English	French	Notes	Complete/Exclude
 or 'B' for BOTH: E// 			
Specify measurement system for height, weight, and temperature.			
Is the ENTIRE physical exam NORMAL			
YS-PHY-EXAM-NORM			
 Initial Impression: 			
Do you need to enter comments			
No Physical Exam on file for 			
YS PHY EX PRINT			
No Physical Exams on file			
PREVIOUS PHYSICAL EXAMS			
Enter EXAM NUMBER to edit or			
Enter <CR> to create NEW exam: 			
Enter 'E' to EDIT an existing physical for this patient.			
Enter 'P' to PRINT a current physical for this patient.			
Enter 'E' to ENTER a new physical for this patient.			
Enter 'Q' to QUIT the exam process.			
Entering 'Y' or <CR> for 'YES' accepts the given PREVIOUS exam for EDITING			
or PRINTING.			
ENTERING 'N' for 'NO' allows you to ENTER a new exam.			
IMPORTANT NOTE: (1). You may NOT enter MORE than ONE EXAM per PATIENT per DAY.			
(2). Only the DESIGNATED EXAMINER can EDIT a PREVIOUS exam.			
Enter a previous physical exam NUMBER to EDIT an existing exam.			
Or enter <CR> to CREATE a NEW physical exam.			
*** ONLY THE DESIGNATED EXAMINER MAY EDIT A PREVIOUSLY ENTERED EXAM ***			
**    A PREVIOUS physical EXAM for this PATIENT was created TODAY     **			
** You may NOT create MORE than ONE physical EXAM per PATIENT per DAY **			
** The EXAM SAVED with the remaining portion SET to NORMAL **			
** PROCESSING OF THIS EXAM WAS TERMINATED **			
**     << EXAM DELETED FROM FILES >>      **			
**   << EXAM SAVED >>   **			
** The EXAM SAVED with remaining portion set as previously entered **			
SF 506			
Identifying Data <<section 1>>			
PATIENT LISTED AS INELIGIBLE			
ALIAS: 			
MARITAL STAT: 			
LEGAL ADD: 			
PHONE 1: 			
PHONE 2: 			
PHONE 3: 			
PHONE 4: 			
EMER CONT: 			
RELATION: 			
ARLINGTON, TX ZIP			
Next of Kin, Employment, Claim Number Data <<section 2>>			
NEXT OF KIN: 			
KIN-2: 			
DESIGNEE: 			
   SERVICE CON: 			
YES  			
PAYMENT: $			
FATHER: 			
MOTHER: 			
MOTHERS MAIDEN: 			
Disability, Financial Data <<section 3>>			
MONETARY BEN:			
  MILT RETIREMENT: $			
  VA PENSION: $			
  GI INSUR: $			
  SS INSUR: $			
  OTH RETIRE: $			
  OTH PERSONAL INCOME: $			
EXPIR DATE			
ABLE TO DEFRAY EXP: 			
DOES NOT APPLY			
PAY FOR TRAVEL: 			
 ELIGIB CODE: 			
PEND VER			
PEND RE-VER			
  INTER RESP DT: 			
METH OF VER: 			
Military Data <<section 4>>			
 PREV CARE: 			
SERV RECORD: BRANCH			
SERVICE # ENTER DATE SEPAR DATE DISCHARGE TYPE			
NON-VET CLASS: 			
AGENCY/ALL COUNTRY: 			
COMBAT: 			
WHERE: 			
WAR: 			
ION RADIAT: 			
 ION REG: 			
AO REG: 			
AO EXAM: 			
AO #: 			
  DENTAL INJURY IN SERV: 			
TEETH EXTRACTED IN SERVICE: 			
Inpatient Data <<section 5>>			
Last 5 Admissions:			
Last 5 Applications for care: 			
Date in			
Type of Benefit			
Outpatient Data <<section 6 >>			
Diagnosis List <<section 7>>			
Only Active Diagnosis			
Last Physical Exam <<section 8>>			
NO PHYSICALS ON FILE			
Impressions:			
Problem List, Psychological Tests and Interviews <<section 9>>			
HISTORY 1: ** NONE ON FILE **			
PHYSICAL: 			
PHYSICAL: ** NONE ON FILE **			
PROBLEM LIST : 			
** NOT ON FILE **			
ON FILE			
PROGRESS NOTES: LAST 			
PROGRESS NOTES: ** NONE ON FILE **			
NO PSYCHOLOGICAL TESTS OR INTERVIEWS HAVE BEEN COMPLETED			
Psychological Tests/Interviews:			
Short Problem List <<section 10>>			
Enter section number(s) or 'P' to print or 'Q' for quick look 			
Enter a numeric string ex. 2,4,7-9			
'P' or 'p' for print 'Q' or 'q' for quick look			
Including all sections...			
