11/19/2020 MDS 3.

0 Section K - Swallowing / Nutritional Status - Bean, Bradley (4435)

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MDS 3.0 Section K - Swallowing / Nutritional Status

Resident Information Assessment Information RUG Information PDPM Information Submission Information
Resident: Bean, Bradley (4435) ARD/Target 2020-11-18 State: PA1 Primary Diagnosis: N/A MDS In Progress
Admit Date: 11/30/2017 Date: State Alternate: Clinical Category: N/A Status:
Payer: Medicaid Pending PA OBRA Reason: Significant change in status Insurance Billing: PA1 Recent Surgery: N/A HIPPS: N/A A0410: 3.Unit is Medicare and/or Medicaid c
Mdcr Start Date: PPS Reason: None of the above Insurance Non-Therapy: PA1 PT/OT: N/A SLP: N/A Submit Submit to CMS
PPS OMRA: Nursing: N/A NTA: N/A Req:
Entry/Discharge: None of the above

A B C D E F G GG H I J K L M N O P Q S V X Save Save & Exit Cancel

K0100. Swallowing Disorder

Signs and symptoms of possible swallowing disorder
Select all that apply
A. Loss of liquids/solids from mouth when eating or drinking Tools ▼

K0100A - response required

Yes No -

B. Holding food in mouth/cheeks or residual food in mouth after meals Tools ▼

K0100B - response required

Yes No -

C. Coughing or choking during meals or when swallowing medications Tools ▼

K0100C - response required

Yes No -

D. Complaints of difficulty or pain when swallowing Tools ▼

K0100D - response required

Yes No -

Z. None of the above Tools ▼

None of the above

K0200. Height and Weight - While measuring, if the number is X.1 - X.4 round down; X.5 or greater round up
A. Height (in inches) Tools ▼

K0200A - response required

B. Weight (in pounds) Tools ▼

K0200B - response required

K0300. Weight Loss

Loss of 5% or more in the last month or loss of 10% or more in last 6 months Tools ▼

K0300 - response required

0. No or unknown

1. Yes, on prescribed weight-loss regimen

2. Yes, not on prescribed weight-loss regimen

-. Not assessed

K0310. Weight Gain

Gain of 5% or more in the last month or gain of 10% or more in last 6 months
Gain of 5% or more in the last month or gain of 10% or more in last 6 months Tools ▼

K0310 - response required

0. No or unknown

1. Yes, on physician-prescribed weight-gain regimen

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11/19/2020 MDS 3.0 Section K - Swallowing / Nutritional Status - Bean, Bradley (4435)

2. Yes, not on physician-prescribed weight-gain regimen

-. Not assessed

K0510. Nutrition approaches

Check all of the following nutritional approaches that were performed during the last 7 days.

1. While NOT a Resident

Performed while NOT a resident of this facility and within the last 7 days. Only check column 1 if resident entered (admission or reentry) IN THE LAST 7 days. If resident last entered 7 or more
days ago, leave column 1 blank.
2. While a Resident
Performed while a resident of this facility and within the last 7 days.

1. While NOT a Resident 2. While a Resident

A. Parenteral/IV feeding Question K0510A1 disabled by question A2300
Tools ▼ Tools ▼

K0510A2 - response required

0. Not checked (No)
1. Checked (Yes) 0. Not checked (No)
-. Not assessed/no information 1. Checked (Yes)
-. Not assessed/no information

B. Feeding tube - nasogastric or Question K0510B1 disabled by question A2300

Tools ▼ Tools ▼
abdominal (PEG)

K0510B2 - response required

0. Not checked (No)
1. Checked (Yes) 0. Not checked (No)
-. Not assessed/no information 1. Checked (Yes)
-. Not assessed/no information

C. Mechanically altered diet - require

Tools ▼
change in texture of food or liquids
(e.g., pureed food, thickened liquids)
K0510C2 - response required

n/a
0. Not checked (No)

1. Checked (Yes)

-. Not assessed/no information

D. Therapeutic diet - (e.g., low salt,

Tools ▼
diabetics, low cholesterol)

K0510D2 - response required

n/a
0. Not checked (No)

1. Checked (Yes)

-. Not assessed/no information

Z. None of the above Question K0510Z1 disabled by question A2300

Tools ▼ Tools ▼

None of the above None of the above

K0710. Percent Intake by Artificial Route

Complete K0710 only if Column 1 and/or Column 2 are checked for K0510A and/or K0510B

1. While NOT a Resident

Performed while NOT a resident of this facility and within the last 7 days. Only enter a code in column 1 if resident entered (admission or reentry) IN THE LAST 7 DAYS. If resident last entered 7
or more days ago, leave column 1 blank
2. While a Resident
Performed while a resident of this facility and within the last 7 days
3. During entire 7 days
Performed during the entire last 7 days

1. While NOT a Resident 2. While a Resident 3. During Entire 7 Days

A. Proportion of total calories
Tools ▼ Tools ▼
the resident received through
parenteral or tube feeding
K0710A2 - response required K0710A3 - response required

n/a 1. 25% or less 1. 25% or less

2. 26-50% 2. 26-50%

3. 51% or more 3. 51% or more

-. Not assessed/no information -. Not assessed/no information

B. Average fluid intake per n/a

Tools ▼ Tools ▼
day by IV or tube feeding

K0710B2 - response required K0710B3 - response required

1. 500 cc/day or less 1. 500 cc/day or less

2. 501 cc/day or more 2. 501 cc/day or more

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11/19/2020 MDS 3.0 Section K - Swallowing / Nutritional Status - Bean, Bradley (4435)
-. Not assessed/no information -. Not assessed/no information

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