Page 280 - QAP Manual 2020
P. 280

Background Information

                                         Q#      Q                      Indicator/Intent       Other Notes                        Field Appropriate (Y/N)
                                         BI-12   What other conditions   Record the person’s co-  Information should come from records   N
                                                 are noted in this person’s   occurring diagnoses other   and have been diagnosed by a clinician.
                                                 record?                than ID                For each diagnosis, please check off a
                                                                                               ‘yes’, ‘no’, or ‘don’t know’ response.

                                         BI-13   What health conditions   Record additional    Information should come from records   N
                                                 are noted in this person’s   conditions other than ID   and have been diagnosed by a clinician.
                                                 record?                                       For each diagnosis, please check off a
                                                                                               ‘yes’, ‘no’, or ‘don’t know’ response.


                                         BI-14   What is this person’s   Primary language      If person is bilingual, please select the   Y
                                                 primary language? (What                       language the person is most comfortable
                                                 language does s/he best                       with or uses more often.
                                                 understand?)

                                         BI-15   What is this person’s   Person’s primary      Only one means of communication can   Y
                                                 preferred means of     communication style    be coded; if the person uses more than
                                                 communication?                                one type of communication style, please
                                                                                               code the most frequently used method or
                                                                                               the method the person feels most
                                                                                               comfortable using.

                                         BI-16   How would you describe   Level of support needed                                 Y
                                                 this person’s mobility?   to move self around their
                                                                        environment






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