Re: [Hardhats-members] DISPOSITION

2005-02-07 Thread James Gray
Yep.  Thanks, but I still need to figure out how to fix the disposition.  I 
tried the two disposition options on the menu and did not find the right 
way.

Jim Gray
- Original Message - 
From: Nancy Anthracite [EMAIL PROTECTED]
To: hardhats-members@lists.sourceforge.net
Sent: Saturday, February 05, 2005 5:02 PM
Subject: Re: [Hardhats-members] DISPOSITION


The ADT Output Users Manual in the VDL, ADT section says:
Each patient registration for care must receive a corresponding 
disposition.
A disposition shows the final outcome of the registration; whether the
patient was admitted, treated and released, scheduled for a return visit,
etc.  An open disposition is a registration which has not received a
disposition.  A pending disposition is a registration which was 
dispositioned
with a disposition type of PENDING DETERMINATION.

Does that help?
On Saturday 05 February 2005 04:53 pm, James Gray wrote:
I am trying to test some stuff in registration.  I have this message
popping up:
There is still an open disposition--register aborted.
How do I take care of that?
Jim Gray

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RE: [Hardhats-members] Install problems with GDE and aliases?

2005-02-07 Thread Steven . Tomlinson
You may want to try putting the aliases in your .bashrc file.

Steven B. Tomlinson
[EMAIL PROTECTED]
Pacific Telehealth and Technology Hui
www.PacificHui.org




 -Original Message-
 From: [EMAIL PROTECTED]
 [mailto:[EMAIL PROTECTED] 
 Behalf Of Peter
 Charbonnier
 Sent: Sunday, February 06, 2005 2:38 PM
 To: hardhats-members@lists.sourceforge.net
 Subject: [Hardhats-members] Install problems with GDE and aliases?
 
 
 Hello,
 
 This weekend I went out and picked up a new HD and installed Fedora
 Core 3 in the hopes of getting OpenVistA up and running on my computer
 at home.  Things went well making the dual boot comp, but when I went
 to install VistA I hit a snag.
 
 Everything was fine until the very end of the Quick Start 
 Installation Guide:
 
 5.Create the globals file:
 First logout and login as the vista user, then enter the 
 following commands:
 gde
 At the GDE prompt type:
 
 When I open a Terminal window and type gde I get - bash: gde:
 command not found
 
 The other aliases I set in the .bash_profile also look like they are
 bombing out.  I either get the command not found error or Cannot
 access global directory.  I think that I've set-up something wrong in
 the .bash_profile, although that's just a guess.  As I said, I've only
 just installed Linux this weekend.  I really hope it doesn't have
 anything to do with the big use core 1 only warning on the pacific
 telehealth website.
 
 Any help would be appreciated.
 
 Thanks,
 Peter Charbonnier
 Overlake Hospital
 Bellevue WA
 
 
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Re: [Hardhats-members] Patient access to medical records.

2005-02-07 Thread Jim Self
Joseph wrote:
 From what I understand MyHealth-e-Vet employs a 3 tier
architecture.with Oracle storing the patient's data extracted from
VistA. It is not a real time link for updatesit is done by a batch
process.

I don't think it is quite as bad as a batch process. I looked at it when this 
topic first
came up some months ago and from what I recall of it, it updates the data for an
individual patient record via HL7 on request from the patient while the patient 
is viewing
the record. I didn't actually try the update for the demo patient I was looking 
at, but I
expect that it would update within a few minutes when requested.


I agree with Nancy that it would be best and perhaps easier to
replace it.


Starting with an OpenVistA database and building on M2Web, I think it would be 
fairly easy
(as programming goes ;) ) for someone familiar with the data structure (files 
and fields)
of the medical record to provide a similar view of live data.

I expect that the extra layers of isolation and encryption in the current 
MyHealth-e-Vet
could be implemented as well with GT.M and other Open Source tools.

I should add that the functionality of the current system is
very good...another kudo to the VA here...while the rest of the world
has been talking about patient access to medical records for years the
VA is doing it.

