Form CMS-10136 PGP_TD-PAT_Screen_ShotsJH

This is the log on screen for the PAT tool. It shows the current PRA Disclaimer and OMB approval number. It will be updated to reflect the new
approval date, when received.
This screen has space for the user to type in his/her user name, password, performance year and SQL server information.

This screen from the “User Guide” shows “General Abstraction Guidelines” to assist users in completing the tool.

Demographics Module

This screen shows all of the demographic information for the patient for whom the practice is reporting clinical data. There is one screen per
patient. The information on this sheet is pre-populated using Medicare claims and enrollment information and includes the patient’s name, gender,
Medicare ID #, and date of birth. In addition, the panel on the right side of the screen shows which categories of measures the patient qualifies for
(e.g. diabetes, congestive heart failure, coronary artery disease, and preventive services) and where the patient is in the reporting order. The screen
shows whether the reporting for this patient is complete or incomplete and allows the practice to put in some comments specific to this patient
such as why the patient was excluded, the source of data used for reporting, etc.

This is the screen for reporting the measures for coronary artery disease (CAD). Every patient eligible for reporting the CAD will have their own
screen. Before completing the form, the practice will confirm that the patient has the diagnosis by selecting “Yes” or “No” in the box labeled
“CAD Confirmed”. Then each of the measures has its own box whereby the user can type in information such as lab values, put in dates of tests by
clicking on a calendar, and choosing “yes” or “no” from a drop down menu to confirm that a test was given. As with the demographic module
screen, the right side of the screen shows what measures the patient qualifies for in reporting and the reporting status for that patient.

This is the screen for reporting the measures for chronic obstructive pulmonary disease (COPD). Every patient eligible for reporting the COPD
will have their own screen. Before completing the form, the practice will confirm that the patient has the diagnosis by selecting “Yes” or “No” in
the box labeled “COPD Confirmed”. Then each of the measures has its own box whereby the user can type in information such as lab values, put
in dates of tests by clicking on a calendar, and choosing “yes” or “no” from a drop down menu to confirm that a test was given. As with the
demographic module screen, the right side of the screen shows what measures the patient qualifies for in reporting and the reporting status for that
patient.

This is the screen for reporting the measures for diabetes mellitus (DM). Every patient eligible for reporting the diabetes measures will have their
own screen. Before completing the form, the practice will confirm that the patient has the diagnosis by selecting “Yes” or “No” in the box labeled
“DM Confirmed”. Then each of the measures has its own box whereby the user can type in information such as lab values, put in dates of tests by
clicking on a calendar, and choosing “yes” or “no” from a drop down menu to confirm that a test was given. As with the demographic module
screen, the right side of the screen shows what measures the patient qualifies for in reporting and the reporting status for that patient.

This is the screen for reporting one of two measures for frail elderly (FE). Every patient eligible for reporting the frail elderly measures will have
their own screen. The measure has its own box whereby the user can type in information such as lab values, put in dates of tests by clicking on a
calendar, and choosing “yes” or “no” from a drop down menu to confirm that a test was given. As with the demographic module screen, the right
side of the screen shows what measures the patient qualifies for in reporting and the reporting status for that patient.

This is the screen for reporting one of two measures for frail elderly (FE). Every patient eligible for reporting the frail elderly measures will have
their own screen. Before completing the form, the practice will confirm that the patient has the diagnosis by selecting “Yes” or “No” in the box
labeled “Confirm Dx of Fracture”. The measure has its own box whereby the user can type in information such as lab values, put in dates of tests
by clicking on a calendar, and choosing “yes” or “no” from a drop down menu to confirm that a test was given. As with the demographic module
screen, the right side of the screen shows what measures the patient qualifies for in reporting and the reporting status for that patient.

This is the screen for reporting the measures for heart failure (HF). Every patient eligible for reporting the heart failure measures will have their
own screen. Before completing the form, the practice will confirm that the patient has the diagnosis by selecting “Yes” or “No” in the box labeled
“HF Confirmed”. Then each of the measures has its own box whereby the user can type in information such as weight, put in dates of visits by
clicking on a calendar, and choosing “yes” or “no” from a drop down menu to confirm that a test was given. If a measure is not appropriate for the
patient, there is an option to select reasons for that from a drop down menu. As with the demographic module screen, the right side of the screen
shows what measures the patient qualifies for in reporting and the reporting status for that patient.

This is the screen for reporting the measures for hypertension (HTN). Every patient eligible for reporting the hypertension measures will have their
own screen. Before completing the form, the practice will confirm that the patient has the diagnosis by selecting “Yes” or “No” in the box labeled
“HTN Confirmed”. Then each of the measures has its own box whereby the user can type in information such as weight, put in dates of visits by
clicking on a calendar, and choosing “yes” or “no” from a drop down menu to confirm that a test was given. Then, for each of the office visit dates
shown, the practice provides the required information about whether or not blood pressure was checked. As with the demographic module screen,
the right side of the screen shows what measures the patient qualifies for in reporting and the reporting status for that patient.

This is the screen for reporting one of three meaningful use measures. Every patient eligible for reporting this measure will have their own screen.
As with the demographic module screen, the right side of the screen shows what measures the patient qualifies for in reporting and the reporting
status for that patient.

This is the screen for reporting one of three meaningful use measures. Every patient eligible for reporting this measure will have their own screen.
As with the demographic module screen, the right side of the screen shows what measures the patient qualifies for in reporting and the reporting
status for that patient.

This is the screen for reporting one of three meaningful use measures. Every patient eligible for reporting this measure will have their own screen.
As with the demographic module screen, the right side of the screen shows what measures the patient qualifies for in reporting and the reporting
status for that patient.

This is the screen for reporting one of four preventive care measures. Every patient eligible for reporting this measure will have their
own screen. As with the demographic module screen, the right side of the screen shows what measures the patient qualifies for in
reporting and the reporting status for that patient.

This is the screen for reporting the colorectal cancer screening measure. Every patient eligible for reporting this measure will have their own
screen. As with the demographic module screen, the right side of the screen shows what measures the patient qualifies for in reporting and the
reporting status for that patient.

This is the screen for reporting one of four preventive care measures. Every patient eligible for reporting this measure will have their own screen.
As with the demographic module screen, the right side of the screen shows what measures the patient qualifies for in reporting and the reporting
status for that patient.

This is the screen for reporting one of four preventive care measures. Every patient eligible for reporting this measure will have their own screen.
As with the demographic module screen, the right side of the screen shows what measures the patient qualifies for in reporting and the reporting
status for that patient.

This is the screen for reporting the transitions of care/care coordination measure. Every patient eligible for reporting this measure will have their
own screen. As with the demographic module screen, the right side of the screen shows what measures the patient qualifies for in reporting and the
reporting status for that patient.