Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

[Belfi, Karen]

17/2015 03:44 PM

Status:

Resolved (IP only)

Discharge Period:

N/A

CCN:




Thank you, Kim

Kim Izard  | Team Leader - Clinical Outcomes
SSMHealth - St. Louis/Southern Illinois Regions
1015 Corporate Square Drive Suite 240
Creve Coeur, MO 63132
Office - 314-989-2137
Cell - 618-670-3616
kimberly_iz...@ssmhc.com<mailto:kimberly_iz...@ssmhc.com>

[cid:image002.jpg@01D126C3.A84271A0]


This e-mail message is confidential, intended only for the named recipient(s) 
above and may contain information that is privileged or exempt from disclosure 
under applicable law. If you are not the intended recipient(s), you are 
notified that the dissemination, distribution or copying of this message is 
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named recipient(s) please notify the sender at the e-mail address or telephone 
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From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Belfi, Karen
Sent: Tuesday, November 24, 2015 6:22 AM
To: 'sepsisgroups@lists.sepsisgroups.org' 
<sepsisgroups@lists.sepsisgroups.org<mailto:sepsisgroups@lists.sepsisgroups.org>>
Subject: Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

This answer doesn't address crystalloid fluids, however.
In the CMS power point, Bob stated that the patient needed to receive 
crystalloid fluids in order to select septic shock if only criteria is lactate.

Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
484-476-8092
Pager: 5240
[cid:image001.png@01D126C3.A84271A0]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Tribuiani, Barbara
Sent: Friday, November 20, 2015 10:54 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: [Sepsis Groups] FW: Septic Shock Present [Incident: 151007-000178]

Hello All-

Please see below response form Qnet re: septic shock present. I found this to 
be very helpful.

Barb

From: IQR Q System [mailto:cms...@mailps.custhelp.com]
Sent: Friday, November 20, 2015 10:11 AM
To: Tribuiani, Barbara
Subject: Septic Shock Present [Incident: 151007-000178]



Recently you requested personal assistance from our on-line support center. 
Below is a summary of your request and our response.

If this issue is not resolved to your satisfaction, you may reopen it within 
the next 2 days.

Thank you for allowing us to be of service to you.

To access your question from our support site, click 
here.<https://cms-ip.custhelp.com/app/account/questions/detail/i_id/267055>

 Subject

Septic Shock Present



 Discussion Thread

 Response Via Email (Deb Lindner)

11/20/2015 10:10 AM

Barbara,

An addendum to the Specifications Manual for the National Hospital Inpatient 
Quality Reporting (IQR) Program (5.0b) has been posted to QualityNet at 
www.qualitynet.org/dcs/ContentServer?c=Page=QnetPublic%2FPage%2FQnetTier2=1141662756099<http://www.qualitynet.org/dcs/ContentServer?c=Page=QnetPublic%2FPage%2FQnetTier2=1141662756099>.

There are 3 ways Septic Shock can be present:

1. Documentation of severe sepsis present and persistent hypotension in the 
hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration

2. Documentation of severe sepsis present and an initial lactate level is >= 4 
mmol/L

3. Physician/APN/PA documentation of Septic Shock

If you have documentation of severe sepsis being present and an initial lactate 
>= 4 mmol/L then you can answer "Yes" to Septic Shock Present.

 Response Via Email (Martha Boese)

10/08/2015 09:19 AM

Due to the volume of inquires related to the SEP-1 measure we are experiencing 
a response lag time. Responses to SEP-1 questions are being answered daily. 
Please be reminded that Q are available in the QualityNet knowledge base 
tool<https://cms-ip.custhelp.com/app/answers/list/c/576> and a SEP-1 fact sheet 
<https://www.qualitynet.org/dcs/BlobServer?blobkey=id=true=1228890481688=multipart%2Foctet-stream=Content-Disposition=attachment%3Bfilename%3DHos_Sepsis-FactSheet_082015.pdf=urldata=MungoBlobs>
  is posted on QualityNet. A 
recording<http://qualityreportingcenter.com/media/eventrecordings/IQR/IQR08242015/index.html>,
 
slides<http://www.qualityreportingcenter.com/wp-content/uploads/2015/08/IQR_Webinar-August_SEP-1-Part-I-20150824-vFINAL-5081.pdf>
 , and 
Q<http://www.qualityreportingcenter.com/wp-content/uploads/2015/09/8-24-15-IQR-Q-A-Transcript_Responses.pdf>
 from the August 24th National Provider call are available for review. The 
recording<https://cc.readytalk.com/play?id=g35che> and 
slides<http://www.qualityreportingcenter.com/wp-content/uploads/2015/09/IQR_Webinar-September_SEP-1-PartII_FINAL2015-09-21_508.pdf>
 for September 21st are available for review.