Joseph

Nancy Anthracite wrote:
 Patients have access to a database that is not directly part of CPRS and is
 accessed through the Internet called MyHealth-e-Vet .  I have asked to get
 the software from the VA but I don't know the answer yet. It is rather
 complex, from what I understand, and uses a lot of proprietary programs and
 special equipment.  It really sounds as if the best thing to do is to replace
 it with something else.

 On Friday 04 February 2005 07:14 am, Nick James wrote:

Was curious! As far as I know only a person from the
new patient file (provider...), has access to the
patient's medical record.
Can a patient access his own medical record? Does he
use CPRS? If so, how are the keys to be
assigned... security...?

Nick

---
Jim Self
Systems Architect, Lead Developer
VMTH Computer Services, UC Davis
(http://www.vmth.ucdavis.edu/us/jaself)


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Re: [Hardhats-members] Install problems with GDE and aliases?

2005-02-07 Thread K.S. Bhaskar
Peter --

In order to run, GT.M minimally needs the following environment
variables set in the shell:

 - $gtm_dist to point to the directory where GT.M is installed
 - $gtmroutines to define a search path for routines
 - $gtmgbldir to point to a global directory file

Details are in the Admin  Ops Guide.  Furthermore, to run gde a shell
alias should define gde as something like $gtm_dist/mumps -run ^GDE.
So, it looks as if environment settings are not getting set for you.
Are you sure your .bash_profile is getting executed?

Also, the way that you are going about installing OpenVistA is a from
scratch approach that gives you more flexibility, but is more
complicated.  For a first install, it would much easier to download from
Source Forge (http://sourceforge.net/projects/worldvista) OpenVistA
SemiVivA 0.4.  Assuming that you have downloaded the file
as /Distrib/OpenVistA/OpenVistaSemiVivA0.4.tgz, as root, execute:

  cd /usr/local
  tar zxvf /Distrib/OpenVistA/OpenVistaSemiVivA0.4.tgz

Now, as a normal user, if you execute /usr/local/OpenVistA/vista, you
can start with OpenVistA.

Note that Fedora Core may or may not include Xdialog, which the shell
script /usr/local/OpenVistA/vista uses.  If it does not include it, you
will need to get it from http://xdialog.dyns.net

Regards
-- Bhaskar

On Sun, 2005-02-06 at 16:38 -0800, Peter Charbonnier wrote:
 Hello,
 
 This weekend I went out and picked up a new HD and installed Fedora
 Core 3 in the hopes of getting OpenVistA up and running on my computer
 at home.  Things went well making the dual boot comp, but when I went
 to install VistA I hit a snag.
 
 Everything was fine until the very end of the Quick Start Installation Guide:
 
 5.Create the globals file:
 First logout and login as the vista user, then enter the following commands:
 gde
 At the GDE prompt type:
 
 When I open a Terminal window and type gde I get - bash: gde:
 command not found
 
 The other aliases I set in the .bash_profile also look like they are
 bombing out.  I either get the command not found error or Cannot
 access global directory.  I think that I've set-up something wrong in
 the .bash_profile, although that's just a guess.  As I said, I've only
 just installed Linux this weekend.  I really hope it doesn't have
 anything to do with the big use core 1 only warning on the pacific
 telehealth website.
 
 Any help would be appreciated.
 
 Thanks,
 Peter Charbonnier
 Overlake Hospital
 Bellevue WA
 
 
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Re: [Hardhats-members] Install problems with GDE and aliases?

2005-02-07 Thread K.S. Bhaskar
Peter --

Chris' suggestion to use OpenVistA VivA 0.4 is also a good one.  You can
download and burn an ISO image, and simply boot it to run OpenVistA and
you can also install Linux, GT.M and OpenVistA on your hard drive from
it.  The Linux is a little dated (early 2004 vintage), but it is a
Debian distribution, so it can be upgraded post-installation and kept
current.

-- Bhaskar

On Sun, 2005-02-06 at 18:47 -0800, Chris Richardson wrote:
 Peter;
 
How wedded are you to Fedora??   Try downloading the Live VivA ISO and
 burn a disk.  Try booting off of the disk you burn from the ISO and then
 click on the install to the harddrive ICON.  It goes up pretty easy if you
 don't get too fancy.  Morphix becomes  There are a couple of modification I
 made in the vista install script that you will find in
 /usr/local/OpenVistA/ that I will make available.   Right now, just don't
 forget to run D ^DINIT .  Most of the inputs are defaulted already.
 
