A simple form to help MDS-involved staff in calculating to determine each of the PDPM case-mix components: PT, OT, SLP, Nursing and NTA. This worksheet was made because other forms that are out there had extra information not needed! This guide is simplified to be used by a busy MDS nurse or MDS-involved clinician in mind and made by an MDS nurse who needs to determine the PDPM HIPPS fast! This form is similar to the RUG-IV table that breaks it down to determine the resident's RUG level.

This is a 14 page file (originally 9-page) PDF file revised 08/15/19.  The first 9 pages are tables to help determine levels or codes.  The rest of the pages are step-by-step questions to ask to calculate the levels and codes.  To be used with the ICD 10 mapping (free from CMS.gov and free for download in the Free Forms & Resources page).


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PDPM Worksheet Guide: A form to calculate & determine the 5 PDPM components


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