Symptom or Sign



Abdominal Pain1

Abrupt onset severe pain or distention, OR

with fever, vomiting

Mild diffuse or localized pain, unrelieved by antacids or laxatives

Abdominal Distention1

Rapid onset, OR presence of marked tenderness, fever, vomiting, GI bleeding

Progressive or persistent distension not associated with symptoms

Abdominal Tenderness1

(e.g., bloating, cramps, etc. …)

Associated with fever, continuous GI bleeding, or other acute symptoms

Persistent discomfort not associated with other acute symptoms


Accompanied by significant pain or bleeding

If bleeding continues or if associated with evidence of local infection


Abrupt onset of significant change from usual, OR associated with fever or new onset abnormal neurological signs

Continued progression or persistence of symptoms

Altered Mental Status

Abrupt significant change in cognitive function from usual with or without altered level of consciousness

Persistent change from usual cognitive function

with no other criteria met for immediate notification

Appetite, Diminished

No oral intake 2 consecutive meals

Significant decline in food and fluid intake in resident with marginal hydration and nutritional status


Acute episode with wheezing, dyspnea, or respiratory distress

Self-limited episode that was more extensive or less responsive to treatment than the usual