English French Notes Complete/Exclude patients found. Select STATUS: To list only those patients with this problem in a specific status, select: BOTH ACTIVE & INACTIVE Someone else is currently editing this file. Missing problem narrative Invalid patient Invalid provider Invalid problem Patient does not match for this problem Date Recorded is not editable Cannot delete problem status Date Resolved cannot be prior to Date of Onset Date Recorded cannot be prior to Date of Onset data item Invalid ICD Diagnosis Invalid Lexicon term Duplicate problem Invalid hospital location Invalid problem status Invalid Date of Onset Invalid Date Resolved Active problems cannot have a Date Resolved Invalid Date Recorded Invalid SC flag Invalid AO flag Invalid IR flag Invalid EC flag Invalid HNC flag Invalid MST flag DATA NAME HEAD AND/OR NECK CANCER No problems available. OR WORKSTATION PRN| OR WINDOWS HFS ICD- AI/RHEUM MeSH TITLE 38 Select Problem(s) Enter the problems you wish to act on , as a range or list of numbers Select Problem Enter the number of the problem you wish to Are you sure you want to continue? Enter YES if you want to duplicate this problem on this patient's list; press to re-enter the problem name. is already an ACTIVE problem on this patient's list! Onset: Resolved: This problem is currently being edited by another user! Enter YES to remove this value or NO to leave it unchanged. Are you sure you want to remove this value? + Next Screen - Prev Screen ?? More actions ERROR -- Please check your Patient Files #2 and #9000001 for inconsistencies. AO/IR/EC/HNC/MST Enter YES to continue and add new problem(s) for this patient: press to select another action. DATE OF DEATH: Lastname,F Enter the clinic to be associated with these problems, if available Only clinics are allowed! Select Specialty Subset: GENERAL PROBLEM Because many discipline-specific terms are synonyms to other terms, they are not accessible unless you specify the appropriate subset of the Clinical Lexicon to select from. Choose from: Nursing Immunologic Dental Social Work General Problem GMRA*4.0*2 GMRA*4.0*2 has not been installed on your system. Done. It does not appear that GMRA*4.0*2 was installed. Please contact your IRM Field Office Customer Support Representative. GMRA*4.0*5 GMRA*4.0*2 was installed on Your current AUTOVERIFY site parameters are: Site Parameter Name: Autoverify Food/Drug/Other: NO AUTOVERIFY AUTOVERIFY DRUG ONLY AUTOVERIFY FOOD ONLY AUTOVERIFY DRUG/FOOD AUTOVERIFY OTHER ONLY AUTOVERIFY DRUG/OTHER AUTOVERIFY FOOD/OTHER AUTOVERIFY ALL Autoverify Logical Operator: Autoverify Observed/Historical: AUTOVERIFY HISTORICAL ONLY AUTOVERIFY OBSERVED ONLY AUTOVERIFY BOTH Want to stop (Y/N) Answer YES to continue or NO to halt. Since your site does not autoverify any reactions you can halt now. Autoverify this reaction (Y/N) Answer YES to mark this reaction as autoverified or NO to leave it unchanged. Answering YES will change the ORIGINATOR SIGN OFF and VERIFIED fields to YES and enter a date/time into the VERIFICATION DATE/TIME field (i.e., this will mark the record as autoverified). Answering NO will not change the record. No unsigned reactions were found for the time period between the installation of GMRA*4.0*2 and GMRA*4.0*5. DO NOT USE DECIMAL VALUES. 1 Current Inpatients 2 Outpatients over Date/Time range 3 New Admissions over Date/Time range 4 All of the above Enter the number(s) for those groups to be used in this report: (1-4): ENTER THE NUMBER(S) FOR THOSE GROUPS TO BE INCLUDED IN THIS REPORT. THIS RESPONSE MUST BE A LIST OR RANGE, E.G., 1,3 OR 2-3 Enter date/time range in which patients were admitted into the hospital seen at an outpatient clinic Enter START Date (time optional): ENTER THE START DATE/TIME OF RANGE TO SEE PATIENTS THAT WERE ADMITTED TO THE HOSPITAL SEEN AT AN OUTPATIENT CLINIC Enter END Date (time optional): T// ENTER THE END DATE/TIME OF RANGE TO SEE PATIENTS THAT WERE Another Do you mean ALL Locations Enter Y for yes you mean ALL or N for no. YOU HAVE ALREADY SELECTED: TO STOP: You may deselect from the list by typing a '-' followed by location name. E.g. -3E would delete 3E from the list of locations already selected. You may enter the word ALL to select all appropriate locations. GMRA* List of patients without ID band or Chart marked Request queued... Request NOT queued please try later... ID BAND/CHART ID BAND PATIENTS WITH UNMARKED ID BAND/CHART CURRENT INPATIENTS NEW ADMISSIONS / NEW ADMISSIONS