308 lines
10 KiB
Plaintext
308 lines
10 KiB
Plaintext
English French Notes Complete/Exclude
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1. Highest educational level attained:
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2. Special educational training or skills:
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Is not, or unknown if
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currently enrolled in an educational program
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or trade school.
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4. Educational Assesment:
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IV. Military History:
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1. Period of Service:
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4. Service Connected Disability:
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5. Military Assessment:
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V. Social/Family Relationship:
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1. Marital status:
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SOCIAL WORK SERVICE-REPORTS AND SUMMARIES
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4. Describe Social Support System:
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5. Present use of Community Resources:
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6. Current Living arrangements:
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7. Social/Family Assessment:
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VI. Legal Situation:
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Power of Attorney:
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Living Will:
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Guardianship:
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Legal Assessment:
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VII. Current Substance Abuse Problems:
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Comments on Substance Abuse:
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VIII. Psycho-Social Assessment:
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IX. Preliminary List of Problems
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Initial Plan of Action
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3. MILITARY HISTORY
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4. SOCIAL/FAMILY RELATIONSHIPS
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5. LEGAL SITUATION
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6. CURRENT SUBSTANCE ABUSE
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7. PRELIMINARY PROBLEMS
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8. PSYCHO-SOCIAL ASSESSMENT
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Enter number(s) to enter/edit i.e => 1 or 1,8 or All or
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Do you want to print Assessment data
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Enter the number of the category for this patient you want to enter/edit.
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For example if you want to enter/edit the categories
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Enter the number
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i.e. 2,3 separated by comma or enter any
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combination of numbers separated by commas or if all categories are to be
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edited, press carriage return for default of
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. VALID NUMBERS ARE 1-8.
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INVALID CATEGORY NUMBER(s) ! Do you want to try again
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CLINICAL SUPERVISOR'S REPORT
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Task Queued to Print !
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PG.
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CLINICAL SUPERVISORY REPORT
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PLANNING DATE
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NOTE DATE
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1. CLOSING NOTES
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2. DISCHARGE PLANNING
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ENTER 1, 2 OR 'ALL' FOR BOTH NOTES TO PRINT or '^' to EXIT:
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CLOSING NOTE:
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AFTER CARE PLAN:
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OPEN DATE:
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CLOSED DATE:
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NOTE ENTERED:
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SERVICES OFFERED:
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DISCHARGE PLAN:
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DISCHARGE PLAN ENTERED:
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CLOSING
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DISCHARGE PLANNING
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WARD/BED:
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PROBLEMS:
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INITIAL PLAN OF ACTION:
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SELECT SURROGATE SUPERVISOR:
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SELECT SURROGATED SUPERVISOR:
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YOU CANNOT BE YOUR OWN SURROGATE !
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DO YOU WANT TO TRY AGAIN
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DIRECT SERVICES PROVIDED FROM:
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DIRECT SERVICES REPORT
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DIRECT SERVICES CATEGORY FOR
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COMPLETE SERVICE
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Do you want Complete Service
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Enter 'YES' to print the complete service.
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Do you want report by Supervisor
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Enter 'YES' to print the report by supervisor
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Enter Supervisor's last name
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To print the report for a supervisor, enter the supervisor's last name.
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Enter Social Worker's last name
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To print the report for a worker, enter the worker's last name.
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'Y' for Yes
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'N' for No
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Enter RCH:
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INQUIRY INTO RCH FILE REPORT
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RCH HOME REGISTRY FOR A SINGLE HOME:
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1. ALL HOMES
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2. A SINGLE HOME ?
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ENTER 1 or 2 1//
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ENTER RCH:
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RESIDENTIAL CARE HOME REPORT
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Enter the number one (1) if all homes are to print, else enter the number
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two (2) for an individual home.
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Do you want to screen Now (One to seven days)
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Enter 'YES' to run current date or up to seven days in the past.
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There were no possible High-Risk patients found for SOCIAL WORK SERVICE !
