| 1 | QANPSD1 ;HISC/GJC-Pseudo VA 10-2633 ;10/1/92
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| 2 |  ;;2.0;Incident Reporting;**1,16**;08/07/1992
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| 3 |  ;
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| 4 |  W !?5,"PATIENT: ",$G(QANAME),?45,"PATIENT ID: ",$G(QANPID)
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| 5 |  W !?5,"SOCIAL SECURITY NUMBER: ",$G(QANSSN),?45,"AGE: ",$G(QANAGE)
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| 6 |  W !?5,"DATE/TIME INCIDENT: ",$G(QANDATE),?45,"DATE INITIATED: ",$G(QANINIT)
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| 7 |  W !?5,"WARD/CLINIC: ",$G(QANWARD),?45,"SERVICE: ",$G(QANSERV)
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| 8 |  I 'QANBLNK,($D(^QA(742,QANDFN,2,0))) W !?5,"CLINICAL DIAGNOSIS: " S (QAN,QANFLAG)=0 F  S QAN=$O(^QA(742,QANDFN,2,QAN)) Q:QAN'>0  D DIAG Q:QANFIN["^"
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| 9 |  I QANBLNK W !?5,"CLINICAL DIAGNOSIS: ",!!!!!
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| 10 |  S QANFLAG=0  Q:QANFIN["^"
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| 11 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !!?5,"ADMISSION DATE: ",$G(QANADMT),?45,"INCIDENT TYPE: ",$G(QANINCD)
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| 12 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?5,"WITNESS: ",$G(QANWIT) W:$G(QANWIT)["Y" ?45,"RELATIONSHIP TO PATIENT: __________"
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| 13 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?5,"INCIDENT LOCATION: ",$G(QANILOC),?45,"CASE NUMBER: ",$G(QANCASE)
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| 14 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"
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| 15 |  I 'QANBLNK,($D(^QA(742.4,QANIEN,1,0))) W !!?5,"INCIDENT DESCRIPTION: " S (QAN,QANFLAG)=0 F  S QAN=$O(^QA(742.4,QANIEN,1,QAN)) Q:QAN'>0  D DESCR Q:QANFIN["^"
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| 16 |  I QANBLNK W !!?5,"INCIDENT DESCRIPTION: ",!!
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| 17 |  S QANFLAG=0  Q:QANFIN["^"
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| 18 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !!!?5,"SIGNATURE AND TITLE OF REPORTER: _________________________",!
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| 19 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W ?5,"DATE: __________",!
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| 20 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?5,"PHYSICIAN'S EXAMINATION FINDINGS/ACTIONS:",!!!!!
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| 21 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?10,"SEVERITY LEVEL: 0  1  2  3"
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| 22 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !!?10,"EXAMINING PHYSICIAN'S SIGNATURE: _________________________",!?10,"DATE: __________",!
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| 23 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?5,"SERVICE LEVEL FINDINGS/ACTIONS:",!!!
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| 24 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?10,"SIGNATURE: _________________________",!?10,"DATE: __________",!!
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| 25 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W $G(QANEQ),!
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| 26 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?5,"CHIEF OF STAFF REVIEW:",!!?5,"INCIDENT TYPE: ",$G(QANINCD)
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| 27 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"
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| 28 |  I 'QANBLNK,($D(^QA(742,QANDFN,1,0))) W !?5,"RESPONSIBLE SERVICE: " S (QAN,QANFLAG)=0 F  S QAN=$O(^QA(742,QANDFN,1,QAN)) Q:QAN'>0  D RSERV Q:QANFIN["^"
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| 29 |  I QANBLNK W !?5,"RESPONSIBLE SERVICE: "
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| 30 |  S QANFLAG=0  Q:QANFIN["^"
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| 31 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !!?5,"COMMENTS: ",!!!
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| 32 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?5,"RECOMMENDATIONS FOR FURTHER FOLLOW-UP: ",!?10,"NO",!?10,"YES",!
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| 33 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?10,"SPECIFY:",!!!
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| 34 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?10,"COS SIGNATURE: _________________________",!?10,"DATE: __________"
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| 35 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !!,$G(QANEQ),!!?5,"DIRECTOR'S REVIEW:",!!
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| 36 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?5,"ACTION TAKEN BY MEDICAL CENTER:",?45,"NEED FOR FURTHER REVIEW:"
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| 37 |  I 'QANBLNK,($D(^QA(742.4,QANIEN,2,0))) S (QAN,QAN(0),QANFLAG)=0 F  S QAN=$O(^QA(742.4,QANIEN,2,QAN)) Q:QAN'>0  D MEDC Q:QANFIN["^"
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| 38 |  S QANFLAG=0  Q:QANFIN["^"
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| 39 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"
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| 40 |  I 'QANBLNK,('$D(^QA(742.4,QANIEN,2,0))) W !?45,$G(QANLREV)
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| 41 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !!!?5,"DIRECTOR'S SIGNATURE: _________________________",!
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| 42 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W ?5,"DATE: __________",!
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| 43 |  Q
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| 44 | DESCR ;Incident Description word processing
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| 45 |  S X=$G(^QA(742.4,QANIEN,1,QAN,0)),DIWF="",DIWR=50,DIWL=10,QANFLAG=1
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| 46 |  K ^UTILITY($J,"W") D ^DIWP
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| 47 |  S QANMN=0,QANLBL="INCIDENT DESCRIPTION: "
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| 48 |  F  S QANMN=+$O(^UTILITY($J,"W",DIWL,QANMN)) Q:QANMN'>0  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?15,^(QANMN,0)
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| 49 |  Q
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| 50 | RSERV ;Responsible Service multiple
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| 51 |  S QANLBL="RESPONSIBLE SERVICE: ",QANFLAG=1
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| 52 |  S Y=$P(^QA(742,QANDFN,1,QAN,0),U),C=$P(^DD(742.01,.01,0),U,2) D:Y]"" Y^DIQ
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| 53 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?15,Y
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| 54 |  Q
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| 55 | DIAG ;Patient Diagnosis multiple
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| 56 |  S QANLBL="CLINICAL DIAGNOSIS: ",QANFLAG=1
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| 57 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?15,$P(^QA(742,QANDFN,2,QAN,0),U)
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| 58 |  Q
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| 59 | MEDC ;Medical Center Action multiple
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| 60 |  S QAN(0)=QAN(0)+1,QANLBL="ACTION TAKEN BY MEDICAL CENTER: ",QANFLAG=1
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| 61 |  S Y=$P(^QA(742.4,QANIEN,2,QAN,0),U),C=$P(^DD(742.42,.01,0),U,2) D:Y]"" Y^DIQ
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| 62 |  D:$Y>(IOSL-8) HDH^QANPSDO Q:QANFIN["^"  W !?10,Y W:QAN(0)=1 ?45,$G(QANLREV)
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| 63 |  Q
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