + EXP 3 1811 1813 N PROV1410 THE NUMBER OF TECHNOLOGISTS WHO HAVE COMPLETED THREE YEARS (90 SEMESTER HOURS) OF PERTINENT ACADEMIC STUDIES OUTLINED IN CFR 493.1433(B)(4) AND HAVE ONE YEAR OF LAB EXPERIENCE COBOL NAME: NUM-TECHNOLO-90CR-1YR TECHNOLOGIST - 90 HRS + TRAINING 3 1814 1816 N PROV1405 THE NUMBER OF TECHNOLOGISTS WHO HAVE COMPLETED THREE YEARS (90 SEMESTER HOURS) OF ACADEMIC STUDY AND COM- PLETED AT LEAST ONE YEAR TRAINING IN A SCHOOL OF MEDICAL TECHNOLOGY (CFR 493.1433(B)(2). COBOL NAME: NUM-TECHNOLO-3YR-1YR 010 HISTOCOMPATIBILITY 1 1817 1817 C PROV1865 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-010-HISTOCOMPAT VALUES: N NOT APPROVED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 23 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME Y APPROVED 010A TRANSPLANT 1 1818 1818 C PROV1870 INDICATES IF A LABORATORY IS APPROVED TO PERFORM TESTS IN THIS SUBSPECIALTY COBOL NAME: SC-010A-TRANSPLANT VALUES: N NOT APPROVED Y APPROVED 010B NON-TRANSPLANT 1 1819 1819 C PROV1875 INDICATES IF A LABORATORY IS APPROVED TO PERFORM TESTS IN THIS SUBSPECIALTY COBOL NAME: SC-010B-NON-TRANSPLANT VALUES: N NOT APPROVED Y APPROVED 100 MICROBIOLOGY 1 1820 1820 C PROV1880 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-100-MICROBIO VALUES: N NOT APPROVED Y APPROVED 110 BACTERIOLOGY 1 1821 1821 C PROV1885 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-110-BACTERIOLOGY VALUES: N NOT APPROVED Y APPROVED 110C MYCOBACTERIOLOGY 1 1822 1822 C PROV1890 INDICATES IF A LABORATORY IS APPROVED TO PERFORM TESTS IN MYCOBACTERIOLOGY, WHICH IS WITHIN THE BACTERIOLOGY SUBSPECIALTY COBOL NAME: SC-110C-MYCOBACT VALUES: N NOT APPROVED Y APPROVED 120 MYCOLOGY 1 1823 1823 C PROV1895 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-120-MYCOLOGY VALUES: N NOT APPROVED Y APPROVED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 24 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 130 PARASITOLOGY 1 1824 1824 C PROV1900 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-130-PARASITOLOGY VALUES: N NOT APPROVED Y APPROVED 140 VIROLOGY 1 1825 1825 C PROV1910 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-140-VIROLOGY VALUES: N NOT APPROVED Y APPROVED 150 OTHER MICROBIOLOGY 1 1826 1826 C PROV1915 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-150-OTHER-MICROBIO VALUES: N NOT APPROVED Y APPROVED 200 DIAGNOSTIC IMMUNOLOGY 1 1827 1827 C PROV1920 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-200-DIAG-IMMUNOL VALUES: N NOT APPROVED Y APPROVED 210 SYPHILIS 1 1828 1828 C PROV1925 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-210-SYPHILIS VALUES: N NOT APPROVED Y APPROVED 220 GEN IMMUNOLOGY 1 1829 1829 C PROV1930 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-220-GEN-IMMUNOL VALUES: N NOT APPROVED Y APPROVED 300 CHEMISTRY 1 1830 1830 C PROV1935 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-300-CHEMISTRY VALUES: N NOT APPROVED Y APPROVED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 25 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 310 ROUTINE CHEMISTRY 1 1831 1831 C PROV1940 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-310-ROUTINE VALUES: N NOT APPROVED Y APPROVED 320 URINALYSIS 1 1832 1832 C PROV1945 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-320-URINALYSIS VALUES: N NOT APPROVED Y APPROVED 330 OTHER CHEMISTRY 1 1833 1833 C PROV1950 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-330-OTHER-CHEMISTRY VALUES: N NOT APPROVED Y APPROVED 330D ENDOCRINOLOGY 1 1834 1834 C PROV1955 INDICATES IF A LABORATORY IS APPROVED TO PERFORM TESTS IN ENDOCRINOLOGY, WHICH IS WITHIN THE OTHER CHEMISTRY SUBSPECIALTY COBOL NAME: SC-330D-ENDOCRINOLOGY VALUES: N NOT APPROVED Y APPROVED 330E TOXICOLOGY 1 1835 1835 C PROV1960 INDICATES IF A LABORATORY IS APPROVED TO PERFORM TESTS IN TOXICOLOGY, WHICH IS WITHIN THE OTHER CHEMISTRY SUBSPECIALTY COBOL NAME: SC-330E-TOXICOLOGY VALUES: N NOT APPROVED Y APPROVED 400 HEMATOLOGY 1 1836 1836 C PROV1965 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-400-HEMATOLOGY VALUES: N NOT APPROVED Y APPROVED 500 IMMUNOHEMATOLOGY 1 1837 1837 C PROV1970 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-500-IMMUNOHEM VALUES: * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 26 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME N NOT APPROVED Y APPROVED 510 ABO + RH GROUP 1 1838 1838 C PROV1975 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-510-ABO-RH-GROUP VALUES: N NOT APPROVED Y APPROVED 520 RH TITERS 1 1839 1839 C PROV1980 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-520-RH-TITERS VALUES: N NOT APPROVED Y APPROVED 530 COMPATIBILITY TEST 1 1840 1840 C PROV1985 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-530-CROSS-MATCH VALUES: N NOT APPROVED Y APPROVED 540 ANTIBODY DETECT + OTHER 1 1841 1841 C PROV1990 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-540-OTHER-IMMUNOHEM VALUES: N NOT APPROVED Y APPROVED 600 PATHOLOGY 1 1842 1842 C PROV1995 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-600-PATHOLOGY VALUES: N NOT APPROVED Y APPROVED 610 HISTOPATHOLOGY 1 1843 1843 C PROV2000 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-610-HISTOPATH VALUES: N NOT APPROVED Y APPROVED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 27 MEDICARE LABORATORIES, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 620 ORAL PATHOLOGY 1 1844 1844 C PROV2005 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-620-ORAL VALUES: N NOT APPROVED Y APPROVED 630 CYTOLOGY 1 1845 1845 C PROV2010 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-630-CYTOLOGY VALUES: N NOT APPROVED Y APPROVED 800 RADIOBIOASSAY 1 1846 1846 C PROV2015 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-800-RADIOBIO VALUES: N NOT APPROVED Y APPROVED 900 CYTOGENETICS 1 1847 1847 C PROV2020 INDICATES IF A LABORATORY IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY COBOL NAME: SC-900-CYTOGENETICS VALUES: N NOT APPROVED Y APPROVED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 X-RAY CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 07 PORTABLE X-RAY SUPPLIERS CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00510 BLUE SHIELD (ALABAMA) 00520 BLUE SHIELD (ARKANSAS) 00528 BLUE SHIELD (ARKANSAS/LOUISIANA) 00542 BLUE SHIELD (CALIFORNIA) 00550 BLUE SHIELD (COLORADO) 00570 BLUE SHIELD (DELAWARE) 00580 BLUE SHIELD (DISTRICT OF COLUMBIA) 00590 BLUE SHIELD (FLORIDA) 00621 BLUE SHIELD (ILLINOIS) 00630 BLUE SHIELD (INDIANA) 00640 BLUE SHIELD (IOWA) 00650 BLUE SHIELD (KANSAS) 00655 BLUE SHIELD (KANSAS/NEBRASKA) 00660 BLUE SHIELD (KENTUCKY) 00690 BLUE SHIELD (MARYLAND) 00700 BLUE SHIELD (MASSACHUSETTS) 00710 BLUE SHIELD (MICHIGAN) 00720 BLUE SHIELD (MINNESOTA) 00740 BLUE SHIELD (KANSAS CITY) 00751 BLUE SHIELD (MONTANA) 00770 BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780 BLUE SHIELD (TRI-STATE) 00801 BLUE SHIELD (BUFFALO) 00803 BLUE SHIELD (EMPIRE) 00820 BLUE SHIELD (NORTH DAKOTA) 00825 BLUE SHIELD (NORTH DAKOTA/WYOMING) 00860 BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865 BLUE SHIELD (PENNSYLVANIA) 00870 BLUE SHIELD (RHODE ISLAND) 00880 BLUE SHIELD (SOUTH CAROLINA) 00900 BLUE SHIELD (TEXAS) 00910 BLUE SHIELD (UTAH) 00930 BLUE SHIELD (WASHINGTON) 00951 WISCONSIN PHYSICIANS SERVICE 00973 BLUE SHIELD (PUERTO RICO) 00974 BLUE SHIELD (VIRGIN ISLANDS) 01010 AETNA (PEORIA) 01020 AETNA (ALASKA) 01030 AETNA (ARIZONA) 01040 AETNA (GEORGIA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 01120 AETNA (HAWAII) 01290 AETNA (NEVADA) 01360 AETNA (NEW MEXICO) 01370 AETNA (OKLAHOMA) 01380 AETNA (OREGON) 02050 OCCIDENTAL (CALIFORNIA) 05130 EQICOR (IDAHO) 05440 EQICOR (TENNESSEE) 05535 EQICOR (NORTH CAROLINA) 10071 TRAVELERS (RRB) 10230 TRAVELERS (CONNECTICUT) 10240 TRAVELERS (MINNESOTA) 10250 TRAVELERS (MISSISSIPPI) 10490 TRAVELERS (VIRGINIA) 10492 TRAVELERS - VIRGINIA SPECIAL PROJECT 11260 GENERAL AMERICAN 14330 GROUP HEALTH INC (NEW YORK) 16360 NATIONWIDE (OHIO) 16510 NATIONWIDE (WEST VIRGINIA) 21200 MASSACHUSETTS/MAINE * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 INDIVIDUAL 02 PARTNERSHIP 03 CORPORATION 04 OTHER THAN PRIVATE ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE OTHER PERSONNEL 7.2 795 801 N PROV1075 THE NUMBER OF FULL-TIME EQUIVALENT OTHER SALARIED PERSONNEL EMPLOYED BY A FACILITY. COBOL NAME: NUM-OTHER-PERSNL DIRECTOR QUALIFICATIONS 1 1848 1848 C PROV1715 INDICATES THE QUALIFICATIONS OF THE DIRECTOR OF A SUPPLIER OF PORTABLE X-RAY SERVICES. COBOL NAME: QUAL-OF-DIRECTOR VALUES: 1 PHYSICIAN 2 PHD/SCD 3 MS/MA 4 BS/BA 5 OTHER TECHNOLOGISTS - ASSOC DEGREE 7.2 1849 1855 N PROV0735 THE NUMBER OF TECHNOLOGISTS WITH ASSOCIATE DEGREES IN RADIOLOGIC TECHNOLOGY. COBOL NAME: NUM-AS-RADIO-TECH * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TECHNOLOGISTS - BS/BA DEGREE 7.2 1856 1862 N PROV0750 NUMBER OF TECHNOLOGISTS WITH BACHELOR OF SCIENCE OR BACHELOR OF ARTS DEGREES IN RADIOLOGIC TECHNOLOGY. COBOL NAME: NUM-BS-BA-RAD-TECH TECHNOLOGISTS - 2 YEAR RADIOLOGY 7.2 1863 1869 N PROV1515 THE NUMBER OF FULL-TIME EQUIVALENT TECHNOLOGISTS EMPLOYED BY A PORTABLE X-RAY PROVIDER WHO ARE GRADUATES OF A TWO YEAR APPROVED SCHOOL OF RADIOLOGIC TECHNOLOGY. COBOL NAME: NUM-2YR-RADIO-TECH * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 OPT OR SPECH PATHOLOGY CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 08 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 00510 BLUE SHIELD (ALABAMA) 00520 BLUE SHIELD (ARKANSAS) 00528 BLUE SHIELD (ARKANSAS/LOUISIANA) 00542 BLUE SHIELD (CALIFORNIA) 00550 BLUE SHIELD (COLORADO) 00570 BLUE SHIELD (DELAWARE) 00580 BLUE SHIELD (DISTRICT OF COLUMBIA) 00590 BLUE SHIELD (FLORIDA) 00621 BLUE SHIELD (ILLINOIS) 00630 BLUE SHIELD (INDIANA) 00640 BLUE SHIELD (IOWA) 00650 BLUE SHIELD (KANSAS) 00655 BLUE SHIELD (KANSAS/NEBRASKA) 00660 BLUE SHIELD (KENTUCKY) 00690 BLUE SHIELD (MARYLAND) 00700 BLUE SHIELD (MASSACHUSETTS) 00710 BLUE SHIELD (MICHIGAN) 00720 BLUE SHIELD (MINNESOTA) 00740 BLUE SHIELD (KANSAS CITY) 00751 BLUE SHIELD (MONTANA) 00770 BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780 BLUE SHIELD (TRI-STATE) 00801 BLUE SHIELD (BUFFALO) 00803 BLUE SHIELD (EMPIRE) 00820 BLUE SHIELD (NORTH DAKOTA) 00825 BLUE SHIELD (NORTH DAKOTA/WYOMING) 00860 BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865 BLUE SHIELD (PENNSYLVANIA) 00870 BLUE SHIELD (RHODE ISLAND) 00880 BLUE SHIELD (SOUTH CAROLINA) 00900 BLUE SHIELD (TEXAS) 00910 BLUE SHIELD (UTAH) 00930 BLUE SHIELD (WASHINGTON) 00951 WISCONSIN PHYSICIANS SERVICE 00973 BLUE SHIELD (PUERTO RICO) 00974 BLUE SHIELD (VIRGIN ISLANDS) 01010 AETNA (PEORIA) 01020 AETNA (ALASKA) 01030 AETNA (ARIZONA) 01040 AETNA (GEORGIA) 01120 AETNA (HAWAII) 01290 AETNA (NEVADA) 01360 AETNA (NEW MEXICO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME 01370 AETNA (OKLAHOMA) 01380 AETNA (OREGON) 02050 OCCIDENTAL (CALIFORNIA) 05130 EQICOR (IDAHO) 05440 EQICOR (TENNESSEE) 05535 EQICOR (NORTH CAROLINA) 10071 TRAVELERS (RRB) 10230 TRAVELERS (CONNECTICUT) 10240 TRAVELERS (MINNESOTA) 10250 TRAVELERS (MISSISSIPPI) 10490 TRAVELERS (VIRGINIA) 10492 TRAVELERS - VIRGINIA SPECIAL PROJECT 11260 GENERAL AMERICAN 14330 GROUP HEALTH INC (NEW YORK) 16360 NATIONWIDE (OHIO) 16510 NATIONWIDE (WEST VIRGINIA) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 21200 MASSACHUSETTS/MAINE 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 VOL. NON-PROF. NOT CHURCH 02 VOLUNTARY NON PROFIT CHURCH 03 STATE GOVERNMENT 04 LOCAL GOVERNMENT 05 COMBINATION GOVERNMENT & VOL. 06 PROPRIETARY ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE OCCUPATIONAL THERAPISTS 7.2 788 794 N PROV1050 THE NUMBER OF FULL TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-OCCUP-THERAPISTS PHYSICAL THERAPISTS 7.2 803 809 N PROV1125 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-PHYS-THERAPY RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME PHYSICAL THERAPISTS 7.2 1635 1641 N PROV1120 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-PHYS-THERAPISTS SPEECH PATHOLOGISTS, AUDIOLOGISTS 7.2 1649 1655 N PROV1220 THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS OR AUDIOLOGISTS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-SPEECH-PATH-AUDIO DOES FACIL. PROVIDES OPT OCCUP 1 1870 1870 C PROV1685 DOES FACILITY PROVIDE OCCUPATIONAL THERAPY SERVICES ?? COBOL NAME: PROVIDES-OCCUP-THERAPY VALUES: N NO Y YES PHYSICAL THERAPIST - ARRANGEMENT 7.2 1871 1877 N PROV1105 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY ARRANGEMENT IN AN OUTPATIENT PHYSICAL THERAPY FACILITY. COBOL NAME: NUM-PHY-THER-ARGNM SPEECH PATHOLOGISTS - ARRANGEMENT 7.2 1878 1884 N PROV1215 THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS EMPLOYED BY ARRANGEMENT IN AN OUTPATIENT PHYSICAL THERAPY FACILITY. COBOL NAME: NUM-SPEECH-PATH-AR SPEECH PATHOLOGISTS - TOTAL 7.2 1885 1891 N PROV1210 THE TOTAL NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS ON STAFF AND BY ARRANGEMENT IN AN OUTPATIENT PHYSICAL THERAPY FACILITY. COBOL NAME: NUM-SPEECH-PATH SRV: PHYSICAL THERAPY/SPEECH PATH 1 1892 1892 C PROV2500 INDICATES IF PHYSICAL THERAPY AND/OR SPEECH PATHOLOGY SERVICES ARE PROVIDED BY A OUTPATIENT PHYSICAL THERAPY PROVIDER. COBOL NAME: SP-SPEECH-AND-PATH VALUES: 1 PHYSICAL THERAPY 2 SPEECH PATHOLOGY 3 BOTH 4 OCCUPATIONAL THERAPY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 END STAGE RENAL DISEASE CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 09 END STAGE RENAL DISEASE FACILITIES CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 FOR PROFIT - INDIVIDUAL 02 FOR PROFIT - PARTNERSHIP 03 FOR PROFIT - CORPORATION 04 FOR PROFIT - OTHER 05 NOT FOR PROFIT - INDIVIDUAL 06 NOT FOR PROFIT - PARTNERSHIP 07 NOT FOR PROFIT - CORPORATION 08 NOT FOR PROFIT - OTHER 09 GOVERNMENT - STATE 10 GOVERNMENT - COUNTY 11 GOVERNMENT - CITY 12 GOVERNMENT - CITY/COUNTY 13 GOV. - HOSP. DIST. OR AUTHORITY 14 GOVERNMENT - NON FEDERAL OTHER 15 GOV. - VETERANS ADMINISTRATION 16 GOVERNMENT - PHS HOSPITAL 17 GOVERNMENT - MILITARY 18 GOVERNMENT - FEDERAL OTHER ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM CAPD CERTIFICATION 1 1893 1893 C PROV0070 INDICATES THE ELIGIBILITY OF AN END STAGE RENAL DISEASE FACILITY TO PROVIDE CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD) SERVICES. COBOL NAME: CAPD-CD VALUES: * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME A ELIGIBLE B ELIGIBILITY BASED ON ACCEPTABLE PLAN OF CORR C ELIGIBILITY DEPENDS ON APPROVAL OF DIRECTOR E NOT ELIGIBLE CCPD CERTIFICATION 1 1894 1894 C PROV0090 INDICATES THE ELIGIBILITY OF AN END STAGE RENAL DISEASE FACILITY TO PROVIDE CONTINUOUS CYCLE PERITONEAL DIALYSIS (CCPD) SERVICES. COBOL NAME: CCPD-CD VALUES: A ELIGIBLE B ELIGIBILITY BASED ON ACCEPTABLE PLAN OF CORR C ELIGIBILITY DEPENDS ON APPROVAL OF DIRECTOR E NOT ELIGIBLE COMPLIANCE: FURNISH DATA TO MIS 1 1895 1895 C PROV0235 INDICATES IF AN ESRD FACILITY IS IN COMPLIANCE WITH THE REQUIREMENT TO FURNISH DATA TO A NATIONAL ESRD MEDICAL INFORMATION SYSTEM. COBOL NAME: COMPL-FURNISH-DATA VALUES: 4 MET 5 NOT MET COMPLIANCE: MEMBERSHIP IN NETWORK 1 1896 1896 C PROV0250 INDICATES IF AN ESRD FACILITY PARTICIPATES IN NETWORK ACTIVITIES. COBOL NAME: COMPL-MEMBER-NETWORK VALUES: 4 MET 5 NOT MET COMPLIANCE: PROVIDER STATUS 1 1897 1897 C PROV0275 INDICATES IF THE HOSPITAL OF WHICH A RENAL TRANSPLANTATION OR DIALYSIS CENTER IS A PART IS AN APPROVED PROVIDER IN THE MEDICARE PROGRAM. COBOL NAME: COMPL-PROV-STATUS VALUES: 4 MET 5 NOT MET ESRD NETWORK # 2 1898 1899 C PROV0685 THE NUMBER OF THE NETWORK TO WHICH THE END STAGE RENAL DIALYSIS FACILITY IS ASSIGNED. COBOL NAME: NETWORK-NUM VALUES: 01 CONN-MAINE-MASS-NEW HAMP-RHODE ISLAND-VERMONT 02 NEW YORK 03 NEW JERSEY, PUERTO RICO AND VIRGIN ISLAND 04 DELAWARE AND PENNSYLVANIA 05 DIST OF COLUM-MARYLAND-VIRGINIA-WEST VIRGINIA 06 GEORGIA, SOUTH CAROLINA AND NORTH CAROLINA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 07 FLORIDA 08 ALABAMA, MISSISSIPPI AND TENNESSEE 09 INDIANA, KENTUCKY AND OHIO 10 ILLINOIS 11 MICH-MINN-NORTH DAKOTA-SOUTH DAKOTA-WISCONSIN 12 IOWA, KANSAS, MISSOURI AND NEBRASKA 13 ARKANSAS, LOUISIANA AND OKLAHOMA 14 TEXAS 15 ARIZONA-COLO-NEVADA-NEW MEXI-UTAH AND WYOMING 16 ALASKA, IDAHO, MONTANA, OREGON AND WASHINGTON 17 COUNTIES IN NORTHERN CALIF, HAWAII, AS, GUAM 18 COUNTIES IN SOUTHERN CALIFORNIA FACILITY ADMINISTRATION, LOCATION 1 1900 1900 C PROV0470 INDICATES HOW A FACILITY IS ADMINISTERED AND WHERE IT IS LOCATED. COBOL NAME: FACILITY-ADMIN-LOCTN VALUES: 1 HOSPITAL ADMINISTERED, HOSPITAL LOCATED 2 HOSPITAL ADMINISTERED, NON-HOSPITAL LOCATED 3 NON-HOSPITAL ADMINISTERED, HOSPITAL LOCATED 4 NON-HOSPITAL