GMRAFN2 ;HIRMFO/WAA-FDA PART 2 MEDWATCH FORM ;11/30/95 15:19
;;4.0;Adverse Reaction Tracking;;Mar 29, 1996
FORM ;This is the main form entry point
W !,"MEDWatch",?80,"Approved by FDA on 10/20/93"
W !,$E(LINE1,1,42),?79,$E(LINE1,79,131)
W !,"THE FDA MEDICAL PRODUCTS REPORTING PROGRAM",?79,"| Triage unit sequence #",?131,"|"
W !,$E(LINE1,1,42),?79,$E(LINE1,79,131)
W !,?79,"|",?131,"|"
W !,?59,"Page ",GMRAPG1," of ",GMRAPG2,?79,$E(LINE1,79,131)
W !,$E(LINE2,1,66),"|",$E(LINE2,68,131)
W !,"A. Patient Information",?66,"| C. Suspect Medication(s)"
W !,$E(LINE1,1,66),"|",$E(LINE1,68,131)
W !,"1. Patient Indentifier|2. DOB: ",+$E(GMRADOB,4,5),"/",+$E(GMRADOB,6,7),"/",$E(GMRADOB,2,3),?43,"|3. Sex|4. Weight",?66,"|1. Name"
W !,GMRAID,?22,"| AGE: "
AGE ;Age at time of event
I GMRAPG1=1 S X1=$P(GMRAPA1(0),U),X2=GMRADOB S X=($E(X1,1,3))-($E(X2,1,3)) S:($E(X1,4,7))<($E(X2,4,7)) X=X-1 W X K X,X1,X2 W ?39,"yrs |"
I GMRAPG1'=1 W ?39,"yrs |"
SEX ;Sex,weight
I GMRAPG1=1 W $P(GMRASEX,U,2),?50,"|",$J((GMRAWEI*.4536),5,1) W:GMRAWEI'="" " kg" W ?66
I GMRAPG1'=1 W ?50,"| kg",?66
SUSPECT ;THIS WILL GET THE NEXT SUSPECTED AGENT
S GMRASUS=$O(^TMP($J,"GMR","A",GMRASUS)) I GMRASUS'<1 S GMRASUS1=GMRASUS
S GMRAGNT1=$S(GMRASUS="":"",1:$G(^TMP($J,"GMR","A",GMRASUS1)))
S:GMRASUS="" GMRASUS1=""
W "| #",GMRASUS1," : " W $E($P(GMRAGNT1,U),1,30)
W !,$E(LINE2,1,66),"|",$E(LINE1,68,131)
W !,"B. Adverse Event or Product Problem",?66
S GMRASUS=$O(^TMP($J,"GMR","A",GMRASUS)) I GMRASUS'<1 S GMRASUS2=GMRASUS
I GMRASUS<1 S GMRASUS2=""
E S GMRAGNT2=(^TMP($J,"GMR","A",GMRASUS))
W "|" W:GMRASUS2'="" " #",GMRASUS2," : ",$E($P(GMRAGNT2,U),1,30)
W !,$E(LINE1,1,66),"|",$E(LINE1,68,131)
W !,"1. [X]Adverse Event [ ]Product problem",?66,"|2. Dose,frequency & route used",?99,"| 3. Therapy dates"
W !,$E(LINE1,1,66),"| #",GMRASUS1,":" W $E($P(GMRAGNT1,U,2),1,8) I $P(GMRAGNT1,U,2)'="",$P($G(^TMP($J,"GMR","A",GMRASUS1,1)),U,5)'="" W ","
I GMRASUS1'="",$P($G(^TMP($J,"GMR","A",GMRASUS1,1)),U,5)'="" W $E($P($G(^TMP($J,"GMR","A",GMRASUS1,1)),U,5),1,8) I $P(GMRAGNT1,U,3)'="" W ","
W $E($P(GMRAGNT1,U,3),1,8),?99,"| #",GMRASUS1," : "
I GMRASUS1'="",$D(^TMP($J,"GMR","A",GMRASUS1,1)) S DT=$P(^(1),U) I DT'="" S DT=$E(DT,4,5)_"/"_$E(DT,6,7)_"/"_$E(DT,2,3) W DT
I GMRASUS1'="",$D(^TMP($J,"GMR","A",GMRASUS1,1)) S DT=$P(^(1),U,2) I DT'="" S DT=$E(DT,4,5)_"/"_$E(DT,6,7)_"/"_$E(DT,2,3) W "-",DT
