CLINICAL KIT: P:\Vendors-Partners\CDC\Fall Risk Assessment\EF\FULL STEADI\20160906\STEADI-09-06-16.ckt
   FORM NAME: Fall prevention-STEADI

This form uses the following observation terms:

Short Name      HDID            Type  Units      Description
--------------- --------------- ----- ---------- ------------------------------------
FALLSLST12MO    31229           T                falls in the last twelve months
FEELUNSTEADY    469160          T                Fall Risk Assessment: Sometimes I feel unsteady when I am walking
FALLWORRY       469162          T                Fall Risk Assessment: I am worried about falling
CANE ADVISE     469159          T                Fall Risk Assessment: I use or have been advised to use a cane or walker to get around safely
HOLDFURNITUR    469161          T                Fall Risk Assessment: I steady myself holding onto furniture when walking at home
PUSH2STAND      469163          T                Fall Risk Assessment: I need to push with my hands to stand up from a chair
TRBLWTHCURB     469164          T                Fall Risk Assessment: I have trouble stepping up onto a curb
RUSH2TOILET     469165          T                Fall Risk Assessment: I often have to rush to the toilet
FTLOSTFEELNG    469166          T                Fall Risk Assessment: I have lost some feeling in my feet
MEDLGHTHEAD     469167          T                Fall Risk Assessment: I take medicine that sometimes makes me fell light headed or more tired than usual
MEDIMPRVMOOD    469168          T                Fall Risk Assessment: I take medicine to help me sleep or improve my mood
OFTENSAD        469169          T                Fall Risk Assessment: I often feel sad or depressed
STEADI SCORE    469170          T                STEADI Fall Risk Assessment: Today's score
STEADIRSKLVL    469171          T                STEADI Risk Level:
PQRI MEAS 4     132149          T                PQRI Measure 4: Screening for Future Fall Risk
RECOMVITD       469174          T                Recommend daily use of vitamin D  /- calcium
REF2FALLPROG    469173          T                Refer to fall prevention program
FALL EDUCAT     5899            T                patient education, prevention of falls
DEFRFALLRISK    469192          T                Defer Comprehensive Fall Risk Eval to future office visit
FALL#LST12MN    469181          T                Number of previous fall in past year
FALLSINJURY     469182          T                Injury sustained from fall(s)?
RECENTFALLHX    471968          T                Fall Risk Assessment: Description of the most recent fall
TUG             395679          T                Timed Up and Go Test
TUG TIME        469178          T                Time for Timed Up and Go (TUG)
30SECSCORE      469179          T                30-Second Chair Stand Score:
30SECPASFAIL    469180          T                Pass/Fail 30-second chair stand
BALANCE TEST    360004          N                Balance Test Score Total
FALLBALGTSTR    203183          T                Falls risk assessment: balance/gait/strength training
BP SYS LYING    2885            N     mm Hg      blood pressure, systolic, supine E&M
BP DIA LYING    2886            N     mm Hg      blood pressure, diastolic, supine
PULSE 1         140014          N     none       Pulse 1
VISUALAIDEYN    73441           T                Wears contacts or glasses
MOBILITYDEV     110034          T                assistive mobility device
BP SYS STAND    2883            N     mm Hg      blood pressure, systolic, standing
BP DIA STAND    2884            N     mm Hg      blood pressure, diastolic, standing
PULSE 2         140015          N     none       Pulse 2
SNELLENRIGHT    471973          T                Snellen Test - right eye
SNELLENLEFT     471974          T                Snellen Test - left eye
BP SYS ST#2     89211           N     mm Hg      Systolic BP Standing #2
BP DIA ST#2     89212           N     mm Hg      Diastolic BP Standing #2
PULSE 3         140016          N     none       Pulse 3
SNELLENBOTH     471975          T                Snellen Test - both eyes
PSTRALDIZZY     469195          T                Postural dizziness?
FULLNONEED      469193          T                Skip comprehensive fall risk assessments - patient is at low risk (
WHYNONEED       469194          T                Reason for skipping comprehensive fall risk assessments
FALLMEDREV      203179          T                Falls risk assessment: medication review and modification
FALLRISKMED     502944          T                Medicaitons which increase fall risk
MEDFALLFACTR    470974          T                Were medications a contributing factor to falls within the past 12 months?
