STANDARD DATA DICTIONARY #853.8 -- VPS CLINICAL SURVEY FILE                                                       6/27/25    PAGE 1
STORED IN ^VPS(853.8,  *** NO DATA STORED YET ***   SITE: WWW.BMIRWIN.COM   UCI: VISTA,VISTA                       (VERSION 1.0)   

DATA          NAME                  GLOBAL        DATA
ELEMENT       TITLE                 LOCATION      TYPE
-----------------------------------------------------------------------------------------------------------------------------------
This is the Clinical Survey Questionnaire data file for VA Point of Service (VPS) Kiosk application. VetLink (patient-facing or
staff-facing) uses Remote Procedure Call (RPC) APIs to store Survey Questionnaire question-patient responses pairs.  
 
The data stored in this file is sorted by patient and by survey. Each patient will have multiple surveys and each survey contains
multiple questions and responses.  



   APPLICATION GROUP(S): GMTS

CROSS
REFERENCED BY: PATIENT(B), KIOSK SESSION IDENTIFIER(C), QUESTIONNAIRE TEMPLATE ID(D), PATIENT SAFETY(E), SURVEY CREATOR(F)

INDEXED BY:    RESPONSE IDENTIFIER & DATE/TIME TAKEN (D), DATE/TIME TAKEN & PATIENT SAFETY (G), PATIENT (H)




853.8,.01     PATIENT                0;1 POINTER TO PATIENT FILE (#2) (Required)

              INPUT TRANSFORM:  S DINUM=X Q
              LAST EDITED:      AUG 24, 2015 
              HELP-PROMPT:      Select the patient who entered the questionnaire. 
              DESCRIPTION:
                                This is the patient who entered the questionnaire.  

              TECHNICAL DESCR:
                                Since this value is DINUM, this field represents the root IEN for this file as well.  

              NOTES:            XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER

              CROSS-REFERENCE:  853.8^B 
                                1)= S ^VPS(853.8,"B",$E(X,1,30),DA)=""
                                2)= K ^VPS(853.8,"B",$E(X,1,30),DA)

              FIELD INDEX:      H (#1342)    REGULAR    IR    LOOKUP & SORTING
                  Short Descr:  Index for Patient Identifier
                    Set Logic:  S ^VPS(853.8,"H",X,DA)=""
                   Kill Logic:  K ^VPS(853.8,"H",X,DA)
                   Whole Kill:  K ^VPS(853.8,"H")
                         X(1):  PATIENT  (853.8,.01)  (Subscr 1)  (forwards)


853.8,1       QUESTIONNAIRE IDENTIFIER 1;0 POINTER Multiple #853.805 (Add New Entry without Asking)

              LAST EDITED:      NOV 12, 2014 
              DESCRIPTION:
                                This multiple stores all the patient's questionnaire identification information.  


853.805,.01     QUESTIONNAIRE IDENTIFIER 0;1 POINTER TO VPS QUESTIONNAIRE IDENTIFIERS FILE (#853.85) (Required)

                INPUT TRANSFORM:  S DINUM=X Q
                LAST EDITED:      AUG 24, 2015 
                HELP-PROMPT:      Enter the IEN to the questionnaire that is being stored. 
                DESCRIPTION:      This is a pointer to the VPS QUESTIONNAIRE IDENTIFIERS FILE (853.85).  It indicates which
                                  questionnaire the patient has responsed to.  

                NOTES:            XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER

                CROSS-REFERENCE:  853.805^B 
                                  1)= S ^VPS(853.8,DA(1),1,"B",$E(X,1,30),DA)=""
                                  2)= K ^VPS(853.8,DA(1),1,"B",$E(X,1,30),DA)


853.805,1       QUESTIONNAIRE          1;0 DATE Multiple #853.81 (Add New Entry without Asking)

                DESCRIPTION:
                                  This multiple represents all questionnaires for the patient.  


853.81,.01        DATE/TIME STORED       0;1 DATE (Required)

                  INPUT TRANSFORM:  S %DT="ESTR" D ^%DT S X=Y K:Y<1 X S:$D(X) DINUM=X Q
                  LAST EDITED:      AUG 24, 2015 
                  HELP-PROMPT:      Enter Date/Time the questionnaire was stored. 
                  DESCRIPTION:      This is the Date/Time when the questionnaire sent by VetLink is stored in VistA. This Date/Time
                                    is automatically generated.  

                  NOTES:            XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER

                  CROSS-REFERENCE:  853.81^B 
                                    1)= S ^VPS(853.8,DA(2),1,DA(1),1,"B",$E(X,1,30),DA)=""
                                    2)= K ^VPS(853.8,DA(2),1,DA(1),1,"B",$E(X,1,30),DA)


853.81,.02        SURVEY CREATOR         0;2 POINTER TO NEW PERSON FILE (#200) (Required)

                  LAST EDITED:      JAN 18, 2016 
                  HELP-PROMPT:      Enter the staff who created this survey. 
                  DESCRIPTION:
                                    This is the staff who created this survey.  