ADMINISTERED AND LOCATED MUR: TRANSPLANTATION 1 1901 1901 C PROV0265 INDICATES HOW A RENAL DIALYSIS CENTER MEETS MINIMAL UTILIZATION RATES FOR TRANSPLANTATION. COBOL NAME: COMPL-MUR-TRANSP VALUES: 1 CONDITIONAL 2 UNCONDITIONAL 3 EXCEPTION 5 NOT MET PATIENT DIALYSIS TRAINING CERT 1 1902 1902 C PROV1600 INDICATES HOW AN END STAGE RENAL DIALYSIS FACILITY IS CERTIFIED TO PROVIDE PATIENT DIALYSIS TRAINING. COBOL NAME: PATIENT-DIAL-TRN-CERT VALUES: A ELIGIBLE TO SUPPLY B ELIGIBILITY IS BASED ON PLAN OF CORRECTION C ELIGIBILITY DEPENDS ON APPROVAL OF PHYSICIAN E NOT ELIGIBLE TO SUPPLY SERVICES PATIENT DIALYSIS TRAINING CODE 1 1903 1903 C PROV1590 INDICATES THE ELIGIBITY OF AN END STAGE RENAL DIALYSIS TO PROVIDE PATIENT DIALYSIS TRAINING. COBOL NAME: PATIENT-DIAL-TRAIN-CD VALUES: A ELIGIBLE TO PROVIDE PATIENT DIALYSIS TRAINING B NOT ELIGIBLE TO PROVIDE PATIENT DIALYSIS TRNG C VOLUNTARY WITHDRAWAL TO PROVIDE PATIENT TRNG D TERMINATION TO RPOVIDE PATIENT DIALYSIS TRNG * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 19 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PATIENT DIALYSIS TRAINING DATE 6 1904 1909 C PROV1595 THE DATE OF THE DETERMINATION OF ELIGIBILITY OF AN END STAGE RENAL DISEASE FACILITY TO PROVIDE PATIENT DIALYSIS TRAINING. COBOL NAME: PATIENT-DIAL-TRAIN-DT RENAL DIALYSIS CENTER CODE 1 1910 1910 C PROV1760 INDICATES THE ELIGIBILITY OF AN END STAGE DIALYSIS FACILITY TO PROVIDE RENAL DIALYSIS CENTER SERVICES. COBOL NAME: RENAL-DIAL-CENTER-CD VALUES: A ELIGIBLE B NOT ELIGIBLE C VOLUNTARY WITHDRAWAL D TERMINATION RENAL DIALYSIS CENTER DATE 6 1911 1916 C PROV1765 DATE OF THE DETERMINATION OF ELIGIBILITY OF AN END STAGE RENAL DIALYSIS FACILITY TO PROVIDE DIALYSIS CENTER SERVICES. COBOL NAME: RENAL-DIAL-CENTER-DT RENAL DIALYSIS FACILITY CODE 1 1917 1917 C PROV1580 INDICATES THE ELIGIBILITY OF AN END STAGE RENAL DIALYSIS FACILITY TO PROVIDE RENAL DIALYSIS FACILITY SERVICES. COBOL NAME: PATIENT-DIAL-FACTY-CD VALUES: A ELIGIBLE B NOT ELIGIBLE C VOLUNTARY WITHDRAWAL D TERMINATION RENAL DIALYSIS FACILITY DATE 6 1918 1923 C PROV1585 DATE OF THE DETERMINATION OF ELIGIBILITY OF AN END STAGE RENAL DIALYSIS FACILITY TO PROVIDE DIALYSIS FACILITY SERVICES. COBOL NAME: PATIENT-DIAL-FACTY-DT RENAL TRANSPLANT CENTER CODE 1 1924 1924 C PROV1770 INDICATES THE ELIGIBILITY OF AN END STAGE RENAL DIALYSIS FACILITY TO PROVIDE TRANSPLANTATION SERVICES. COBOL NAME: RENAL-TRANSP-CENTER-CD VALUES: A ELIGIBLE B NOT ELIGIBLE C VOLUNTARY WITHDRAWAL D TERMINATION RENAL TRANSPLANT CENTER DATE 6 1925 1930 C PROV1775 DATE OF THE DETERMINATION OF ELIGIBILITY OF AN END STAGE RENAL DIALYSIS FACILITY TO PROVIDE TRANSPLANTATION SERVICES. COBOL NAME: RENAL-TRANSP-CENTER-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 20 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SELF DIALYSIS CERTIFICATION 1 1931 1931 C PROV2030 THE STATE AGENCY'S CERTIFICATION OF ELIGIBILITY OF AN END STAGE RENAL DIALYSIS FACILITY TO PROVIDE SELF DIALYSIS SERVICES. COBOL NAME: SELF-DIAL-CERT VALUES: A ELIGIBLE B ELIGIBILITY IS BASED ON ACCEPTABLE POC C ELIGIBILITY DEPENDS ON APPROVAL OF PHYSICIAN E NOT ELIGIBLE SELF DIALYSIS CODE 1 1932 1932 C PROV2025 INDICATES THE ELIGIBILITY OF AN END STAGE RENAL DIALYSIS FACILITY TO PROVIDE SELF DIALYSIS SERVICES. COBOL NAME: SELF-DIAL-CD VALUES: A ELIGIBLE B NOT ELIGIBLE C VOLUNTARY WITHDRAWAL D TERMINATION SELF DIALYSIS DATE 6 1933 1938 C PROV2035 DATE OF THE DETERMINATION OF ELIGIBILITY OF AN END STAGE RENAL DIALYSIS FACILITY TO PROVIDE SELF DIALYSIS SERVICES. COBOL NAME: SELF-DIAL-DT STAFF ASSISTED DIALYSIS CERT 1 1939 1939 C PROV2705 INDICATES HOW AN END STAGE RENAL DIALYSIS FACILITY IS CERTIFED TO PROVIDE STAFF ASSISTED RENAL DIALYSIS. COBOL NAME: STAFF-ASDIAL-CERT VALUES: A ELIGIBLE TO SUPPLY B ELIGIBILITY BASED ON ACCEPTABLE POC C ELIGIBILITY BASED ON APPROVAL OF MD DIRECTOR E NOT ELIGIBLE TO SUPPLY SERVICE STATIONS - HEMODIALYSIS 3 1940 1942 N PROV1230 THE TOTAL NUMBER OF HEMODIALYSIS STATIONS IN AN END STAGE RENAL DISEASE (ESRD) FACILITY. COBOL NAME: NUM-STATION-HEMO STATIONS - PERITONEAL 3 1943 1945 N PROV1235 THE TOTAL NUMBER OF PERITONEAL STATIONS IN AN END STAGE RENAL DISEASE (ESRD) FACILITY. COBOL NAME: NUM-STATION-PERT STATIONS - TOTAL 3 1946 1948 N PROV2855 THE TOTAL NUMBER OF APPROVED DIALYSIS STATIONS IN AN END STAGE RENAL DIALYSIS FACILITY. COBOL NAME: TOT-STATIONS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 21 END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TRANSPLANTATION CERTIFICATION 1 1949 1949 C PROV2870 INDICATES HOW AN END STAGE RENAL DIALYSIS FACILITY IS CERTIFIED TO PROVIDE TRANSPLANTATION SERVICES SERVICES. COBOL NAME: TRANSP-CERT VALUES: A ELIGIBLE TO SUPPLY B ELIGIBILITY IS BASED ON ACCEPTABLE POC C ELIGIBILITY DEPENDS ON APPROVAL OF PHYSICIAN D ELIGIBILITY DEPENDS ON HISTO LAB ARRANGEMENTS E NOT ELIGIBLE TO SUPPLY SERVICES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 NURSING FACILITY CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 10 NURSING FACILITIES CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 FOR PROFIT - INDIVIDUAL 02 FOR PROFIT - PARTNERSHIP 03 FOR PROFIT - CORPORATION 04 NONPROFIT - CHURCH RELATED 05 NONPROFIT - CORPORATION 06 NONPROFIT - OTHER 07 GOVERNMENT - STATE 08 GOVERNMENT - COUNTY 09 GOVERNMENT - CITY 10 GOVERNMENT - CITY/COUNTY 11 GOVERNMENT - HOSPITAL DISTRICT 12 GOVERNMENT - FEDERAL ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE BEDS - TOTAL 5 683 687 N PROV0740 TOTAL NUMBER OF BEDS IN A FACILITY, INCLUDING THOSE IN NON-PARTICIPATING OR NON-LICENSED AREAS. COBOL NAME: NUM-BEDS BEDS - TOTAL CERTIFIED 5 688 692 N PROV0755 NUMBER OF BEDS IN MEDICARE AND/OR MEDICAID CERTIFIED AREAS WITHIN A FACILITY. COBOL NAME: NUM-CERT-BEDS COMPLIANCE: LIFE SAFETY CODE 1 752 752 C PROV0240 INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN RECOMMENDED FOR A PROVIDER. COBOL NAME: COMPL-LSC VALUES: 1 WAIVER RECOMMENDED PROGRAM PARTICIPATION 1 823 823 C PROV1670 INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE, MEDICAID, OR BOTH PROGRAMS. COBOL NAME: PROG-PARTCI VALUES: 2 MEDICAID ONLY REGIONAL OVERRIDE #1 (NUMBER BEDS) 1 841 841 C PROV1545 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-1 VALUES: * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME Y RECORD HAS BEEN APPROVED REGIONAL OVERRIDE #2 (STAFFING) 1 842 842 C PROV1550 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-2 VALUES: Y RECORD HAS BEEN APPROVED RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM ACTIVITY THERAPISTS - CONTRACT 7.2 940 946 N PROV0695 THE NUMBER OF FULL TIME EQUIVALENT ACTIVITIES THERAPISTS UNDER CONTRACT TO THE FACILITY COBOL NAME: NUM-ACT-THER-CONTRACT ACTIVITY THERAPISTS - FULL TIME 7.2 947 953 N PROV0700 THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES THERAPISTS EMPLOYED FULL TIME BY THE FACILITY COBOL NAME: NUM-ACT-THER-FULL-TIME ACTIVITY THERAPISTS - PART TIME 7.2 954 960 N PROV0705 THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES THERAPISTS EMPLOYED PART-TIME BY THE FACILITY. COBOL NAME: NUM-ACT-THER-PART-TIME ADMINISTRATOR - CONTRACT 7.2 961 967 N PROV0710 THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATORS UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-ADMN-CONTRACT ADMINISTRATOR - FULL TIME 7.2 968 974 N PROV0715 THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATORS EMPLOYED ON A FULL TIME BASIS BY THE FACILITY. COBOL NAME: NUM-ADMN-FULL-TIME ADMINISTRATOR - PART TIME 7.2 975 981 N PROV0720 THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATORS EMPLOYED ON A PART-TIME BASIS BY THE FACILITY. COBOL NAME: NUM-ADMN-PART-TIME * ADMISSION SUSPENSION DATE 6 982 987 C PROV0030 THE DATE THAT PAYMENTS FOR NEW ADMISSIONS IN A LONG TERM CARE FACILITY WILL BE DENIED IF AN INTERMEDIATE SANCTION IS TAKEN AGAINST THE FACILITY. COBOL NAME: ADMIN-SUSP-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME AIDES/ORDERLIES - CONTRACT 7.2 988 994 N PROV1000 THE NUMBER OF FULL-TIME EQUIVALENT AIDES/ORDERLIES UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-NURSE-AID-CONTRACT AIDES/ORDERLIES - FULL TIME 7.2 995 1001 N PROV1005 THE NUMBER OF FULL-TIME EQUIVALENT AIDES/ORDERLIES EMPLOYED BY THE FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-NURSE-AID-FULL-TIME AIDES/ORDERLIES - PART TIME 7.2 1002 1008 N PROV1010 THE NUMBER OF FULL-TIME EQUIVALENT AIDES/ORDERLIES EMPLOYED BY THE FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-NURSE-AID-PART-TIME BEDS - NURSING FACILITY 4 1013 1016 N PROV1455 NUMBER OF MEDICAID CERTIFIED SKILLED NURSING CARE BEDS IN A FACILITY. COBOL NAME: NUM-T19-SNF-BEDS COMPLIANCE: BEDS PER ROOM WAIVER 1 1022 1022 C PROV0225 INDICATES IF A WAIVER OF THE BEDS PER ROOM REQUIREMENT HAS BEEN RECOMMENDED FOR A FACILITY. COBOL NAME: COMPL-BEDS-PER-ROOM VALUES: 1 WAIVER RECOMMENDED COMPLIANCE: PATIENT ROOM SIZE 1 1023 1023 C PROV0270 INDICATES IF A WAIVER OF PATIENT ROOM SIZE HAS BEEN RECOMMENDED FOR A FACILITY. COBOL NAME: COMPL-PATIENT-ROOM-SZ VALUES: 1 WAIVER RECOMMENDED COMPLIANCE: 7 DAY REGISTERED NURSE 1 1024 1024 C PROV0295 INDICATES IF A WAIVER OF THE 7 DAY REGISTERED NURSE REQUIREMENTS HAS BEEN RECOMMENDED FOR A SNF OR NF. COBOL NAME: COMPL-7-DAY-RN VALUES: 1 WAIVER RECOMMENDED DATE OF RO TITLE 19 FINAL REVIEW 6 1025 1030 C PROV0410 THE DATE THE REGIONAL OFFICE COMPLETES ITS REVIEW OF A TITLE 19 (MEDICAID) CERTIFICATION KIT. COBOL NAME: DT-RO-FINAL-REV DENTISTS - CONTRACT 7.2 1031 1037 N PROV0785 THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-DENTIST-CONTRACT DENTISTS - FULL TIME 7.2 1038 1044 N PROV0790 THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-DENTIST-FULL-TIME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME DENTISTS - PART TIME 7.2 1045 1051 N PROV0795 THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-DENTIST-PART-TIME DIETITIANS - CONTRACT 7.2 1052 1058 N PROV0805 THE NUMBER OF FULL-TIME EQUIVALENT UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-DIET-CONTRACT DIETITIANS - FULL TIME 7.2 1059 1065 N PROV0810 THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-DIET-FULL-TIME DIETITIANS - PART TIME 7.2 1066 1072 N PROV0815 THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-DIET-PART-TIME EXPERIMENTAL RESEARCH CONDUCTED 1 1073 1073 C PROV0465 INDICATES IF A FACILITY USES RESIDENTS TO DEVELOP AND TEST CLINICAL TREATMENTS. COBOL NAME: EXPER-RESEARCH VALUES: N NO Y YES FACILITY PART OF A CCRC 1 1074 1074 C PROV3235 INDICATES IF THE FACILITY IS PART OF A CONTINUING CARE RETIREMENT COMMUNITY (CCRC). COBOL NAME: CCRC-FACIL VALUES: N NO Y YES FOOD SERVICE - CONTRACT 7.2 1075 1081 N PROV0860 THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE PERSONNEL UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-FOOD-SRV-CONTRACT FOOD SERVICE - FULL TIME 7.2 1082 1088 N PROV0865 THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-FOOD-SRV-FULL-TIME FOOD SERVICE - PART TIME 7.2 1089 1095 N PROV0870 THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-FOOD-SRV-PART-TIME HOUSEKEEPING - CONTRACT 7.2 1096 1102 N PROV0925 THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING PERSONNEL UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-HOUSE-CONTRACT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 19 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME HOUSEKEEPING - FULL TIME 7.2 1103 1109 N PROV0930 THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-HOUSE-FULL-TIME HOUSEKEEPING - PART TIME 7.2 1110 1116 N PROV0935 THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-HOUSE-PART-TIME LPN/LVN - CONTRACT 7.2 1117 1123 N PROV1465 THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/ VOCATIONAL NURSES UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-VOC-NURSE-CONTRACT LPN/LVN - FULL TIME 7.2 1124 1130 N PROV1470 THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/ VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-VOC-NURSE-FULL-TIME LPN/LVN - PART TIME 7.2 1131 1137 N PROV1475 THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/ VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-VOC-NURSE-PART-TIME LTC AGREEMENT BEGINNING DATE 6 1138 1143 C PROV0620 THE BEGINNING DATE OF A CERTIFIED LONG TERM CARE FACILI TY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-BEGIN-DT LTC AGREEMENT ENDING DATE 6 1144 1149 C PROV0625 THE ENDING DATE OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-END-DT LTC AGREEMENT EXTENSION DATE 6 1150 1155 C PROV0630 THE LAST DATE OF AN EXTENSION OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-EXT-DT LTC CROSS REFERENCE PROVIDER # 6 1156 1161 C PROV0640 THIS CROSS REFERENCE NUMBER IDENTIFIES LTC PROVIDER NUMBERS THAT WERE TERMINATED IN 1985 BECAUSE OF POLICY CHANGES WHICH STATES THAT SNF/ICF DISTINCT PARTS OR DUA LLY CERTIFIED PORTIONS ARE ASSIGNED SINGLE SNF PROV NO. COBOL NAME: LTC-CROSS-REF-PROV-NUM MEDICAL DIRECTOR - CONTRACT 7.2 1162 1168 N PROV0960 NUMBER OF MEDICAL DIRECTORS UNDER CONTRACT. COBOL NAME: NUM-MED-CONTRACT MEDICAL DIRECTOR - FULL TIME 7.2 1169 1175 N PROV0965 THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-MED-FULL-TIME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 20 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME MEDICAL DIRECTOR - PART TIME 7.2 1176 1182 N PROV0970 THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-MED-PART-TIME MENTAL HEALTH SERVICES - CONTRACT 7.2 1183 1189 N PROV0980 THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH SERVICES PERSONNEL UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-MEN-HLTH-CONTRACT MENTAL HEALTH SERVICES - FULL TIME 7.2 1190 1196 N PROV0985 THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-MEN-HLTH-FULL-TIME MENTAL HEALTH SERVICES - PART TIME 7.2 1197 1203 N PROV0990 THE NUMBER OF FULL TIME EQUIVALENT MENTAL HEALTH SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-MEN-HLTH-PART-TIME MULTI-FACILITY ORGANIZATION NAME 38 1204 1241 C PROV0680 THE NAME OF THE MULTI-FACILITY ORGANIZATION THAT OWNS THE FACILITY. COBOL NAME: NAME-MULT-FACL-ORG MULTI-FACILITY ORGANIZATION OWNED 1 1242 1242 C PROV0675 INDICATES IF A FACILITY IS OWNED BY AN ORGANIZATION THAT OWNS (OR LEASES) TWO OR MORE NURSING FACILITIES. COBOL NAME: MULT-FACL-ORG VALUES: N NO Y YES OCCUPATIONAL THERAPIST - CONTRACT 7.2 1243 1249 N PROV1035 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-OCC-THER-CONTRACT OCCUPATIONAL THERAPIST - FULL TIME 7.2 1250 1256 N PROV1040 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-OCC-THER-FULL-TIME OCCUPATIONAL THERAPIST - PART TIME 7.2 1257 1263 N PROV1045 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-OCC-THER-PART-TIME OCCUPATIONAL THERAPY ASST-CONTRACT 7.2 1264 1270 N PROV1020 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY ASSISTANTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-OCC-AID-CONTRACT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 21 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME OCCUPATIONAL THERAPY ASST-FULL 7.2 1271 1277 N PROV1025 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-OCC-AID-FULL-TIME OCCUPATIONAL THERAPY ASST-PART 7.2 1278 1284 N PROV1030 THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-OCC-AID-PART-TIME ORGANIZED FAMILY GROUP 1 1285 1285 C PROV1535 INDICATES IF THE FACILITY HAS AN ORGANIZED GROUP OF FAMILY MEMBERS OF RESIDENTS. COBOL NAME: ORG-FAMILY-GRP VALUES: N NO Y YES ORGANIZED RESIDENT GROUP 1 1286 1286 C PROV1540 INDICATES IF THE FACILITY HAS AN ORGANIZED RESIDENTS GROUP. COBOL NAME: ORG-RESID-GRP VALUES: N NO Y YES OTHER - CONTRACT 7.2 1287 1293 N PROV3265 THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED IN ANY OTHER CATEGORIES UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-OTH-CONTRACT OTHER - FULL TIME 7.2 1294 1300 N PROV3245 THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A FULL-TIME BASIS. COBOL NAME: NUM-OTH-FULL-TIME OTHER - PART TIME 7.2 1301 1307 N PROV3255 THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A PART-TIME BASIS. COBOL NAME: NUM-OTH-PART-TIME OTHER PHYSICIAN - CONTRACT 7.2 1308 1314 N PROV1060 THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS UNDER CONTRACT TO A FACILITY COBOL NAME: NUM-OTH-PHY-CONTRACT OTHER PHYSICIAN - FULL TIME 7.2 1315 1321 N PROV1065 THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-OTH-PHY-FULL-TIME OTHER PHYSICIAN - PART TIME 7.2 1322 1328 N PROV1070 THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-OTH-PHY-PART-TIME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 22 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PHARMACISTS - CONTRACT 7.2 1329 1335 