MEDALERTOVRD    436272          T                Medication alert override indication
PQRS MEAS154    352941          T                PQRS Measure 154:  Fall risk assessment
PQRI MEAS155    187612          T                PQRI Measure 155 Falls: Plan of Care
VISUAL ACUIT    2568            T                visual acuity, OU (both eyes)
FALLCOGSCREN    471971          T                Fall Risk Assessment: Cognitive screen
MUSCTONESTRN    471969          T                Fall Risk Assessment: Muscle Tone and Strength
FOOTINSPECTN    233677          T                Inspection of foot on exam
FALLHOMSFETY    469196          T                Discussed home safety for falls :
PE COMMENTS     8064            T                physical exam comments
REF_OT          111654          T                REFER TO OCCUPATIONAL THERAPY
REF_EYE         13400030        T                Referral to Eye Clinic
REFER PODIAT    7834            T                referral to podiatrist
REF_MH          13400034        T                Referral to Mental Health
STEADI EDUC     469172          T                Educate patient/care giver
FALLINFOGIVN    120589          T                fall risk and prevention information and counseling given
FALLCAREPLAN    469197          T                Fall Risk Care Plan
FALLFOLLTIME    469199          T                Follow-up timing
FALLFOLLTYPE    469200          T                Follow-up type
FALL FU NOTE    469201          T                Notes taken at follow-up


This form uses the following observation terms not included in your database:



This form uses the following flowsheet views:



This form uses the following problem custom lists:



This form uses the following medication custom lists:



This form includes the following items:

Type                                     Label                Connection                    
---------------------------------------- -------------------- ------------------------------
Page                                     Fall Screen          
  Section                                                     
    Multi-item row                                            
      Action Button                      Why should I do a Fa RUNPROCESS {userok("FALLS ARE A MAJOR THREAT FOR YOUR PATIENTS:" + hret + hret + "*  More than one in four people 65 and older fall each year." + hret + hret + "*  Every second of every day in the U.S. an older American falls." + hret + hret + "*  1 out of 5 falls cause a serious injury such as a fracture or head trauma." + hret + hret + "*  Direct medical costs for fall injuries total over $30 billion annually." + hret + "   Hospital costs account for two-thirds of the total." + hret + hret + "*  By integrating fall prevention into clinical practice physicians have the potential     to reduce future falls by nearly 25%.")}
      Action Button                      About this toolkit.. RUNPROCESS {userok("This Encounter Form is based on the CDC STEADI Fall Prevention toolkit and will guide you through conducting a multifactorial fall risk evaluation including screening, gait/strength/balance assessment, focused physical exam, and plan of care." + hret + hret + "If your patient is identified as 'Increased Risk', yellow prompts will guide you to next steps")}
  Section                                Chart Note Translati 
    Multi-item row                                            
      Radio button                                            DOCUMENT.TRANSLATION
      Action Button                      Pull in previous dat SETVALUES [-1]["FALLSLST12MO",<Previous Observation>]["FEELUNSTEADY",<Previous Observation>]["FALLWORRY",<Previous Observation>]["CANE ADVISE",<Previous Observation>]["HOLDFURNITUR",<Previous Observation>]["PUSH2STAND",<Previous Observation>]["TRBLWTHCURB",<Previous Observation>]["RUSH2TOILET",<Previous Observation>]["FTLOSTFEELNG",<Previous Observation>]["MEDLGHTHEAD",<Previous Observation>]["MEDIMPRVMOOD",<Previous Observation>]["OFTENSAD",<Previous Observation>]["STEADI SCORE",<Previous Observation>]["STEADIRSKLVL",<Previous Observation>]["RECOMVITD",<Previous Observation>]["REF2FALLPROG",<Previous Observation>]["DEFRFALLRISK",<Previous Observation>]["FALL#LST12MN",<Previous Observation>]["FALLSINJURY",<Previous Observation>]["RECENTFALLHX",<Previous Observation>]["TUG",<Previous Observation>]["TUG TIME",<Previous Observation>]["30SECSCORE",<Previous Observation>]["30SECPASFAIL",<Previous Observation>]["BALANCE TEST",<Previous Observation>]["FALLBALGTSTR",<Previous Observation>]["BP SYS LYING",<Previous Observation>]["BP DIA LYING",<Previous Observation>]["PULSE 1",<Previous Observation>]["VISUALAIDEYN",<Previous Observation>]["MOBILITYDEV",<Previous Observation>]["BP SYS STAND",<Previous Observation>]["BP DIA STAND",<Previous Observation>]["PULSE 2",<Previous Observation>]["SNELLENRIGHT",<Previous Observation>]["SNELLENLEFT",<Previous Observation>]["BP SYS ST#2",<Previous Observation>]["BP DIA ST#2",<Previous Observation>]["PULSE 3",<Previous Observation>]["SNELLENBOTH",<Previous Observation>]["PSTRALDIZZY",<Previous Observation>]["FULLNONEED",<Previous Observation>]["WHYNONEED",<Previous Observation>]["FALLMEDREV",<Previous Observation>]["MEDFALLFACTR",<Previous Observation>]["VISUAL ACUIT",<Previous Observation>]["FALLCOGSCREN",<Previous Observation>]["FALLHOMSFETY",<Previous Observation>]["MUSCTONESTRN",<Previous Observation>]["FOOTINSPECTN",<Previous Observation>]["REF_OT",<Previous Observation>]["STEADI EDUC",<Previous Observation>]["FALLCAREPLAN",<Previous Observation>]["FALLFOLLTIME",<Previous Observation>]["FALLFOLLTYPE",<Previous Observation>]["FALL FU NOTE",<Previous Observation>]
  Section                                Patient Self-Assessm 
    Multi-visibility                                          
      Visibility region                                       OBSNOW("STEADI SCORE") == ""
        Multi-item row                                        
          Text                           If a Fall Risk Patie 
          Action Button                  Get Scanned Data     RUNPROCESS {OBSNOW("FALLSLST12MO",GetLaterObs_STEADI("31229.00")) 
      Visibility region                                       LAST_SIGNED_OBS_DATE("STEADIRSKLVL") == ._TODAYSDATE
        Text                             Today's scanned STEA 
    Multi-item row                                            
      Text                               *                    
      Text                               required to score    
      Action Button                      Ref                  RUNPROCESS {userok("This 12 question patient fall risk self-assessment and screening tool is based on the STEADI Stay Independent brochure, available online at www.cdc.gov/STEADI." + hret + hret + "A score of >=4 on the screening tool or a response of 'Yes' to any key question (indicated with an *) will indicate the patient is at increased risk of falling.")}
    Multi-item row                                            
      Text                               *                    
      Radio button                       I have fallen in the FALLSLST12MO
    Multi-item row                                            
      Text                               *                    
      Radio button                       Sometimes I feel uns FEELUNSTEADY
    Multi-item row                                            
      Text                               *                    
      Radio button                       I am worried about f FALLWORRY
    Radio button                         I use or have been a CANE ADVISE
    Radio button                         I steady myself hold HOLDFURNITUR
    Radio button                         I need to push with  PUSH2STAND
    Radio button                         I have trouble stepp TRBLWTHCURB
    Radio button                         I often have to rush RUSH2TOILET