W !,"2. Outcomes attributed to adverse event",?66,"|",$E(LINE1,66,97),"|",$E(LINE1,99,130)
S X1=0 W !," ["
I GMRAPG1=1 W $S($P(^GMR(120.85,GMRAPA1,0),U,3)="y":"X",1:" ") S:$P(^(0),U,3)="y" X1=1 W "] death: " I X1=1 S Y=$P($G(^DPT(DFN,.35)),U) I Y'<1 W $E(Y,4,5),"/",$E(Y,6,7),"/",$E(Y,2,3)
I GMRAPG1'=1 W " ] death:"
W ?30,"["
I GMRAPG1=1 W $S($P(^GMR(120.85,GMRAPA1,0),U,10)="y":"X",1:" ") S:$P(^(0),U,10)="y" X1=1 W "] disability"
I GMRAPG1'=1 W " ] disability"
W ?66,"|" I GMRASUS2'="" W " #",GMRASUS2,":" W $E($P(GMRAGNT2,U,2),1,8) I $P(GMRAGNT2,U,2)'="",$P($G(^TMP($J,"GMR","A",GMRASUS2,1)),U,5)'="" W ","
I GMRASUS2,$P($G(^TMP($J,"GMR","A",GMRASUS2,1)),U,5)'="" W $E($P($G(^TMP($J,"GMR","A",GMRASUS2,1)),U,5),1,8) I $P(GMRAGNT2,U,3)'="" W ","
I GMRASUS2'="" W $E($P(GMRAGNT2,U,3),1,(24-$L($E($P(GMRAGNT2,U,2),1,12)))),?99,"| #",GMRASUS2," : " D
.I $D(^TMP($J,"GMR","A",GMRASUS2,1)) S DT=$P(^(1),U) S DT=$E(DT,4,5)_"/"_$E(DT,6,7)_"/"_$E(DT,2,3) W DT
.I $D(^TMP($J,"GMR","A",GMRASUS2,1)) S DT=$P(^(1),U,2) I DT'="" S DT=$E(DT,4,5)_"/"_$E(DT,6,7)_"/"_$E(DT,2,3) W "-",DT
.Q
I GMRASUS2="" W ?99,"|"
S X2=0 W !," ["
I GMRAPG1=1 W $S($P(^GMR(120.85,GMRAPA1,0),U,5)="y":"X",1:" ") S:$P(^(0),U,5)="y" X1=1 W "] life-threatening"
I GMRAPG1'=1 W " ] life-threatening"
S X2=0 W ?30,"["
I GMRAPG1=1 W $S($P(^GMR(120.85,GMRAPA1,0),U,16)="y":"X",1:" ") S:$P(^(0),U,16)="y" X1=1 W "] congenital anomaly",?66,"|",$E(LINE1,68,131)
I GMRAPG1'=1 W " ] congenital anomaly",?66,"|",$E(LINE1,68,131)
W !," [" I GMRAPG1=1 D
.I $P(^GMR(120.85,GMRAPA1,0),U,9)="y" W "X" S X1=1 Q
.I $P(^GMR(120.85,GMRAPA1,0),U,7)="y" W "X" S X1=1 Q
.W " "
.Q
I GMRAPG1'=1 W " "
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HGMRAFN2 4158 printed Oct 16, 2024@17:40:01 Page 2
GMRAFN2 ;HIRMFO/WAA-FDA PART 2 MEDWATCH FORM ;11/30/95 15:19
+1 ;;4.0;Adverse Reaction Tracking;;Mar 29, 1996
FORM ;This is the main form entry point
+1 WRITE !,"MEDWatch",?80,"Approved by FDA on 10/20/93"
+2 WRITE !,$EXTRACT(LINE1,1,42),?79,$EXTRACT(LINE1,79,131)
+3 WRITE !,"THE FDA MEDICAL PRODUCTS REPORTING PROGRAM",?79,"| Triage unit sequence #",?131,"|"
+4 WRITE !,$EXTRACT(LINE1,1,42),?79,$EXTRACT(LINE1,79,131)
+5 WRITE !,?79,"|",?131,"|"
+6 WRITE !,?59,"Page ",GMRAPG1," of ",GMRAPG2,?79,$EXTRACT(LINE1,79,131)
+7 WRITE !,$EXTRACT(LINE2,1,66),"|",$EXTRACT(LINE2,68,131)
