Specifications Manual for Joint Commission National Quality Measures (v2019A1)
Home » Date Last Known Well

Release Notes:
Data Element
Version 2019A1

Name:Date Last Known Well
Collected For: ASR-IP-1, ASR-OP-1, STK-4
Definition:The date prior to hospital arrival at which the patient was last known to be without the signs and symptoms of the current stroke or at his or her baseline state of health.
Question:What was the date associated with the time at which the patient was last known to be well or at his or her baseline state of health?
Length:10 - MM-DD-YYYY (includes dashes) or UTD
Allowable Values:

MM = Month (01-12)
DD = Day (01-31)
YYYY = Year (20xx)
UTD = Unable to Determine
Notes for Abstraction:
  • Enter the date associated with the Time Last Known Well.
    If the date last known well is unable to be determined from medical record documentation, enter “UTD.”
  • The medical record must be abstracted as documented (taken at “face value”). When the date documented is obviously in error (not a valid date/format) and no other documentation is found that provides this information, the abstractor should select “UTD.”
    Documentation indicates the Date Last Known Well was 03- 42 -20xx. No other documentation in the medical record provides a valid date. Since the Date Last Known Well is outside of the range listed in the Allowable Values for “Day,” it is not a valid date and the abstractor should select “UTD.”
Note: Transmission of a case with an invalid date as described above will be rejected from the CMS Clinical Warehouse and the Joint Commission’s Data Warehouse. Use of “UTD” for Date Last Known Well allows the case to be accepted into the warehouse.
  • If the date last known well is documented as a specific date and entered as Date Last Known Well on a “Code Stroke” form or stroke-specific electronic template, enter that date as the date last known well. Documentation of Date Last Known Well on a stroke-specific form or template should be selected regardless of other dates last known well documented elsewhere in the medical record.
  • References in relation to Arrival Date are acceptable (e.g., today, tonight, this evening, and this morning). The Date Last Known Well and the Arrival Date may be the same date or a different date.
    • “Wife reports patient normal this evening until approximately 9 PM.” Hospital arrival is 0030 on 12-10-20xx.” Date Last Known Well is 12-09-20xx.
    • “Patient states he felt perfectly fine earlier today. At noon, he began to have trouble seeing.” Hospital arrival is 3:59 PM on 12-10-20xx.” Date Last Known Well is 12-10-20xx.
  • If a reference to date last known well is documented without a specific date, enter that date for the Date Last Known Well. If multiple dates are documented, select the earliest date.
    • “Patient last known well today (day of arrival).” Select Arrival Date for Date Last Known Well.
    • “Patient normal yesterday (day before arrival) documented in H&P and consult note documents that patient was last known to be well on Monday (two days prior to arrival).” Select Monday’s date for Date Last Known Well.
Suggested Data Sources:
  • Emergency department record
  • History and physical
  • Nursing flow sheet
  • Progress notes
  • Medication administration record (MAR)
  • Transfer sheet
  • Ambulance record
  • Code Stroke form/template
  • IV flow sheets

Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion

Signs and Symptoms of Stroke
  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache

Code Stroke Form
  • Stroke Activation Form
  • Stroke Alert Form
  • Stroke Assessment Form
  • Stroke Intervention Form
  • Stroke Rapid Response Form
  • Thrombolysis Checklist
  • tPA Eligibility Form

Code Stroke Form
  • Stroke Education Form
  • Core Measure Form

Date Last Known Well
CPT® only copyright 2019 American Medical Association. All rights reserved.
Specifications Manual for Joint Commission National Quality Measures (v2019A1)
Discharges 10-01-19 through 12-31-19 (4Q19)


CPT® only copyright 2019 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.

You, your employees and agents are authorized to use CPT® only as contained in The Joint Commission performance measures solely for your own personal use in directly participating in healthcare programs administered by The Joint Commission. You acknowledge that the American Medical Association (“AMA”) holds all copyright, trademark and other rights in CPT®.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT® for resale and/or license, transferring copies of CPT® to any party not bound by this Agreement, creating any modified or derivative work of CPT®, or making any commercial use of CPT®. License to use CPT® for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, AMA Plaza, 330 North Wabash Avenue, Suite 39300, Chicago, Illinois 60611-5885. Applications are available at the American Medical Association Web site, www.ama- assn.org/go/cpt.

U.S. Government Rights This product includes CPT® which is commercial technical data, which was developed exclusively at private expense by the American Medical Association, 330 North Wabash Avenue, Chicago, Illinois 60611. The American Medical Association does not agree to license CPT® to the Federal Government based on the license in FAR 52.227-14 (Data Rights - General) and DFARS 252.227-7015 (Technical Data - Commercial Items) or any other license provision. The American Medical Association reserves all rights to approve any license with any Federal agency.

Disclaimer of Warranties and Liabilities. CPT® is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the (AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with The Joint Commission, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled “accept”.