MDS 3.0 Data Collection Tool?

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    Does anyone have a really really good mds 3.0 data collection tool that they made? I am trying to make a good one in the right order as I am writing this, but realize I suck at making things like this! LOL If anyone wants to share my E-mail is
    Thanks so much =)
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    I make copies of blank MDS relevant items for each discipline such as b-e for social services, k for dietary, etc and hand them out to the individual who will do the assessments after indicating the ARD on the forms. Thsn I have a cheat sheet I use for infor from the computer. I could send it to you, if you give me your email addy.
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    ard:________ 7 back:________ 14 back:________

    lastmds ard/type:__________________________
    bims:________/________ mood:________/________

    (sect.i) active diagnosis list:
    uti past 30 days? y n
    since last assessment? y n date:________________

    medicationsused/taken (in past 7 days)


    sect.j: (in past 7 days) sob w/ exertion
    sob @ rest sob whenlaying flat hospice/terminal fever vomiting

    j01800 falls (since admit or last assessment)
    no injury_________ minorinjury_________
    major injury_________

    sect.k: (in past 7 days)
    weight:_____________ height:____________

    sect.m: (in past 7 days)
    askin report/treatment book for pressure ulcers, skin tears, incont. skin relatedproblems, surgical wounds, etc.

    sect.n (in last 7 days)
    # of days injectionsgiven:_____________
    # of days insulingiven:______________
    # of days phys. changedinsulin orders:___________

    # of days these meds used in past 7 days:
    antipsychotic_____ antianxiety_____ diuretic_____ antidepressant_____ hypnotic_____ anticoagulant_____ antibiotic_____

    sect.o (in last 14 days) while not a resident
    chemo radiation oxygen suction trach vent/respirator bipap/cpap ivmed transfusion dialysis hospice isolation(strict)

    sect.o (in last 14 days) while a resident
    chemo radiation oxygen suction trach vent/respirator bipap/cpap iv med transfusion dialysis hospice isolation(strict)

    flu shot:______________ pneumo:______________

    physicianexam/visits (in the past 14 days)

    phys. orders (in the past 14 days)
    *not clarifications or readmit orders

    sect. p restraints used inthe past 7 days: y n
    used daily or notdaily?

    othernotes, etc. can go on the back side

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