| 1 | English French Notes Complete/Exclude
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| 2 | 1. Highest educational level attained:
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| 3 | 2. Special educational training or skills:
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| 4 | Is not, or unknown if
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| 5 | currently enrolled in an educational program
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| 6 | or trade school.
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| 7 | 4. Educational Assesment:
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| 8 | IV. Military History:
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| 9 | 1. Period of Service:
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| 10 | 4. Service Connected Disability:
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| 11 | 5. Military Assessment:
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| 12 | V. Social/Family Relationship:
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| 13 | 1. Marital status:
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| 14 | SOCIAL WORK SERVICE-REPORTS AND SUMMARIES
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| 15 | 4. Describe Social Support System:
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| 16 | 5. Present use of Community Resources:
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| 17 | 6. Current Living arrangements:
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| 18 | 7. Social/Family Assessment:
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| 19 | VI. Legal Situation:
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| 20 | Power of Attorney:
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| 21 | Living Will:
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| 22 | Guardianship:
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| 23 | Legal Assessment:
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| 24 | VII. Current Substance Abuse Problems:
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| 25 | Comments on Substance Abuse:
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| 26 | VIII. Psycho-Social Assessment:
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| 27 | IX. Preliminary List of Problems
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| 28 | Initial Plan of Action
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| 29 | 3. MILITARY HISTORY
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| 30 | 4. SOCIAL/FAMILY RELATIONSHIPS
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| 31 | 5. LEGAL SITUATION
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| 32 | 6. CURRENT SUBSTANCE ABUSE
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| 33 | 7. PRELIMINARY PROBLEMS
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| 34 | 8. PSYCHO-SOCIAL ASSESSMENT
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| 35 | Enter number(s) to enter/edit i.e => 1 or 1,8 or All or
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| 36 | Do you want to print Assessment data
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| 37 | Enter the number of the category for this patient you want to enter/edit.
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| 38 | For example if you want to enter/edit the categories
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| 39 | Enter the number
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| 40 | i.e. 2,3 separated by comma or enter any
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| 41 | combination of numbers separated by commas or if all categories are to be
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| 42 | edited, press carriage return for default of
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| 43 | . VALID NUMBERS ARE 1-8.
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| 44 | INVALID CATEGORY NUMBER(s) ! Do you want to try again
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| 45 | CLINICAL SUPERVISOR'S REPORT
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| 46 | Task Queued to Print !
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| 47 | PG.
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| 48 | CLINICAL SUPERVISORY REPORT
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| 49 | PLANNING DATE
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| 50 | NOTE DATE
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| 51 | 1. CLOSING NOTES
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| 52 | 2. DISCHARGE PLANNING
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| 53 | ENTER 1, 2 OR 'ALL' FOR BOTH NOTES TO PRINT or '^' to EXIT:
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| 54 | CLOSING NOTE:
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| 55 | AFTER CARE PLAN:
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| 56 | OPEN DATE:
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| 57 | CLOSED DATE:
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| 58 | NOTE ENTERED:
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| 59 | SERVICES OFFERED:
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| 60 | DISCHARGE PLAN:
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| 61 | DISCHARGE PLAN ENTERED:
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| 62 | CLOSING
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| 63 | DISCHARGE PLANNING
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| 64 | WARD/BED:
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| 65 | PROBLEMS:
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| 66 | INITIAL PLAN OF ACTION:
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| 67 | SELECT SURROGATE SUPERVISOR:
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| 68 | SELECT SURROGATED SUPERVISOR:
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| 69 | YOU CANNOT BE YOUR OWN SURROGATE !
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| 70 | DO YOU WANT TO TRY AGAIN
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| 71 | DIRECT SERVICES PROVIDED FROM:
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| 72 | DIRECT SERVICES REPORT
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| 73 | DIRECT SERVICES CATEGORY FOR
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| 74 | COMPLETE SERVICE
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| 75 | Do you want Complete Service
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| 76 | Enter 'YES' to print the complete service.
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| 77 | Do you want report by Supervisor
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| 78 | Enter 'YES' to print the report by supervisor
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| 79 | Enter Supervisor's last name
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| 80 | To print the report for a supervisor, enter the supervisor's last name.
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| 81 | Enter Social Worker's last name
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| 82 | To print the report for a worker, enter the worker's last name.
