MDS 3.0: Recommended Form - Ucla - GeroNet

Section M Skin ConditionsM10. Other Ulcers, Wounds, and Skin ProblemsCheck all that apply in the past 5 days:a. Venous or arterial ulcer(s)b. Diabetic foot ulcer(s)c. Other foot or lower extremity infection (cellulitis)d. Surgical wound(s)e. Open lesion(s) other than ulcers, rashes, cuts (e.g., cancer lesion)f. Burn(s)g. None of the above were presentCheck all that apply.M11. Skin and Ulcer TreatmentsCheck all that apply in the past 5 days:a. Pressure reducing device for chairb. Pressure reducing device for bedc. Turning/repositioning programd. Nutrition or hydration intervention to manage skin problemse. Ulcer caref. Surgical wound careg. Application of dressings (with or without topical medications) other than to feeth. Applications of ointments/medications other than to feeti. Application of dressings to feet (with or without topical medications)j. None of the above were providedCheck all that apply.Section N MedicationsN1. InjectionsRecord the number of days that injectable medications were received during the last 5 days or since admission ifless than 5 days.DaysN2. Medications ReceivedCheck all medications the resident received at any time during the last 5 days or since admission if less than 5 days:a. Antipsychoticb. Antianxietyc. Antidepressantd. Hypnotice. Anticoagulant (warfarin, heparin, or low-molecular weight heparin)f. None of the above were receivedCheck all that apply.Recommended MDS 3.0 24