853.81,1          QUESTIONNAIRE RESPONSE 1;0 Multiple #853.811 (Add New Entry without Asking)

                  DESCRIPTION:      This is the questionnaire response multiple.  A patient may respond to a questionnaire more
                                    than one time.  


853.811,.01         RESPONSE IDENTIFIER    0;1 FREE TEXT (Required)

                    INPUT TRANSFORM:  K:$L(X)>60!($L(X)<3) X
                    LAST EDITED:      SEP 09, 2015 
                    HELP-PROMPT:      Answer must be 3-60 characters in length. 
                    DESCRIPTION:
                                      This field contains the questionnaire response identifier from VetLink.  

                    CROSS-REFERENCE:  853.811^B 
                                      1)= S ^VPS(853.8,DA(3),1,DA(2),1,DA(1),1,"B",$E(X,1,30),DA)=""
                                      2)= K ^VPS(853.8,DA(3),1,DA(2),1,DA(1),1,"B",$E(X,1,30),DA)

                    RECORD INDEXES:   D (#1340) (WHOLE FILE #853.8)

853.811,.02         DATE/TIME TAKEN        0;2 DATE

                    INPUT TRANSFORM:  S %DT="ESTR" D ^%DT S X=Y K:Y<1 X
                    LAST EDITED:      SEP 16, 2015 
                    HELP-PROMPT:      Enter date/time patient took the questionnaire. 
                    DESCRIPTION:
                                      This field contains the date/time the patient took this questionnaire.  

                    RECORD INDEXES:   D (#1340) (WHOLE FILE #853.8)

853.811,.03         DATE/TIME LAST MODIFIED 0;3 DATE

                    INPUT TRANSFORM:  S %DT="ESTR" D ^%DT S X=Y K:Y<1 X
                    LAST EDITED:      SEP 16, 2015 
                    HELP-PROMPT:      Enter the date/time someone last modified this questionnaire. 
                    DESCRIPTION:
                                      This is the Date/Time the survey was modified by patient or staff.  


853.811,.04         COMPLETION STATUS      0;4 SET (Required)

                                      '1' FOR COMPLETE; 
                                      '2' FOR INCOMPLETE; 
                    LAST EDITED:      AUG 24, 2015 
                    HELP-PROMPT:      Enter the completion status. 
                    DESCRIPTION:
                                      This field contains the completion status for this questionnaire.  


853.811,.05         PATIENT SAFETY         0;5 SET (Required)

                                      '1' FOR YES; 
                                      '2' FOR NO; 
                    LAST EDITED:      AUG 24, 2015 
                    HELP-PROMPT:      Enter the patient safety status. 
                    DESCRIPTION:
                                      This field contains the indicator for patient safety.  


853.811,.06         IMMEDIATE ACTION       0;6 SET

                                      '1' FOR YES; 
                                      '2' FOR NO; 
                    LAST EDITED:      AUG 24, 2015 
                    HELP-PROMPT:      Enter the immediate action status. 
                    DESCRIPTION:
                                      This field contains an indicator that immediate action is required.  


853.811,1           APPOINTMENT CHECK-IN   1;0 Multiple #853.8111 (Add New Entry without Asking)

                    LAST EDITED:      AUG 25, 2014 
                    HELP-PROMPT:      Enter question presented in the questionnaire (must be 1-250 characters). 
                    DESCRIPTION:
                                      This multiple contains appointment check-in identifiers.  


853.8111,.01          APPOINTMENT CHECK-IN ID 0;1 FREE TEXT

                      INPUT TRANSFORM:  K:$L(X)>250!($L(X)<3) X
                      LAST EDITED:      SEP 16, 2015 
                      HELP-PROMPT:      Answer must be 3-250 characters in length. 
                      DESCRIPTION:
                                        This field contains an appointment check-in identifier.  


853.8111,1            ANSWER HISTORY D/T     1;1 DATE

                      INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:X<1 X
                      LAST EDITED:      MAR 10, 2016 
                      HELP-PROMPT:      Enter the date/time the Clinical Survey answer was recorded.  
                      DESCRIPTION:      Answer History date/time represents the date and time the entry in this subfile was
                                        recorded.  




853.811,2           ADDITIONAL CALCULATED VALUE 2;0 Multiple #853.8112 (Add New Entry without Asking)

                      LAST EDITED:      AUG 25, 2014 
                      HELP-PROMPT:      Enter response provided to the question (must be 1-250 characters). 
                      DESCRIPTION:
                                        This multiple stores response additional calculated value information.  


853.8112,.01          ADDITIONAL CALC VALUE NAME 0;1 FREE TEXT (Required)

                        INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
                        LAST EDITED:      AUG 24, 2015 
                        HELP-PROMPT:      Answer must be 1-20 characters in length. 
                        DESCRIPTION:
                                          This field contains the name of the additional calculated value.  