   I've been installing this ISO most of  the weekend on a couple of
 machines.   Am spending a lot of time looking for a decent partition-level
 backup that might make creating new replacements fast and easy.  The Live CD
 is cool, but if you could just layer in the pre-established partitions back
 in to recover to a known point, we would really have something.  I have
 looked at g4l (no guarantees and pretty unstable) and SystemImage (more
 stable and easier from the reading/Also has been reported to work over the
 net),  autoinstall (pulled, but notinstalled), and fai to name a few.
 
   I can call you from the VA hospital in the morning and talk you through
 it, if you can send me your phone number.   Send me your phone number to
 [EMAIL PROTECTED] if you don't want to publish it here.  I can't send mail
 on my private account from work, but I should be able to help talk you
 through it.
 
  Best wishes;   Chris Richardson

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[Hardhats-members] ICD9 Updates

2005-02-07 Thread Walton, Edward NMN(WSH)
Title: ICD9 Updates





Last year the ICD9 update (patch) was not released by October 1. Last year we updated an old ICD9 file we have been using. We want to switch to the new format for the ICD9 file but if we can not get the updates on time we will not be able to bill. There has been a grace period in the past but I am told that is going away. Does the VA have to comply? I have been told that the updates will now be twice a year. Will we have to make our own patches to make the time requirement?




Re: [Hardhats-members] VistA-Office Buffer RFI

2005-02-07 Thread Kevin Toppenberg
This has all become so formal.

Smells like money is in the air

Kevin

--- Michael Ginsburg [EMAIL PROTECTED] wrote:

 Attached is a copy of an RFI that IFMC just issued.
 Feel free to
 redistribute to any organizations that might be
 interested.
 
 Regards,
 
 
 Mike Ginsburg
 Project Manager
 Iowa Foundation for Medical Care
 410-581-2543 - Office
 410-419-9371 - Cell
 

 ATTACHMENT part 2 application/msword name=VistA
buffer RFI.doc



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Re: [Hardhats-members] how to dictate an operation report?

2005-02-07 Thread Nick James
Kevin
I followed the steps you have given, that leads to
another question. When we click on the new note
button, it presumes that its a progress report and
hence you can only type in certain types of notes
(ADDICTION  ASI-ADDICTION SEVERITY INDEX, ADVANCE
DIRECTIVE, ASSESSMENT  WRIISC ASSESSMENT NOTE...).
But the operation report ??? Does this mean that only
these progress reports can be transcribed from CPRS?
Or are there some other settings to get the operation
report up?

Also the message  YOU MAY  NOT VIEW THIS UNSIGNED
NOTE. is what i get to see as of now from the tiu
menu (signed in as the transcriptionist and the
author). The problem is that the author of the report
is also not allowed to view it! I guess I'm missing
out on something!

Thanks
Nick. 

--- Kevin Toppenberg [EMAIL PROTECTED] wrote:

 Nick,
 
 I just checked about transcriptionists typing
 directly
 into CPRS, and yes they can
 1. I had to add OR CPRS GUI..  as a  secondary menu
 option.
 2. In CPRS, when creating the note (i.e. New
 Note),
 it will ask for a location and time for the note. 
 At
 the bottom of that dialog, there is a drop-down
 field
 for Author.  Change that to the name of the doctor
 dictating the report.  Then the transcriptionist can
 type directly into CPRS.  One note, however, is that
 as soon as the transcriptionist leaves the note, it
 becomes sealed, and a message is displayed YOU MAY
 NOT VIEW THIS UNSIGNED NOTE.  -- i.e. it wants the
 Author to sign it before others can view it.  So the
 transcriptionists must make all corrections needed
 before leaving the note.
 
 I needed to figure this out for my site too, so
 thanks
 for the prompting.
 
 Kevin
 
 
 
 --- Nick James [EMAIL PROTECTED] wrote:
 
  Kevin,
  while i was trying to solve this problem,i figured
  that i had not assigned the transcriptionist in
 the
  transcriptionist user class (TIU). After doing so
 i
  have assigned the 'tiu main menu transcription' to
  the
  user. I can in the menu select the operation
 report,
  but am neither allowed to view it Nor edit it.
  (either
  as the transcriptionist or the author)the status
  does
  not change from undictated. How do i link the
 report
  to be typed to the transcriptionist?
  
