| 1 | English French Notes Complete/Exclude
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| 2 | or 'B' for BOTH: E//
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| 3 | Specify measurement system for height, weight, and temperature.
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| 4 | Is the ENTIRE physical exam NORMAL
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| 5 | YS-PHY-EXAM-NORM
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| 6 | Initial Impression:
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| 7 | Do you need to enter comments
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| 8 | No Physical Exam on file for
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| 9 | YS PHY EX PRINT
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| 10 | No Physical Exams on file
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| 11 | PREVIOUS PHYSICAL EXAMS
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| 12 | Enter EXAM NUMBER to edit or
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| 13 | Enter <CR> to create NEW exam:
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| 14 | Enter 'E' to EDIT an existing physical for this patient.
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| 15 | Enter 'P' to PRINT a current physical for this patient.
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| 16 | Enter 'E' to ENTER a new physical for this patient.
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| 17 | Enter 'Q' to QUIT the exam process.
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| 18 | Entering 'Y' or <CR> for 'YES' accepts the given PREVIOUS exam for EDITING
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| 19 | or PRINTING.
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| 20 | ENTERING 'N' for 'NO' allows you to ENTER a new exam.
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| 21 | IMPORTANT NOTE: (1). You may NOT enter MORE than ONE EXAM per PATIENT per DAY.
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| 22 | (2). Only the DESIGNATED EXAMINER can EDIT a PREVIOUS exam.
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| 23 | Enter a previous physical exam NUMBER to EDIT an existing exam.
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| 24 | Or enter <CR> to CREATE a NEW physical exam.
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| 25 | *** ONLY THE DESIGNATED EXAMINER MAY EDIT A PREVIOUSLY ENTERED EXAM ***
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| 26 | ** A PREVIOUS physical EXAM for this PATIENT was created TODAY **
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| 27 | ** You may NOT create MORE than ONE physical EXAM per PATIENT per DAY **
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| 28 | ** The EXAM SAVED with the remaining portion SET to NORMAL **
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| 29 | ** PROCESSING OF THIS EXAM WAS TERMINATED **
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| 30 | ** << EXAM DELETED FROM FILES >> **
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| 31 | ** << EXAM SAVED >> **
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| 32 | ** The EXAM SAVED with remaining portion set as previously entered **
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| 33 | SF 506
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| 34 | Identifying Data <<section 1>>
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| 35 | PATIENT LISTED AS INELIGIBLE
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| 36 | ALIAS:
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| 37 | MARITAL STAT:
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| 38 | LEGAL ADD:
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| 39 | PHONE 1:
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| 40 | PHONE 2:
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| 41 | PHONE 3:
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| 42 | PHONE 4:
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| 43 | EMER CONT:
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| 44 | RELATION:
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| 45 | ARLINGTON, TX ZIP
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| 46 | Next of Kin, Employment, Claim Number Data <<section 2>>
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| 47 | NEXT OF KIN:
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| 48 | KIN-2:
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| 49 | DESIGNEE:
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| 50 | SERVICE CON:
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| 51 | YES
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| 52 | PAYMENT: $
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| 53 | FATHER:
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| 54 | MOTHER:
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| 55 | MOTHERS MAIDEN:
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| 56 | Disability, Financial Data <<section 3>>
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| 57 | MONETARY BEN:
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| 58 | MILT RETIREMENT: $
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| 59 | VA PENSION: $
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| 60 | GI INSUR: $
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| 61 | SS INSUR: $
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| 62 | OTH RETIRE: $
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| 63 | OTH PERSONAL INCOME: $
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| 64 | EXPIR DATE
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| 65 | ABLE TO DEFRAY EXP:
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| 66 | DOES NOT APPLY
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| 67 | PAY FOR TRAVEL:
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| 68 | ELIGIB CODE:
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| 69 | PEND VER
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| 70 | PEND RE-VER
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| 71 | INTER RESP DT:
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| 72 | METH OF VER:
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| 73 | Military Data <<section 4>>
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| 74 | PREV CARE:
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| 75 | SERV RECORD: BRANCH
