Minimum Data Set MDS Mortality Risk Index Revised (MMRI-R)

Are you evaluating a patient in a nursig home?

Yes

Birthday (enter MM/DD/YY)

Date of assessment (enter MM/DD/YY)

Gender

Male

Female

Was the patient admitted to the nursing home in the past 3 months?

Yes

Has the patient unintentionally lost weight in the past 3 months?

Yes

Does the patient have renal failure?

Yes

Does the patient have chronic heart failure?

Yes

Does the patient have a poor appetite?

Yes

Is the patient dehydrated?

Yes

Is the patient short of breath?

Yes

Does the patient have cancer?

Yes

Has the patient shown a deterioration in cognition during the past 3 months?

Yes

Select the appropriate answer for each activity of daily living

Mobility

Eating

Toilet use

Personal hygiene

Data complete?

Evaluation appropriate?

Subscore for age and cancer

Subscore for activities of daily living and cognitive status

Total score

Predicted mortality rate

Caution: A qualified health practitioner should verify all results.
Keep patient data confidential and comply with all legal requirements.

Evaluation

Results

Please fill out required fields.

Interpretation and Description

References

Next Steps in Evaluation

Diagnosis

Therapy

Monitoring

Patient Concerns

Specialty

Objective

ICD-10

Minimum Data Set (MDS) Mortality Risk Index Revised (MMRI-R)

Purpose: To evaluate a patient in a nursing home using the revised minimum data set (MDS) mortality risk index (MMRI-R).