English	French	Notes	Complete/Exclude
  |   (specify type): 			
               |			
|   * HIV-1/HIV-2 combination EIA . |			
  | * If HIV laboratory tests were not documented,  Yes  No   Unk.|			
|   * HIV-1 Western blot/IFA ...... |			
  |   is HIV diagnosis documented by a physician?   |			
|   * Other HIV antibody test ..... |			
  | * If yes, provide date of documentation by physician  			
  | 3. IMMUNOLOGIC LAB TESTS:                                     |			
|   * HIV-2 Western blot .......... |			
  |    At or closest to current diagnostic status         Mo. Yr. |			
| 2. POSITIVE HIV DETECTION TEST: (Record earliest test)         |    * CD4 Count ........... 			
|   * HIV culture .....................................  			
 %                    			
|   * HIV antigen test ................................  			
  |    First <200 uL or <14%                                      |			
|   * HIV PCR, DNA or RNA probe .......................  			
 =================================================  VIII. CLINICAL STATUS  ======================================================			
| CLINICAL         YES  NO | ENTER DATE PATIENT  Asymptomatic                               Mo. Yr.      Symptomatic   Mo. Yr.   |			
| RECORD REVIEWED  |			
| | WAS DIAGNOSED AS:  (including acute retroviral syndrome and                                         |			
|                          |                      persistant generalized lymphadenopathy):  			
       (not AIDS):   			
|                                         Initial       Initial |                                         Initial       Initial  |			
|                                        Diagnosis       Date   |                                        Diagnosis       Date    |			
|     AIDS INDICATOR DISEASES            Def.  Pres.    Mo. Yr. |     AIDS INDICATOR DISEASES            Def.  Pres.    Mo. Yr.  |			
|Candidiasis, bronchi, trachea, or lungs  |			
Lymphoma, Burkitt's (or equivalent term) |			
Lymphoma, Immunoblastic (or equivalent                          |			
|Carcinoma, invasive cervical             |			
|Coccidioidomycosis, disseminated or                            |Lymphoma, primary in brain               |			
Mycobacterium avium complex or                                  |			
    M. kansasii, disseminated or                                |			
|Cryptosporidiosis, chronic intestinal                          |    extrapulmonary                       |			
|   (> 1 month duration)                  |			
|Cytomegalovirus disease (other than in                         |M. tuberculosis, disseminated                                   |			
|   liver, spleen or nodes)               |			
    or extrapulmonary *                  |			
|Cytomegalovirus retinitis (with loss of                        |Mycobacterium, of other species or                              |			
    unidentified species, disseminated                          |			
|HIV encephalopathy                       |			
  |    or extrapulmonary                    |			
|Herpes simplex: chronic ulcer(s) (>1 mo.                       |Pneumocystis carinii pneumonia           |			
|   duration); or bronchitis, pneumonitis,                      |Penumonia, recurrent in 12 mo. period    |			
|   or esophagitis                        |			
Progressive multifocal                                          |			
|Histoplasmosis, disseminated or                                |    leukoencephalopathy                  |			
Salmonella septicemia, recurrent         |			
|Isosporiasis, chronic intestinal (>1 mo.                       |Toxoplasmosis of brain                   |			
  |Wasting Syndrome due to HIV              |			
|     Def.=definitive diagnosis  Pres.=presumptive diagnosis    |    * RVCT CASE NO.: _______________                            |			
| * If HIV tests were not positive or were not done, does this patient have                                                      |			
|   an immunodeficiency that would disqualify him/her from the AIDS case definition          |			
| Has this patient been informed of his/her HIV infection?  |			
| Unk. | This patient is receiving or             |			
| This patient's partners will be notified about their HIV exposure and counseled by: | * HIV related medical services           |			
| Health department    |			
| Unknown     | * Substance abuse treatment services     |			
| This patient received or is receiving:  | This patient has been enrolled at:        | This patient's medical treatment is      |			
|  * Anti-retroviral    Yes  No   Unk.    |  Clinical Trial       Clinic              |  PRIMARILY reimbursed by:                |			
| Private ins/HMO    |			
| No coverage  |			
| Other public funds |			
|                       Yes  No   Unk.    |  |			
|  * PCP prophylaxis    |			
| Unknown         |      trial/government program            |			
| FOR WOMEN: *This patient is receiving or has been referred for gynecological or obstetrical services: . |			
|            *Is this patient currently pregnant? ....................................................... |			
|            *Has this patient delivered live born infants? ...  |			
|Yes (If delivered after 1977, provide birth   |			
information below for the most recent birth)            |			
| CHILD'S DATE OF BIRTH:  | Hospital of Birth: 			
   |  Child's Soundex:        | Child's State Patient No.   |			
|     Mo.  Day  Yr.       |                                             |   | | | | |  __________  |  | | | | | | | | | | |      |			
Definitive			
Presumptive			
  ** NO DATE **			
Diseases Currently Selected:			
   Start Date for Period: 			
    End Date for Period: 			
END CAN NOT BE BEFORE START			
MORE THAN 180 DAYS OF DATA IS TOO MUCH TO TRANSMIT.			