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| 76 | SERVICE # ENTER DATE SEPAR DATE DISCHARGE TYPE
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| 77 | NON-VET CLASS:
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| 78 | AGENCY/ALL COUNTRY:
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| 79 | COMBAT:
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| 80 | WHERE:
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| 81 | WAR:
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| 82 | ION RADIAT:
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| 83 | ION REG:
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| 84 | AO REG:
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| 85 | AO EXAM:
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| 86 | AO #:
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| 87 | DENTAL INJURY IN SERV:
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| 88 | TEETH EXTRACTED IN SERVICE:
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| 89 | Inpatient Data <<section 5>>
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| 90 | Last 5 Admissions:
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| 91 | Last 5 Applications for care:
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| 92 | Date in
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| 93 | Type of Benefit
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| 94 | Outpatient Data <<section 6 >>
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| 95 | Diagnosis List <<section 7>>
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| 96 | Only Active Diagnosis
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| 97 | Last Physical Exam <<section 8>>
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| 98 | NO PHYSICALS ON FILE
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| 99 | Impressions:
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| 100 | Problem List, Psychological Tests and Interviews <<section 9>>
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| 101 | HISTORY 1: ** NONE ON FILE **
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| 102 | PHYSICAL:
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| 103 | PHYSICAL: ** NONE ON FILE **
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| 104 | PROBLEM LIST :
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| 105 | ** NOT ON FILE **
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| 106 | ON FILE
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| 107 | PROGRESS NOTES: LAST
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| 108 | PROGRESS NOTES: ** NONE ON FILE **
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| 109 | NO PSYCHOLOGICAL TESTS OR INTERVIEWS HAVE BEEN COMPLETED
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| 110 | Psychological Tests/Interviews:
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| 111 | Short Problem List <<section 10>>
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| 112 | Enter section number(s) or 'P' to print or 'Q' for quick look
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| 113 | Enter a numeric string ex. 2,4,7-9
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| 114 | 'P' or 'p' for print 'Q' or 'q' for quick look
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| 115 | Including all sections...
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| 116 | - You can't queue to a CRT!
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| 117 | YS PROFILE PRT
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| 118 | Problem List
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| 119 | VAF 10-1415
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| 120 | Indicator(s)
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| 121 | Onset
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| 122 | Recorded
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| 123 | ADDITIONAL PROBLEM
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| 124 | REFORMULATED TO:
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| 125 | EXISTING PROBLEM
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| 126 | NEW PROBLEM
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| 127 | OTHER PROBLEM
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| 128 | DSM DIAGNOSIS
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| 129 | ICD9 DIAGNOSIS
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| 130 | There is already a 'Problem List' on this patient!
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| 131 | Select another option to modify the existing 'Problem List'.
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| 132 | CRITICAL ITEM SCREEN
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| 133 | Answer (Y)es, (N)o, or (U)ncertain, i.e. (Y/N or U)
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| 134 | to exit CRITICAL ITEM SCREEN)
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| 135 | There is already a 'Suicidal/Self-Injury' problem
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| 136 | on file. Do you want to edit this problem? N//
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| 137 | Is patient a Suicidal/Self-Injury Risk? (Y/N/U) N//
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| 138 | YyNnUu
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| 139 | Incomplete data base
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| 140 | Uncertain about suicidal/self-injury risk
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| 141 | Is patient a violence risk? (Y/N/U) N//
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| 142 | Uncertain about violence risk
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| 143 | There is already a 'Psychosis' problem
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| 144 | Does patient have a psychosis? (Y/N/U) N//
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| 145 | Uncertain about psychosis
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| 146 | Do you want a (P)sychosis problem or (D)SM diagnosis?
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| 147 | (P)sychosis problem
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| 148 | (D)SM diagnosis
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| 149 | ANSWER (P or D):
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| 150 | PpDd
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| 151 | There is no 'Problem List' on this patient.