N PROV1085 THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-PHAR-CONTRACT PHARMACISTS - FULL TIME 7.2 1336 1342 N PROV1090 THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-PHAR-FULL-TIME PHARMACISTS - PART TIME 7.2 1343 1349 N PROV1095 THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-PHAR-PART-TIME PHYSICAL THERAPISTS - CONTRACT 7.2 1350 1356 N PROV1430 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-THER-CONTRACT PHYSICAL THERAPISTS - FULL TIME 7.2 1357 1363 N PROV1435 THE NUMBER OF FULL TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-THER-FULL-TIME PHYSICAL THERAPISTS - PART TIME 7.2 1364 1370 N PROV1440 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-THER-PART-TIME PHYSICAL THERAPY ASST - CONTRACT 7.2 1371 1377 N PROV1415 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY ASSISTANTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-THER-AID-CONTRACT PHYSICAL THERAPY ASST - FULL TIME 7.2 1378 1384 N PROV1420 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-THER-AID-FULL-TIME PHYSICAL THERAPY ASST - PART TIME 7.2 1385 1391 N PROV1425 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY ASSISTANTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-THER-AID-PART-TIME PHYSICIAN EXTENDER - CONTRACT 7.2 1392 1398 N PROV3270 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS UNDER CONTRACT TO THE FACILITY. COBOL NAME: NUM-PHYS-EXT-CONTRACT PHYSICIAN EXTENDER - FULL TIME 7.2 1399 1405 N PROV3250 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS EMPLOYED BY THE FACILITY ON A FULL-TIME BASIS. COBOL NAME: NUM-PHYS-EXT-FULL-TIME PHYSICIAN EXTENDER - PART TIME 7.2 1406 1412 N PROV3260 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS EMPLOYED BY THE FACILITY ON A PART-TIME BASIS. COBOL NAME: NUM-PHYS-EXT-PART-TIME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 23 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PODIATRISTS - CONTRACT 7.2 1413 1419 N PROV1130 THE NUMBER OF FULL TIME EQUIVALENT PODIATRISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-POD-CONTRACT PODIATRISTS - FULL TIME 7.2 1420 1426 N PROV1135 THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED BY A AFCILITY ON A FULL TIME BASIS. COBOL NAME: NUM-POD-FULL-TIME PODIATRISTS - PART TIME 7.2 1427 1433 N PROV1140 THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-POD-PART-TIME PRIOR ADMISSION SUSPENSION DATE 6 1434 1439 C PROV1610 PREVIOUS DATE A SUSPENSION OF ADMISSIONS WAS INVOKED FOR A PROVIDER. COBOL NAME: PRIOR-ADMIN-SUSP-DT PRIOR LTC END DATE 6 1440 1445 C PROV1630 THE LAST DATE OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT FOR A PRIOR SURVEY. COBOL NAME: PRIOR-LTC-END-DT PRIOR LTC EXTENSION DATE 6 1446 1451 C PROV1635 THE LAST DATE OF AN EXTENSION OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT FOR A PRIOR SURVEY. COBOL NAME: PRIOR-LTC-EXT-DT PRIOR RESCIND SUSPENSION DATE 6 1452 1457 C PROV1640 THE EFFECTIVE DATE OF A PREVIOUS SUSPENSION OF ADMISSIONS TO A LTC FACILITY. COBOL NAME: PRIOR-RESC-SUSP-DT PROVIDER BASED FACILITY 1 1458 1458 C PROV1675 INDICATES IF A LONG TERM CARE FACILITY IS PROVIDER BASED. COBOL NAME: PROV-BASED-FACILITY VALUES: N NOT HOSPITAL BASED Y HOSPITAL BASED REGISTERED NURSE - CONTRACT 7.2 1459 1465 N PROV1150 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-REG-NURSE-CONTRACT REGISTERED NURSE - FULL TIME 7.2 1466 1472 N PROV1155 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-REG-NURSE-FULL-TIME REGISTERED NURSE - PART TIME 7.2 1473 1479 N PROV1160 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-REG-NURSE-PART-TIME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 24 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME RESCIND SUSPENSION DATE 6 1480 1485 C PROV1825 DATE THAT THE SUPENSION OF PAYMENTS FOR NEW ADMISSIONS TO A LONG TERM CARE FACILITY (LTC) IS RESCINDED. COBOL NAME: RESC-SUSP-DT SOCIAL WORKER - CONTRACT 7.2 1486 1492 N PROV1170 THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-SOCIAL-CONTRACT SOCIAL WORKER - FULL TIME 7.2 1493 1499 N PROV1175 THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-SOCIAL-FULL-TIME SOCIAL WORKER - PART TIME 7.2 1500 1506 N PROV1180 THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-SOCIAL-PART-TIME SPECIAL CARE BEDS-AIDS 3 1507 1509 N PROV0725 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH AIDS. COBOL NAME: NUM-AIDS-BEDS SPECIAL CARE BEDS-ALZHEIMERS 3 1510 1512 N PROV0730 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH ALZEHEIMERS. COBOL NAME: NUM-ALZHEIMERS-BEDS SPECIAL CARE BEDS-DIALYSIS 3 1513 1515 N PROV0800 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS NEEDING DIALYSIS. COBOL NAME: NUM-DIAL-BEDS SPECIAL CARE BEDS-DISABLED CHILD 3 1516 1518 N PROV0855 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR DEISCABLED CHILDREN. COBOL NAME: NUM-DIS-CHILD-BEDS SPECIAL CARE BEDS-HEAD TRAUMA 3 1519 1521 N PROV0905 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILTY FOR RESIDENTS WITH HEAD TRAUMA. COBOL NAME: NUM-HEAD-TRAUMA-BEDS SPECIAL CARE BEDS-HOSPICE 3 1522 1524 N PROV0920 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY A FACILITY FOR RESIDENTS NEEDING HOSPICE SERVICES. COBOL NAME: NUM-HOSPICE-BEDS SPECIAL CARE BEDS-HUNTINGTONS 3 1525 1527 N PROV0940 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH HUNTINGTON'S DISEASE COBOL NAME: NUM-HUNTING-DIS-BEDS SPECIAL CARE BEDS-SPEC REHAB 3 1528 1530 N PROV1205 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH SPECIALIZED REHAB NEEDS. COBOL NAME: NUM-SPEC-REHAB-BEDS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 25 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL CARE BEDS-VENTILATOR 3 1531 1533 N PROV1460 THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED BY THE FACILITY FOR RESIDENTS WITH VENTILATOR/ RESIPIRATORY CARE NEEDS. COBOL NAME: NUM-VENT-RESP-BEDS SPEECH PATHOLOGIST - CONTRACT 7.2 1534 1540 N PROV1190 THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS UNDER CONTRACT TO A FACILITY. COBOL NAME: NUM-SPCH-PATH-CONTRACT SPEECH PATHOLOGIST - FULL TIME 7.2 1541 1547 N PROV1195 THE NUMBER OF FULL-TIME EQUIVALENT SPPECH PATHOLOGISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS. COBOL NAME: NUM-SPCH-PATH-FULL-TIME SPEECH PATHOLOGIST - PART TIME 7.2 1548 1554 N PROV1200 THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS. COBOL NAME: NUM-SPCH-PATH-PART-TIME SRV: ACTIVITIES-OFFSITE-RESIDENTS 1 1555 1555 C PROV3390 INDICATES IF ACTIVITIES SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-ACT-THER-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: ACTIVITIES-ONSITE-NON RES 1 1556 1556 C PROV3385 INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS. COBOL NAME: SP-ACT-THER-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: ACTIVITIES-ONSITE-RESIDENTS 1 1557 1557 C PROV3380 INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-ACT-THER-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: BLOOD ADMIN-OFFSITE-RESIDENTS 1 1558 1558 C PROV3525 INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-ADM-BLOOD-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 26 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: BLOOD ADMIN-ONSITE-NONRES 1 1559 1559 C PROV3520 INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS. COBOL NAME: SP-ADM-BLOOD-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: BLOOD ADMIN-ONSITE-RESIDENTS 1 1560 1560 C PROV3515 INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-ADM-BLOOD-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: CLINICAL LAB-OFFSITE-RESIDENT 1 1561 1561 C PROV3495 INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-CLIN-LAB-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: CLINICAL LAB-ONSITE-NON RES 1 1562 1562 C PROV3490 INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-CLIN-LAB-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: CLINICAL LAB-ONSITE-RESIDENTS 1 1563 1563 C PROV3485 INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-CLIN-LAB-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DENTAL-OFFSITE-RESIDENTS 1 1564 1564 C PROV3435 INDICATES IF DENTAL SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-DENTAL-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DENTAL-ONSITE-NON RESIDENTS 1 1565 1565 C PROV3430 INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-DENTAL-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 27 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: DENTAL-ONSITE-RESIDENTS 1 1566 1566 C PROV3425 INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-DENTAL-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DIETARY-OFFSITE-RESIDENTS 1 1567 1567 C PROV3345 INDICATES IF DIETARY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-DIETARY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DIETARY-ONSITE-NON RESIDENTS 1 1568 1568 C PROV3340 INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-DIETARY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: DIETARY-ONSITE-RESIDENTS 1 1569 1569 C PROV3335 INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-DIETARY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: HOUSEKEEPING ONSITE-NON RES 1 1570 1570 C PROV3535 INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-HOUSE-KP-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: HOUSEKEEPING-OFFSITE-RES 1 1571 1571 C PROV3540 INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-HOUSE-KP-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: HOUSEKEEPING-ONSITE-RESIDENTS 1 1572 1572 C PROV3530 INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-HOUSE-KP-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 28 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: MENTAL HEALTH-OFFSITE-RES 1 1573 1573 C PROV3465 INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-MEN-HLTH-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: MENTAL HEALTH-ONSITE-NON RES 1 1574 1574 C PROV3460 INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-MEN-HLTH-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: MENTAL HEALTH-ONSITE-RESID 1 1575 1575 C PROV3455 INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-MEN-HLTH-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: NURSING-OFFSITE-RESIDENTS 1 1576 1576 C PROV3315 INDICATES IF NURSING SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-NURSING-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: NURSING-ONSITE-NON RESIDENTS 1 1577 1577 C PROV3310 INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-NURSING-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: NURSING-ONSITE-RESIDENTS 1 1578 1578 C PROV3305 INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-NURSING-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: OCCUP THER-OFFSITE-RESIDENTS 1 1579 1579 C PROV3360 INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-OCC-THER-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 29 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: OCCUP THER-ONSITE-NON RESID 1 1580 1580 C PROV3355 INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-OCC-THER-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: OCCUP THER-ONSITE-RESIDENTS 1 1581 1581 C PROV3350 INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-OCC-THER-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHARMACY-OFFSITE-RESIDENTS 1 1582 1582 C PROV3330 INDICATES IF PHARMACY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHARMACY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHARMACY-ONSITE-NON RESIDENTS 1 1583 1583 C PROV3325 INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHARMACY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHARMACY-ONSITE-RESIDENTS 1 1584 1584 C PROV3320 INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHARMACY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS EXTENDER-OFFSITE-RESID 1 1585 1585 C PROV3300 INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHYS-EXT-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS EXTENDER-ONSITE-NON RES 1 1586 1586 C PROV3295 INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHYS-EXT-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 30 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: PHYS EXTENDER-ONSITE-RESIDENT 1 1587 1587 C PROV3290 INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHYS-EXT-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS THER-OFFSITE-RESIDENTS 1 1588 1588 C PROV3375 INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHYS-THER-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS THER-ONSITE-NON RESIDENT 1 1589 1589 C PROV3370 INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHYS-THER-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYS THER-ONSITE-RESIDENTS 1 1590 1590 C PROV3365 INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHYS-THER-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYSICIAN-OFFSITE-RESIDENTS 1 1591 1591 C PROV3285 INDICATES IF PHYSICIAN SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PHYS-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYSICIAN-ONSITE-NON RESIDENT 1 1592 1592 C PROV3280 INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PHYS-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PHYSICIAN-ONSITE-RESIDENTS 1 1593 1593 C PROV3275 INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PHYS-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 31 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: PODIATRY-OFFSITE-RESIDENTS 1 1594 1594 C PROV3450 INDICATES IF PODIATRY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-PODIATRY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PODIATRY-ONSITE-NON RESIDENTS 1 1595 1595 C PROV3445 INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-PODIATRY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: PODIATRY-ONSITE-RESIDENTS 1 1596 1596 C PROV3440 INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-PODIATRY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SOCIAL WORK-OFFSITE-RESIDENTS 1 1597 1597 C PROV3405 INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-MED-SOC-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SOCIAL WORK-ONSITE-NON RESID 1 1598 1598 C PROV3400 INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-MED-SOC-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SOCIAL WORK-ONSITE-RESIDENTS 1 1599 1599 C PROV3395 INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-MED-SOC-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SPEECH PATH-OFFSITE-RESIDEN 1 1600 1600 C PROV3420 INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-SPEECH-PH-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 32 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: SPEECH PATH-ONSITE-NON RESID 1 1601 1601 C PROV3415 INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-SPEECH-PH-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: SPEECH PATH-ONSITE-RESIDENTS 1 1602 1602 C PROV3410 INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-SPEECH-PH-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: VOCATIONAL-OFFSITE-RESIDENTS 1 1603 1603 C PROV3480 INDICATES IF VOCATIONAL SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-VOC-GUID-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: VOCATIONAL-ONSITE-NON RESID 1 1604 1604 C PROV3475 INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-VOC-GUID-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: VOCATIONAL-ONSITE-RESIDENTS 1 1605 1605 C PROV3470 INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-VOC-GUID-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: XRAY-OFFSITE-RESIDENTS 1 1606 1606 C PROV3510 INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED OFFSITE TO RESIDENTS. COBOL NAME: SP-DIAG-XRAY-OFF-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED SRV: XRAY-ONSITE-NON RESIDENTS 1 1607 1607 C PROV3505 INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED ONSITE TO NON RESIDENTS. COBOL NAME: SP-DIAG-XRAY-ON-NON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 33 NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: XRAY-ONSITE-RESIDENTS 1 1608 1608 C PROV3500 INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED ONSITE TO RESIDENTS. COBOL NAME: SP-DIAG-XRAY-ON-RES VALUES: N SERVICE IS NOT PROVIDED Y SERVICE IS PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 ICF/MR CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 11 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 PRIVATE NON PROFIT 02 PRIVATE PROPRIETARY 03 STATE 04 CITY/TOWN 05 COUNTY 06 CITY/COUNTY 07 