308 lines
10 KiB
Plaintext
308 lines
10 KiB
Plaintext
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English French Notes Complete/Exclude
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or 'B' for BOTH: E//
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Specify measurement system for height, weight, and temperature.
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Is the ENTIRE physical exam NORMAL
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YS-PHY-EXAM-NORM
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Initial Impression:
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Do you need to enter comments
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No Physical Exam on file for
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YS PHY EX PRINT
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No Physical Exams on file
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PREVIOUS PHYSICAL EXAMS
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Enter EXAM NUMBER to edit or
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Enter <CR> to create NEW exam:
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Enter 'E' to EDIT an existing physical for this patient.
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Enter 'P' to PRINT a current physical for this patient.
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Enter 'E' to ENTER a new physical for this patient.
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Enter 'Q' to QUIT the exam process.
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Entering 'Y' or <CR> for 'YES' accepts the given PREVIOUS exam for EDITING
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or PRINTING.
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ENTERING 'N' for 'NO' allows you to ENTER a new exam.
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IMPORTANT NOTE: (1). You may NOT enter MORE than ONE EXAM per PATIENT per DAY.
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(2). Only the DESIGNATED EXAMINER can EDIT a PREVIOUS exam.
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Enter a previous physical exam NUMBER to EDIT an existing exam.
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Or enter <CR> to CREATE a NEW physical exam.
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*** ONLY THE DESIGNATED EXAMINER MAY EDIT A PREVIOUSLY ENTERED EXAM ***
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** A PREVIOUS physical EXAM for this PATIENT was created TODAY **
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** You may NOT create MORE than ONE physical EXAM per PATIENT per DAY **
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** The EXAM SAVED with the remaining portion SET to NORMAL **
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** PROCESSING OF THIS EXAM WAS TERMINATED **
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** << EXAM DELETED FROM FILES >> **
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** << EXAM SAVED >> **
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** The EXAM SAVED with remaining portion set as previously entered **
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SF 506
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Identifying Data <<section 1>>
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PATIENT LISTED AS INELIGIBLE
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ALIAS:
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MARITAL STAT:
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LEGAL ADD:
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PHONE 1:
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PHONE 2:
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PHONE 3:
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PHONE 4:
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EMER CONT:
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RELATION:
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ARLINGTON, TX ZIP
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Next of Kin, Employment, Claim Number Data <<section 2>>
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NEXT OF KIN:
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KIN-2:
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DESIGNEE:
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SERVICE CON:
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YES
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PAYMENT: $
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FATHER:
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MOTHER:
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MOTHERS MAIDEN:
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Disability, Financial Data <<section 3>>
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MONETARY BEN:
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MILT RETIREMENT: $
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VA PENSION: $
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GI INSUR: $
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SS INSUR: $
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OTH RETIRE: $
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OTH PERSONAL INCOME: $
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EXPIR DATE
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ABLE TO DEFRAY EXP:
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DOES NOT APPLY
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PAY FOR TRAVEL:
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ELIGIB CODE:
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PEND VER
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PEND RE-VER
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INTER RESP DT:
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METH OF VER:
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Military Data <<section 4>>
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PREV CARE:
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SERV RECORD: BRANCH
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SERVICE # ENTER DATE SEPAR DATE DISCHARGE TYPE
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NON-VET CLASS:
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AGENCY/ALL COUNTRY:
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COMBAT:
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WHERE:
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WAR:
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ION RADIAT:
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ION REG:
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AO REG:
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AO EXAM:
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AO #:
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DENTAL INJURY IN SERV:
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TEETH EXTRACTED IN SERVICE:
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Inpatient Data <<section 5>>
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Last 5 Admissions:
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Last 5 Applications for care:
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Date in
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Type of Benefit
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Outpatient Data <<section 6 >>
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Diagnosis List <<section 7>>
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Only Active Diagnosis
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Last Physical Exam <<section 8>>
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NO PHYSICALS ON FILE
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Impressions:
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Problem List, Psychological Tests and Interviews <<section 9>>
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HISTORY 1: ** NONE ON FILE **
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PHYSICAL:
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PHYSICAL: ** NONE ON FILE **
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PROBLEM LIST :
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** NOT ON FILE **
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ON FILE
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PROGRESS NOTES: LAST
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PROGRESS NOTES: ** NONE ON FILE **
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NO PSYCHOLOGICAL TESTS OR INTERVIEWS HAVE BEEN COMPLETED
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Psychological Tests/Interviews:
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Short Problem List <<section 10>>
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Enter section number(s) or 'P' to print or 'Q' for quick look
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Enter a numeric string ex. 2,4,7-9
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'P' or 'p' for print 'Q' or 'q' for quick look
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Including all sections...