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| 152 | Some 'CRITICAL ITEMS' will be asked to formulate a new 'Problem List'.
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| 153 | DO YOU WANT THE CRITICAL ITEM SCREEN? N//
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| 154 | Do you want to see problems already on the list? N//
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| 155 | No 'Problem List' entries exist for this patient.
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| 156 | There is already a 'Violence risk' problem
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| 157 | There is already an 'Alcohol abuse' problem
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| 158 | Does patient have an alcohol abuse problem? (Y/N/U) N//
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| 159 | Uncertain about alcohol abuse
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| 160 | Do you want an (A)lcohol misuse problem or a (D)SM diagnosis?
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| 161 | ANSWER (A or D):
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| 162 | There is already a 'Substance (non-alcohol) abuse' problem
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| 163 | Does patient abuse drugs/other non-alcohol substances? (Y/N/U) N//
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| 164 | Uncertain about drug/non-alcohol substance abuse
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| 165 | Do you want (S)ubstance (non-alcohol) problem
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| 166 | or (D)SM diagnosis?
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| 167 | ANSWER (S or D):
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| 168 | SsDd
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| 169 | There is already a 'General physical' problem
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| 170 | Does patient have significant physical problems? (Y/N/U) N//
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| 171 | Uncertain about general physical problem
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| 172 | Do you want a (P)hysical problem or an ICD-9 (D)iagnosis?
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| 173 | Uncertain indicates insufficient information to make a decision
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| 174 | With indicator '
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| 175 | on the problem list? Y//
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| 176 | Problem '
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| 177 | ' is already on the problem list.
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| 178 | Indicator '
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| 179 | has been added to
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| 180 | is already on
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| 181 | the problem list.
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| 182 | is already on the problem list
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| 183 | Do you want to see the INDICATORS associated with this problem? N//
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| 184 | INDICATORS for
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| 185 | PROBLEM LIST FOR
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| 186 | permanently changed!
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| 187 | Are you sure you want to edit
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| 188 | will display potential problem areas.
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| 189 | will display a list of problems presently recorded.
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| 190 | will permit change of presently recorded data.
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| 191 | will allow further refinement of this problem area.
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| 192 | will by pass this problem area.
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| 193 | indicates insufficient information to make a decision.
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| 194 | accesses the coding struture of the DSM.
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| 195 | The alternate entry accesses the
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| 196 | as defined by this system.
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| 197 | access the coding structure of the ICD-9.
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| 198 | Select EXISTING PROBLEM:
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| 199 | Select NEW PROBLEM:
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| 200 | This problem is not currently on the problem list.
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| 201 | Additional information about the problem must be entered!
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| 202 | This problem is already on the problem list
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| 203 | Do you want to edit it? N//
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| 204 | 'Other' is not currently on the problem list
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| 205 | Select DSM DIAGNOSIS:
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| 206 | Select ICD9 DIAGNOSIS:
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| 207 | Problem reformulated to:
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| 208 | Type 'Y' or 'N'.
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| 209 | INACTIVE!
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| 210 | REACTIVATED!
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| 211 | RESOLVED!
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| 212 | REFORMULATED!
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| 213 | CHANGED!
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| 214 | has been REFORMULATED!
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| 215 | It is not necessary to INACTIVATE a REFORMULATED problem!
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| 216 | has been RESOLVED!
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| 217 | It is not necessary to INACTIVATE a RESOLVED problem!
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| 218 | REACTIVATE
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| 219 | RESOLVE
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| 220 | CHANGE
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| 221 | is already active!
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| 222 | REFORMULATE
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| 223 | is INACTIVE!
