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Responses

[If there is an appendix with answer options and definitions, that content goes here. Otherwise just list the available answer options without the answerID and answerCode.]

[Item]

Definition

[Item name in bold]

[Description of the item.]

INCLUDES: [inclusions; separate inclusions with semicolons]

EXCLUDES: [exclusions (choose “appropriate answer option” instead); separate exclusions with semicolons (and always tell the user what to do instead)]

[Item name in bold]

[Description of the item.]

INCLUDES: [inclusions; separate inclusions with semicolons]

EXCLUDES: [exclusions (choose “appropriate answer option” instead); separate exclusions with semicolons (and always tell the user what to do instead)]

Additional Guidance

User Interface

Setting

Nursing Facility

Field Location

Event tab

Description

Determination of the event type that is being reported.

On-screen Prompt

Check all that apply. Please note: “Poisoning” should be submitted as “Other.” “Food allergy” and “medication allergy” should be submitted as “Medication or other substance.” The event type “Treatment related” has been split into “Contractures,” “Dehydration,” “Diabetic coma,” “Fecal impaction,” “Intravascular embolisms related to IV therapy,” and “Pressure ulcer.”

Field Type

Checkbox

History

Start Date

Spring 2012

End Date

n/a

Change History

n/a

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