| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | contact number(+) | 0;1 | FREE TEXT | B | This is a self generated Contact number used to identify consumer contact. | |
| 1 | date of contact(+) | 0;2 | DATE-TIME | D | This is the date the Patient Representative was initially contacted. The date must be Today or earlier. | |
| 2 | patient name | 0;3 | POINTER | 2 | E | This is the name of the patient concerned in the inquiry. |
| 3 | ssn | COMPUTED | This is the Social Security Number of the patient concerned in the contact. | |||
| 4 | dob | COMPUTED | This is the date of birth of the patient concerned in the contact. | |||
| 5 | sex | COMPUTED | This is the sex of the patient concerned in the contact. | |||
| 6 | eligibility status | 0;4 | FREE TEXT | This is the patient's eligibility status at the time of the contact. | ||
| 7 | category | 0;5 | FREE TEXT | This is the Means test category assigned to the patient at the time of the contact. | ||
| 8 | information taken by | 0;6 | POINTER | 200 | This is the name of the person who collected the information from the contact. | |
| 9 | entered by(+) | 0;7 | POINTER | 200 | This is the person entering the contact information. This is not a user interactive field. | |
| 10 | name of contact | 0;8 | FREE TEXT | This is the name of the person who contacted the Patient Representative. | ||
| 11 | telephone no. of contact | 0;9 | FREE TEXT | This is the telephone number of the contact. Use one of the following formats. Use a hyphen in the main portion of the number. Leave a space between area code and the number and between the number and any extension. i.e. 123 123-1234 123 123-1234 1234 123-1234 123-1234 1234 | ||
| 12 | contact made by | 0;10 | SET OF CODES | PA:Patient RE:Relative FR:Friend CO:Congressional VH:VISN/HQ VO:Veterans Service Organization AT:Attorney/Legal Guardian/Conservator/Trustee DI:Director's Office ST:Staff - VAMC OT:Other | CMB | This is the person, organization, or authority that made the contact. |
| 13 | source of contact | 0;11 | SET OF CODES | L:Letter W:Ward Visit V:Visit P:Phone S:Survey I:Internet | This is how the contact was made. | |
| 14 | location of event | 0;12 | POINTER | 44 | This is the hospital location associated with the issue of the contact. | |
| 15 | *services involved | 1;0 | MULTIPLE | 745.115 | ||
| 16 | *category of care | 2;1 | POINTER | 745.3 | This is the patient's service and level of care as defined for the Quality Matrix. | |
| 16.5 | treatment status(+) | 2;2 | SET OF CODES | I:Inpatient O:Outpatient D:Domiciliary N:NHCU L:Long Term Psych E:Extended/Intermed. Care H:HBHC | This indicates whether the patient was inpatient, outpatient, etc. | |
| 17 | employee | 8;0 | MULTIPLE | 745.117 | This is the employee allegedly involved in the issue or the employee receiving the compliment. | |
| 18 | *refer to | 10;0 | MULTIPLE | 745.118 | This is the person or service the issue is referred to for action. | |
| 19 | date sent | 2;4 | DATE-TIME | This is the date the issue was referred to a person or service for action. | ||
| 20 | days response expected by | 2;5 | NUMERIC | This is the number of days to expect a response on the issue. Enter a whole number between 0 and 9999. | ||
| 20.1 | date due | COMPUTED | If there is a number in the Days Response Expected By field, that is added to the Date Sent to obtain the entry in the Date Due field. Date Due applies to when a response is expected for a Report of Contact. | |||
| 21 | issue codes | 3;0 | MULTIPLE | 745.121 | This is a code for a brief statement of the issue. | |
| 22 | issue text | 4;0 | WORD-PROCESSING | This is a written discussion of the issue(s). | ||
| 23 | *report of contact generated | 5;1 | BOOLEAN | 0:NO 1:YES | This field contains a "1" when a report of contact has been generated. This is not a user interactive field. | |
| 24 | qm involvement | 9;0 | MULTIPLE | 745.124 | This is the type of QM activity for this same issue. | |
| 25 | resolution comments | 6;0 | WORD-PROCESSING | This is a discussion of how the issue or issues were resolved. | ||
| 26 | date resolved | 7;1 | DATE-TIME | This is the date the record was closed. | ||
| 27 | status | 7;2 | SET OF CODES | O:Open C:Closed | This field contains "O" while the record is Open and "C" when the record is Closed. This is not a user interactive field. | |
| 28 | refer contact to | 11;0 | MULTIPLE | 745.128 | This is the person(s) who will be notified of this patient contact. | |
| 29 | congressional contact | 0;13 | POINTER | 745.4 | This is the congressional office or person that contacted the Patient Representative. | |
| 30 | source(s) of contact | 12;0 | MULTIPLE | 745.11 | ||
| 31 | period of service | 0;14 | POINTER | 21 | This is the period of service, taken from the Patient File. | |
| 32 | persian gulf service | 0;15 | BOOLEAN | Y:YES N:NO | This is taken from the Patient file, field #.32201, Persian War Service. | |
| 33 | refer to seat | 2;3 | BOOLEAN | Y:YES N:NO | Has this Report of Contact been referred to SEAT? | |
| 34 | *date resolved | 7;3 | DATE-TIME | This field will not be used-was set up in planning stages of patch QAC*2*3 | ||
| 35 | days to resolution | 7;4 | NUMERIC | This a field calculated by subtracting date ROC created by date resolved. | ||
| 36 | level of satisfaction | 7;5 | SET OF CODES | 1:Not at all satisfied 2:Slightly satisfied 3:Somewhat satisfied 4:Pretty satisfied 5:Very satisfied 6:Extremey satisfied | This is the patient's level of satisfaction with the resolution of the Report of Contact. This field will not be used after patch QAC*2*17. | |
| 37 | division(+) | 0;16 | POINTER | 4 | This field will hold the Division where the Contact occured. | |
| 38 | discipline | 13;1 | FREE TEXT | |||
| 39 | resolved by seat? | 2;6 | BOOLEAN | Y:YES N:NO | This field stores whether or not there has been a resolution of the problem by SEAT. | |
| 40 | seat resolution comments | 14;0 | WORD-PROCESSING | |||
| 41 | roll-up status | 7;6 | SET OF CODES | 0:CLEARED 1:REJECTED 2:SENT - OPEN 3:EDITED | This field is being changed with QAC*2.0*17. The field will now contain a "3" if it was edited since the last run of the QAC Patient Representative Roll-up. It will be deleted after the next run. ******************Original use of this field****************************** ****This field will be stuffed if a record is rejected from roll-up either because the record has not been closed or does not have at least one issue code. It will also be stuffed if it was sent but still open. | |
| 43 | internal appeal | 2;7 | BOOLEAN | Y:YES N:NO | This field will flag ROCs that need, or have gotten, Internal Appeals. |
Not Referenced