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| 83 | 'Y' for Yes
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| 84 | 'N' for No
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| 85 | Enter RCH:
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| 86 | INQUIRY INTO RCH FILE REPORT
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| 87 | RCH HOME REGISTRY FOR A SINGLE HOME:
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| 88 | 1. ALL HOMES
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| 89 | 2. A SINGLE HOME ?
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| 90 | ENTER 1 or 2 1//
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| 91 | ENTER RCH:
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| 92 | RESIDENTIAL CARE HOME REPORT
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| 93 | Enter the number one (1) if all homes are to print, else enter the number
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| 94 | two (2) for an individual home.
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| 95 | Do you want to screen Now (One to seven days)
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| 96 | Enter 'YES' to run current date or up to seven days in the past.
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| 97 | There were no possible High-Risk patients found for SOCIAL WORK SERVICE !
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| 98 | or OLDER -
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| 99 | NSC INSURANCE COVERAGE -
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| 100 | FEMALE -
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| 101 | AGE 70 or greater and 2 or more OPT clinics -
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| 102 | GENERAL DELIVERY
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| 103 | GENERAL DELIVERY ADDRESS -
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| 104 | NO ADDRESS -
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| 105 | NO TEMPORARY ADDRESS -
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| 106 | HIGH-RISK WARD -
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| 107 | IRREGULAR DISCHARGE -
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| 108 | READMITTED WITHIN ONE MONTH -
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| 109 | PREVIOUS SPECIAL POPULATION PATIENT -
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| 110 | HOME DIALYSIS -
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| 111 | HBHC -
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| 112 | SCI HOME CARE -
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| 113 | OTHER HOME BASED PROGRAMS -
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| 114 | ADMISSION DUE TO ACCIDENT -
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| 115 | INCOME LESS THAN LOCAL AMOUNT
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| 116 | SEEN BY SOCIAL WORK & LOCATION RCH or CNH -
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| 117 | OPENED:
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| 118 | SOCIAL WORK HIGH RISK SCREENING PROFILE
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| 119 | WORKER:
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| 120 | SOCIAL WORKER: CASE NOT OPENED TO SOCIAL WORK SERVICE
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| 121 | DATE ADMITTED:
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| 122 | DATE SCREENED:____________
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| 123 | PATIENT ADDRESS:
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| 124 | PATIENT ADDRESS UNAVAILABLE
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| 125 | NOK NAME:
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| 126 | NOK ADDRESS:
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| 127 | ADDITIONAL CONTACTS:
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| 128 | MARITAL STATUS:
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| 129 | EMPLOYMENT STATUS:
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| 130 | INSURANCE COVERAGE:
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| 131 | VETERANS STATUS:
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| 132 | HB
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| 133 | SC CONDITION:
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| 134 | ADMISSION DIAGNOSIS:
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| 135 | LOCATION LAST VA TREATMENT:
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| 136 | POSITIVE SCREENING CRITERIA:
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| 137 | SOCIAL WORKER ASSESSMENT & PLAN:
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| 138 | ROOM NO.:
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| 139 | Social Worker
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| 140 | UNEARNED INCOME (Current):
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| 141 | DISABILITY PAYMENT
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| 142 | HB AMOUNT
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| 143 | VA PENSION
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| 144 | INCOME SCREENING (
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| 145 | INTEREST,DIVIDEND,ANNUITY
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| 146 | SOCIAL SECURITY (Includes SSI)
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| 147 | WORKERS COMP OR BLACK LUNG
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| 148 | *ALL OTHER INCOME
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| 149 | TOTAL INCOME:
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| 150 | *-This total may include amounts already listed under current 'UNEARNED INCOME'.
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| 151 | BEGINNING SCREEN DATE:
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| 152 | This report is formatted for 80 columns and must be sent to a printer.
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| 153 | MANUAL HIGH-RISK SCREENING REPORT
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| 154 | HOME DIAYLSIS -
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| 155 | Do you want Complete Service
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| 156 | THERE IS NOTHING TO REPORT FOR LOCATION OF PATIENTS BY COST CENTERS
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| 157 | THERE IS NOTHING TO REPORT ON AMIS LOCATIONS FOR
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| 158 | SUPERVISOR
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| 159 | SOCIAL WORKER
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| 160 | LOCATION OF PATIENTS BY COST CENTERS
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| 161 | SOCIAL WORK DIVISIONAL LOCATION OF PATIENTS BY COST CENTERS REPORT
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| 162 | COMPLETE SERVICE for DIVISION
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| 163 | PATIENT INQUIRY REPORT
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| 164 | DELETING SW POSITIONS FILE (#654)
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| 165 | XMQ-SWA
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| 166 | XMQ-SWM
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| 167 | XMQ-SWK
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| 168 | INSTALLING SECURITY KEY '
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| 169 | ' FOR SOCIAL WORK DATA TRANSMISSION
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| 170 | HOLDERS WILL HAVE TO BE ADDED
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| 171 | INSTALLING RELAY DOMAIN 'Q-SWA.VA.GOV' FOR SOCIAL WORK DATA TRANSMISSION...
