English	French	Notes	Complete/Exclude
options found under the Operations Menu.  If you want to display a two screen			
overview of this case, enter '2'.			
  To delete this case from your records,			
enter '3'.  Please note that deleting a case will remove EVERYTHING pertaining			
to this operative procedure.			
List of Surgery Risk Assessments			
  1. List of Incomplete Assessments			
  2. List of Completed Assessments			
  3. List of Transmitted Assessments			
  4. List of Non-Assessed Major Surgical Cases			
  5. List of All Major Surgical Cases			
  6. List of All Surgical Cases			
  7. List of Completed/Transmitted Assessments Missing Information			
Select the Number of the Report Desired: 			
This report is designed to print to your terminal screen or a printer.  When			
using a printer, a 132 column format is used.			
Print the List of Assessments to which Device: 			
Select the number corresponding to the type of report you want to print.			
Print by Surgical Specialty ?  YES// 			
Enter <RET> to print the report by surgical specialty, or 'N' to print			
the report listing all surgical cases.			
Print report for ALL specialties ?  YES// 			
Enter <RET> to print the report for all surgical specialties, or 'N' to 			
print the report for a specific surgical specialty.			
Print the Report for which Surgical Specialty: 			
ALL SURGICAL CASES BY SURGICAL SPECIALTY			
ALL SURGICAL CASES			
TRANSMITTED RISK ASSESSMENTS			
TRANSMISSION DATE			
Preoperative Information			
Preoperative Laboratory Information			
want to edit.  Examples of proper responses are listed below.			
   Are you sure you want to delete all information 			
ANESTHESIA SERVICE			
ANESTHESIA AMIS			
DATE REVIEWED: 			
ANESTHETICS ADMINISTERED BY PRINCIPAL TECHNIQUE USED			
TOTAL NO OF ANES-       |             |             |             |             |             |			
THETICS ADMINISTERED    |   GENERAL   |   MAC       |   SPINAL    |   EPIDURAL  |   OTHER     |   LOCAL			
Anesthesia AMIS			
ANESTHETICS FOR PROCEDURES ADMINISTERED BY:			
**     ANESTHETICS FOR DIAG. & THERA. PROCEDURES ADMINISTERED BY:			
ANESTHESIOLOGIST    |  NURSE ANESTHETIST   |       OTHER			
**   ANESTHESIOLOGIST  |  NURSE ANESTHETIST   |     OTHER			
 NUMBER OF | NO. OF |  NUMBER OF  | NO. OF |  NUMBER OF | NO. OF			
**  NUMBER OF | NO. OF |  NUMBER OF  | NO. OF |  NUMBER OF | NO. OF			
ANESTHETICS| DEATHS | ANESTHETICS | DEATHS | ANESTHETICS| DEATHS			
DEATHS WITHIN 24 HOURS OF INDUCTION OF ANESTHETIC			
TOTAL NUMBER			
   OF DEATHS			
No operations exist for this patient.  Assessment cannot be entered.			
Enter the number of the desired operation			
' to enter a new case.			
This case is currently flagged as meeting Risk Assessment exclusion criteria.			
Are you sure that you want to create a Risk Assessment for this surgical			
Enter 'YES' to create an assessment for this surgical case, or 'NO' to quit			
Select Operation, or enter <RET> to continue listing Procedures: 			
An operation must be selected !			
The following information is required for the Anesthesia AMIS and for Risk			
Assessment.			
Airway Index: 			
Would you like to enter additional anesthesia related information ? NO// 			
If you would like to enter anesthesia information in addition to what is			
required for the Anesthesia AMIS, enter 'YES'.  Enter RETURN to leave this			
ANESTHESIA INFO			
List of Anesthetic Procedures			
Print List of Anesthetic Procedures for			
1. O.R. Surgical Procedures.			
LIST OF ANESTHETIC PROCEDURES			
Enter '1' or press <RET> to print the List of Anesthetic Procedures			
performed in the OR with a surgical procedure.  Enter '2' to print the			
List of Anesthetic Procedures performed as or with a Non-OR Procedure.			
Enter '3' to print the List of Anesthetic Procedures including both of			
the above categories of procedures.			
