MSH|^~\&|ITS||||201912051150||ORU^R01|4124187|D|2.3|||AL|NE
PID|1|FHATVIG0010263|BH00005072|BH4441|ITSTEST^RENE||19680101|F||||||||||BH000235/19|9875205337
PV1|1|I
OBR|1|||||201912051115|201912051115|201912051115||||||||||||RESP|FH-AC FU||||S||||||
OBX|1|TX|||          \H\NAME\N\:   ITSTEST,RENE          
OBX|2|TX|||         \H\ACCT#\N\:   BH000235/19   \H\UNIT#\N\:  BH00005072     
OBX|3|TX|||         \H\ADM DT\N\:   31/07/19   \H\PHN\N\:  9875205337     
OBX|4|TX|||         \H\LOC\N\:   BH-2A   \H\RM/B\N\:  BH2A-256-1     
OBX|5|TX|||\H\Asthma Clinic Follow Up Ax\N\         \H\DOB\N\:   01/01/1968   \H\A/S\N\:  51 F     
OBX|6|TX|||         \H\REG CAT\N\:   BH.ACU          
OBX|7|TX|||         \H\ATT DR\N\:   Oedoc,Marytrain MD          
OBX|8|TX|||         \H\FAM DR\N\:   Oedoc,Marytrain MD          
OBX|9|TX|||\ZU\                                                                                                                                                                     \N\                      
OBX|10|TX|||Dear Dr. [*] (referring physician/GP),  
OBX|11|TX|||  
OBX|12|TX|||\H\I: REFERRAL INFORMATION/PRESENTATION  
OBX|13|TX|||\ZHU\  
OBX|14|TX|||\H\Referred by:\N\ [*g RT REFER]  
OBX|15|TX|||\H\Interval history: \N\[*]  
OBX|16|TX|||\H\Symptoms:\N\ [*g RT SYMPTOM], [*g RT SYMPTOM], [*g RT SYMPTOM]. Requiring rescue inhaler x [*] daily.   
OBX|17|TX|||\H\Emergency department visits in the last year:\N\ [*]  
OBX|18|TX|||\H\Unplanned physician visits in the last year: \N\[*]  
OBX|19|TX|||\H\Weeks of oral corticosteroid usage in last year: \N\[*]  
OBX|20|TX|||\H\Increased rescue inhaler usage since: \N\[*]  
OBX|21|TX|||  
OBX|22|TX|||\H\II: INVESTIGATIONS  
OBX|23|TX|||\ZHU\  
OBX|24|TX|||\N\x - Use to select as it applies to your patient  
OBX|25|TX|||\ZHU\  
OBX|26|TX||| 3  
OBX|27|TX|||  
OBX|28|TX||| \H\Investigation  Date  
OBX|29|TX|||   
OBX|30|TX||| \N\Spirometry Testing YYYY.MM.DD  
OBX|31|TX|||   
OBX|32|TX||| Methacholine YYYY.MM.DD  
OBX|33|TX|||   
OBX|34|TX||| Exercise YYYY.MM.DD  
OBX|35|TX|||   
OBX|36|TX||| Respirology Consultation YYYY.MM.DD  
OBX|37|TX|||  
OBX|38|TX|||\ZHU\  
OBX|39|TX|||\H\III: CURRENT MANAGEMENT  
OBX|40|TX|||\N\  
OBX|41|TX|||\H\Triggers:\N\ [*]  
OBX|42|TX||| 3  
OBX|43|TX|||  
OBX|44|TX||| Common cold  Cold air  Emotion  
OBX|45|TX|||   
OBX|46|TX||| Animals  Weather changes  Exercise  
OBX|47|TX|||   
OBX|48|TX||| Dust  Smoke     Cigarette Smoke  
OBX|49|TX|||   
OBX|50|TX||| Mould  Pollution  GERD  
OBX|51|TX|||   
OBX|52|TX||| Pollen  Strong smells  Medications  
OBX|53|TX|||   
OBX|54|TX||| Outdoor allergens      
OBX|55|TX|||  
OBX|56|TX|||  
OBX|57|TX|||\H\Allergies:\N\ Please see EMR header. Update Patient Data Screen for allergies not listed.   
