/KaraDayDemo Houston SNF/Residents/Darnell Washington · 74M · MR-EXT-042
ipaMedicare A2 active gaps
Current HIPPS
NAPE0
→
After capture
NAFF0
+$114.27/day
+$7,542 remaining stay
Resident chart
most-recent note · 2 MDS sections
therapy · 2026-04-22 18:30:00+00 · PT
PT progress note — Day 13. Resident Darnell Washington demonstrating significant functional improvement since admission for CHF exacerbation. Ambulated 120 feet in hallway x2 with rolling walker and supervision only; SpO2 maintained 94–97% throughout. Sit-to-stand transfers now require contact guard assist only — marked improvement from moderate assist on evaluation. Stair negotiation assessed: able to complete 4 steps with one handrail and close supervision. Balance: Berg Balance Scale scored 42/56, indicating low-to-moderate fall risk. Resident tolerated full therapy session without significant dyspnea. Discharge planning discussed with resident and therapy team: anticipate return to home with home health PT referral. Resident demonstrating good carryover of energy conservation techniques. Recommend transition to home health PT within 1–2 days of discharge. Short-term goals met; updated goals established for final SNF therapy days.
MDS 3.0 · Section I — Active Diagnoses · target 2026-04-23
I0900Peripheral Vascular Disease···☐ NOT CODED
I2000Pneumonia···☐ NOT CODED
I2500Wound Infection···☐ NOT CODED
I3500Pressure Ulcer Stage 3···☐ NOT CODED
I4500Diabetes Mellitus···☐ NOT CODED
MDS · Section O — Special Treatments · target 2026-04-23
O0100H2IV Medications Post-admit···☐ NOT CODED
O0100M2Isolation/Precautions···☐ NOT CODED
O0100F2Ventilator/Respirator Post-admit···☐ NOT CODED
Gap detection · grounded
claude-opus-4-7 · 847ms · 2.1k tok
DEPRESSIONmedium
Notes describe depressive symptoms. Score a PHQ-9 (D0150) or staff assessment (D0500) at next MDS to capture for nursing classification.
Field: pdpmDepression
Evidence: "[RN] ...of meals. Resident continues to express low mood intermittently; reports sleeping better this week. Skin check performed: coccyx...", "[MD] ...in PT daily. Of note, resident endorses low mood, decreased interest in activities, and poor sleep since hospitalization. He sta..."
OXYGENmedium
Notes describe supplemental oxygen. Capture O0100C (oxygen) at next MDS — drives Special Care High nursing classification.
Field: O0100C
Evidence: "[PT] ...th rolling walker and supervision only; SpO2 maintained 94–97% throughout. Sit-to-stand transfers now require contact guard ...", "[RN] .... Vital signs: BP 132/78, HR 80, RR 18, SpO2 97% on room air. No respiratory distress noted at rest; tolerates short-distanc..."