 - You can't queue to a CRT!			
YS PROFILE PRT			
 Problem List			
VAF 10-1415			
Indicator(s)			
Onset			
Recorded			
ADDITIONAL PROBLEM			
REFORMULATED TO: 			
EXISTING PROBLEM			
NEW PROBLEM			
OTHER PROBLEM			
DSM DIAGNOSIS			
ICD9 DIAGNOSIS			
There is already a 'Problem List' on this patient!			
Select another option to modify the existing 'Problem List'.			
CRITICAL ITEM SCREEN			
Answer (Y)es, (N)o, or (U)ncertain, i.e. (Y/N or U)			
 to exit CRITICAL ITEM SCREEN)			
There is already a 'Suicidal/Self-Injury' problem			
on file.  Do you want to edit this problem? N// 			
Is patient a Suicidal/Self-Injury Risk? (Y/N/U) N// 			
YyNnUu			
Incomplete data base			
Uncertain about suicidal/self-injury risk			
Is patient a violence risk? (Y/N/U) N// 			
Uncertain about violence risk			
There is already a 'Psychosis' problem			
Does patient have a psychosis? (Y/N/U) N// 			
Uncertain about psychosis			
Do you want a (P)sychosis problem or (D)SM diagnosis? 			
(P)sychosis problem			
(D)SM diagnosis			
ANSWER (P or D): 			
PpDd			
There is no 'Problem List' on this patient.			
Some 'CRITICAL ITEMS' will be asked to formulate a new 'Problem List'.			
DO YOU WANT THE CRITICAL ITEM SCREEN? N// 			
Do you want to see problems already on the list? N// 			
No 'Problem List' entries exist for this patient.			
There is already a 'Violence risk' problem			
There is already an 'Alcohol abuse' problem			
Does patient have an alcohol abuse problem? (Y/N/U) N// 			
Uncertain about alcohol abuse			
Do you want an (A)lcohol misuse problem or a (D)SM diagnosis?			
ANSWER (A or D): 			
There is already a 'Substance (non-alcohol) abuse' problem			
Does patient abuse drugs/other non-alcohol substances? (Y/N/U) N// 			
Uncertain about drug/non-alcohol substance abuse			
Do you want (S)ubstance (non-alcohol) problem			
or (D)SM diagnosis?			
ANSWER (S or D): 			
SsDd			
There is already a 'General physical' problem			
Does patient have significant physical problems? (Y/N/U) N// 			
Uncertain about general physical problem			
Do you want a (P)hysical problem or an ICD-9 (D)iagnosis?			
Uncertain indicates insufficient information to make a decision			
With indicator '			
on the problem list? Y// 			
Problem '			
' is already on the problem list.			
Indicator '			
has been added to			
is already on			
 the problem list.			
 is already on the problem list			
Do you want to see the INDICATORS associated with this problem? N// 			
INDICATORS for 			
PROBLEM LIST FOR 			
permanently changed!			
Are you sure you want to edit 			
 will display potential problem areas.			
 will display a list of problems presently recorded.			
 will permit change of presently recorded data.			
 will allow further refinement of this problem area.			
 will by pass this problem area.			
 indicates insufficient information to make a decision.			
 accesses the coding struture of the DSM.			
The alternate entry accesses the 			
 as defined by this system.			
 access the coding structure of the ICD-9.			
Select EXISTING PROBLEM: 			
Select NEW PROBLEM: 			
This problem is not currently on the problem list.			