OTHER ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE BEDS - TOTAL 5 683 687 N PROV0740 TOTAL NUMBER OF BEDS IN A FACILITY, INCLUDING THOSE IN NON-PARTICIPATING OR NON-LICENSED AREAS. COBOL NAME: NUM-BEDS BEDS - TOTAL CERTIFIED 5 688 692 N PROV0755 NUMBER OF BEDS IN MEDICARE AND/OR MEDICAID CERTIFIED AREAS WITHIN A FACILITY. COBOL NAME: NUM-CERT-BEDS COMPLIANCE: LIFE SAFETY CODE 1 752 752 C PROV0240 INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN RECOMMENDED FOR A PROVIDER. COBOL NAME: COMPL-LSC VALUES: 1 WAIVER RECOMMENDED LICENSED PRACTICAL NURSES 7.2 779 785 N PROV0955 NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL OR VOCATIONAL NURSES EMPLOYED BY A FACILITY. COBOL NAME: NUM-LPN-LVN PROGRAM PARTICIPATION 1 823 823 C PROV1670 INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE, MEDICAID, OR BOTH PROGRAMS. COBOL NAME: PROG-PARTCI VALUES: 2 MEDICAID ONLY REGIONAL OVERRIDE #1 (NUMBER BEDS) 1 841 841 C PROV1545 THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE ODIE DATA ENTRY SYSTEM. COBOL NAME: OVERRIDE-1 VALUES: Y RECORD HAS BEEN APPROVED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME REGISTERED NURSES 7.2 844 850 N PROV1145 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED PROFESSIONAL NURSES EMPLOYED BY A PROVIDER. COBOL NAME: NUM-REG-NURS RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM * ADMISSION SUSPENSION DATE 6 982 987 C PROV0030 THE DATE THAT PAYMENTS FOR NEW ADMISSIONS IN A LONG TERM CARE FACILITY WILL BE DENIED IF AN INTERMEDIATE SANCTION IS TAKEN AGAINST THE FACILITY. COBOL NAME: ADMIN-SUSP-DT COMPLIANCE: BEDS PER ROOM WAIVER 1 1022 1022 C PROV0225 INDICATES IF A WAIVER OF THE BEDS PER ROOM REQUIREMENT HAS BEEN RECOMMENDED FOR A FACILITY. COBOL NAME: COMPL-BEDS-PER-ROOM VALUES: 1 WAIVER RECOMMENDED COMPLIANCE: PATIENT ROOM SIZE 1 1023 1023 C PROV0270 INDICATES IF A WAIVER OF PATIENT ROOM SIZE HAS BEEN RECOMMENDED FOR A FACILITY. COBOL NAME: COMPL-PATIENT-ROOM-SZ VALUES: 1 WAIVER RECOMMENDED DATE OF RO TITLE 19 FINAL REVIEW 6 1025 1030 C PROV0410 THE DATE THE REGIONAL OFFICE COMPLETES ITS REVIEW OF A TITLE 19 (MEDICAID) CERTIFICATION KIT. COBOL NAME: DT-RO-FINAL-REV LTC AGREEMENT BEGINNING DATE 6 1138 1143 C PROV0620 THE BEGINNING DATE OF A CERTIFIED LONG TERM CARE FACILI TY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-BEGIN-DT LTC AGREEMENT ENDING DATE 6 1144 1149 C PROV0625 THE ENDING DATE OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-END-DT LTC AGREEMENT EXTENSION DATE 6 1150 1155 C PROV0630 THE LAST DATE OF AN EXTENSION OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT. COBOL NAME: LTC-AGREE-EXT-DT LTC CROSS REFERENCE PROVIDER # 6 1156 1161 C PROV0640 THIS CROSS REFERENCE NUMBER IDENTIFIES LTC PROVIDER NUMBERS THAT WERE TERMINATED IN 1985 BECAUSE OF POLICY CHANGES WHICH STATES THAT SNF/ICF DISTINCT PARTS OR DUA LLY CERTIFIED PORTIONS ARE ASSIGNED SINGLE SNF PROV NO. COBOL NAME: LTC-CROSS-REF-PROV-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3- SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR ADMISSION SUSPENSION DATE 6 1434 1439 C PROV1610 PREVIOUS DATE A SUSPENSION OF ADMISSIONS WAS INVOKED FOR A PROVIDER. COBOL NAME: PRIOR-ADMIN-SUSP-DT PRIOR LTC END DATE 6 1440 1445 C PROV1630 THE LAST DATE OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT FOR A PRIOR SURVEY. COBOL NAME: PRIOR-LTC-END-DT PRIOR LTC EXTENSION DATE 6 1446 1451 C PROV1635 THE LAST DATE OF AN EXTENSION OF A CERTIFIED LONG TERM CARE FACILITY'S TIME LIMITED AGREEMENT FOR A PRIOR SURVEY. COBOL NAME: PRIOR-LTC-EXT-DT PRIOR RESCIND SUSPENSION DATE 6 1452 1457 C PROV1640 THE EFFECTIVE DATE OF A PREVIOUS SUSPENSION OF ADMISSIONS TO A LTC FACILITY. COBOL NAME: PRIOR-RESC-SUSP-DT PROVIDER BASED FACILITY 1 1458 1458 C PROV1675 INDICATES IF A LONG TERM CARE FACILITY IS PROVIDER BASED. COBOL NAME: PROV-BASED-FACILITY VALUES: N NOT DISTINCT PART OF HOSP,SNF,ICF Y DISTINCT PART OF A HOSPITAL, SNF OR ICF RESCIND SUSPENSION DATE 6 1480 1485 C PROV1825 DATE THAT THE SUPENSION OF PAYMENTS FOR NEW ADMISSIONS TO A LONG TERM CARE FACILITY (LTC) IS RESCINDED. COBOL NAME: RESC-SUSP-DT BEDS - ICF/MR 4 1950 1953 N PROV0945 NUMBER OF CERTIFIED BEDS IN AN INTERMEDIATE CARE FACILITY FOR THE MENTALLY RETARDED. COBOL NAME: NUM-ICF-MR-BEDS DIRECT CARE PERSONNEL 7.2 1954 1960 N PROV0780 NUMBER OF FULL-TIME EQUIVALENT DIRECT CARE PERSONNEL EMPLOYED BY AN INTERMEDIATE CARE FACILITY FOR THE MENTALLY RETARDED. COBOL NAME: NUM-DCARE-PERSNL TOTAL # OF EMPLOYEES 9.2 1961 1969 N PROV2850 THE TOTAL NUMBER OF FULL-TIME EMPLOYEES IN A HOSPICE OR AN INTERMEDIATE CARE FACILITY/MENTAL RETARDATION FACILITY. COBOL NAME: TOT-EMPLOYEES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 RURAL HEALTH CLINICS CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 12 RURAL HEALTH CLINICS CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 03 STATE GOVERNMENT 04 LOCAL GOVERNMENT 05 FEDERAL GOVERNMENT 1A FOR PROFIT INDIVIDUAL 1B FOR PROFIT CORPORATION 1C FOR PROFIT PARTNERSHIP 2A NON PROFIT INDIVIDUAL 2B NON PROFIT CORPORATION 2C NON PROFIT PARTNERSHIP ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE OTHER PERSONNEL 7.2 795 801 N PROV1075 THE NUMBER OF FULL-TIME EQUIVALENT OTHER SALARIED PERSONNEL EMPLOYED BY A FACILITY. COBOL NAME: NUM-OTHER-PERSNL PHYSICIAN ASSISTANTS 7.2 810 816 N PROV1115 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN ASSISTANTS EMPLOYED BY A HOSPITAL OR RURAL HEALTH CLINIC. COBOL NAME: NUM-PHYS-ASSIST FEDERAL PROGRAM SUPPORT 1 1970 1970 C PROV0480 INDICATES IF A CLINIC IS RECEIVING SUPPORT FROM A FEDERAL PROGRAM TO PROVIDE HEALTH SERVICES IN A MEDICALLY UNDERSERVED AREA OR IN AN AREA WITH A SHORTAGE OF PRIMARY CARE HEALTH MANPOWER. COBOL NAME: FED-PROG-SUPPORT VALUES: N NO Y YES NURSE PRACTITIONERS 7.2 1971 1977 N PROV1015 NUMBER OF FULL-TIME EQUIVALENT NURSE PRACTITIONERS IN A RURAL HEALTH CLINIC. COBOL NAME: NUM-NURSE-PRACT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PARENT PROVIDER NUMBER 10 1978 1987 C PROV1560 THE IDENTIFICATION NUMBER OF THE PARENT PROVIDER WHEN A RURAL HEALTH CLINIC IS PART OF AN EXISTING MEDICARE PROVIDER. COBOL NAME: PARENT-PROV-NUM PHYSICIANS 7.2 1988 1994 N PROV1110 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIANS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-PHYS TITLE OF FEDERAL PROGRAM 26 1995 2020 C PROV2845 THE NAME OF A FEDERAL PROGRAM WHICH PROVIDES SUPPORT TO A RURAL HEALTH CLINIC TO PROVIDE SERVICES IN A MEDICALLY UNDERSERVED AREA OR AN AREA WITH A SHORTAGE OF PRIMARY CARE HEALTH MANPOWER. COBOL NAME: TITL-FED-PROGR VALUES: COMM HLTH PRG (330)COMMUNITY HEALTH PROGRAM (330) INDIAN HEALTH SERV INDIAN HEALTH SERVICE MIGRT HLTH PRG (329)MIGRANT HEALTH PROGRAM (329) NATNL HEALTH SRV DELNATIONAL HEALTH SERVICE DELIVERY PROGRAM RURAL OUTREACH DEMORURAL OUTREACH DEMO GRANT PROGRAM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 13 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00510 BLUE SHIELD (ALABAMA) 00520 BLUE SHIELD (ARKANSAS) 00528 BLUE SHIELD (ARKANSAS/LOUISIANA) 00542 BLUE SHIELD (CALIFORNIA) 00550 BLUE SHIELD (COLORADO) 00570 BLUE SHIELD (DELAWARE) 00580 BLUE SHIELD (DISTRICT OF COLUMBIA) 00590 BLUE SHIELD (FLORIDA) 00621 BLUE SHIELD (ILLINOIS) 00630 BLUE SHIELD (INDIANA) 00640 BLUE SHIELD (IOWA) 00650 BLUE SHIELD (KANSAS) 00655 BLUE SHIELD (KANSAS/NEBRASKA) 00660 BLUE SHIELD (KENTUCKY) 00690 BLUE SHIELD (MARYLAND) 00700 BLUE SHIELD (MASSACHUSETTS) 00710 BLUE SHIELD (MICHIGAN) 00720 BLUE SHIELD (MINNESOTA) 00740 BLUE SHIELD (KANSAS CITY) 00751 BLUE SHIELD (MONTANA) 00770 BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780 BLUE SHIELD (TRI-STATE) 00801 BLUE SHIELD (BUFFALO) 00803 BLUE SHIELD (EMPIRE) 00820 BLUE SHIELD (NORTH DAKOTA) 00825 BLUE SHIELD (NORTH DAKOTA/WYOMING) 00860 BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865 BLUE SHIELD (PENNSYLVANIA) 00870 BLUE SHIELD (RHODE ISLAND) 00880 BLUE SHIELD (SOUTH CAROLINA) 00900 BLUE SHIELD (TEXAS) 00910 BLUE SHIELD (UTAH) 00930 BLUE SHIELD (WASHINGTON) 00951 WISCONSIN PHYSICIANS SERVICE 00973 BLUE SHIELD (PUERTO RICO) 00974 BLUE SHIELD (VIRGIN ISLANDS) 01010 AETNA (PEORIA) 01020 AETNA (ALASKA) 01030 AETNA (ARIZONA) 01040 AETNA (GEORGIA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME 01120 AETNA (HAWAII) 01290 AETNA (NEVADA) 01360 AETNA (NEW MEXICO) 01370 AETNA (OKLAHOMA) 01380 AETNA (OREGON) 02050 OCCIDENTAL (CALIFORNIA) 05130 EQICOR (IDAHO) 05440 EQICOR (TENNESSEE) 05535 EQICOR (NORTH CAROLINA) 10071 TRAVELERS (RRB) 10230 TRAVELERS (CONNECTICUT) 10240 TRAVELERS (MINNESOTA) 10250 TRAVELERS (MISSISSIPPI) 10490 TRAVELERS (VIRGINIA) 10492 TRAVELERS - VIRGINIA SPECIAL PROJECT 11260 GENERAL AMERICAN 14330 GROUP HEALTH INC (NEW YORK) 16360 NATIONWIDE (OHIO) 16510 NATIONWIDE (WEST VIRGINIA) 21200 MASSACHUSETTS/MAINE * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4 SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 COMPREHENSIVE OUTPATIENT CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 14 COMPREHENSIVE OUTPATIENT REHAB FACILITIES CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 PROPRIETARY 02 NON PROFIT CHURCH 03 NON PROFIT OTHER 04 GOVERNMENT ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM SRV: OCCUPATIONAL THERAPY 1 917 917 C PROV2270 INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-OCCUP-THERAPY VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: PHYSICAL THERAPY 1 927 927 C PROV2370 INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-PHYSICAL-THERAPY VALUES: 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: SOCIAL 1 935 935 C PROV2485 INDICATES HOW SOCIAL SERVICES ARE PROVIDED. COBOL NAME: SP-SOCIAL VALUES: 0 NOT PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: SPEECH PATHOLOGY 1 936 936 C PROV2505 INDICATES HOW SPEECH PATHOLOGY SERVICES ARE PROVIDED. COBOL NAME: SP-SPEECH-PATH VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR PARTICIPATION MEDICARE OPT/SP 1 2021 2021 C PROV1570 INDICATES IF A COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY ALSO PARTICIPATES IN MEDICARE AS A PROVIDER OF OUTPATIENT PHYSICAL THERAPY AND/OR SPEECH PATHOLOGY. COBOL NAME: PARTIC-OPT-SP VALUES: N NO Y YES SRV: OCCUPATIONAL THERAPY #2 1 2022 2022 C PROV2275 INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-OCCUP-THERAPY-2 VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: OCCUPATIONAL THERAPY #3 1 2023 2023 C PROV2280 INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-OCCUP-THERAPY-3 VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: ORTHOTIC/PROSTHETIC 1 2024 2024 C PROV2325 INDICATES HOW ORTHOTIC/PROSTHETIC SERVICES ARE PROVIDED BY A COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY. COBOL NAME: SP-ORTHOTIC-PROSTHET VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: ORTHOTIC/PROSTHETIC #2 1 2025 2025 C PROV2330 INDICATES HOW ORTHOTIC/PROSTHETIC SERVICES ARE PROVIDED BY A COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY. COBOL NAME: SP-ORTHOTIC-PROSTHET-2 VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: ORTHOTIC/PROSTHETIC #3 1 2026 2026 C PROV2335 INDICATES HOW ORTHOTIC/PROSTHETIC SERVICES ARE PROVIDED BY A COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY. COBOL NAME: SP-ORTHOTIC-PROSTHET-3 VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: PHYSICAL THERAPY #2 1 2027 2027 C PROV2375 INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-PHYSICAL-THERAPY-2 VALUES: 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: PHYSICAL THERAPY #3 1 2028 2028 C PROV2380 INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-PHYSICAL-THERAPY-3 VALUES: 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: PHYSICIAN 1 2029 2029 C PROV2385 INDICATES HOW PHYSICIAN SERVICES ARE PROVIDED. COBOL NAME: SP-PHYSICIAN VALUES: 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: PHYSICIAN #2 1 2030 2030 C PROV2390 INDICATES HOW PHYSICIAN SERVICES ARE PROVIDED. COBOL NAME: SP-PHYSICIAN-2 VALUES: 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 19 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: PHYSICIAN #3 1 2031 2031 C PROV2395 INDICATES HOW PHYSICIAN SERVICES ARE PROVIDED. COBOL NAME: SP-PHYSICIAN-3 VALUES: 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: PSYCHOLOGICAL 1 2032 2032 C PROV2420 INDICATES HOW PSYCHOLOGICAL SERVICES ARE PROVIDED. COBOL NAME: SP-PSYCHOLOGICAL VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: PSYCHOLOGICAL #2 1 2033 2033 C PROV2425 INDICATES HOW PSYCHOLOGICAL SERVICES ARE PROVIDED. COBOL NAME: SP-PSYCHOLOGICAL-2 VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: PSYCHOLOGICAL #3 1 2034 2034 C PROV2430 INDICATES HOW PSYCHOLOGICAL SERVICES ARE PROVIDED. COBOL NAME: SP-PSYCHOLOGICAL-3 VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: RESPIRATORY CARE 1 2035 2035 C PROV2455 INDICATES HOW RESPIRATORY CARE SERVICES ARE PROVIDED. COBOL NAME: SP-RESP-CARE VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: RESPIRATORY CARE #2 1 2036 2036 C PROV2460 INDICATES HOW RESPIRATORY CARE SERVICES ARE PROVIDED. COBOL NAME: SP-RESP-CARE-2 VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 20 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: RESPIRATORY CARE #3 1 2037 2037 C PROV2465 INDICATES HOW RESPIRATORY CARE SERVICES ARE PROVIDED. COBOL NAME: SP-RESP-CARE-3 VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: SOCIAL #2 1 2038 2038 C PROV2490 INDICATES HOW SOCIAL SERVICES ARE PROVIDED. COBOL NAME: SP-SOCIAL-2 VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: SOCIAL #3 1 2039 2039 C PROV2495 INDICATES HOW SOCIAL SERVICES ARE PROVIDED. COBOL NAME: SP-SOCIAL-3 VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: SPEECH PATHOLOGY #2 1 2040 2040 C PROV2510 INDICATES HOW SPEECH PATHOLOGY SERVICES ARE PROVIDED. COBOL NAME: SP-SPEECH-PATH-2 VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR SRV: SPEECH PATHOLOGY #3 1 2041 2041 C PROV2515 INDICATES HOW SPEECH PATHOLOGY SERVICES ARE PROVIDED. COBOL NAME: SP-SPEECH-PATH-3 VALUES: 0 NOT PROVIDED 1 PROVIDED BY EMPLOYEES 2 PROVIDED UNDER ARRANGEMENT 3 PROVIDED BY INDEPENDENT CONTRACTOR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 AMBULATORY SURGICAL CENTER CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 15 AMBULATORY SURGICAL CENTERS CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 00510 BLUE SHIELD (ALABAMA) 00520 BLUE SHIELD (ARKANSAS) 00528 BLUE SHIELD (ARKANSAS/LOUISIANA) 00542 BLUE SHIELD (CALIFORNIA) 00550 BLUE SHIELD (COLORADO) 00570 BLUE SHIELD (DELAWARE) 00580 BLUE SHIELD (DISTRICT OF COLUMBIA) 00590 BLUE SHIELD (FLORIDA) 00621 BLUE SHIELD (ILLINOIS) 00630 BLUE SHIELD (INDIANA) 00640 BLUE SHIELD (IOWA) 00650 BLUE SHIELD (KANSAS) 00655 BLUE SHIELD (KANSAS/NEBRASKA) 00660 BLUE SHIELD (KENTUCKY) 00690 BLUE SHIELD (MARYLAND) 00700 BLUE SHIELD (MASSACHUSETTS) 00710 BLUE SHIELD (MICHIGAN) 00720 BLUE SHIELD (MINNESOTA) 00740 BLUE SHIELD (KANSAS CITY) 00751 BLUE SHIELD (MONTANA) 00770 BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780 BLUE SHIELD (TRI-STATE) 00801 BLUE SHIELD (BUFFALO) 00803 BLUE SHIELD (EMPIRE) 00820 BLUE SHIELD (NORTH DAKOTA) 00825 BLUE SHIELD (NORTH DAKOTA/WYOMING) 00860 BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865 BLUE SHIELD (PENNSYLVANIA) 00870 BLUE SHIELD (RHODE ISLAND) 00880 BLUE SHIELD (SOUTH CAROLINA) 00900 BLUE SHIELD (TEXAS) 00910 BLUE SHIELD (UTAH) 00930 BLUE SHIELD (WASHINGTON) 00951 WISCONSIN PHYSICIANS SERVICE 00973 BLUE SHIELD (PUERTO RICO) 00974 BLUE SHIELD (VIRGIN ISLANDS) 01010 AETNA (PEORIA) 01020 AETNA (ALASKA) 01030 AETNA (ARIZONA) 01040 AETNA (GEORGIA) 01120 AETNA (HAWAII) 01290 AETNA (NEVADA) 01360 AETNA (NEW MEXICO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 01370 AETNA (OKLAHOMA) 01380 AETNA (OREGON) 02050 OCCIDENTAL (CALIFORNIA) 05130 EQICOR (IDAHO) 05440 EQICOR (TENNESSEE) 05535 EQICOR (NORTH CAROLINA) 10071 TRAVELERS (RRB) 10230 TRAVELERS (CONNECTICUT) 10240 TRAVELERS (MINNESOTA) 10250 TRAVELERS (MISSISSIPPI) 10490 TRAVELERS (VIRGINIA) 10492 TRAVELERS - VIRGINIA SPECIAL PROJECT 11260 GENERAL AMERICAN 14330 GROUP HEALTH INC (NEW YORK) 16360 NATIONWIDE (OHIO) 16510 NATIONWIDE (WEST VIRGINIA) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 21200 MASSACHUSETTS/MAINE 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 PROPRIETARY 02 NON PROFIT 03 GOVERNMENT ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE COMPLIANCE: LIFE SAFETY CODE 1 752 752 C PROV0240 INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN RECOMMENDED FOR A PROVIDER. COBOL NAME: COMPL-LSC VALUES: 1 WAIVER RECOMMENDED RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM SRV: PHARMACY 1 926 926 C PROV2365 INDICATES HOW PHARMACY SERVICES ARE PROVIDED. COBOL NAME: SP-PHARMACY VALUES: 1 PROVIDED DIRECTLY BY THE FACILITY 2 PROVIDED THROUGH AN OUTSIDE SOURCE 3 COMBINATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: OTHER 1 1662 1662 C PROV2340 INDICATES HOW OTHER (NOT SPECIFIED) SERVICES ARE PROVIDED. COBOL NAME: SP-OTHER VALUES: N NOT OFFERED Y OFFERED DATE CENTER BEGAN PROVIDING SERV 6 2042 2047 C PROV0415 THE DATE AN AMBULATORY SURGICAL CENTER (ASC) BEGAN PROVIDING HEALTH CARE SERVICES. COBOL NAME: DT-SERVICE-BEGAN FREE STANDING INDICATOR (ASC) 1 2048 2048 C PROV0550 INDICATES IF THE AMBULATORY SURGICAL CENTER IS FREE STANDING. THIS INDICATOR IS USED BY SOME STANDARD REPORTS TO GET CERTAIN PROVIDER RANGES. COBOL NAME: FREE-STAND-IND VALUES: 1 FREE STANDING HOSPITAL BASED INDICATOR 1 2049 2049 C PROV0565 INDICATES IF AN AMBULATORY SURGICAL CENTER IS HOSPITAL BASED. THIS INDICATOR IS USED BY SOME STANDARD REPORTS TO GET CERTAIN PROVIDER RANGES. COBOL NAME: HOSP-BASED-IND VALUES: 1 HOSPITAL BASED OPERATING ROOMS 2 2050 2051 N PROV1055 THE NUMBER OF OPERATING ROOMS IN AN AMBULATORY SURGICAL CENTER. COBOL NAME: NUM-OPERATING-ROOMS SPEC: CARDIOVASCULAR 1 2052 2052 C PROV2095 INDICATES IF CARDIOVASCULAR SURGERY IS OFFERED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-CARDIOVASCULAR VALUES: N NOT OFFERED Y OFFERED SPEC: FOOT 1 2053 2053 C PROV2145 INDICATES IF FOOT SURGERY IS OFFERED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-FOOT VALUES: N NOT OFFERED Y OFFERED SPEC: GENERAL 1 2054 2054 C PROV2150 INDICATES IF GENERAL SURGERY IS OFFERED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-GENERAL VALUES: N NOT OFFERED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 19 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME Y OFFERED SPEC: NEUROLOGICAL 1 2055 2055 C PROV2240 INDICATES IF NEUROLOGICAL SURGERY IS OFFERED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-NEUROLOGICAL VALUES: N NOT OFFERED Y OFFERED SPEC: OBSTETRICS/GYNECOLOGY 1 2056 2056 C PROV2260 INDICATES IF OBSTETRICS/GYNECOLOGY SURGERY IS OFFERED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-OBSTETR-GYNECOL VALUES: N NOT OFFERED Y OFFERED SPEC: OPTHAMOLOGY 1 2057 2057 C PROV2290 INDICATES IF OPTHAMOLOGY SURGERY IS OFFERED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-OPTHAMOLOGY-SURG VALUES: N NOT OFFERED Y OFFERED SPEC: ORAL 1 2058 2058 C PROV2305 INDICATES IF ORAL SURGERY IS OFFERED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-ORAL VALUES: N NOT OFFERED Y OFFERED SPEC: ORTHOPEDIC 1 2059 2059 C PROV2320 INDICATES IF ORTHOPEDIC SURGERY IS OFFERED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-ORTHOPEDIC VALUES: N NOT OFFERED Y OFFERED SPEC: OTOLARYNGOLOGY 1 2060 2060 C PROV2345 INDICATES IF OTOLARYNGOLOGY SURGERY IS OFFERED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-OTOLARYRGOLOGY VALUES: N NOT OFFERED Y OFFERED SPEC: PLASTIC 1 2061 2061 C PROV2400 INDICATES IF PLASTIC SURGERY IS OFFERED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-PLASTIC VALUES: * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 20 AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME N NOT OFFERED Y OFFERED SPEC: THORACIC 1 2062 2062 C PROV2525 INDICATES IF THORACIC SURGERY IS OFFERED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-THORACIC VALUES: N NOT OFFERED Y OFFERED SPEC: UROLOGY 1 2063 2063 C PROV2530 INDICATES IF UROLOGY SURGERY IS OFFERED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-UROLOGY VALUES: N NOT OFFERED Y OFFERED SRV: EKG 1 2064 2064 C PROV2135 INDICATES IF EKG SERVICES ARE PROVIDED BY AN AMBULATORY SURGICAL CENTER. COBOL NAME: SP-EKG VALUES: 0 NOT PROVIDED 1 PROVIDED DIRECTLY BY THE FACILITY 2 PROVIDED THROUGH AN OUTSIDE SOURCE 3 COMBINATION SRV: LABORATORY 1 2065 2065 C PROV2200 INDICATES HOW LABORATORY SERVICES ARE PROVIDED. COBOL NAME: SP-LABORATORY VALUES: 1 PROVIDED DIRECTLY BY THE FACILITY 2 PROVIDED THROUGH AN OUTSIDE SOURCE 3 COMBINATION SRV: RADIOLOGY 1 2066 2066 C PROV2435 INDICATES HOW RADIOLOGY SERVICES ARE PROVIDED. COBOL NAME: SP-RADIOLOGY VALUES: 1 PROVIDED DIRECTLY BY THE FACILITY 2 PROVIDED THROUGH AN OUTSIDE SOURCE 3 COMBINATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 HOSPICE CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 16 HOSPICES CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 VOLUNTARY NON-PROFIT - CHURCH 02 VOLUNTARY NON-PROFIT - PRIVATE 03 VOLUNTARY NON-PROFIT - OTHER 04 PROPRIETARY - INDIVIDUAL 05 PROPRIETARY - PARTNERSHIP 06 PROPRIETARY - CORPORATION 07 PROPRIETARY - OTHER 08 GOVERNMENT - STATE 09 GOVERNMENT - COUNTY 10 GOVERNMENT - CITY 11 GOVERNMENT - CITY-COUNTY 12 COMBINATION GOV. & NONPROFIT 13 OTHER ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE COMPLIANCE: LIFE SAFETY CODE 1 752 752 C PROV0240 INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN RECOMMENDED FOR A PROVIDER. COBOL NAME: COMPL-LSC VALUES: 1 WAIVER RECOMMENDED LICENSED PRACTICAL NURSES 7.2 779 785 N PROV0955 NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL OR VOCATIONAL NURSES EMPLOYED BY A FACILITY. COBOL NAME: NUM-LPN-LVN OTHER PERSONNEL 7.2 795 801 N PROV1075 THE NUMBER OF FULL-TIME EQUIVALENT OTHER SALARIED PERSONNEL EMPLOYED BY A FACILITY. COBOL NAME: NUM-OTHER-PERSNL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGISTERED NURSES 7.2 844 850 N PROV1145 THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED PROFESSIONAL NURSES EMPLOYED BY A PROVIDER. COBOL NAME: NUM-REG-NURS RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM SRV: OCCUPATIONAL THERAPY 1 917 917 C PROV2270 INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-OCCUP-THERAPY VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: PHYSICAL THERAPY 1 927 927 C PROV2370 INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED. COBOL NAME: SP-PHYSICAL-THERAPY VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: SPEECH PATHOLOGY 1 936 936 C PROV2505 INDICATES HOW SPEECH PATHOLOGY SERVICES ARE PROVIDED. COBOL NAME: SP-SPEECH-PATH VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION HOME HEALTH AIDES 7.2 1615 1621 N PROV0910 NUMBER OF FULL-TIME EQUIVALENT HOME HEALTH AIDES EMPLOYED BY A HOME HEALTH AGENCY OR HOSPICE. COBOL NAME: NUM-HOME-HEALTH-AIDES SRV: MEDICAL SOCIAL 1 1659 1659 C PROV2220 INDICATES HOW MEDICAL SOCIAL SERVICES ARE PROVIDED COBOL NAME: SP-MEDICAL-SOCIAL VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SRV: NURSING 1 1660 1660 C PROV2250 INDICATES HOW NURSING SERVICES ARE PROVIDED. COBOL NAME: SP-NURSING VALUES: 1 PROVIDED BY STAFF 7 COMBINATION SRV: OTHER 1 1662 1662 C PROV2340 INDICATES HOW OTHER (NOT SPECIFIED) SERVICES ARE PROVIDED. COBOL NAME: SP-OTHER VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION TOTAL # OF EMPLOYEES 9.2 1961 1969 N PROV2850 THE TOTAL NUMBER OF FULL-TIME EMPLOYEES IN A HOSPICE OR AN INTERMEDIATE CARE FACILITY/MENTAL RETARDATION FACILITY. COBOL NAME: TOT-EMPLOYEES PHYSICIANS 7.2 1988 1994 N PROV1110 THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIANS EMPLOYED BY A PROVIDER. COBOL NAME: NUM-PHYS SRV: PHYSICIAN 1 2029 2029 C PROV2385 INDICATES HOW PHYSICIAN SERVICES ARE PROVIDED. COBOL NAME: SP-PHYSICIAN VALUES: 1 PROVIDED BY STAFF ACUTE/RESPITE CARE INDICATOR 1 2067 2067 C PROV0015 INDICATES IF THE HOSPICE PROVIDES ACUTE AND/OR RESPITE SHORT TERM INPATIENT CARE. COBOL NAME: ACUTE-RESPITE VALUES: A SHORT TERM INPATIENT ACUTE CARE PROV'D IN HSP B SHORT TERM INPATIENT RESPITE CARE PROV IN HSP C ST INPATIENT ACUTE & RESPITE CARE PROV IN HSP COUNSELORS - STAFF 7.2 2068 2074 N PROV1225 THE NUMBER OF FULL-TIME EQUIVALENT COUNSELORS EMPLOYED BY A HOSPICE. COBOL NAME: NUM-STAFF-COUNSL COUNSELORS - VOLUNTEER 7.2 2075 2081 N PROV1480 THE NUMBER OF FULL-TIME EQUIVALENT VOLUNTEER COUNSELORS IN A HOSPICE. COBOL NAME: NUM-VOL-COUNSL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 19 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME HOME HEALTH AIDES - VOLUNTEER 7.2 2082 2088 N PROV1485 THE NUMBER OF FULL-TIME EQUIVALENT VOLUNTEER HOME HEALTH AIDES IN A HOSPICE. COBOL NAME: NUM-VOL-HHA HOMEMAKERS - STAFF 7.2 2089 2095 N PROV0915 THE NUMBER OF FULL-TIME EQUIVALENT HOMEMAKERS EMPLOYED BY A HOSPICE. COBOL NAME: NUM-HOMEMAKERS HOMEMAKERS - VOLUNTEER 7.2 2096 2102 N PROV1490 THE NUMBER OF FULL-TIME EQUIVALENT HOMEMAKERS IN A HOSPICE. COBOL NAME: NUM-VOL-HOMEMKR LPNS/LVNS - VOLUNTEER 7.2 2103 2109 N PROV1495 THE NUMBER OF FULL-TIME EQUIVALENT VOLUNTEER LICENSED PRACTICAL/VOCATIONAL NURSES IN A HOSPICE. COBOL NAME: NUM-VOL-LPN-LVN MEDICAL SOCIAL WORKERS 7.2 2110 2116 N PROV0975 NUMBER OF FULL-TIME EQUIVALENT MEDICAL SOCIAL WORKERS EMPLOYED BY A HOSPITAL OR HOSPICE. COBOL NAME: NUM-MED-SOCIAL-WRKS MEDICAL SOCIAL WORKERS - VOLUNTEER 7.2 2117 2123 N PROV1510 THE NUMBER OF FULL-TIME EQUIVALENT VOLUNTEER MEDICAL SOCIAL WORKERS IN A HOSPICE. COBOL NAME: NUM-VOL-SOC-WORK PHYSICIANS - VOLUNTEER 7.2 2124 2130 N PROV1500 THE NUMBER OF FULL-TIME EQUIVALENT VOLUNTEER PHYSICIANS IN A HOSPICE. COBOL NAME: NUM-VOL-PHYS REGISTERED NURSES - VOLUNTEER 7.2 2131 2137 N PROV1505 THE NUMBER OF FULL-TIME EQUIVALENT VOLUNTEER REGISTERED NURSES IN A HOSPICE. COBOL NAME: NUM-VOL-REG-NURS SRV: COUNSELING 1 2138 2138 C PROV2115 INDICATES HOW COUNSELING SERVICES ARE PROVIDED BY A HOSPICE. COBOL NAME: SP-COUNSELING VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: HOME HEALTH AIDE 1 2139 2139 C PROV2165 INDICATES HOW HOME HEALTH AIDE SERVICES ARE PROVIDED BY A HOSPICE. COBOL NAME: SP-HOME-HEALTH-AIDE VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 20 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 3 COMBINATION SRV: HOMEMAKER 1 2140 2140 C PROV2170 INDICATES HOW HOMEMAKER SERVICES ARE PROVIDED BY A HOSPICE. COBOL NAME: SP-HOMEMAKER VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: MEDICAL SUPPLIES 1 2141 2141 C PROV2225 INDICATES HOW MEDICAL SUPPLIES SERVICES ARE PROVIDED BY A HOSPICE. COBOL NAME: SP-MEDICAL-SUPPLIES VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION SRV: SHORT TERM INPATIENT CARE 1 2142 2142 C PROV2480 INDICATES HOW SHORT TERM INPATIENT CARE SERVICES ARE PROVIDED BY A HOSPICE. COBOL NAME: SP-SHORT-TERM-INCARE VALUES: 0 NOT PROVIDED 1 PROVIDED BY STAFF 2 PROVIDED UNDER ARRANGEMENT 3 COMBINATION VOLUNTEERS - OTHER 7.2 2143 2149 N PROV1080 THE NUMBER OF FULL-TIME EQUIVALENT OTHER VOLUNTEERS IN A HOSPICE. COBOL NAME: NUM-OTHER-VOLS VOLUNTEERS - TOTAL 9.2 2150 2158 N PROV2860 THE NUMBER OF FULL-TIME VOLUNTEERS IN A HOSPICE. COBOL NAME: TOT-VOLS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 ORGAN PROCUREMENT CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 17 ORGAN PROCUREMENT ORGANIZATIONS CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 3 TERMINATION 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND VALUES: 01 CLIA CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 18 CLIA67 LABORATORIES CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC VALUES: Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 00510 BLUE SHIELD (ALABAMA) 00520 BLUE SHIELD (ARKANSAS) 00528 BLUE SHIELD (ARKANSAS/LOUISIANA) 00542 BLUE SHIELD (CALIFORNIA) 00550 BLUE SHIELD (COLORADO) 00570 BLUE SHIELD (DELAWARE) 00580 BLUE SHIELD (DISTRICT OF COLUMBIA) 00590 BLUE SHIELD (FLORIDA) 00621 BLUE SHIELD (ILLINOIS) 00630 BLUE SHIELD (INDIANA) 00640 BLUE SHIELD (IOWA) 00650 BLUE SHIELD (KANSAS) 00655 BLUE SHIELD (KANSAS/NEBRASKA) 00660 BLUE SHIELD (KENTUCKY) 00690 BLUE SHIELD (MARYLAND) 00700 BLUE SHIELD (MASSACHUSETTS) 00710 BLUE SHIELD (MICHIGAN) 00720 BLUE SHIELD (MINNESOTA) 00740 BLUE SHIELD (KANSAS CITY) 00751 BLUE SHIELD (MONTANA) 00770 BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780 BLUE SHIELD (TRI-STATE) 00801 BLUE SHIELD (BUFFALO) 00803 BLUE SHIELD (EMPIRE) 00820 BLUE SHIELD (NORTH DAKOTA) 00825 BLUE SHIELD (NORTH DAKOTA/WYOMING) 00860 BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865 BLUE SHIELD (PENNSYLVANIA) 00870 BLUE SHIELD (RHODE ISLAND) 00880 BLUE SHIELD (SOUTH CAROLINA) 00900 BLUE SHIELD (TEXAS) 00910 BLUE SHIELD (UTAH) 00930 BLUE SHIELD (WASHINGTON) 00951 WISCONSIN PHYSICIANS SERVICE 00973 BLUE SHIELD (PUERTO RICO) 00974 BLUE SHIELD (VIRGIN ISLANDS) 01010 AETNA (PEORIA) 01020 AETNA (ALASKA) 01030 AETNA (ARIZONA) 01040 AETNA (GEORGIA) 01120 AETNA (HAWAII) 01290 AETNA (NEVADA) 01360 AETNA (NEW MEXICO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 01370 AETNA (OKLAHOMA) 01380 AETNA (OREGON) 02050 OCCIDENTAL (CALIFORNIA) 05130 EQICOR (IDAHO) 05440 EQICOR (TENNESSEE) 05535 EQICOR (NORTH CAROLINA) 10071 TRAVELERS (RRB) 10230 TRAVELERS (CONNECTICUT) 10240 TRAVELERS (MINNESOTA) 10250 TRAVELERS (MISSISSIPPI) 10490 TRAVELERS (VIRGINIA) 10492 TRAVELERS - VIRGINIA SPECIAL PROJECT 11260 GENERAL AMERICAN 14330 GROUP HEALTH INC (NEW YORK) 16360 NATIONWIDE (OHIO) 16510 NATIONWIDE (WEST VIRGINIA) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 21200 MASSACHUSETTS/MAINE 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND VALUES: Y YES SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 2 RECERTIFICATION 3 TERMINATION 4 CHANGE OF OWNERSHIP 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 VOL. NON-PROF. - RELIGIOUS AFF. 02 VOLUNTARY NON-PROFIT - PRIVATE 03 VOLUNTARY NON-PROFIT - OTHER 04 PROPRIETARY 05 GOVERNMENT - CITY 06 GOVERNMENT - COUNTY 07 GOVERNMENT - STATE 08 GOVERNMENT - FEDERAL 09 GOVERNMENT - OTHER 10 OTHER (SURVEYED PRIOR TO 040491) 11 UNKNOWN (PRIOR TO 040491 SURVEYS) ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE CALENDAR YEAR TEST VOLUME 2 1669 1670 C PROV2615 THE NUMBER OF TESTS PERFORMED BY A LAB FOR THE PRE- VIOUS CALENDAR YEAR FOR ALL SPECIALTIES AND SUB- SPECIALTIES COBOL NAME: SPEC-CALENDAR-YEAR CLIA LAB PROGRAM STATUS 1 1671 1671 C PROV0615 THE TYPE OF LABORATORY, I.E. HOSPITAL OR INDEPEDENT, AND THE PROGRAM(S) (MEDICARE, CLIA) IN WHICH THE LAB PARTICIPATES COBOL NAME: LAB-PROGRAM-STATUS VALUES: 2 INDEPENDENT CLIA LAB * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 3 INDEPENDENT MEDICARE/CLIA LAB 4 HOSPITAL BASED CLIA ONLY LAB CYTOTECHNOLOGISTS-PROF EXAM 3 1672 1674 N PROV0775 NUMBER OF CYTOTECHNOLOGISTS QUALIFIED UNDER CFR 405.1437(B)(3) WHICH REQUIRES SATISFACTORY GRADES IN PROFICIENCY EXAMINATIONS. COBOL NAME: NUM-CYTOTECHS-3 CYTOTECHNOLOGISTS-2 YR COLL 3 1675 1677 N PROV0765 NUMBER OF CYTOTECHNOLOGISTS QUALIFIED UNDER CFR 493.1437(B)(1) WHICH REQUIRES TWO YEARS OF COLLEGE, TWELVE MONTHS OF CYTOTECHNOLOGY TRAINING AND SIX MONTHS OF FORMAL TRAINING. COBOL NAME: NUM-CYTOTECHS-1 CYTOTECHNOLOGISTS-6 MO TRAIN 3 1678 1680 N PROV0770 # OF CYTOTECHNOLOGISTS QUALIFIED UNDER CFR CFR 493.1437(B)(2) WHICH REQUIRES THAT PRIOR TO 1/1/69, THE CYTOTECH IS A HS GRAD WITH 6 MTHS TRNG IN CYTOTECH, AND 2 YRS FULLTIME SUPERVISORY EXPER IN CYTOTECHNOLOGY COBOL NAME: NUM-CYTOTECHS-2 GENERAL SUPERVISOR - CYTOTECH 3 1681 1683 N PROV0880 THE NUMBER OF LAB GENERAL SUPERVISORS, QUALIFIED UNDER CFR 493.1427(B)(5), WHO HAVE FOUR YEARS EXPERIENCE AS CYTOTECHNOLOGISTS. COBOL NAME: NUM-GN-SUP-CYTOTECH GENERAL SUPERVISOR - GRANDFATHERED 3 1684 1686 N PROV0885 THE NUMBER OF LAB GENERAL SUPERVISORS QUALIFIED PRIOR TO 7/1/71 WITH AT LEAST 15 YEARS FULL-TIME EXPERIENCE PRIOR TO 1/1/68. (SEE CFR 493.1427(B)(6). COBOL NAME: NUM-GN-SUP-GRFATHER GENERAL SUPERVISOR - MD/DOCTORATE 3 1687 1689 N PROV0895 THE NUMBER OF LAB GENERAL SUPERVISORS, QUALIFIED UNDER CFR 493.1427(B)(2) WHO ARE PHYSICIANS OR HAVE DOCTORAL DEGREES IN A CLINICAL, PHYSICAL OR BIOLOGICAL SCIENCE AND 2 YEARS EXPERIENCE IN A LABORATORY. COBOL NAME: NUM-GN-SUP-PHYS-DOCT GENERAL SUPERVISOR - QUALIFIED DIR 3 1690 1692 N PROV0900 THE NUMBER OF GENERAL SUPERVISORS QUALIFIED UNDER CFR 493.1427(B)(1) WHO MAY ALSO SERVE AS THE LABORATORY DIRECTOR COBOL NAME: NUM-GN-SUP-QUALIF GENERAL SUPERVISOR - 6 YRS EXP 3 1693 1695 N PROV0875 THE NUMBER OF LAB GENERAL SUPERVISORS, QUALIFIED UNDER CFR 493.1427(B)(4), WHO ARE LAB TECHNOLOGISTS WITH AT LEAST 6 YRS FULL-TIME LAB EXPERIENCE. COBOL NAME: NUM-GN-SUP-CLT-PLUS6 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 19 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME GENERAL SUPERVISOR-MASTERS DEGREE 3 1696 1698 N PROV0890 THE NUMBER OF LAB GENERAL SUPERVISORS QUALIFIED UNDER CFR 493.1427(B)32) WHO POSSESS MASTER'S DEGREES IN A CHEMICAL, PHYSICAL OR BIOLOGICAL SCIENCE AND HAVE AT LEAST 4 YEARS LAB EXPERIENCE. COBOL NAME: NUM-GN-SUP-MST-DEGREE IMMUNOHEMATOLOGY TEST FOR TRANSFUS 1 1699 1699 C PROV2085 INDICATES IF A LABORATORY PERFORMS IMMUNOHEMATOLOGY TESTS FOR TRANSFUSION PURPOSES COBOL NAME: