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| # | Location | File | Last Modified |
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| 1 | TBIeP2_v3.4.16.zip\Registries TBI\TBI_UserInterface\documents | TBIAPPLICATIONFIELDDEFINITIONS.doc | Wed Apr 18 17:57:47 2018 UTC |
| 2 | TBIeP2_v3.4.16.zip\Registries TBI\TBI_UserInterface\documents | TBIAPPLICATIONFIELDDEFINITIONS.doc | Mon Apr 23 13:38:27 2018 UTC |
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| 2 | TRACKING A PPLICATION | |
| 3 | DATA DEFIN ITIONS | |
| 4 | August 14, 2008 | |
| 5 | Facility I D | |
| 6 | ||
| 7 | Facility w here the T BI screen was comple ted | |
| 8 | Name/SS# o f Patient with + scr een and de siring eva l | |
| 9 | ||
| 10 | Patient id entifier f or the OEF /OIF veter an that ha d a positi ve TBI scr een, and | |
| 11 | agreed to a comprehe nsive TBI evaluation . | |
| 12 | Date of sc reening | |
| 13 | ||
| 14 | Date TBI s creening w as complet ed. Value is listed as a date range fro m April | |
| 15 | 2007 to pr esent date . | |
| 16 | Date of Co nsult/Refe rral | |
| 17 | ||
| 18 | Date when a consulta tion was s ubmitted/r eferral ma de for the comprehen sive TBI | |
| 19 | evaluation . Value i s listed a s a date r ange from April 2007 to presen t date. | |
| 20 | Not Applic able | |
| 21 | ||
| 22 | Check box that shoul d be selec ted when a consultat ion or ref erral was not | |
| 23 | submitted. Selecti on of this check box will acti vate the ‘ Other Cons ult/Referr al | |
| 24 | Status’ fi eld for fu rther clar ification. | |
| 25 | Other Cons ult/Referr al status | |
| 26 | ||
| 27 | Consult no t submitte d | |
| 28 | ||
| 29 | ||
| 30 | Should be selected w hen a cons ult was no t submitte d/referral was not | |
| 31 | ||
| 32 | ||
| 33 | made for t he compreh ensive TBI evaluatio n. Select ion of thi s field wi ll | |
| 34 | ||
| 35 | ||
| 36 | prompt the user to t ake follow up action , and the status of this case cannot | |
| 37 | ||
| 38 | ||
| 39 | move to ‘c ompleted’ until appr opriate ac tion has b een taken and indica ted | |
| 40 | ||
| 41 | ||
| 42 | on the web applicati on. | |
| 43 | ||
| 44 | Evaluation without r eferral/co nsult | |
| 45 | ||
| 46 | ||
| 47 | Should be selected w hen the co mprehensiv e TBI eval uation was | |
| 48 | ||
| 49 | ||
| 50 | ||
| 51 | completed without su bmission o f a consul t/making a referral due to | |
| 52 | ||
| 53 | ||
| 54 | facility p ractice pa tterns. | |
| 55 | Attempts t o Contact Patient fo r Scheduli ng Purpose s | |
| 56 | ||
| 57 | Unable | |
| 58 | ||
| 59 | ||
| 60 | The initia l attempt to contact the patie nt for sch eduling ne eds to occ ur | |
| 61 | ||
| 62 | ||
| 63 | within 5 d ays of rec eipt of th e consult/ referral f or a compr ehensive T BI | |
| 64 | ||
| 65 | ||
| 66 | evaluation . Two add itional at tempts mus t occur wi thin 14 da ys from | |
| 67 | ||
| 68 | ||
| 69 | positive s creen. If all three attempts to contact the patie nt within the first | |
| 70 | ||
| 71 | ||
| 72 | 14 days of the posit ive screen are unsuc cessful, a certified letter is sent to | |
| 73 | ||
| 74 | ||
| 75 | the patien t providin g contact informatio n should t hey desire to call f or an | |
| 76 | ||
| 77 | ||