The following link will give you more information on the upcoming October 26th 
National Provider call and the opportunity to register fo

Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

[Belfi, Karen]

There is a bullet point in the specification manual that states: If crystalloid 
fluids were not administered after the presentation date and time of severe 
sepsis, choose value "2", which is No.
This was confirmed by Bob Dickerson in his presentation on October 26.
He stated:

"Now please note, in the septic shock present data element, there is a bullet 
point in the note for abstraction indicating that if crystalloid fluids were 
not administered after severe sepsis presentation date and time, that you would 
select allowable value 2 for septic shock present, which is equivalent to No. 
For purposes of SEP-1 measure, at this point in time, regardless of how septic 
shock is identified, if no crystalloid fluids were given after severe sepsis 
presentation, you will select allowable value 2, which is No, for septic shock 
present".

This is found on page 27. Below is a direct link to the transcript.

http://www.qualityreportingcenter.com/wp-content/uploads/2015/11/IQR_10-26_WebinarPresentationTranscript_v2_FINAL_508.pdf


Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
484-476-8092
Pager: 5240
[cid:image001.png@01D126B1.0D88EFC0]

From: Mary Draper [mailto:mary.dra...@johnmuirhealth.com]
Sent: Tuesday, November 24, 2015 12:02 PM
To: Belfi, Karen; 'sepsisgroups@lists.sepsisgroups.org'
Subject: RE: Septic Shock Present [Incident: 151007-000178]

Karen, I don't see that crystalloids need to be given if the lactate if > 4.
There is an "or" between the fluids and the lactate > 4.

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com>

"O, let us always have a mountain within our soul,
  with a peak so high that we never quite reach the top...
  For then we will always strive for greater things
  And will not be content  with merely climbing hills." Ardath Rodale


From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Belfi, Karen
Sent: Tuesday, November 24, 2015 4:22 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

This answer doesn't address crystalloid fluids, however.
In the CMS power point, Bob stated that the patient needed to receive 
crystalloid fluids in order to select septic shock if only criteria is lactate.

Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
484-476-8092
Pager: 5240
[cid:image001.png@01D126B1.0D88EFC0]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Tribuiani, Barbara
Sent: Friday, November 20, 2015 10:54 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: [Sepsis Groups] FW: Septic Shock Present [Incident: 151007-000178]

Hello All-

Please see below response form Qnet re: septic shock present. I found this to 
be very helpful.

Barb

From: IQR Q System [mailto:cms...@mailps.custhelp.com]
Sent: Friday, November 20, 2015 10:11 AM
To: Tribuiani, Barbara
Subject: Septic Shock Present [Incident: 151007-000178]



Recently you requested personal assistance from our on-line support center. 
Below is a summary of your request and our response.

If this issue is not resolved to your satisfaction, you may reopen it within 
the next 2 days.

Thank you for allowing us to be of service to you.

To access your question from our support site, click 
here.<https://cms-ip.custhelp.com/app/account/questions/detail/i_id/267055>

 Subject

Septic Shock Present



 Discussion Thread

 Response Via Email (Deb Lindner)

11/20/2015 10:10 AM

Barbara,

An addendum to the Specifications Manual for the National Hospital Inpatient 
Quality Reporting (IQR) Program (5.0b) has been posted to QualityNet at 
www.qualitynet.org/dcs/ContentServer?c=Page=QnetPublic%2FPage%2FQnetTier2=1141662756099<http://www.qualitynet.org/dcs/ContentServer?c=Page=QnetPublic%2FPage%2FQnetTier2=1141662756099>.

There are 3 ways Septic Shock can be present:

1. Documentation of severe sepsis present and persistent hypotension in the 
hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration

2. Documentation of severe sepsis present and an initial lactate level is >= 4 
mmol/L

3. Physician/APN/PA documentation of Septic Shock

If you have documentation of severe sepsis being present and an initial lactate 
>= 4 mmol/L then you can answer "Yes" to Septic Shock Present.

 Response Via Email (Martha Boese)

10/08/2015 09:19 AM

Due to the volume of inquires related to the SEP-1 measure we are experiencing 
a response lag time. Responses to SEP-1 questions are being answered daily. 
Please be reminded that Q are available in the QualityNet knowledge base 
tool<https://cms-ip.custhelp.com/app/answers/list/c/576> and a SEP-1 fact sheet 
<https://www.qualitynet.org/

Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

[Mary Draper]

Karen, I don't see that crystalloids need to be given if the lactate if > 4.
There is an "or" between the fluids and the lactate > 4.

