File A&SP_CLINIC_VISIT(509850.6) Data List
| DATE |
TIME SPENT (minutes) |
LINKED C&P EXAM |
C AND P STATUS |
*SECOND CLINCIAN |
*LEAD ROLE |
PATIENT NAME |
AGE ON APPOINTMENT |
PROCEDURE CODE |
REVIEW OF MEDICAL RECORDS |
MEDICAL HISTORY |
PHYSICAL EXAMINATION |
DIAGNOSTIC AND CLINICAL TESTS |
DIAGNOSIS |
PCE VISIT IEN |
LAST SENT TO PCE |
LAST EDITED IN QUASAR |
EVENT CAPTURE PROCEDURE |
PATIENT ELIGIBILITY CODE |
C AND P |
CLINIC LOCATION |
SECONDARY PROVIDER |
SERVICE CONNECTED |
AGENT ORANGE |
DIAGNOSTIC CODE |
RADIATION |
ENVIRONMENTAL CONTAMINANTS |
CLINIC STOP CODE |
TONE R500 |
TONE R1000 |
TONE R2000 |
TONE R3000 |
TONE R4000 |
TONE R AVERAGE |
TONE L500 |
TONE L1000 |
TONE L2000 |
TONE L3000 |
TONE L4000 |
TONE L AVERAGE |
CNC R |
CNC L |
W22 R |
W22 L |
SIGNATURE |
DATE SIGNED |
ADEQUATED BY |
DATE ADEQUATED |
*NU6 R |
*NU6 L |
DATE OF AUDIOMETRIC TESTING |
COMPLETER TITLE |
ADEQUATOR TITLE |
HEAD AND/OR NECK CANCER |
COMBAT RELATED |
CDR ACCOUNT |
APPOINTMENT TIME |
PRIMARY PROVIDER |
PCE ERROR |
DIVISION |
STUDENT |
*OTHER PROVIDER |
VISIT ELIGIBILITY |
*DISPOSITION |
MILITARY SEXUAL TRAUMA |
EXCEPTION DATE |