[613] | 1 | GMRAFN2 ;HIRMFO/WAA-FDA PART 2 MEDWATCH FORM ;11/30/95 15:19
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| 2 | ;;4.0;Adverse Reaction Tracking;;Mar 29, 1996
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| 3 | FORM ;This is the main form entry point
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| 4 | W !,"MEDWatch",?80,"Approved by FDA on 10/20/93"
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| 5 | W !,$E(LINE1,1,42),?79,$E(LINE1,79,131)
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| 6 | W !,"THE FDA MEDICAL PRODUCTS REPORTING PROGRAM",?79,"| Triage unit sequence #",?131,"|"
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| 7 | W !,$E(LINE1,1,42),?79,$E(LINE1,79,131)
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| 8 | W !,?79,"|",?131,"|"
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| 9 | W !,?59,"Page ",GMRAPG1," of ",GMRAPG2,?79,$E(LINE1,79,131)
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| 10 | W !,$E(LINE2,1,66),"|",$E(LINE2,68,131)
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| 11 | W !,"A. Patient Information",?66,"| C. Suspect Medication(s)"
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| 12 | W !,$E(LINE1,1,66),"|",$E(LINE1,68,131)
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| 13 | W !,"1. Patient Indentifier|2. DOB: ",+$E(GMRADOB,4,5),"/",+$E(GMRADOB,6,7),"/",$E(GMRADOB,2,3),?43,"|3. Sex|4. Weight",?66,"|1. Name"
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| 14 | W !,GMRAID,?22,"| AGE: "
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| 15 | AGE ;Age at time of event
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| 16 | I GMRAPG1=1 S X1=$P(GMRAPA1(0),U),X2=GMRADOB S X=($E(X1,1,3))-($E(X2,1,3)) S:($E(X1,4,7))<($E(X2,4,7)) X=X-1 W X K X,X1,X2 W ?39,"yrs |"
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| 17 | I GMRAPG1'=1 W ?39,"yrs |"
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| 18 | SEX ;Sex,weight
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| 19 | I GMRAPG1=1 W $P(GMRASEX,U,2),?50,"|",$J((GMRAWEI*.4536),5,1) W:GMRAWEI'="" " kg" W ?66
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| 20 | I GMRAPG1'=1 W ?50,"| kg",?66
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| 21 | SUSPECT ;THIS WILL GET THE NEXT SUSPECTED AGENT
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| 22 | S GMRASUS=$O(^TMP($J,"GMR","A",GMRASUS)) I GMRASUS'<1 S GMRASUS1=GMRASUS
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| 23 | S GMRAGNT1=$S(GMRASUS="":"",1:$G(^TMP($J,"GMR","A",GMRASUS1)))
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| 24 | S:GMRASUS="" GMRASUS1=""
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| 25 | W "| #",GMRASUS1," : " W $E($P(GMRAGNT1,U),1,30)
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| 26 | W !,$E(LINE2,1,66),"|",$E(LINE1,68,131)
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| 27 | W !,"B. Adverse Event or Product Problem",?66
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| 28 | S GMRASUS=$O(^TMP($J,"GMR","A",GMRASUS)) I GMRASUS'<1 S GMRASUS2=GMRASUS
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| 29 | I GMRASUS<1 S GMRASUS2=""
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| 30 | E S GMRAGNT2=(^TMP($J,"GMR","A",GMRASUS))
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| 31 | W "|" W:GMRASUS2'="" " #",GMRASUS2," : ",$E($P(GMRAGNT2,U),1,30)
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| 32 | W !,$E(LINE1,1,66),"|",$E(LINE1,68,131)
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| 33 | W !,"1. [X]Adverse Event [ ]Product problem",?66,"|2. Dose,frequency & route used",?99,"| 3. Therapy dates"
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| 34 | W !,$E(LINE1,1,66),"| #",GMRASUS1,":" W $E($P(GMRAGNT1,U,2),1,8) I $P(GMRAGNT1,U,2)'="",$P($G(^TMP($J,"GMR","A",GMRASUS1,1)),U,5)'="" W ","