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- You can't queue to a CRT!
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YS PROFILE PRT
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Problem List
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VAF 10-1415
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Indicator(s)
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Onset
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Recorded
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ADDITIONAL PROBLEM
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REFORMULATED TO:
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EXISTING PROBLEM
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NEW PROBLEM
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OTHER PROBLEM
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DSM DIAGNOSIS
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ICD9 DIAGNOSIS
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There is already a 'Problem List' on this patient!
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Select another option to modify the existing 'Problem List'.
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CRITICAL ITEM SCREEN
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Answer (Y)es, (N)o, or (U)ncertain, i.e. (Y/N or U)
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to exit CRITICAL ITEM SCREEN)
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There is already a 'Suicidal/Self-Injury' problem
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on file. Do you want to edit this problem? N//
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Is patient a Suicidal/Self-Injury Risk? (Y/N/U) N//
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YyNnUu
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Incomplete data base
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Uncertain about suicidal/self-injury risk
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Is patient a violence risk? (Y/N/U) N//
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Uncertain about violence risk
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There is already a 'Psychosis' problem
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Does patient have a psychosis? (Y/N/U) N//
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Uncertain about psychosis
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Do you want a (P)sychosis problem or (D)SM diagnosis?
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(P)sychosis problem
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(D)SM diagnosis
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ANSWER (P or D):
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PpDd
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There is no 'Problem List' on this patient.
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Some 'CRITICAL ITEMS' will be asked to formulate a new 'Problem List'.
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DO YOU WANT THE CRITICAL ITEM SCREEN? N//
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Do you want to see problems already on the list? N//
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No 'Problem List' entries exist for this patient.
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There is already a 'Violence risk' problem
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There is already an 'Alcohol abuse' problem
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Does patient have an alcohol abuse problem? (Y/N/U) N//
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Uncertain about alcohol abuse
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Do you want an (A)lcohol misuse problem or a (D)SM diagnosis?
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ANSWER (A or D):
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There is already a 'Substance (non-alcohol) abuse' problem
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Does patient abuse drugs/other non-alcohol substances? (Y/N/U) N//
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Uncertain about drug/non-alcohol substance abuse
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Do you want (S)ubstance (non-alcohol) problem
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or (D)SM diagnosis?
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ANSWER (S or D):
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SsDd
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There is already a 'General physical' problem
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Does patient have significant physical problems? (Y/N/U) N//
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Uncertain about general physical problem
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Do you want a (P)hysical problem or an ICD-9 (D)iagnosis?
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Uncertain indicates insufficient information to make a decision
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With indicator '
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on the problem list? Y//
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Problem '
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' is already on the problem list.
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Indicator '
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has been added to
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is already on
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the problem list.
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is already on the problem list
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Do you want to see the INDICATORS associated with this problem? N//
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INDICATORS for
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PROBLEM LIST FOR
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permanently changed!
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Are you sure you want to edit
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will display potential problem areas.
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will display a list of problems presently recorded.
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will permit change of presently recorded data.
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will allow further refinement of this problem area.
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will by pass this problem area.
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indicates insufficient information to make a decision.
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accesses the coding struture of the DSM.
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The alternate entry accesses the
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as defined by this system.
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access the coding structure of the ICD-9.
