English	French	Notes	Complete/Exclude
 8. Other Procedures CPT Code:			
 9. Preoperative Risk Factors: 			
10. Cardiac Surgery to Non-VA Facility: 			
Select Operative Risk Summary Information to Edit: 			
2. Enter the corresponding number to update the information in a particular			
   field.  (For example, enter '3' to update Surgical Priority)			
3. Enter two numbers separated by a ':' to enter a range of information.			
   (For example, enter '1:2' to update Physician's Preoperative Estimate of			
   Mortality and ASA Classification.)			
Enter/Edit Patient Resource Data			
1. Capture Information from PIMS Records			
2. Enter, Edit, or Review Information			
Enter '1' if you want to capture patient information from PIMS			
records.  Enter '2' if you want to enter, edit, or review patient			
other information on this screen.			
No Study			
Unable to determine			
Remains intubated at 30 days			
Remains in ICU at 30 days			
Are you sure you want to retrieve information from PIMS records ? 			
4. Enter 'N' or 'NO' to enter negative response for all items.			
5. Enter '@' to delete information from all items.			
To identify the date and time the patient was discharged from intensive			
care following surgery, see the following list of patient movements			
that occurred during the inpatient stay associated with this surgery.			
CABG Distal Anastomoses			
14. Cardiac Transplant:			
 1. Number with Vein:			
15. Electrophysiologic Procedure:			
 2. Number with IMA:			
16. Misc. Cardiac Procedures:			
 3. Number with Radial Artery:			
A. ASD Repair:			
 4. Number with Other Artery:			
B. VSD Repair:			
 5. Number with Other Conduit:			
C. Myxoma Resection:			
D. Foreign Body Removal:			
 6. Aortic Valve Replacement:			
E. Myectomy for IHSS:			
 7. Mitral Valve Replacement:			
 8. Tricuspid Valve Replacement:			
G. Other Tumor Resection:			
 9. Valve Repair:			
H. Other Procedure(s):			
10. LV Aneurysmectomy:			
17. Minimally Invasive Procedure: 			
11. Great Vessel Repair (Req CPB):			
18. Batista Procedure:			
12. Total Ischemic Time:			
19. Incision Type:			
13. Total CPB Time:			
20. Convert Off Pump to CPB:			
* Other Procedures List: 			
Miscellaneous Cardiac Procedures			
   Sure you want to delete all Misc. Cardiac Procedures information ? 			
 1. Operative Death:			
 2. Date of Death:			
 3. Perioperative MI:			
 5. Renal Failure Requiring Dialysis:			
 6. Low Cardiac Output  > or = 6 Hours:			
 8. Reoperation for Bleeding:			
 9. On Ventilator > or = 48 Hours:			
10. Repeat Cardiopulmonary Bypass:			
13. Cardiac Arrest Requiring CPR:			
PAGE: 2 OF 2			
1. WOUND COMPLICATIONS:			
4. CNS COMPLICATIONS:			
   A. Superficial Infection:			
   A. Cerebral Vascular Accident:			
   B. Deep Wound Infection:			
   C. Wound Dehiscence:			
   C. Neurological Deficits:			
2. RESPIRATORY COMPLICATIONS:			
5. CARDIAC COMPLICATIONS:			
   A. Arrest Requiring CPR:			
   B. Unplanned Intubation:			
   B. Myocardial Infarction:			
   C. Pulmonary Embolism:			
   C. Pulmonary Edema:			
   D. On Ventilator > 48 Hours:			
3. URINARY TRACT COMPLICATIONS: 			
6. OTHER COMPLICATIONS:			
   A. Renal Insufficiency: 			
   A. Ileus/Bowel Obstruction:			
   B. Acute Renal Failure:			
   C. Urinary Tract Infection:			
   C. Graft/Prosthesis Failure:			
   E. Systemic Sepsis: 			
 mm Hg			
 2. Aortic Systolic Pressure: 			
 3. *PA Systolic Pressure:			
 4. *PAW Mean Pressure:			
 5. Left Main Stenosis:			
 6. LAD Stenosis:			
 7. Right Coronary Stenosis:			
 8. Circumflex Stenosis:			
 9. LV Contraction Grade  (from contrast 			
    or radionuclide angiogram or 2D echo): 			
10. Mitral Regurgitation:			
II  0.45-0.54    MILD DYSFUNCTION			
III  0.35-0.44  MODERATE DYSFUNCTION			
IIIa 0.40-0.44 MODERATE DYSFUNCTION A			
IIIb			
IIIb 0.35-0.39 MODERATE DYSFUNCTION B			
IV  0.25-0.34  SEVERE DYSFUNCTION			
V  <0.25  VERY SEVERE DYSFUNCTION			
NO LV STUDY			
This assessment has already been verified and transmitted.  It cannot be			
deleted.  If the assessment was transmitted in error, use the option 'Update			
an Assessment Transmitted in Error'.			