    Radio button                         I have lost some fee FTLOSTFEELNG
    Radio button                         I take medicine that MEDLGHTHEAD
    Radio button                         I take medicine to h MEDIMPRVMOOD
    Radio button                         I often feel sad or  OFTENSAD
    Multi-item row                                            
      Text                                                    
      Multi-visibility                                        
        Visibility region                                     obsnow("PQRI MEAS 4") == "" and obsnow("STEADI SCORE") <> ""
          Check box                                           DOCUMENT.REVIEWED_FALL_SCREEN
        Visibility region                                     obsnow("PQRI MEAS 4") <> "" and obsnow("STEADI SCORE") <> ""
          Data display                   CMS Measure 139:     PQRI MEAS 4
    Visibility region                                         obsnow("STEADIRSKLVL") <> "" OR (obsnow("FALLSLST12MO") <> "" AND obsnow("FEELUNSTEADY") <> "" AND obsnow("FALLWORRY") <> "")
      Multi-item row                                          
        Data display                     Today's score:       STEADI SCORE
        Data display                     This patient is at   STEADIRSKLVL
        Action Button                    Score Fall Risk      RUNPROCESS {Score_FallRisk()}
        Action Button                    ?                    RUNPROCESS {userok("If you make ANY changes to the answers above: " + hret + hret + "You will need to press 'Score Fall Risk' again to have the Score and Risk Level recalculated.")}
    Visibility region                                         MED_LIST_CHANGES() == ""
      Multi-item row                                          
        Text                             MEDICATIONS HAVE NOT 
        Action Button                    Update Medications   ADD_MEDICATION 
  Section                                Risk Level           
    Multi-visibility                                          
      Visibility region                                       obsnow("STEADIRSKLVL") == "Low Risk" AND obsnow("FALLSLST12MO") <> "Yes" AND CompileMedAnswers() == ""  AND Val(DOCUMENT.HOLD_SIZE_OF) == 0
        Text                             All patients 65+ wou 
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Text                                                  
        Multi-item row                                        
          Check box                      Refer to fall preven REF2FALLPROG
          Text                                                
        Check box                        Educate patient      FALL EDUCAT
        Edit field                       Note:                DOCUMENT.NOTE_65_
        Multi-item row                                        
          Action Button                  CDC Patient Handouts RUNPROCESS {runshellopen("http://www.cdc.gov/steadi/patient.html")}
          Action Button                  Description of CDC P RUNPROCESS {userok("Resources:" + hret + hret + "Stay Independent: Give this brochure to patients to help them to check their risk of falling. (Available in both English and Spanish.)" + hret + hret + "Chair Rise Exercise: Recommend this simple exercise to your older patients to help improve their thigh and buttock strength and to reduce their fall risk. (Available in both English and Spanish.)" + hret + hret + "What YOU Can Do to Prevent Falls: Use this brochure to help patients learn how to reduce their chances of falling." + hret + hret + "Postural Hypotension, What It Is and How to Manage It: Use this brochure to teach patients how to manage their postural hypotension. (Available in both English and Spanish.)" + hret + hret + "Check for Safety: A Home Fall Prevention Checklist for Older Adults: Encourage patients to use this checklist to help identify and eliminate fall hazards in their home." + hret + hret + "Recommended Programs Form: Use this form to recommend community programs to your older patients to increase their strength and balance. An example of such a program is Tai Chi.")}
        Text                             Assessment and Inter 
      Visibility region                                       obsnow("STEADIRSKLVL") == "Low Risk" AND obsnow("FALLSLST12MO") <> "Yes" AND CompileMedAnswers() <> "" AND Val(DOCUMENT.HOLD_SIZE_OF) == 0
        Text                             All patients 65+ wou 
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Text                            Consider further ev 
          Action Button                  ?                    RUNPROCESS {userok("*The patient answered 'yes' to one or more of the following questions:" + hret + hret + " * I take medicine that sometime makes me feel light-headed/more tired than usual" + hret + "    ->  These side effects can increase the chance of falling." + hret + hret + " * I take medicine to help me sleep or improve my mood" + hret + "    ->  These medicines, including OTC agents, can increase the chance of falling." + hret + hret + " * I often feel sad or depressed" + hret + "    ->  Symptoms of depression are linked to falls.")}
          Text                                                
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
        Multi-item row                                        
          Check box                      Refer to fall preven REF2FALLPROG
          Text                                                
        Check box                        Educate patient      FALL EDUCAT
        Edit field                       Note:                DOCUMENT.NOTE_65_
        Multi-item row                                        
          Action Button                  CDC Patient Handouts RUNPROCESS {runshellopen("http://www.cdc.gov/steadi/patient.html")}
          Action Button                  Description of CDC P RUNPROCESS {userok("Resources:" + hret + hret + "Stay Independent: Give this brochure to patients to help them to check their risk of falling. (Available in both English and Spanish.)" + hret + hret + "Chair Rise Exercise: Recommend this simple exercise to your older patients to help improve their thigh and buttock strength and to reduce their fall risk. (Available in both English and Spanish.)" + hret + hret + "What YOU Can Do to Prevent Falls: Use this brochure to help patients learn how to reduce their chances of falling." + hret + hret + "Postural Hypotension, What It Is and How to Manage It: Use this brochure to teach patients how to manage their postural hypotension. (Available in both English and Spanish.)" + hret + hret + "Check for Safety: A Home Fall Prevention Checklist for Older Adults: Encourage patients to use this checklist to help identify and eliminate fall hazards in their home." + hret + hret + "Recommended Programs Form: Use this form to recommend community programs to your older patients to increase their strength and balance. An example of such a program is Tai Chi.")}
        Text                             Assessment and Inter 
      Visibility region                                       obsnow("STEADIRSKLVL") == "Low Risk" AND obsnow("FALLSLST12MO") <> "Yes" AND Val(DOCUMENT.HOLD_SIZE_OF) > 0
        Text                             All patients 65+ wou 
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Data display                   Med Risk Review iden Val(DOCUMENT.HOLD_SIZE_OF)
          Text                           medications linked t 
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
        Multi-item row                                        
          Check box                      Refer to fall preven REF2FALLPROG
          Text                                                
        Check box                        Educate patient      FALL EDUCAT
        Edit field                       Note:                DOCUMENT.NOTE_65_
        Multi-item row                                        
