| [604] | 1 | English French  Notes   Complete/Exclude
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 | 2 |  8. Other Procedures CPT Code:                  
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 | 3 |  9. Preoperative Risk Factors:                  
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 | 4 | 10. Cardiac Surgery to Non-VA Facility:                         
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 | 5 | Select Operative Risk Summary Information to Edit:                      
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 | 6 | 2. Enter the corresponding number to update the information in a particular                     
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 | 7 |    field.  (For example, enter '3' to update Surgical Priority)                 
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 | 8 | 3. Enter two numbers separated by a ':' to enter a range of information.                        
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 | 9 |    (For example, enter '1:2' to update Physician's Preoperative Estimate of                     
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 | 10 |    Mortality and ASA Classification.)                   
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 | 11 | Enter/Edit Patient Resource Data                        
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 | 12 | 1. Capture Information from PIMS Records                        
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 | 13 | 2. Enter, Edit, or Review Information                   
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 | 14 | Enter '1' if you want to capture patient information from PIMS                  
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 | 15 | records.  Enter '2' if you want to enter, edit, or review patient                       
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 | 16 | other information on this screen.                       
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 | 17 | No Study                        
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 | 18 | Unable to determine                     
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 | 19 | Remains intubated at 30 days                    
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 | 20 | Remains in ICU at 30 days                       
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 | 21 | Are you sure you want to retrieve information from PIMS records ?                       
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 | 22 | 4. Enter 'N' or 'NO' to enter negative response for all items.                  
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 | 23 | 5. Enter '@' to delete information from all items.                      
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 | 24 | To identify the date and time the patient was discharged from intensive                 
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 | 25 | care following surgery, see the following list of patient movements                     
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 | 26 | that occurred during the inpatient stay associated with this surgery.                   
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 | 27 | CABG Distal Anastomoses                 
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 | 28 | 14. Cardiac Transplant:                 
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 | 29 |  1. Number with Vein:                   
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 | 30 | 15. Electrophysiologic Procedure:                       
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 | 31 |  2. Number with IMA:                    
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 | 32 | 16. Misc. Cardiac Procedures:                   
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 | 33 |  3. Number with Radial Artery:                  
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 | 34 | A. ASD Repair:                  
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 | 35 |  4. Number with Other Artery:                   
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 | 36 | B. VSD Repair:                  
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 | 37 |  5. Number with Other Conduit:                  
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 | 38 | C. Myxoma Resection:                    
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 | 39 | D. Foreign Body Removal:                        
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 | 40 |  6. Aortic Valve Replacement:                   
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 | 41 | E. Myectomy for IHSS:                   
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 | 42 |  7. Mitral Valve Replacement:                   
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 | 43 |  8. Tricuspid Valve Replacement:                        
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 | 44 | G. Other Tumor Resection:                       
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 | 45 |  9. Valve Repair:                       
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 | 46 | H. Other Procedure(s):                  
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 | 47 | 10. LV Aneurysmectomy:                  
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 | 48 | 17. Minimally Invasive Procedure:                       
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 | 49 | 11. Great Vessel Repair (Req CPB):                      
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 | 50 | 18. Batista Procedure:                  
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 | 51 | 12. Total Ischemic Time:                        
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 | 52 | 19. Incision Type:                      
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 | 53 | 13. Total CPB Time:                     
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 | 54 | 20. Convert Off Pump to CPB:                    
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 | 55 | * Other Procedures List:                        
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 | 56 | Miscellaneous Cardiac Procedures                        
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 | 57 |    Sure you want to delete all Misc. Cardiac Procedures information ?                   
