Optimistic 2 Data Template Walkthrough Name of Variable Name Allowable responses for that Description of variable Reason CMS is Report (or column header variable (or column header) asking for this Template on (column header) This identifier will be used to Resident’s MRN as assigned by your identify the resident in each of All Forms MRN facility. Should uniquely identify Any MRN the files you submit and resident and not the stay. throughout the life of the project. Resident First_Name Resident Name Roster Letters, no numbers Provides identifying data to CMS Last_Name Resident Last Name Middle_Initial_or_Name Resident Middle Initial or Name Use mm/dd/yyyy format; for example, Date_of_Birth Resident’s date of birth Provides identifying data to CMS 07/15/2017. Cannot be blank. Gender Resident’s gender Use for male or for female. Provides identifying data to CMS “M” “F” Identifies the PCP provider to PCP_Last_Name Last name of the resident’s PCP Letters, no numbers help link residents with their PCP_First_Name First name of the resident’s PCP Letters, no numbers information on other templates. We ask for first and last name PCP’s NPI number. CMS will use the separately. This allows us to PCP_NPI NPI number to identify PCPs when they Ten-digit number assist you with your data bill. questions as quickly as possible. If a resident elects to opt out of Use mm/dd/yyyy format; for example, Allows our team to track which Opt_Out_Date OPTIMSTIC, record the date the opt-out 07/15/2017. Leave blank if the residents have opted out. This form was signed here. resident has not opted out. allows us to keep an accurate roster of eligible residents and to identify which residents do If a resident has previously opted out not want to participate in the of OPTIMISTIC, but changes their mind, Use mm/dd/yyyy format; for example, Opt_Back_In_Date intervention. record the date of the decision to 07/15/2017. Can be blank. participate here.
Optimistic 2 Data Template Walkthrough Name of Report Template Variable Name (or column header on Description of variable (or column header) Allowable responses for that variable (column header) Reason CMS is asking for this All Forms MRN Resident’s MRN as assigned by your facility. Should uniquely identify resident and not the stay. Any MRN This identifier will be used to identify the resident in each of the files you submit and throughout the life of the project. Resident Roster First_Name Resident Name Letters, no numbers Provides identifying data to CMS Last_Name Resident Last Name Middle_Initial_or_Name Resident Middle Initial or Name Date_of_Birth Resident’s date of birth Use mm/dd/yyyy format; for example, 07/15/2017. Cannot be blank. Provides identifying data to CMS Gender Resident’s gender Use “M” for male or “F” for female. Provides identifying data to CMS PCP_Last_Name Last name of the resident’s PCP Letters, no numbers Identifies the PCP provider to help link residents with their information on other templates. We ask for first and last name separately. This allows us to assist you with your data questions as quickly as possible. PCP_First_Name First name of the resident’s PCP Letters, no numbers PCP_NPI PCP’s NPI number. CMS will use the NPI number to identify PCPs when they bill. Ten-digit number Opt_Out_Date If a resident elects to opt out of OPTIMSTIC, record the date the opt-out form was signed here. Use mm/dd/yyyy format; for example, 07/15/2017. Leave blank if the resident has not opted out. Allows our team to track which residents have opted out. This allows us to keep an accurate roster of eligible residents and to identify which residents do not want to participate in the intervention. Opt_Back_In_Date If a resident has previously opted out of OPTIMISTIC, but changes their mind, record the date of the decision to participate here. Use mm/dd/yyyy format; for example, 07/15/2017. Can be blank.