MSH|^~\&|ITS|COM|||201912180907||ORU^R01|4130719|D|2.3|||AL|NE
PID|1|FHATVIG0011393|CM00001047|AB8166|ITSTEST^CRS^TEST||19391001|F||||||||||CM000010/19|
PV1|1|O
OBR|1|||||201912180902|20191218|201912180902||||||||||||CRS|FOLLOW-UP1||||S||||||
OBX|1|TX|||           \H\       NAME\N\:   ITSTEST,CRS TEST           
OBX|2|TX|||      \H\       ACCT#\N\:   CM000010/19    \H\UNIT#\N\:  CM00001047     
OBX|3|TX|||      \H\       ADM DT\N\:   02/10/19    \H\PHN\N\:       
OBX|4|TX|||\H\Community Respiratory Services\N\      \H\       LOC\N\:   CM.CRP    \H\RM/B\N\:       
OBX|5|TX|||\H\Clinical Follow-up\N\      \H\       DOB\N\:   01/10/1939    \H\A/S\N\:  80 F     
OBX|6|TX|||      \H\       REG CAT\N\:   CM.RCR           
OBX|7|TX|||            \H\ATT DR\N\:    DOC,TEST A                \H\Att Fax:  \N\          
OBX|8|TX|||      \H\      FAM DR\N\:   DOC,TEST A   \H\           Fam Fax:   \N\        
OBX|9|TX|||\ZU\                                                                                                                                                                     \N\                        
OBX|10|TX|||\H\CRS:  Telephone 604.514.6106  \F\  Fax 604.514.6079  \F\  Toll Free 1.888.514.6106  
OBX|11|TX|||  
OBX|12|TX|||\N\\H\Referral date: \N\18/12/19  
OBX|13|TX|||\H\Patient's Address: \N\         3419 54 ST.                     
OBX|14|TX|||\H\City: \N\         ABBOTSFORD            
OBX|15|TX|||\H\Postal Code: \N\         V1Y 2F1     
OBX|16|TX|||\H\Patient's Phone #: \N\         (123)654-9875       
OBX|17|TX|||\H\Primary Dx: \N\  
OBX|18|TX|||\H\Secondary Dx: \N\  
OBX|19|TX|||\H\Approved for: \N\  
OBX|20|TX|||\H\System: \N\  
OBX|21|TX|||\H\Supplier: \N\  
OBX|22|TX|||\H\Follow up date: \N\  
OBX|23|TX|||  
OBX|24|TX|||\ZHU\Recommendations:  
OBX|25|TX|||  
OBX|26|TX|||\H\Oxygen Therapy : \N\[*g CRS O2 YN]      \H\LPM Rest:\N\ [*]       \H\LPM Nocturnal:\N\ [*]      \H\LPM Ambulation:\N\ [*]  
OBX|27|TX|||  
OBX|28|TX|||1. [*]  
OBX|29|TX|||2. [*]  
OBX|30|TX|||3. [*]  
OBX|31|TX|||   
OBX|32|TX|||  
OBX|33|TX|||\ZHU\Quality of Life Measures:  
OBX|34|TX|||\N\  
OBX|35|TX|||MMRC: [*g CRS MMRC]                   CAT Score:                GOLD: [*g CRS GOLD]   STAGE: [*g CRS GSTAGE]                            BODE: [*g CRS Bode]  
OBX|36|TX|||   
OBX|37|TX|||  
OBX|38|TX|||\ZHU\Oximetry Data:\N\   
OBX|39|TX|||  
OBX|40|TX|||  
OBX|41|TX|||  
OBX|42|TX|||\ZHU\OXIMETRY O2 FLOW AT REST \H\                                              \ZHU\Ambulation 0  0  0  0    
OBX|43|TX|||   
OBX|44|TX||| \H\LPM SpO2 HR/RR SpO2 HR/RR \ZHU\DISTANCE\H\ (meters) \ZHU\TIME\H\ (minutes) Recovery Time (minutes)  