+8 WRITE !,"A. Patient Information",?66,"| C. Suspect Medication(s)"
+9 WRITE !,$EXTRACT(LINE1,1,66),"|",$EXTRACT(LINE1,68,131)
+10 WRITE !,"1. Patient Indentifier|2. DOB: ",+$EXTRACT(GMRADOB,4,5),"/",+$EXTRACT(GMRADOB,6,7),"/",$EXTRACT(GMRADOB,2,3),?43,"|3. Sex|4. Weight",?66,"|1. Name"
+11 WRITE !,GMRAID,?22,"| AGE: "
AGE ;Age at time of event
+1 IF GMRAPG1=1
SET X1=$PIECE(GMRAPA1(0),U)
SET X2=GMRADOB
SET X=($EXTRACT(X1,1,3))-($EXTRACT(X2,1,3))
if ($EXTRACT(X1,4,7))<($EXTRACT(X2,4,7))
SET X=X-1
WRITE X
KILL X,X1,X2
WRITE ?39,"yrs |"
+2 IF GMRAPG1'=1
WRITE ?39,"yrs |"
SEX ;Sex,weight
+1 IF GMRAPG1=1
WRITE $PIECE(GMRASEX,U,2),?50,"|",$JUSTIFY((GMRAWEI*.4536),5,1)
if GMRAWEI'=""
WRITE " kg"
WRITE ?66
+2 IF GMRAPG1'=1
WRITE ?50,"| kg",?66
SUSPECT ;THIS WILL GET THE NEXT SUSPECTED AGENT
+1 SET GMRASUS=$ORDER(^TMP($JOB,"GMR","A",GMRASUS))
IF GMRASUS'<1
SET GMRASUS1=GMRASUS
+2 SET GMRAGNT1=$SELECT(GMRASUS="":"",1:$GET(^TMP($JOB,"GMR","A",GMRASUS1)))
+3 if GMRASUS=""
SET GMRASUS1=""
+4 WRITE "| #",GMRASUS1," : "
WRITE $EXTRACT($PIECE(GMRAGNT1,U),1,30)
+5 WRITE !,$EXTRACT(LINE2,1,66),"|",$EXTRACT(LINE1,68,131)
+6 WRITE !,"B. Adverse Event or Product Problem",?66
+7 SET GMRASUS=$ORDER(^TMP($JOB,"GMR","A",GMRASUS))
IF GMRASUS'<1
SET GMRASUS2=GMRASUS
+8 IF GMRASUS<1
SET GMRASUS2=""
+9 IF '$TEST
SET GMRAGNT2=(^TMP($JOB,"GMR","A",GMRASUS))
+10 WRITE "|"
if GMRASUS2'=""
WRITE " #",GMRASUS2," : ",$EXTRACT($PIECE(GMRAGNT2,U),1,30)
+11 WRITE !,$EXTRACT(LINE1,1,66),"|",$EXTRACT(LINE1,68,131)
+12 WRITE !,"1. [X]Adverse Event [ ]Product problem",?66,"|2. Dose,frequency & route used",?99,"| 3. Therapy dates"
+13 WRITE !,$EXTRACT(LINE1,1,66),"| #",GMRASUS1,":"
WRITE $EXTRACT($PIECE(GMRAGNT1,U,2),1,8)
IF $PIECE(GMRAGNT1,U,2)'=""
IF $PIECE($GET(^TMP($JOB,"GMR","A",GMRASUS1,1)),U,5)'=""
WRITE ","
+14 IF GMRASUS1'=""
IF $PIECE($GET(^TMP($JOB,"GMR","A",GMRASUS1,1)),U,5)'=""
WRITE $EXTRACT($PIECE($GET(^TMP($JOB,"GMR","A",GMRASUS1,1)),U,5),1,8)
IF $PIECE(GMRAGNT1,U,3)'=""
WRITE ","
+15 WRITE $EXTRACT($PIECE(GMRAGNT1,U,3),1,8),?99,"| #",GMRASUS1," : "
+16 IF GMRASUS1'=""
IF $DATA(^TMP($JOB,"GMR","A",GMRASUS1,1))
SET DT=$PIECE(^(1),U)
IF DT'=""
SET DT=$EXTRACT(DT,4,5)_"/"_$EXTRACT(DT,6,7)_"/"_$EXTRACT(DT,2,3)
WRITE DT
+17 IF GMRASUS1'=""
IF $DATA(^TMP($JOB,"GMR","A",GMRASUS1,1))
SET DT=$PIECE(^(1),U,2)