          Action Button                  CDC Patient Handouts RUNPROCESS {runshellopen("http://www.cdc.gov/steadi/patient.html")}
          Action Button                  Description of CDC P RUNPROCESS {userok("Resources:" + hret + hret + "Stay Independent: Give this brochure to patients to help them to check their risk of falling. (Available in both English and Spanish.)" + hret + hret + "Chair Rise Exercise: Recommend this simple exercise to your older patients to help improve their thigh and buttock strength and to reduce their fall risk. (Available in both English and Spanish.)" + hret + hret + "What YOU Can Do to Prevent Falls: Use this brochure to help patients learn how to reduce their chances of falling." + hret + hret + "Postural Hypotension, What It Is and How to Manage It: Use this brochure to teach patients how to manage their postural hypotension. (Available in both English and Spanish.)" + hret + hret + "Check for Safety: A Home Fall Prevention Checklist for Older Adults: Encourage patients to use this checklist to help identify and eliminate fall hazards in their home." + hret + hret + "Recommended Programs Form: Use this form to recommend community programs to your older patients to increase their strength and balance. An example of such a program is Tai Chi.")}
        Text                             Assessment and Inter 
      Visibility region                                       obsnow("STEADIRSKLVL") == "Increased Risk" AND obsnow("FALLSLST12MO") <> "Yes" AND obsnow("DEFRFALLRISK") == ""
        Multi-item row                                        
          Text                                                
          Action Button                  Go to: Assessments T RUNPROCESS JUMP_TO_TAB("Assessments")
        Text                                                  
        Multi-item row                                        
          Text                           OR                   
          Check box                                           DEFRFALLRISK
        Text                                                  
      Visibility region                                       obsnow("STEADIRSKLVL") == "Increased Risk" AND obsnow("FALLSLST12MO") <> "Yes" AND CompileMedAnswers() == "" AND Val(DOCUMENT.HOLD_SIZE_OF) == 0 AND obsnow("DEFRFALLRISK") <> ""
        Multi-item row                                        
          Text                                                
          Action Button                  Go to: Assessments T RUNPROCESS JUMP_TO_TAB("Assessments")
        Text                                                  
        Multi-item row                                        
          Text                           OR                   
          Check box                                           DEFRFALLRISK
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
      Visibility region                                       obsnow("STEADIRSKLVL") == "Increased Risk" AND obsnow("FALLSLST12MO") <> "Yes" AND CompileMedAnswers() <> ""  AND Val(DOCUMENT.HOLD_SIZE_OF) == 0AND obsnow("DEFRFALLRISK") <> ""
        Multi-item row                                        
          Text                                                
          Action Button                  Go to: Assessments T RUNPROCESS JUMP_TO_TAB("Assessments")
        Text                                                  
        Multi-item row                                        
          Text                           OR                   
          Check box                                           DEFRFALLRISK
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Text                            Consider further ev 
          Action Button                  ?                    RUNPROCESS {userok("*The patient answered 'yes' to one or more of the following questions:" + hret + hret + " * I take medicine that sometime makes me feel light-headed/more tired than usual" + hret + "    ->  These side effects can increase the chance of falling." + hret + hret + " * I take medicine to help me sleep or improve my mood" + hret + "    ->  These medicines, including OTC agents, can increase the chance of falling." + hret + hret + " * I often feel sad or depressed" + hret + "    ->  Symptoms of depression are linked to falls.")}
          Text                                                
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
      Visibility region                                       obsnow("STEADIRSKLVL") == "Increased Risk" AND obsnow("FALLSLST12MO") <> "Yes" AND Val(DOCUMENT.HOLD_SIZE_OF) > 0 AND obsnow("DEFRFALLRISK") <> ""
        Multi-item row                                        
          Text                                                
          Action Button                  Go to: Assessments T RUNPROCESS JUMP_TO_TAB("Assessments")
        Text                                                  
        Multi-item row                                        
          Text                           OR                   
          Check box                                           DEFRFALLRISK
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Data display                   Med Risk Review iden Val(DOCUMENT.HOLD_SIZE_OF)
          Text                           medications linked t 
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
      Visibility region                                       obsnow("FALLSLST12MO") == "Yes" AND obsnow("STEADIRSKLVL") <> ""  AND obsnow("DEFRFALLRISK") == ""
        Multi-item row                                        
          Dropdown list                  Number of falls in p FALL#LST12MN
          Dropdown list                  Sustained a fall inj FALLSINJURY
          Action Button                  gFallDxLabel         RUNPROCESS {IF MATCH(PROB_AFTER("comma"),1,"FALLS") == 0 THEN MEL_ADD_PROBLEM("hx of", "Falls", "ICD-v15.88", str(._TODAYSDATE), "", "") ELSE "" ENDIF}
        Multi-item row                                        
          Text                           Description of most  
          Multi-line edit field          Circumstances of fal RECENTFALLHX
        Text                                                  
        Multi-item row                                        
          Action Button                  Go to: Assessments T RUNPROCESS JUMP_TO_TAB("Assessments")
          Text                           OR                   
          Check box                                           DEFRFALLRISK
        Text                                                  
      Visibility region                                       obsnow("FALLSLST12MO") == "Yes" AND obsnow("STEADIRSKLVL") <> "" AND CompileMedAnswers() <> ""  AND Val(DOCUMENT.HOLD_SIZE_OF) == 0 AND obsnow("DEFRFALLRISK") <> ""
        Multi-item row                                        
          Dropdown list                  Number of falls in p FALL#LST12MN
          Dropdown list                  Sustained a fall inj FALLSINJURY
          Action Button                  gFallDxLabel         RUNPROCESS {IF MATCH(PROB_AFTER("comma"),1,"FALLS") == 0 THEN MEL_ADD_PROBLEM("hx of", "Falls", "ICD-v15.88", str(._TODAYSDATE), "", "") ELSE "" ENDIF}
        Multi-item row                                        
          Text                           Description of most  
          Multi-line edit field          Circumstances of fal RECENTFALLHX
        Text                                                  
        Multi-item row                                        
          Action Button                  Go to: Assessments T RUNPROCESS JUMP_TO_TAB("Assessments")
          Text                           OR                   
          Check box                                           DEFRFALLRISK
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Text                            Consider further ev 
