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FieldReportForm for the Perform web

Name: Type: Size: Values: Tooltip message: Attributes:
TopicType label 1   Classify a topic by function  
ImprovementFocus checkbox 3 ACEiOrARbPrescribedAtDischargeForLVSD, AntibioticTiming, AspirinAtArrival, AspirinPrescribedAtDischarge, BetaBlockerAtArrival, BetaBlockerPrescribedAtDischarge, BloodCulturesCollectedPriorToInitialAntiobiotic, BloodCulturesPerformedWithin24Hours, CardiacSurgeryPatientsWithControlledPostoperativeBloodGlucose, ColorectalSurgeryPatientsWithImmediatePostoperativeNormothermia, CompletePsychiatricAssessment, DischargeAssessmentSentToNextLevelOfCareProvider, DischargeInstructions, EngagingFamiliesInTreatment, EvaluationofLVSFunction, FailureModeAndEffectsAnalysisinBHC, FibrinolyticTherapyWithin30MinutesOfHospitalArrival, HomeManagementPlanOfCareGivenToPatientOrCaregiver, HoursOfRestraintUse, HoursOfSeclusionUse, InfluenzaVaccination, InitialAntibioticSelectionForCAPPatients, InpatientMortality, InpatientNeonatalMortality, LDLCholesterolAssessment, LipidLoweringTherapyAtDischarge, OutcomeInformedCareProcesses, OxygenationAssessment, PatientsDischargedOnMultipleAntipsychoticMedications, PneumococcalVaccination, PrimaryPCIReceivedWithin90MinutesOfHospitalArrival, ProphylacticAntibioticReceivedWithinOneHourPriorToSurgery, ProphylacticAntibioticSelectionForSurgicalPatients, ProphylacticAntibioticsDiscontinuedWithin24Hours, QualityOfLife? -Employment, QualityOfLife? -Housing, RapidTestingForInfluenza, RelieversForInpatientAsthma, ScreeningAndBriefIntervention, SmokeFreeHospitalCampus, SmokingCessationCounselingPrograms, SurgeryPatientsReceivedAppropriateVTEProphylaxisWithin24Hours, SurgeryPatientsWithAppropriateHairRemoval, SurgeryPatientsWithRecommendedVTEProphylaxisOrdered, SystemicCorticosteriodsForInpatientAsthma, ThirdOrFourthDegreeLaceration Specify area focus for this report. M
Title text 50   Title for report. M
Summary textarea 50x4   Brief (>100 words) summary or headline for report.  
HealthcareOrganization select 1 AlleghenySBIRTProjectPittsburghPA, ArkansasMethodistMedicalCenterParagouldAR, ArroyoGrandeCommunityHospitalArroyoGrandeCa, BeaufortMemorialHospitalBeaufortSC, BostonMedicalCenterBostonMA, BristolCommunityCollegeFallRiverMA, CastleMedicalCenterKailuaHI, ChicagoSecondWindChicagoIL, DHSDASAChicagoIL, HarborviewMedicalCenterSeattleWA, HarlingenMedicalCenterHarlingenTx, HarrisCountyHospitalDistricthoustontx, JasonASeidelPsyDPCDenverCO, LakesideHospitalBastropTX, NorthBayHealthcareFairfieldCA, NorthBrowardHospitalDistrictFtLauderdaleFL, OperationPARIncPinellasParkFL, ParkviewMedicalCenterPuebloCO, SetonHealthCenterForSmokingCessationTroyNY, SmallHospitalRuralTownIA, SouthcentralFoundationAnchorageAK, UnitedHospitalCenterClarksburgWV, UniversityAtAlbanySUNYAlbanyNY, UniversityOfCaliforniaDavisMedicalCenterDavisCA, UniversityOfHartfordWestHartfordCT, UniversityOfHawaiiHonoluluHI, UniversityOfMassachusettsAmherstAmherstMA Organization submitting this report. M
Posted By text 30   Person who posted report M

Related Topic: TopicClassification, WebPreferences, TWikiForms

For more information about how you can use form to organize topics or create simple database applications, see TWikiForms.

r4 - 29 Mar 2007 - 18:12:48 - LynnwoodBrown
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