Need 2 numbers for each element. Code the WORST on your shift.

*Resident Self-Performance* G0110	*Assistance Provided* G0110
0 = Independent “doesn’t need you”	0 = Independent “doesn’t need you”
1 = Able to do the task with supervision “hands off”	1 = Set up is needed “hands off”
2 = Needs you to guide “hands on, no weight bearing”	2 = 1 person assist
3 = Resident works with you “hands on weight bearing”	3 = 2+ person assist or mechanical lifter
4 = CNAs doing all the work
8 = Activity did not occur	8 = Activity did not occur
G0120 - Bathing (Same codes as above.)	G0120 - Bathing
0 = Independent “doesn’t need you”—May code Independent in bathing if the resident does all bathing, except back and hair.	Codes same as G0110 Assistance Provided.
1 = Able to do the task with supervision “hands off”
2 = Able to do the task with help with the transfer only
3 = Resident needed help with some aspect of bathing

4 = CNAs doing all the work


8 = Activity did not occur

A. Bed mobility - how resident moves to and from lying position, turns side to side, and positions body while in bed or alternate sleep furniture

B. Transfer - how resident moves between surfaces including to or from bed, chair, wheelchair, standing position (excludes to/from bath/toilet)

C. Walk in room - how resident walks between locations in his/her room

D. Walk in corridor - how resident walks in corridor on unit

E. Locomotion on unit - how resident moves between locations in his/her room and adjacent corridor on same floor. If in wheelchair, self-sufficiency once in chair

F. Locomotion off unit - how resident moves to and returns from off-unit locations (e.g., areas set aside for dining, activities or treatments). If facility has only one floor, how resident moves to and from distant areas on the floor. If in wheelchair, self-sufficiency once in chair

G. Dressing - how resident puts on, fastens and takes off all items of clothing, including donning/removing a prosthesis or TED hose. Dressing includes putting on and changing pajamas and housedresses.

H. Eating - how resident eats and drinks, regardless of skill. Do not include eating/drinking during medication pass. Includes intake of nourishment by other means (e.g., tube feeding, total parenteral nutrition, IV fluids administered for nutrition or hydration)

I. Toilet use - how resident uses the toilet room, commode, bedpan, or urinal; transfers on/off toilet; cleanses self after elimination; changes pad; manages ostomy or catheter; and adjusts clothes. Do not include emptying of bedpan, urinal, bedside commode, catheter bag or ostomy bag

J. Personal hygiene - how resident maintains personal hygiene, including combing hair, brushing teeth, shaving, applying makeup, washing/drying face and hands (excludes baths and showers)

G0120 Bathing

How resident takes full-body bath/shower, sponge bath, transfers in/out of tub/shower (excludes washing of back & hair).

H0300 Urinary Continence

Code the number of Continent and Incontinent urinations during your shift.

H0400 Bowel Continence

Code the number of Continent and Incontinent bowel movements during your shift.

For each bowel movement, describe the Bowel Characteristics using the following codes:

Consistency:	N (Normal)	Size:	S (Small)	Color:	N (Normal)
	H (Hard)		M (Medium)		C (Clay Colored)
	S (Soft)		L (Large)		B (Black)
	L (Loose)				R (Red)

Example:

1. The resident had 2 bowel movements during your shift, both were continent. Code “2” in Continent and “0” in Incontinent.

2. Consistency: Both bowel movements were hard, so code HH.

3. Size: One bowel movement was small, the other medium, so code SM

4. Color: Both were clay colored so code CC.