  Can transcriptionists type directly into CPRS?
  
  Thanks
  Nick.
  --- Kevin Toppenberg [EMAIL PROTECTED] wrote:
  
   Nick,
   
   I assume, since you are working with a hospital,
   that
   you will be using transcriptionists.  This is
 the
   same
   issue I am working with right now.  
   
   Many transcriptionists prefer to type in word
   processors, rather than into CPRS.  They'll have
   more
   tools at their disposal.  So VistA is designed
 to
   allow them to prepair a large document with
  multiple
   patient reports in it.  Each report has a
 separate
   header.  Then the file is uploaded to VistA. 
 The
   upload process then scans through the document
 and
   identifies each report.  Each report specifies
 the
   type of note it is, i.e. SURGICAL NOTE, or
 PROGESS
   NOTE etc.  These note types are set up by you. 
  Each
   note type has a cooresponding filer program. 
 This
   is
   a program that prepairs a document entry in file
   #8925
   (TIU DOCUMENT) for the filer to put the report
  into.

   
   The TIU (Text integration utilities) module has
  some
   sample filer programs that one can use to
  customize
   for your location.  I know that one of these
  samples
   focuses on surgical reports.  It somehow ties
 the
   report to the surgical entity in VistA.  I
 haven't
   explored the surgical side of things since I am
   outpatient here.
   
   This doesn't directly answer your question, but
 I
   hope
   it gives you some background info that helps.
   
   Kevin
   
   
   --- Nick James [EMAIL PROTECTED] wrote:
   

I have sucessfully done a dummy surgery on my
  test
patient! have even managed to get the Nurse's
interoperative report and anesthesia report
  signed
and
completed! But the problem now is that when i
  try
   to
get to the Operation report (in CPRS) , i
 cannot
   get
the status moving from undictated. How does
 one
dictate these reports and have the alert to
 sign
   it?

From the Operation Menu, 

Select Operation Menu Option: OR  Operation
  Report

 * * The Operation Report for this case is not
  yet
available. * *


Nick.




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Re: [Hardhats-members] how to dictate an operation report?

2005-02-07 Thread Nick James

When i, as the author(^ZU) of the report, try to sign
the document, it states that the Elecrtonic signature
not yet enabled. But i have created the entry for the
electronic signature in the new person file.

How does one enable the Electronic signature?
Wonder why the elecrtonic signature need not have been
enabled for the Other reports i've worked with
(Nurse's Interoperative report and Anesthesia report)?

Nick
--- Kevin Toppenberg [EMAIL PROTECTED] wrote:

 Nick,
 
 I just checked about transcriptionists typing
 directly
 into CPRS, and yes they can
 1. I had to add OR CPRS GUI..  as a  secondary menu
 option.
 2. In CPRS, when creating the note (i.e. New
 Note),
 it will ask for a location and time for the note. 
 At
 the bottom of that dialog, there is a drop-down
 field
 for Author.  Change that to the name of the doctor
 dictating the report.  Then the transcriptionist can
 type directly into CPRS.  One note, however, is that
 as soon as the transcriptionist leaves the note, it
 becomes sealed, and a message is displayed YOU MAY
 NOT VIEW THIS UNSIGNED NOTE.  -- i.e. it wants the
 Author to sign it before others can view it.  So the
 transcriptionists must make all corrections needed
 before leaving the note.
 
 I needed to figure this out for my site too, so
 thanks
 for the prompting.
 
 Kevin
 
 
 
 --- Nick James [EMAIL PROTECTED] wrote:
 
  Kevin,
  while i was trying to solve this problem,i figured
  that i had not assigned the transcriptionist in
 the
  transcriptionist user class (TIU). After doing so
 i
  have assigned the 'tiu main menu transcription' to
  the
  user. I can in the menu select the operation
 report,
  but am neither allowed to view it Nor edit it.
  (either
  as the transcriptionist or the author)the status
  does
  not change from undictated. How do i link the
 report
  to be typed to the transcriptionist?
  