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| 35 | I GMRASUS1'="",$P($G(^TMP($J,"GMR","A",GMRASUS1,1)),U,5)'="" W $E($P($G(^TMP($J,"GMR","A",GMRASUS1,1)),U,5),1,8) I $P(GMRAGNT1,U,3)'="" W ","
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| 36 | W $E($P(GMRAGNT1,U,3),1,8),?99,"| #",GMRASUS1," : "
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| 37 | I GMRASUS1'="",$D(^TMP($J,"GMR","A",GMRASUS1,1)) S DT=$P(^(1),U) I DT'="" S DT=$E(DT,4,5)_"/"_$E(DT,6,7)_"/"_$E(DT,2,3) W DT
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| 38 | I GMRASUS1'="",$D(^TMP($J,"GMR","A",GMRASUS1,1)) S DT=$P(^(1),U,2) I DT'="" S DT=$E(DT,4,5)_"/"_$E(DT,6,7)_"/"_$E(DT,2,3) W "-",DT
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| 39 | W !,"2. Outcomes attributed to adverse event",?66,"|",$E(LINE1,66,97),"|",$E(LINE1,99,130)
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| 40 | S X1=0 W !," ["
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| 41 | I GMRAPG1=1 W $S($P(^GMR(120.85,GMRAPA1,0),U,3)="y":"X",1:" ") S:$P(^(0),U,3)="y" X1=1 W "] death: " I X1=1 S Y=$P($G(^DPT(DFN,.35)),U) I Y'<1 W $E(Y,4,5),"/",$E(Y,6,7),"/",$E(Y,2,3)
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| 42 | I GMRAPG1'=1 W " ] death:"
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| 43 | W ?30,"["
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| 44 | I GMRAPG1=1 W $S($P(^GMR(120.85,GMRAPA1,0),U,10)="y":"X",1:" ") S:$P(^(0),U,10)="y" X1=1 W "] disability"
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| 45 | I GMRAPG1'=1 W " ] disability"
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| 46 | W ?66,"|" I GMRASUS2'="" W " #",GMRASUS2,":" W $E($P(GMRAGNT2,U,2),1,8) I $P(GMRAGNT2,U,2)'="",$P($G(^TMP($J,"GMR","A",GMRASUS2,1)),U,5)'="" W ","
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| 47 | I GMRASUS2,$P($G(^TMP($J,"GMR","A",GMRASUS2,1)),U,5)'="" W $E($P($G(^TMP($J,"GMR","A",GMRASUS2,1)),U,5),1,8) I $P(GMRAGNT2,U,3)'="" W ","
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| 48 | I GMRASUS2'="" W $E($P(GMRAGNT2,U,3),1,(24-$L($E($P(GMRAGNT2,U,2),1,12)))),?99,"| #",GMRASUS2," : " D
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| 49 | .I $D(^TMP($J,"GMR","A",GMRASUS2,1)) S DT=$P(^(1),U) S DT=$E(DT,4,5)_"/"_$E(DT,6,7)_"/"_$E(DT,2,3) W DT
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| 50 | .I $D(^TMP($J,"GMR","A",GMRASUS2,1)) S DT=$P(^(1),U,2) I DT'="" S DT=$E(DT,4,5)_"/"_$E(DT,6,7)_"/"_$E(DT,2,3) W "-",DT
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| 51 | .Q
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| 52 | I GMRASUS2="" W ?99,"|"
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| 53 | S X2=0 W !," ["
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| 54 | I GMRAPG1=1 W $S($P(^GMR(120.85,GMRAPA1,0),U,5)="y":"X",1:" ") S:$P(^(0),U,5)="y" X1=1 W "] life-threatening"
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| 55 | I GMRAPG1'=1 W " ] life-threatening"
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| 56 | S X2=0 W ?30,"["
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| 57 | I GMRAPG1=1 W $S($P(^GMR(120.85,GMRAPA1,0),U,16)="y":"X",1:" ") S:$P(^(0),U,16)="y" X1=1 W "] congenital anomaly",?66,"|",$E(LINE1,68,131)
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| 58 | I GMRAPG1'=1 W " ] congenital anomaly",?66,"|",$E(LINE1,68,131)
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| 59 | W !," [" I GMRAPG1=1 D
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| 60 | .I $P(^GMR(120.85,GMRAPA1,0),U,9)="y" W "X" S X1=1 Q
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| 61 | .I $P(^GMR(120.85,GMRAPA1,0),U,7)="y" W "X" S X1=1 Q
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| 62 | .W " "
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| 63 | .Q
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| 64 | I GMRAPG1'=1 W " "
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| 65 | Q
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