OBX|58|TX|||  
OBX|59|TX|||Previous allergy test done [*]  
OBX|60|TX|||  
OBX|61|TX|||\H\Respiratory medications\N\: x - Use to select as it applies to your patient  
OBX|62|TX|||  
OBX|63|TX||| 3  
OBX|64|TX|||  
OBX|65|TX||| \H\Respiratory medications   Dose Frequency Actual Usage Device Technique  
OBX|66|TX|||   
OBX|67|TX||| \N\salbutamol (Ventolin HFA) 100mcg 2-4p PRN [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|68|TX|||   
OBX|69|TX||| ipratropium (Atrovent) 20mcg 2-4p PRN [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|70|TX|||   
OBX|71|TX||| ciclesonide (Alvesco) 100/200mcg 1-2p OD [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|72|TX|||   
OBX|73|TX||| fluticasone (Arnuity) 100/200mcg 1p OD [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|74|TX|||   
OBX|75|TX||| fluticasone (Flovent) 50/125/250mcg 1-2p BID [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|76|TX|||   
OBX|77|TX||| fluticasone/salmeterol (Advair) 100/250/500/50mcg  1p BID [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|78|TX|||   
OBX|79|TX||| budesonide/formoterol (Symbicort) 100/200/6mcg 1-2p BID/TID [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|80|TX|||   
OBX|81|TX||| fluticasone/vilanterol (Breo) 100/200/25mcg 1p OD [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|82|TX|||   
OBX|83|TX||| aclidinium (Tudorza) 400mcg 1p BID [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|84|TX|||   
OBX|85|TX||| glycopyrronium (Seebri) 50mcg 1p OD [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|86|TX|||   
OBX|87|TX||| tiotropium (Spiriva) 2.5mcg  2p OD [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|88|TX|||   
OBX|89|TX||| umeclidinium (Incruse) 62.5mcg 1p OD [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|90|TX|||   
OBX|91|TX||| mometason/formoterol (Zenhale) 50/5mcg [*] [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|92|TX|||   
OBX|93|TX||| mometason/formoterol (Zenhale) 100/5mcg [*] [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|94|TX|||   
OBX|95|TX||| mometason/formoterol (Zenhale) 200/5mcg [*] [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|96|TX|||   
OBX|97|TX||| [*]    [*] [*] [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|98|TX|||   
OBX|99|TX||| [*] [*] [*] [*] [*g RTDEVICE1] [*g RTTECH1]  
OBX|100|TX|||  
OBX|101|TX|||  
OBX|102|TX|||\H\IV: RISK FACTORS DISCUSSION  
OBX|103|TX|||  
OBX|104|TX|||Family Hx  
OBX|105|TX|||\N\[*]  
OBX|106|TX|||\H\  
OBX|107|TX|||PMHx  
OBX|108|TX|||\N\[*]  
OBX|109|TX|||Asthma since [*].  
OBX|110|TX|||Rescue inhaler since [*].  
OBX|111|TX|||Maintenance ICS/LABA since [*].  
OBX|112|TX|||Ezcema since [*].  
OBX|113|TX|||GERD: [*g YN]  
OBX|114|TX|||Sinusitis: [*g YN]  
OBX|115|TX|||Previous hospitalization or intubation: [*g YN]  
OBX|116|TX|||  
OBX|117|TX|||\H\Environmental exposures  
OBX|118|TX|||\N\Upbringing: [*]  
OBX|119|TX|||Workplace: [*]  
OBX|120|TX|||Home: [*]  
OBX|121|TX|||\H\  
OBX|122|TX|||Smoking Hx  
OBX|123|TX|||\N\Status: [*g RTCIG]  
OBX|124|TX|||History: [*] pack years  
OBX|125|TX|||Exposure to 2nd hand smoke? [*g YN]  
OBX|126|TX|||Exposure in the past year? [*g YN]  
OBX|127|TX|||  