                        CROSS-REFERENCE:  853.8112^B 
                                          1)= S ^VPS(853.8,DA(4),1,DA(3),1,DA(2),1,DA(1),2,"B",$E(X,1,30),DA)=""
                                          2)= K ^VPS(853.8,DA(4),1,DA(3),1,DA(2),1,DA(1),2,"B",$E(X,1,30),DA)


853.8112,.02          ADDITIONAL CALC VALUE SCORE 0;2 FREE TEXT (Required)

                        INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
                        LAST EDITED:      AUG 24, 2015 
                        HELP-PROMPT:      Answer must be 1-20 characters in length. 
                        DESCRIPTION:
                                          This field contains the score for the additional calcualted value.  


853.8112,1            ANSWER HISTORY D/T       2;1 DATE

                        INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:X<1 X
                        LAST EDITED:      MAR 10, 2016 
                        HELP-PROMPT:      Enter the date/time the Clinical Survey answer was recorded.  
                        DESCRIPTION:      Answer History date/time represents the date and time the entry in this subfile was
                                          recorded.  




853.811,3           QUESTIONS                  3;0 Multiple #853.8113 (Add New Entry without Asking)

                        LAST EDITED:      AUG 25, 2014 
                        HELP-PROMPT:      Enter calculated value for the question (must be 1-250 characters). 
                        DESCRIPTION:
                                          This multiple contains the question details of a given questionnaire.  


853.8113,.01          QUESTION NUMBER            0;1 FREE TEXT (Required)

                          INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
                          LAST EDITED:      AUG 24, 2015 
                          HELP-PROMPT:      Answer must be 1-4 characters in length. 
                          DESCRIPTION:
                                            This field contains the number associated with a question on the given questionnaire.  

                          CROSS-REFERENCE:  853.8113^B 
                                            1)= S ^VPS(853.8,DA(4),1,DA(3),1,DA(2),1,DA(1),3,"B",$E(X,1,30),DA)=""
                                            2)= K ^VPS(853.8,DA(4),1,DA(3),1,DA(2),1,DA(1),3,"B",$E(X,1,30),DA)


853.8113,1            QUESTION CALCULATED VALUE  1;1 FREE TEXT (Required)

                          INPUT TRANSFORM:  K:$L(X)>250!($L(X)<3) X
                          LAST EDITED:      AUG 24, 2015 
                          HELP-PROMPT:      Enter calculated value for the question (must be 3-250 characters).  
                          DESCRIPTION:
                                            This is calculated value for each question generated by Vetlink. 


853.8113,2            QUESTION PRESENTED         2;0   WORD-PROCESSING #853.81132   (IGNORE "|")

                          DESCRIPTION:      This field contains a question of the given questionnaire. This question is displayed
                                            to the patient then the patient is to provide an answer to this question.  


                            LAST EDITED:      AUG 24, 2015 
                            HELP-PROMPT:      Enter a question for the given questionnaire to be answered by the patient. 
                            DESCRIPTION:      This field contains a question of the given questionnaire. This question is displayed
                                              to the patient then the patient is to provide an answer to this question.  




853.8113,3            ANSWER                       3;0 Multiple #853.81133 (Add New Entry without Asking)

                            DESCRIPTION:      This multiple contains the answer(s) the patient gave to the given question on the
                                              given questionnaire.  


853.81133,.01           ANSWER IDENTIFIER            0;1 FREE TEXT (Required)

                              INPUT TRANSFORM:  K:$L(X)>250!($L(X)<3) X
                              LAST EDITED:      AUG 24, 2015 
                              HELP-PROMPT:      Answer must be 3-250 characters in length. 
                              DESCRIPTION:
                                                This field contains an answer identifier.  

                              CROSS-REFERENCE:  853.81133^B 
                                                1)= S ^VPS(853.8,DA(5),1,DA(4),1,DA(3),1,DA(2),3,DA(1),3,"B",$E(X,1,250),DA)=""
                                                2)= K ^VPS(853.8,DA(5),1,DA(4),1,DA(3),1,DA(2),3,DA(1),3,"B",$E(X,1,250),DA)


853.81133,.02           INTERFACE USED               1;1 SET (Required)

                                                '1' FOR ADMIN; 
                                                '2' FOR KIOSK; 
                              LAST EDITED:      AUG 24, 2015 
                              HELP-PROMPT:      Enter a value for which interface was used. 
                              DESCRIPTION:
                                                This field identifies what interface the data came from.  


853.81133,.03           RESPONDENT                   1;2 SET (Required)

                                                '1' FOR PATIENT; 
                                                '2' FOR STAFF; 
                                                '3' FOR OTHER; 
                              LAST EDITED:      AUG 24, 2015 
                              HELP-PROMPT:      Enter a value for the respondent. 
                              DESCRIPTION:
                                                This field captures who actually supplied the data.  


