SELECT Assessment_Completed_M0090 FROM #Request.prefix_db_agency#.Assessment_New where Assessment_ID = '#session.cs.AssessmentId#' SELECT id,Diagnosis,Case_Mix_Message FROM #Request.prefix_db_lookup#.Dx_list_ICD10 WHERE id='#form.Diagnosislistid#' SELECT id,Diagnosis,Case_Mix_Message FROM #Request.prefix_db_lookup#.diagnosis_list WHERE id='#form.Diagnosislistid#' SELECT id,Diagnosis,Case_Mix_Message FROM #Request.prefix_db_lookup#.Dx_list_ICD10 WHERE Diagnosis LIKE '%#form.M1020Manifestsearch#%' and Manfestation='M' and Manfestation is not null SELECT id,Diagnosis,Case_Mix_Message FROM #Request.prefix_db_lookup#.diagnosis_list WHERE Diagnosis LIKE '%#form.M1020Manifestsearch#%' and Manfestation='M' and Manfestation is not null SELECT id,Diagnosis,Case_Mix_Message FROM #Request.prefix_db_lookup#.Dx_list_ICD10 WHERE id='#form.M1020ManifestDiagnosisid#' SELECT id,Diagnosis,Case_Mix_Message FROM #Request.prefix_db_lookup#.diagnosis_list WHERE id='#form.M1020ManifestDiagnosisid#'

Manifestation Diagnosis Select

Click Select Button

#M1020ManifestDiagnosis.Diagnosis#

#M1020ManifestDiagnosis.Case_Mix_Message#

Diagnosis Select

#M1020Select.Diagnosis#

Primary?

Yes No

*SEVERITY KEY
0 - Asymptomatic, no treatment needed
1 - Symptoms well controlled
2 - Symptoms controlled with difficulty
3 - Symptoms poorly controlled
4 - history of rehospitalizations

Secondary?

YesNo

Severity level

012
34

Onset or Exacerbation

(O)(E)

Add Case Mix For
ICD10 Z-Code

Add Manifestation For
ICD10 Z-Code

#M1020ManifestSelect.Diagnosis#

If this is a ICD10 Z-Code, and you want to add a case mix diagnosis, click "add case mix..."now to include that data. Click "add manifestation" to add a manifestation code.