M1400 - When is the patient dyspneic or noticeably Short of Breath?

checked>0 - Never, patient is not short of breath checked > 1 - When walking more than 20 feet, climbing stairs checked> 2 - With moderate exertion checked/> 3 - With minimal exertion or with agitation checked/> 4 - At rest (during day or night)

M1410 - Respiratory Treatments utilized at home: (Mark all that apply.)

checked type="checkbox" value="1 - Oxygen (intermittent or continuous)" /> 1 - Oxygen (intermittent or continuous) checked type="checkbox" value="2 - Ventilator (continually or at night)" /> 2 - Ventilator (continually or at night) checked type="checkbox" value="3 - Continuous / Bi-level positive airway pressure" /> 3 - Continuous / Bi-level positive airway pressure checked value="4 - None of the above" /> 4 - None of the above

M1501 Symptoms in Heart Failure Patients: If patient has been diagnosed with heart failure, did the patient exhibit symptoms indicated by clinical heart failure guidelines (including dyspnea,orthopnea,edema,or weight gain) at the time of or at any time since most recent SOC/ROC assessment?M1500 Symptoms in Heart Failure Patients: If pt has been diagnosed with heart failure, did s/he exhibit symptoms at any point since the previous OASIS assessment?

checked/> 0 - No checked/> 1 - Yes checked/> 2 - Not assessed checked/> NA - Patient does not have diagnosis of heart failure

M1511 If patient has been diagnosed with heart failure and has exhibited symptoms indicative of heart failure at the time of or at any time since the most recent SOC/ROC assessment,what action(s) has (have) been taken to respond?M1510 Heart Failure Follow-up: If pt has been diagnosed with heart failure and has exhibited heart failure symptoms since the previous OASIS assessment, what action(s) has (have) been taken to respond? (Mark all that apply.)

checked type="checkbox" value="0 - No action taken" /> 0 - No action taken checked name="chkM1510NAction" type="checkbox" value="1 - Patient's physician (or other primary care practitioner) contacted the same day" /> 1 - Patient's physician (or other primary care practitioner) contacted the same day checked name="chkM1510NAction" type="checkbox" value="2 - Patient advised to get emergency treatment (e.g., call 911 or go to emergency room)" /> 2 - Patient advised to get emergency treatment (e.g., call 911 or go to emergency room) checked type="checkbox" value="3 - Implemented physician-ordered patient-specific established parameters for treatment" /> 3 - Implemented physician-ordered patient-specific established parameters for treatment checked type="checkbox" value="4 - Patient education or other clinical interventions" /> 4 - Patient education or other clinical interventions checked value="5 - Obtained change in care plan orders (e.g., increased monitoring by agency, change in visit frequency, telehealth, etc.)" /> 5 - Obtained change in care plan orders (e.g., increased monitoring by agency, change in visit frequency, telehealth, etc.)

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