853.81133,.04           RESPONDENT NAME              1;3 FREE TEXT

                              INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
                              LAST EDITED:      AUG 24, 2015 
                              HELP-PROMPT:      Answer must be 1-60 characters in length. 
                              DESCRIPTION:      This is the name of the person that answered this question, if different from the
                                                patient.  If the response was not answered by the patient, this field is required.  


853.81133,.05           ANSWER HISTORY D/T           1;6 DATE

                              INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:X<1 X
                              LAST EDITED:      MAR 10, 2016 
                              HELP-PROMPT:      Enter the date/time the Clinical Survey answer was recorded. 
                              DESCRIPTION:      Answer History date/time represents the date and time the entry in this subfile was
                                                recorded.  


853.81133,1             ANSWER DATE/TIME             1;4 DATE (Required)

                              INPUT TRANSFORM:  S %DT="ESTR" D ^%DT S X=Y K:Y<1 X
                              LAST EDITED:      SEP 16, 2015 
                              HELP-PROMPT:      Enter date/time answer was provided. 
                              DESCRIPTION:
                                                This field contains the date/time the patient answered the given question.  


853.81133,2             INTERVIEWER NAME             1;5 FREE TEXT

                              INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
                              LAST EDITED:      AUG 24, 2015 
                              HELP-PROMPT:      Answer must be 1-60 characters in length. 
                              DESCRIPTION:
                                                This is the name of the staff member that asked the associated question.  


853.81133,3             KIOSK IDENTIFIER             2;1 FREE TEXT

                              INPUT TRANSFORM:  K:$L(X)>250!($L(X)<3) X
                              LAST EDITED:      AUG 24, 2015 
                              HELP-PROMPT:      Answer must be 3-250 characters in length. 
                              DESCRIPTION:
                                                This field contains the kiosk identifier.  


853.81133,4             KIOSK SESSION IDENTIFIER     3;1 FREE TEXT

                              INPUT TRANSFORM:  K:$L(X)>250!($L(X)<3) X
                              LAST EDITED:      SEP 11, 2015 
                              HELP-PROMPT:      Answer must be 3-250 characters in length. 
                              DESCRIPTION:
                                                This field contains the kiosk session identifier.  

                              CROSS-REFERENCE:  853.8^C 
                                                1)= S ^VPS(853.8,"C",$E(X,1,30),DA(5),DA(4),DA(3),DA(2),DA(1),DA)=""
                                                2)= K ^VPS(853.8,"C",$E(X,1,30),DA(5),DA(4),DA(3),DA(2),DA(1),DA)
                                                Index needed for edit validation. If key fields do not match then information
                                                cannot be editted.  



853.81133,5             KIOSK GROUP IDENTIFIER       4;1 FREE TEXT

                              INPUT TRANSFORM:  K:$L(X)>250!($L(X)<3) X
                              LAST EDITED:      AUG 24, 2015 
                              HELP-PROMPT:      Answer must be 3-250 characters in length. 
                              DESCRIPTION:
                                                This field contains the kiosk group identifier.  


853.81133,6             ANSWER TEXT                  5;0   WORD-PROCESSING #853.811336   (IGNORE "|")

                              DESCRIPTION:      This field contains the information the patient gave in response to the given
                                                question.  


                                LAST EDITED:      AUG 24, 2015 
                                HELP-PROMPT:      Enter the patient's response to the given question. 
                                DESCRIPTION:      This field contains the information the patient gave in response to the given
                                                  question.  








853.811,4           SURVEY CALCULATED VALUE            4;1 FREE TEXT (Required)

                                INPUT TRANSFORM:  K:$L(X)>250!($L(X)<3) X
                                LAST EDITED:      AUG 26, 2015 
                                HELP-PROMPT:      Enter calculated value for the survey. This value must be 3-250 characters in 
                                                  length.  
                                DESCRIPTION:
                                                  This is the calculated value for the whole survey generated by Vetlink. 




853.81,2          DATE/TIME TAKEN                      0;3 DATE (Required)

                                INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
                                LAST EDITED:      NOV 14, 2014 
                                HELP-PROMPT:      Enter Date/Time the questionnaire was taken. 
                                DESCRIPTION:
                                                  This is the date/time the survey was taken by the patient.  

                                RECORD INDEXES:   G (#1341) (WHOLE FILE #853.8)

853.81,3          DATE/TIME LAST MODIFIED              0;4 DATE (Required)

                                INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
                                LAST EDITED:      NOV 07, 2014 
                                HELP-PROMPT:      Enter Date/Time the questionnaire last modified. 
                                DESCRIPTION:
                                                  This is the Date/Time the survey was modified by patient or staff.  


853.81,4          INTERVIEWER STAFF                    0;5 POINTER TO NEW PERSON FILE (#200)

                                LAST EDITED:      AUG 25, 2014 
                                HELP-PROMPT:      Enter the staff who interviewed the patient. 
                                DESCRIPTION:
                                                  This is the staff who interviewed the patient during the survey.  