PLEASE ENTER 'Y' TO DELETE THE CAUSATIVE AGENT 'N' NOT TO DELETE THE DATA Do you wish to delete Causative Agent One moment please deleting data... Fire Bulletin to Mark Patient Allergy DFN= Allergy Adverse Reaction ALLERGY;0 PHARMACOLOGIC;2 UNKNOWN;U ALLERGY;A PHARMACOLOGIC;P OTHER REACTION PHARM UNKNOWN CAUSATIVE AGENT: AGENT: INGREDIENTS: VA DRUG CLASSES: ORIGINATOR: ORIGINATED: SIGN OFF: OBS/HIST: ID BAND MARKED: CHART MARKED: SIGNS/SYMPTOMS: MECHANISM: VERIFIER: VERIFIED: USER ENTERING IN ERROR: ALLERGY/ADVERSE REACTION DATA EXISTS FOR THIS PATIENT HOWEVER, THERE IS DATA ENTERED IN ERROR ON FILE PATIENT HAS ANSWERED NKA BUT HAS DATA ON FILE ALLERGY/ADVERSE REACTION REPORTS Select 1:DRUG, 2:FOOD, 3:OTHER Type of allergy Select 1:ACTIVE, 2:ENTERED IN ERROR Which would you like to see? This patient has No Known Allergies. THERE IS NO DATA FOR THIS REPORT. TYPE: GMRA Print Complete List of Patient's Reactions ALLERGY/ADVERSE REACTIONS TO BE SIGNED OFF ORIGINATION DATE/TIME GMRA-ALLERGY VERIFY NO DATA FOR THIS REPORT Patient reactions not signed off ACTIVE ALLERGY/ADVERSE REACTION LISTING OBS/ ADVERSE REACTION NO ALLERGY/ADVERSE REACTION DATA EXISTS FOR THIS PATIENT Patient has answered NKA. No Data Found Reactions: This a print out of the allergies signed off for the patient VER. Press RETURN to continue or '^' to stop listing Press RETURN to continue, '^' stop reactant listing. OUT PATIENT GMRA ENTERED IN ERROR G.GMRA VERIFY G.GMRA MARK CHART No data for this REPORT. PLEASE TRY LATER Print FDA Exception Report FDA EXCEPTION REPORT ( Starting at ORIGINATION D/T CAUSATIVE AGENT This patient has No Known Allergies This patient has no allergies on file Enter the Date to start search (Time optional) ENTER THE DATE YOU WANT THE SYSTEM TO START IT'S SEARCH Select Start Date Select End Date YOU CAN ONLY EDIT DRUG REACTIONS Indicate which FDA Report Sections to be completed: 1. Reaction Information 2. Suspect Drug(s) Information 3. Concomitant Drugs and History 4. Manufacturer Information 5. Initial Reporter Choose number(s) of sections to be edited ENTER THE NUMBER SECTION OR SECTIONS YOU WISH TO COMPLETE. YOU CAN ENTER: YOU TYPE SYSTEM WILL DO THIS REPORT SHOULD BE SENT TO A 132 COLUMN PRINTER. PLEASE TRY AGAIN LATER Produce FDA Report for ATTACHMENT PAGE PATIENT ID: SUSPECT MEDICATION: DATE OF EVENT: Section B. Part 5. Describe event Continued Section B. Part 6. Relevant Test/Laboratory Data Continued: TEST: COLLECTION DATE: Section B. Part 7. Other Relevant History Continued Section C. Part 10. Concomitant Drugs Continued Select Start Date/Time Select End Date/Time Do you want an Abbreviated report ENTER FOR YES OR FOR NO Print FDA Report by Date/Time (SENT TO FDA: FDA ABBREVIATED REPORT SUSPECTED AGENT D/T OF EVENT MEDWatch Approved by FDA on 10/20/93 THE FDA MEDICAL PRODUCTS REPORTING PROGRAM | Triage unit sequence # A. Patient Information | C. Suspect Medication(s) 1. Patient Indentifier|2. DOB: B. Adverse Event or Product Problem 1. [X]Adverse Event [ ]Product problem |2. Dose,frequency & route used | 3. Therapy dates 2. Outcomes attributed to adverse event ] congenital anomaly ] congenital anomaly ] required intervention to |4. Diagnosis for use(indication)|5. Event abated after use initial or prolonged prevent impairment/damage | stopped or dose reduced? 3. Date of event |4. Date of this report |6. Lot # (if known) |7. Exp. date|8. Event reappeared after 5. Describe event or problem SEE ATTACHED |9. (Not applicable to adverse drug event reports) 6. Relevant test/laboratory data. including dates |10. Concomitant medical products/therapy dates(exclude treatment) PLEASE SEE ATTACHED |D. Suspect Medical Devices 7. Other relevant History, including preexisting medical | Note: Please use the actual MedWatch form if the event | involves a suspected device as well as a suspect drug Mail to: MedWatch or FAX to: 5600 Fishers Lane 1-800-FDA-0178 |2. Health professional? |3. Occupation |4. Reported to Mfr. |5. If you don't want your identity disclosed to the Manufacturer, | place an in the box.[ FDA Form 3500 Submission of a report does not constitute an admission that medical personnel or the product caused or contributed to the event. Select a LOCAL ALLERGY/ADVERSE REACTION: THIS ENTRY IS BEING EDITED BY SOMEONE ELSE CANNOT EDIT NAME FIELD OF A NATIONAL ALLERGY. Select a LOCAL SIGN/SYMPTOM: (no editing) NAME: HOSPITAL// (No editing) #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################