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 | 58 |  1. Operative Death:                    
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 | 59 |  2. Date of Death:                      
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 | 60 |  3. Perioperative MI:                   
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 | 61 |  5. Renal Failure Requiring Dialysis:                   
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 | 62 |  6. Low Cardiac Output  > or = 6 Hours:                 
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 | 63 |  8. Reoperation for Bleeding:                   
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 | 64 |  9. On Ventilator > or = 48 Hours:                      
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 | 65 | 10. Repeat Cardiopulmonary Bypass:                      
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 | 66 | 13. Cardiac Arrest Requiring CPR:                       
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 | 67 | PAGE: 2 OF 2                    
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 | 68 | 1. WOUND COMPLICATIONS:                 
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 | 69 | 4. CNS COMPLICATIONS:                   
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 | 70 |    A. Superficial Infection:                    
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 | 71 |    A. Cerebral Vascular Accident:                       
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 | 72 |    B. Deep Wound Infection:                     
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 | 73 |    C. Wound Dehiscence:                 
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 | 74 |    C. Neurological Deficits:                    
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 | 75 | 2. RESPIRATORY COMPLICATIONS:                   
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 | 76 | 5. CARDIAC COMPLICATIONS:                       
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 | 77 |    A. Arrest Requiring CPR:                     
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 | 78 |    B. Unplanned Intubation:                     
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 | 79 |    B. Myocardial Infarction:                    
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 | 80 |    C. Pulmonary Embolism:                       
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 | 81 |    C. Pulmonary Edema:                  
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 | 82 |    D. On Ventilator > 48 Hours:                 
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 | 83 | 3. URINARY TRACT COMPLICATIONS:                         
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 | 84 | 6. OTHER COMPLICATIONS:                 
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 | 85 |    A. Renal Insufficiency:                      
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 | 86 |    A. Ileus/Bowel Obstruction:                  
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 | 87 |    B. Acute Renal Failure:                      
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 | 88 |    C. Urinary Tract Infection:                  
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 | 89 |    C. Graft/Prosthesis Failure:                 
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 | 90 |    E. Systemic Sepsis:                  
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 | 91 |  mm Hg                  
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 | 92 |  2. Aortic Systolic Pressure:                   
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 | 93 |  3. *PA Systolic Pressure:                      
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 | 94 |  4. *PAW Mean Pressure:                 
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 | 95 |  5. Left Main Stenosis:                 
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 | 96 |  6. LAD Stenosis:                       
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 | 97 |  7. Right Coronary Stenosis:                    
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 | 98 |  8. Circumflex Stenosis:                        
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 | 99 |  9. LV Contraction Grade  (from contrast                        
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 | 100 |     or radionuclide angiogram or 2D echo):                      
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 | 101 | 10. Mitral Regurgitation:                       
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 | 102 | II  0.45-0.54    MILD DYSFUNCTION                       
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 | 103 | III  0.35-0.44  MODERATE DYSFUNCTION                    
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 | 104 | IIIa 0.40-0.44 MODERATE DYSFUNCTION A                   
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 | 105 | IIIb                    
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 | 106 | IIIb 0.35-0.39 MODERATE DYSFUNCTION B                   
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 | 107 | IV  0.25-0.34  SEVERE DYSFUNCTION                       
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 | 108 | V  <0.25  VERY SEVERE DYSFUNCTION                       
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 | 109 | NO LV STUDY                     
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 | 110 | This assessment has already been verified and transmitted.  It cannot be                        
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 | 111 | deleted.  If the assessment was transmitted in error, use the option 'Update                    
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 | 112 | an Assessment Transmitted in Error'.                    
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 | 113 | This assessment has already been verified.  It cannot be deleted.  If the                       
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 | 114 | assessment was verified in error, use the option 'Update an Assessment Verified                 
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 | 115 | in Error'.                      
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 | 116 | This assessment has a current status of                         
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 | 117 | Enter <RET> if this assessment was selected in error and should not be deleted.                 
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 | 118 | If you want to delete this assessment, enter 'YES'.                     
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 | 119 | Deleting Assessment...                  
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 | 120 | SUPERVISOR CODES: 1-STAFF CASE, 2-STAFF ASSISTED BY RESIDENT OR C.R.N.A.,  3-STAFF ASSISTING C.R.N.A.,  4-STAFF ASSISTING RESIDENT                      
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 | 121 | 5-STAFF CONSULTING IN OR, 6-STAFF AVAILABLE IN OR SUITE, 7-STAFF AVAILABLE IN HOSP./UNIV. COMPLEX                       
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 | 122 | 8-STAFF CALLED FOR EMERGENCY, 9-C.R.N.A. INDEPENDENT DUTY MD/DDS SUP.                   