OBX|128|TX|||Readiness Scale (e.g., stages of change). x - Use to select as it applies to your patient  
OBX|129|TX|||  
OBX|130|TX||| 3  
OBX|131|TX|||  
OBX|132|TX||| Pre-contemplation (not thinking about quitting)  
OBX|133|TX|||   
OBX|134|TX||| Contemplation (thinking about quitting but not ready to quit)  
OBX|135|TX|||   
OBX|136|TX||| Preparation (getting ready to quit)  
OBX|137|TX|||   
OBX|138|TX||| Action (quitting)  
OBX|139|TX|||   
OBX|140|TX||| Maintenance (remaining a non-smoker)  
OBX|141|TX|||  
OBX|142|TX|||  
OBX|143|TX|||Other inhalants (Marijuana, crack/cocaine etc.) [*g YN]  
OBX|144|TX|||If yes, how often [*]  
OBX|145|TX|||  
OBX|146|TX|||\H\Lifestyle  
OBX|147|TX|||\N\Exercise: [*]  
OBX|148|TX|||Pets: [*]  
OBX|149|TX|||Diet: [*]  
OBX|150|TX|||  
OBX|151|TX|||\H\V: EDUCATION SUMMARY  
OBX|152|TX|||  
OBX|153|TX|||1. \N\Asthma pathophysiology explained with lung models: [*g RT PTED]  
OBX|154|TX|||\H\2. \N\Risk factors identified. Discussed exposure limitation plan and trigger avoidance: [*g RT PTED]  
OBX|155|TX|||\H\3. \N\Reviewed respiratory device technique. Pt provided spacer for usage with all MDI inhalers: [*g RT PTED]  
OBX|156|TX|||\H\4. \N\Discussed importance of consistent inhaled corticosteroid (ICS) usage in context of reducing airway remodelling: [*g RT PTED]  
OBX|157|TX|||\H\5. \N\Discussed early warning signs, signs \T\ symptoms of respiratory distress: [*g RT PTED]  
OBX|158|TX|||\H\6. \N\Discussed side-effects of medications: [*g RT PTED]  
OBX|159|TX|||\H\7. \N\Taught peak flow technique: [*g RT PTED1]  
OBX|160|TX|||\H\8. \N\Explained signs \T\ symptoms monitoring: [*g RT PTED]  
OBX|161|TX|||\H\9. \N\Asthma Action Plan drafted - physician endorsement required. See attached.  
OBX|162|TX|||\H\10. \N\Smoking cessation education: stage [*]  
OBX|163|TX|||\H\11. \N\Epi-pen teaching: [*]  
OBX|164|TX|||  
OBX|165|TX|||\H\VI: BARRIERS TO ASTHMA CONTROL  
OBX|166|TX|||\N\  
OBX|167|TX|||\H\1. \N\Financial: Introduced client to Fair Pharmacare. Special authority completed for physician endorsement. See attached.  
OBX|168|TX|||\H\2. \N\GP: Introduced client to College of Physicians and Surgeons website   
OBX|169|TX|||\H\3. \N\Psychological stability: Referred to [*]  
OBX|170|TX||| 3  
OBX|171|TX|||  
OBX|172|TX||| SFU Psychology Centre (778-782-4720)  
OBX|173|TX|||   
OBX|174|TX||| Tri-cities Mental Health Centre (604-777-8400) for CBT group therapy  
OBX|175|TX|||   
OBX|176|TX||| New West UBC Counselling Centre (604-525-6651)  
OBX|177|TX|||  
OBX|178|TX|||\H\4.\N\ Dietary: Referral to [*]  
OBX|179|TX|||  
OBX|180|TX|||\H\VII: RECOMMENDATIONS  
OBX|181|TX|||\N\  
OBX|182|TX|||[*]  
OBX|183|TX|||  
OBX|184|TX|||\H\VIII: PLAN  
OBX|185|TX|||\N\  
OBX|186|TX|||1. Pt booked with Dr. [*] (GP) on [*] (YYYY/MM/DD)  
OBX|187|TX|||2. Pt to maintain peak flow, signs \T\ symptoms diary.   
OBX|188|TX|||3. Pt booked for asthma education follow up [*] (YYYY/MM/DD) @ [*] (HHMM) for serial spirometry and ongoing asthma education.   
OBX|189|TX|||4. Pt provided clinic contact information and will contact as needed.  
OBX|190|TX|||  
OBX|191|TX|||Thank you for the privilege of being involved in [FIRSTNAME]?s care.  
