Development of Electronic Transition Tools for Home Health Care (continued)

Appendix C. Mapping of CMS-485 and e-485 to the Continuity of Care Record

  CMS-485 e-485 (extended version of CMS-485) CCR (Continuity of Care Record)
1 Patient HI Claim No. Patient HI Claim No.  
2 Start of Care Date Start of Care Date <PlanOfCare><Plan><DateTime>
3 Certification Period Certification Period <PlanOfCare><Plan><DateTime>**
4 Medical Record No. Omitted Omitted
5 Provider No. Omitted Omitted
6 Patient Information Patient Information <Actor>
7 Provider Information Provider Information <Actor>
8 Date of Birth Date of Birth <Actor>
9 Sex Sex <Actor>
10 Medications Medications <PlanOfCare><Plan><OrderRequest>
  Medication Adjustment <PlanOfCare><Plan><OrderRequest>
  Physician Notification <PlanOfCare><Plan><OrderRequest>
11 Principal Diagnosis Principal Diagnosis <Body><Problems>
11 Other Diagnosis Other Diagnosis <Body><Problems>
12 Surgical Procedure, date, ICD-9 code Surgical Procedure, date, ICD-9 code <Body><Problems>
13 Other Pertinent Diagnosis: date of onset/exacerbation Other Pertinent Diagnosis: date of onset/exacerbation <Body><Problems>
14 DME and Supplies DME and Supplies <PlanOfCare><Plan><OrderRequest>
15 Safety Measures Safety Measures <PlanOfCare><Plan><OrderRequest>
16 Nutritional Requirements Nutritional Requirements <PlanOfCare><Plan><OrderRequest>
17 Allergies Allergies <Body><Alerts>
18A Functional Limitations Functional Limitations <Body><Problems>
18B Activities Permitted Activities Permitted <PlanOfCare><Plan><OrderRequest>
19 Mental Status Mental Status <Body><FunctionalStatus>
20 Prognosis Prognosis <Body><Problems>
21 Orders for Discipline and Treatments Orders for Discipline and Treatments <PlanOfCare><Plan><OrderRequest>
22 Goals Goals/Rehab <PlanOfCare><Plan><DischargePlan>
22 Discharge Plan Discharge Plan <PlanOfCare><Plan><DischargePlan>
22 Rehab Potential Rehab Potential <PlanOfCare><Plan><DischargePlan>

Notes:
Since the e-485 was for start of home care, the start of the certification period = the start of the care date.
It is not clear from the CCR documentation where to put financial certification information.

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Proceed to Appendix D