This assessment has already been verified.  It cannot be deleted.  If the			
assessment was verified in error, use the option 'Update an Assessment Verified			
in Error'.			
This assessment has a current status of 			
Enter <RET> if this assessment was selected in error and should not be deleted.			
If you want to delete this assessment, enter 'YES'.			
Deleting Assessment...			
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			
5-STAFF CONSULTING IN OR, 6-STAFF AVAILABLE IN OR SUITE, 7-STAFF AVAILABLE IN HOSP./UNIV. COMPLEX			
8-STAFF CALLED FOR EMERGENCY, 9-C.R.N.A. INDEPENDENT DUTY MD/DDS SUP.			
Anesthesia Provider Report			
Do you want to print the report for all Anesthesia Providers ? YES// 			
Enter RETURN to print the report for all anesthesia providers, or 'NO'			
to select a specific anesthesia provider.			
Print the report for which Anesthesia Provider ?  			
ANESTHESIA PROVIDER REPORT			
SRPRO*			
ASA CLASS			
LEVEL OF SUPERVISION			
RELIEF ANESTH			
PRINCIPAL TECHNIQUE			
ELAPSED ANES TIME			
ASST ANESTH			
ANESTHESIA AGENT			
Press RETURN to continue, '^' to quit  			
Are you sure that you want to change the status of this assessment			
The Assessment Status has been changed to 'INCOMPLETE'.			
This assessment already has the status, 'INCOMPLETE'.			
Enter RETURN if the assessment was 			
 in error and the status			
should be changed to 'INCOMPLETE' to allow editing.  Otherwise, enter 'NO'.			
ADD ON TODAY (NONEMERGENT)			
1. Exclusion Criteria: 			
2. Surgical Priority:			
3. Surgical Specialty:			
4. Principal Operation (CPT):			
5. Principal Anesthesia Technique: 			
6. Major or Minor:			
Select Excluded Case Information to Edit: 			
2. Enter a number (1-6) to update the information in that field.  (For			
   example, enter '2' to update Surgical Priority)			
3. Enter a range of numbers (1-6) separated by a ':' to enter a range of			
   information.  (For example, enter '1:2' to update the Exclusion Criteria 			
   and Surgical Priority)			
Reason for not Creating an Assessment			
This selection loads the most recent lab data for tests performed			
within 90 days before the operation.			
Do you want to automatically load preoperative lab data ?  YES//  			
Enter <RET> to automatically load preoperative lab data from the patient's lab record, or 'NO' to return to the menu.			
Lab data NOT loaded.			
The 'Time the Operation Began' must be entered before continuing.			
..Searching lab record for latest preoperative test data....			
Do you want to enter 'Time the Operation Began' at this time ?  YES//  			
The time that the operation began must be entered prior to capturing the			
preoperative lab data.  Enter 'YES' to input 'Time the Operation Began',			
or 'NO' to return to the menu.			
..Moving preoperative lab test data to Surgery Risk Assessment file....			
This selection loads highest or lowest lab data for tests performed within			
30 days after the operation.			
Do you want to automatically load postoperative lab data ?  YES//  			
Enter <RET> to automatically load postoperative lab data from the patient's lab record, or 'NO' to return to the menu.			
'Time the Operation Ends' must be entered before continuing.			
..Searching lab record for postoperative lab test data....			
Do you want to enter the time that the operation was completed at 			
this time ?  YES//  			
Enter 'YES' to input 'Time the Operation Ends' or 			
'NO' to return to the menu.			
..Moving postoperative lab data to Surgery Risk Assessment file....			
You must select a surgery risk assessment prior to using this option.			
Enter/Edit Laboratory Test Results			
1. Capture Preoperative Laboratory Information			
2. Capture Postoperative Laboratory Information			
3. Enter, Edit, or Review Laboratory Test Results			
Enter '1' if you want to capture preoperative laboratory test results from the			
DHCP Laboratory records.  Enter '2' if you want to capture the postoperative			
laboratory test results from the DHCP Laboratory records.  If you want to 			
enter, edit, or review preoperative and postoperative laboratory test results,			
If you want to continue listing incomplete assessments, enter <RET>.  Enter			
'^' to return to the menu.			
