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

Development of Electronic Transition Tools for Home Health Care

 CMS-485e-485 (extended version of CMS-485)CCR (Continuity of Care Record)
1Patient HI Claim No.Patient HI Claim No. 
2Start of Care DateStart of Care Date<PlanOfCare><Plan><DateTime>
3Certification PeriodCertification Period<PlanOfCare><Plan><DateTime>**
4Medical Record No.OmittedOmitted
5Provider No.OmittedOmitted
6Patient InformationPatient Information<Actor>
7Provider InformationProvider Information<Actor>
8Date of BirthDate of Birth<Actor>
9SexSex<Actor>
10MedicationsMedications<PlanOfCare><Plan><OrderRequest>
 Medication Adjustment<PlanOfCare><Plan><OrderRequest>
 Physician Notification<PlanOfCare><Plan><OrderRequest>
11Principal DiagnosisPrincipal Diagnosis<Body><Problems>
11Other DiagnosisOther Diagnosis<Body><Problems>
12Surgical Procedure, date, ICD-9 codeSurgical Procedure, date, ICD-9 code<Body><Problems>
13Other Pertinent Diagnosis: date of onset/exacerbationOther Pertinent Diagnosis: date of onset/exacerbation<Body><Problems>
14DME and SuppliesDME and Supplies<PlanOfCare><Plan><OrderRequest>
15Safety MeasuresSafety Measures<PlanOfCare><Plan><OrderRequest>
16Nutritional RequirementsNutritional Requirements<PlanOfCare><Plan><OrderRequest>
17AllergiesAllergies<Body><Alerts>
18AFunctional LimitationsFunctional Limitations<Body><Problems>
18BActivities PermittedActivities Permitted<PlanOfCare><Plan><OrderRequest>
19Mental StatusMental Status<Body><FunctionalStatus>
20PrognosisPrognosis<Body><Problems>
21Orders for Discipline and TreatmentsOrders for Discipline and Treatments<PlanOfCare><Plan><OrderRequest>
22GoalsGoals/Rehab<PlanOfCare><Plan><DischargePlan>
22Discharge PlanDischarge Plan<PlanOfCare><Plan><DischargePlan>
22Rehab PotentialRehab 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.

Current as of September 2007
Internet Citation: Appendix C. Mapping of CMS-485 and e-485 to the Continuity of Care Record: Development of Electronic Transition Tools for Home Health Care. September 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/hcbs/etransitions/etransitionsapc.html