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| 224 | YS PROB LIST PRINT
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| 225 | Short Problem List
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| 226 | NO PROBLEMS ON FILE
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| 227 | PROBLEM(S):
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| 228 | (A)ctive, (H)istorical, (C)omplete, (S)hort or (Q)uit? A//
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| 229 | Do you wish problem indicators? N//
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| 230 | YS PROB REPT
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| 231 | CRITICAL PROBLEM
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| 232 | not specified ***
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| 233 | (last editing list)
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| 234 | TAB,BLA,TOP,MAR,FIL, , ,NEW,PAR
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| 235 | VT,TAB,BL,TOP,MAR,FILL,PAGE,SPACE,OUT,PAR,,PGN
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| 236 | YSPX=
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| 237 | YSPLM=YSPLM
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| 238 | YSPGI)
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| 239 | * Patient Messages/Crisis Notes may be moved to
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| 240 | Progress Notes through the MHS Manager Option.
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| 241 | NUMBER (Type '+' only to list more than one):
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| 242 | Are you adding a NEW
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| 243 | for this patient? Y//
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| 244 | SF 509
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| 245 | Please enter appropriate response indicating action to be taken.
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| 246 | will permit editing of text entered this date.
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| 247 | will permit entry of new text.
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| 248 | Enter corresponding number of text to be accessed.
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| 249 | will permit entry of new text.
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| 250 | returns to edit question.
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| 251 | YS TEXT PRINT
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| 252 | ALL? Y//
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| 253 | Begin
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| 254 | Through
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| 255 | YS TEXT PRINT 2
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| 256 | SECLUSION/RESTRAINT INFORMATION
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| 257 | No patients listed in Seclusion/Restraint.
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| 258 | Patient shown in Seclusion/Restraint at this time.
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| 259 | Was patient searched
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| 260 | If patient was not searched, a reason should be given for the omission.
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| 261 | INSUFFICIENT INFORMATION
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| 262 | Do you need to edit the above information
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| 263 | After the information is filed, you may no longer edit it.
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| 264 | You may alter the information now.
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| 265 | Save this information
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| 266 | NO, will delete this information from the record.
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| 267 | YES, will file it under the patient's name.
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| 268 | INFORMATION NOTED.
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| 269 | < ENTRY FOR
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| 270 | Patient Name Required.
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| 271 | No patients currently listed in seclusion/restraint.
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| 272 | The following patient(s) are currently listed as being in Seclusion/Restraint:
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| 273 | * Written order required.
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| 274 | DATE & TIME
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| 275 | RELEASE FROM SECLUSION/RESTRAINT
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| 276 | No patients listed as requiring release.
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| 277 | Patient not listed as in Seclusion/Restraint.
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| 278 | shown as released
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| 279 | < RELEASE DELETED >
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| 280 | PATIENT NOTED AS RELEASED.
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| 281 | REVIEW OF SECLUSION/RESTRAINT ASSESSMENT
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| 282 | No review action required.
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| 283 | The following S/R actions have not been reviewed:
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| 284 | Select action for review:
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| 285 | Not valid - re-enter.
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| 286 | < REVIEW ACTION DELETED >
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| 287 | REVIEW ACTION NOTED.
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| 288 | No other review action required.
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| 289 | < OBSERVATION DELETED >
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| 290 | OBSERVATION NOTED.
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| 291 | EDIT OF TYPE OF SECLUSION/RESTRAINT ORDER
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| 292 | SECLUSION/RESTRAINT EPISODES REQUIRING WRITTEN ORDERS:
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| 293 | * Written Order Required.
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| 294 | No patients listed as requiring a written order.
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| 295 | Written order not required for this patient.
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| 296 | Select PATIENT NAME:
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| 297 | Patient not shown on file.
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| 298 | Is this the entry you wish to delete
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| 299 | YES will remove the entry from the file. It will not be recoverable.
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| 300 | NO will exit you from this option. Entry will remain on file.
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| 301 | MONTHLY REPORT OF RESTRAINT AND SECLUSION (VA Form 10-2683)
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| 302 | THIS REPORT MUST BE SENT TO A PRINTER WHICH ACCEPTS A 132-CHARACTER LINE.
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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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