| 78 | appointmen t. This l etter must be sent w ithin 14 d ays of the positive | |
| 79 | ||
| 80 | ||
| 81 | screen. A ll efforts to contac t the pati ent should be docume nted in th e | |
| 82 | ||
| 83 | ||
| 84 | patient's health rec ord. | |
| 85 | ||
| 86 | Refused | |
| 87 | ||
| 88 | ||
| 89 | Patient wa s successf ully conta cted for s cheduling purposes, but the pa tient | |
| 90 | ||
| 91 | refused th e offer of a compreh ensive TBI evaluatio n. | |
| 92 | ||
| 93 | Scheduled: Date offe red by fac ility | |
| 94 | ||
| 95 | ||
| 96 | Patient wa s successf ully conta cted, and the patien t agreed t o an | |
| 97 | ||
| 98 | ||
| 99 | ||
| 100 | appointmen t schedule d on the d ate offere d by the f acility. | |
| 101 | ||
| 102 | Scheduled: Date requ ested by p atient | |
| 103 | ||
| 104 | ||
| 105 | Patient wa s successf ully conta cted, and the appoin tment was made on a | |
| 106 | ||
| 107 | ||
| 108 | date reque sted by th e patient. | |
| 109 | ||
| 110 | Unavailabl e | |
| 111 | ||
| 112 | ||
| 113 | Patient is not avail able for s cheduling due to rea sons beyon d their co ntrol | |
| 114 | ||
| 115 | ||
| 116 | (i.e. inca rceration, death, or redeploym ent). | |
| 117 | Date Sched uled with TBI Evalua tion Team | |
| 118 | ||
| 119 | Correspond s with app ointment d ate for co mprehensiv e TBI eval uation tha t is | |
| 120 | scheduled in CPRS/Vi sta. Valu e reflects date rang e from Apr il 2007 to present | |
| 121 | date. | |
| 122 | Time to Sc heduled Ap pt with TB I Evaluati on Team | |
| 123 | ||
| 124 | Calculated value tha t is the d ifference in days be tween the date of th e positive | |
| 125 | TBI screen and the d ate of the scheduled appointme nt with th e TBI eval uation | |
| 126 | team. | |
| 127 | Delay in C ompleting Evaluation (Response reflects any reason for a del ay in comp leting the comprehen sive TBI e valuation. ) | |
| 128 | ||
| 129 | No Show | |
| 130 | ||
| 131 | ||
| 132 | Patient di d not show for their scheduled appointme nt for the | |
| 133 | ||
| 134 | ||
| 135 | ||
| 136 | comprehens ive TBI ev aluation. | |
| 137 | ||
| 138 | Cancellati on by pati ent | |
| 139 | ||
| 140 | ||
| 141 | Patient ca ncelled th eir schedu led appoin tment for the compre hensive TB I | |
| 142 | ||
| 143 | ||
| 144 | evaluation . | |
| 145 | ||
| 146 | Cancellati on by clin ic | |
| 147 | ||
| 148 | ||
| 149 | Clinic can celled the scheduled appointme nt for the comprehen sive TBI | |
| 150 | ||
| 151 | ||
| 152 | evaluation . | |
| 153 | ||
| 154 | ||
| 155 | **This res ponse does not justi fy not com pleting th e evaluati on, | |
| 156 | ||
| 157 | ||
| 158 | ||
| 159 | and will c reate a ne w entry be ginning wi th the 'Co ntact' fie lds. | |
| 160 | ||
| 161 | Delay in c onsult/ref erral subm ission | |
| 162 | ||
| 163 | ||
| 164 | The time d elay in co mpleting t he TBI eva luation wa s impacted by a dela y | |
| 165 | ||
| 166 | ||
| 167 | in submiss ion of the consultat ion or ref erral to t he TBI eva luation te am. | |
| 168 | ||
| 169 | No delay i n completi ng evaluat ion | |
| 170 | ||
| 171 | ||
| 172 | Option is selected i f the TBI evaluation process f ell within 30 days o f the | |
| 173 | ||
| 174 | ||
| 175 | positive T BI screen. | |
