Delete a Lab Test

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How to delete a CHEMISTRY test from the LAB PACKAGE

1. It is against Clinical Laboratory Improvement Amendments (CLIA) regulations to delete lab results from a patient record. According to the regulations, incorrect patient results must not be removed from Lab Reporting. Comments should be added to the results indicating the reason–entered in error—-, the date, time and person responsible for taking the action.  All this should be in the system for tracking purposes. Below are instructions for this process.

 

Core Applications …

Device Management …

Menu Management …

Programmer Options …

Operations Management …

Spool Management …

Information Security Officer Menu …

Taskman Management …

User Management …

FM     VA FileMan …

Application Utilities …

Capacity Planning …

HL7 Main Menu …

Test an option not in your menu

 

Select Systems Manager Menu Option: test an option not in your menu

Option entry to test: lrmenu     Laboratory DHCP Menu

1  Phlebotomy menu …

2  Accessioning menu …

3  Process data in lab menu …

4  Quality control menu …

5  Results menu …

6  Help Menu …

7  Ward lab menu …

8  Anatomic pathology …

11 Supervisor menu …

LSM    Lab Shipping Menu …

 

Select Laboratory DHCP Menu Option: 3 Process data in lab menu

 

EA     Enter/verify data (auto instrument)

EL     Enter/verify data (Load list)

EM     Enter/verify/modify data (manual)

EW     Enter/verify data (Work list)

GA     Group verify (EA, EL, EW)

MP     Misc. Processing Menu …

Accession order then immediately enter data

Batch data entry (chem, hem, tox, etc.)

Build a load/work list

Bypass normal data entry

Download a load list to an Instrument.

Fast Bypass Data Entry/Verify

Lookup accession

Order/test status

Print a load/work list

Std/QC/Reps Manual Workload count

Unload Load/Work List

 

Select Process data in lab menu Option: em Enter/verify/modify data (manual)

 

Do you want to review the data before and after you edit? YES// <enter>

Do you wish to see all previously verified results? NO// <enter>

 

Select one of the following:

 

• Accession Number
• Unique Identifier (UID)

 

Verify by: 1//   Accession Number

Select Accession:

 

 

How to delete a PATHOLOGY test from the LAB PACKAGE

In order to meet the requirements of CAP and JCAHO, no option exists to “unrelease a report” Changes in reports should be done using either the modified or supplemental reports options.

 

In the rare event that an accession is assigned to the wrong patient and the data needs to be corrected, the Move Anatomic Path [LRAPMV] option can be used if appropriate.

 

If not, the global will need to be edited to “unrelease” the report before anything else can be done.

 

Editing will need to be done by someone from the IRM staff with programmer access. Once the LRDFN for the patient is ascertained, Date Report Completed field (#.03) and Release Report field (#.11) need to be deleted for Files #63.08 (SURGICAL PATHOLOGY), #63.09 (CYTOPATHOLOGY), or #63.02 (ELECTRON MICROSCOPY).

 

Input to what File: LAB DATA//            (7057 entries)

EDIT WHICH FIELD: ALL// 8 SURGICAL PATHOLOGY  (multiple)    EDIT WHICH SURGICAL PATHOLOGY SUB-FIELD: ALL// <enter>

THEN EDIT FIELD:

 

 

Select LAB DATA LRDFN: 5683 <– This number is obtained from the PATIENT file.

Select DATE/TIME SPECIMEN TAKEN: APR 7,2011// ———————————- ———————————————

DATE/TIME SPECIMEN TAKEN: Apr 07, 2011//   SPECIMEN SUBMITTED BY:

Select SPECIMEN: n/a// <– All of this data – bolded in black – was deleted yesterday in an attempt to resolve

SPECIMEN: n/a//

    SURGICAL WORKLOAD PROFILE:

    GROSS DESCRIPTION/CUTTING DATE:

    GROSS DESCRIPTION/CUTTING TYPE:

    GROSS DESCRIPTION COUNTED:

    Select PARAFFIN BLOCK ID:

    Select PLASTIC  BLOCK ID:

    Select FROZEN  TISSUE ID:

  Select SPECIMEN:

  BRIEF CLINICAL HISTORY:

    THERE ARE NO LINES!

    Edit? NO//

  PREOPERATIVE DIAGNOSIS:

    THERE ARE NO LINES!

    Edit? NO//

  OPERATIVE FINDINGS:

    THERE ARE NO LINES!     Edit? NO//   POSTOPERATIVE DIAGNOSIS:

    THERE ARE NO LINES!