IF DT'=""
SET DT=$EXTRACT(DT,4,5)_"/"_$EXTRACT(DT,6,7)_"/"_$EXTRACT(DT,2,3)
WRITE "-",DT
+18 WRITE !,"2. Outcomes attributed to adverse event",?66,"|",$EXTRACT(LINE1,66,97),"|",$EXTRACT(LINE1,99,130)
+19 SET X1=0
WRITE !," ["
+20 IF GMRAPG1=1
WRITE $SELECT($PIECE(^GMR(120.85,GMRAPA1,0),U,3)="y":"X",1:" ")
if $PIECE(^(0),U,3)="y"
SET X1=1
WRITE "] death: "
IF X1=1
SET Y=$PIECE($GET(^DPT(DFN,.35)),U)
IF Y'<1
WRITE $EXTRACT(Y,4,5),"/",$EXTRACT(Y,6,7),"/",$EXTRACT(Y,2,3)
+21 IF GMRAPG1'=1
WRITE " ] death:"
+22 WRITE ?30,"["
+23 IF GMRAPG1=1
WRITE $SELECT($PIECE(^GMR(120.85,GMRAPA1,0),U,10)="y":"X",1:" ")
if $PIECE(^(0),U,10)="y"
SET X1=1
WRITE "] disability"
+24 IF GMRAPG1'=1
WRITE " ] disability"
+25 WRITE ?66,"|"
IF GMRASUS2'=""
WRITE " #",GMRASUS2,":"
WRITE $EXTRACT($PIECE(GMRAGNT2,U,2),1,8)
IF $PIECE(GMRAGNT2,U,2)'=""
IF $PIECE($GET(^TMP($JOB,"GMR","A",GMRASUS2,1)),U,5)'=""
WRITE ","
+26 IF GMRASUS2
IF $PIECE($GET(^TMP($JOB,"GMR","A",GMRASUS2,1)),U,5)'=""
WRITE $EXTRACT($PIECE($GET(^TMP($JOB,"GMR","A",GMRASUS2,1)),U,5),1,8)
IF $PIECE(GMRAGNT2,U,3)'=""
WRITE ","
+27 IF GMRASUS2'=""
WRITE $EXTRACT($PIECE(GMRAGNT2,U,3),1,(24-$LENGTH($EXTRACT($PIECE(GMRAGNT2,U,2),1,12)))),?99,"| #",GMRASUS2," : "
Begin DoDot:1
+28 IF $DATA(^TMP($JOB,"GMR","A",GMRASUS2,1))
SET DT=$PIECE(^(1),U)
SET DT=$EXTRACT(DT,4,5)_"/"_$EXTRACT(DT,6,7)_"/"_$EXTRACT(DT,2,3)
WRITE DT
+29 IF $DATA(^TMP($JOB,"GMR","A",GMRASUS2,1))
SET DT=$PIECE(^(1),U,2)
IF DT'=""
SET DT=$EXTRACT(DT,4,5)_"/"_$EXTRACT(DT,6,7)_"/"_$EXTRACT(DT,2,3)
WRITE "-",DT
+30 QUIT
End DoDot:1
+31 IF GMRASUS2=""
WRITE ?99,"|"
+32 SET X2=0
WRITE !," ["
+33 IF GMRAPG1=1
WRITE $SELECT($PIECE(^GMR(120.85,GMRAPA1,0),U,5)="y":"X",1:" ")
if $PIECE(^(0),U,5)="y"
SET X1=1
WRITE "] life-threatening"
+34 IF GMRAPG1'=1
WRITE " ] life-threatening"
+35 SET X2=0
WRITE ?30,"["
+36 IF GMRAPG1=1
WRITE $SELECT($PIECE(^GMR(120.85,GMRAPA1,0),U,16)="y":"X",1:" ")
if $PIECE(^(0),U,16)="y"
SET X1=1
WRITE "] congenital anomaly",?66,"|",$EXTRACT(LINE1,68,131)
+37 IF GMRAPG1'=1
WRITE " ] congenital anomaly",?66,"|",$EXTRACT(LINE1,68,131)
+38 WRITE !," ["
IF GMRAPG1=1
Begin DoDot:1
+39 IF $PIECE(^GMR(120.85,GMRAPA1,0),U,9)="y"
WRITE "X"
SET X1=1
QUIT
+40 IF $PIECE(^GMR(120.85,GMRAPA1,0),U,7)="y"
WRITE "X"
SET X1=1
QUIT
+41 WRITE " "
+42 QUIT
End DoDot:1
+43 IF GMRAPG1'=1
WRITE " "
+44 QUIT