SP-BLOOD-BANK-IMMUN VALUES: N NO Y YES LAB DIRECTORS - DOCTORATES 3 1700 1702 N PROV0830 THE NUMBER OF LAB DIRECTORS QUALIFIED UNDER CFR 493.1415(B)(4), WHICH REQUIRES DOCTORAL DEGREES AND BOARD CERTIFICATION OR 4 OR MORE YEARS EXPERIENCE IN AN APPROVED CLINICAL LABORATORY. COBOL NAME: NUM-DIR-DOCT-DEGREE LAB DIRECTORS - GRANDFATHERED 3 1703 1705 N PROV0835 THE NUMBER OF LAB DIRECTORS QUALIFIED UNDER CFR 493.1415(B)(5) WHO QUALIFIED PRIOR TO JULY 1, 1971, UNDER THE GRANDFATHER CLAUSE. COBOL NAME: NUM-DIR-GRFATHER LAB DIRECTORS - MD PATHOLOGISTS 3 1706 1708 N PROV0840 THE NUMBER OF LAB DIRECTORS QUALIFIED UNDER CFR 493.1415(B)(1) WHO ARE PHYSICIANS BOARD CERTIFIED IN ANATOMICAL AND/OR CLINICAL PATHOLOGY OR POSSESS EQUIVALENT QUALIFICATIONS. COBOL NAME: NUM-DIR-PATHOLOGIST LAB DIRECTORS - MD SPECIALTY 3 1709 1711 N PROV0845 THE NUMBER OF LAB DIRECTORS QUALIFIED UNDER CFR 493.1415(B)(2), WHO ARE PHYSICIANS BOARD CERTIFIED IN ONE OF THE LAB SPECIALTIES OR WHO HAVE 4 YEARS OF FT EXPERIENCE IN A LAB, INCLUDING 2 YEARS SPECIALIZED TRNG COBOL NAME: NUM-DIR-PHYS-BOARD LAB DIRECTORS - ORAL PATHOLOGY 3 1712 1714 N PROV0825 NUMBER OF LABORATORY DIRECTORS WHO ARE BOARD CERTIFIED IN ORAL PATHOLOGY OR_WHO POSSESS EQUIVALENT QUALIFICATIONS._SEE CFR 493.1415(B)(3) COBOL NAME: NUM-DIR-DENTIST LAB DIRECTORS - STATE DEEMED 3 1715 1717 N PROV0850 NUMBER OF DIRECTORS THAT QUALIFY UNDER STATE LAW TO DIRECT THE LABORATORY (CFR 493.1415(B)(6)). COBOL NAME: NUM-DIR-STATE-DEEMED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 20 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TECH SUPER - BA/BS CHEMISTRY 3 1718 1720 N PROV1275 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(S) TO PERFORM CHEMISTRY TESTS, WHO ARE DIRECTORS WITH A BS IN CHEMICAL SCIENCE AND 6 YEARS RELATED EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-CHEM TECH SUPER - BA/BS HEMATOLOGY 3 1721 1723 N PROV1285 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER_CFR 493.1421(O) TO PERFORM HEMATOLOGY TESTS, WHO ARE DIRECTORS WITH A BS IN BIOLOGY, IMMUNOLOGY OR MICRO- BIOLOGY, AND HAVE 6 YEARS EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-HEM TECH SUPER - BA/BS IMMUNOHEM 3 1724 1726 N PROV1290 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(R) TO PERFORM BLOOD GROUPING TESTS, WHO ARE DIRECTORS WITH A BS IN BIOLOGY, IMMUNOLOGY OR MICRO- BIOLOGY, AND 6 YEARS EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-IMHE TECH SUPER - BA/BS IMMUNOLOGY 3 1727 1729 N PROV1295 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(P) TO PERFORM DIAGNOSTIC IMMUNOLOGY TESTS, WHO ARE DIRECTORS WITH A BS IN BIOLOGY, CHEMISTRY, IMMU- NOLOGY OR MICROBIOLOGY, AND HAVE 6 YEARS EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-IMM TECH SUPER - BA/BS MICROBIO 3 1730 1732 N PROV1300 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(N) TO PERFORM MICROBIOLOGY TESTS WHO ARE DIRECTORS WITH A BS IN BIOLOGY AND 6 YEARS MICROBIOLOGY EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-MICR TECH SUPER - BA/BS RADIOBIO 3 1733 1735 N PROV1305 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(Q) TO PERFORM RADIOBIOASSAY TESTS WHO ARE DIRECTORS WITH A BS IN CHEMICAL, PHYSICAL OR BIOLOGICAL SCIENCE AND HAVE 6 YEARS EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-RADI TECH SUPER - BA/BS SPEC EXP 3 1736 1738 N PROV1280 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(T) TO PERFORM SPECIFIC LAB TESTS WHO ARE DIRECTORS WITH A BS IN MEDICAL TECHNOLOGY AND HAVE 6 YEARS SPECIALIZED EXPERIENCE COBOL NAME: NUM-TECH-SUP-BA-BS-EXP TECH SUPER - CLINICAL CHEMISTRY 3 1739 1741 N PROV1310 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(D) TO PERFORM TESTS IN CHEM UNDER THE SUP OF A BOARD CERT MD OR HAVE EQUIV QUALIFS OR HAVE DOCT/MAST DEGREE IN CHEM AND 4 YRS EXP IN CLINICAL CHEMISTRY COBOL NAME: NUM-TECH-SUP-CHEMISTRY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 21 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TECH SUPER - CYTOGENETICS 3 1742 1744 N PROV1315 # OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(K) TO PERFORM IN CLINICAL CYTOGENETICS WHO ARE DIRECTORS WITH A DOCTORAL DEGREE IN BIOLOGY OR PHYSICIANS AND HAVE 4 YEARS EXPERIENCE IN GENETICS COBOL NAME: NUM-TECH-SUP-CYTOGEN TECH SUPER - CYTOLOGY 3 1745 1747 N PROV1320 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(F) TO PERFORM CYTOLOGY TESTS UNDER THE SUPERVISION OF A BOARD CERTIFIED PHYSICIAN OR WHO POSSESS EQUIVALENT QUALIFICATIONS COBOL NAME: NUM-TECH-SUP-CYTOLOGY TECH SUPER - DIAGNOSTIC IMMUN 3 1748 1750 N PROV1345 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(C) TO PERFORM TESTS IN DIAGNOSTIC IMMUN- OLOGY UNDER THE SUP OF A BOARD CERT MD OR HAVE EQUIV QUALIFS OR HAVE DOCT/MAST DEGREE IN RELATED SCIENCES COBOL NAME: NUM-TECH-SUP-IMMUNOL TECH SUPER - HEMATOLOGY 3 1751 1753 N PROV1330 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(E) TO PERFORM HEMATOLOGY TESTS UNDER SUPERVISION OF A BOARD CERT MD OR WHO POSSESS BS OR MS DEGREES IN RELATED SCIENCES AND 4 YRS HEMATOLOGY EXPER. COBOL NAME: NUM-TECH-SUP-HEMATOLOGY TECH SUPER - HISTO PATHOLOGY 3 1754 1756 N PROV1325 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(G) TO PERFORM TESTS IN HISTOPATHOLOGY UNDER THE SUPERVISION OF A BOARD CERTIFIED MD OR WHO POSSESS EQUIVALENT QUALIFICATIONS COBOL NAME: NUM-TECH-SUP-DERMATOLGY TECH SUPER - HISTOCOMPATIBILITY 3 1757 1759 N PROV1335 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(J)TO PERFORM TESTS IN HISTO UNDER SUP OF MD OR WHO POSSESS DOCT DEGREES OR ARE MD'S WITH 4 YRS EXP IN IMMUNOLOGY INCLUDING 2 YRS OF HISTO TESTING COBOL NAME: NUM-TECH-SUP-HISTOCOM TECH SUPER - IMMUNOHEMATOLOGY 3 1760 1762 N PROV1340 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(L) TO PERFORM TESTS IN IMMUNOHEMATOLOGY UNDER SUP OF A BOARD CERT MD OR HAVE EQUIV QUALIFS OR ARE PHYSICIANS WITH 2 YRS EXP IN IMMUNOHEMATOLOGY COBOL NAME: NUM-TECH-SUP-IMMUNOHEM TECH SUPER - MICROBIOLOGY 3 1763 1765 N PROV1350 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(B) TO PERFORM MICRO TESTS UNDER SUPERV OF A BOARD CERT MD, OR WHO HOLD DOCTORAL OR MASTER DEGREES IN MICRO AND HAVE 4 YRS EXP IN CLINICAL MICROBIOLOGY COBOL NAME: NUM-TECH-SUP-MICROBIO * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 22 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TECH SUPER - ORAL PATHOLOGY 3 1766 1768 N PROV1355 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(H) TO PERFORM TESTS IN ORAL PATHOLOGY UNDER SUPERVISION OF A BOARD CERT MD OR WHO HAVE EQUIVALENT QUALIFICATIONS COBOL NAME: NUM-TECH-SUP-ORAL-PATH TECH SUPER - PATHOLOGIST 3 1769 1771 N PROV1360 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(A) TO PERFORM ALL BUT HISTOCOMPATIBILITY AND CLINICAL CYTOGENETICS WHO ARE MD'S CERT IN BOTH ANATOMICAL AND CLINICAL PATH OR HAVE EQUIV QUALIFICATNS COBOL NAME: NUM-TECH-SUP-PATHOLOGY TECH SUPER - PHS EXAM 3 1772 1774 N PROV1365 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(M) WITH SATISFACTORY GRADES IN EXAMINATIONS CONDUCTED BY THE PUBLIC HEALTH SERVICE. COBOL NAME: NUM-TECH-SUP-PHS-EXAM TECH SUPER - RADIOBIOASSAY 3 1775 1777 N PROV1370 THE NUMBER OF TECHNICAL SUPERVISORS QUALIFIED UNDER CFR 493.1421(I) WHO ARE BOARD CERT MD'S OR WHO HAVE A DOCTORATE/MASTERS/BACH DEGREE IN RELATED SCIENCES OR ARE PHYSICIANS WITH 4 YEARS EXP IN RADIOBIOASSAY COBOL NAME: NUM-TECH-SUP-RADIOBIO TECHNICIAN TRAINEES 3 1778 1780 N PROV1375 THE NUMBER OF TECHNICIAN TRAINEES IN LABORATORIES WHO ARE HIGH SCHOOL GRADUATES AND WHO ARE RECEIVING THE REQUIRED 2 YEARS LAB EXPERIENCE AND ARE PARTICIPATING IN A STRUCTURED TRAINING PROGRAM.(CFR 493.1402) COBOL NAME: NUM-TECH-TRAINEES TECHNICIANS - GRANDFATHERED 3 1781 1783 N PROV1245 THE NUMBER OF TECHNICIANS QUALIFIED UNDER CFR 493.1441(B)(5) WHO WAS PERFORMING THE DUTIES OF A LAB TECHNICIAN BETWEEN 7/1/61 & 1/1/68 AND HAS AT LEAST 5 YEARS EXPERIENCE PRIOR TO 1/1/68. COBOL NAME: NUM-TECH-GRFATHER TECHNICIANS - MILITARY 3 1784 1786 N PROV1260 THE NUMBER OF TECHNICIANS QUALIFIED UNDER CFR 493.1441(B)(4) WHO COMPLETED AN OFFICIAL MILITARY MEDICAL LABORATORY PROCEDURES COURSE OF AT LEAST 50 WEEKS DURATION. COBOL NAME: NUM-TECH-MILITARY TECHNICIANS - PROFICIENCY EXAM 3 1787 1789 N PROV1265 THE NUMBER OF TECHNICIANS QUALIFIED UNDER CFR 493.1441(B)(6) WHO ACHIEVED A SATISFACTORY GRADE IN AN APPROVED PROFICIENCY EXAMINATION PRIOR TO 12/31/77. COBOL NAME: NUM-TECH-PES-EXAM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 23 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TECHNICIANS-AA PLUS 60 CREDIT HRS 3 1790 1792 N PROV1380 THE NUMBER OF LABORATORY TECHNICIANS WHO HAVE COMPLETED EITHER 60 HOURS OF ACADEMIC CREDIT OR HAVE ASSOCIATE DEGREES IN A COURSE OF STUDY THAT INCLUDES MEDICAL LABORATORY TECHNIQUES (CFR 493.1441(B)(1). COBOL NAME: NUM-TECH-60-CREDITS TECHNICIANS-HIGH SCH + EXPERIENCE 3 1793 1795 N PROV1255 THE NUMBER OF TECHNICIANS QUALIFIED UNDER CFR 493.1441(B)(3) WHO ARE HIGH SCHOOL GRADUATES AND HAVE TWO YEARS OF PERTINENT LABORATORY EXPERIENCE. COBOL NAME: NUM-TECH-HS-AND-2YR TECHNICIANS-HIGH SCH + TRAINING 3 1796 1798 N PROV1250 THE NUMBER OF TECHNICIANS QUALIFIED UNDER CFR 493.1441(B)(2) WHO COMPLETED HIGH SCHOOL AND ONE YEAR IN A TECHNICIAN TRAINING PROGRAM. COBOL NAME: NUM-TECH-HS-AND-1YR TECHNOLOGIST - BACHELORS DEGREE 3 1799 1801 N PROV1385 THE NUMBER OF LAB TECHNOLOGISTS WHO HAVE EARNED BACHELOR'S DEGREES IN CHEMICAL, BIOLOGICAL, OR PHYSICAL SCIENCE AND HAVE ONE YEAR EXPERIENCE/TRAINING IN RELATED SPECIALTY (CFR 493.1433(B)(3)). COBOL NAME: NUM-TECHNOLO-BS-BA TECHNOLOGIST - BS MED TECH 3 1802 1804 N PROV1390 THE NUMBER OF TECHNOLOGISTS WHO HAVE EARNED BACHELOR'S DEGREES IN MEDICAL TECHNOLOGY (CFR 493.1433(B)(1)). COBOL NAME: NUM-TECHNOLO-BS-MT TECHNOLOGIST - GRANDFATHERED 3 1805 1807 N PROV1395 THE NUMBER OF TECHNOLOGISTS WHO QUALIFIED PRIOR TO JULY 1, 1971 & WHO WERE PERFORMING AS TECHNOLOGISTS BETWEEN 7/1/61 & 1/1/68 & HAVE AT LEAST TEN YEARS LAB EXPERIENCE PRIOR TO 1/1/68 (CFR 493.1433(B)(5)). COBOL NAME: NUM-TECHNOLO-GRFATHER TECHNOLOGIST - PROFICIENCY EXAM 3 1808 1810 N PROV1400 THE NUMBER OF TECHNOLOGISTS WHO HAVE ACHIEVED A SATISFACTORY GRADE IN A PROFICIENCY EXAM APPROVED BY THE SECRETARY (CFR 493.1433(B)(6)). COBOL NAME: NUM-TECHNOLO-PES-EXAM TECHNOLOGIST - 90 HRS + EXP 3 1811 1813 N PROV1410 THE NUMBER OF TECHNOLOGISTS WHO HAVE COMPLETED THREE YEARS (90 SEMESTER HOURS) OF PERTINENT ACADEMIC STUDIES OUTLINED IN CFR 493.1433(B)(4) AND HAVE ONE YEAR OF LAB EXPERIENCE COBOL NAME: NUM-TECHNOLO-90CR-1YR TECHNOLOGIST - 90 HRS + TRAINING 3 1814 1816 N PROV1405 THE NUMBER OF TECHNOLOGISTS WHO HAVE COMPLETED THREE YEARS (90 SEMESTER HOURS) OF ACADEMIC STUDY AND COM- PLETED AT LEAST ONE YEAR TRAINING IN A SCHOOL OF MEDICAL TECHNOLOGY (CFR 493.1433(B)(2). COBOL NAME: NUM-TECHNOLO-3YR-1YR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 24 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 010 HISTOCOMPATIBILITY 1 1817 1817 C PROV1865 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-010-HISTOCOMPAT VALUES: N NOT APPROVED Y APPROVED 010A TRANSPLANT 1 1818 1818 C PROV1870 INDICATES IF A LABORATORY IS APPROVED TO PERFORM TESTS IN THIS SUBSPECIALTY COBOL NAME: SC-010A-TRANSPLANT VALUES: N NOT APPROVED Y APPROVED 010B NON-TRANSPLANT 1 1819 1819 C PROV1875 INDICATES IF A LABORATORY IS APPROVED TO PERFORM TESTS IN THIS SUBSPECIALTY COBOL NAME: SC-010B-NON-TRANSPLANT VALUES: N NOT APPROVED Y APPROVED 100 MICROBIOLOGY 1 1820 1820 C PROV1880 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-100-MICROBIO VALUES: N NOT APPROVED Y APPROVED 110 BACTERIOLOGY 1 1821 1821 C PROV1885 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-110-BACTERIOLOGY VALUES: N NOT APPROVED Y APPROVED 110C MYCOBACTERIOLOGY 1 1822 1822 C PROV1890 INDICATES IF A LABORATORY IS APPROVED TO PERFORM TESTS IN MYCOBACTERIOLOGY, WHICH IS WITHIN THE BACTERIOLOGY SUBSPECIALTY COBOL NAME: SC-110C-MYCOBACT VALUES: N NOT APPROVED Y APPROVED 120 MYCOLOGY 1 1823 1823 C PROV1895 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-120-MYCOLOGY VALUES: N NOT APPROVED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 25 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME Y APPROVED 130 PARASITOLOGY 1 1824 1824 C PROV1900 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-130-PARASITOLOGY VALUES: N NOT APPROVED Y APPROVED 140 VIROLOGY 1 1825 1825 C PROV1910 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-140-VIROLOGY VALUES: N NOT APPROVED Y APPROVED 150 OTHER MICROBIOLOGY 1 1826 1826 C PROV1915 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-150-OTHER-MICROBIO VALUES: N NOT APPROVED Y APPROVED 200 DIAGNOSTIC IMMUNOLOGY 1 1827 1827 C PROV1920 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-200-DIAG-IMMUNOL VALUES: N NOT APPROVED Y APPROVED 210 SYPHILIS 1 1828 1828 C PROV1925 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-210-SYPHILIS VALUES: N NOT APPROVED Y APPROVED 220 GEN IMMUNOLOGY 1 1829 1829 C PROV1930 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-220-GEN-IMMUNOL VALUES: N NOT APPROVED Y APPROVED 300 CHEMISTRY 1 1830 1830 C PROV1935 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-300-CHEMISTRY VALUES: * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 26 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME N NOT APPROVED Y APPROVED 310 ROUTINE CHEMISTRY 1 1831 1831 C PROV1940 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-310-ROUTINE VALUES: N NOT APPROVED Y APPROVED 320 URINALYSIS 1 1832 1832 C PROV1945 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-320-URINALYSIS VALUES: N NOT APPROVED Y APPROVED 330 OTHER CHEMISTRY 1 1833 1833 C PROV1950 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-330-OTHER-CHEMISTRY VALUES: N NOT APPROVED Y APPROVED 330D ENDOCRINOLOGY 1 1834 1834 C PROV1955 INDICATES IF A LABORATORY IS APPROVED TO PERFORM TESTS IN ENDOCRINOLOGY, WHICH IS WITHIN THE OTHER CHEMISTRY SUBSPECIALTY COBOL NAME: SC-330D-ENDOCRINOLOGY VALUES: N NOT APPROVED Y APPROVED 330E TOXICOLOGY 1 1835 1835 C PROV1960 INDICATES IF A LABORATORY IS APPROVED TO PERFORM TESTS IN TOXICOLOGY, WHICH IS WITHIN THE OTHER CHEMISTRY SUBSPECIALTY COBOL NAME: SC-330E-TOXICOLOGY VALUES: N NOT APPROVED Y APPROVED 400 HEMATOLOGY 1 1836 1836 C PROV1965 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-400-HEMATOLOGY VALUES: N NOT APPROVED Y APPROVED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 27 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 500 IMMUNOHEMATOLOGY 1 1837 1837 C PROV1970 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-500-IMMUNOHEM VALUES: N NOT APPROVED Y APPROVED 510 ABO + RH GROUP 1 1838 1838 C PROV1975 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-510-ABO-RH-GROUP VALUES: N NOT APPROVED Y APPROVED 520 RH TITERS 1 1839 1839 C PROV1980 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-520-RH-TITERS VALUES: N NOT APPROVED Y APPROVED 530 COMPATIBILITY TEST 1 1840 1840 C PROV1985 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-530-CROSS-MATCH VALUES: N NOT APPROVED Y APPROVED 540 ANTIBODY DETECT + OTHER 1 1841 1841 C PROV1990 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-540-OTHER-IMMUNOHEM VALUES: N NOT APPROVED Y APPROVED 600 PATHOLOGY 1 1842 1842 C PROV1995 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-600-PATHOLOGY VALUES: N NOT APPROVED Y APPROVED 610 HISTOPATHOLOGY 1 1843 1843 C PROV2000 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-610-HISTOPATH VALUES: N NOT APPROVED Y APPROVED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 28 CLIA67 LABORATORIES, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 620 ORAL PATHOLOGY 1 1844 1844 C PROV2005 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-620-ORAL VALUES: N NOT APPROVED Y APPROVED 630 CYTOLOGY 1 1845 1845 C PROV2010 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-630-CYTOLOGY VALUES: N NOT APPROVED Y APPROVED 800 RADIOBIOASSAY 1 1846 1846 C PROV2015 INDICATES IF A LAB IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY. COBOL NAME: SC-800-RADIOBIO VALUES: N NOT APPROVED Y APPROVED 900 CYTOGENETICS 1 1847 1847 C PROV2020 INDICATES IF A LABORATORY IS APPROVED TO PERFORM TESTS IN THIS SPECIALTY COBOL NAME: SC-900-CYTOGENETICS VALUES: N NOT APPROVED Y APPROVED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 19 COMMUNITY MENTAL HEALTH CENTERS CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 3 TERMINATION 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 PROPRIETARY 02 CHURCH RELATED 03 NONPROFIT CORPORATION 04 OTHER NONPROFIT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 