OBX|45|TX|||   
OBX|46|TX|||Room Air             
OBX|47|TX|||   
OBX|48|TX|||A) Cont Flow (lpm)           
OBX|49|TX|||   
OBX|50|TX|||B) Cont Flow (lpm)           
OBX|51|TX|||   
OBX|52|TX|||A) OCD (pulse)           
OBX|53|TX|||   
OBX|54|TX|||B) OCD (pulse)          
OBX|55|TX|||   
OBX|56|TX|||C) OCD (pulse)           
OBX|57|TX|||  
OBX|58|TX|||\N\  
OBX|59|TX|||\ZHU\Last Overnight Oximetry Test Date:\H\   
OBX|60|TX|||\N\  
OBX|61|TX|||\ZHU\Visit Summary:\H\ \N\[*]  
OBX|62|TX|||\ZHU\  
OBX|63|TX|||Past Medical History:\N\     
OBX|64|TX|||\ZHU\  
OBX|65|TX|||Respiratory Medications:  
OBX|66|TX|||  
OBX|67|TX|||\H\Short acting beta 2 agonists (SABA): \N\[*g CRS SABA]  
OBX|68|TX|||  
OBX|69|TX|||\H\Short acting Muscarinics (SAMA): \N\[*g CRS SAMA]  
OBX|70|TX|||  
OBX|71|TX|||\H\Long acting beta 2 agonists (LABA):\N\ [*g CRS LABA]  
OBX|72|TX|||  
OBX|73|TX|||\H\Long acting Muscarinics (LAMA):\N\ [*g CRS LAMA]  
OBX|74|TX|||  
OBX|75|TX|||\H\Inhaled Corticosteroid (ICS):\N\ [*g CRS ICS]  
OBX|76|TX|||\ZHU\  
OBX|77|TX|||\H\Combination SABA/SAMA:\N\ [*g CRS SA SA]  
OBX|78|TX|||  
OBX|79|TX|||\H\Combination LABA/LAMA:\N\ [*g CRS LA LA]  
OBX|80|TX|||  
OBX|81|TX|||\H\Combination ICS/LABA:\N\ [*g CRS ICS LA]  
OBX|82|TX|||\ZHU\  
OBX|83|TX|||\H\Combination ICS/LAMA/LABA:\N\ [*g CRS ICS LM]  
OBX|84|TX|||\ZHU\  
OBX|85|TX|||\N\Comment: [*]  
OBX|86|TX|||\ZHU\  
OBX|87|TX|||Other Medication:\N\     
OBX|88|TX|||  
OBX|89|TX|||\ZHU\Allergies:\H\   
OBX|90|TX|||\N\                  
OBX|91|TX|||  
OBX|92|TX|||\ZHU\Respiratory Assessment:  
OBX|93|TX|||\N\  
OBX|94|TX|||* \H\PFT or Spirometry completed: \N\ \H\Date:   
OBX|95|TX|||\N\      \H\FEV1/FVC:\N\ , \H\FEV1 %:\N\ , \H\FVC %:\N\   \H\DLCO: \N\    
OBX|96|TX|||\H\      FEV1 % CHANGE:\N\    \H\FVC % CHANGE:\N\   \H\Peak flow: \N\[*]    
OBX|97|TX|||            \H\Interpretation: \N\[*]  
OBX|98|TX|||  
OBX|99|TX|||\H\* Smoking History:\N\   
OBX|100|TX|||      \H\Smoker:\N\   \H\Total pack years:\N\    \H\Quit:\N\              \H\Smoking Cessation:\N\   
OBX|101|TX|||  
OBX|102|TX|||* \H\Number of COPD exacerbations / COPD Flare-ups in the past year:\N\ [*g CRS FLA 1]   \H\Number of hospital admissions: \N\ [*g CRS FLA 1]    
OBX|103|TX|||     
OBX|104|TX|||* \H\Written COPD Flare-up plan: \N\[*g CRS FLA YN]    
OBX|105|TX|||             \H\If yes, please comment: \N\[*]  
OBX|106|TX|||  
OBX|107|TX|||* \H\Annual vaccination: \N\[*g CRS FLA YN]                        \H\Pneumonia vaccine: \N\[*g CRS FLA YN]               \H\ Date: \N\[*]  
OBX|108|TX|||  
OBX|109|TX|||* \H\Cough:\N\ [*g CRS COU YN]   \H\Productive:\N\ [*g CRS PRO YN]  \H\Sputum color:\N\ [*g CRS SPUTUM]  