          Action Button                  ?                    RUNPROCESS {userok("*The patient answered 'yes' to one or more of the following questions:" + hret + hret + " * I take medicine that sometime makes me feel light-headed/more tired than usual" + hret + "    ->  These side effects can increase the chance of falling." + hret + hret + " * I take medicine to help me sleep or improve my mood" + hret + "    ->  These medicines, including OTC agents, can increase the chance of falling." + hret + hret + " * I often feel sad or depressed" + hret + "    ->  Symptoms of depression are linked to falls.")}
          Text                                                
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
      Visibility region                                       obsnow("FALLSLST12MO") == "Yes" AND obsnow("STEADIRSKLVL") <> "" AND Val(DOCUMENT.HOLD_SIZE_OF) > 0 AND obsnow("DEFRFALLRISK") <> ""
        Multi-item row                                        
          Dropdown list                  Number of falls in p FALL#LST12MN
          Dropdown list                  Sustained a fall inj FALLSINJURY
          Action Button                  gFallDxLabel         RUNPROCESS {IF MATCH(PROB_AFTER("comma"),1,"FALLS") == 0 THEN MEL_ADD_PROBLEM("hx of", "Falls", "ICD-v15.88", str(._TODAYSDATE), "", "") ELSE "" ENDIF}
        Multi-item row                                        
          Text                           Description of most  
          Multi-line edit field          Circumstances of fal RECENTFALLHX
        Text                                                  
        Multi-item row                                        
          Action Button                  Go to: Assessments T RUNPROCESS JUMP_TO_TAB("Assessments")
          Text                           OR                   
          Check box                                           DEFRFALLRISK
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Data display                   Med Risk Review iden Val(DOCUMENT.HOLD_SIZE_OF)
          Text                           medications linked t 
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
      Visibility region                                       obsnow("FALLSLST12MO") == "Yes" AND obsnow("STEADIRSKLVL") <> "" AND CompileMedAnswers() == "" AND Val(DOCUMENT.HOLD_SIZE_OF) == 0 AND obsnow("DEFRFALLRISK") <> ""
        Multi-item row                                        
          Dropdown list                  Number of falls in p FALL#LST12MN
          Dropdown list                  Sustained a fall inj FALLSINJURY
          Action Button                  gFallDxLabel         RUNPROCESS {IF MATCH(PROB_AFTER("comma"),1,"FALLS") == 0 THEN MEL_ADD_PROBLEM("hx of", "Falls", "ICD-v15.88", str(._TODAYSDATE), "", "") ELSE "" ENDIF}
        Multi-item row                                        
          Text                           Description of most  
          Multi-line edit field          Circumstances of fal RECENTFALLHX
        Text                                                  
        Multi-item row                                        
          Action Button                  Go to: Assessments T RUNPROCESS JUMP_TO_TAB("Assessments")
          Text                           OR                   
          Check box                                           DEFRFALLRISK
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
    Action Button                        CDC STEADI Resources RUNPROCESS {runshellopen("www.cdc.gov/STEADI")}
Page                                     Assessments          
  Section                                                     
    Multi-item row                                            
      Heading                            Gate, Strength, Bala 
      Text                               Do one or more of th 
      Action Button                      Click to view instru RUNPROCESS {runshellopen("http://www.cdc.gov/STEADI/videos.html")}
    Check box                            View additional test DOCUMENT.VIEW_ADDITIO
  Section                                Timed Up and Go Test 
    Heading                              Timed Up and Go Test 
    Multi-item row                                            
      Action Button                      Instructions         RUNPROCESS {userok("The Timed Up and Go (TUG) Test" + hret + hret + "Purpose: To assess mobility" + hret + hret + "Equipment: A stopwatch" + hret + hret + "Directions: Patients wear their regular footwear and can use a walking aid if needed. Begin by having the patient sit back in a standard arm chair and identify a line 3 meters or 10 feet away on the floor." + hret + hret + "Instructions to the patient: " + hret + hret + "1. Stand up from the chair" + hret + hret + "2. Walk to the line on the floor at your normal pace" + hret + hret + "3. Turn" + hret + hret + "4. Walk back to the chair at your normal pace" + hret + hret + "5. Sit down again" + Hret + hret + "On the word 'Go' begin timing. Stop timing after patient has sat back down and record." + hret + hret + "*** An older adult who takes >= 12 seconds to complete the TUG is at high risk for falling.")}
      Text                                                    
      Data display                                            TUG
    Multi-item row                                            
      Edit field                         TUG Time (seconds):  TUG TIME
      Check box                          Patient unable to do DOCUMENT.PATIENT_UNAB_TUG
      Text                                                    
    Multi-item row                                            
      Text                               Observe postural sta 
      Text                                                    
    Multi-item row                                            
      Listbox                            Observe postural sta DOCUMENT.OBSERVE_TUG1
      Listbox                            Observe postural sta DOCUMENT.OBSERVE_TUG2
    Visibility region                                         DOCUMENT.VIEW_ADDITIO <> ""
      Text                               30-Second Chair Stan 
      Multi-item row                                          
        Action Button                    Instructions         RUNPROCESS {userok("The 30-Second Chair Stand Test Purpose: To test leg strength and endurance" + hret + hret + "Equipment: A chair with a straight back without arm rests (seat 17 inches high) and a stopwatch" + hret + hret + "Instructions to the patient: " + hret + hret + "1. Sit in the middle of the chair." + hret + hret + "2. Place your hands on the opposite shoulder crossed at the wrists." + hret + hret + "3. Keep your feet flat on the floor." + hret + hret + "4. Keep your back straight and keep your arms against your chest." + hret + hret + "5. On 'Go', rise to a full standing position and then sit back down again." + hret + hret + "6. Repeat this for 30 seconds." + hret + hret + "On the word 'Go' begin timing. If the patient must use his/her arms to stand, stop the test. Record '0' for the number and score." + hret + hret + "Count the number of times the patient comes to a full standing position in 30 seconds. If the patient is over halfway to a standing position when 30 seconds have elapsed, count it as a stand." + hret + hret + "Record the number of times the patient stands in 30 seconds." + hret + hret + "A below average score indicates a high risk for falls." + hret + hret + "*** Below Average Scores are:" + hret + hret + " Age 60-64   (Men: <14, Women: <12)" + hret + hret + " Age 65-69   (Men: <12, Women: <11)" + hret + hret + " Age 70-74   (Men: <12, Women: <10)" + hret + hret + " Age 75-79   (Men: <11, Women: <10)" + hret + hret + " Age 80-84   (Men: <10, Women: <9)" + hret + hret + " Age 85-89   (Men: <8, Women: <8)" + hret + hret + " Age 90-94   (Men: <7, Women: <4)")}
        Edit field                       Score:               30SECSCORE
