checked type="checkbox" value="1 - Improper medication administration" /> 1 - Improper medication administration checked value="2 - Injury caused by fall" /> 2 - Injury caused by fall checked value="3 - Respiratory infection (e.g., pneumonia, bronchitis)" /> 3 - Respiratory infection (e.g., pneumonia, bronchitis) checked value="4 - Other respiratory problem" /> 4 - Other respiratory problem checked value="5 - Heart failure (e.g., fluid overload)" /> 5 - Heart failure (e.g., fluid overload) checked value="6 - Cardiac dysrhythmia (irregular heartbeat)" /> 6 - Cardiac dysrhythmia (irregular heartbeat) checked value="7 - Myocardial infarction or chest pain" /> 7 - Myocardial infarction or chest pain checked value="8 - Other heart disease" /> 8 - Other heart disease checked value="9 - Stroke (CVA) or TIA" /> 9 - Stroke (CVA) or TIA checked value="10 - Hypo/Hyperglycemia, diabetes out of control" /> 10 - Hypo/Hyperglycemia, diabetes out of control checked value="11 - GI bleeding, obstruction, constipation, impaction" /> 11 - GI bleeding, obstruction, constipation, impaction checked value="12 - Dehydration, malnutrition" /> 12 - Dehydration, malnutrition checked value="13 - Urinary tract infection" /> 13 - Urinary tract infection checked value="14 - IV catheter-related infection or complication" /> 14 - IV catheter-related infection or complication checked value="15 - Wound infection or deterioration" /> 15 - Wound infection or deterioration checked value="16 - Uncontrolled pain" /> 16 - Uncontrolled pain checked value="17 - Acute mental/behavioral health problem" /> 17 - Acute mental/behavioral health problem checked value="18 - Deep vein thrombosis, pulmonary embolus" /> 18 - Deep vein thrombosis, pulmonary embolus checked value="19 - Other than above reasons" /> 19 - Other than above reasons checked value="UK - Reason unknown" /> UK - Reason unknown