Mary Draper RN BSN
Coordinator Quality Improvement
Peer Review Support CV/CT
Quality Management
Office (925) 674-2045
Cell (925) 451-8792
Fax (925) 674-2373
mary.dra...@johnmuirhealth.com<mailto:mary.dra...@johnmuirhealth.com>

"O, let us always have a mountain within our soul,
  with a peak so high that we never quite reach the top...
  For then we will always strive for greater things
  And will not be content  with merely climbing hills." Ardath Rodale


From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Belfi, Karen
Sent: Tuesday, November 24, 2015 4:22 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

This answer doesn't address crystalloid fluids, however.
In the CMS power point, Bob stated that the patient needed to receive 
crystalloid fluids in order to select septic shock if only criteria is lactate.

Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
484-476-8092
Pager: 5240
[cid:image001.png@01D12696.B82D4720]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Tribuiani, Barbara
Sent: Friday, November 20, 2015 10:54 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: [Sepsis Groups] FW: Septic Shock Present [Incident: 151007-000178]

Hello All-

Please see below response form Qnet re: septic shock present. I found this to 
be very helpful.

Barb

From: IQR Q System [mailto:cms...@mailps.custhelp.com]
Sent: Friday, November 20, 2015 10:11 AM
To: Tribuiani, Barbara
Subject: Septic Shock Present [Incident: 151007-000178]



Recently you requested personal assistance from our on-line support center. 
Below is a summary of your request and our response.

If this issue is not resolved to your satisfaction, you may reopen it within 
the next 2 days.

Thank you for allowing us to be of service to you.

To access your question from our support site, click 
here.<https://cms-ip.custhelp.com/app/account/questions/detail/i_id/267055>

 Subject

Septic Shock Present



 Discussion Thread

 Response Via Email (Deb Lindner)

11/20/2015 10:10 AM

Barbara,

An addendum to the Specifications Manual for the National Hospital Inpatient 
Quality Reporting (IQR) Program (5.0b) has been posted to QualityNet at 
www.qualitynet.org/dcs/ContentServer?c=Page=QnetPublic%2FPage%2FQnetTier2=1141662756099<http://www.qualitynet.org/dcs/ContentServer?c=Page=QnetPublic%2FPage%2FQnetTier2=1141662756099>.

There are 3 ways Septic Shock can be present:

1. Documentation of severe sepsis present and persistent hypotension in the 
hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration

2. Documentation of severe sepsis present and an initial lactate level is >= 4 
mmol/L

3. Physician/APN/PA documentation of Septic Shock

If you have documentation of severe sepsis being present and an initial lactate 
>= 4 mmol/L then you can answer "Yes" to Septic Shock Present.

 Response Via Email (Martha Boese)

10/08/2015 09:19 AM

Due to the volume of inquires related to the SEP-1 measure we are experiencing 
a response lag time. Responses to SEP-1 questions are being answered daily. 
Please be reminded that Q are available in the QualityNet knowledge base 
tool<https://cms-ip.custhelp.com/app/answers/list/c/576> and a SEP-1 fact sheet 
<https://www.qualitynet.org/dcs/BlobServer?blobkey=id=true=1228890481688=multipart%2Foctet-stream=Content-Disposition=attachment%3Bfilename%3DHos_Sepsis-FactSheet_082015.pdf=urldata=MungoBlobs>
  is posted on QualityNet. A 
recording<http://qualityreportingcenter.com/media/eventrecordings/IQR/IQR08242015/index.html>,
 
slides<http://www.qualityreportingcenter.com/wp-content/uploads/2015/08/IQR_Webinar-August_SEP-1-Part-I-20150824-vFINAL-5081.pdf>
 , and 
Q<http://www.qualityreportingcenter.com/wp-content/uploads/2015/09/8-24-15-IQR-Q-A-Transcript_Responses.pdf>
 from the August 24th National Provider call are available for review. The 
recording<https://cc.readytalk.com/play?id=g35che> and 
slides<http://www.qualityreportingcenter.com/wp-content/uploads/2015/09/IQR_Webinar-September_SEP-1-PartII_FINAL2015-09-21_508.pdf>
 for September 21st are available for review.

The following link will give you more information on the upcoming October 26th 
National Provider call and the opportunity to register for the event: 
http://www.qualityreportingcenter.com/wp-content/uploads/2015/08/IQR_Sepis_series-Flyer-vFINAL-1508.pdf.

