English	French	Notes	Complete/Exclude
1.  Highest educational level attained: 			
2.  Special educational training or skills: 			
Is not, or unknown if			
 currently enrolled in an educational program			
 or trade school.			
4.  Educational Assesment:			
IV.  Military History:			
1.  Period of Service: 			
4.  Service Connected Disability: 			
5.  Military Assessment: 			
V.  Social/Family Relationship:			
1.  Marital status: 			
SOCIAL WORK SERVICE-REPORTS AND SUMMARIES			
4.  Describe Social Support System: 			
5.  Present use of Community Resources: 			
6.  Current Living arrangements: 			
7.  Social/Family Assessment: 			
VI.  Legal Situation:			
Power of Attorney:			
Living Will: 			
Guardianship: 			
Legal Assessment: 			
VII.  Current Substance Abuse Problems: 			
 Comments on Substance Abuse: 			
VIII. Psycho-Social Assessment: 			
IX.  Preliminary List of Problems			
Initial Plan of Action			
3.  MILITARY HISTORY			
4.  SOCIAL/FAMILY RELATIONSHIPS			
5.  LEGAL SITUATION			
6.  CURRENT SUBSTANCE ABUSE			
7.  PRELIMINARY PROBLEMS			
8.  PSYCHO-SOCIAL ASSESSMENT			
Enter number(s) to enter/edit i.e => 1 or 1,8 or All or 			
Do you want to print Assessment data			
Enter the number of the category for this patient you want to enter/edit.			
For example if you want to enter/edit the categories 			
Enter the number 			
 i.e. 2,3 separated by comma or enter any			
combination of numbers separated by commas or if all categories are to be			
edited, press carriage return for default of 			
. VALID NUMBERS ARE 1-8.			
INVALID CATEGORY NUMBER(s) !  Do you want to try again			
CLINICAL SUPERVISOR'S REPORT			
Task Queued to Print !			
PG. 			
CLINICAL SUPERVISORY REPORT			
PLANNING DATE			
NOTE DATE			
1.  CLOSING NOTES			
2.  DISCHARGE PLANNING			
ENTER 1, 2 OR 'ALL' FOR BOTH NOTES TO PRINT or '^' to EXIT: 			
CLOSING NOTE:			
AFTER CARE PLAN: 			
OPEN DATE:  			
CLOSED DATE: 			
NOTE ENTERED: 			
SERVICES OFFERED:			
DISCHARGE PLAN: 			
DISCHARGE PLAN ENTERED: 			
CLOSING 			
DISCHARGE PLANNING 			
WARD/BED: 			
PROBLEMS: 			
INITIAL PLAN OF ACTION: 			
SELECT SURROGATE SUPERVISOR: 			
SELECT SURROGATED SUPERVISOR: 			
YOU CANNOT BE YOUR OWN SURROGATE !			
DO YOU WANT TO TRY AGAIN			
DIRECT SERVICES PROVIDED FROM: 			
DIRECT SERVICES REPORT			
DIRECT SERVICES CATEGORY FOR 			
COMPLETE SERVICE			
Do you want Complete Service			
Enter 'YES' to print the complete service.			
Do you want report by Supervisor 			
Enter 'YES' to print the report by supervisor			
Enter Supervisor's last name 			
To print the report for a supervisor, enter the supervisor's last name.			
Enter Social Worker's last name 			
To print the report for a worker, enter the worker's last name.			
'Y' for Yes			
'N' for No			
Enter RCH: 			
INQUIRY INTO RCH FILE REPORT			
RCH HOME REGISTRY FOR A SINGLE HOME: 			
1. ALL HOMES			
2. A SINGLE HOME ?			
ENTER 1 or 2  1// 			
ENTER RCH: 			
RESIDENTIAL CARE HOME REPORT			
Enter the number one (1) if all homes are to print, else enter the number			
two (2) for an individual home.			
Do you want to screen Now (One to seven days)			
Enter 'YES' to run current date or up to seven days in the past.			
There were no possible High-Risk patients found for SOCIAL WORK SERVICE !			
