| [613] | 1 | IMRCDP4 ;HCIOFO/NCA - Display CDC Form (Cont.) ;7/16/97 08:56
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| 2 | ;;2.1;IMMUNOLOGY CASE REGISTRY;;Feb 09, 1998
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| 3 | Q:IMRUT
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| 4 | W !,"======================================================== VI. LABORATORY DATA ===================================================="
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| 5 | W !,"| 1. HIV ANTIBODY TESTS AT DIAGNOSIS: Not Test Date | Mo. Yr. |"
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| 6 | W !,"| (Indicate FIRST test) Pos Neg Ind Done Mo. Yr. | * Date of last documented NEGATIVE HIV test ",$S(IMRPT:$$DAT^IMRCDCPX(111.01),1:"__ __")," |"
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| 7 | W !,"| * HIV-1 EIA ................... |",$S(IMRPT:$$VAL^IMRCDCPX(9.4,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(9.4,0),1:0),"| - |"
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| 8 | W $S(IMRPT:$$VAL^IMRCDCPX(9.4,9),1:9),"| ",$S(IMRPT:$$DAT^IMRCDCPX(108.27),1:"__ __")," | (specify type): "
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| 9 | S X=$S(IMRPT:$$FIELD^IMRCDCPX(158,IMRPT,111.02,"E"),1:"") W X_$P(UNDR,"_",1,(30-$L(X)))," |"
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| 10 | W !,"| * HIV-1/HIV-2 combination EIA . |",$S(IMRPT:$$VAL^IMRCDCPX(110.17,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(110.17,0),1:0)
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| 11 | W "| - |",$S(IMRPT:$$VAL^IMRCDCPX(110.17,9),1:9),"| ",$S(IMRPT:$$DAT^IMRCDCPX(110.18),1:"__ __")," | * If HIV laboratory tests were not documented, Yes No Unk.|"
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| 12 | W !,"| * HIV-1 Western blot/IFA ...... |",$S(IMRPT:$$VAL^IMRCDCPX(9.5,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(9.5,0),1:0),"| |"
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| 13 | W $S(IMRPT:$$VAL^IMRCDCPX(9.5,8),1:8),"| |",$S(IMRPT:$$VAL^IMRCDCPX(9.5,9),1:9),"| ",$S(IMRPT:$$DAT^IMRCDCPX(108.28),1:"__ __")
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| 14 | W " | is HIV diagnosis documented by a physician? |",$S(IMRPT:$$VAL^IMRCDCPX(111.03,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(111.03,0),1:0),"| |",$S(IMRPT:$$VAL^IMRCDCPX(111.03,9),1:9),"| |"
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| 15 | W !,"| * Other HIV antibody test ..... |",$S(IMRPT:$$VAL^IMRCDCPX(9.6,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(9.6,0),1:0),"| |",$S(IMRPT:$$VAL^IMRCDCPX(9.6,8),1:8)
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| 16 | W "| |",$S(IMRPT:$$VAL^IMRCDCPX(9.6,9),1:9),"| ",$S(IMRPT:$$DAT^IMRCDCPX(108.29),1:"__ __")," | * If yes, provide date of documentation by physician ",$S(IMRPT:$$DAT^IMRCDCPX(111.04),1:"__ __")," |"
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| 17 | W !,"| (specify): " S X=$S(IMRPT:$$FIELD^IMRCDCPX(158,IMRPT,9.7,"E"),1:"")
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| 18 | W X_$P(UNDR,"_",1,(25-$L(X)))," |===============================================================|"
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| 19 | W !,"| * HIV-2 EIA ................... |",$S(IMRPT:$$VAL^IMRCDCPX(102.2,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(102.2,0),1:0),"| - |"
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| 20 | W $S(IMRPT:$$VAL^IMRCDCPX(102.2,9),1:8),"| ",$S(IMRPT:$$DAT^IMRCDCPX(108.3),1:"__ __")," | 3. IMMUNOLOGIC LAB TESTS: |"
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| 21 | W !,"| * HIV-2 Western blot .......... |",$S(IMRPT:$$VAL^IMRCDCPX(110.19,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(110.19,0),1:0),"| |"
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| 22 | W $S(IMRPT:$$VAL^IMRCDCPX(110.19,8),1:8),"| |",$S(IMRPT:$$VAL^IMRCDCPX(110.19,9),1:9),"| ",$S(IMRPT:$$DAT^IMRCDCPX(110.2),1:"__ __")
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| 23 | W " | At or closest to current diagnostic status Mo. Yr. |"
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| 24 | W !,"| 2. POSITIVE HIV DETECTION TEST: (Record earliest test) | * CD4 Count ........... "
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| 25 | S X=$S(IMRPT:$$FIELD^IMRCDCPX(158,IMRPT,102.21,"E"),1:0)
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| 26 | S X=$S(X>0:$J(X,5),1:"_,___") W X," cells/uL ",$S(IMRPT:$$DAT^IMRCDCPX(108.31),1:"__ __")," |"
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| 27 | W !,"| * HIV culture ..................................... ",$S(IMRPT:$$DAT^IMRCDCPX(111.1),1:"__ __")," | * CD4 Percent ......... "
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| 28 | S X=$S(IMRPT:$$FIELD^IMRCDCPX(158,IMRPT,102.22,"E"),1:0)
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| 29 | S X=$S(X>0:$J(X,2),1:"__") W X," % ",$S(IMRPT:$$DAT^IMRCDCPX(111.05),1:"__ __")," |"
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| 30 | W !,"| * HIV antigen test ................................ ",$S(IMRPT:$$DAT^IMRCDCPX(111.11),1:"__ __")," | First <200 uL or <14% |"
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| 31 | W !,"| * HIV PCR, DNA or RNA probe ....................... ",$S(IMRPT:$$DAT^IMRCDCPX(111.12),1:"__ __")," | * CD4 Count ........... "
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| 32 | S X=$S(IMRPT:$$FIELD^IMRCDCPX(158,IMRPT,111.06,"E"),1:"")
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| 33 | S X=$S(X'="":$J(X,5),1:"_,___") W X," cells/uL ",$S(IMRPT:$$DAT^IMRCDCPX(111.07),1:"__ __")," |"
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| 34 | D HDR^IMRCDCPR
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| 35 | Q
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