        Text                                                  
        Action Button                    Calculate Risk       RUNPROCESS {CalcChairStandRisk()}
        Text                                                  
        Data display                                          30SECPASFAIL
      Multi-line edit field              Notes:               DOCUMENT.THIRTYSECONDNOTES
    Visibility region                                         DOCUMENT.VIEW_ADDITIO <> ""
      Text                               4-Stage Balance Test 
      Multi-item row                                          
        Action Button                    Instructions         RUNPROCESS {userok("The 4-Stage Balance Test to assess static balance" + hret + hret + "Equipment: A stopwatch" + hret + hret + "Directions: There are four progressively more challenging positions. Patients should not use an assistive device (cane or walker) and keep their eyes open." + hret + hret + "Describe and demonstrate each position. Stand next to the patient, hold his/her arm and help them assume the correct foot position." + hret + hret + "When the patient is steady, let go, but remain ready to catch the patient if he/she should lose their balance." + hret + hret + "If the patient can hold a position for 10 seconds without moving his/her feet or needing support, go on to the next position. If not, stop the test." + hret + hret + "Instructions to the patient: " + hret + hret + "I'm going to show you four positions." + hret + hret + "Try to stand in each position for 10 seconds. You can hold your arms out or move your body to help keep your balance but don't move your feet. Hold this position until I tell you to stop." + hret + hret + "For each stage, say 'Ready, begin' and begin timing. After 10 seconds, say 'Stop.'" + hret + hret + "Here are the detailed instructions of the 4 positions:" + hret + hret + "1. Stand with your feet side by side." + hret + hret + "2. Place the instep of one foot so it is touching the big toe of the other foot." + hret + hret + "3. Place one foot in front of the other, heel touching toe." + hret + hret + "4. Stand on one foot." + hret + hret + "*** An older adult who cannot hold the tandem stance for at least 10 seconds is at increased risk of falling.")}
        Text                                                  
        Data display                                          BALANCE TEST
      Multi-item row                                          
        Edit field                       1. Stand with your f DOCUMENT.Q1_4STAGE
        Text                                                  
      Multi-item row                                          
        Edit field                       2. Place the instep  DOCUMENT.Q2_4STAGE
        Text                                                  
      Multi-item row                                          
        Edit field                       3. Place one foot in DOCUMENT.Q3_4STAGE
        Text                                                  
      Multi-item row                                          
        Edit field                       4. Stand on one foot DOCUMENT.Q4_4STAGE
        Text                                                  
      Multi-line edit field              Notes:               DOCUMENT.BALANCENOTES
    Multi-visibility                                          
      Visibility region                                       (obsnow("TUG") == "Failed" OR obsnow("BALANCE TEST") == "Failed" OR obsnow("30SECPASFAIL") == "Failed") AND (OBSNOW("FALLSLST12MO") == "No" OR (VAL(OBSNOW("FALL#LST12MN")) == 1 AND OBSNOW("FALLSINJURY") == "no"))  AND Val(DOCUMENT.HOLD_SIZE_OF) > 0
        Text                                                  
        Multi-item row                                        
          Text                           Patient is at        
          Text                           MODERATE RISK        
          Text                            for falls           
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Data display                   Med Risk Review iden Val(DOCUMENT.HOLD_SIZE_OF)
          Text                           medications linked t 
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
        Multi-item row                                        
          Check box                      Refer to PT to impro FALLBALGTSTR
          Text                                                
        Multi-item row                                        
          Check box                      Refer to fall preven REF2FALLPROG
          Text                                                
        Multi-item row                                        
          Check box                      Educate patient/care FALL EDUCAT
          Text                                                
        Text                                                  
        Check box                                             DEFRFALLRISK
        Text                                                  
        Multi-item row                                        
          Action Button                  CDC Patient Handouts RUNPROCESS {runshellopen("http://www.cdc.gov/steadi/patient.html")}
          Action Button                  Description of CDC P RUNPROCESS {userok("Resources:" + hret + hret + "Stay Independent: Give this brochure to patients to help them to check their risk of falling. (Available in both English and Spanish.)" + hret + hret + "Chair Rise Exercise: Recommend this simple exercise to your older patients to help improve their thigh and buttock strength and to reduce their fall risk. (Available in both English and Spanish.)" + hret + hret + "What YOU Can Do to Prevent Falls: Use this brochure to help patients learn how to reduce their chances of falling." + hret + hret + "Postural Hypotension, What It Is and How to Manage It: Use this brochure to teach patients how to manage their postural hypotension. (Available in both English and Spanish.)" + hret + hret + "Check for Safety: A Home Fall Prevention Checklist for Older Adults: Encourage patients to use this checklist to help identify and eliminate fall hazards in their home." + hret + hret + "Recommended Programs Form: Use this form to recommend community programs to your older patients to increase their strength and balance. An example of such a program is Tai Chi.")}
        Text                             Assessment and Inter 
      Visibility region                                       (obsnow("TUG") == "Failed" OR obsnow("BALANCE TEST") == "Failed" OR obsnow("30SECPASFAIL") == "Failed") AND (OBSNOW("FALLSLST12MO") == "No" OR (VAL(OBSNOW("FALL#LST12MN")) == 1 AND OBSNOW("FALLSINJURY") == "no"))  AND Val(DOCUMENT.HOLD_SIZE_OF) == 0 AND CompileMedAnswers() <> ""
        Text                                                  
        Multi-item row                                        
          Text                           Patient is at        
          Text                           MODERATE RISK        
          Text                            for falls           
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Text                            Consider further ev 
          Action Button                  ?                    RUNPROCESS {userok("*The patient answered 'yes' to one or more of the following questions:" + hret + hret + " * I take medicine that sometime makes me feel light-headed/more tired than usual" + hret + "    ->  These side effects can increase the chance of falling." + hret + hret + " * I take medicine to help me sleep or improve my mood" + hret + "    ->  These medicines, including OTC agents, can increase the chance of falling." + hret + hret + " * I often feel sad or depressed" + hret + "    ->  Symptoms of depression are linked to falls.")}
          Text                                                
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