853.81,5          SURVEY CALCULATED VALUE              1;1 FREE TEXT

                                INPUT TRANSFORM:  K:$L(X)>250!($L(X)<1) X
                                LAST EDITED:      AUG 25, 2014 
                                HELP-PROMPT:      Enter calculated value for the survey. This value must be 3-250 characters in 
                                                  length. 
                                DESCRIPTION:
                                                  This is the calculated value for the whole survey generated by Vetlink.  


853.81,6          COMPLETION STATUS                    2;1 SET

                                                  'C' FOR COMPLETED; 
                                                  'I' FOR INCOMPLETE; 
                                LAST EDITED:      AUG 25, 2014 
                                HELP-PROMPT:      Enter completion status for the questionnaire. 
                                DESCRIPTION:
                                                  This field indicates whether or not the survey was completed.  


853.81,7          PATIENT SAFETY                       2;2 SET

                                                  'Y' FOR YES; 
                                                  'N' FOR NO; 
                                LAST EDITED:      NOV 14, 2014 
                                HELP-PROMPT:      Enter whether or not this is Patient Safety Questionnaire. 
                                DESCRIPTION:
                                                  This field indicates whether or not the survey is a patient safety.  

                                CROSS-REFERENCE:  853.8^E 
                                                  1)= S ^VPS(853.8,"E",$E(X,1,30),DA(1),DA)=""
                                                  2)= K ^VPS(853.8,"E",$E(X,1,30),DA(1),DA)
                                                  This cross refernce of Patient Safty Field is for searching.  


                                RECORD INDEXES:   G (#1341) (WHOLE FILE #853.8)

853.81,8          IMMEDIATE ACTION                     2;3 SET

                                                  'Y' FOR YES; 
                                                  'N' FOR NO; 
                                LAST EDITED:      AUG 25, 2014 
                                HELP-PROMPT:      Enter whether or not the questionnaire requires immediate action. 
                                DESCRIPTION:
                                                  This field indicates whether or not the survey requires immediate action.  


853.81,11         QUESTIONNAIRE TEMPLATE ID            0;7 POINTER TO VPS QUESTIONNAIRE IDENTIFIERS FILE (#853.85) (Required)

                                LAST EDITED:      MAR 10, 2015 
                                DESCRIPTION:
                                                  This is the questionnaire template identification number.  

                                CROSS-REFERENCE:  853.8^D 
                                                  1)= S ^VPS(853.8,"D",$E(X,1,30),DA(1),DA)=""
                                                  2)= K ^VPS(853.8,"D",$E(X,1,30),DA(1),DA)
                                                  This cross reference selects questionnaires taken by patients using the
                                                  Questionnaire Template ID.  



853.81,12         SURVEY CREATOR                       0;8 POINTER TO NEW PERSON FILE (#200) (Required)

                                LAST EDITED:      NOV 14, 2014 
                                HELP-PROMPT:      Enter the staff who created this survey. 
                                DESCRIPTION:
                                                  This is the staff who created this survey.  

                                CROSS-REFERENCE:  853.8^F 
                                                  1)= S ^VPS(853.8,"F",$E(X,1,30),DA(1),DA)=""
                                                  2)= K ^VPS(853.8,"F",$E(X,1,30),DA(1),DA)
                                                  This cross reference of the survey creator is for searching.  



853.81,20         QUESTIONS                            3;0 Multiple #853.811

                                DESCRIPTION:
                                                  This multiple represents all questions for the survey.  


853.811,.01         RESPONSE IDENTIFIER                  0;1 FREE TEXT (Required)

                                  INPUT TRANSFORM:  K:$L(X)>60!($L(X)<3) X
                                  LAST EDITED:      SEP 09, 2015 
                                  HELP-PROMPT:      Answer must be 3-60 characters in length. 
                                  DESCRIPTION:
                                                    This field contains the questionnaire response identifier from VetLink.  

                                  CROSS-REFERENCE:  853.811^B 
                                                    1)= S ^VPS(853.8,DA(3),1,DA(2),1,DA(1),1,"B",$E(X,1,30),DA)=""
                                                    2)= K ^VPS(853.8,DA(3),1,DA(2),1,DA(1),1,"B",$E(X,1,30),DA)

                                  RECORD INDEXES:   D (#1340) (WHOLE FILE #853.8)

853.811,.02         DATE/TIME TAKEN                      0;2 DATE

                                  INPUT TRANSFORM:  S %DT="ESTR" D ^%DT S X=Y K:Y<1 X
                                  LAST EDITED:      SEP 16, 2015 
                                  HELP-PROMPT:      Enter date/time patient took the questionnaire. 
                                  DESCRIPTION:
                                                    This field contains the date/time the patient took this questionnaire.  

