Form 0920-0278 Attachment D - 2016 NHAMCS ASL PRF Changes

Attachment D
2016 NHAMCS Ambulatory Surgery Patient Record Form (PRF) Changes
Proposed changes are indicated in RED.


Modified-Anesthesia types
“Anesthesia” Section
ANESTH:
Old
 NONE
 General
 Conscious/IV sedation/MAC (Monitored
Anesthesia Care)
 Regional epidural
 Regional peripheral nerve
 Regional peribulbar
 Regional retrobulbar
 Regional spinal (Subarachnoid)
 Regional, other
 Local /Topical
 Other



New
 NONE
 General
 Conscious/IV sedation/MAC
(Monitored Anesthesia Care)
 Local/Topical
 Regional epidural
 Regional peribulbar block
 Regional peripheral nerve block
 Regional retrobulbar block
 Regional spinal (subarachnoid)
 Other regional block
 Other

Modified-Visit Disposition
“Visit Disposition” Section
ASCDISP:
Old
New
Mark (X) one box.
Mark (X) all that apply.
1. Routine discharge to customary
1. Routine discharge to customary
residence
residence
2. Discharge to observation status
2. Discharge to observation status
3. Discharge to post-surgical/recovery care  Discharge to post-surgical/recovery care
facility
facility
4. Admitted to hospital as inpatient
3. Admitted to hospital as inpatient
5. Referred to ED
4. Referred to ED
6. Surgery terminated
5. Surgery terminated
Reason for surgery termination
Reason for surgery termination
Allergic reaction
Allergic reaction
Unable to intubate
Unable to intubate
Other
Other
Unknown
Unknown
7. Procedure canceled on arrival to
6. Procedure canceled on arrival to clinic
ambulatory surgery unit
or ambulatory surgery unit/location

Reason for cancellation
Patient not n.p.o./fasting
Incomplete or inadequate medical
evaluation
Surgical issue
Other
Unknown
8. Other
9. Unknown



Reason for cancellation
Patient not n.p.o./fasting
Incomplete or inadequate medical
evaluation
Surgical issue
Other
Unknown
7. Other
8. Unknown

Modified-Follow-up Information
“Follow-up Information” Section
LEARNED:
Old
New
What was learned from this follow-up:
What was learned from this follow-up:
1. Unable to reach patient
1. Unable to reach patient
2. Patient reported no problems
2. Patient reported no medical or surgical
3. Patient reported problems and sought
problems
medical care
3. Patient reported medical or surgical
4. Patient reported problems and was
problems and sought medical care
advised by ambulatory surgery staff to
4. Patient reported medical or surgical
seek medical care
problems and was advised by staff to
5. Patient reported problems, but no followseek medical care
up medical care was needed
5. Patient reported medical or surgical
6. Other
problems, but no follow-up medical care
7. Unknown
was needed
6. Other
7. Unknown