GMRAFN5 ;HIRMFO/WAA-FDA MEDWATCH FORM ;11/30/95 15:36
;;4.0;Adverse Reaction Tracking;;Mar 29, 1996
S GMRAX=$G(^GMR(120.85,GMRAPA1,"RPT"))
W ?66,"|1. Name, address & phone #: " I GMRAPG1=1 W $P(GMRAX,U)
W !,$E(LINE2,1,66),"|" I GMRAPG1=1 W $E($P(GMRAX,U,2)_" "_$P(GMRAX,U,3)_" "_$P(GMRAX,U,4),1,63)
W !,?66,"|" I GMRAPG1=1 W $E($P(GMRAX,U,5),1,63) W:$P(GMRAX,U,6)'="" ", ",$P(^DIC(5,$P(GMRAX,U,6),0),U)," " W:$P(GMRAX,U,7)'="" $P(GMRAX,U,7) W " ",$P(GMRAX,U,8)
W !,"Mail to: MedWatch or FAX to:",?66,"|",$E(LINE1,68,131)
W !," 5600 Fishers Lane 1-800-FDA-0178",?66,"|2. Health professional? |3. Occupation |4. Reported to Mfr."
W !," Rockville, MD 20852-9787",?66,"|"
I GMRAPG1=1 W ?70,"[",$S($P(GMRAX,U,9)="n":"NO",$P(GMRAX,U,9)="y":"YES",1:" "),"]"
W ?91,"|" I GMRAPG1=1 W $E($P(GMRAX,U,11),1,14)
W ?106,"|" I GMRAPG1=1 W ?110,"[",$S($P($G(^GMR(120.85,GMRAPA1,"PTC1")),U,7)'="":"YES",1:"NO"),"]"
W !,?66,"|",$E(LINE1,68,131)
W !,?66,"|5. If you don't want your identity disclosed to the Manufacturer,"
W !,?66,"| place an ""X"" in the box.["
I GMRAPG1=1 W $S($P(GMRAX,U,10)="n":"X",1:" "),"]"
I GMRAPG1'=1 W " ]"
W !,"FDA Form 3500",?66,"|",$E(LINE2,68,131)
W !!,"Submission of a report does not constitute an admission that medical personnel or the product caused or contributed to the event."
W @IOF
Q
CONCO ;PRINT CONCOMITANT DRUG DATA
S GMRAX=$G(^TMP($J,"GMR","C",GMRACCT)) K ^TMP($J,"GMR","C",GMRACCT)
W " ",$P(GMRAX,U)," " I $P(GMRAX,U,2)'="" W $E($P(GMRAX,U,2),4,5),"/",$E($P(GMRAX,U,2),6,7),"/",$E($P(GMRAX,U,2),2,3)
I $P(GMRAX,U,3)'="" W "-",$E($P(GMRAX,U,3),4,5),"/",$E($P(GMRAX,U,3),6,7),"/",$E($P(GMRAX,U,3),2,3)
K GMRAX
I '$D(^TMP($J,"GMR","C",(GMRACCT+1))) S GMRANOC=0
Q
GMRAFN5 ;HIRMFO/WAA-FDA MEDWATCH FORM ;11/30/95 15:36
+1 ;;4.0;Adverse Reaction Tracking;;Mar 29, 1996
+2 SET GMRAX=$GET(^GMR(120.85,GMRAPA1,"RPT"))
+3 WRITE ?66,"|1. Name, address & phone #: "
IF GMRAPG1=1
WRITE $PIECE(GMRAX,U)
+4 WRITE !,$EXTRACT(LINE2,1,66),"|"
IF GMRAPG1=1
WRITE $EXTRACT($PIECE(GMRAX,U,2)_" "_$PIECE(GMRAX,U,3)_" "_$PIECE(GMRAX,U,4),1,63)
+5 WRITE !,?66,"|"
IF GMRAPG1=1
WRITE $EXTRACT($PIECE(GMRAX,U,5),1,63)
IF $PIECE(GMRAX,U,6)'=""
WRITE ", ",$PIECE(^DIC(5,$PIECE(GMRAX,U,6),0),U)," "
IF $PIECE(GMRAX,U,7)'=""
WRITE $PIECE(GMRAX,U,7)
WRITE " ",$PIECE(GMRAX,U,8)
+6 WRITE !,"Mail to: MedWatch or FAX to:",?66,"|",$EXTRACT(LINE1,68,131)
+7 WRITE !," 5600 Fishers Lane 1-800-FDA-0178",?66,"|2. Health professional? |3. Occupation |4. Reported to Mfr."
+8 WRITE !," Rockville, MD 20852-9787",?66,"|"
+9 IF GMRAPG1=1
WRITE ?70,"[",$SELECT($PIECE(GMRAX,U,9)="n":"NO",$PIECE(GMRAX,U,9)="y":"YES",1:" "),"]"
+10 WRITE ?91,"|"
IF GMRAPG1=1
WRITE $EXTRACT($PIECE(GMRAX,U,11),1,14)
+11 WRITE ?106,"|"
IF GMRAPG1=1
WRITE ?110,"[",$SELECT($PIECE($GET(^GMR(120.85,GMRAPA1,"PTC1")),U,7)'="":"YES",1:"NO"),"]"
+12 WRITE !,?66,"|",$EXTRACT(LINE1,68,131)
+13 WRITE !,?66,"|5. If you don't want your identity disclosed to the Manufacturer,"
+14 WRITE !,?66,"| place an ""X"" in the box.["
+15 IF GMRAPG1=1
WRITE $SELECT($PIECE(GMRAX,U,10)="n":"X",1:" "),"]"
+16 IF GMRAPG1'=1
WRITE " ]"
+17 WRITE !,"FDA Form 3500",?66,"|",$EXTRACT(LINE2,68,131)
+18 WRITE !!,"Submission of a report does not constitute an admission that medical personnel or the product caused or contributed to the event."
+19 WRITE @IOF
+20 QUIT
CONCO ;PRINT CONCOMITANT DRUG DATA
+1 SET GMRAX=$GET(^TMP($JOB,"GMR","C",GMRACCT))
KILL ^TMP($JOB,"GMR","C",GMRACCT)
+2 WRITE " ",$PIECE(GMRAX,U)," "
IF $PIECE(GMRAX,U,2)'=""
WRITE $EXTRACT($PIECE(GMRAX,U,2),4,5),"/",$EXTRACT($PIECE(GMRAX,U,2),6,7),"/",$EXTRACT($PIECE(GMRAX,U,2),2,3)
+3 IF $PIECE(GMRAX,U,3)'=""
WRITE "-",$EXTRACT($PIECE(GMRAX,U,3),4,5),"/",$EXTRACT($PIECE(GMRAX,U,3),6,7),"/",$EXTRACT($PIECE(GMRAX,U,3),2,3)
+4 KILL GMRAX
+5 IF '$DATA(^TMP($JOB,"GMR","C",(GMRACCT+1)))
SET GMRANOC=0
+6 QUIT