        Multi-item row                                        
          Check box                      Refer to PT to impro FALLBALGTSTR
          Text                                                
        Multi-item row                                        
          Check box                      Refer to fall preven REF2FALLPROG
          Text                                                
        Multi-item row                                        
          Check box                      Educate patient/care FALL EDUCAT
          Text                                                
        Text                                                  
        Check box                                             DEFRFALLRISK
        Text                                                  
        Multi-item row                                        
          Action Button                  CDC Patient Handouts RUNPROCESS {runshellopen("http://www.cdc.gov/steadi/patient.html")}
          Action Button                  Description of CDC P RUNPROCESS {userok("Resources:" + hret + hret + "Stay Independent: Give this brochure to patients to help them to check their risk of falling. (Available in both English and Spanish.)" + hret + hret + "Chair Rise Exercise: Recommend this simple exercise to your older patients to help improve their thigh and buttock strength and to reduce their fall risk. (Available in both English and Spanish.)" + hret + hret + "What YOU Can Do to Prevent Falls: Use this brochure to help patients learn how to reduce their chances of falling." + hret + hret + "Postural Hypotension, What It Is and How to Manage It: Use this brochure to teach patients how to manage their postural hypotension. (Available in both English and Spanish.)" + hret + hret + "Check for Safety: A Home Fall Prevention Checklist for Older Adults: Encourage patients to use this checklist to help identify and eliminate fall hazards in their home." + hret + hret + "Recommended Programs Form: Use this form to recommend community programs to your older patients to increase their strength and balance. An example of such a program is Tai Chi.")}
        Text                             Assessment and Inter 
      Visibility region                                       (obsnow("TUG") == "Failed" OR obsnow("BALANCE TEST") == "Failed" OR obsnow("30SECPASFAIL") == "Failed") AND (OBSNOW("FALLSLST12MO") == "No" OR (VAL(OBSNOW("FALL#LST12MN")) == 1 AND OBSNOW("FALLSINJURY") == "no"))  AND Val(DOCUMENT.HOLD_SIZE_OF) == 0 AND CompileMedAnswers() == ""
        Text                                                  
        Multi-item row                                        
          Text                           Patient is at        
          Text                           MODERATE RISK        
          Text                            for falls           
        Text                                                  
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Check box                      Refer to PT to impro FALLBALGTSTR
          Text                                                
        Multi-item row                                        
          Check box                      Refer to fall preven REF2FALLPROG
          Text                                                
        Multi-item row                                        
          Check box                      Educate patient/care FALL EDUCAT
          Text                                                
        Text                                                  
        Check box                                             DEFRFALLRISK
        Text                                                  
        Multi-item row                                        
          Action Button                  CDC Patient Handouts RUNPROCESS {runshellopen("http://www.cdc.gov/steadi/patient.html")}
          Action Button                  Description of CDC P RUNPROCESS {userok("Resources:" + hret + hret + "Stay Independent: Give this brochure to patients to help them to check their risk of falling. (Available in both English and Spanish.)" + hret + hret + "Chair Rise Exercise: Recommend this simple exercise to your older patients to help improve their thigh and buttock strength and to reduce their fall risk. (Available in both English and Spanish.)" + hret + hret + "What YOU Can Do to Prevent Falls: Use this brochure to help patients learn how to reduce their chances of falling." + hret + hret + "Postural Hypotension, What It Is and How to Manage It: Use this brochure to teach patients how to manage their postural hypotension. (Available in both English and Spanish.)" + hret + hret + "Check for Safety: A Home Fall Prevention Checklist for Older Adults: Encourage patients to use this checklist to help identify and eliminate fall hazards in their home." + hret + hret + "Recommended Programs Form: Use this form to recommend community programs to your older patients to increase their strength and balance. An example of such a program is Tai Chi.")}
        Text                             Assessment and Inter 
      Visibility region                                       {(obsnow("TUG") <> "" OR obsnow("BALANCE TEST") <> "" OR obsnow("30SECPASFAIL") <> "") AND obsnow("TUG") <> "Failed" AND obsnow("BALANCE TEST") <> "Failed" AND obsnow("30SECPASFAIL") <> "Failed" AND obsnow("STEADIRSKLVL") <> "" AND obsnow("STEADIRSKLVL") <> "Low Risk"  AND Val(DOCUMENT.HOLD_SIZE_OF) > 0}
        Text                                                  
        Text                             Failed fall screen b 
        Text                             consider additional  
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Data display                   Med Risk Review iden Val(DOCUMENT.HOLD_SIZE_OF)
          Text                           medications linked t 
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
        Text                             Additional Assessmen 
        Multi-item row                                        
          Text                           Postural Hypotension 
          Action Button                  ?                    RUNPROCESS {userok("Measuring Orthostatic Blood Pressure" + hret + hret + "1. Have the patient lie down for 5 minutes." + hret + hret + "2. Measure blood pressure and pulse rate." + hret + hret + "3. Have the patient stand." + hret + hret + "4. Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes." + hret + hret + "*** A drop in bp of >19 mm Hg, or in diastolic bp of >9 mm Hg, or experiencing lightheadedness or dizziness is considered abnormal.")}
          Text                           Vision               
          Text                           Mobility             
        Multi-item row                                        
          Edit field                     Supine               BP SYS LYING
          Edit field                     /                    BP DIA LYING
          Text                           mm Hg                
          Edit field                     HR                   PULSE 1
          Check box                      Wears glasses/contac VISUALAIDEYN
          Dropdown list                  Mobility aid:        MOBILITYDEV
        Multi-item row                                        
          Edit field                     Standing (1m)        BP SYS STAND
          Edit field                     /                    BP DIA STAND
          Text                           mm Hg                
          Edit field                     HR                   PULSE 2
          Edit field                     Right:               SNELLENRIGHT
          Edit field                     Left:                SNELLENLEFT
          Text                                                
        Multi-item row                                        
