Sample oasis assessment form 2026

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  1. Click ‘Get Form’ to open the sample oasis assessment form in the editor.
  2. Begin by filling in your personal details at the top of the form, including your Client Name, Birthdate, Family Doctor, and Appointment Date.
  3. In Section 1, check all applicable boxes to indicate your goals for the assessment. This helps the OASIS Team understand your needs better.
  4. Use the provided diagram to shade areas where you feel pain. Specify which joint is most concerning and note when the pain started.
  5. Rate your pain levels on a scale from 0 to 10 for both resting and worst pain experienced in the last six months.
  6. Continue with questions about stiffness and activities that worsen your pain. Provide detailed answers as needed.
  7. List any functional limitations you experience in daily activities and any additional information you want to share with the OASIS Team.
  8. Complete the Pain Management section by detailing past relief methods and current medications or supplements.
  9. Finally, document any other medical conditions, previous surgeries, and allergies before saving your completed form.

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The Outcome and Assessment Information Set (OASIS) is a group of standard data elements developed, tested and refined over the past two decades through an extensive research and demonstration program funded largely by the Centers for Medicare and Medicaid Services (CMS), the Robert Wood Johnson Foundation and the New
Upload the file to CMS (QIES/QTSO) . Once an OASIS is transmitted and received, the file should be marked as exported on the OASIS Export screen. NOTE: This step is critical to the agencys ability to bill.
INTRODUCTION. The Outcome and Assessment Information Set (OASIS) is a comprehensive assessment designed to collect information on nearly 100 items related to a home care recipients demographic information, clinical status, functional status, and service needs (Centers for Medicare and Medicaid Services [CMS], 2009a).
It contains information regarding the patient such as the clinical condition, comorbidities, physical and mental state, functional status, living situation and health care needs. Many agencies use the data to identify areas where they can improve patient care.

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