| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | name(+) | 0;1 | POINTER | 2 | B | This field identifies the medical patient's name followed by his/her first name followed by a space and his/her middle initial and a period. |
| 1 | liver biopsy | GI;1 | BOOLEAN | Y:YES N:NO | This field identifies if a liver biopsy has been done. | |
| 2 | allergies | COMPUTED | This field identifies if the patient has allergies. | |||
| 3 | history of bleeding disorder | GI;3 | BOOLEAN | Y:YES N:NO | This field identifies if the patient has a history of bleeding disorder. | |
| 4 | valvular heart disease | GI;4 | BOOLEAN | Y:YES N:NO | This field identifies if the patient has a valvular heart disease. | |
| 5 | glaucoma | GI;5 | BOOLEAN | Y:YES N:NO | This field identifies if the patient has glaucoma. | |
| 6 | history comments | GI;6 | FREE TEXT | This field identifies a free text field. Enter any pertinent history comments. | ||
| 7 | pacing indication | P;0 | MULTIPLE | 690.07 | This field defines the medical rationale for electronic cardiac regulation. | |
| 8 | risk factor (pace) | P1;0 | MULTIPLE | 690.08 | This field indicates the conditions for which electronic cardiac regulation is a hazard for this patient. | |
| 9 | psc status | P2;1 | SET OF CODES | 1:EAST PSC FOLLOW-UP 2:ARTIFICIAL 3:DEAD 4:REGISTRY ONLY 5:EXPLANT TEST ONLY 6:EXPLANTED,NO REPLACEMENT 7:WEST PSC FOLLOW-UP 8:LOST TO FOLLOW-UP | This field indicates the Pacemaker Surveillance Center Status. | |
| 10 | indication for file closure | P3;1 | SET OF CODES | 1:DEATH 2:LOST TO FOLLOW-UP 3:PACEMAKER REMOVAL 4:DISCHARGE FOR ANOTHER REASON | This field identifies the reason for the file to be closed. | |
| 11 | cause of death | P3;2 | SET OF CODES | 1:RELATED TO PACEMAKER 2:RELATED TO ELECTRODE 3:CARDIAC-UNRELATED TO PACEMAKER 4:NON-CARDIAC-UNRELATED TO PACEMAKER 5:CAUSE UNKNOWN | This field identifies the cause of death. | |
| 12 | suddenness of death | P3;3 | SET OF CODES | 1:SUDDEN-WITHIN ONE HOUR OF SYMPTOMS 2:NON-SUDDEN 3:UNKNOWN | This field identifies the reason for the sudden death. | |
| 13 | date of file closure | P3;4 | DATE-TIME | This field identifies the date when the file is closed. | ||
| 14 | discharge (pacemaker) reason | P3;5 | FREE TEXT | This field identifies the rationale for the release of the patient. | ||
| 15 | transmitted pacemaker reports | P4;0 | MULTIPLE | 690.015 | This field contains the date of each report. | |
| 16 | date of initial implant | P3;6 | DATE-TIME | This field identifies the date of implant. | ||
| 17 | telephone followup provided by | P2;2 | SET OF CODES | E:VA EASTERN PACEMAKER SURVEILLANCE CENTER W:VA WESTERN PACEMAKER SURVEILLANCE CENTER L:LOCAL VAMC | This field identifies the location for a follow-up visit. | |
| 18 | reason for file closure | P3;7 | FREE TEXT | This field identifies an extended explanation for the file to be closed. |