Please close your question if it is answered by these resources. We will 
continue working diligently to reduce response lag time in replying to 
questions.

 Customer By Web Form (barbara tribuiani)

10/07/2015 05:56 PM

Hello,
For this data element is lactate >4 (i

Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

[Izard, Kimberly]

vileged or exempt from disclosure 
under applicable law. If you are not the intended recipient(s), you are 
notified that the dissemination, distribution or copying of this message is 
strictly prohibited. If you received this message in error, or are not the 
named recipient(s) please notify the sender at the e-mail address or telephone 
number above and delete this e-mail from your computer. Thank you!

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Belfi, Karen
Sent: Tuesday, November 24, 2015 6:22 AM
To: 'sepsisgroups@lists.sepsisgroups.org' <sepsisgroups@lists.sepsisgroups.org>
Subject: Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

This answer doesn't address crystalloid fluids, however.
In the CMS power point, Bob stated that the patient needed to receive 
crystalloid fluids in order to select septic shock if only criteria is lactate.

Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
484-476-8092
Pager: 5240
[cid:25FFED76-F7F0-4047-910F-0D7077ED1E1E]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Tribuiani, Barbara
Sent: Friday, November 20, 2015 10:54 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: [Sepsis Groups] FW: Septic Shock Present [Incident: 151007-000178]

Hello All-

Please see below response form Qnet re: septic shock present. I found this to 
be very helpful.

Barb

From: IQR Q System [mailto:cms...@mailps.custhelp.com]
Sent: Friday, November 20, 2015 10:11 AM
To: Tribuiani, Barbara
Subject: Septic Shock Present [Incident: 151007-000178]



Recently you requested personal assistance from our on-line support center. 
Below is a summary of your request and our response.

If this issue is not resolved to your satisfaction, you may reopen it within 
the next 2 days.

Thank you for allowing us to be of service to you.

To access your question from our support site, click 
here.<https://cms-ip.custhelp.com/app/account/questions/detail/i_id/267055>

 Subject

Septic Shock Present



 Discussion Thread

 Response Via Email (Deb Lindner)

11/20/2015 10:10 AM

Barbara,

An addendum to the Specifications Manual for the National Hospital Inpatient 
Quality Reporting (IQR) Program (5.0b) has been posted to QualityNet at 
www.qualitynet.org/dcs/ContentServer?c=Page=QnetPublic%2FPage%2FQnetTier2=1141662756099<http://www.qualitynet.org/dcs/ContentServer?c=Page=QnetPublic%2FPage%2FQnetTier2=1141662756099>.

There are 3 ways Septic Shock can be present:

1. Documentation of severe sepsis present and persistent hypotension in the 
hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration

2. Documentation of severe sepsis present and an initial lactate level is >= 4 
mmol/L

3. Physician/APN/PA documentation of Septic Shock

If you have documentation of severe sepsis being present and an initial lactate 
>= 4 mmol/L then you can answer "Yes" to Septic Shock Present.

 Response Via Email (Martha Boese)

10/08/2015 09:19 AM

Due to the volume of inquires related to the SEP-1 measure we are experiencing 
a response lag time. Responses to SEP-1 questions are being answered daily. 
Please be reminded that Q are available in the QualityNet knowledge base 
tool<https://cms-ip.custhelp.com/app/answers/list/c/576> and a SEP-1 fact sheet 
<https://www.qualitynet.org/dcs/BlobServer?blobkey=id=true=1228890481688=multipart%2Foctet-stream=Content-Disposition=attachment%3Bfilename%3DHos_Sepsis-FactSheet_082015.pdf=urldata=MungoBlobs>
  is posted on QualityNet. A 
recording<http://qualityreportingcenter.com/media/eventrecordings/IQR/IQR08242015/index.html>,
 
slides<http://www.qualityreportingcenter.com/wp-content/uploads/2015/08/IQR_Webinar-August_SEP-1-Part-I-20150824-vFINAL-5081.pdf>
 , and 
Q<http://www.qualityreportingcenter.com/wp-content/uploads/2015/09/8-24-15-IQR-Q-A-Transcript_Responses.pdf>
 from the August 24th National Provider call are available for review. The 
recording<https://cc.readytalk.com/play?id=g35che> and 
slides<http://www.qualityreportingcenter.com/wp-content/uploads/2015/09/IQR_Webinar-September_SEP-1-PartII_FINAL2015-09-21_508.pdf>
 for September 21st are available for review.

