XXXXXXXXXXXXX
PROCEDURE CODE TEMPLATE
XXXXXXXXXXXXXXXXXXX
Registry Section: PROCEDURE CODE TEMPLATE
Field Name: PROCEDURE CODE*
Data
Field Name: PCODE (1-50)
Accessible
by IDPH: YES
Max. Length of Field: 5
Type
of Field: CODE (V) REPEAT
FIELD 50 TIMES
Value
Range: O1 - 99.99
Definition:
The ICD 9 procedure code listed in the ICD-9-CM coding manual for each
procedure that your hospital performed on the patient.
Value: Appendix 5.c.vii.
Registry Section: PROCEDURE CODE TEMPLATE
Field Name: PROCEDURE CODE ID NUMBER
Data
Field Name: PCODEID
Accessible
by IDPH: YES - GENERIC CONVERSION
Max. Length of Field: 5
Type
of Field: CODE (V)
Value
Range: 10000 - 90000
Definition:
The identity of the person responsible for performing a specific procedure for
this patient. The field will be downloaded
to IDPH as a generic conversion.
Value: Appendix 5.c.ix.
Registry Section: PROCEDURE CODE TEMPLATE
Field Name: PROCEDURE CODE DATE/TIME
Data
Field Name: PCODEDATE / TIME
Accessible
by IDPH: YES
Max. Length of Field:
2, 2, 4 / 2, 2
Type
of Field: DATE/TIME
Value
Range: 01-12, 01-31, 1991
TO PRESENT / 00-23, 00-59, UNK, NA ^
Definition:
The date/time the patient’s procedure was performed. Enter the date in
MM/DD/YYYY format. Use military time
format 00:00 to 23:59.
***Recommend that NA not be used at this time
Registry Section: PROCEDURE
CODE TEMPLATE
Field Name: PROCEDURE CODE LOCATION OF PATIENT
Data
Field Name: PCODELOCATE
Accessible
by IDPH: YES
Max. Length of Field: 5
Type
of Field: CODE (V)
Value
Range: TRH, PRH, ED, OR, OR1-30, ICU, STP, FLR, RAD,
OTH, UNK, NA
Definition: Location
of patient when procedure was performed.
Value: TRH - Transfer
Hospital
PRH
- Pre-Hospital
ED - Emergency Department
CCL - Cardiac Cath. Lab
OR1 - Operating Room visit 1
OR2
(to 30) - Operating Room visit
2 to 30....
ICU - Intensive/Coronary Care Unit
STP - Step-Down Unit, Intermediate
Care
FLR - Floor
RAD - Radiology
OTH - Other
UNK - Unknown
NA - Not Applicable
*Note: In order to streamline data
entry, priority should be given to entering the following types of procedures
in the registry-
v
Prehospital and ED: all invasive procedures
(except peripheral IV access) plus spinal immobilization and airway management
(except routine O2 therapy).
v
All surgical, invasive, or interventional
radiology procedures
Optional/institutional discretion: labs, CT’s, x-rays,
peripheral IV’s, pulse ox, cardiac monitor, O2, etc.
>>>>>>>>> CATEGORY LEVEL OF TRAUMA TEAM ACTIVATION <<<<<<<<<<
Registry Section: CATEGORY
TEMPLATE
Field
Name: CATEGORY
LEVEL OF TRAUMA TEAM ACTIVATION
Data Field Name: TRAUMACAT
Accessible by IDPH: YES
Max. Length
of Field: 2
Type of Field: CODE (V)
Value
Range: I, II, O
Definition: This field indicates the management of
trauma patients. Enter the Category
level
of trauma assessment:
Category
I: Pre-hospital minimum triage criteria are met for Category I (515.Appendix C) or In-house inclusion
criteria for Category I are met (515.Appendix F).
Category II: Pre-hospital
minimum triage criteria are met for Category II (515. Appendix C) or In-house
inclusion criteria for Category II is met
(515.Appendix
F).
Other: Other includes all
other reportable trauma cases that do not meet the Category I or II
definitions.
A reportable trauma patient is
one who was involved in a traumatic
event
and one of the following:
Penetrating
injury of head, neck, torso, groin
Two
or more body regions with potential life or limb threat
Combination
trauma with >= 20% TBSA Burn
Amputation
above wrist or ankle
Limb
paralysis and/or sensory deficit above the wrist and ankle
Flail
chest
Two
or more proximal long bone fractures
Category II Pick
List:
Ejection
from motor vehicle
Death
in same passenger compartment
Fall
> 20 feet (Peds - falls >= three time body length of child)
Pregnancy
>= 24 weeks
Registry Section: CATEGORY
TEMPLATE
Field Name: CATEGORY -
LOCATION OF TRAUMA ACTIVATION
Data Field Name:
CATACTLOCATE
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range: TRH, PRH, ED, ICU, STP, FLR,
RAD, OTH, UNK, NA
Definition: The initial location of the patient when the trauma criteria
was met.