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 | 123 | Anesthesia Provider Report                      
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 | 124 | Do you want to print the report for all Anesthesia Providers ? YES//                    
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 | 125 | Enter RETURN to print the report for all anesthesia providers, or 'NO'                  
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 | 126 | to select a specific anesthesia provider.                       
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 | 127 | Print the report for which Anesthesia Provider ?                        
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 | 128 | ANESTHESIA PROVIDER REPORT                      
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 | 129 | SRPRO*                  
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 | 130 | ASA CLASS                       
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 | 131 | LEVEL OF SUPERVISION                    
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 | 132 | RELIEF ANESTH                   
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 | 133 | PRINCIPAL TECHNIQUE                     
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 | 134 | ELAPSED ANES TIME                       
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 | 135 | ASST ANESTH                     
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 | 136 | ANESTHESIA AGENT                        
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 | 137 | Press RETURN to continue, '^' to quit                   
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 | 138 | Are you sure that you want to change the status of this assessment                      
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 | 139 | The Assessment Status has been changed to 'INCOMPLETE'.                 
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 | 140 | This assessment already has the status, 'INCOMPLETE'.                   
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 | 141 | Enter RETURN if the assessment was                      
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 | 142 |  in error and the status                        
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 | 143 | should be changed to 'INCOMPLETE' to allow editing.  Otherwise, enter 'NO'.                     
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 | 144 | ADD ON TODAY (NONEMERGENT)                      
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 | 145 | 1. Exclusion Criteria:                  
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 | 146 | 2. Surgical Priority:                   
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 | 147 | 3. Surgical Specialty:                  
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 | 148 | 4. Principal Operation (CPT):                   
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 | 149 | 5. Principal Anesthesia Technique:                      
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 | 150 | 6. Major or Minor:                      
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 | 151 | Select Excluded Case Information to Edit:                       
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 | 152 | 2. Enter a number (1-6) to update the information in that field.  (For                  
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 | 153 |    example, enter '2' to update Surgical Priority)                      
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 | 154 | 3. Enter a range of numbers (1-6) separated by a ':' to enter a range of                        
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 | 155 |    information.  (For example, enter '1:2' to update the Exclusion Criteria                     
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 | 156 |    and Surgical Priority)                       
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 | 157 | Reason for not Creating an Assessment                   
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 | 158 | This selection loads the most recent lab data for tests performed                       
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 | 159 | within 90 days before the operation.                    
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 | 160 | Do you want to automatically load preoperative lab data ?  YES//                        
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 | 161 | Enter <RET> to automatically load preoperative lab data from the patient's lab record, or 'NO' to return to the menu.                   
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 | 162 | Lab data NOT loaded.                    
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 | 163 | The 'Time the Operation Began' must be entered before continuing.                       
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 | 164 | ..Searching lab record for latest preoperative test data....                    
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 | 165 | Do you want to enter 'Time the Operation Began' at this time ?  YES//                   
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 | 166 | The time that the operation began must be entered prior to capturing the                        
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 | 167 | preoperative lab data.  Enter 'YES' to input 'Time the Operation Began',                        
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 | 168 | or 'NO' to return to the menu.                  
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 | 169 | ..Moving preoperative lab test data to Surgery Risk Assessment file....                 
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 | 170 | This selection loads highest or lowest lab data for tests performed within                      
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 | 171 | 30 days after the operation.                    
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 | 172 | Do you want to automatically load postoperative lab data ?  YES//                       
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 | 173 | Enter <RET> to automatically load postoperative lab data from the patient's lab record, or 'NO' to return to the menu.                  
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 | 174 | 'Time the Operation Ends' must be entered before continuing.                    
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 | 175 | ..Searching lab record for postoperative lab test data....                      
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 | 176 | Do you want to enter the time that the operation was completed at                       
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 | 177 | this time ?  YES//                      
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 | 178 | Enter 'YES' to input 'Time the Operation Ends' or                       
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 | 179 | 'NO' to return to the menu.                     
