308 lines
13 KiB
Plaintext
308 lines
13 KiB
Plaintext
English French Notes Complete/Exclude
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| (specify type):
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| * HIV-1/HIV-2 combination EIA . |
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| * If HIV laboratory tests were not documented, Yes No Unk.|
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| * HIV-1 Western blot/IFA ...... |
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| is HIV diagnosis documented by a physician? |
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| * Other HIV antibody test ..... |
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| * If yes, provide date of documentation by physician
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| 3. IMMUNOLOGIC LAB TESTS: |
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| * HIV-2 Western blot .......... |
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| At or closest to current diagnostic status Mo. Yr. |
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| 2. POSITIVE HIV DETECTION TEST: (Record earliest test) | * CD4 Count ...........
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| * HIV culture .....................................
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%
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| * HIV antigen test ................................
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| First <200 uL or <14% |
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| * HIV PCR, DNA or RNA probe .......................
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================================================= VIII. CLINICAL STATUS ======================================================
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| CLINICAL YES NO | ENTER DATE PATIENT Asymptomatic Mo. Yr. Symptomatic Mo. Yr. |
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| RECORD REVIEWED |
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| | WAS DIAGNOSED AS: (including acute retroviral syndrome and |
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| | persistant generalized lymphadenopathy):
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(not AIDS):
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| Initial Initial | Initial Initial |
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| Diagnosis Date | Diagnosis Date |
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| AIDS INDICATOR DISEASES Def. Pres. Mo. Yr. | AIDS INDICATOR DISEASES Def. Pres. Mo. Yr. |
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|Candidiasis, bronchi, trachea, or lungs |
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Lymphoma, Burkitt's (or equivalent term) |
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Lymphoma, Immunoblastic (or equivalent |
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|Carcinoma, invasive cervical |
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|Coccidioidomycosis, disseminated or |Lymphoma, primary in brain |
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Mycobacterium avium complex or |
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M. kansasii, disseminated or |
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|Cryptosporidiosis, chronic intestinal | extrapulmonary |
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| (> 1 month duration) |
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|Cytomegalovirus disease (other than in |M. tuberculosis, disseminated |
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| liver, spleen or nodes) |
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or extrapulmonary * |
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|Cytomegalovirus retinitis (with loss of |Mycobacterium, of other species or |
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unidentified species, disseminated |
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|HIV encephalopathy |
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| or extrapulmonary |
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|Herpes simplex: chronic ulcer(s) (>1 mo. |Pneumocystis carinii pneumonia |
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| duration); or bronchitis, pneumonitis, |Penumonia, recurrent in 12 mo. period |
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| or esophagitis |
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Progressive multifocal |
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|Histoplasmosis, disseminated or | leukoencephalopathy |
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Salmonella septicemia, recurrent |
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|Isosporiasis, chronic intestinal (>1 mo. |Toxoplasmosis of brain |
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|Wasting Syndrome due to HIV |
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| Def.=definitive diagnosis Pres.=presumptive diagnosis | * RVCT CASE NO.: _______________ |
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| * If HIV tests were not positive or were not done, does this patient have |
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| an immunodeficiency that would disqualify him/her from the AIDS case definition |
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| Has this patient been informed of his/her HIV infection? |
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| Unk. | This patient is receiving or |
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| This patient's partners will be notified about their HIV exposure and counseled by: | * HIV related medical services |
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| Health department |
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| Unknown | * Substance abuse treatment services |
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| This patient received or is receiving: | This patient has been enrolled at: | This patient's medical treatment is |
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| * Anti-retroviral Yes No Unk. | Clinical Trial Clinic | PRIMARILY reimbursed by: |
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| Private ins/HMO |
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| No coverage |
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| Other public funds |
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| Yes No Unk. | |
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| * PCP prophylaxis |
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| Unknown | trial/government program |
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| FOR WOMEN: *This patient is receiving or has been referred for gynecological or obstetrical services: . |
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| *Is this patient currently pregnant? ....................................................... |
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| *Has this patient delivered live born infants? ... |
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|Yes (If delivered after 1977, provide birth |
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information below for the most recent birth) |
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| CHILD'S DATE OF BIRTH: | Hospital of Birth:
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| Child's Soundex: | Child's State Patient No. |
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| Mo. Day Yr. | | | | | | | __________ | | | | | | | | | | | | |
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Definitive
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Presumptive
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** NO DATE **
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Diseases Currently Selected:
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Start Date for Period:
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End Date for Period:
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END CAN NOT BE BEFORE START
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MORE THAN 180 DAYS OF DATA IS TOO MUCH TO TRANSMIT.