OBX|192|TX|||  
OBX|193|TX|||Rene Campbell , RRT, CRE, FCSRT  
OBX|194|TX|||\H\Asthma Clinic Educator  
OBX|195|TX|||\N\Date/Time:  \ZU\05/12/19\N\  \ZU\1115  
OBX|196|TX|||\H\  
OBX|197|TX|||Attachments  
OBX|198|TX|||\N\1. Spirometry  
OBX|199|TX|||2. Draft asthma action plan   
OBX|200|TX|||3. Special authority  
OBX|201|TX|||4. Referral for [*]  
OBX|202|TX|||  
OBX|203|TX|||Report cc'd to  
OBX|204|TX|||Dr [*] ([*]specialty)  
OBX|205|TX|||  
OBX|206|TX|||\H\Clinical Reference Guidelines  
OBX|207|TX|||\N\CTS Asthma update 2012  
OBX|208|TX|||GINA 2017 update  
OBX|209|TX|||GOLD 2017 update  
OBX|210|TX|||CTS COPD update 2008  

MSH|^~\&|ITS||||201912051151||ORU^R01|4124221|D|2.3|||AL|NE
PID|1|FHATVIG0010159|LM00005391|AB8056|ITSTEST^IPCASP||19680101|M||||||||||LM000502/19|9875214454
PV1|1|I
OBR|1|||||201912021248|201912021200|201912021248||||||||||||INF|INFCRO||||S||||||
OBX|1|TX|||          \H\NAME\N\:   ITSTEST,IPCASP           
OBX|2|TX|||         \H\ACCT#\N\:   LM000502/19    \H\UNIT#\N\:  LM00005391     
OBX|3|TX|||         \H\ADM DT\N\:   24/07/19    \H\PHN\N\:  9875214454     
OBX|4|TX|||\H\Infection Control Services\N\         \H\LOC\N\:   LM-2S    \H\RM/B\N\:  LM2S-205-1     
OBX|5|TX|||\H\Infection Control for CRO\N\         \H\DOB\N\:   01/01/1968    \H\A/S\N\:  51 M     
OBX|6|TX|||         \H\REG CAT\N\:   L.ACU           
OBX|7|TX|||         \H\ATT DR\N\:   Oedoc,Marytrain MD           
OBX|8|TX|||         \H\FAM DR\N\:   Oedoc,Marytrain MD           
OBX|9|TX|||\ZU\                                                                                                                                                                     \N\                       
OBX|10|TX|||\ZHU\INFECTION PREVENTION \T\ CONTROL ASSESSMENT FOR CARBAPENEM-RESISTANT ORGANISMS (CRO)  
OBX|11|TX|||   
OBX|12|TX|||\H\Date\N\:  02/12/19   
OBX|13|TX|||\ZHU\  
OBX|14|TX|||\H\Patient Name:\N\ ITSTEST,IPCASP has been identified as colonized/infected with CRO.  
OBX|15|TX|||  
OBX|16|TX||| (Medical Microbiologist) was consulted on this date  and the following recommendations must be followed:  
OBX|17|TX|||\ZU\  
OBX|18|TX|||\ZI\Delete as appropriate:  
OBX|19|TX|||\ZHU\  
OBX|20|TX|||Maintain Contact Precautions and initiate Droplet Precautions if a patient has CRO in their respiratory tract AND has productive cough.  
OBX|21|TX|||\N\- Patient  requires a single occupancy room.  
OBX|22|TX|||- Patient  requires dedicated toileting facilities.  
OBX|23|TX|||- Patient requires  equipment.   
OBX|24|TX|||   - If disposable equipment is not available, dedicate equipment until discharge (e.g. bedpans, thermometers, stethoscopes).  
OBX|25|TX|||     
OBX|26|TX|||*The Medical Microbiologist must be consulted before cohorting ANY patients with a CRO as the resistance mechanism may differ and can be transferred between organisms.     
OBX|27|TX|||     
OBX|28|TX|||\ZHU\Discontinuation of Precautions:  
OBX|29|TX|||\H\-\N\Precautions shall be continued for the duration of the hospitalization of CRO patients and on all subsequent admissions, until further documentations states otherwise.   
OBX|30|TX|||-Once a CRO patient is discharged, the unit staff must contact Housekeeping to request an Isolation Discharge Clean.  
OBX|31|TX|||  
OBX|32|TX|||\ZU\If indicated by Medical Microbiologist, the room must be inspected by an EVS supervisor prior to admitting another patient into the room.   
OBX|33|TX|||\N\  
OBX|34|TX|||\H\Rene Campbell, IPC Practitioner   
OBX|35|TX|||Local   
OBX|36|TX|||\N\Date/Time:  \ZU\02/12/19\N\ \ZU\1248