O.R. SURGICAL AND NON-O.R. PROCEDURES			
PRIN ANESTHETIST			
ANESTH TECHNIQUE			
END TIME			
ANESTH AGENT			
INCOMPLETE RISK ASSESSMENTS			
SRECIALTY NOT ENTERED			
Select Postoperative Outcome: 			
1. Enter 'A' to update all outcome information.			
2. Enter a number (1-3) to update an individual outcome element.  (For			
   example, enter '1' to update all postoperative diagnosis)			
3. Enter a range of numbers (1-3) separated by a ':' to enter a range of			
   outcomes.  (For example, enter '1:3' to enter postoperative diagnosis,			
   length of postoperative stay, and 30 day postoperative status)			
2. Enter a number (1-13) to update the information in that field.  (For			
   example, enter '2' to update Principal Operation.)			
3. Enter a range of numbers (1-13) separated by a ':' to enter a range of			
   Principal Operation, and Principal CPT Code.)			
Concurrent case information cannot be updated using the Risk Assessment			
Module.  To update the CPT code of a concurrent case, please use an option			
contained within the Operation Menu.			
Concurrent Procedure: 			
Surgeon: 			
 1. Surgical Specialty: 			
 2. Principal Operation: 			
 3. Principal CPT Code: 			
 4. Other Procedures:			
 5. Concurrent Procedure:			
 6. PGY of Primary Surgeon:			
 7. Surgical Priority:			
 8. Wound Classification: 			
 9. ASA Classification:			
10. Anesthesia Technique:			
11. RBC Units Transfused:			
12. Postop Diagnosis Code (ICD9):			
13. Major or Minor:			
1. Other Procedure (1):			
   CPT Code:			
2. Other Procedure (2):			
3. Other Procedure (3):			
4. Other Procedure (4):			
5. Other Procedure (5):			
Select Other Operative Procedure Information: 			
2. Enter a number (1-5) to update one specific procedure.  For example, 			
   enter '1' to update Other Procedure (1).			
3. Enter a range of numbers, separated by a ':' to update more than one			
   procedure.  For example, enter '1:2' to enter Other Procedure (1) and			
   Other Procedure (2).			
Other Operative Procedure (			
DISCHARGED ALIVE			
DIED IN HOSPITAL			
REMAINS IN VAMC FACILITY			
TRANSFERRED TO ANOTHER VAMC			
1. Postoperative Diagnosis Code (ICD9):			
2. Length of Postoperative Hospital Stay:			
3. 30 Day Postoperative Status:			
Other Procedure (			
Operation Date: 			
Ethnicity:			
Race:			
Transfer Status: 			
Observation 			
Hospital Admission Date:			
Hospital Discharge Date:			
Admitted/Transferred to Surgical Service:			
Discharged/Transferred to Chronic Care:			
In/Out-Patient Status:			
Enter <RET> to continue printing the remaining pages of this assessment, or			
'^' to exit this option.			
VA CARDIAC RISK ASSESSMENT			
VA NON-CARDIAC RISK ASSESSMENT             Assessment: 			
All complications must be entered using the option contained within the			
Complications Menu.			
VA CARDIAC SURGERY RISK ASSESSMENT PROGRAM			
Assessment Number: 			
Hospital Number: 			
Cardiac Surgery Performed at Non-VA Facility (but funded by VA): 			
I. CLINICAL DATA			
Gender:			
Resting ST Depression:			
Functional Status: 			
PTCI: 			
Prior MI:			
Diabetes:			
Prior Heart Surgery:			
COPD:			
Peripheral Vascular Disease:			
FEV1:			
Cerebral Vascular Disease:			
Cardiomegaly (X-ray): 			
Angina (use CCS Class):			
Pulmonary Rales:			
CHF (use NYHA Class):			
Current Smoker: 			
Current Diuretic Use:			
Creatinine:			
Current Digoxin Use:			
Hemoglobin:			
IV NTG 48 Hours Preceding Surgery:			
Serum Albumin:			
Preop Use of IABP:			
Active Endocarditis:			
Hypertension:			
II. CARDIAC CATHETERIZATION AND ANGIOGRAPHIC DATA			
Cardiac Catheterization Date: 			
LVEDP:			
Left Main Stenosis:			
Aortic Systolic Pressure:			
LAD Stenosis:			
*PA Systolic Pressure:			
Right Coronary Stenosis:			
*PAW Mean Pressure:			
Circumflex Stenosis:			
Mitral Regurgitation:			
LV Contraction Grade (from contrast or radionuclide angiogram or 2D Echo):			
Ejection Fraction Range			
Definition			