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TRY A SHORTER DATE RANGE.
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IMMUNOLOGY DATA.
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*NEW PATIENT*
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Monthly, Quarterly, Semi-Annually, Yearly, Fiscal Yearly, User Selectable
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Select date range type:
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Enter the first few letters of one of the choices listed below.
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Please enter a month and year
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MONTH OF
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Enter Quarter Period and FY you wish Semi-Annual range to end with
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Enter Quarter and Year:
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Enter Quarter Period in this format: 2nd quarter 1988 would be 2-88, 2/88, 2 88
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Enter Quarter 1 to 4 only
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QUARTER FY
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SEMI-ANNUAL PERIOD ENDING
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FISCAL
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Enter a 2 or 4 digit
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FISCAL YEAR
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YEAR
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Enter beginning and ending dates for the desired time period:
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Ending Date:
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PERIOD FROM
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Range selected:
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***** Patient has a DATE OF DEATH, setting it to 2 ****
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**** Patient has an ICR DATE OF DEATH ENTERED, setting status to DEAD ****
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Do you want to enter an ICR DATE OF DEATH (Y/N) ?
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***** PATIENT FILE has NO date of death entered,
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AND IMR DATE OF DEATH FIELD HAS NO DATE *****
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***** You must choose 1 or 9 *****
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Enter Coded SSN
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I will now search the database to decode the SSN... please wait
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The coded number you entered is either not listed in your local ICR
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or was typed incorrectly. Please check that you entered the coded SSN
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correctly. *** NO TRANSLATION FOUND FOR THIS PATIENT ***
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Coded SSN:
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Patient's id in the Immunology Case Study file:
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Coded Date of Birth:
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Patient's number in the Patient file:
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BE ABSOLUTELY SURE BEFORE USING THIS OPTION -- IT WILL DELETE ALL DATA
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FOR THE SPECIFIED INDIVIDUAL FROM THE IMMUNOLOGY CASE FILE
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ARE YOU ABSOLUTELY SURE? N//
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IMRTEXT(
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IMMUNOLOGY DATA
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Do you want to Enter/Edit CDC form data now
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This patient must be entered into the Immunology Case Study file using
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The Enter/Edit option first.
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Is this patient REALLY supposed to be in your database (Y/N)?
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Are you sure,
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should be
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in your database (Y/N)?
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Sending the past 365 days of data to the HIV National Database..
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Select *SECURE* ALLOWABLE PRINTERS (Field 7) from ICR Site Parameters File:
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Select one of the valid devices
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IMR*2.0*23
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Please install IMR*2*23 first. ICR v2.1 Installation halted.
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File Access
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YOU HAVE INSUFFICIENT SECURITY TO ACCESS THIS OPTION
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SEE YOUR IMMUNOLOGY COORDINATOR FOR THE PROPER KEYS
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IMR ACCESS VIOLATION NOTICE
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IMR ACCESS VIOLATION BY
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IMR - IMMUNOLOGY UNATHORIZED ACCESS ATTEMPT
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An attempt was made to invoke IMR functionality by a person who does
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not have the neccessary Security Keys. Details of this attempt
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are as follows:
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Violator's Name:
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Time:
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VIOLATION:
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ACCESS WAS ATTEMPTED BUT NOT GAINED
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Removing Unused Data Dictionary Fields...
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Deleting Unused Routines...
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Deleting Unused Data...
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Removing Unused Options...
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IMRO REPORTS MENU
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IMRO BY DX
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IMRO BY NAME
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IMRO DELETE
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IMRO ENTER
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IMRO MASTER
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IMRO NO DX
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IMRO TRANSMIT
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Populating Data Fields in File 158...
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44)=DATE OF HIV+ (CAT 2) STATUS
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Populating new NLF ENTRY field in File 158.9...
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Removing unused File 158.96 dictionary and data...
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Queuing the IMR REGISTRY DATA option to run immediately...
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Rescheduling the IMR REGISTRY DATA option...
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IMR REGISTRY DATA
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IMMUNOLOGY.VA.GOV
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Deleting unused input templates...
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IMR LPOINTER
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IMR PPOINTER
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Adding VIRAL LOAD entry to File 158.95...
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VIRAL LOAD
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ICR-RX ARCHIVE DATE SEARCH
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Holders of KEYS for 'IMR' Package as of:
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KEY HOLDERS:
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UNKNOWN USER #
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Deleting the field definitions...
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The definitions have been deleted.
