How are you supposed to complete the discharge assessment when a resident suddenly leaves the facility?

Q: My question is related to the discharge tracking forms now with clinical subset items. My understanding is that a discharge tracking form MUST be completed within seven days for any resident who is discharged from the facility with return not anticipated, and for resident’s with discharge return anticipated. This includes discharges to hospitals. How is one to interview and complete an assessment on a resident that is ill enough to be transferred out to the hospital via ambulance or 911? On weekends at our facility the MDS staff are off and made aware on their return Monday of any discharges to the hospital. Even with the MDS 2.0 OBRA assessments, if a resident is in the window for their quarterly or annual and go out to the hospital and are admitted, you do not have to complete the assessment. You have the option of completing within a certain time frame on return to the facility. Is my understanding correct? How can you accurately complete the assessment when the resident is not available? The manual does not differentiate between return not anticipated, and return anticipated. Do you anticipate any changes to this requirement?

A: I understand your concerns and I do not anticipate much more change to this discharge assessment requirement. However, the requirement for discharge reporting has changed dramatically under MDS 3.0 from MDS 2.0. The term “Discharge trackers” is no longer used. Instead, there are 3 distinct ‘discharge reporting’ situations:

  • Discharge assessment—return not anticipated (A0310F=10)
  • Discharge assessment—return anticipated (A0310F=11)
  • Death in the facility tracking record. A0310F=12)

The death in the facility tracking record is only demographic and administrative elements, cannot be combined with any other record, and must be completed within 7 days after the resident’s death.

The other 2 types of discharge require the use of the ND/SD discharge form, which includes demographic, administrative, and clinical items and must be completed within 14 days (rather than 7 days) after the discharge.

Sometimes, due to emergent care, it may not be possible to capture all of the data points on the 27-page discharge assessment. In those cases the use of the ‘-‘ to fill those items is acceptable, as long as all items that can be completed are coded.

A discharge assessment may be combined with another assessment when the ARD dates match. However, this assessment cannot be deferred while the patient is in the hospital as it reflects the resident’s condition on date of discharge to the hospital.


  1. Monia Newcomer RN

    Diane, In section N of the 3.0 MDS we count the days insulin was given and the days the insulin order was changed. Does this count toward reinbursement??
    Section O now had orders and visits. If the physician is called every day with the result of a PT INR and the coumadin dosage is changed every day, does this count as a new order every day or as routine order.

  2. Mari Herman

    Hi Diane: The discharge question has me a little confused. If a person d/c to a hospital, wouldn’t you do the discharge assessment and not combine it with the quarterly? I guess if it’s a quarterly or annual you choose to combine the assessments, you would do it as a change in condition on the MDS-right?
    Mari Herman, RN


    With the sheer volume of paper now involved with 3.0, interested to hear suggestions on just where to keep the last 15 mo of MDSs that need to be available…our charts won’t support these extra sheets. Also, do youall work on a ‘scrap’ MDS, then enter and print an official MDS for the chart? I’m not set up for everyone to enter their own data, so I compile a pre-printed MDS, and keep it 15 mo

  4. Pam Ancona LPN RAC-CT

    How do we transition from 2.0 to 3.0 at the end of September with 14, 30, 60and 90 day assessments? Do we split the days in Sept under 2.0 and the remaining days under 3.0? or can we just move our ARD so it falls in October and capture all days under 3.0? I understand the Option 1 as it applies to a new admission but would that apply for all other assessments that fall btw the 2 months?

  5. MacKenzie

    The transition options for the MDS 3.0 can apply to the 5 day, 14 day, 30 day, 60 day, and 90 day assessment. For all of these you can choose to complete and MDS 2.0 for the September days in the pay period and an MDS 3.0 of the same type for the October days in the pay period. Or you can complete an MDS 2.0 for the September days in the pay period, not do the same type of MDS 3.0, and instead do the next scheduled MDS 3.0 to cover all the days in October for that pay period and the ones remaining from the previous pay period. Or you can just complete an MDS 3.0 in October, which will generate a RUG-III grouper for the days in September and a RUG-IV grouper for the days in October in the pay period. I have explained the options in greater detail here:

    At the bottom of that blog post you will find a link to a CMS web page where there are some great tools and spreadsheets to walk you through the transition process.

    I hope this helps.

  6. Kathleen

    I have a question about the discharge- return anticipated assessment. What if the resident does not return to the facility, do we need to make an assessment to close the record of that particular resident? Or that discharge assessment is enough for the bed tracking?

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