| Parent File | Name | Number | Package |
|---|---|---|---|
| 853.81 | QUESTIONNAIRE RESPONSE | 853.811 | VA Point of Service |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | RESPONSE IDENTIFIER | 0;1 | FREE TEXT | ************************REQUIRED FIELD************************
|
| .02 | DATE/TIME TAKEN | 0;2 | DATE |
|
| .03 | DATE/TIME LAST MODIFIED | 0;3 | DATE |
|
| .04 | COMPLETION STATUS | 0;4 | SET | ************************REQUIRED FIELD************************
|
| .05 | PATIENT SAFETY | 0;5 | SET | ************************REQUIRED FIELD************************
|
| .06 | IMMEDIATE ACTION | 0;6 | SET |
|
| 1 | APPOINTMENT CHECK-IN | 1;0 | Multiple #853.8111 | 853.8111
|
| 2 | ADDITIONAL CALCULATED VALUE | 2;0 | Multiple #853.8112 | 853.8112
|
| 3 | QUESTIONS | 3;0 | Multiple #853.8113 | 853.8113
|
| 4 | SURVEY CALCULATED VALUE | 4;1 | FREE TEXT | ************************REQUIRED FIELD************************
|