COMPLETED RISK ASSESSMENTS			
ASSESSMENT #			
OPERATION DATE			
PRINCIPAL OPERATION			
ANESTHESIA TECHNIQUE			
SURGERY SERVICE			
PRINCIPAL OPERATIVE PROCEDURE			
DATE COMPLETED			
** SURGICAL SPECIALTY: 			
PAGE: 1 OF 2			
PREOP LABORATORY RESULTS			
LATEST PREOP LAB RESULTS IN 90 DAYS PRIOR TO SURGERY			
 1. Serum Sodium: 			
 3. Serum Creatinine: 			
 4. Serum Albumin:			
 5. Total Bilirubin:			
 7. Alkaline Phosphatase:			
10. Platelet Count:			
Select Preoperative Laboratory Information to Edit: 			
2. Enter a number (1-12) to update the information in that field.  (For			
   example, enter '2' to update Preoperative BUN)			
3. Enter a range of numbers (1-12) separated by a ':' to enter a range of			
   BUN, and Serum Creatinine)			
Report of Monthly Case Workload Totals			
This option provides a report of the monthly risk assessment surgical case			
workload totals for the following categories:			
1. All cases performed			
2. Excluded cases			
3. Assessed cases			
4. Non-assessed cases			
5. Cardiac cases			
6. Non-cardiac cases			
7. Assessed cases per day (based on 20 days/month)			
This report may be printed and/or transmitted to the national database.			
Compile workload totals for which month and year? 			
Enter the month and year for which to run this report,			
for example, 'MAY 94', 'MAY 1994', '5/94' or '5 94'.			
Compile totals for 			
Do you want this report to be transmitted to the central database			
Enter YES to have this report automatically transmitted to the central			
database.  Enter NO if you do NOT want this report transmitted.			
Do you also want to print this report			
Enter NO if you want to have this report transmitted, but do not want to			
have it printed.  Enter YES if you do want to print the report as well as			
have it transmitted.			
Print report on which Device: 			
Report of Surgical Case Workload			
Queue report to run at what date/time? 			
One month ago, you had an operation at the VA Medical Center.  We are			
interested in how you feel.  Have you had any health problems since your			
operation ?  We would like to hear from you.  Please take a few minutes			
to answer these questions and return this letter in the self-addressed			
stamped envelope.			
Have you been to a hospital or seen a doctor for any reason since your			
If you answered NO, you do not need to answer any more questions.  Please			
return this sheet in the self-addressed stamped envelope.			
If you have answered YES, please answer the following questions.			
1) Have you been seen in an outpatient clinic or doctor's office ? 			
Why did you go to the clinic or doctor's office ? ________________			
Where ? (name and location) _____________________  Date ? ________			
Who was your doctor ? ____________________________________________			
2) Were you admitted to a hospital ?  ___ Yes  ___ No			
Why did you go to the hospital ? _________________________________			
Please return this letter whether or not you have had any medical problems.			
Your health and opinion are important to us.  Thank You.			
Surgical Clinical Nurse Reviewer			
NO ASSESSMENT			
CPT CODE MISSING			
NON-ASSESSED MAJOR SURGICAL CASES BY SURGICAL SPECIALTY			
ALL MAJOR SURGICAL CASES BY SURGICAL SPECIALTY			
OPERATIVE PROCEDURE(S)			
ASSESSMENT STATUS			
EXCLUSION CRITERIA			
PRINCIPAL CPT CODE			
NON-ASSESSED MAJOR SURGICAL CASES			
ALL MAJOR SURGICAL CASES			
SRA,$J)			
TOTAL MAJOR CASES FOR ALL SPECIALTIES: 			
If you want to continue listing assessments, enter <RET>.  Enter '^' to			
return to the menu.			
TOTAL CASES FOR ALL SPECIALTIES: 			
SURGICAL SPECIALTY: 			
COMPLETED/TRANSMITTED ASSESSMENTS MISSING INFORMATION			
NON-CARDIAC			
Missing information:			
OPERATION(S)			
TOTAL FOR ALL SPECIALTIES: 			
Select Postoperative Laboratory Information to Edit: 			
   example, enter '5' to update Highest Serum Creatinine)			
   Lowest Serum Sodium, and Highest Potassium)			
POSTOP LAB RESULTS WITHIN 30 DAYS AFTER SURGERY			
 1. Highest Serum Sodium:			
 2. Lowest Serum Sodium:			
 3. Highest Potassium:			
 4. Lowest Potassium:			
 5. Highest Serum Creatinine: 			
 6. Highest CPK: 			
 7. Highest CPK-MB Band: 			
 8. Highest Total Bilirubin: 			
 9. Highest WBC:			
10. Lowest Hematocrit:			
11. Highest Troponin I:			
12. Highest Troponin T:			
Select Operation: 			
Enter the number corresponding to the surgical case for which you will be			
creating a surgical risk assessment.			
1. Enter Information			
2. Review Information			
3. Delete Surgery Case			
Select Number:  1//  			
Enter RETURN or '1' to enter or edit information contained within one of the			
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