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| 172 | INSTALLING RELAY DOMAIN 'Q-RHC.VA.GOV' FOR SOCIAL WORK DATA TRANSMISSION...
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| 173 | INSTALLING MAIL GROUP 'SWA' TO RECEIVE SOCIAL WORK TRANSMISSION CONFIRMATION...
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| 174 | MEMBERS WILL HAVE TO BE ADDED...
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| 175 | INSTALLING RELAY DOMAIN 'Q-SWM.VA.GOV' FOR SOCIAL WORK DATA TRANSMISSION...
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| 176 | INSTALLING MAIL GROUP 'RHC' TO RECEIVE SOCIAL WORK TRANSMISSION CONFIRMATION...
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| 177 | INSTALLING MAIL GROUP 'SWM' TO RECEIVE SOCIAL WORK TRANSMISSION CONFIRMATION...
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| 178 | Are You:
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| 179 | 1. Adding and Replacing a Worker
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| 180 | Enter 1 or 2 1//
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| 181 | SELECT NEW WORKER:
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| 182 | INCOMPLETE WORKER INFORMATION!! DATA NOT ADDED.
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| 183 | WHICH WORKER TO REPLACE ?
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| 184 | ARE YOU SURE YOU WANT TO REPLACE THIS WORKER
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| 185 | REPLACEMENT WORKER ?
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| 186 | WORKERS INFORMATION MUST BE COMPLETE
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| 187 | Entering the number one (1) will allow you to add a new worker and then assign
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| 188 | that new worker a current worker's case load.
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| 189 | The number two (2) allows you to assign a current worker's case load to another current worker.
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| 190 | PLEASE ENTER SOCIAL WORK SITE PARAMETERS !!!
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| 191 | SELECT DIVISION:
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| 192 | Open date
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| 193 | CASE FOR
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| 194 | IS ALREADY OPENED BY
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| 195 | HOMES MUST BE ADDED. THIS ENTRY WILL BE DELETED
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| 196 | DO YOU WANT TO CLOSE CASE
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| 197 | DO YOU WANT TO OPEN ANOTHER NEW CASE
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| 198 | Was this a High Risk Patient
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| 199 | SELECT HOME:
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| 200 | INCOMPLETE DATA!! RECORD DELETED.
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| 201 | DELETING OLD NAMESPACE (SW) SORT TEMPLATES...
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| 202 | Sort Template...<DELETED>
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| 203 | DELETING OLD NAMESPACE (SW) INPUT TEMPLATES...
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| 204 | Input Temple...<DELETED>
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| 205 | DELETING OLD NAMESPACE (SW) PRINT TEMPLATES...
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| 206 | Print Template...<DELETED>
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| 207 | DELETING OLD NAMESPACE (SW) OPTIONS...
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| 208 | Menu Option...<DELETED>
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| 209 | DELETING OBSOLETE OPTIONS...
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| 210 | Option to re-index the 'CP' and 'BS5' x-refs in file #650
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| 211 | Option QUEUED to run
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| 212 | BE SURE LABELS ARE IN PRINTER PROPERLY
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| 213 | WHEN READY PRESS RETURN OR ENTER KEY. ARE YOU READY
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| 214 | RESIDENTIAL CARE HOME ADDRESS LIST
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| 215 | LABELS WILL PRINT LATER
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| 216 | Problems and Outcomes Report
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| 217 | NOT ATTAINED
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| 218 | PROB.
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| 219 | NOT TO TREAT
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| 220 | CR BARR.
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| 221 | VAMC BARR.