Value: TRH - Transfer
Hospital
PRH -
Pre-Hospital
ED -
Emergency Department
ICU -
Intensive/Coronary Care Unit
STP -
Step Down Unit / Intermediate Care Unit
FLR -
Floor
RAD -
Radiology
OTH -
Other
UNK -
Unknown
NA - Not Applicable
Registry Section: CATEGORY
TEMPLATE
Field Name: CATEGORY - INITIAL
DATE/TIME TRAUMA ACTIVATION DECLARED
Data Field Name:
CATACTDATE/TIME
Accessible by IDPH:
YES
Max. Length of Field: 2, 2, 4 / 2, 2
Type of Field:
DATE/TIME
Value Range: 01-12, 01-31, 1991 TO PRESENT /
00-23, 00-59, UNK, NA ^
Definition: The initial date/time when the patient met the trauma
criteria. Enter the date in MM/DD/YYYY
format. Use military time format 00:00 to 23:59.
Registry Section: CATEGORY
TEMPLATE
Field Name: CATEGORY - TRAUMA
CATEGORY CHANGE
Data Field Name:
CATACTCHG
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range: I, II, NA
Definition: This field indicates the category trauma grade change. Patients may be upgraded at any time during
ED treatment. The trauma surgeon’s
response time requirements begin at the time of the upgrade. Once a patient has been assigned a Category I
or II status that patient cannot be downgraded until the trauma surgeon or
appropriate sub-specialist evaluates the patient. Enter NA if the patient’s trauma grade did
not change.
Value: I - Category I
II - Category II
NA
- Not Applicable
Registry Section: CATEGORY
TEMPLATE
Field Name: CATEGORY -
DATE/TIME OF TRAUMA CATEGORY GRADE CHANGE
Data Field Name:
CATACTCHGDATE/TIME
Accessible by IDPH:
YES
Max. Length of Field: 2, 2, 4 / 2, 2
Type of Field:
DATE/TIME
Value Range: 01-12, 01-31, 1991 TO PRESENT /
00-23, 00-59, UNK, NA ^
Definition: The initial date/time the patient’s
trauma category criteria assessment changed.
Enter the date in MM/DD/YYYY format.
Use military time format 00:00 to 23:59.
>>>>>>>>>>>>>> FUNCTIONAL INDEPENDENCE MEASURE TEMPLATE*
<<<<<<<<<< ******Not applicable in children <
7 years old****
Registry Section: FIMS TEMPLATE
Field Name: EXPRESSION
CAPABILITY AT ADMIT/DISCHARGE
Data Field Name:
EXPRESSADM/DC
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range: 1 - 4, 8, 9
Definition: The measure of the patient’s expression of verbal or
nonverbal language at time of admission (use pre-injury capability)/or
discharge (actual capability).
Value: 4 -
Independent
3 -
Independent with device
2 -
Dependent - partial help required
1 -
Dependent - total help required
8 -
Unknown
9 -
Not Applicable (age< 7)
Registry Section: FIMS TEMPLATE
Field Name: FEEDING
CAPABILITY AT ADMIT/DISCHARGE
Data Field Name:
FEEDADM/DC
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range: 1 - 4, 8, 9
Definition: The measure of the patient’s feeding ability at time of
admission (use pre-injury status)/discharge.
This includes using utensils to bring food to the mouth, chewing, and
swallowing.
Value: 4 -
Independent
3 -
Independent with device
2 -
Dependent - partial help required
1 -
Dependent - total help required
8 -
Unknown
9 - Not Applicable (age< 7)
Registry Section: FIMS TEMPLATE
Field Name: LOCOMOTION
CAPABILITY AT ADMIT/DISCHARGE
Data Field Name:
LOCOADM/DC
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range: 1 - 4, 8, 9
Definition: The measure of the patient’s locomotion ability at time of
admission (use pre-injury status)/discharge.
This includes walking once in a standing position, or using a
wheelchair, once in a seated position.
