308 lines
14 KiB
Plaintext
308 lines
14 KiB
Plaintext
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English French Notes Complete/Exclude
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entries contain no assessment information.
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The computer will then automatically merge those assessments for which the
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patient has only one surgical case and one surgery risk assessment for the
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date entered in the SURGERY RISK ASSESSMENT file (139).
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If the patient has
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more than one surgical case on that date, or if there is not any surgical case
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entered for the corresponding date in the SURGERY RISK ASSESSMENT file, that
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assessment will need to be manually matched.
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Risk Assessment Pre-Conversion:
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Deleting all entries from the SURGERY RISK ASSESSMENT file (139) which do not
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contain assessment information or have an operation date prior to the
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selected start date.
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NO ASSESS
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Entries in the SURGERY RISK ASSESSMENT file (139) which were deleted
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because they contained no assessment information, or had an operation date
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prior to the selected start date.
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DATE OF OPERATION:
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RISK ASSESSMENT ENTRIES NOT CONVERTED, NO ASSESSMENT INFORMATION
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RISK ASSESSMENT CONVERSION
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SROA CONVERT
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The following entries in the SURGERY RISK ASSESSMENT file (139) cannot be
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converted because the patient has no surgical cases entered in the SURGERY
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Deleting all Assessments in which the patient entered has no Surgery cases
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on file
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Automatically matching Risk Assessment entries with Surgery Cases
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The following assessments were matched with entries in the SURGERY file (130)
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based on the patient identifier and date of operation.
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Do you want to continue with the manual matching process now ? YES//
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SURGERY CASE NUMBER:
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SURGERY RISK ASSESSMENT ENTRIES AUTOMATICALLY CONVERTED
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Enter 'YES' if you want to continue converting assessments manually, or 'NO'
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ASSESSMENT NUMBER:
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There were no Surgery cases for
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within the 60 days before
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or after the date of operation entered in this assessment.
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Select the NUMBER corresponding to the
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Surgery Case that this Assessment matches:
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Enter the number that corresponds to the Surgery case that this assessment
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matches. If the assessment does not relate to any of the cases listed above,
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enter RETURN at the prompt.
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Are you sure that this is the correct Surgery Case ? YES//
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Enter 'YES' to convert the assessemnt into the Surgery file, or 'NO' to make
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another selection.
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Converting Risk Assessment Information...
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Do you want to match the Risk Assessment with this Surgical Case ? NO//
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Enter 'YES' to move the Risk Assessment information into this surgical case,
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or 'NO' if the information does not relate to this surgical case.
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Since this assessment cannot be matched to any Surgery case, it must be
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Enter 'YES' to delete this assessment from the SURGERY RISK ASSESSMENT
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file (139), or 'NO' to continue matching other assessments.
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Deleting assessment from SURGERY RISK ASSESSMENT file (139)...
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Queuing task to delete all SRA options from your system.
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Delete all SRA options from OPTION file (19)
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SROA RISK ASSESSMENT
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This option will self destruct now...
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1. ATTENDING IN O.R.
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2. ATTENDING IN O.R. SUITE
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3. ATTEND NOT PRESENT, BUT AVAILABLE
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ATTENDING CODE NOT ENTERED
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POSTOPERATIVE DIAGNOSIS NOT ENTERED
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There are more cases for the date range selected. If you want to continue
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listing them, enter RETURN. Enter '^' to exit from this option.
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ATTENDING SURGEON REPORT
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1ST ASST
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ATTENDING CODE
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2ND ASST
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TOTAL CASES
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TOTAL CASES FROM
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3. ATTENDING NOT PRESENT, BUT AVAILABLE
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* ATTENDING CODE NOT ENTERED
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ATTENDING SURGEON CUMULATIVE REPORT
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Enter RETURN to continue printing the report, or '^' to exit from this option.
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ATTENDING SURGEON:
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ZZ
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There are more cases for the date range listed. If you want to continue
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Enter RETURN if you want to display the totals for each specialty, or '^' to
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exit from this report.
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TOTAL CASES FOR THIS SPECIALTY
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CARDIAC ASSESSMENT TRANSMISSION COMPLETE
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RISK ASSESSMENT SCNR
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The Cardiac Surgery Risk Assessment Transmission was completed at
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assessment was sent.
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assessments were sent.
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OPERATION DATE:
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NO ICD9
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RISK ASSESSMENT TRANSMISSION COMPLETE
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The Surgery Risk Assessment Transmission was completed at
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assessment was
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assessments were
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G.RISK ASSESSMENT@ISC-CHICAGO.VA.GOV
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Attending Surgeon Report
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Do you want to print the report for all Attending Surgeons ? YES//
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a specific person.
