source: WorldVistAEHR/trunk/r/ICR_IMMUNOLOGY_CASE_REGISTRY-IMR/IMRCDP3.m

Last change on this file was 613, checked in by George Lilly, 15 years ago

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1IMRCDP3 ;HCIOFO/NCA - Display CDC Form (Cont.) ;7/16/97 08:55
2 ;;2.1;IMMUNOLOGY CASE REGISTRY;;Feb 09, 1998
3 Q:IMRUT
4 W !,"| State/Country | | * Received clotting factor for hemophilia/coagulation disorder ............. |",$S(IMRPT:$$VAL^IMRCDCPX(15.9,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(15.9,0),1:0),"| |"
5 W $S(IMRPT:$$VAL^IMRCDCPX(15.9,9),1:9),"| |"
6 W !,"| | | Specify disorder: |",$S(IMRPT:$$VAL^IMRCDCPX(16.12,1),1:1),"| Factor VIII |",$S(IMRPT:$$VAL^IMRCDCPX(16.12,2),1:2),"| Factor IX |"
7 W $S(IMRPT:$$VAL^IMRCDCPX(16.12,8),1:8),"| Other |"
8 W !,"| FACILITY SETTING (check one) | | * (Hemophilia A) (Hemophilia B) (specify): "
9 S X=$S(IMRPT:$$FIELD^IMRCDCPX(158,IMRPT,16.13,"E"),1:"") W X_$P(UNDR,"_",1,(15-$L(X)))," |"
10 W !,"| |",$S(IMRPT:$$VAL^IMRCDCPX(110.16,1),1:1),"| Public |",$S(IMRPT:$$VAL^IMRCDCPX(110.16,2),1:2),"| Private | | * HETEROSEXUAL relations with any of the following: |"
11 W !,"| |",$S(IMRPT:$$VAL^IMRCDCPX(110.16,3),1:3),"| Federal |",$S(IMRPT:$$VAL^IMRCDCPX(110.16,9),1:9),"| Unknown | | * Intravenous/injection drug user ........................................ |"
12 W $S(IMRPT:$$VAL^IMRCDCPX(16.22,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(16.22,0),1:0),"| |",$S(IMRPT:$$VAL^IMRCDCPX(16.22,9),1:9),"| |"
13 W !,"| | | * Bisexual male .......................................................... |",$S(IMRPT:$$VAL^IMRCDCPX(16.23,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(16.23,0),1:0),"| |"
14 W $S(IMRPT:$$VAL^IMRCDCPX(16.23,9),1:9),"| |"
15 W !,"| | | * Person with hemophilia/coagulation disorder ............................ |",$S(IMRPT:$$VAL^IMRCDCPX(16.24,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(16.24,0),1:0),"| |"
16 W $S(IMRPT:$$VAL^IMRCDCPX(16.24,9),1:9),"| |"
17 W !,"| FACILITY TYPE (check one) | | * Transfusion recipient with documented HIV infection .................... |",$S(IMRPT:$$VAL^IMRCDCPX(16.25,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(16.25,0),1:0),"| |"
18 W $S(IMRPT:$$VAL^IMRCDCPX(16.25,9),1:9),"| |"
19 W !,"| |",$S(IMRPT:$$VAL^IMRCDCPX(112.06,"01"),1:"01"),"| Physician,HMO | | * Transplant recipient with documented HIV infection ..................... |",$S(IMRPT:$$VAL^IMRCDCPX(110.03,1),1:1),"| |"
20 W $S(IMRPT:$$VAL^IMRCDCPX(110.03,0),1:0),"| |",$S(IMRPT:$$VAL^IMRCDCPX(110.03,9),1:9),"| |"
21 W !,"| |",$S(IMRPT:$$VAL^IMRCDCPX(112.06,31),1:31),"| Hospital,Inpatient | | * Person with AIDS or documented HIV infection, risk not specified ....... |"
22 W $S(IMRPT:$$VAL^IMRCDCPX(16.26,1),1:1),"| |"
23 W $S(IMRPT:$$VAL^IMRCDCPX(16.26,0),1:0),"| |",$S(IMRPT:$$VAL^IMRCDCPX(16.26,9),1:9),"| |"
24 W !,"| |",$S(IMRPT:$$VAL^IMRCDCPX(112.06,88),1:88),"| Other (specify): | | * Received transfusion of blood/blood components (other than clotting factor) |"
25 W $S(IMRPT:$$VAL^IMRCDCPX(16.14,1),1:1)
26 W "| |",$S(IMRPT:$$VAL^IMRCDCPX(16.14,0),1:0),"| |",$S(IMRPT:$$VAL^IMRCDCPX(16.14,9),1:9),"| |"
27 W !,"| " S X=$S(IMRPT:$$FIELD^IMRCDCPX(158,IMRPT,102.1,"E"),1:"")
28 W X_$P(UNDR,"_",1,(22-$L(X)))," | | Mo. Yr. Mo. Yr.",?129,"|"
29 W !," | FIRST ",IMRFT," LAST ",IMRLT,?129,"|"
30 W !," | * Received transplant of tissue/organs or artificial insemination .......... |",$S(IMRPT:$$VAL^IMRCDCPX(102.14,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(102.14,0),1:0),"| |"
31 W $S(IMRPT:$$VAL^IMRCDCPX(102.14,9),1:9),"| |"
32 W !," | * Worked in a health-care or clinical laboratory setting ................... |",$S(IMRPT:$$VAL^IMRCDCPX(16.17,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(16.17,0),1:0),"| |"
33 W $S(IMRPT:$$VAL^IMRCDCPX(16.17,9),1:9),"| |"
34 W !," | (specify occupation): "
35 S X=$S(IMRPT:$$FIELD^IMRCDCPX(158,IMRPT,16.18,"E"),1:"")
36 W X_$P(UNDR,"_",1,(15-$L(X))),?129,"|"
37 W !," ================================"
38 W "=============================================================="
39 D HDR^IMRCDCPR
40 Q
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