| 176 | ||
| 177 | Clinic Cap acity | |
| 178 | ||
| 179 | ||
| 180 | Option is selected i f your ava ilable cli nic slots do not mee t the dema nd | |
| 181 | ||
| 182 | Delay in S uccessful Patient Co ntact | |
| 183 | ||
| 184 | ||
| 185 | Option is selected w hen the cl inic makes multiple attempts t o contact | |
| 186 | ||
| 187 | ||
| 188 | patient be fore succe ssfully es tablishing contact a nd schedul ing the | |
| 189 | ||
| 190 | ||
| 191 | ||
| 192 | appointmen t | |
| 193 | ||
| 194 | ** Multipl e Patient No Show/Ca ncellation -- Cases for which an entry o f ‘Cancell ed by Pati ent’ or ‘N o Show’ re quire furt her attemp ts at sche duling an appointmen t by the c linic, whi ch should be indicat ed on this form begi nning with the ‘Atte mpts to Co ntact Pati ent for Sc heduling P urposes’ f ield. Thi s applicat ion will c apture up to 3 attem pts to sch edule and complete t he TBI eva luation. Cases wher e a total of 3 cance llations b y the pati ent and/or no shows will satis fy the req uirements of this tr acking app lication. | |
| 195 | Date Evalu ation Comp leted | |
| 196 | ||
| 197 | Entry of d ate when t he compreh ensive TBI evaluatio n was | |
| 198 | completed by the TBI | |
| 199 | evaluation Team. C alendar pr ovides dat e range fr om April 2 007 to pre sent date. | |
| 200 | From this entry, the Time to C ompleted E valuation value is c alculated as the | |
| 201 | difference in days b etween the date of t he positiv e TBI scre en and the date the | |
| 202 | TBI evalua tion was c ompleted. | |
| 203 | Time to Co mpleted Ev aluation | |
| 204 | ||
| 205 | Calculated value tha t is the d ifference in days be tween the date of th e positive | |
| 206 | TBI screen and the d ate the TB I evaluati on was com pleted. | |
| 207 | Definitive TBI Diagn osis | |
| 208 | ||
| 209 | Value is a Yes/No/Un certain re sponse ind icating if the resul ts of the | |
| 210 | ||
| 211 | comprehens ive TBI ev aluation r esulted in a definit ive diagno sis of TBI . | |
| 212 | Responsibl e TBI Eval uation Tea m (Service /Clinic) | |
| 213 | ||
| 214 | Response r epresents the Servic e/Clinic r esponsible for compl eting the TBI | |
| 215 | evaluation . Values can be PM& R, Neurolo gy, Behavi oral Healt h, Primary Care | |
| 216 | with Speci alty Train ing in TBI , or Other . | |
| 217 | ||
| 218 | **A select ion of ‘Ot her’ will open a fre e text box where the responden t | |
| 219 | describes the treatm ent TBI ev aluation t eam scenar io that is different from | |
| 220 | the availa ble select ions above . For ins tance, a f acility ma y use Fee Basis | |
| 221 | providers or provide rs from an affiliate d facility to comple te the com prehensive | |
| 222 | ||
| 223 | TBI evalua tion. | |
| 224 | ||
| 225 | **Polytrau ma Point o f Contact Facilities would sel ect ‘Other ’ and | |
| 226 | then indic ate if | |
| 227 | they refer red their patient to a Polytra uma Suppor t Clinic T eam site o r | |
| 228 | Polytrauma Network S ite for th eir TBI ev aluation. | |
| 229 | Assistance : | |
| 230 | ||
| 231 | VSSC Help Desk- http:// URL /FAQ/HD_re quest.asp | |
| 232 | ||
| 233 | Douglas Bi delspach- 717 272 66 21 x4401 |
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