The following link will give you more information on the upcoming October 26th 
National Provider call and the opportunity to register for the event: 
http://www.qualityreportingcenter.com/wp-content/uploads/2015/08/IQR_Sepis_series-Flyer-vFINAL-1508.pdf.

Please close your question if it is answered by these resources. We will 
continue working diligently to reduce response lag time in replying to 
questions.

 Customer By Web Form (barbara tribuiani)

10/07/2015 05:56 PM

Hello,
For this data element is lactate >4 (initial or repeat) enough to say "yes"? I 
know the other criteria is "peristent hypotension after 30ml/kg" but I am 
somewhat confused about how the lactate plays into this

Re: [Sepsis Groups] Septic Shock Present [Incident: 151007-000178]

[Belfi, Karen]

This answer doesn't address crystalloid fluids, however.
In the CMS power point, Bob stated that the patient needed to receive 
crystalloid fluids in order to select septic shock if only criteria is lactate.

Karen Belfi, RN, MSN
Quality Outcomes Coordinator
Lankenau Medical Center
484-476-8092
Pager: 5240
[cid:image001.png@01D12688.DA9B3EB0]

From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On 
Behalf Of Tribuiani, Barbara
Sent: Friday, November 20, 2015 10:54 AM
To: 'sepsisgroups@lists.sepsisgroups.org'
Subject: [Sepsis Groups] FW: Septic Shock Present [Incident: 151007-000178]

Hello All-

Please see below response form Qnet re: septic shock present. I found this to 
be very helpful.

Barb

From: IQR Q System [mailto:cms...@mailps.custhelp.com]
Sent: Friday, November 20, 2015 10:11 AM
To: Tribuiani, Barbara
Subject: Septic Shock Present [Incident: 151007-000178]



Recently you requested personal assistance from our on-line support center. 
Below is a summary of your request and our response.

If this issue is not resolved to your satisfaction, you may reopen it within 
the next 2 days.

Thank you for allowing us to be of service to you.

To access your question from our support site, click 
here.

 Subject

Septic Shock Present



 Discussion Thread

 Response Via Email (Deb Lindner)

11/20/2015 10:10 AM

Barbara,

An addendum to the Specifications Manual for the National Hospital Inpatient 
Quality Reporting (IQR) Program (5.0b) has been posted to QualityNet at 
www.qualitynet.org/dcs/ContentServer?c=Page=QnetPublic%2FPage%2FQnetTier2=1141662756099.

There are 3 ways Septic Shock can be present:

1. Documentation of severe sepsis present and persistent hypotension in the 
hour after the conclusion of the 30 mL/kg Crystalloid Fluid Administration

2. Documentation of severe sepsis present and an initial lactate level is >= 4 
mmol/L

3. Physician/APN/PA documentation of Septic Shock

If you have documentation of severe sepsis being present and an initial lactate 
>= 4 mmol/L then you can answer "Yes" to Septic Shock Present.

 Response Via Email (Martha Boese)

10/08/2015 09:19 AM

Due to the volume of inquires related to the SEP-1 measure we are experiencing 
a response lag time. Responses to SEP-1 questions are being answered daily. 
Please be reminded that Q are available in the QualityNet knowledge base 
tool and a SEP-1 fact sheet 

  is posted on QualityNet. A 
recording,
 
slides
 , and 
Q
 from the August 24th National Provider call are available for review. The 
recording and 
slides
 for September 21st are available for review.

The following link will give you more information on the upcoming October 26th 
National Provider call and the opportunity to register for the event: 
http://www.qualityreportingcenter.com/wp-content/uploads/2015/08/IQR_Sepis_series-Flyer-vFINAL-1508.pdf.

Please close your question if it is answered by these resources. We will 
continue working diligently to reduce response lag time in replying to 
questions.

 Customer By Web Form (barbara tribuiani)

10/07/2015 05:56 PM

Hello,
For this data element is lactate >4 (initial or repeat) enough to say "yes"? I 
know the other criteria is "peristent hypotension after 30ml/kg" but I am 
somewhat confused about how the lactate plays into this. Is it necessary to 
have "severe sepsis present" via all three criteria to answer "yes"?
Thank you very much



 Question Reference #151007-000178

Escalation Level:

5 Business Days

Product Level 1:

Hospital Inpatient Quality Reporting

Category Level 1:

Hospital Inpatient - Sepsis

Category Level 2:

Septic Shock Present

Date Created:

10/07/2015 05:56 PM

Last Updated:

11/20/2015 10:10 AM

Status:

Resolved (IP only)

Discharge Period:

N/A

CCN:




[---001:002376:40406---]

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