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or OLDER -
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NSC INSURANCE COVERAGE -
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FEMALE -
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AGE 70 or greater and 2 or more OPT clinics -
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GENERAL DELIVERY
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GENERAL DELIVERY ADDRESS -
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NO ADDRESS -
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NO TEMPORARY ADDRESS -
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HIGH-RISK WARD -
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IRREGULAR DISCHARGE -
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READMITTED WITHIN ONE MONTH -
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PREVIOUS SPECIAL POPULATION PATIENT -
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HOME DIALYSIS -
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HBHC -
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SCI HOME CARE -
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OTHER HOME BASED PROGRAMS -
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ADMISSION DUE TO ACCIDENT -
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INCOME LESS THAN LOCAL AMOUNT
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SEEN BY SOCIAL WORK & LOCATION RCH or CNH -
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OPENED:
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SOCIAL WORK HIGH RISK SCREENING PROFILE
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WORKER:
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SOCIAL WORKER: CASE NOT OPENED TO SOCIAL WORK SERVICE
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DATE ADMITTED:
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DATE SCREENED:____________
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PATIENT ADDRESS:
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PATIENT ADDRESS UNAVAILABLE
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NOK NAME:
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NOK ADDRESS:
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ADDITIONAL CONTACTS:
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MARITAL STATUS:
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EMPLOYMENT STATUS:
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INSURANCE COVERAGE:
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VETERANS STATUS:
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HB
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SC CONDITION:
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ADMISSION DIAGNOSIS:
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LOCATION LAST VA TREATMENT:
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POSITIVE SCREENING CRITERIA:
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SOCIAL WORKER ASSESSMENT & PLAN:
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ROOM NO.:
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Social Worker
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UNEARNED INCOME (Current):
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DISABILITY PAYMENT
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HB AMOUNT
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VA PENSION
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INCOME SCREENING (
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INTEREST,DIVIDEND,ANNUITY
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SOCIAL SECURITY (Includes SSI)
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WORKERS COMP OR BLACK LUNG
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*ALL OTHER INCOME
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TOTAL INCOME:
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*-This total may include amounts already listed under current 'UNEARNED INCOME'.
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BEGINNING SCREEN DATE:
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This report is formatted for 80 columns and must be sent to a printer.
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MANUAL HIGH-RISK SCREENING REPORT
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HOME DIAYLSIS -
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Do you want Complete Service
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THERE IS NOTHING TO REPORT FOR LOCATION OF PATIENTS BY COST CENTERS
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THERE IS NOTHING TO REPORT ON AMIS LOCATIONS FOR
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SUPERVISOR
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SOCIAL WORKER
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LOCATION OF PATIENTS BY COST CENTERS
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SOCIAL WORK DIVISIONAL LOCATION OF PATIENTS BY COST CENTERS REPORT
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COMPLETE SERVICE for DIVISION
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PATIENT INQUIRY REPORT
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DELETING SW POSITIONS FILE (#654)
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XMQ-SWA
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XMQ-SWM
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XMQ-SWK
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INSTALLING SECURITY KEY '
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' FOR SOCIAL WORK DATA TRANSMISSION
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HOLDERS WILL HAVE TO BE ADDED
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INSTALLING RELAY DOMAIN 'Q-SWA.VA.GOV' FOR SOCIAL WORK DATA TRANSMISSION...
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INSTALLING RELAY DOMAIN 'Q-RHC.VA.GOV' FOR SOCIAL WORK DATA TRANSMISSION...
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INSTALLING MAIL GROUP 'SWA' TO RECEIVE SOCIAL WORK TRANSMISSION CONFIRMATION...
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MEMBERS WILL HAVE TO BE ADDED...
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INSTALLING RELAY DOMAIN 'Q-SWM.VA.GOV' FOR SOCIAL WORK DATA TRANSMISSION...
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INSTALLING MAIL GROUP 'RHC' TO RECEIVE SOCIAL WORK TRANSMISSION CONFIRMATION...
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INSTALLING MAIL GROUP 'SWM' TO RECEIVE SOCIAL WORK TRANSMISSION CONFIRMATION...
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Are You:
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1. Adding and Replacing a Worker
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Enter 1 or 2 1//
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SELECT NEW WORKER:
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INCOMPLETE WORKER INFORMATION!! DATA NOT ADDED.
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WHICH WORKER TO REPLACE ?
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ARE YOU SURE YOU WANT TO REPLACE THIS WORKER
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REPLACEMENT WORKER ?
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WORKERS INFORMATION MUST BE COMPLETE
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Entering the number one (1) will allow you to add a new worker and then assign
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that new worker a current worker's case load.
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The number two (2) allows you to assign a current worker's case load to another current worker.
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PLEASE ENTER SOCIAL WORK SITE PARAMETERS !!!
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SELECT DIVISION:
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Open date
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CASE FOR
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IS ALREADY OPENED BY
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HOMES MUST BE ADDED. THIS ENTRY WILL BE DELETED
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DO YOU WANT TO CLOSE CASE
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DO YOU WANT TO OPEN ANOTHER NEW CASE
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Was this a High Risk Patient
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SELECT HOME:
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INCOMPLETE DATA!! RECORD DELETED.
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DELETING OLD NAMESPACE (SW) SORT TEMPLATES...