OBX|110|TX|||  
OBX|111|TX|||* \H\Breathing techniques reviewed:\N\ [*g CRS BT YN]  
OBX|112|TX|||   \H\Comments:\N\ [*]  
OBX|113|TX|||  
OBX|114|TX|||\H\* Auscultation:\N\ [*]  
OBX|115|TX|||  
OBX|116|TX|||* \H\Safe use of oxygen reviewed: \N\[*g CRS OS 1]  
OBX|117|TX|||\ZHU\  
OBX|118|TX|||\H\* Living situation:\N\ [*g CRS LIVING]  
OBX|119|TX|||  
OBX|120|TX|||* \H\Weight: \N\[*g CRS WEIGHT]  
OBX|121|TX|||  
OBX|122|TX|||\ZHU\Self-Management/Goals:  
OBX|123|TX|||\N\  
OBX|124|TX|||Does the client have a goal that their health prevents them from achieving? [*]  
OBX|125|TX|||            If \H\yes\N\, document: [*]  
OBX|126|TX|||  
OBX|127|TX|||Self-Management Goal: [*g CRS SMG YN]  
OBX|128|TX|||   If \H\yes\N\, document: [*]  
OBX|129|TX|||  
OBX|130|TX|||Action Plan\H\:\N\ [*g CRS AP YN]  
OBX|131|TX|||   If \H\yes\N\, select: [*g CRS AP]    
OBX|132|TX|||      
OBX|133|TX|||Report on action plan: [*]  
OBX|134|TX|||  
OBX|135|TX|||Problem-solving: [*g CRS PS YN]  
OBX|136|TX|||   If \H\yes\N\, document: [*]  
OBX|137|TX|||  
OBX|138|TX|||Resources provided: [*]  
OBX|139|TX|||  
OBX|140|TX|||\ZHU\Comments:\H\ \N\[*]  
OBX|141|TX|||Asthma / Family History: [*]  
OBX|142|TX|||Description of a typical asthma exacerbation: [*]  
OBX|143|TX|||Written asthma flare-up plan:   
OBX|144|TX|||If yes,  please comment: [*]  
OBX|145|TX|||Triggers: [*]  
OBX|146|TX|||Number of exacerbations/ flare-ups in the past year: [*]  
OBX|147|TX|||Number of exacerbations/ flare-ups requiring hospitalization in the past year: [*]  
OBX|148|TX|||Number of exacerbations/ flare-ups requiring ICU admission in the past year: [*]  
OBX|149|TX|||Attended or attending asthma clinic:   
OBX|150|TX|||Eosinophil Count: [*]            Date: [*]  
OBX|151|TX|||Asthma Control Test Score: [*]  
OBX|152|TX|||  
OBX|153|TX|||  
OBX|154|TX|||  
OBX|155|TX|||\H\____________________________________________________  
OBX|156|TX|||  
OBX|157|TX|||Completed By:  \ZI\Ryan Asistio,\N\  RRT  
OBX|158|TX|||   
OBX|159|TX|||Registered Respiratory Therapist  
OBX|160|TX|||Fraser Health Community Respiratory Services  
OBX|161|TX|||  
OBX|162|TX|||Date/Time:  \ZU\18/12/19\N\  \ZU\0902  
OBX|163|TX|||\H\____________________________________________________  
OBX|164|TX|||\ZU\                                                                                                                                                           
OBX|165|TX|||\H\ADDENDUM  
OBX|166|TX|||  
OBX|167|TX|||\N\ADDEDUM AT 0905  
OBX|168|TX|||Signed By:   \ZIU\Ryan Asistio  
OBX|169|TX|||\N\Date/Time:   \ZU\18/12/19\N\ \ZU\0905