05 STATE 06 LOCAL 07 FEDERAL ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM MD OTHER - ARRANGEMENT 7.2 2159 2165 N PROV3000 THE NUMBER OF FULL TIME EQUIVALENT OTHER MDS EMPLOYED UNDER ARRANGEMENT BY A COMMUNITY MENTAL HEALTH CENTER COBOL NAME: NUM-M-D-OTHER-ARGNM MD OTHER - DIRECT 7.2 2166 2172 N PROV2995 THE NUMBER OF FULL TIME EQUIVALENT OTHER MDS EMPLOYED DIRECTLY BY A COMMUNITY MENTAL HEALTH CENTER. COBOL NAME: NUM-M-D-OTHER-DIR MD PSYCHIATRIST - ARRANGEMENT 7.2 2173 2179 N PROV2990 THE NUMBER OF FULL TIME EQUIVALENT MD PSYCHIATRISTS EMPLOYED UNDER ARRANGEMENT BY A COMMUNITY MENTAL HEALTH CENTER. COBOL NAME: NUM-M-D-PSYCHIATR-ARGNM MD PSYCHIATRIST - DIRECT 7.2 2180 2186 N PROV2985 THE NUMBER OF FULL TIME EQUIVALENT MD PSYCHIATRISTS EMPLOYED DIRECTLY BY A COMMUNITY MENTAL HEALTH CENTER. COBOL NAME: NUM-M-D-PSYCHIATR-DIR NURSE - ARRANGEMENT 7.2 2187 2193 N PROV3020 THE NUMBER OF FULL TIME EQUIVALENT NURSES EMPLOYED UNDER ARRANGEMENT BY A COMMUNITY MENTAL HEALTH CENTER. COBOL NAME: NUM-NURSE-ARGNM NURSE - DIRECT 7.2 2194 2200 N PROV3015 THE NUMBER OF FULL TIME EQUIVALENT NURSES EMPLOYED DIRECTLY BY A COMMUNITY MENTAL HEALTH CENTER. COBOL NAME: NUM-NURSE-DIR OTHER - ARRANGEMENT 7.2 2201 2207 N PROV3080 THE NUMBER OF FULL TIME EQUIVALENT OTHER STAFF EMPLOYED UNDER ARRANGEMENT BY A COMMUNITY MENTAL HEALTH CENTER. COBOL NAME: NUM-OTHER-ARGNM OTHER - DIRECT 7.2 2208 2214 N PROV3075 THE NUMBER OF FULL TIME EQUIVALENT OTHER STAFF EMPLOYED DIRECTLY BY A COMMUNITY MENTAL HEALTH CENTER. COBOL NAME: NUM-OTHER-DIR PSYCHOLOGIST - ARRANGEMENT 7.2 2215 2221 N PROV3010 THE NUMBER OF FULL TIME EQUIVALENT PSYCHOLOGISTS EMPLOYED UNDER ARRANGEMENT BY A COMMUNITY MENTAL HEALTH CENTER. COBOL NAME: NUM-PSYCHOL-ARGNM PSYCHOLOGIST - DIRECT 7.2 2222 2228 N PROV3005 THE NUMBER OF FULL TIME EQUIVALENT PSYCHOLOGISTS EMPLOYED DIRECTLY BY A COMMUNITY MENTAL HEALTH CENTER. COBOL NAME: NUM-PSYCHOL-DIR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SOCIAL WORKER (BS) - ARRANGEMENT 7.2 2229 2235 N PROV3030 THE NUMBER OF FULL TIME EQUIVALENT SOCIAL WORKERS (BS) EMPLOYED UNDER ARRANGEMENT BY A COMMUNITY MENTAL HEALTH CENTER. COBOL NAME: NUM-SOC-WRKS-BS-ARGNM SOCIAL WORKER (BS) - DIRECT 7.2 2236 2242 N PROV3025 THE NUMBER OF FULL TIME EQUIVALENT SOCIAL WORKERS (BS) EMPLOYED DIRECTLY BY A CMHC. COBOL NAME: NUM-SOC-WRKS-BS-DIR SOCIAL WORKER (MS) - ARRANGEMENT 7.2 2243 2249 N PROV3040 THE NUMBER OF FULL TIME EQUIVALENT SOCIAL WORKERS (MS) EMPLOYED UNDER ARRANGEMENT BY A CMHC. COBOL NAME: NUM-SOC-WRKS-MS-ARGNM SOCIAL WORKER (MS) - DIRECT 7.2 2250 2256 N PROV3035 THE NUMBER OF FULL TIME EQUIVALENT SOCIAL WORKERS (MS) EMPLOYED DIRECTLY BY A CMHC. COBOL NAME: NUM-SOC-WRKS-MS-DIR THERAPIST (GROUP) - ARRANGEMENT 7.2 2257 2263 N PROV3070 THE NUMBER OF FULL TIME EQUIVALENT GROUP THERAPISTS EMPLOYED UNDER ARRANGEMENT BY A CMHC. COBOL NAME: NUM-THER-GROUP-ARGNM THERAPIST (GROUP) - DIRECT 7.2 2264 2270 N PROV3065 THE NUMBER OF FULL TIME EQUIVALENT GROUP THERAPISTS EMPLOYED DIRECTLY BY A CMHC. COBOL NAME: NUM-THER-GROUP-DIR THERAPIST (OCCUPATIONAL)-ARRANGMNT 7.2 2271 2277 N PROV3060 THE NUMBER OF FULL TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED UNDER ARRANGEMENT BY A CMHC. COBOL NAME: NUM-THER-OCCUP-ARGNM THERAPIST (OCCUPATIONAL)-DIRECT 7.2 2278 2284 N PROV3055 THE NUMBER OF FULL TIME EQUIVALENT OCCUPATIONAL THERAPISTS EMPLOYED DIRECTLY BY A CMHC. COBOL NAME: NUM-THER-OCCUP-DIR THERAPIST (RECREATIONAL)-ARRANGMNT 7.2 2285 2291 N PROV3050 THE NUMBER OF FULL TIME EQUIVALENT RECREATIONAL THERAPISTS EMPLOYED UNDER ARRANGEMENT BY A CMHC. COBOL NAME: NUM-THER-RECR-ARGNM THERAPIST (RECREATIONAL)-DIRECT 7.2 2292 2298 N PROV3045 THE NUMBER OF FULL TIME EQUIVALENT RECREATIONAL THERAPISTS EMPLOYED DIRECTLY BY A CMHC. COBOL NAME: NUM-THER-RECR-DIR PART OF A PARTICIPATING PROVIDER 1 2335 2335 C PROV2935 INDICATES IF A SUPPLIER IS PART OF ANOTHER PROVIDER OF MEDICARE/MEDICAID SERVICES. COBOL NAME: PART-MEDICARE-MEDICAID * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 20 SCREENING MAMMOGRAPHY CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 00510 BLUE SHIELD (ALABAMA) 00520 BLUE SHIELD (ARKANSAS) 00528 BLUE SHIELD (ARKANSAS/LOUISIANA) 00542 BLUE SHIELD (CALIFORNIA) 00550 BLUE SHIELD (COLORADO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00570 BLUE SHIELD (DELAWARE) 00580 BLUE SHIELD (DISTRICT OF COLUMBIA) 00590 BLUE SHIELD (FLORIDA) 00621 BLUE SHIELD (ILLINOIS) 00630 BLUE SHIELD (INDIANA) 00640 BLUE SHIELD (IOWA) 00650 BLUE SHIELD (KANSAS) 00655 BLUE SHIELD (KANSAS/NEBRASKA) 00660 BLUE SHIELD (KENTUCKY) 00690 BLUE SHIELD (MARYLAND) 00700 BLUE SHIELD (MASSACHUSETTS) 00710 BLUE SHIELD (MICHIGAN) 00720 BLUE SHIELD (MINNESOTA) 00740 BLUE SHIELD (KANSAS CITY) 00751 BLUE SHIELD (MONTANA) 00770 BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780 BLUE SHIELD (TRI-STATE) 00801 BLUE SHIELD (BUFFALO) 00803 BLUE SHIELD (EMPIRE) 00820 BLUE SHIELD (NORTH DAKOTA) 00825 BLUE SHIELD (NORTH DAKOTA/WYOMING) 00860 BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865 BLUE SHIELD (PENNSYLVANIA) 00870 BLUE SHIELD (RHODE ISLAND) 00880 BLUE SHIELD (SOUTH CAROLINA) 00900 BLUE SHIELD (TEXAS) 00910 BLUE SHIELD (UTAH) 00930 BLUE SHIELD (WASHINGTON) 00951 WISCONSIN PHYSICIANS SERVICE 00973 BLUE SHIELD (PUERTO RICO) 00974 BLUE SHIELD (VIRGIN ISLANDS) 01010 AETNA (PEORIA) 01020 AETNA (ALASKA) 01030 AETNA (ARIZONA) 01040 AETNA (GEORGIA) 01120 AETNA (HAWAII) 01290 AETNA (NEVADA) 01360 AETNA (NEW MEXICO) 01370 AETNA (OKLAHOMA) 01380 AETNA (OREGON) 02050 OCCIDENTAL (CALIFORNIA) 05130 EQICOR (IDAHO) 05440 EQICOR (TENNESSEE) 05535 EQICOR (NORTH CAROLINA) 10071 TRAVELERS (RRB) 10230 TRAVELERS (CONNECTICUT) 10240 TRAVELERS (MINNESOTA) 10250 TRAVELERS (MISSISSIPPI) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 10490 TRAVELERS (VIRGINIA) 10492 TRAVELERS - VIRGINIA SPECIAL PROJECT 11260 GENERAL AMERICAN 14330 GROUP HEALTH INC (NEW YORK) 16360 NATIONWIDE (OHIO) 16510 NATIONWIDE (WEST VIRGINIA) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 21200 MASSACHUSETTS/MAINE 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 3 TERMINATION 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 PROPRIETARY 02 CHURCH RELATED 03 NONPROFIT CORPORATION 04 OTHER NONPROFIT 05 STATE 06 LOCAL 07 FEDERAL ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 17 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM CONSULTING PHYSICIANS-ARRANGEMENT 6.2 2299 2304 N PROV2945 THE NUMBER OF FULL-TIME EQUIVALENT CONSULTING PHYSICIANS AVAILABLE THROUGH ARRANGEMENT TO A SCREENING MAMMOGRAPHY SUPPLIER. COBOL NAME: NUM-CONSULT-PHY-ARGNM CONSULTING PHYSICIANS-DIRECT 6.2 2305 2310 N PROV2940 THE NUMBER OF FULL-TIME EQUIVALENT CONSULTING PHYSICIANS AVAILABLE ON STAFF TO A SCREENING MAMMOGRAPHY SUPPLIER. COBOL NAME: NUM-CONSULT-PHY-DIR INTERPRETING PHYSICIANS-ARRANGEMNT 6.2 2311 2316 N PROV2955 THE NUMBER OF FULL-TIME EQUIVALENT INTERPRETING PHYSICIANS AVAILABLE THROUGH ARRANGEMENT TO A SCREENING MAMMOGRAPHY SUPPLIER. COBOL NAME: NUM-INTER-PHY-ARGNM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 18 SCREENING MAMMOGRAPHY, CATEGORY = "20" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME INTERPRETING PHYSICIANS-DIRECT 6.2 2317 2322 N PROV2950 THE NUMBER OF FULL-TIME EQUIVALENT INTERPRETING PHYSICIANS AVAILABLE ON STAFF TO A SCREENING MAMMOGRAPHY SUPPLIER. COBOL NAME: NUM-INTER-PHY-DIR MEDICAL PHYSICIST-ARRANGEMENT 6.2 2323 2328 N PROV2965 THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL PHYSICISTS AVAILABLE THROUGH ARRANGEMENT TO A SCREENING MAMMOGRAPHY SUPPLIER. COBOL NAME: NUM-MED-PHYSIC-ARGNM MEDICAL PHYSICIST-DIRECT 6.2 2329 2334 N PROV2960 THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL PHYSICISTS AVAILABLE ON STAFF TO A SCREENING MAMMOGRAPHY SUPPLIER. COBOL NAME: NUM-MED-PHYSIC-DIR PART OF A PARTICIPATING PROVIDER 1 2335 2335 C PROV2935 INDICATES IF A SUPPLIER IS PART OF ANOTHER PROVIDER OF MEDICARE/MEDICAID SERVICES. COBOL NAME: PART-MEDICARE-MEDICAID VALUES: N NO Y YES TECHNOLOGIST-ARRANGEMENT 6.2 2336 2341 N PROV2975 THE NUMBER OF FULL-TIME EQUIVALENT TECHNOLOGISTS AVAILABLE THROUGH ARRANGEMENT TO A SCREENING MAMMOGRAPHY SUPPLIER. COBOL NAME: NUM-TECHNO-ARGNM TECHNOLOGIST-DIRECT 6.2 2342 2347 N PROV2970 THE NUMBER OF FULL-TIME EQUIVALENT TECHNOLOGISTS AVAILBLE ON STAFF TO A SCREENING MAMMOGRAPHY SUPPLIER. COBOL NAME: NUM-TECHNO-DIR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 1 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CATEGORY - SUBTYPE OF PROVIDER 2 1 2 C PROV0085 A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED NURSING FACILITIES AND HOSPITALS. COBOL NAME: CATEGORY-SUBTYPE-IND CATEGORY OF PROVIDER/SUPPLIER 2 3 4 C PROV0075 IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE PROVIDER OR SUPPLIER. COBOL NAME: CATEGORY VALUES: 21 FEDERALLY QUALIFIED HEALTH CENTERS CHANGE OF OWNERSHIP COUNTER 2 5 6 N PROV0095 THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS TAKEN PLACE FOR A PARTICULAR PROVIDER. COBOL NAME: CHOW-CNT CHANGE OF OWNERSHIP DATE 6 7 12 C PROV0100 EFFECTIVE DATE OF A CHANGE OF OWNERSHIP. COBOL NAME: CHOW-DT CITY 28 13 40 C PROV3225 CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED. COBOL NAME: CITY COMPLAINT INDICATOR 1 41 41 C PROV0195 INDICATES A COMPLAINT SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: COMP-IND COMPLIANCE: PLAN OF CORRECTION 1 42 42 C PROV0220 INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION OF DEFICIENCIES. COBOL NAME: COMPL-ACCEPT-PLAN-COR VALUES: 1 COMPLIANCE BASED ON ACCEPTABLE POC COMPLIANCE: STATUS 1 43 43 C PROV2715 INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE WITH PROGRAM REQUIREMENTS. COBOL NAME: STATUS-COMPL VALUES: A IN COMPLIANCE B NOT IN COMPLIANCE * COUNTER FOR SUB TO UNSUB IN COMP 2 44 45 N PROV3565 A COUNTER WHICH INDICATES THE NUMBER OF TIMES A COMPLAINT SURVEY WENT FROM SUBSTANTIATED TO UNSUBSTANTIATED FOR A PARTICULAR PROVIDER. COBOL NAME: UPDATED-SUB-UNSUB-COMP COUNTY CODE 3 46 48 C PROV2695 SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY IS LOCATED. COBOL NAME: SSA-COUNTY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 2 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CROSS REFERENCE PROVIDER NUMBER 10 49 58 C PROV0300 NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER. COBOL NAME: CROSS-REF-PROV-NUM CURRENT COMPLAINT SURVEY DATE 6 59 64 C PROV0200 DATE OF THE MOST CURRENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-1 CURRENT CONDITION (CORR DATE >L33) 4 65 68 N PROV0305 THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES CORRECTED LATER THAN THE CERTIFICATION APPROVAL DATE (L33). COBOL NAME: CUR-COP-COUNTER CURRENT CONDITION ALL 4 69 72 N PROV0355 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-COND-ALL CURRENT CONDITION NOT CORRECTED 4 73 76 N PROV0360 THE NUMBER OF CONDITIONS OF PARTICIPATION THAT ARE NOT CURRENTLY CORRECTED. COBOL NAME: CUR-TOT-COND-EXCL-7 CURRENT DEF: CORRECTED 4 77 80 N PROV0385 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES FROM THE CURRENT SURVEY THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-TOT-DEFS-7 CURRENT DEF: NO DATE TO CORRECT 4 81 84 N PROV0375 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT DO NOT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-5 CURRENT DEF: NOT CORRECTED 4 85 88 N PROV0365 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE NOT BEEN CORRECTED. COBOL NAME: CUR-TOT-DEF-EXCL-7 CURRENT DEF: PLAN OF CORRECTION 4 89 92 N PROV0380 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES WITH PLANS FOR CORRECTION. COBOL NAME: CUR-TOT-DEFS-6 CURRENT DEF: REFUSED 4 93 96 N PROV0395 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-TOT-DEFS-9 CURRENT DEF: REPEAT 4 97 100 N PROV1790 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES CITED ON BOTH THE CURRENT AND FIRST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-C-PLUS-1 CURRENT DEF: TOTAL 4 101 104 N PROV0370 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES AT THE TIME OF SURVEY. COBOL NAME: CUR-TOT-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 3 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT DEF: WAIVER 4 105 108 N PROV0390 THE NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-TOT-DEFS-8 CURRENT FMS SURVEY DATE 6 109 114 C PROV0500 CURRENT FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-1 CURRENT HEALTH DEF: ALL 4 115 118 N PROV0350 THE NUMBER OF HEALTH DEFICIENCIES ON THE MOST RECENT SURVEY. COBOL NAME: CUR-SRF-DEFS-ALL CURRENT HEALTH DEF: NOT CORRECTED 4 119 122 N PROV0345 THE NUMBER OF HEALTH DEFICIENCIES THAT ARE NOT CORRECTED ON THE CURRENT SURVEY. COBOL NAME: CUR-SRF-DEF-EXCL-7 CURRENT LSC DEF: ALL 4 123 126 N PROV0310 THE TOTAL NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-LSC-DEFS-ALL CURRENT RO FLAG: ALL 4 127 130 N PROV0315 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS. COBOL NAME: CUR-ROF-DEFS-ALL CURRENT RO FLAG: NO DATE 4 131 134 N PROV0320 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT DO NOT HAVE A DATE FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-5 CURRENT RO FLAG: REFUSED 4 135 138 N PROV0340 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT THE PROVIDER REFUSED TO CORRECT. COBOL NAME: CUR-ROF-DEFS-9 CURRENT RO FLAG: WAIVER 4 139 142 N PROV0335 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE BEEN APPROVED FOR WAIVER. COBOL NAME: CUR-ROF-DEFS-8 CURRENT RO FLAG:DATE OF CORRECTION 4 143 146 N PROV0330 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY, FROM A LIST OF SELECTED REQUIREMENTS, THAT HAVE BEEN CORRECTED. COBOL NAME: CUR-ROF-DEFS-7 CURRENT RO FLAG:PLAN OF CORRECTION 4 147 150 N PROV0325 THE NUMBER OF DEFICIENCIES ON THE CURRENT SURVEY FROM A LIST OF SELECTED REQUIREMENTS THAT HAVE PLANS FOR CORRECTION. COBOL NAME: CUR-ROF-DEFS-6 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 4 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME CURRENT STANDARD: ALL 4 151 154 N PROV0400 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE CURRENT SURVEY. COBOL NAME: CUR-TOT-STDS-ALL CURRENT SURVEY DATE 6 155 160 C PROV2740 THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY, WHICHEVER IS LATER. THE "OFFICIAL" SURVEY DATE FOR THE PROVIDER. COBOL NAME: SURVEY-DT-1 CURRENT SURVEY TRANSACTION DATE 6 161 166 C PROV2785 THE DATE THE CURRENT SURVEY WAS FIRST ENTERED INTO MMACS. COBOL NAME: SURVEY-TRANS-DT DATE APPROVAL WAS ENTERED 6 167 172 C PROV0065 THE DATE THE CERTIFICATION DETERMINATION APPROVAL DATE (L33) OF A PROVIDER OR SUPPLIER IS ENTERED INTO THE SYSTEM. COBOL NAME: APPROVAL-DT-ENTERED * DATE WHEN PROVIDER WAS ADDED 6 173 178 C PROV0020 DATE IN WHICH THE PROVIDER RECORD WAS ADDED TO THE FILE. COBOL NAME: ADD-DT DETERMINATION APPROVAL DATE 6 179 184 C PROV0405 THE DATE A FINAL DETERMINATION IS MADE CONCERNING THE ELIGIBILITY OF A PROVIDER OR SUPPLIER TO PROVIDE SERVICES. THIS DATE MAY BE COMPUTER-GENERATED. COBOL NAME: DETER-APPROVAL-DT ELIGIBILITY CODE 1 185 185 C PROV0455 INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: ELIG-CD VALUES: 1 ELIGIBLE TO PARTICIPATE 2 NOT ELIGIBLE TO PARTICIPATE ERRONEOUS DEFICIENCIES EXIST 1 186 186 C PROV0460 AN INDICATION OF WHETHER THE DEFICIENCIES CITED DURING A SURVEY CORRESPOND WITH THE TYPE OF FACILITY E.G., IF SWINGBED HOSPITAL DEFS ARE CITED IN A NON SWINGBED HOS DEFS CAN BE ENTERED BUT FLAG INDICATOR WILL DISPLAY 'Y' COBOL NAME: ERR-DEFC * FACILITY NAME 38 187 224 C PROV0475 THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS. COBOL NAME: FACILITY-NAME FLAG/SAMPLE INDICATOR 1 225 225 C PROV0490 SHOWS IF A CERTIFICATION CASE IS FLAGGED(HAS 1 OR MORE CONDITION AND/OR REGIONAL OFFICE FLAG DEFICIENCY), UN-F LAGGED, OR IS UNFLAGGED BUT SELECTED AT RANDOM FOR REVI EW BY RO. THIS CODE IS GENERATED AT TIME KIT IS ENTERED COBOL NAME: FLAG-IND * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 5 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME VALUES: 1 FLAGGED 2 UNFLAGGED 3 UNFLAGGED, SELECTED FOR RO REVIEW FMS SURVEY INDICATOR 1 226 226 C PROV0495 INDICATES AT LEAST 1 FMS SURVEY EXISTS FOR THIS PROVIDER. COBOL NAME: FMS-IND FOURTH COMPLAINT SURVEY DATE 6 227 232 C PROV0215 DATE OF THE FOURTH RECENT SURVEY DATE COBOL NAME: COMP-SURVEY-DT-4 FOURTH FMS SURVEY DATE 6 233 238 C PROV0515 FOURTH FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-4 FOURTH SURVEY DATE 6 239 244 C PROV2755 THE "OFFICIAL" DATE OF THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-4 FOURTH SURVEY: ALL CONDITIONS 4 245 248 N PROV0535 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-COND-ALL