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Sort Template...<DELETED>
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DELETING OLD NAMESPACE (SW) INPUT TEMPLATES...
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Input Temple...<DELETED>
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DELETING OLD NAMESPACE (SW) PRINT TEMPLATES...
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Print Template...<DELETED>
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DELETING OLD NAMESPACE (SW) OPTIONS...
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Menu Option...<DELETED>
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DELETING OBSOLETE OPTIONS...
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Option to re-index the 'CP' and 'BS5' x-refs in file #650
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Option QUEUED to run
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BE SURE LABELS ARE IN PRINTER PROPERLY
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WHEN READY PRESS RETURN OR ENTER KEY. ARE YOU READY
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RESIDENTIAL CARE HOME ADDRESS LIST
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LABELS WILL PRINT LATER
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Problems and Outcomes Report
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NOT ATTAINED
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PROB.
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NOT TO TREAT
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CR BARR.
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VAMC BARR.
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NOTE: P/F=PATIENT/FAMILY, CR=COMMUNITY RESOURCES, BARR.=BARRIERS
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DIVISONAL PROBLEMS AND OUTCOME REPORT
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NOTE: P/F=PATIENT/FAMILY, CR=COMMUNITY RESOURCES, BARR.=BARRIERS
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PRINT ALL AMIS REPORTS OPTION
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RCH PATIENT REGISTRY FOR ALL OPEN CASES FOR A SINGLE WORKER
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COMPLETE: OPEN CASES
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SUMMARY: OPEN CASES
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RCH PATIENT REGISTRY FOR ALL CASES
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PATIENT STATUS REPORT
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RESOURCES/REFERRALS
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THERE IS DATA IN THE SOCIAL WORK CASE FILE. DO YOU WANT TO CONTINUE
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INSTALLATION TERMINATED !
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DO YOU WANT TO DELETE OLD NAMESPACE (SW) TEMPLATES AND OPTIONS NOW
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IF 'YES' ALL SOCIAL WORK CASE DATA WILL BE DELETED.
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IF 'NO' THE INSTALL WILL TERMINATE, BUT ALL CASES MUST BE CLOSED,
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TRANSMITTED TO AUSTIN, AND CASE DATA MUST BE PURGED.
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RCH PATIENT REGISTRY FOR ALL OPEN CASES
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Ending date must be after starting date
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QUALITY MGMT. MONITOR I REPORT - SOCIAL WORK
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DISCHARGE PLANNING
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FAMILY CONFERENCE
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Quality Management Monitor II
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Family involvement in Discharged Planning
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Total Patients
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Family Conference
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% rec'd Family Conference
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QUALITY MGMT. MONITOR III REPORT - SOCIAL WORK
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Quality Management Monitor III
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Timeliness of service to patients receiving discharge planning
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# PTS REC'D
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DISCH. PLAN.
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AVG. # ELAPSED DAYS
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QUALITY MGMT. MONITOR IV REPORT - SOCIAL WORK
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Quality Management Monitor IV
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Level of problem resolution by problem code
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Worker's #:
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Resolutions
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Occurred
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QUALITY MGMT. MONITOR V REPORT - SOCIAL WORK
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Quality Management Monitor V
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Access to Social Work Services by Location
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Total # Patients
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Treatment Episodes
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POST DISCHARGE FOLLOW-UP
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Quality Management Monitor I
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Follow-up of discharged inpatients who received
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Discharged Planning
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and had
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Problems related to care
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Post Discharge Follow-up
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QUALITY MGMT. REVIEW I REPORT - SOCIAL WORK
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Quality Management Review I
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Non-Followup of discharged inpatients who received
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Date Opened
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QUALITY MGMT. REVIEW III REPORT - SOCIAL WORK
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Avg. # Elapsed Days:
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Quality Management Review III
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Worker's #
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Elapsed Days
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QUALITY MANAGEMENT REVIEW IV REPORT - SOCIAL WORK
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Quality Management Review IV
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Unresolved problems
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QUALITY MGMT. REVIEW II REPORT - SOCIAL WORK
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Quality Management Review II
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RCH AMIS 256 FROM
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RESIDENTIAL CARE HOME AMIS REPORT
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CASES OPENED DURING QUARTER
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CASES CLOSED DURING QUARTER
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TOTAL CASES TREATED
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PREVIOUS LIVING ARRANGEMENTS
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VA CARE
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VAH EXCESS
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VA DOM
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VA CNH
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VA NH
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VA RES.
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NON NH
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LEVEL OF CARE CAPACITY
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SPECIAL PATIENT POPULATION
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RCS AMIS REPORT 10-0173
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RCS 10-0173 AMIS REPORT
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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