                                  RECORD INDEXES:   D (#1340) (WHOLE FILE #853.8)

853.811,.03         DATE/TIME LAST MODIFIED              0;3 DATE

                                  INPUT TRANSFORM:  S %DT="ESTR" D ^%DT S X=Y K:Y<1 X
                                  LAST EDITED:      SEP 16, 2015 
                                  HELP-PROMPT:      Enter the date/time someone last modified this questionnaire. 
                                  DESCRIPTION:
                                                    This is the Date/Time the survey was modified by patient or staff.  


853.811,.04         COMPLETION STATUS                    0;4 SET (Required)

                                                    '1' FOR COMPLETE; 
                                                    '2' FOR INCOMPLETE; 
                                  LAST EDITED:      AUG 24, 2015 
                                  HELP-PROMPT:      Enter the completion status. 
                                  DESCRIPTION:
                                                    This field contains the completion status for this questionnaire.  


853.811,.05         PATIENT SAFETY                       0;5 SET (Required)

                                                    '1' FOR YES; 
                                                    '2' FOR NO; 
                                  LAST EDITED:      AUG 24, 2015 
                                  HELP-PROMPT:      Enter the patient safety status. 
                                  DESCRIPTION:
                                                    This field contains the indicator for patient safety.  


853.811,.06         IMMEDIATE ACTION                     0;6 SET

                                                    '1' FOR YES; 
                                                    '2' FOR NO; 
                                  LAST EDITED:      AUG 24, 2015 
                                  HELP-PROMPT:      Enter the immediate action status. 
                                  DESCRIPTION:
                                                    This field contains an indicator that immediate action is required.  


853.811,1           APPOINTMENT CHECK-IN                 1;0 Multiple #853.8111 (Add New Entry without Asking)

                                  LAST EDITED:      AUG 25, 2014 
                                  HELP-PROMPT:      Enter question presented in the questionnaire (must be 1-250 characters). 
                                  DESCRIPTION:
                                                    This multiple contains appointment check-in identifiers.  


853.8111,.01          APPOINTMENT CHECK-IN ID              0;1 FREE TEXT

                                    INPUT TRANSFORM:  K:$L(X)>250!($L(X)<3) X
                                    LAST EDITED:      SEP 16, 2015 
                                    HELP-PROMPT:      Answer must be 3-250 characters in length. 
                                    DESCRIPTION:
                                                      This field contains an appointment check-in identifier.  


853.8111,1            ANSWER HISTORY D/T                   1;1 DATE

                                    INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:X<1 X
                                    LAST EDITED:      MAR 10, 2016 
                                    HELP-PROMPT:      Enter the date/time the Clinical Survey answer was recorded.  
                                    DESCRIPTION:      Answer History date/time represents the date and time the entry in this 
                                                      subfile was recorded.  




853.811,2           ADDITIONAL CALCULATED VALUE            2;0 Multiple #853.8112 (Add New Entry without Asking)

                                    LAST EDITED:      AUG 25, 2014 
                                    HELP-PROMPT:      Enter response provided to the question (must be 1-250 characters). 
                                    DESCRIPTION:
                                                      This multiple stores response additional calculated value information.  


853.8112,.01          ADDITIONAL CALC VALUE NAME             0;1 FREE TEXT (Required)

                                      INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
                                      LAST EDITED:      AUG 24, 2015 
                                      HELP-PROMPT:      Answer must be 1-20 characters in length. 
                                      DESCRIPTION:
                                                        This field contains the name of the additional calculated value.  

                                      CROSS-REFERENCE:  853.8112^B 
                                                        1)= S ^VPS(853.8,DA(4),1,DA(3),1,DA(2),1,DA(1),2,"B",$E(X,1,30),DA)=""
                                                        2)= K ^VPS(853.8,DA(4),1,DA(3),1,DA(2),1,DA(1),2,"B",$E(X,1,30),DA)


853.8112,.02          ADDITIONAL CALC VALUE SCORE            0;2 FREE TEXT (Required)

                                      INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
                                      LAST EDITED:      AUG 24, 2015 
                                      HELP-PROMPT:      Answer must be 1-20 characters in length. 
                                      DESCRIPTION:
                                                        This field contains the score for the additional calcualted value.  


853.8112,1            ANSWER HISTORY D/T                     2;1 DATE

                                      INPUT TRANSFORM:  S %DT="ETX" D ^%DT S X=Y K:X<1 X
                                      LAST EDITED:      MAR 10, 2016 
                                      HELP-PROMPT:      Enter the date/time the Clinical Survey answer was recorded.  
                                      DESCRIPTION:      Answer History date/time represents the date and time the entry in this 
                                                        subfile was recorded.  




853.811,3           QUESTIONS                                3;0 Multiple #853.8113 (Add New Entry without Asking)

                                      LAST EDITED:      AUG 25, 2014 
                                      HELP-PROMPT:      Enter calculated value for the question (must be 1-250 characters). 
                                      DESCRIPTION:
                                                        This multiple contains the question details of a given questionnaire.  