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 | 180 | ..Moving postoperative lab data to Surgery Risk Assessment file....                     
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 | 181 | You must select a surgery risk assessment prior to using this option.                   
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 | 182 | Enter/Edit Laboratory Test Results                      
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 | 183 | 1. Capture Preoperative Laboratory Information                  
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 | 184 | 2. Capture Postoperative Laboratory Information                 
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 | 185 | 3. Enter, Edit, or Review Laboratory Test Results                       
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 | 186 | Enter '1' if you want to capture preoperative laboratory test results from the                  
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 | 187 | DHCP Laboratory records.  Enter '2' if you want to capture the postoperative                    
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 | 188 | laboratory test results from the DHCP Laboratory records.  If you want to                       
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 | 189 | enter, edit, or review preoperative and postoperative laboratory test results,                  
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 | 190 | If you want to continue listing incomplete assessments, enter <RET>.  Enter                     
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 | 191 | '^' to return to the menu.                      
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 | 192 | COMPLETED RISK ASSESSMENTS                      
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 | 193 | ASSESSMENT #                    
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 | 194 | OPERATION DATE                  
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 | 195 | PRINCIPAL OPERATION                     
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 | 196 | ANESTHESIA TECHNIQUE                    
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 | 197 | SURGERY SERVICE                 
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 | 198 | PRINCIPAL OPERATIVE PROCEDURE                   
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 | 199 | DATE COMPLETED                  
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 | 200 | ** SURGICAL SPECIALTY:                  
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 | 201 | PAGE: 1 OF 2                    
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 | 202 | PREOP LABORATORY RESULTS                        
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 | 203 | LATEST PREOP LAB RESULTS IN 90 DAYS PRIOR TO SURGERY                    
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 | 204 |  1. Serum Sodium:                       
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 | 205 |  3. Serum Creatinine:                   
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 | 206 |  4. Serum Albumin:                      
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 | 207 |  5. Total Bilirubin:                    
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 | 208 |  7. Alkaline Phosphatase:                       
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 | 209 | 10. Platelet Count:                     
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 | 210 | Select Preoperative Laboratory Information to Edit:                     
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 | 211 | 2. Enter a number (1-12) to update the information in that field.  (For                 
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 | 212 |    example, enter '2' to update Preoperative BUN)                       
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 | 213 | 3. Enter a range of numbers (1-12) separated by a ':' to enter a range of                       
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 | 214 |    BUN, and Serum Creatinine)                   
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 | 215 | Report of Monthly Case Workload Totals                  
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 | 216 | This option provides a report of the monthly risk assessment surgical case                      
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 | 217 | workload totals for the following categories:                   
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 | 218 | 1. All cases performed                  
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 | 219 | 2. Excluded cases                       
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 | 220 | 3. Assessed cases                       
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 | 221 | 4. Non-assessed cases                   
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 | 222 | 5. Cardiac cases                        
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 | 223 | 6. Non-cardiac cases                    
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 | 224 | 7. Assessed cases per day (based on 20 days/month)                      
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 | 225 | This report may be printed and/or transmitted to the national database.                 
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 | 226 | Compile workload totals for which month and year?                       
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 | 227 | Enter the month and year for which to run this report,                  
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 | 228 | for example, 'MAY 94', 'MAY 1994', '5/94' or '5 94'.                    
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 | 229 | Compile totals for                      
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 | 230 | Do you want this report to be transmitted to the central database                       
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 | 231 | Enter YES to have this report automatically transmitted to the central                  
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 | 232 | database.  Enter NO if you do NOT want this report transmitted.                 
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 | 233 | Do you also want to print this report                   
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 | 234 | Enter NO if you want to have this report transmitted, but do not want to                        
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 | 235 | have it printed.  Enter YES if you do want to print the report as well as                       
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 | 236 | have it transmitted.                    
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 | 237 | Print report on which Device:                   
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 | 238 | Report of Surgical Case Workload                        
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 | 239 | Queue report to run at what date/time?                  