TRY A SHORTER DATE RANGE.			
IMMUNOLOGY DATA. 			
  *NEW PATIENT*			
Monthly,  Quarterly,  Semi-Annually,  Yearly,  Fiscal Yearly,  User Selectable			
Select date range type: 			
Enter the first few letters of one of the choices listed below.			
Please enter a month and year			
MONTH OF 			
Enter Quarter Period and FY you wish Semi-Annual range to end with			
Enter Quarter and Year: 			
Enter Quarter Period in this format: 2nd quarter 1988 would be 2-88, 2/88, 2 88			
Enter Quarter 1 to 4 only			
 QUARTER FY 			
SEMI-ANNUAL PERIOD ENDING 			
FISCAL 			
Enter a 2 or 4 digit 			
FISCAL YEAR 			
YEAR 			
Enter beginning and ending dates for the desired time period:			
Ending Date:    			
PERIOD FROM 			
Range selected: 			
***** Patient has a DATE OF DEATH, setting it to 2 ****			
**** Patient has an ICR DATE OF DEATH ENTERED, setting status to DEAD ****			
Do you want to enter an ICR DATE OF DEATH (Y/N) ? 			
***** PATIENT FILE has NO date of death entered,			
AND IMR DATE OF DEATH FIELD HAS NO DATE *****			
*****  You must choose 1 or 9 *****			
Enter Coded SSN			
I will now search the database to decode the SSN... please wait			
The coded number you entered is either not listed in your local ICR			
or was typed incorrectly.  Please check that you entered the coded SSN			
correctly.   *** NO TRANSLATION FOUND FOR THIS PATIENT ***			
Coded SSN: 			
Patient's id in the Immunology Case Study file: 			
Coded Date of Birth: 			
Patient's number in the Patient file: 			
BE ABSOLUTELY SURE BEFORE USING THIS OPTION -- IT WILL DELETE ALL DATA			
FOR THE SPECIFIED INDIVIDUAL FROM THE IMMUNOLOGY CASE FILE			
ARE YOU ABSOLUTELY SURE? N// 			
IMRTEXT(			
IMMUNOLOGY DATA 			
Do you want to Enter/Edit CDC form data now			
This patient must be entered into the Immunology Case Study file using			
The Enter/Edit option first.			
Is this patient REALLY supposed to be in your database (Y/N)?			
Are you sure, 			
 should be			
 in your database (Y/N)?			
Sending the past 365 days of data to the HIV National Database..			
Select *SECURE* ALLOWABLE PRINTERS (Field 7) from ICR Site Parameters File:			
Select one of the valid devices			
IMR*2.0*23			
Please install IMR*2*23 first. ICR v2.1 Installation halted.			
File Access 			
     YOU HAVE INSUFFICIENT SECURITY TO ACCESS THIS OPTION			
     SEE YOUR IMMUNOLOGY COORDINATOR FOR THE PROPER KEYS			
IMR ACCESS VIOLATION NOTICE			
IMR ACCESS VIOLATION BY 			
IMR - IMMUNOLOGY UNATHORIZED ACCESS ATTEMPT			
An attempt was made to invoke IMR functionality by a person who does			
not have the neccessary Security Keys.  Details of this attempt			
are as follows:			
Violator's Name:  			
Time:             			
VIOLATION:        			
ACCESS WAS ATTEMPTED BUT NOT GAINED			
Removing Unused Data Dictionary Fields...			
Deleting Unused Routines...			
Deleting Unused Data...			
Removing Unused Options...			
IMRO REPORTS MENU			
IMRO BY DX			
IMRO BY NAME			
IMRO DELETE			
IMRO ENTER			
IMRO MASTER			
IMRO NO DX			
IMRO TRANSMIT			
Populating Data Fields in File 158...			
          44)=DATE OF HIV+ (CAT 2) STATUS			
Populating new NLF ENTRY field in File 158.9...			
Removing unused File 158.96 dictionary and data...			
Queuing the IMR REGISTRY DATA option to run immediately...			
Rescheduling the IMR REGISTRY DATA option...			
IMR REGISTRY DATA			
IMMUNOLOGY.VA.GOV			
Deleting unused input templates...			
IMR LPOINTER			
IMR PPOINTER			
Adding VIRAL LOAD entry to File 158.95...			
VIRAL LOAD			
ICR-RX ARCHIVE DATE SEARCH			
Holders of KEYS for 'IMR' Package as of: 			
 KEY HOLDERS:			
UNKNOWN USER # 			
Deleting the field definitions...			
The definitions have been deleted.			