    Edit? NO//

  PATHOLOGIST:

  RESIDENT PATHOLOGIST:

  DATE REPORT COMPLETED:

SURGICAL PATH ACC #: SP 11 997//   (‘SURGICAL PATH ACC #’ is UNEDITABLE)   SURGEON/PHYSICIAN:

PATIENT LOCATION:

TYPIST: lw//

DATE/TIME SPECIMEN RECEIVED: APR 8,2011@13:15//   REPORT RELEASE DATE/TIME:

RELEASED BY:

TC CODE:

ORIGINAL RELEASE DATE: APR 11,2011@15:51:07// @

SURE YOU WANT TO DELETE? y (Yes)

Select TIU REFERENCE DATE/TIME – SP: APR 11,2011@15:51:07

//

Select TIU REFERENCE DATE/TIME – SP: APR 11,2011@15:51:07

//

TIU REFERENCE DATE/TIME – SP: APR 11,2011@15:51:07

//

TIU ENTRY POINTER – SP: LR SURGICAL PATHOLOGY REPORT

//

TIU CHECKSUM – SP: 184146525A//   (‘TIU CHECKSUM – SP’ is UNEDITABLE)

DATE REPORT MODIFIED – SP: MAY 13,2011@10:23:58 // @

SURE YOU WANT TO DELETE? y (Yes)

PERSON MODIFYING TEXT: WILLIAMS,LAUREN//

DIAGNOSIS MODIFIED:

Select DELAYED REPORT COMMENT:

Select COMMENT:

GROSS DESCRIPTION:

THERE ARE NO LINES!

Edit? NO//

MICROSCOPIC DESCRIPTION:

THERE ARE NO LINES!

Edit? NO//

Select SUPPLEMENTARY REPORT DATE/TIME: APR 8,2011//

SUPPLEMENTARY REPORT DATE/TIME: APR 8,2011//

RELEASE SUPPLEMENTARY REPORT:

DESCRIPTION:

THERE ARE NO LINES!

Edit? NO//

Select SUPPLEMENTARY REPORT MODIFIED:

FROZEN SECTION:

THERE ARE NO LINES!

Edit? NO//

SURGICAL PATH DIAGNOSIS:. . .

. . .

– Unremarkable ectocervical type mucosa.

 

1. C) Right Ovarian Cyst Wall, Cystectomy:

– Ovarian tissue with luteinized tissue of  hemorrhagic corpus luteum cyst.

 

CPT CODES: CPT 88305 X 3; ICD 220

 

4-11-11/np

 

Edit? NO// y YES

 

==[ WRAP ]==[INSERT ]========< SURGICAL PATH DIAGNOSIS[Press <F1>H for help]====

**DELETE ALL OF THE REPORT TEXT

 

========T=======T=======T=======T=======T=======T=======T=======T

=======T>======

 

 

Select DATE MICROSCOPIC EXAM MODIFIED: MAY 13,2011@10:00:29// @

SURE YOU WANT TO DELETE THE ENTIRE DATE MICROSCOPIC EXAM MODIFIED? y (Yes)

Select DATE MICROSCOPIC EXAM MODIFIED: MAY 12,2011@11:49:38// @

SURE YOU WANT TO DELETE THE ENTIRE DATE MICROSCOPIC EXAM MODIFIED? y (Yes)

Select DATE MICROSCOPIC EXAM MODIFIED:

Select DATE DIAGNOSIS MODIFIED:

Select DATE FROZEN SECTION MODIFIED: MAY 13,2011@10:00:32// @

   SURE YOU WANT TO DELETE THE ENTIRE DATE FROZEN SECTION MODIFIED? y (Yes)   Select DATE FROZEN SECTION MODIFIED:

Select DATE GROSS DESCRIPTION CHANGED: MAY 13,2011@10:24:28// @

   SURE YOU WANT TO DELETE THE ENTIRE DATE GROSS DESCRIPTION CHANGED? y (Yes)

Select DATE GROSS DESCRIPTION CHANGED: MAY 12,2011@11:49:36// @

   SURE YOU WANT TO DELETE THE ENTIRE DATE GROSS DESCRIPTION CHANGED? y (Yes)

Select DATE GROSS DESCRIPTION CHANGED:

Select QA CODE:

Select ORGAN/TISSUE:

Select CPT/ICD DIAGNOSIS:

Select IMAGE:

Select DATE/TIME SPECIMEN TAKEN:

 

Core Applications …

Device Management …

Menu Management …

Programmer Options …

Operations Management …

Spool Management …

Information Security Officer Menu …

Taskman Management …

User Management …

FM     VA FileMan …

Application Utilities …

Capacity Planning …

HL7 Main Menu …

Test an option not in your menu

 

Select Systems Manager Menu Option: test an option not in your menu

Option entry to test: delete accession #, ANAT PATH LRAPKILL     Delete accession #, anat path

Select ANATOMIC PATHOLOGY SECTION: SURGICAL PATHOLOGY

 

Delete an Accession Number

 

 

Accession number date: 4/7/11 (APR 07, 2011)

 

Select Accession # : 997

TEST,PATIENT ID: 00001234 DOB: Dec 01, 1999

 

ACC # 997  DATE RECEIVED: Apr 08, 2011 13:15  OK to DELETE ? NO// Y