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Attending Surgeon Reports
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1. Attending Surgeon Report
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2. Attending Surgeon Cumulative Report
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3. Attending Surgeon Report and Attending Surgeon Cumulative Report
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Select the number corresponding with the desired report(s):
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Start report for each attending surgeon on a new page ?
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Do you want the report for all Surgical Specialties ? YES//
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Enter 'YES' to print this report for all Surgical Specialties, or 'NO' to
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The Attending Surgeon Report was designed to use a 132 column format.
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The Attending Surgeon Cumulative Report was designed to use an 80 column format.
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Print the report on which Device ?
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Enter '1' if you want to print the Attending Surgeon Report only. If you only want to print the Attending Surgeon Cumulative Report, enter '2'. Enter '3' to
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print both reports.
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Print the Report for which Attending Surgeon ?
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Do you want to view the totals for attending codes only ? NO//
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Enter RETURN to dispay individual case information and the total number of
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cases for each code. If you only want to display the totals for the attending
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This report is designed to use an 80 column format.
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ZZ ATTENDING NOT ENTERED
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Enter RETURN to continue with this report, or '^' to quit this option.
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ZZ SPECIALTY NOT ENTERED
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This patient had a previous non-cardiac operation on
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Do you want to duplicate the preoperative information from the earlier
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assessment in this assessment?
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Anesthesia Technique
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Other Procedure CPT Code
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POSTOP OCCURRENCE DATE
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Date Noted on
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(Postop Occurrence)
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NO ICD9 CODE ENTERED
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Death Unrelated/Related
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Enter risk assessment preop information for this patient (Y/N)
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Will this procedure require cardiopulmonary bypass (Y/N) ?
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Enter Cardiac Preoperative information
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1. Clinical Information
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2. Cardiac Catheterization & Angiographic Data
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3. Operative Risk Summary Data
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Enter the number of the selection to be edited.
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PREOPERATIVE LABORATORY TEST INFORMATION
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The SURGERY SITE PARAMETERS file indicates this site/division does not use
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the Cardiac Risk Assessment module. Therefore, this option is not available
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for use.
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Enter category of emergency.
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1. Emergent (ongoing ischemia)
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2. Emergent (hemodynamic compromise)
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3. Emergent (arrest with CPR)
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Enter number (1, 2 or 3):
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Is this emergency case a cardiac procedure requiring cardiopulmonary
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This is the category of emergency reflecting the patient's cardiovascular
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condition at the time of transport to the operating room:
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1. Emergent (ongoing ischemia) - Clinical condition mandates immediate
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surgery usually on day of catheterization because of ischemia despite
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medical therapy, such as intravenous nitroglycerine. Ischemia should
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be manifested as chest pain and/or ST-segment depression.
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2. Emergent (hemodynamic compromise) - Persistent hypotension (arterial
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systolic pressure < 80 mm Hg) and/or low cardiac output (cardiac index
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< 2.0 L/min/MxM) despite iontropic and/or mechanical circulatory
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support mandates immediates surgery within hours of the cardiac
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3. Emergent (arrest with CPR) - Patient is taken to the operating room in
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full cardiac arrest with the circulation supported by cardiopulmonary
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resuscitation (excludes patients being adequately perfused by a
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cardiopulmonary support system).
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Enter the appropriate number to designate the category of emergency.
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workload totals which include the following categories:
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4. Not logged major cases
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The second part of this report provides the total number of incomplete
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assessments remaining for the month selected and the prior 12 months.
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REPORT OF MONTHLY SURGICAL CASE WORKLOAD
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TOTAL CASES PERFORMED
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TOTAL MAJOR CASES
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TOTAL MINOR CASES
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CASES MEETING EXCLUSION CRITERIA
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ANESTHESIA TYPE
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EXCEEDS MAX. ASSESSMENTS
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EXCEEDS MAXIMUM TURPS
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STUDY CRITERIA
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SCNR WAS ON A/L
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CONCURRENT CASE
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EXCEEDS MAXIMUM HERNIAS
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ASSESSED CASES
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NOT LOGGED MAJOR CASES
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CARDIAC CASES
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NON-CARDIAC CASES
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ASSESSED CASES PER DAY
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NUMBER OF INCOMPLETE ASSESSMENTS REMAINING FOR PAST YEAR
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SURGERY WORKLOAD
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.13///SAFETY STRAP
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Request Blood Availability (Y/N)
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Type and Crossmatch, Screen, or Autologous
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TYPE & CROSSMATCH
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REQUESTED BLOOD COMPONENTS:
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UNITS NOT ENTERED
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Report of Cancellations
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NOTE: This report contains all cancelled cases, including those that were
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cancelled after the patient had entered the operating room. Aborted
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cases are identified by an '*' next to the procedure name.