Unknown error (			
CD4 or T4 (ACTUAL LEVEL)			
CD4 or T4 (PERCENTAGE)			
** SORRY NO LABORATORY REFERENCE IN PLACE **			
SORRY, HIV COORDINATOR HAS NOT SET UP LAB LINKS			
Local ICR Demographics by Category			
Do you want to check for entries in the ICR file without CATEGORY data			
Do you want a list of patients with MISSING data elements			
Local ICR Demographics By Category			
Patients Seen During 			
LIVING 			
ALIVE & DECEASED 			
DECEASED 			
PATIENTS IN THE FILE			
HIV+			
HIV+TC			
AIDS-3			
Checking for entries in the ICR file without CATEGORY data.			
    None found.			
 in the IMMUNOLOGY CASE REGISTRY file with			
NO CATEGORY indicated --			
DO YOU WANT TO SEE THE LIST			
Missing Categories			
ALIVE (or unknown)			
GAY OR BISEXUAL MAN			
IV DRUG USER			
GAY OR BISEXUAL DRUG USER			
RECV'D TRANSFUSION/TRANSPLANT			
WORK-HEALTH/CLINICAL			
ADULT, CONFIRMED OTHER RISK			
UNSPECIFIED ELIGIBILITY			
UNSPECIFIED POS			
SEEN AS OUTPATIENT			
SEEN AS INPATIENT			
SEEN IN LABORATORY			
PRESCRIPTION(S) FILLED			
Print Data by CATEGORY as well as totals			
Answer YES to get separate listings of utilization by HIV CATEGORY as well as the total population.			
Selected IP/OP Activty			
SD*5.3*131			
NO SC ID			
NO SC			
NO ID			
NO BS			
How many of the highest users do you want identified ? 0// 			
Enter the number, 0 or greater of the individuals with the highest			
utilization of pharmacy fills and/or cost you wish listed			
NO CATEGORY DEFINED^HIV+^HIV+ (CD4<500)^AIDS-3^AIDS			
TOTAL HIV+ (ALL CATEGORIES) POPULATION			
FOR THE PERIOD 			
SELECTED OUTPATIENT ACTIVITY			
A 'stop' is credited for each entry of a stop code, while a 'visit' is split			
among each stop credited on a given date.  Thus, a single visit with two stop			
codes credited will show as 0.5 visit for each stop code.  			
A total of 1.00			
visit is given for out patient activity on a given date.			
Totals:      			
 patients for 			
NOT IDENTIFIED			
OCCURRENCES OF NO STOP CODE ID			
ADD/EDIT STOP CODE			
SCHEDULED VISIT			
INPATIENT AND OUTPATIENT ACTIVITY			
STOP CODES			
SELECTED INPATIENT ACTIVITY			
 stays and 			
 days of inpatient care			
Median Length of Stay (MLOS): 			
Average Length of Stay (ALOS): 			
OCCURRENCES OF NO BEDSECTION ID			
HIGHEST UTILIZATION OF VISITS			
HIGHEST NUMBER OF STAYS			
HIGHEST NUMBER OF DAYS			
  moved in: 			
   PTF entry: 			
Number of Days Patients Not Seen			
Enter the number of days you want to check if any patient has not been seen			
Immunology Followup List			
FOLLOW UP REPORT			
PATIENTS AT RISK OF LOSS TO FOLLOW UP			
NOT SEEN IN OVER 			
Local Registry List - ICR Patients			
Select Type of Patients			
List New Patients added to the registry during this time (Y/N)? N// 			
Do you want the list sorted by Category (Y/N)? N// 			
Do you want the list sorted by Reimbursement Level (Y/N)? N// 			
List Immunology Patients			
***NO PATIENTS FOUND IN DATE RANGE***			
REGISTRY LIST			
REIM LEV			
Minimum number of results reported for a test to be listed			
This number (1 or greater) is used to keep from showing long lists of infrequent tests by setting a minimum number of results for display			
Selected LAB Activity			
Enter the number, 0 or greater, of the individuals with the highest			
utilization of laboratory orders you wish listed			
LABORATORY UTILIZATION DATA			
Totals:  			
 orders placed (			
 results reported)			
 during this period for 			
These include 			
 different entries from LAB TEST file			
 placed for 			
 in file, not included above			
# OF DIFFERENT			
LAB TESTS			
Max # Results			
Reported			
Per Patient (# patients)			
***This report will give you a list of your local lab links.***			
List Local Lab Links			
LOCAL LAB LINKS			
Local Name			
>>>>> Please wait. Searching for Viral Load & CD4 Values.....			
Type of Test			
**NO DATA FOUND**			
Summary Utilization Data			
Answer YES to sort by HIV CATEGORY.			
Immunology Summary Utilization Data			
Select Facility Source of Information			
Sending Request Message to the National Registry...			
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