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Unknown error (
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CD4 or T4 (ACTUAL LEVEL)
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CD4 or T4 (PERCENTAGE)
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** SORRY NO LABORATORY REFERENCE IN PLACE **
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SORRY, HIV COORDINATOR HAS NOT SET UP LAB LINKS
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Local ICR Demographics by Category
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Do you want to check for entries in the ICR file without CATEGORY data
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Do you want a list of patients with MISSING data elements
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Local ICR Demographics By Category
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Patients Seen During
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LIVING
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ALIVE & DECEASED
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DECEASED
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PATIENTS IN THE FILE
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HIV+
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HIV+TC
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AIDS-3
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Checking for entries in the ICR file without CATEGORY data.
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None found.
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in the IMMUNOLOGY CASE REGISTRY file with
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NO CATEGORY indicated --
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DO YOU WANT TO SEE THE LIST
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Missing Categories
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ALIVE (or unknown)
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GAY OR BISEXUAL MAN
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IV DRUG USER
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GAY OR BISEXUAL DRUG USER
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RECV'D TRANSFUSION/TRANSPLANT
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WORK-HEALTH/CLINICAL
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ADULT, CONFIRMED OTHER RISK
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UNSPECIFIED ELIGIBILITY
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UNSPECIFIED POS
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SEEN AS OUTPATIENT
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SEEN AS INPATIENT
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SEEN IN LABORATORY
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PRESCRIPTION(S) FILLED
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Print Data by CATEGORY as well as totals
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Answer YES to get separate listings of utilization by HIV CATEGORY as well as the total population.
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Selected IP/OP Activty
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SD*5.3*131
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NO SC ID
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NO SC
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NO ID
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NO BS
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How many of the highest users do you want identified ? 0//
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Enter the number, 0 or greater of the individuals with the highest
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utilization of pharmacy fills and/or cost you wish listed
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NO CATEGORY DEFINED^HIV+^HIV+ (CD4<500)^AIDS-3^AIDS
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TOTAL HIV+ (ALL CATEGORIES) POPULATION
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FOR THE PERIOD
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SELECTED OUTPATIENT ACTIVITY
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A 'stop' is credited for each entry of a stop code, while a 'visit' is split
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among each stop credited on a given date. Thus, a single visit with two stop
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codes credited will show as 0.5 visit for each stop code.
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A total of 1.00
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visit is given for out patient activity on a given date.
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Totals:
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patients for
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NOT IDENTIFIED
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OCCURRENCES OF NO STOP CODE ID
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ADD/EDIT STOP CODE
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SCHEDULED VISIT
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INPATIENT AND OUTPATIENT ACTIVITY
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STOP CODES
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SELECTED INPATIENT ACTIVITY
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stays and
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days of inpatient care
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Median Length of Stay (MLOS):
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Average Length of Stay (ALOS):
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OCCURRENCES OF NO BEDSECTION ID
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HIGHEST UTILIZATION OF VISITS
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HIGHEST NUMBER OF STAYS
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HIGHEST NUMBER OF DAYS
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moved in:
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PTF entry:
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Number of Days Patients Not Seen
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Enter the number of days you want to check if any patient has not been seen
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Immunology Followup List
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FOLLOW UP REPORT
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PATIENTS AT RISK OF LOSS TO FOLLOW UP
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NOT SEEN IN OVER
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Local Registry List - ICR Patients
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Select Type of Patients
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List New Patients added to the registry during this time (Y/N)? N//
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Do you want the list sorted by Category (Y/N)? N//
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Do you want the list sorted by Reimbursement Level (Y/N)? N//
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List Immunology Patients
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***NO PATIENTS FOUND IN DATE RANGE***
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REGISTRY LIST
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REIM LEV
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Minimum number of results reported for a test to be listed
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This number (1 or greater) is used to keep from showing long lists of infrequent tests by setting a minimum number of results for display
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Selected LAB Activity
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Enter the number, 0 or greater, of the individuals with the highest
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utilization of laboratory orders you wish listed
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LABORATORY UTILIZATION DATA
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Totals:
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orders placed (
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results reported)
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during this period for
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These include
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different entries from LAB TEST file
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placed for
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in file, not included above
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# OF DIFFERENT
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LAB TESTS
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Max # Results
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Reported
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Per Patient (# patients)
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***This report will give you a list of your local lab links.***
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List Local Lab Links
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LOCAL LAB LINKS
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Local Name
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>>>>> Please wait. Searching for Viral Load & CD4 Values.....
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Type of Test
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**NO DATA FOUND**
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Summary Utilization Data
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Answer YES to sort by HIV CATEGORY.
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Immunology Summary Utilization Data
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Select Facility Source of Information
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Sending Request Message to the National Registry...
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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