853.8113,.01          QUESTION NUMBER                          0;1 FREE TEXT (Required)

                                        INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
                                        LAST EDITED:      AUG 24, 2015 
                                        HELP-PROMPT:      Answer must be 1-4 characters in length. 
                                        DESCRIPTION:      This field contains the number associated with a question on the given 
                                                          questionnaire.  

                                        CROSS-REFERENCE:  853.8113^B 
                                                          1)= S ^VPS(853.8,DA(4),1,DA(3),1,DA(2),1,DA(1),3,"B",$E(X,1,30),DA)=""
                                                          2)= K ^VPS(853.8,DA(4),1,DA(3),1,DA(2),1,DA(1),3,"B",$E(X,1,30),DA)


853.8113,1            QUESTION CALCULATED VALUE                1;1 FREE TEXT (Required)

                                        INPUT TRANSFORM:  K:$L(X)>250!($L(X)<3) X
                                        LAST EDITED:      AUG 24, 2015 
                                        HELP-PROMPT:      Enter calculated value for the question (must be 3-250 characters).  
                                        DESCRIPTION:
                                                          This is calculated value for each question generated by Vetlink. 


853.8113,2            QUESTION PRESENTED                       2;0   WORD-PROCESSING #853.81132   (IGNORE "|")

                                        DESCRIPTION:      This field contains a question of the given questionnaire. This question 
                                                          is displayed to the patient then the patient is to provide an answer to 
                                                          this question.  


                                          LAST EDITED:      AUG 24, 2015 
                                          HELP-PROMPT:      Enter a question for the given questionnaire to be answered by the 
                                                            patient. 
                                          DESCRIPTION:      This field contains a question of the given questionnaire. This
                                                            question is displayed to the patient then the patient is to provide an
                                                            answer to this question.  




853.8113,3            ANSWER                                     3;0 Multiple #853.81133 (Add New Entry without Asking)

                                          DESCRIPTION:      This multiple contains the answer(s) the patient gave to the given 
                                                            question on the given questionnaire.  


853.81133,.01           ANSWER IDENTIFIER                          0;1 FREE TEXT (Required)

                                            INPUT TRANSFORM:  K:$L(X)>250!($L(X)<3) X
                                            LAST EDITED:      AUG 24, 2015 
                                            HELP-PROMPT:      Answer must be 3-250 characters in length. 
                                            DESCRIPTION:
                                                              This field contains an answer identifier.  

                                            CROSS-REFERENCE:  853.81133^B 
                                1)= S ^VPS(853.8,DA(5),1,DA(4),1,DA(3),1,DA(2),3,DA(1),3,"B",$E(X,1,250),DA)=""
                                2)= K ^VPS(853.8,DA(5),1,DA(4),1,DA(3),1,DA(2),3,DA(1),3,"B",$E(X,1,250),DA)


853.81133,.02           INTERFACE USED 1;1 SET (Required)

                                '1' FOR ADMIN; 
                                '2' FOR KIOSK; 
                                            LAST EDITED: AUG 24, 2015 
                                            HELP-PROMPT:Enter a value for which interface was used. 
                                            DESCRIPTION:
                                This field identifies what interface the data came from.  


853.81133,.03           RESPONDENT   1;2 SET (Required)

                                '1' FOR PATIENT; 
                                '2' FOR STAFF; 
                                '3' FOR OTHER; 
                                            LAST EDITED: AUG 24, 2015 
                                            HELP-PROMPT:Enter a value for the respondent. 
                                            DESCRIPTION:
                                This field captures who actually supplied the data.  


853.81133,.04           RESPONDENT NAME 1;3 FREE TEXT

                                            INPUT TRANSFORM:K:$L(X)>60!($L(X)<1) X
                                            LAST EDITED: AUG 24, 2015 
                                            HELP-PROMPT:Answer must be 1-60 characters in length. 
                                            DESCRIPTION:
                                This is the name of the person that answered this question, if different from the patient.  If the
                                response was not answered by the patient, this field is required.  


853.81133,.05           ANSWER HISTORY D/T 1;6 DATE

                                            INPUT TRANSFORM:S %DT="ETX" D ^%DT S X=Y K:X<1 X
                                            LAST EDITED: MAR 10, 2016 
                                            HELP-PROMPT:Enter the date/time the Clinical Survey answer was recorded. 
                                            DESCRIPTION:
                                Answer History date/time represents the date and time the entry in this subfile was recorded.  


853.81133,1             ANSWER DATE/TIME 1;4 DATE (Required)

                                            INPUT TRANSFORM:S %DT="ESTR" D ^%DT S X=Y K:Y<1 X
                                            LAST EDITED: SEP 16, 2015 
                                            HELP-PROMPT:Enter date/time answer was provided. 
                                            DESCRIPTION:
                                This field contains the date/time the patient answered the given question.  