Value: 4 -
Independent
3 -
Independent with device
2 -
Dependent - partial help required
1 -
Dependent - total help required
8 -
Unknown
9 - Not Applicable (age< 7)
>>>>>>>>>>
DO NOT RESUSCITATE / ORGAN DONOR TEMPLATE
<<<<<<<<<<<<<<
Registry Section: DNR / ORGAN DONOR TEMPLATE
Field Name: DO NOT
RESUSCITATE (DNR) ORDER
Data Field Name:
DNR
Accessible by IDPH:
YES
Max. Length of Field: 1
Type of Field:
CHAR
Value Range: Y, N, UNK, NA
Definition: The patient does not authorize cardiopulmonary
resuscitation. The patient acknowledges
that cardiopulmonary resuscitation (CPR) will not be performed if breathing or
heart beat stops.
Registry Section: DNR
/ ORGAN DONOR TEMPLATE
Field Name: ORGAN DONOR
Data Field Name:
ORGANDONOR
Accessible by IDPH:
YES
Max. Length of Field: 1
Type of Field:
CHAR
Value Range:
Y, N, U
Definition: Indicates if the patient is an organ donor.
Value: Y - Yes, organs were donated
N - No, organs were not
donated
U- Unknown
Registry Section: DNR / ORGAN DONOR TEMPLATE
Field Name: NOT AN ORGAN
DONOR
Data Field Name:
NOTORGANDONOR
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range: NR, REF, UNS, UNK, NA
Definition: If the Organ Donor field is ‘N’, this field will indicate
why the patient is not an organ donor.
Value: NR - Not
Requested for donation
REF -
Refused donation
UNS -
Unsuitable for donation
UNK -
Patient expired but unknown if organ(s) were donated
NA -
Patient survived
Registry Section: DNR / ORGAN DONOR TEMPLATE
Field Name: ORGANS DONATED
Data Field Name:
ORGANSDONATED
Accessible by IDPH:
YES
Max. Length of Field: 5
Type of Field:
CODE (V)
Value Range:
PICK ALL THAT APPLY
Definition: If the Organ Donor field is ‘Y’, this field will indicate
the organs or tissue donated by the patient. PICK ALL that apply.
Value: Heart Liver Kidney
Cornea Pancreas Lung
Skin Bone Other
Registry Section: PATIENT
DEMOGRAPHY
Field Name: HOSPITAL NUMBER
Data
Field Name: HOSPITALNO
Accessible
by IDPH: YES
Max. Length of Field:
5
Type
of Field: CODE (V) -
INTERNAL
Value
Range: 10001 -99999
Definition: The
5 digit numeric code assigned to your Hospital.
Hospital Numbers are assigned by the Illinois Department of Public
Health. (Automatically entered in the registry.)
Value: Appendix
5.c.i.
Registry Section: PATIENT
DEMOGRAPHY
Field Name: TRAUMA HOSPITAL DESIGNATION
Data
Field Name: HOSPTRDESIGN
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: CODE (V) -
INTERNAL
Value
Range: 1, 1P, 2, 2P
Definition:
Trauma Center
Designation criteria are listed in the Supplemental Documentation, Section
515.2030 to 515.2045 of the Illinois Administrative Code. This value is based on the hospital number
and taken the Facility File Listing (Appendix 5.c.i.).
Value: Appendix
5.c.i.
Value
Interpretation:
1 -
Level I Trauma Center
Designation
1P - Level I Pediatric Trauma
Center Designation
2 -
Level II Trauma Center
Designation
2P - Level II Pediatric Trauma
Center Designation
0 -
Non Trauma center
Registry Section: PATIENT
DEMOGRAPHY
Field Name: EMS REGION
Data
Field Name: EMSREGION
Accessible
by IDPH: YES
Max. Length of Field:
2
Type
of Field: CHAR, INTERNAL
Value
Range: 01 - 11
Definition:
The two digit number code assigned to the Trauma
Center’s geographic regional
location by the Illinois Department of Public Health as listed in the Appendix
5.c.i., and is based on the hospital number, taken from the Facility File
Listing. (Auto-generated)
Value: Appendix
5.c.i.
Value Interpretation:
01 - Region 1
02 - Region 2
03 - Region 3
04 - Region 4
05 - Region 5
06 - Region 6
07 - Region 7
08 - Region 8
09 - Region 9
10 - Region 10
11 - Region 11
Registry Section: PATIENT
DEMOGRAPHY
Field Name: REGISTRY NUMBER
Data
Field Name: REGISTERNO
Accessible
by IDPH: YES
Max. Length of Field:
10
Type
of Field: INTEGER, INTERNAL
Value
Range: 0000000001 - 9999999999
Definition:
Auto-generated sequential unique number assigned by the program that identifies
the patient record.</