 or OLDER - 			
NSC INSURANCE COVERAGE - 			
FEMALE - 			
AGE 70 or greater and 2 or more OPT clinics - 			
GENERAL DELIVERY			
GENERAL DELIVERY ADDRESS - 			
NO ADDRESS - 			
NO TEMPORARY ADDRESS - 			
HIGH-RISK WARD - 			
IRREGULAR DISCHARGE - 			
READMITTED WITHIN ONE MONTH - 			
PREVIOUS SPECIAL POPULATION PATIENT - 			
HOME DIALYSIS - 			
HBHC - 			
SCI HOME CARE - 			
OTHER HOME BASED PROGRAMS - 			
ADMISSION DUE TO ACCIDENT - 			
INCOME LESS THAN LOCAL AMOUNT			
SEEN BY SOCIAL WORK & LOCATION RCH or CNH - 			
OPENED: 			
SOCIAL WORK HIGH RISK SCREENING PROFILE			
WORKER: 			
SOCIAL WORKER: CASE NOT OPENED TO SOCIAL WORK SERVICE			
DATE ADMITTED: 			
DATE SCREENED:____________ 			
PATIENT ADDRESS: 			
PATIENT ADDRESS UNAVAILABLE			
NOK NAME: 			
NOK ADDRESS: 			
ADDITIONAL CONTACTS:			
   MARITAL STATUS: 			
EMPLOYMENT STATUS: 			
INSURANCE COVERAGE: 			
VETERANS STATUS: 			
HB 			
 SC CONDITION: 			
ADMISSION DIAGNOSIS: 			
LOCATION LAST VA TREATMENT: 			
POSITIVE SCREENING CRITERIA: 			
SOCIAL WORKER ASSESSMENT & PLAN:			
ROOM NO.: 			
Social Worker			
UNEARNED INCOME (Current):			
DISABILITY PAYMENT			
HB AMOUNT			
VA PENSION			
INCOME SCREENING (			
INTEREST,DIVIDEND,ANNUITY			
SOCIAL SECURITY (Includes SSI)			
WORKERS COMP OR BLACK LUNG			
*ALL OTHER INCOME			
TOTAL INCOME:			
*-This total may include amounts already listed under current 'UNEARNED INCOME'.			
BEGINNING SCREEN DATE: 			
This report is formatted for 80 columns and must be sent to a printer.			
MANUAL HIGH-RISK SCREENING REPORT			
HOME DIAYLSIS - 			
Do you want Complete Service 			
THERE IS NOTHING TO REPORT FOR LOCATION OF PATIENTS BY COST CENTERS 			
THERE IS NOTHING TO REPORT ON AMIS LOCATIONS FOR 			
SUPERVISOR 			
SOCIAL WORKER 			
LOCATION OF PATIENTS BY COST CENTERS			
SOCIAL WORK DIVISIONAL LOCATION OF PATIENTS BY COST CENTERS REPORT			
COMPLETE SERVICE for DIVISION 			
PATIENT INQUIRY REPORT			
DELETING SW POSITIONS FILE (#654)			
XMQ-SWA			
XMQ-SWM			
XMQ-SWK			
INSTALLING SECURITY KEY '			
' FOR SOCIAL WORK DATA TRANSMISSION			
HOLDERS WILL HAVE TO BE ADDED			
INSTALLING RELAY DOMAIN 'Q-SWA.VA.GOV' FOR SOCIAL WORK DATA TRANSMISSION...			
INSTALLING RELAY DOMAIN 'Q-RHC.VA.GOV' FOR SOCIAL WORK DATA TRANSMISSION...			
INSTALLING MAIL GROUP 'SWA' TO RECEIVE SOCIAL WORK TRANSMISSION CONFIRMATION...			
MEMBERS WILL HAVE TO BE ADDED...			
INSTALLING RELAY DOMAIN 'Q-SWM.VA.GOV' FOR SOCIAL WORK DATA TRANSMISSION...			
INSTALLING MAIL GROUP 'RHC' TO RECEIVE SOCIAL WORK TRANSMISSION CONFIRMATION...			
INSTALLING MAIL GROUP 'SWM' TO RECEIVE SOCIAL WORK TRANSMISSION CONFIRMATION...			
Are You: 			
1. Adding and Replacing a Worker			
Enter 1 or 2  1// 			
SELECT NEW WORKER: 			
INCOMPLETE WORKER INFORMATION!!  DATA NOT ADDED.			
WHICH WORKER TO REPLACE ? 			
ARE YOU SURE YOU WANT TO REPLACE THIS WORKER			
REPLACEMENT WORKER ? 			
WORKERS INFORMATION MUST BE COMPLETE			
Entering the number one (1) will allow you to add a new worker and then assign			
that new worker a current worker's case load.			
The number two (2) allows you to assign a current worker's case load to another current worker.			
PLEASE ENTER SOCIAL WORK SITE PARAMETERS !!!			
SELECT DIVISION: 			
Open date			
CASE FOR 			
 IS ALREADY OPENED BY 			
HOMES MUST BE ADDED.  THIS ENTRY WILL BE DELETED			
DO YOU WANT TO CLOSE CASE			
DO YOU WANT TO OPEN ANOTHER NEW CASE			
Was this a High Risk Patient			
SELECT HOME: 			
INCOMPLETE DATA!!  RECORD DELETED.			
DELETING OLD NAMESPACE (SW) SORT TEMPLATES...			
