Cms 802 PDF Details

CMS 802 is a course offered at the University of Maine that covers topics related to web content management. The course provides students with the opportunity to learn about different aspects of web content management, including how to develop and manage websites, create and format documents for the web, and use various tools to publish content online. In addition, students will learn about search engine optimization (SEO) and online marketing strategies. The course is taught by Professor Liza Loop, who has more than 20 years of experience in web development and online marketing. She is an expert in using Content Management Systems (CMS), such as WordPress, Joomla!, Drupal, and Sitecore. Professor Loop is also the author of several books on website design and online marketing.

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Form NameCms 802
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namescms 802 matrix, cms 802 form, roster sample, cms802

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OMB Exempt


The Matrix is used to identify pertinent care categories for: 1) newly admitted residents in the last 30 days who are still residing in the facility, and 2) all other residents. The facility completes the resident name, resident room number and columns 1–20, which are described in detail below. Blank columns are for Surveyor Use Only.

All information entered into the form should be verified by a staff member knowledgeable about the resident population. Information must be reflective of all residents as of the day of survey.

Unless stated otherwise, for each resident mark an X for all columns that are pertinent.

1.Residents Admitted within the Past 30 days: Resident(s) who were admitted to the facility within the past 30 days and currently residing in the facility.

2.Alzheimer’s/Dementia: Resident(s) who have a diagnosis of Alzheimer’s disease or dementia of any type.

3.MD, ID or RC & No PASARR Level II: Resident(s) who have a serious mental disorder, intellectual disability or a related condition but does not have a PASARR level II evaluation and determination.

4.Medications: Resident(s) receiving any of the

following medications: (I) = Insulin, (AC) = Anticoagulant (e.g. Direct thrombin inhibitors and low weight molecular weight heparin [e.g., Pradaxa, Xarelto, Coumadin, Fragmin]. Do not include Aspirin or Plavix), (ABX) = Antibiotic, (D) = Diuretic,

(O) = Opioid, (H) = Hypnotic, (AA) = Antianxiety, (AP) = Antipsychotic, (AD) Antidepressant, (RESP) = Respiratory (e.g., inhaler, nebulizer).

NOTE: Record meds according to a drug’s pharmacological classification, not how it is used.

5.Pressure Ulcer(s) (any stage): Resident(s) who have a pressure ulcer at any stage, including suspected deep tissue injury (mark the highest stage: I, II, III, IV, U for unstageable, S for sDTI) and whether the pressure ulcer is facility acquired (FA).

6.Worsened Pressure Ulcer(s) at any stage: Resident(s) with a pressure ulcer at any stage that have worsened.

7.Excessive Weight Loss without Prescribed Weight Loss program: Resident(s) with an unintended (not on a prescribed weight loss program) weight loss > 5% within the past 30 days or >10% within the past 180 days. Exclude residents receiving hospice services.

8.Tube Feeding: Resident(s) who receive enteral (E) or parenteral (P) feedings.

9.Dehydration: Resident(s) identified with actual hydration concerns takes in less than the recommended 1,500 ml of fluids daily (water or liquids in beverages and water in foods with high fluid content, such as gelatin and soups).

10.Physical Restraints: Resident(s) who have a physical restraint in use. A restraint is defined as the use of any manual method, physical or mechanicaldevice, material or equipment attached or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body (e.g., bed rail, trunk restraint, limb restraint, chair prevents rising, mitts on hands, confined to room, etc.). Do not code wander guards as a restraint.

11.Fall(s) (F) or Fall(s) with Injury (FI) or Major Injury (FMI): Resident(s) who have fallen in the facility in the past 90 days or since admission and have incurred an injury or not. A major injury includes bone fractures, joint dislocation, closed head injury with altered consciousness, subdural hematoma.

12.Indwelling Urinary Catheter: Resident(s) with an indwelling catheter (including suprapubic catheter and nephrostomy tube).

13.Dialysis: Resident(s) who are receiving (H) hemodialysis or (P) peritoneal dialysis either within the facility (F) or offsite (O).

14.Hospice: Resident(s) who have elected or are currently receiving hospice services.

15.End of Life/Comfort Care/Palliative Care: Resident(s) who are receiving end of life or palliative care (not including Hospice).

16.Tracheostomy: Resident(s) who have a tracheostomy.

17.Ventilator: Resident(s) who are receiving invasive mechanical ventilation.

18.Transmission-Based Precautions: Resident(s) who are currently onTransmission-basedPrecautions.

19.Intravenous therapy: Resident(s) who are receiving intravenous therapy through a central line, peripherally inserted central catheter, or other intravenous catheter.

20.Infections: Resident(s) who has a communicable disease or infection (e.g., MDRO-M, pneumonia-P, tuberculosis-TB, viral hepatitis-VH, C. difficile-C, wound infection-WI, UTI, sepsis-SEP, scabies-SCA, gastroenteritis-GI such as norovirus, SARS-CoV-2 suspected or confirmed-COVID, and other-O with description).

CMS-802 (11/2020)

CMS-802 (







Resident Room Number


Date of Admission if Admitted within the

Past 30 Days


2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Alzheimer’s / Dementia

MD, ID or RC & No PASARR Level II

Medications: Insulin (I), Anticoagulant (AC), Antibiotic (ABX), Diuretic (D), Opioid (O), Hypnotic (H), Antianxiety (AA), Antipsychotic (AP), Antidepressant (AD), Respiratory (RESP)

Pressure Ulcer(s) (highest stage I, II, III, IV, U, S), Facility Acquired (FA)

Worsened Pressure Ulcer(s) (any stage)

Excessive Weight Loss

Without Prescribed Weight Loss Program

Tube Feeding: Enteral (E) or Parenteral (P)


Physical Restraints

Fall (F), Fall with Injury (FI), or

Fall w/Major Injury (FMI)

Indwelling Catheter

Dialysis: Peritoneal (P), Hemo (H), in facility (F) or offsite (O)


End of Life Care / Comfort Care / Palliative Care



Transmission-Based Precautions

Intravenous therapy

Infections (M, WI, P, TB, VH, C, UTI, SEP, SCA, GI, COVID, O - describe)






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