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| 222 | NOTE: P/F=PATIENT/FAMILY, CR=COMMUNITY RESOURCES, BARR.=BARRIERS
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| 223 | DIVISONAL PROBLEMS AND OUTCOME REPORT
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| 224 | NOTE: P/F=PATIENT/FAMILY, CR=COMMUNITY RESOURCES, BARR.=BARRIERS
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| 225 | PRINT ALL AMIS REPORTS OPTION
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| 226 | RCH PATIENT REGISTRY FOR ALL OPEN CASES FOR A SINGLE WORKER
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| 227 | COMPLETE: OPEN CASES
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| 228 | SUMMARY: OPEN CASES
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| 229 | RCH PATIENT REGISTRY FOR ALL CASES
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| 230 | PATIENT STATUS REPORT
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| 231 | RESOURCES/REFERRALS
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| 232 | THERE IS DATA IN THE SOCIAL WORK CASE FILE. DO YOU WANT TO CONTINUE
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| 233 | INSTALLATION TERMINATED !
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| 234 | DO YOU WANT TO DELETE OLD NAMESPACE (SW) TEMPLATES AND OPTIONS NOW
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| 235 | IF 'YES' ALL SOCIAL WORK CASE DATA WILL BE DELETED.
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| 236 | IF 'NO' THE INSTALL WILL TERMINATE, BUT ALL CASES MUST BE CLOSED,
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| 237 | TRANSMITTED TO AUSTIN, AND CASE DATA MUST BE PURGED.
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| 238 | RCH PATIENT REGISTRY FOR ALL OPEN CASES
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| 239 | Ending date must be after starting date
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| 240 | QUALITY MGMT. MONITOR I REPORT - SOCIAL WORK
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| 241 | DISCHARGE PLANNING
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| 242 | FAMILY CONFERENCE
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| 243 | Quality Management Monitor II
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| 244 | Family involvement in Discharged Planning
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| 245 | Total Patients
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| 246 | Family Conference
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| 247 | % rec'd Family Conference
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| 248 | QUALITY MGMT. MONITOR III REPORT - SOCIAL WORK
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| 249 | Quality Management Monitor III
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| 250 | Timeliness of service to patients receiving discharge planning
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| 251 | # PTS REC'D
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| 252 | DISCH. PLAN.
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| 253 | AVG. # ELAPSED DAYS
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| 254 | QUALITY MGMT. MONITOR IV REPORT - SOCIAL WORK
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| 255 | Quality Management Monitor IV
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| 256 | Level of problem resolution by problem code
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| 257 | Worker's #:
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| 258 | Resolutions
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| 259 | Occurred
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| 260 | QUALITY MGMT. MONITOR V REPORT - SOCIAL WORK
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| 261 | Quality Management Monitor V
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| 262 | Access to Social Work Services by Location
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| 263 | Total # Patients
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| 264 | Treatment Episodes
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| 265 | POST DISCHARGE FOLLOW-UP
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| 266 | Quality Management Monitor I
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| 267 | Follow-up of discharged inpatients who received
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| 268 | Discharged Planning
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| 269 | and had
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| 270 | Problems related to care
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| 271 | Post Discharge Follow-up
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| 272 | QUALITY MGMT. REVIEW I REPORT - SOCIAL WORK
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| 273 | Quality Management Review I
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| 274 | Non-Followup of discharged inpatients who received
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| 275 | Date Opened
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| 276 | QUALITY MGMT. REVIEW III REPORT - SOCIAL WORK
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| 277 | Avg. # Elapsed Days:
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| 278 | Quality Management Review III
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| 279 | Worker's #
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| 280 | Elapsed Days
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| 281 | QUALITY MANAGEMENT REVIEW IV REPORT - SOCIAL WORK
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| 282 | Quality Management Review IV
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| 283 | Unresolved problems
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| 284 | QUALITY MGMT. REVIEW II REPORT - SOCIAL WORK
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| 285 | Quality Management Review II
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| 286 | RCH AMIS 256 FROM
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| 287 | RESIDENTIAL CARE HOME AMIS REPORT
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| 288 | CASES OPENED DURING QUARTER
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| 289 | CASES CLOSED DURING QUARTER
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| 290 | TOTAL CASES TREATED
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| 291 | PREVIOUS LIVING ARRANGEMENTS
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| 292 | VA CARE
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| 293 | VAH EXCESS
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| 294 | VA DOM
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| 295 | VA CNH
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| 296 | VA NH
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| 297 | VA RES.
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| 298 | NON NH
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| 299 | LEVEL OF CARE CAPACITY
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| 300 | SPECIAL PATIENT POPULATION
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| 301 | RCS AMIS REPORT 10-0173
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| 302 | RCS 10-0173 AMIS REPORT
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| 303 | #################### #################### ####################
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| 304 | #################### #################### ####################
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| 305 | #################### #################### ####################
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| 306 | #################### #################### ####################
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| 307 | #################### #################### ####################
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