SELECT Patient_ID, Last_Name_M0040 AS Last_Name, First_Name_M0040 AS First_Name, Middle_Initial_M0040 AS Middle ,Payer_ID FROM #Request.prefix_db_agency#.patient WHERE Patient_Id = '#session.cs.patientid#' AND Agency_Id = '#session.AgencyId#' select Assessment_ID,M0420_Assess, Pain1, Pain2, Pain3, pain4, Pain5, Discharged_From_M0175, Start_of_Care_M0030, Inpatient_Discharge_Date_NA_M0180, Dress_Upper_M0650, Medical_or_Treatment_Change_M0200, Conditions_Prior_M0220, Therapies_Home_M0250, NUTRITION_485, Rehab_Prognosis_M0270, Life_Exp_M0280, High_Risk_Factors_M0290, Vision_M0390,Hearing_M0400, Freq_of_Pain_M0420,Intrac_Pain_M0430, Open_Wounds_M0440, Pressure_Ulcer_M0445, Pressure_Ulcer_a_M0450, Pressure_Ulcer_c_M0450, Pressure_Ulcer_d_M0450, Pressure_Ulcer_e_M0450, Pressure_Ulcer_Stage_M0460, Pressure_Ulcer_Status_M0464, Stasis_Ulcer_Num_M0470, Stasis_Ulcer_Hidden_M0474, Stasis_Ulcer_Status_M0476, Surgical_Wound_M0482, Surgical_Wound_OB_M0484, Surgical_Wound_Hidden_M0486, Surgical_Wound_Status_M0488, Breathing_M0490, Resp_Treatments_M0500, UTI_M0510, Urinary_INcont_M0520, Bowel_Incont_M0540, Ostomy_for_Bowel_M0550, Cog_Function_M0560, When_Confused_M0570, Depressive_Feelings_M0590, Patient_Behav_Weekly_M0610, Patient_Behav_freq_M0620, Psy_Nursing_M0630, Grooming_M0640, Grooming_M0640p, Dress_Upper_M0650p, Dress_Lower_M0660, Dress_Lower_M0660p, Bathing_M0670, Bathing_M0670p, Toileting_M0680, Assessment_Note, Record_Created_By, Transmission_status FROM #Request.prefix_db_agency#.Assessment_New where Assessment_ID='#session.cs.AssessmentId#' select Last_Name,First_Name from #Request.prefix_db_lookup#.Employee where Employee_ID = '#AssForm.Record_Created_By#' pat = CreateObject("Component", "assessment"); get_pain_que = pat.get_pain_ques('1 - Start of care - further visits planned','pain');

#DateFormat(AssForm.Start_of_Care_M0030,'mm/dd/yyyy')# - ST Pediatric Form

Reason for Evaluation

Other Services Involved(By Current Agencies)

Other Agencies Involved

Physician

Current Diet

Liquids

Cognition (Age Appropriate)

Short Term Memory

checked/> 0 - Impaired checked/> 1 - Appropriate for Age

Long Term Memory

checked/> 0 - Impaired checked/> 1 - Appropriate for Age

Orientation

checked/> 0 - Impaired checked/> 1 - Appropriate for Age

Attention Span

checked/> 0 - Impaired checked/> 1 - Appropriate for Age

Reading (Age Appropriate)

Indicates Wants/Needs

checked/> 0 - Unable checked/> 1 - Severe Impairment checked/> 2 - Moderate Impairment checked/> 3 - Mild impairment checked/> 4 - Within Functional Limits checked/> 5 - Infant skill not age appropriate

Writing (Age Appropriate)

Paragraph

Speech/Voice (Age Appropriate)

Swallowing (Age Appropriate)

Verbal Expression (Age Appropriate)

Conversation

checked/> 0 - Unable checked/> 1 - Severe Impairment checked/> 2 - Moderate Impairment checked/> 3 - Mild impairment checked/> 4 - Within Functional Limits checked/> 5 - Infant Skill not Age Appropriate

Auditory Comprehension (Age Appropriate)

Conversation

Speech Reading

No Pain Pain Assessment Pain assessment incomplete

Comments