FOURTH SURVEY: ALL DEFICIENCIES 4 249 252 N PROV0540 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-DEFS-ALL FOURTH SURVEY: HEALTH 4 253 256 N PROV0530 THE NUMBER OF HEALTH DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-SRF-DEFS-ALL FOURTH SURVEY: LIFE SAFETY CODE 4 257 260 N PROV0520 THE NUMBER OF LIFE SAFETY DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-LSC-DEFS-ALL FOURTH SURVEY: REG OFF FLAGS 4 261 264 N PROV0525 THE NUMBER OF DEFICIENCIES, FROM A LIST OF SELECTED REQUIREMENTS, ON THE FOURTH MOST RECENT SURVEY IN MMACS COBOL NAME: FORTH-ROF-DEFS-ALL FOURTH SURVEY: STANDARDS 4 265 268 N PROV0545 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE FOURTH MOST RECENT SURVEY IN MMACS. COBOL NAME: FORTH-TOT-STDS-ALL INTERMEDIARY NUMBER 5 269 273 C PROV0605 A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER SERVICING A PROVIDER OR SUPPLIER. COBOL NAME: INTER-CARRIER-NUM VALUES: 00010 BLUE CROSS (ALABAMA) 00020 BLUE CROSS (ARKANSAS) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 6 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 00030 BLUE CROSS (ARIZONA) 00040 BLUE CROSS (CALIFORNIA) 00060 BLUE CROSS (CONNECTICUT) 00070 BLUE CROSS (DELAWARE) 00090 BLUE CROSS (FLORIDA) 00101 BLUE CROSS (GEORGIA) 00121 HEALTH CARE SERVICE CORPORATION 00130 BLUE CROSS (INDIANA) 00140 BLUE CROSS (IOWA/SOUTH DAKOTA) 00150 BLUE CROSS (KANSAS) 00160 BLUE CROSS (KENTUCKY) 00180 BLUE CROSS (MAINE) 00190 BLUE CROSS (MARYLAND) 00200 BLUE CROSS (MASSACHUSETTS) 00210 BLUE CROSS (MICHIGAN) 00220 BLUE CROSS (MINNESOTA) 00230 BLUE CROSS (MISSISSIPPI) 00231 BLUE CROSS (LOUISIANA) 00241 BLUE CROSS (MISSOURI) 00250 BLUE CROSS (MONTANA) 00260 BLUE CROSS (NEBRASKA) 00270 NEW HAMPSHIRE-VERMONT HEALTH SERVICE 00280 BLUE CROSS (NEW JERSEY) 00290 BLUE CROSS (NEW MEXICO) 00308 BLUE CROSS (EMPIRE) 00310 BLUE CROSS (NORTH CAROLINA) 00320 BLUE CROSS (NORTH DAKOTA) 00332 COMMUNITY MUTUAL INSURANCE CO 00340 BLUE CROSS (OKLAHOMA) 00350 BLUE CROSS (OREGON) 00351 BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362 BLUE CROSS (INDEPENDENCE) 00363 BLUE CROSS (WESTERN PENNSYLVANIA) 00370 BLUE CROSS (RHODE ISLAND) 00380 BLUE CROSS (SOUTH CAROLINA) 00390 BLUE CROSS (TENNESSEE) 00400 BLUE CROSS (TEXAS) 00410 BLUE CROSS (UTAH) 00423 BLUE CROSS (VIRGINIA/WEST VA) 00430 BLUE CROSS (WASHINGTON & ALASKA) 00450 BLUE CROSS (WISCONSIN) 00460 BLUE CROSS (WYOMING) 00468 BLUE CROSS (NORTH CAROLINA FOR PR) 17120 HAWAII MEDICAL SERVICE ASSOCIATION 50333 TRAVELERS (NEW YORK) 51051 AETNA (PETALUMA) 51070 AETNA (FARMINGTON) 51100 AETNA (CLEARWATER) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 7 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 51140 AETNA (PEORIA) 51390 AETNA (FORT WASHINGTON) 52280 MUTUAL OF OMAHA 57400 COOPERATIVA (PUERTO RICO) * LAST UPDATE DATE FOR THIS PROVIDER 6 274 279 C PROV2895 DATE IN WHICH THE PROVIDER RECORDS WAS UPDATED. COBOL NAME: UPDATE-DT * MEDICARE OR MEDICAID VENDOR NUMBER 12 280 291 C PROV0655 A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING PURPOSES. COBOL NAME: MEDICAID-VEND-NUM * OLD LSC SHORT FORM DATE 6 292 297 C PROV2910 THIS IS THE DATE OF THE OLDEST LSC SURVEY WHEN A SHORT FORM WAS USED CONSECUTIVELY. COBOL NAME: OLD-SHORT-FM-SURVEY-DT PARTICIPATION DATE 6 298 303 C PROV1565 THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: PARTCI-DT PRIOR CHANGE OF OWNERSHIP 6 304 309 C PROV1615 THE DATE OF A PRIOR CHANGE OF OWNERSHIP. COBOL NAME: PRIOR-CHOW-DT PRIOR COMPLAINT SURVEY DATE 6 310 315 C PROV0205 DATE OF THE SECOND RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-2 PRIOR FMS SURVEY DATE 6 316 321 C PROV0505 PRIOR FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-2 PRIOR INTERMEDIARY NUMBER 5 322 326 C PROV1620 A PREVIOUS INTERMEDIARY NUMBER.WHEN COBOL NAME: PRIOR-INTER-CARRIER-NUM PRIOR SURVEY DATE 6 327 332 C PROV2745 DATE OF THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-2 PRIOR SURVEY: ALL COPS 4 333 336 N PROV1655 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-COND-ALL PRIOR SURVEY: ALL DEFICIENCIES 4 337 340 N PROV1660 THE TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-DEFS-ALL PRIOR SURVEY: ALL HEALTH DEFS 4 341 344 N PROV1650 THE NUMBER OF HEALTH DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-SRF-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 8 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME PRIOR SURVEY: LIFE SAFETY DEFS 4 345 348 N PROV1625 THE NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-LSC-DEFS-ALL PRIOR SURVEY: REG OFFICE FLAGS 4 349 352 N PROV1645 THE NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE SECOND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-ROF-DEFS-ALL PRIOR SURVEY: STANDARDS 4 353 356 N PROV1665 THE NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE SECEND MOST RECENT SURVEY IN MMACS. COBOL NAME: PRIOR-TOT-STDS-ALL PROVIDER NUMBER 10 357 366 C PROV1680 A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS- SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER. A PROVIDER IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER, A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER. COBOL NAME: PROV-NUM RECORD TYPE 1 367 367 C PROV1720 THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD. COBOL NAME: RECORD-TYPE VALUES: A ACCEPTED P PENDING W WORK RECURRING CONDITION COUNTER 4 368 371 N PROV1780 INDICATES THE NUMBER OF CONDITION OF PARTICIPATION DEFICIENCIES ON CURRENT SURVEY AND EITHER THE 2ND OR 3RD PRIOR SURVEY. COBOL NAME: REPEAT-COP-2-OF-3 RECURRING REPEAT DEFICIENCIES 4 372 375 N PROV1795 THE NUMBER OF HEALTH AND LIFE SAFETY CODE DEFICIENCIES ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-DEF-2-OF-3 REGION CODE 2 376 377 C PROV1725 THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE STATE IN WHICH THE PROVIDER IS LOCATED. COBOL NAME: REGION VALUES: 01 I BOSTON 02 II NEW YORK 03 III PHILADELPHIA 04 IV ATLANTA 05 V CHICAGO 06 VI DALLAS 07 VII KANSAS CITY 08 VIII DENVER 09 IX SAN FRANCISCO 10 X SEATTLE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 9 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME REGIONAL OFFICE ANALYST 3 378 380 C PROV1835 IDENTIFIES THE REGIONAL OFFICE ANALYST WHO REVIEWED THE CERTIFICATION OF A PARTICULAR PROVIDER. COBOL NAME: RO-ANALYST REPEAT CONDITION COUNTER 4 381 384 N PROV1785 NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON BOTH THE CURRENT AND 1ST PRIOR SURVEYS. COBOL NAME: REPEAT-COP-2-OF-4 REPEAT REGULATION DEF COUNTER 4 385 388 N PROV1800 THE NUMBER OF REGULATIONS THAT WERE REPEATED IN THE CURRENT SURVEY WITH THE PREVIOUS SURVEY. COBOL NAME: REPEAT-DEF-2-OF-4 RESURVEY COUNTER 2 389 390 N PROV1830 THE TOTAL NUMBER OF TIMES A PARTICULAR PROVIDER HAS GONE THROUGH THE RECERTIFICATION PROCESS. COBOL NAME: RESURVEY-CNT RO RECEIPT DATE 6 391 396 C PROV1840 THE DATE THE REGIONAL OFFICE RECEIVED THE CERTIFICATION MATERIAL FROM THE STATE AGENCY. COBOL NAME: RO-RECPT-DT SKELETON RECORD INDICATOR 1 397 397 C PROV2045 INDICATES RECORD IS A SKELETON RECORD. THIS MEANS ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE FOR THIS PROVIDER. COBOL NAME: SKELETON-IND SPECIAL RO DATE FIELD 6 398 403 C PROV2915 THIS FIELD IS USED BY REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-DT SPECIAL RO TEXT FIELD 30 404 433 C PROV2920 THIS FIELD IS USED BY THE REGIONAL OFFICE FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-RO-TEXT SPECIAL STATE AGENCY DATE 6 434 439 C PROV2925 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-DT SPECIAL STATE AGENCY TEXT FIELD 30 440 469 C PROV2930 THIS FIELD IS USED BY STATE AGENCY FOR WHATEVER THEY WANT. IT IS JUST A SPECIAL FIELD FOR THEIR USE. COBOL NAME: SPEC-SA-TEXT STATE ABBREVIATION 2 470 471 C PROV3230 STATE ABBREVIATION COBOL NAME: STATE-ABBREV VALUES: AK ALASKA AL ALABAMA AR ARKANSAS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 10 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME AS AMERICAN SAMOA AZ ARIZONA CA CALIFORNIA CM SAIPAN CN CANADA CO COLORADO CT CONNECTICUT DC DISTRICT OF COLUMBIA DE DELAWARE FL FLORIDA GA GEORGIA GU GUAM HI HAWAII IA IOWA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MA MASSACHUSETTS MD MARYLAND ME MAINE MI MICHIGAN MN MINNESOTA MO MISSOURI MS MISSISSIPPI MT MONTANA MX MEXICO NC NORTH CAROLINA ND NORTH DAKOTA NE NEBRASKA NH NEW HAMPSHIRE NJ NEW JERSEY NM NEW MEXICO NV NEVADA NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA PR PUERTO RICO RI RHODE ISLAND SC SOUTH CAROLINA SD SOUTH DAKOTA TN TENNESSEE TX TEXAS UT UTAH * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 11 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME VA VIRGINIA VI VIRGIN ISLANDS VT VERMONT WA WASHINGTON WI WISCONSIN WV WEST VIRGINIA WY WYOMING STATE CODE (SSA) 2 472 473 C PROV2700 TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS LOCATED. COBOL NAME: SSA-STATE VALUES: 01 ALABAMA 02 ALASKA 03 ARIZONA 04 ARKANSAS 05 CALIFORNIA 06 COLORADO 07 CONNECTICUT 08 DELAWARE 09 DISTRICT OF COLUMBIA 10 FLORIDA 11 GEORGIA 12 HAWAII 13 IDAHO 14 ILLINOIS 15 INDIANA 16 IOWA 17 KANSAS 18 KENTUCKY 19 LOUISIANA 20 MAINE 21 MARYLAND 22 MASSACHUSETTS 23 MICHIGAN 24 MINNESOTA 25 MISSISSIPPI 26 MISSOURI 27 MONTANA 28 NEBRASKA 29 NEVADA 30 NEW HAMPSHIRE 31 NEW JERSEY 32 NEW MEXICO 33 NEW YORK 34 NORTH CAROLINA 35 NORTH DAKOTA 36 OHIO * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 12 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 37 OKLAHOMA 38 OREGON 39 PENNSYLVANIA 40 PUERTO RICO 41 RHODE ISLAND 42 SOUTH CAROLINA 43 SOUTH DAKOTA 44 TENNESSEE 45 TEXAS 46 UTAH 47 VERMONT 48 VIRGIN ISLANDS 49 VIRGINIA 50 WASHINGTON 51 WEST VIRGINIA 52 WISCONSIN 53 WYOMING 54 AFRICA 55 CALIFORNIA 56 CANADA 57 WEST INDIES 58 EUROPE 59 MEXICO 60 OCEANIA 61 PHILIPPINES 62 SOUTH AMERICA 63 UNITED STATES POSSESSIONS 64 AMERICAN SAMOA 65 GUAM 66 SAIPAN 67 TEXAS STATES REGION CODE 3 474 476 C PROV2710 FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION WITHIN THE STATE WHERE THE FACILITY IS LOCATED COBOL NAME: STATE-REGION-CD * STREET ADDRESS 38 477 514 C PROV2720 STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO PROVIDE MEDICARE AND/OR MEDICAID SERVICES. COBOL NAME: STREET-ADDRESS SURVEY AGENCY REVIEW DATE 6 515 520 C PROV2730 DATE THE AUTHORIZED REPRESENTATIVE OF THE STATE SURVEY AGENCY REVIEWED AND FORWARDED THE CERTIFICATION MATERIAL. COBOL NAME: SURVEY-AGCY-APP-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 13 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME SURVEY RECORD ADD DATE 6 521 526 C PROV2735 THE DATE A SURVEY RECORD IS ACCEPTED TO THE MMACS MASTER FILE. COBOL NAME: SURVEY-DT-ON-MASTER SURVEYOR SIGNATURE DATE 6 527 532 C PROV2790 DATE A SURVEYOR SIGNS AND DATES THE TRANSMITTAL FORM AFTER ENSURING THAT THE CERTIFICATION DOCUMENTS ARE COMPLETE AND ACCURATE. COBOL NAME: SURVEYOR-SIGN-DT TELEPHONE NUMBER 10 533 542 C PROV1605 THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR THE OPERATOR OF A PROVIDER. COBOL NAME: PHONE-NUM TERMINATION CODE 1 543 543 C PROV2805 THE REASON A FACILITY HAS BEEN TERMINATED FROM THE MEDICARE AND/OR MEDICAID PROGRAMS COBOL NAME: TERM-CD VALUES: 0 ACTIVE 1 VOL-MERG,CLOSE 2 VOL-REIMBURSE 3 VOL-RISK INVOL 4 VOL-OTHER 5 INVOL-FAIL REQ 6 INVOL-AGREEMNT 7 OTH-STATUS CHG TERMINATION DATE 6 544 549 C PROV2810 THE EFFECTIVE DATE OF TERMINATION OF CERTIFICATION OF A FACILITY. COBOL NAME: TERM-DT THIRD COMPLAINT SURVEY DATE 6 550 555 C PROV0210 DATE OF THE THIRD RECENT COMPLAINT SURVEY COBOL NAME: COMP-SURVEY-DT-3 THIRD FMS SURVEY DATE 6 556 561 C PROV0510 THIRD FMS SURVEY DATE COBOL NAME: FMS-SURVEY-DT-3 THIRD SURVEY DATE 6 562 567 C PROV2750 THE "OFFICIAL" DATE OF THE THIRD MOST RECENT SURVEY IN MMACS. COBOL NAME: SURVEY-DT-3 THIRD SURVEY: ALL CONDITIONS 4 568 571 N PROV2830 THE NUMBER OF CONDITIONS OF PARTICIPATION OUT OF COMPLIANCE ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-COND-ALL THIRD SURVEY: ALL DEFICIENCIES 4 572 575 N PROV2835 TOTAL NUMBER OF HEALTH AND LIFE SAFETY DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-DEFS-ALL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 14 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME THIRD SURVEY: HEALTH 4 576 579 N PROV2825 NUMBER OF HEALTH DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-SRF-DEFS-ALL THIRD SURVEY: LIFE SAFETY CODE 4 580 583 N PROV2815 NUMBER OF LIFE SAFETY CODE DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-LSC-DEFS-ALL THIRD SURVEY: REG OFF FLAGS 4 584 587 N PROV2820 NUMBER OF DEFICIENCIES FROM A LIST OF SELECTED REQUIREMENTS ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-ROF-DEFS-ALL THIRD SURVEY: STANDARDS 4 588 591 N PROV2840 NUMBER OF STANDARD LEVEL DEFICIENCIES ON THE THIRD MOST RECENT SURVEY. COBOL NAME: THIRD-TOT-STDS-ALL TOTAL 670 HOURS FOR CURRENT SURVEY 8.2 592 599 N PROV3205 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-1 TOTAL 670 HOURS FOR PRIOR 2 SURVEY 8.2 600 607 N PROV3210 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-2 TOTAL 670 HOURS FOR PRIOR 3 SURVEY 8.2 608 615 N PROV3215 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-3 TOTAL 670 HOURS FOR PRIOR 4 SURVEY 8.2 616 623 N PROV3220 TOTAL HOURS FOR ALL 670 FORMS ENTERED FOR THIS SURVEY, THIS INCLUDES REVISITS. COBOL NAME: TOT-670-SURVEY-HRS-4 TYPE OF ACTION 1 624 624 C PROV2880 IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND TRANSMITTAL FORM WAS PREPARED. COBOL NAME: TYPE-ACTION VALUES: 1 INITIAL 3 TERMINATION 6 COMPLAINT SURVEY (NOT USED IN ODIE ANY MORE) TYPE OF CONTROL 2 625 626 C PROV2885 INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES A PROVIDER OF SERVICES. COBOL NAME: TYPE-CONTROL VALUES: 01 RELIGIOUS AFFILIATION 02 PRIVATE 03 OTHER 04 PROPRIETARY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 15 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME 05 GOVERNMENT - STATE/COUNTY 06 GOVERNMENT - COMB. GOVT & VOL. ZIP CODE 5 627 631 C PROV2905 THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER. COBOL NAME: ZIP-CD * 670 COUNTER FOR COMP REVIS SURVEY 2 632 633 N PROV3570 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR E REVISIT SURVEY FOR A PARTICULAR PROVIDER INT HE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-REV-COMP * 670 COUNTER FOR COMP STAND SURVEY 2 634 635 N PROV3585 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAS BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE COMPLAINT SYSTEM. COBOL NAME: UPDATED-670-STAND-COMP * 670 COUNTER FOR FMS REVIS SURVEY 2 636 637 N PROV3575 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-REV-FMS * 670 COUNTER FOR FMS STAND SURVEY 2 638 639 N PROV3590 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY FOR A PARTICULAR PROVIDER IN THE FMS SYSTEM. COBOL NAME: UPDATED-670-STAND-FMS * 670 COUNTER FOR ODIE REVIS SURVEY 2 640 641 N PROV3600 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A REVISIT SURVEY FOR A PARTICULAR PROVIDER IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-REV-ODIE * 670 COUNTER FOR ODIE STAND SURVEY 2 642 643 N PROV3595 A COUNTER WHICH INDICATES THE NUMBER OF TIMES 670 HOURS HAVE BEEN CHANGED FOR A STANDARD SURVEY IN THE ODIE SYSTEM. COBOL NAME: UPDATED-670-STAND-ODIE FIPS STATE CODE 2 644 645 C FIPSTATE FIPS STATE CODE COBOL NAME: WS-FIPS-STATE FIPS COUNTY CODE 3 646 648 C FIPCNTY FIPS COUNTY CODE COBOL NAME: WS-FIPS-CNTY SSA MSA CODE 3 649 651 C SSAMSA SSA MSA CODE COBOL NAME: WS-SSA-MSA SSA MSA SIZE CODE 1 652 652 C SSAMSASZ SSA MSA SIZE CODE COBOL NAME: WS-SSA-MSA-SIZE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92 1DATE: 03/02/93 POS RECORD LAYOUT PAGE: 16 FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS NAME RELATED PROVIDER NUMBER 10 875 884 C PROV1755 THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH DISTINCT PART LONG TERM CARE. THE NUMBER IN THIS FIELD WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE. COBOL NAME: RELATED-PROV-NUM PART OF A PARTICIPATING PROVIDER 1 2335 2335 C PROV2935 INDICATES IF A SUPPLIER IS PART OF ANOTHER PROVIDER OF MEDICARE/MEDICAID SERVICES. COBOL NAME: PART-MEDICARE-MEDICAID FEDERALLY FUNDED HEALTH CENTER 1 2348 2348 C PROV3710 INDICATED WHETHER THIS FQHC IS FEDERALLY FUNDED. COBOL NAME: FED-FUNDED-FFHC VALUES: N NO Y YES FQHC APPROVED RHC PROVIDER # 6 2349 2354 C PROV3705 APPROVED FQHC'S RELATED RHC PROVIDER NUMBER. COBOL NAME: APPROVED-RHC-PROV-NUM FQHC APPROVED RURAL HEALTH CLINIC 1 2355 2355 C PROV3700 INDICATES IF THE FQHC WAS A MEDICARE CERTIFIED RURAL HEALTH CLINIC. COBOL NAME: APPROVED-MEDICARE-RHC VALUES: N NO Y YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 12/02/92