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Select EXISTING PROBLEM:
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Select NEW PROBLEM:
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This problem is not currently on the problem list.
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Additional information about the problem must be entered!
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This problem is already on the problem list
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Do you want to edit it? N//
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'Other' is not currently on the problem list
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Select DSM DIAGNOSIS:
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Select ICD9 DIAGNOSIS:
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Problem reformulated to:
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Type 'Y' or 'N'.
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INACTIVE!
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REACTIVATED!
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RESOLVED!
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REFORMULATED!
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CHANGED!
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has been REFORMULATED!
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It is not necessary to INACTIVATE a REFORMULATED problem!
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has been RESOLVED!
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It is not necessary to INACTIVATE a RESOLVED problem!
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REACTIVATE
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RESOLVE
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CHANGE
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is already active!
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REFORMULATE
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is INACTIVE!
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YS PROB LIST PRINT
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Short Problem List
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NO PROBLEMS ON FILE
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PROBLEM(S):
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(A)ctive, (H)istorical, (C)omplete, (S)hort or (Q)uit? A//
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Do you wish problem indicators? N//
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YS PROB REPT
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CRITICAL PROBLEM
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not specified ***
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(last editing list)
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TAB,BLA,TOP,MAR,FIL, , ,NEW,PAR
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VT,TAB,BL,TOP,MAR,FILL,PAGE,SPACE,OUT,PAR,,PGN
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YSPX=
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YSPLM=YSPLM
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YSPGI)
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* Patient Messages/Crisis Notes may be moved to
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Progress Notes through the MHS Manager Option.
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NUMBER (Type '+' only to list more than one):
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Are you adding a NEW
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for this patient? Y//
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SF 509
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Please enter appropriate response indicating action to be taken.
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will permit editing of text entered this date.
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will permit entry of new text.
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Enter corresponding number of text to be accessed.
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will permit entry of new text.
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returns to edit question.
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YS TEXT PRINT
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ALL? Y//
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Begin
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Through
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YS TEXT PRINT 2
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SECLUSION/RESTRAINT INFORMATION
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No patients listed in Seclusion/Restraint.
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Patient shown in Seclusion/Restraint at this time.
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Was patient searched
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If patient was not searched, a reason should be given for the omission.
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INSUFFICIENT INFORMATION
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Do you need to edit the above information
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After the information is filed, you may no longer edit it.
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You may alter the information now.
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Save this information
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NO, will delete this information from the record.
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YES, will file it under the patient's name.
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INFORMATION NOTED.
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< ENTRY FOR
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Patient Name Required.
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No patients currently listed in seclusion/restraint.
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The following patient(s) are currently listed as being in Seclusion/Restraint:
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* Written order required.
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DATE & TIME
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RELEASE FROM SECLUSION/RESTRAINT
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No patients listed as requiring release.
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Patient not listed as in Seclusion/Restraint.
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shown as released
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< RELEASE DELETED >
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PATIENT NOTED AS RELEASED.
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REVIEW OF SECLUSION/RESTRAINT ASSESSMENT
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No review action required.
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The following S/R actions have not been reviewed:
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Select action for review:
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Not valid - re-enter.
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< REVIEW ACTION DELETED >
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REVIEW ACTION NOTED.
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No other review action required.
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< OBSERVATION DELETED >
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OBSERVATION NOTED.
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EDIT OF TYPE OF SECLUSION/RESTRAINT ORDER
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SECLUSION/RESTRAINT EPISODES REQUIRING WRITTEN ORDERS:
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* Written Order Required.
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No patients listed as requiring a written order.
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Written order not required for this patient.
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Select PATIENT NAME:
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Patient not shown on file.
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Is this the entry you wish to delete
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YES will remove the entry from the file. It will not be recoverable.
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NO will exit you from this option. Entry will remain on file.
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MONTHLY REPORT OF RESTRAINT AND SECLUSION (VA Form 10-2683)
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THIS REPORT MUST BE SENT TO A PRINTER WHICH ACCEPTS A 132-CHARACTER LINE.
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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