853.81133,2             INTERVIEWER NAME 1;5 FREE TEXT

                                            INPUT TRANSFORM:K:$L(X)>60!($L(X)<1) X
                                            LAST EDITED: AUG 24, 2015 
                                            HELP-PROMPT:Answer must be 1-60 characters in length. 
                                            DESCRIPTION:
                                This is the name of the staff member that asked the associated question.  


853.81133,3             KIOSK IDENTIFIER 2;1 FREE TEXT

                                            INPUT TRANSFORM:K:$L(X)>250!($L(X)<3) X
                                            LAST EDITED: AUG 24, 2015 
                                            HELP-PROMPT:Answer must be 3-250 characters in length. 
                                            DESCRIPTION:
                                This field contains the kiosk identifier.  


853.81133,4             KIOSK SESSION IDENTIFIER 3;1 FREE TEXT

                                            INPUT TRANSFORM:K:$L(X)>250!($L(X)<3) X
                                            LAST EDITED: SEP 11, 2015 
                                            HELP-PROMPT:Answer must be 3-250 characters in length. 
                                            DESCRIPTION:
                                This field contains the kiosk session identifier.  

                                            CROSS-REFERENCE:853.8^C 
                                1)= S ^VPS(853.8,"C",$E(X,1,30),DA(5),DA(4),DA(3),DA(2),DA(1),DA)=""
                                2)= K ^VPS(853.8,"C",$E(X,1,30),DA(5),DA(4),DA(3),DA(2),DA(1),DA)
                                Index needed for edit validation. If key fields do not match then information cannot be editted.  



853.81133,5             KIOSK GROUP IDENTIFIER 4;1 FREE TEXT

                                            INPUT TRANSFORM:K:$L(X)>250!($L(X)<3) X
                                            LAST EDITED: AUG 24, 2015 
                                            HELP-PROMPT:Answer must be 3-250 characters in length. 
                                            DESCRIPTION:
                                This field contains the kiosk group identifier.  


853.81133,6             ANSWER TEXT  5;0   WORD-PROCESSING #853.811336   (IGNORE "|")

                                            DESCRIPTION:
                                This field contains the information the patient gave in response to the given question.  


                                              LAST EDITED: AUG 24, 2015 
                                              HELP-PROMPT:Enter the patient's response to the given question. 
                                              DESCRIPTION:
                                  This field contains the information the patient gave in response to the given question.  








853.811,4           SURVEY CALCULATED VALUE 4;1 FREE TEXT (Required)

                                              INPUT TRANSFORM:K:$L(X)>250!($L(X)<3) X
                                              LAST EDITED: AUG 26, 2015 
                                              HELP-PROMPT:Enter calculated value for the survey. This value must be 3-250 
                                  characters in length.  
                                              DESCRIPTION:
                                  This is the calculated value for the whole survey generated by Vetlink. 









      FILES POINTED TO                      FIELDS

NEW PERSON (#200)                 QUESTIONNAIRE:SURVEY CREATOR (#.02)
                                  INTERVIEWER STAFF (#4)
                                  SURVEY CREATOR (#12)

PATIENT (#2)                      PATIENT (#.01)

VPS QUESTIONNAIRE IDENTIFIERS 
                   (#853.85)      QUESTIONNAIRE IDENTIFIER:QUESTIONNAIRE IDENTIFIER (#.01)
                                  QUESTIONNAIRE:QUESTIONNAIRE TEMPLATE ID (#11)


Subfile #853.81

  Record Indexes:

  G (#1341)    RECORD    REGULAR    IR    LOOKUP & SORTING    WHOLE FILE (#853.8)
      Short Descr:  New index
        Set Logic:  S ^VPS(853.8,"G",X(1),X(2),DA(1),DA)=""
       Kill Logic:  K ^VPS(853.8,"G",X(1),X(2),DA(1),DA)
       Whole Kill:  K ^VPS(853.8,"G")
             X(1):  DATE/TIME TAKEN  (853.81,2)  (Subscr 1)  (forwards)
             X(2):  PATIENT SAFETY  (853.81,7)  (Subscr 2)  (forwards)

Subfile #853.811

  Record Indexes:

  D (#1340)    RECORD    REGULAR    IR    LOOKUP & SORTING    WHOLE FILE (#853.8)
      Short Descr:  Index to assist in locating records to modify
        Set Logic:  S ^VPS(853.8,"D",$E(X(1),1,30),$E(X(2),1,14),DA(3),DA(2),DA(1),DA)=""
       Kill Logic:  K ^VPS(853.8,"D",$E(X(1),1,30),$E(X(2),1,14),DA(3),DA(2),DA(1),DA)
       Whole Kill:  K ^VPS(853.8,"D")
             X(1):  RESPONSE IDENTIFIER  (853.811,.01)  (Subscr 1)  (Len 30)  (forwards)
             X(2):  DATE/TIME TAKEN  (853.811,.02)  (Subscr 2)  (Len 14)  (forwards)


INPUT TEMPLATE(S):

PRINT TEMPLATE(S):

SORT TEMPLATE(S):

FORM(S)/BLOCK(S):