 Sort Template...<DELETED>			
DELETING OLD NAMESPACE (SW) INPUT TEMPLATES...			
 Input Temple...<DELETED>			
DELETING OLD NAMESPACE (SW) PRINT TEMPLATES...			
 Print Template...<DELETED>			
DELETING OLD NAMESPACE (SW) OPTIONS...			
 Menu Option...<DELETED>			
DELETING OBSOLETE OPTIONS...			
Option to re-index the 'CP' and 'BS5' x-refs in file #650			
Option QUEUED to run			
BE SURE LABELS ARE IN PRINTER PROPERLY			
WHEN READY PRESS RETURN OR ENTER KEY.  ARE YOU READY			
RESIDENTIAL CARE HOME ADDRESS LIST			
LABELS WILL PRINT LATER			
Problems and Outcomes Report			
NOT ATTAINED			
PROB.			
NOT TO TREAT			
CR BARR.			
VAMC BARR.			
NOTE:  P/F=PATIENT/FAMILY, CR=COMMUNITY RESOURCES, BARR.=BARRIERS			
DIVISONAL PROBLEMS AND OUTCOME REPORT			
NOTE: P/F=PATIENT/FAMILY, CR=COMMUNITY RESOURCES, BARR.=BARRIERS			
PRINT ALL AMIS REPORTS OPTION			
RCH PATIENT REGISTRY FOR ALL OPEN CASES FOR A SINGLE WORKER			
COMPLETE: OPEN CASES			
SUMMARY: OPEN CASES			
RCH PATIENT REGISTRY FOR ALL CASES			
PATIENT STATUS REPORT			
RESOURCES/REFERRALS			
THERE IS DATA IN THE SOCIAL WORK CASE FILE.  DO YOU WANT TO CONTINUE			
INSTALLATION TERMINATED !			
DO YOU WANT TO DELETE OLD NAMESPACE (SW) TEMPLATES AND OPTIONS NOW			
IF 'YES' ALL SOCIAL WORK CASE DATA WILL BE DELETED.			
IF 'NO' THE INSTALL WILL TERMINATE, BUT ALL CASES MUST BE CLOSED,			
TRANSMITTED TO AUSTIN, AND CASE DATA MUST BE PURGED.			
RCH PATIENT REGISTRY FOR ALL OPEN CASES			
Ending date must be after starting date 			
QUALITY MGMT. MONITOR I REPORT - SOCIAL WORK			
DISCHARGE PLANNING			
FAMILY CONFERENCE			
Quality Management Monitor II			
Family involvement in Discharged Planning			
Total Patients			
Family Conference			
% rec'd Family Conference			
QUALITY MGMT. MONITOR III REPORT - SOCIAL WORK			
Quality Management Monitor III			
Timeliness of service to patients receiving discharge planning			
# PTS REC'D			
DISCH. PLAN.			
AVG. # ELAPSED DAYS			
QUALITY MGMT. MONITOR IV REPORT - SOCIAL WORK			
Quality Management Monitor IV			
Level of problem resolution by problem code			
Worker's #: 			
Resolutions			
Occurred			
QUALITY MGMT. MONITOR V REPORT - SOCIAL WORK			
Quality Management Monitor V			
Access to Social Work Services by Location			
Total # Patients			
Treatment Episodes			
POST DISCHARGE FOLLOW-UP			
Quality Management Monitor I			
Follow-up of discharged inpatients who received			
Discharged Planning			
 and had 			
Problems related to care			
Post Discharge Follow-up			
QUALITY MGMT. REVIEW I REPORT - SOCIAL WORK			
Quality Management Review I			
Non-Followup of discharged inpatients who received			
Date Opened			
QUALITY MGMT. REVIEW III REPORT - SOCIAL WORK			
Avg. # Elapsed Days: 			
Quality Management Review III			
Worker's #			
Elapsed Days			
QUALITY MANAGEMENT REVIEW IV REPORT - SOCIAL WORK			
Quality Management Review IV			
Unresolved problems			
QUALITY MGMT. REVIEW II REPORT - SOCIAL WORK			
Quality Management Review II			
RCH AMIS 256 FROM 			
RESIDENTIAL CARE HOME AMIS REPORT			
CASES OPENED DURING QUARTER			
CASES CLOSED DURING QUARTER			
TOTAL CASES TREATED			
PREVIOUS LIVING ARRANGEMENTS			
VA CARE			
VAH EXCESS			
VA DOM			
VA CNH			
VA NH			
VA RES.			
NON NH			
LEVEL OF CARE CAPACITY			
SPECIAL PATIENT POPULATION			
RCS AMIS REPORT 10-0173			
RCS 10-0173 AMIS REPORT 			
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