| ARCHETYPE ID | openEHR-EHR-EVALUATION.MAT_form_current_status.v1 |
|---|---|
| Concept | LAR "News" |
| Description | For completing the current situation |
| Use | *(nb) |
| Misuse | *(nb) |
| Purpose | To document the current situation of the patient |
| References | |
| Copyright | © openEHR Foundation |
| Authors | Author name: Bjørn Næss Organisation: DIPS ASA Email: bna@dips.no Date originally authored: 2013-04-15 |
| Other Details Language | Author name: Bjørn Næss Organisation: DIPS ASA Email: bna@dips.no Date originally authored: 2013-04-15 |
| Other Details (Language Independent) |
|
| Keywords | |
| Lifecycle | 0 |
| Language used | en |
| Citeable Identifier | 1013.1.1592 |
| data | |
| A1 Employment | |
| a) Occupation Status | a) Occupation Status: For paid work and education in elementary school, high school or university universitet(nb) 0: Without employment / unemployment [**(nb)] 1: Full-Time Job [**(nb)] 2: Part time jobs [**(nb)] 3: In education [**(nb)] 4: Part-time work and in education [**(nb)] 9: Unknown [**(nb)] |
| b) Is there any kind of vocational rehabilitation ? | b) Is there any kind of vocational rehabilitation ?: **(nb) |
| c ) Are there any non vocational activities ? | c ) Are there any non vocational activities ?: **(nb) |
| A2 Main income | A2 Main income: **(nb) 0: Supported by other [**(nb)] 1: Earned Income [**(nb)] 2: Student loan / grant [**(nb)] 3: Unemployment Benefits [**(nb)] 4: Sick pay / sick pay partial [**(nb)] 5: Work assessment allowance [**(nb)] 6: Disability pension / retirement pension [**(nb)] 7: allowance for single parent [**(nb)] 8: social [**(nb)] 9: Other [**(nb)] 10: Unknown [**(nb)] |
| A3 Living Conditions | A3 Living Conditions: **(nb) 0: No housing [**(nb)] 1: Hospice / bedsits / hotel [**(nb)] 2: Institution [**(nb)] 3: Prison [**(nb)] 4: With Parents [**(nb)] 5: With Other [Currently accommodated by friends or relatives] 6: private residence [Rented room, apartment or house that the patient owns or rents, does not belong to a rehab or treatment institution] 9: Unknown [**(nb)] 10: Other [**(nb)] |
| A5 blood contamination Status | A5 blood contamination Status: **(nb) |
| a) HIV | a) HIV: HIV antibody test last? |
| b ) Hepatitis C | b ) Hepatitis C: HCV antibody test last? |
| A6 LAR medication | A6 LAR medication: **(nb) |
| A6 LAR medication | A6 LAR medication: **(nb) 0: Methadone [**(nb)] 1: Buprenorphine [**(nb)] 2: Buprenorphine / naloxone [**(nb)] 3: Other [**(nb)] 9: Unknown [**(nb)] |
| Other LAR medication | Other LAR medication: **(nb) |
| A7 Daily Dose in mg | A7 Daily Dose in mg: Encode 999 if the daily dose is unknown Property: Flow rate, mass Units: mg/24h Assumed value: 0.0mg/24h Limit decimal places: -1 |
| A8 Prescribers | A8 Prescribers: **(nb) 0: Physician employed by LAR measures [**(nb)] 1: RGP [**(nb)] 2: Other physician [**(nb)] 9: Unknown [**(nb)] |
| A9 Special conditions | A9 Special conditions: **(nb) |
| a) What type of control sample , the patient ? | a) What type of control sample , the patient ?: **(nb) 0: Urine Samples [**(nb)] 1: Saliva Samples [**(nb)] 2: Both types [**(nb)] 9: Other / Unknown [**(nb)] |
| b ) prescribing benzodiazepines , etc. ? | b ) prescribing benzodiazepines , etc. ?: **(nb) |
| 1 - Yes / No | 1 - Yes / No: **(nb) |
| if yes - specify: | if yes - specify:: **(nb) |
| c ) prescribing some other morphine substances than LAR drug ? | c ) prescribing some other morphine substances than LAR drug ?: **(nb) |
| 1 - Yes / No | 1 - Yes / No: **(nb) |
| if yes - specify: | if yes - specify:: **(nb) |
| A10 Disclosure of LAR - drug | A10 Disclosure of LAR - drug: **(nb) |
| a) The number of deliveries per week | a) The number of deliveries per week: **(nb) |
| b ) Hence the number of dispensed monitored | b ) Hence the number of dispensed monitored: **(nb) |
| c ) Main place of delivery | c ) Main place of delivery: **(nb) |
| Collect Location | Collect Location: **(nb) 0: LAR measures / Specialist [**(nb)] 1: Pharmacies [**(nb)] 2: Local service system [**(nb)] 3: Institution / Bosenter / prison [**(nb)] 4: Medical centers [**(nb)] 9: Other [**(nb)] 10: Unknown [**(nb)] |
| If other - please specify | If other - please specify: **(nb) |
| Other contributors | |
| Translators |