Additional information about the problem must be entered! 			
This problem is already on the problem list			
Do you want to edit it? N// 			
'Other' is not currently on the problem list			
Select DSM DIAGNOSIS: 			
Select ICD9 DIAGNOSIS: 			
Problem reformulated to:			
Type 'Y' or 'N'.			
INACTIVE! 			
REACTIVATED! 			
RESOLVED! 			
REFORMULATED! 			
CHANGED! 			
 has been REFORMULATED!			
It is not necessary to INACTIVATE a REFORMULATED problem!			
 has been RESOLVED!			
It is not necessary to INACTIVATE a RESOLVED problem! 			
REACTIVATE 			
RESOLVE 			
CHANGE 			
 is already active! 			
REFORMULATE 			
 is INACTIVE!			
YS PROB LIST PRINT			
Short Problem List			
NO PROBLEMS ON FILE			
PROBLEM(S):			
(A)ctive, (H)istorical, (C)omplete, (S)hort or (Q)uit? A// 			
Do you wish problem indicators? N// 			
YS PROB REPT			
CRITICAL PROBLEM			
 not specified ***			
(last editing list)			
TAB,BLA,TOP,MAR,FIL,   ,   ,NEW,PAR			
VT,TAB,BL,TOP,MAR,FILL,PAGE,SPACE,OUT,PAR,,PGN			
YSPX=			
YSPLM=YSPLM			
YSPGI)			
* Patient Messages/Crisis Notes may be moved to 			
Progress Notes through the MHS Manager Option.			
 NUMBER (Type '+' only to list more than one): 			
Are you adding a NEW 			
 for this patient? Y// 			
SF 509			
Please enter appropriate response indicating action to be taken.			
 will permit editing of text entered this date.			
 will permit entry of new text.			
Enter corresponding number of text to be accessed.			
 will permit entry of new text.  			
 returns to edit question.			
YS TEXT PRINT			
ALL? Y// 			
Begin 			
Through 			
YS TEXT PRINT 2			
SECLUSION/RESTRAINT INFORMATION			
No patients listed in Seclusion/Restraint.			
Patient shown in Seclusion/Restraint at this time.			
Was patient searched			
If patient was not searched, a reason should be given for the omission.			
INSUFFICIENT INFORMATION			
Do you need to edit the above information			
After the information is filed, you may no longer edit it.			
You may alter the information now.			
Save this information			
NO, will delete this information from the record.			
YES, will file it under the patient's name.			
INFORMATION NOTED.			
< ENTRY FOR 			
Patient Name Required.			
No patients currently listed in seclusion/restraint.			
The following patient(s) are currently listed as being in Seclusion/Restraint:  			
 * Written order required.			
DATE & TIME			
RELEASE FROM SECLUSION/RESTRAINT			
No patients listed as requiring release.			
Patient not listed as in Seclusion/Restraint.			
 shown as released 			
< RELEASE DELETED >			
PATIENT NOTED AS RELEASED.			
REVIEW OF SECLUSION/RESTRAINT ASSESSMENT			
No review action required.			
The following S/R actions have not been reviewed: 			
Select action for review: 			
Not valid - re-enter.			
< REVIEW ACTION DELETED >			
REVIEW ACTION NOTED.			
No other review action required.			
< OBSERVATION DELETED >			
OBSERVATION NOTED.			
EDIT OF TYPE OF SECLUSION/RESTRAINT ORDER			
SECLUSION/RESTRAINT EPISODES REQUIRING WRITTEN ORDERS:  			
 * Written Order Required.			
No patients listed as requiring a written order.			
Written order not required for this patient.			
Select PATIENT NAME:  			
Patient not shown on file.			
Is this the entry you wish to delete			
YES will remove the entry from the file.  It will not be recoverable.			
NO will exit you from this option.  Entry will remain on file.			
MONTHLY REPORT OF RESTRAINT AND SECLUSION (VA Form 10-2683)			
THIS REPORT MUST BE SENT TO A PRINTER WHICH ACCEPTS A 132-CHARACTER LINE.			
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