Outpatient Department Patient Record Form Changes 2015

Attachment N - OPD PRF Changes 2015.docx

National Hospital Ambulatory Medical Care Survey

Outpatient Department Patient Record Form Changes 2015

OMB: 0920-0278

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Attachment N



Changes to 2015 NHAMCS Outpatient Department Patient Record Form (PRF)



Proposed changes are indicated in RED; variable names are in [ ].

  • Remove LMP question from the form [LMP]



  • Modified – Tobacco use [USETOBAC/EVERTOBAC]

Old

  • Never

  • Former

  • Current

  • Unknown


New

  • Not current

  • Current

  • Unknown



New

  • Never

  • Former

  • Unknown




  • Modified-Major Reason for this Visit [MAJOR]



Old Answer list

  • New problem (<3 mos. onset)

  • Chronic problem, routine

  • Chronic problem, flare-up

  • Pre surgery

  • Post surgery

  • Preventive care (e.g., routine prenatal, well-baby, screening, insurance, general exams)


New Answer list

  • New problem (<3 mos. onset)

  • Chronic problem, routine

  • Chronic problem, flare-up

  • Pre-surgery

  • Post-surgery

  • Preventive care (e.g., routine prenatal, well-baby, screening, insurance, general exams)



  • Modified-Injury/Poisoning/Adverse Effect Questions [INJURY]


Old

  • Is this visit related to an injury, poisoning, or adverse effect of medical treatment?

  1. Yes, injury

  2. Yes, poisoning

  3. Yes, adverse effect of medical/surgical care or adverse effect of medicinal drug

  4. No

  5. Unknown


New

  • Is this visit related to an injury/trauma, overdose/poisoning, or adverse effect of medical/surgical treatment?

  1. Yes, injury/trauma

  2. Yes, overdose/poisoning

  3. Yes, adverse effect of medical or surgical treatment or adverse effect of medicinal drug

  4. No

  5. Unknown


Old

  • Did this injury or poisoning occur within 72 hours priors to the date and time of this visit?

  1. Yes

  2. No

  3. Unknown

  4. Not applicable


New

  • Did the injury/trauma, overdose/ poisoning, or adverse effect occur within 72 hours prior to the date and time of this visit?

  1. Yes

  2. No

  3. Unknown

  4. Not applicable


Old

  • Is this injury or poisoning intentional or unintentional?

        1. Intentional

        2. Unintentional (e.g., accidental)

        3. Intent unclear


New

  • Is this injury/trauma, overdose/ poisoning, or adverse effect intentional or unintentional?

  1. Intentional

  2. Unintentional (e.g., accidental)

  3. Intent unclear



New

  • Was the intent of the injury:

  1. Suicide attempt with intent to die

  2. Intentional self-harm without intent to die

  3. Unclear if suicide attempt or intentional self-harm without intent to die

  4. Intentional harm inflicted by another person (e.g., assault, poisoning)


Old

Cause of injury/trauma, overdose, poisoning, or adverse effect.


New

Cause of injury/trauma, overdose/poisoning, or adverse effect of medical/surgical treatment


  • Modified-Checkbox list of patient’s underlying chronic conditions [PAT_HAVE]


Regardless of the diagnoses previously entered, does the patient now have -

Mark all that apply.


Old

New

Alcohol misuse, abuse, or dependence

Alcohol misuse, abuse, or dependence

Alzheimer's disease/Dementia

Alzheimer's disease/Dementia

Arthritis

Arthritis

Asthma

Asthma

---

Autism spectrum disorder

Cancer

Cancer

Cerebrovascular disease/stroke (CVA) or transient ischemic attack (TIA)

Cerebrovascular disease/History of stroke (CVA) or transient ischemic attack (TIA)

Chronic kidney disease (CKD)

Chronic kidney disease (CKD)

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD)

Congestive heart failure (CHF)

Congestive heart failure (CHF)

Coronary artery disease (CAD), ischemic heart disease (IHD) or history of myocardial infarction (MI)

Coronary artery disease (CAD), ischemic heart disease (IHD) or history of myocardial infarction (MI)

Depression

Depression

Diabetes mellitus (DM), Type I

Diabetes mellitus (DM), Type I

Diabetes mellitus (DM), Type II

Diabetes mellitus (DM), Type II

Diabetes mellitus (DM), Type unspecified

Diabetes mellitus (DM), Type unspecified

End-stage renal disease (ESRD)

End-stage renal disease (ESRD)

History of pulmonary embolism (PE) or deep vein thrombosis (DVT)

History of pulmonary embolism (PE) or deep vein thrombosis (DVT) or venous thromboembolism (VTE)

HIV Infection/AIDS

HIV Infection/AIDS

Hyperlipidemia

Hyperlipidemia

Hypertension

Hypertension

Obesity

Obesity

Obstructive sleep apnea (OSA)

Obstructive sleep apnea (OSA)

Osteoporosis

Osteoporosis

Substance abuse or dependence

Substance abuse or dependence

None of the above

None of the above


  • Modified-Services Ordered or Provided [DIAG_SERVICE]



Enter all examinations, laboratory tests, imaging, other procedures or other treatment and health education or counseling ORDERED or PROVIDED.



  • NO SERVICES



Examinations/Screenings:

  • Alcohol misuse screening (includes AUDIT, MAST, CAGE, T-ACE)

  • Breast

  • Depression screening

  • Domestic violence screening

  • Foot

  • Neurologic

  • Pelvic

  • Rectal

  • Retinal/ Eye Exam

  • Skin

  • Substance abuse screening (includes NIDA/NM ASSIST, CAGE-AID, DAST-10)



Laboratory tests:

  • Basic metabolic panel (BMP)

  • CBC

  • Chlamydia test

  • Comprehensive metabolic panel (CMP)

  • Creatinine /Renal function panel

  • Culture, blood

  • Culture, throat

  • Culture, urine

  • Culture, other

  • Glucose, serum

  • Gonorrhea test

  • HbA1c (Glycohemoglobin)

  • Hepatitis testing/Hepatitis panel

  • HIV test

  • HPV DNA test

  • Lipid profile

  • Liver enzymes/Hepatic function panel

  • PAP test

  • Pregnancy/HCG test

  • PSA (prostate specific antigen)

  • Rapid strep test

  • TSH/Thyroid panel

  • Urinalysis

  • Vitamin D test



Procedures:

  • Audiometry

  • Biopsy
    - Provided

  • Cardiac stress test

  • Colonoscopy
    - Provided

  • Cryosurgery (cryotherapy)/ Destruction of tissue

  • EKG/ECG

  • Electroencephalogram (EEG)

  • Electromyogram (EMG)

  • Excision of tissue
    - Provided

  • Fetal monitoring

  • Peak flow

  • Sigmoidoscopy
    - Provided

  • Spirometry

  • Tonometry

  • Tuberculosis skin testing/PPD

  • Upper gastrointestinal endoscopy/EGD
    - Provided



  • Modified- Tests [LAB_TEST]


Old


  • Was blood for the following laboratory tests drawn on the day of the sampled visit or during the 12 months prior to visit?

  1. Enter 1 to Continue


New


  • Was blood for the following laboratory tests drawn on the day of the sampled visit or during the 12 months prior to visit?

  1. Enter 1 to Continue



  • Add CPT codes [CPTCODE]


Old: No CPT codes were collected

New: Allow up to 18 CPT codes


8


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