  Can transcriptionists type directly into CPRS?
  
  Thanks
  Nick.
  --- Kevin Toppenberg [EMAIL PROTECTED] wrote:
  
   Nick,
   
   I assume, since you are working with a hospital,
   that
   you will be using transcriptionists.  This is
 the
   same
   issue I am working with right now.  
   
   Many transcriptionists prefer to type in word
   processors, rather than into CPRS.  They'll have
   more
   tools at their disposal.  So VistA is designed
 to
   allow them to prepair a large document with
  multiple
   patient reports in it.  Each report has a
 separate
   header.  Then the file is uploaded to VistA. 
 The
   upload process then scans through the document
 and
   identifies each report.  Each report specifies
 the
   type of note it is, i.e. SURGICAL NOTE, or
 PROGESS
   NOTE etc.  These note types are set up by you. 
  Each
   note type has a cooresponding filer program. 
 This
   is
   a program that prepairs a document entry in file
   #8925
   (TIU DOCUMENT) for the filer to put the report
  into.

   
   The TIU (Text integration utilities) module has
  some
   sample filer programs that one can use to
  customize
   for your location.  I know that one of these
  samples
   focuses on surgical reports.  It somehow ties
 the
   report to the surgical entity in VistA.  I
 haven't
   explored the surgical side of things since I am
   outpatient here.
   
   This doesn't directly answer your question, but
 I
   hope
   it gives you some background info that helps.
   
   Kevin
   
   
   --- Nick James [EMAIL PROTECTED] wrote:
   

I have sucessfully done a dummy surgery on my
  test
patient! have even managed to get the Nurse's
interoperative report and anesthesia report
  signed
and
completed! But the problem now is that when i
  try
   to
get to the Operation report (in CPRS) , i
 cannot
   get
the status moving from undictated. How does
 one
dictate these reports and have the alert to
 sign
   it?

From the Operation Menu, 

Select Operation Menu Option: OR  Operation
  Report

 * * The Operation Report for this case is not
  yet
available. * *


Nick.



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[Hardhats-members] RBRVS - THE POLITICS

2005-02-07 Thread Thurman Pedigo
RBRVS - The politics 
This series is personal recollection. A few details may be a little off the
mark - though not enough to undermine the message.

Before the discussion of politics it is only fair to make a brief assessment
of the system. The resource based relative scale (RBRVS) has gotten a lot of
bad press because of lack of understanding and political manipulation.
Sadly the term managed care in this country has deteriorated into a system
bureaucratic care, or red tape barrier to access. The dysfunctional health
care payment system in the United States is largely the result of
competitive plans presenting varying schemes of skimming a layered
percentage of expenditure for their role in cost management.  

Many left the American Medical Association (AMA) Interim meeting in December
1989 with the feeling that, with the AMA endorsement of RBRVS, we had a
standard by which to measure progress and time would give us a better idea
of direction. I purchased the first RBRVS diskette release and as I started
analyzing the file, I was surprised to find compensation for family
physicians had not improved as anticipated. The Bush(1)administration,
though promising revenue neutral transition, had removed highly
compensated specialists from the formula. 

This maneuver was both simple, since the Federal government had dealt with
the radiologists, pathologists, and anesthesiologists before the RBRVS was
completed, and quiet, since the media, newspapers and journalists were NOT
sensitive to and, indeed, did not understand, our plight. After adapting the
RBRVS for our schedule, we discovered another weakness. A general surgeon in
our group pointed out that Blue Cross allowed three times the RBRVS fees for
most surgery. (I recalled Dr. Hsiao's comment about 35 cents on the dollar,
and now here it was looming over billing.) We decided we could not leave
that kind of money on the table, even if the surgeon would tolerate it. We
added a modifier, for special fee adjustment, to the formula. 

The Tennessee Academy of Family Physicians adopted, and sent on to the
American Academy of Family Physicians, a resolution asking the AAFP to
promote the idea and lobby commercial carriers to convert to the RBRVS
payment scale. The expectation was a revenue neutral conversion, however
there was a preponderance of proceduralists in the leadership of the AAFP
whose goal was to retain the proceduralist-oriented scale and fight instead
for added privileges - family physicians doing more procedures. This setback
left an imbalanced payment system and as late as 2004 Blue Cross of
Tennessee met severe opposition when they announced plans to adopt the RBRVS
for their fee for service contracts. A clear understanding of the RBRVS and
discounting is essential to designing a practice accounts receivable and
management system. The next installment deals with adapting the RBRVS to
effective electronic accounts management.



