| 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************************ 
  |