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 | 240 | One month ago, you had an operation at the VA Medical Center.  We are                   
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 | 241 | interested in how you feel.  Have you had any health problems since your                        
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 | 242 | operation ?  We would like to hear from you.  Please take a few minutes                 
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 | 243 | to answer these questions and return this letter in the self-addressed                  
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 | 244 | stamped envelope.                       
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 | 245 | Have you been to a hospital or seen a doctor for any reason since your                  
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 | 246 | If you answered NO, you do not need to answer any more questions.  Please                       
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 | 247 | return this sheet in the self-addressed stamped envelope.                       
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 | 248 | If you have answered YES, please answer the following questions.                        
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 | 249 | 1) Have you been seen in an outpatient clinic or doctor's office ?                      
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 | 250 | Why did you go to the clinic or doctor's office ? ________________                      
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 | 251 | Where ? (name and location) _____________________  Date ? ________                      
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 | 252 | Who was your doctor ? ____________________________________________                      
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 | 253 | 2) Were you admitted to a hospital ?  ___ Yes  ___ No                   
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 | 254 | Why did you go to the hospital ? _________________________________                      
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 | 255 | Please return this letter whether or not you have had any medical problems.                     
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 | 256 | Your health and opinion are important to us.  Thank You.                        
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 | 257 | Surgical Clinical Nurse Reviewer                        
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 | 258 | NO ASSESSMENT                   
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 | 259 | CPT CODE MISSING                        
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 | 260 | NON-ASSESSED MAJOR SURGICAL CASES BY SURGICAL SPECIALTY                 
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 | 261 | ALL MAJOR SURGICAL CASES BY SURGICAL SPECIALTY                  
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 | 262 | OPERATIVE PROCEDURE(S)                  
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 | 263 | ASSESSMENT STATUS                       
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 | 264 | EXCLUSION CRITERIA                      
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 | 265 | PRINCIPAL CPT CODE                      
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 | 266 | NON-ASSESSED MAJOR SURGICAL CASES                       
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 | 267 | ALL MAJOR SURGICAL CASES                        
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 | 268 | SRA,$J)                 
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 | 269 | TOTAL MAJOR CASES FOR ALL SPECIALTIES:                  
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 | 270 | If you want to continue listing assessments, enter <RET>.  Enter '^' to                 
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 | 271 | return to the menu.                     
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 | 272 | TOTAL CASES FOR ALL SPECIALTIES:                        
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 | 273 | SURGICAL SPECIALTY:                     
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 | 274 | COMPLETED/TRANSMITTED ASSESSMENTS MISSING INFORMATION                   
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 | 275 | NON-CARDIAC                     
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 | 276 | Missing information:                    
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 | 277 | OPERATION(S)                    
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 | 278 | TOTAL FOR ALL SPECIALTIES:                      
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 | 279 | Select Postoperative Laboratory Information to Edit:                    
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 | 280 |    example, enter '5' to update Highest Serum Creatinine)                       
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 | 281 |    Lowest Serum Sodium, and Highest Potassium)                  
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 | 282 | POSTOP LAB RESULTS WITHIN 30 DAYS AFTER SURGERY                 
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 | 283 |  1. Highest Serum Sodium:                       
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 | 284 |  2. Lowest Serum Sodium:                        
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 | 285 |  3. Highest Potassium:                  
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 | 286 |  4. Lowest Potassium:                   
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 | 287 |  5. Highest Serum Creatinine:                   
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 | 288 |  6. Highest CPK:                        
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 | 289 |  7. Highest CPK-MB Band:                        
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 | 290 |  8. Highest Total Bilirubin:                    
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 | 291 |  9. Highest WBC:                        
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 | 292 | 10. Lowest Hematocrit:                  
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 | 293 | 11. Highest Troponin I:                 
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 | 294 | 12. Highest Troponin T:                 
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 | 295 | Select Operation:                       
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 | 296 | Enter the number corresponding to the surgical case for which you will be                       
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 | 297 | creating a surgical risk assessment.                    
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 | 298 | 1. Enter Information                    
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 | 299 | 2. Review Information                   
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 | 300 | 3. Delete Surgery Case                  
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 | 301 | Select Number:  1//                     
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 | 302 | Enter RETURN or '1' to enter or edit information contained within one of the                    
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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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