source: WorldVistAEHR/trunk/r/ICR_IMMUNOLOGY_CASE_REGISTRY-IMR/IMRCDP7.m@ 1365

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1IMRCDP7 ;HCIOFO/NCA - Display CDC Form (Cont.) ;7/16/97 08:58
2 ;;2.1;IMMUNOLOGY CASE REGISTRY;;Feb 09, 1998
3 Q:IMRUT
4 W !," ================================================ IX. TREATMENT/SERVICES REFERRALS ============================================"
5 W !,"| Has this patient been informed of his/her HIV infection? |",$S(IMRPT:$$VAL^IMRCDCPX(110.06,1),1:1),"| Yes |"
6 W $S(IMRPT:$$VAL^IMRCDCPX(110.06,0),1:0),"| No |",$S(IMRPT:$$VAL^IMRCDCPX(110.06,9),1:9)
7 W "| Unk. | This patient is receiving or |"
8 W !,"| | has been referred for: Yes No Unk. |"
9 W !,"| This patient's partners will be notified about their HIV exposure and counseled by: | * HIV related medical services |"
10 W !,"| |",$S(IMRPT:$$VAL^IMRCDCPX(110.07,1),1:1),"| Health department |",$S(IMRPT:$$VAL^IMRCDCPX(110.07,2),1:2),"| Physician/provider |"
11 W $S(IMRPT:$$VAL^IMRCDCPX(110.07,3),1:3)
12 W "| Patient |",$S(IMRPT:$$VAL^IMRCDCPX(110.07,9),1:9),"| Unknown | * Substance abuse treatment services |"
13 W !?1,LN
14 W !,"| This patient received or is receiving: | This patient has been enrolled at: | This patient's medical treatment is |"
15 W !,"| * Anti-retroviral Yes No Unk. | Clinical Trial Clinic | PRIMARILY reimbursed by: |"
16 W !,"| therapy",?24,"|",$S(IMRPT:$$VAL^IMRCDCPX(110.08,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(110.08,0),1:0),"| |"
17 W $S(IMRPT:$$VAL^IMRCDCPX(110.08,9),1:9),"| | |",$S(IMRPT:$$VAL^IMRCDCPX(110.1,1),1:1)
18 W "| NIH-sponsored |",$S(IMRPT:$$VAL^IMRCDCPX(110.11,1),1:1),"| HRSA-sponsored | |"
19 W $S(IMRPT:$$VAL^IMRCDCPX(110.12,1),1:1),"| Medicaid |",$S(IMRPT:$$VAL^IMRCDCPX(110.12,2),1:2),"| Private ins/HMO |"
20 W !,"| | |",$S(IMRPT:$$VAL^IMRCDCPX(110.1,2),1:2),"| Other |",$S(IMRPT:$$VAL^IMRCDCPX(110.11,2),1:2)
21 W "| Other | |",$S(IMRPT:$$VAL^IMRCDCPX(110.12,3),1:3),"| No coverage |",$S(IMRPT:$$VAL^IMRCDCPX(110.12,4),1:4),"| Other public funds |"
22 W !,"| Yes No Unk. | |",$S(IMRPT:$$VAL^IMRCDCPX(110.1,3),1:3),"| None |"
23 W $S(IMRPT:$$VAL^IMRCDCPX(110.11,3),1:3),"| None | |",$S(IMRPT:$$VAL^IMRCDCPX(110.12,7),1:7)
24 W "| Clinical |",$S(IMRPT:$$VAL^IMRCDCPX(110.12,9),1:9),"| Unknown |"
25 W !,"| * PCP prophylaxis |",$S(IMRPT:$$VAL^IMRCDCPX(110.09,1),1:1),"| |",$S(IMRPT:$$VAL^IMRCDCPX(110.09,0),1:0),"| |"
26 W $S(IMRPT:$$VAL^IMRCDCPX(110.09,9),1:9),"| | |"
27 W $S(IMRPT:$$VAL^IMRCDCPX(110.1,9),1:9),"| Unknown |",$S(IMRPT:$$VAL^IMRCDCPX(110.11,9),1:9),"| Unknown | trial/government program |"
28 W !?1,LN
29 W !,"| FOR WOMEN: *This patient is receiving or has been referred for gynecological or obstetrical services: . |"
30 W $S(IMRPT:$$VAL^IMRCDCPX(110.13,1),1:1),"|Yes |",$S(IMRPT:$$VAL^IMRCDCPX(110.13,0),1:0),"|No |"
31 W $S(IMRPT:$$VAL^IMRCDCPX(110.13,9),1:9),"|Unk |"
32 W !,"| *Is this patient currently pregnant? ....................................................... |"
33 W $S(IMRPT:$$VAL^IMRCDCPX(110.14,1),1:1),"|Yes |",$S(IMRPT:$$VAL^IMRCDCPX(110.14,0),1:0),"|No |",$S(IMRPT:$$VAL^IMRCDCPX(110.14,9),1:9),"|Unk |"
34 W !,"| *Has this patient delivered live born infants? ... |",$S(IMRPT:$$VAL^IMRCDCPX(110.15,1),1:1),"|Yes (If delivered after 1977, provide birth |"
35 W $S(IMRPT:$$VAL^IMRCDCPX(110.15,0),1:0),"|No |",$S(IMRPT:$$VAL^IMRCDCPX(110.15,9),1:9),"|Unk |"
36 W !,"|",?73,"information below for the most recent birth) |"
37 W !?1,LN
38 W !,"| CHILD'S DATE OF BIRTH: | Hospital of Birth: "
39 S X=$S(IMRPT:$$FIELD^IMRCDCPX(158,IMRPT,112.02,"E"),1:"") W X_$P(UNDR,"_",1,(23-$L(X)))," | Child's Soundex: | Child's State Patient No. |"
40 W !,"| Mo. Day Yr. | | | | | | | __________ | | | | | | | | | | | | |"
41 W !,"| " S X=$S(IMRPT:$$FIELD^IMRCDCPX(158,IMRPT,112.01,"I"),1:"")
42 I X'="" S X=$E(X,4,5)_" "_$E(X,6,7)_" "_$E(X,2,3)
43 W $S(X="":" ",1:X)," | City: " S X=$S(IMRPT:$$FIELD^IMRCDCPX(158,IMRPT,112.03,"E"),1:"") W X_$P(UNDR,"_",1,(23-$L(X)))," State: "
44 S X=$S(IMRPT:$$FIELD^IMRCDCPX(158,IMRPT,112.04,"E"),1:"") W X_$P(UNDR,"_",1,(3-$L(X)))," |",?99,"|",?129,"|"
45 D HDR^IMRCDCPR
46 Q
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