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Do you want to print the report for all Surgical Specialties ? YES//
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REPORT OF CANCELLATIONS
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Select An Additional Specialty:
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NO SPECIALTY ENTERED
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>> SURGICAL SPECIALTY:
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CANCEL DATE
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Update Cancelled Case
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No cancelled cases exist on this patient.
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Enter the number of the desired operation.
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Update Perioperative Occurrences for Individual Patient
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Attending
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Surgeon
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No Date of Operation found !
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There are no perioperative occurrences recorded for the selected date range.
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SURGICAL SPECIALTY NOT ENTERED
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These reports are
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This report is
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designed to use a 132 column format.
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PERIOPERATIVE OCCURRENCES
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OCCURRENCE(S) - (DATE)
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OUTCOMES: U - UNRESOLVED, I - IMPROVED, W - WORSE, D - DEATH
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'*' Represents Postoperative Occurrences
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You do not have the access necessary to delete a case from the file.
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By deleting this case, all information stored for this occurrence will be
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removed from the computer.
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Enter 'YES' to delete this occurrence, or RETURN if you have made a mistake.
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Occurrence ...
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2. Occurrence Category:
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3. ICD Diagnosis Code:
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4. Treatment Instituted:
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5. Outcome to Date:
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6. Date Noted:
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*** INFORMATION ENTERED ***
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. Occurrence Comments:
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Select Occurrence Information:
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Enter the number, or range of numbers you want to edit. Examples of proper
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1. Enter 'A' to update all occurrence information.
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to update a specific occurrence element. (For
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example, enter '2' to update the occurrence category)
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3. Enter a range of numbers
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separated by a ':' to enter a range of
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elements. (For example, enter '1:3' to enter occurrence, occurrence
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category, and ICD diagnosis code)
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The occurrence selected does not have a corresponding category. A category
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must be selected at this time, or the occurrence will be deleted.
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Select Occurrence Category:
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Enter 'YES' to delete this occurrence from the patient's record. Enter 'NO'
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to backup and enter a category for this occurrence.
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NOTE: You are about to enter an occurrence for a patient that has not had an
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operation during this admission. If this patient has a surgical procedure
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during the current admission, use the option to enter or edit intraoperative
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and postoperative occurrences.
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ENTER A NEW NON-OPERATIVE OCCURRENCE
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Enter the number of the desired occurrence, or '
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' to enter a new occurrence.
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Enter or Delete Data ? E//
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OCCURRENCE IN WHICH THERE WAS NO SURGICAL PROCEDURE
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DURING THE CURRENT ADMISSION
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Enter RETURN to select an option used to enter or edit information for this
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case. If you would like a two screen overview of this operation, enter
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'Review'. To delete this surgical case from your records, Enter 'Delete'.
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Please note that choosing to delete a case will remove EVERYTHING pertaining
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will be removed from the computer.
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Select the Date of Occurrence:
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When entering a new non-operative occurrence, a date MUST be entered.
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Enter/Edit
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Intraoperative
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Postoperative
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Select a number (
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), or type 'NEW' to enter another occurrence:
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Select the number corresponding to the occurrence you want to update, or
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enter 'NEW' to add another occurrence.
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Occurrences entered for this case.
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Enter a New
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Since you have selected one of the 'OTHER' occurrence categories, an ICD
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Diagnosis Code should be entered for this occurrence.
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Select ICD Diagnosis Code
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Circulating Nurse Staffing Report
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Do you want the report for all nurses ? YES//
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Enter RETURN to print the Circulating Nurse Staffing Report for all
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nurses, or 'NO' to select a specific person.
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Select Circulating Nurse:
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CIRCULATING NURSE STAFFING REPORT
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NURSE*
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SCRUB NURSE
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CIRC. NURSE
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TIME IN
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TIME OUT
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ELAPSED (MINS)
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Enter the name of the drug you wish to flag
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This drug is already flagged for SURGERY.
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Do you want to remove the flag (Y/N)
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Do you want to flag this drug for SURGERY (Y/N)
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ANESTHESIA AGENT^50^.01
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Enter the number which corresponds to the case that you want to enter comments.
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You have entered an invalid number, please select again.
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Date of Operation:
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Attending Surgeon:
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Attending Code:
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Principal
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Postop
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Preop
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Intraoperative Occurrences:
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Postoperative Occurrences:
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Related Returns to Surgery:
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Press RETURN to list more information, or '^' to leave this option.
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Outcome:
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Do you want to store this information in the concurrent case ? YES//
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There is a concurrent surgical case associated with this procedure. A brief
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description of that case is listed below.
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If you answer 'YES', the information you entered for this field will also
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be stored for the concurrent case. If this information is not pertinent for
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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