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Re: [Hardhats-members] how to dictate an operation report?

2005-02-07 Thread Nick James
Kevin,
You've talked about sample filer programs? what
exactly are they and how could i get to them and which
are related to surgical reports?

I feel that the missing link is the transcriptionist.
i wonder how he writes in the dictation.
So basically it comesdown to how is the transcription
entered, or received by
  upload?
Nick
--- Kevin Toppenberg [EMAIL PROTECTED] wrote:

 Nick,
 
 I just checked about transcriptionists typing
 directly
 into CPRS, and yes they can
 1. I had to add OR CPRS GUI..  as a  secondary menu
 option.
 2. In CPRS, when creating the note (i.e. New
 Note),
 it will ask for a location and time for the note. 
 At
 the bottom of that dialog, there is a drop-down
 field
 for Author.  Change that to the name of the doctor
 dictating the report.  Then the transcriptionist can
 type directly into CPRS.  One note, however, is that
 as soon as the transcriptionist leaves the note, it
 becomes sealed, and a message is displayed YOU MAY
 NOT VIEW THIS UNSIGNED NOTE.  -- i.e. it wants the
 Author to sign it before others can view it.  So the
 transcriptionists must make all corrections needed
 before leaving the note.
 
 I needed to figure this out for my site too, so
 thanks
 for the prompting.
 
 Kevin
 
 
 
 --- Nick James [EMAIL PROTECTED] wrote:
 
  Kevin,
  while i was trying to solve this problem,i figured
  that i had not assigned the transcriptionist in
 the
  transcriptionist user class (TIU). After doing so
 i
  have assigned the 'tiu main menu transcription' to
  the
  user. I can in the menu select the operation
 report,
  but am neither allowed to view it Nor edit it.
  (either
  as the transcriptionist or the author)the status
  does
  not change from undictated. How do i link the
 report
  to be typed to the transcriptionist?
  
  Can transcriptionists type directly into CPRS?
  
  Thanks
  Nick.
  --- Kevin Toppenberg [EMAIL PROTECTED] wrote:
  
   Nick,
   
   I assume, since you are working with a hospital,
   that
   you will be using transcriptionists.  This is
 the
   same
   issue I am working with right now.  
   
   Many transcriptionists prefer to type in word
   processors, rather than into CPRS.  They'll have
   more
   tools at their disposal.  So VistA is designed
 to
   allow them to prepair a large document with
  multiple
   patient reports in it.  Each report has a
 separate
   header.  Then the file is uploaded to VistA. 
 The
   upload process then scans through the document
 and
   identifies each report.  Each report specifies
 the
   type of note it is, i.e. SURGICAL NOTE, or
 PROGESS
   NOTE etc.  These note types are set up by you. 
  Each
   note type has a cooresponding filer program. 
 This
   is
   a program that prepairs a document entry in file
   #8925
   (TIU DOCUMENT) for the filer to put the report
  into.

   
   The TIU (Text integration utilities) module has
  some
   sample filer programs that one can use to
  customize
   for your location.  I know that one of these
  samples
   focuses on surgical reports.  It somehow ties
 the
   report to the surgical entity in VistA.  I
 haven't
   explored the surgical side of things since I am
   outpatient here.
   
   This doesn't directly answer your question, but
 I
   hope
   it gives you some background info that helps.
   
   Kevin
   
   
   --- Nick James [EMAIL PROTECTED] wrote:
   

I have sucessfully done a dummy surgery on my
  test
patient! have even managed to get the Nurse's
interoperative report and anesthesia report
  signed
and
completed! But the problem now is that when i
  try
   to
get to the Operation report (in CPRS) , i
 cannot
   get
the status moving from undictated. How does
 one
dictate these reports and have the alert to
 sign
   it?

From the Operation Menu, 

Select Operation Menu Option: OR  Operation
  Report

 * * The Operation Report for this case is not
  yet
available. * *


Nick.



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