III. OPERATIVE RISK SUMMARY DATA			
(Operation Began: 			
Physician's Preoperative			
(Operation Ended: 			
Estimate of Operative Mortality: 			
ASA Classification:			
Surgical Priority:			
CPT Code Missing			
Principal CPT Code: 			
Other Procedures CPT Codes: 			
Preoperative Risk Factors: 			
II             0.45-0.54                   MILD DYSFUNCTION			
III           0.35-0.44                    MODERATE DYSFUNCTION			
IIIa          0.40-0.44                    MODERATE DYSFUNCTION A			
IIIb          0.35-0.39                    MODERATE DYSFUNCTION B			
IV            0.25-0.34                    SEVERE DYSFUNCTION			
 V             <0.25                       VERY SEVERE DYSFUNCTION			
IV. OPERATIVE DATA			
 Incision Type: 			
 A. Cardiac Procedures Requiring Cardiopulmonary Bypass			
Cardiac Transplant:			
Number with Vein:			
Electrophysiologic Procedure:			
Number with IMA:			
Misc. Cardiac Procedures			
Number with Radial Artery:			
ASD Repair: 			
Number with Other Artery:			
VSD Repair:			
Number with Other Conduit:			
Myxoma Resection:			
Aortic Valve Replacement:			
Foreign Body Removal:			
Mitral Valve Replacement:			
Myectomy for IHSS:			
Tricuspid Valve Replacement:			
Pericardiectomy:			
Valve Repair:			
Other Tumor Resection:			
LV Aneurysmectomy:			
Minimally Invasive Procedure: 			
Great Vessel Repair (Req CPB):			
Batista Procedure: 			
Total Ischemic Time (minutes): 			
Other Procedure(s):			
Total CPB Time (minutes): 			
Convert Off Pump to CPB: 			
 B. Operative Death:			
Perioperative MI:			
Reoperation for Bleeding:			
Endocarditis:			
On Ventilator > or = 48 Hours: 			
Renal Failure Requiring Dialysis:			
Repeat Cardiopulmonary Bypass:			
Low Cardiac Output > or = 6 Hours:			
Coma > or = 24 Hours:			
Mediastinitis:			
Stroke/CVA:			
Cardiac Arrest Requiring CPR:			
Trachestomy:			
Mechanical Circulatory Support:			
V. RESOURCE DATA			
Time Patient In  OR: 			
Time Patient Out OR: 			
Date and Time Patient Extubated: 			
Date and Time Patient Discharged from ICU: 			
Resource Data Comments: 			
VI. Socioeconomic Data 			
Employment Status Preoperatively: 			
Race/Ethnic: 			
 *** End of report for 			
VII. Guideline Compliance Indicators: Background Data			
Primary care or referral VAMC identification code: 			
Follow-up VAMC identification code: 			
VIII. Detailed Laboratory Information - Assessment at Patient Discharge			
Note: Laboratory data is collected at the time of assessment completion and			
      can not be edited by the nurse!!			
HDL: 			
LDL: 			
Date of HDL: 			
Date of LDL: 			
Serum Triglyceride: 			
Total Cholesterol: 			
Date of Serum Trig.: 			
Date of Total Cholesterol: 			
Serum Potassium: 			
Date of Serum Potassium: 			
Serum Bilirubin: 			
Date of Serum Bilirubin: 			
IX. Detailed Discharge Information			
   Discharge ICD-9 Codes: 			
   Discharge Disposition: 			
MCAR(691.1			
Enter/Edit Patient Demographic Information			
Enter '1' if you want to capture patient movement information from PIMS			
movement and other information on this screen.			
The Patient's Race and Ethnicity information cannot be updated through the			
Surgery package options.			
NOTE: Items 11 and 12 cannot be updated through the surgery package options.			
1. Enter 'A' to update items 1 through 10.			
Cardiac			
   Sure you want to delete all 			
Select Preoperative Information to Edit: 			
2. Enter a number (1-2) to update the information in that group.  (For			
   example, enter '1' to update all Central Nervous System information)			
   update Impaired Sensorium, enter '1A')			
4. Enter a range of numbers (1-2) separated by a ':' to enter all			
   Central Nervous System and Nutritional/Immune/Other information.			
2. Enter a number (1-5) to update the information in that group.  (For			
   example, enter '4' to update all cardiac information)			
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