          Edit field                     Standing (3m)        BP SYS ST#2
          Edit field                     /                    BP DIA ST#2
          Text                           mm Hg                
          Edit field                     HR                   PULSE 3
          Edit field                     Both:                SNELLENBOTH
          Text                                                
        Multi-item row                                        
          Text                           *                    
          Radio button                   Postural dizziness?  PSTRALDIZZY
          Text                                                
        Text                                                  
        Multi-item row                                        
          Check box                      Skip further assessm FULLNONEED
          Edit field                     reason for skip      WHYNONEED
      Visibility region                                       {(obsnow("TUG") <> "" OR obsnow("BALANCE TEST") <> "" OR obsnow("30SECPASFAIL") <> "") AND obsnow("TUG") <> "Failed" AND obsnow("BALANCE TEST") <> "Failed" AND obsnow("30SECPASFAIL") <> "Failed" AND obsnow("STEADIRSKLVL") <> "" AND obsnow("STEADIRSKLVL") <> "Low Risk"  AND Val(DOCUMENT.HOLD_SIZE_OF) == 0 AND CompileMedAnswers() <> ""}
        Text                                                  
        Text                             Failed fall screen b 
        Text                             consider additional  
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Text                            Consider further ev 
          Action Button                  ?                    RUNPROCESS {userok("*The patient answered 'yes' to one or more of the following questions:" + hret + hret + " * I take medicine that sometime makes me feel light-headed/more tired than usual" + hret + "    ->  These side effects can increase the chance of falling." + hret + hret + " * I take medicine to help me sleep or improve my mood" + hret + "    ->  These medicines, including OTC agents, can increase the chance of falling." + hret + hret + " * I often feel sad or depressed" + hret + "    ->  Symptoms of depression are linked to falls.")}
          Text                                                
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
        Text                             Additional Assessmen 
        Multi-item row                                        
          Text                           Postural Hypotension 
          Action Button                  ?                    RUNPROCESS {userok("Measuring Orthostatic Blood Pressure" + hret + hret + "1. Have the patient lie down for 5 minutes." + hret + hret + "2. Measure blood pressure and pulse rate." + hret + hret + "3. Have the patient stand." + hret + hret + "4. Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes." + hret + hret + "*** A drop in bp of >19 mm Hg, or in diastolic bp of >9 mm Hg, or experiencing lightheadedness or dizziness is considered abnormal.")}
          Text                           Vision               
          Text                           Mobility             
        Multi-item row                                        
          Edit field                     Supine               BP SYS LYING
          Edit field                     /                    BP DIA LYING
          Text                           mm Hg                
          Edit field                     HR                   PULSE 1
          Check box                      Wears glasses/contac VISUALAIDEYN
          Dropdown list                  Mobility aid:        MOBILITYDEV
        Multi-item row                                        
          Edit field                     Standing (1m)        BP SYS STAND
          Edit field                     /                    BP DIA STAND
          Text                           mm Hg                
          Edit field                     HR                   PULSE 2
          Edit field                     Right:               SNELLENRIGHT
          Edit field                     Left:                SNELLENLEFT
          Text                                                
        Multi-item row                                        
          Edit field                     Standing (3m)        BP SYS ST#2
          Edit field                     /                    BP DIA ST#2
          Text                           mm Hg                
          Edit field                     HR                   PULSE 3
          Edit field                     Both:                SNELLENBOTH
          Text                                                
        Multi-item row                                        
          Text                           *                    
          Radio button                   Postural dizziness?  PSTRALDIZZY
          Text                                                
        Text                                                  
        Multi-item row                                        
          Check box                      Skip further assessm FULLNONEED
          Edit field                     reason for skip      WHYNONEED
      Visibility region                                       {(obsnow("TUG") <> "" OR obsnow("BALANCE TEST") <> "" OR obsnow("30SECPASFAIL") <> "") AND obsnow("TUG") <> "Failed" AND obsnow("BALANCE TEST") <> "Failed" AND obsnow("30SECPASFAIL") <> "Failed" AND obsnow("STEADIRSKLVL") <> "" AND obsnow("STEADIRSKLVL") <> "Low Risk"  AND Val(DOCUMENT.HOLD_SIZE_OF) == 0 AND CompileMedAnswers() == ""}
        Text                                                  
        Text                             Failed fall screen b 
        Text                             consider additional  
        Text                                                  
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Text                             Additional Assessmen 
        Multi-item row                                        
          Text                           Postural Hypotension 
          Action Button                  ?                    RUNPROCESS {userok("Measuring Orthostatic Blood Pressure" + hret + hret + "1. Have the patient lie down for 5 minutes." + hret + hret + "2. Measure blood pressure and pulse rate." + hret + hret + "3. Have the patient stand." + hret + hret + "4. Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes." + hret + hret + "*** A drop in bp of >19 mm Hg, or in diastolic bp of >9 mm Hg, or experiencing lightheadedness or dizziness is considered abnormal.")}
          Text                           Vision               
          Text                           Mobility             
        Multi-item row                                        
          Edit field                     Supine               BP SYS LYING
          Edit field                     /                    BP DIA LYING
          Text                           mm Hg                
          Edit field                     HR                   PULSE 1
          Check box                      Wears glasses/contac VISUALAIDEYN
          Dropdown list                  Mobility aid:        MOBILITYDEV
        Multi-item row                                        
          Edit field                     Standing (1m)        BP SYS STAND
          Edit field                     /                    BP DIA STAND
          Text                           mm Hg                
          Edit field                     HR                   PULSE 2
          Edit field                     Right:               SNELLENRIGHT
          Edit field                     Left:                SNELLENLEFT
          Text                                                
        Multi-item row                                        
          Edit field                     Standing (3m)        BP SYS ST#2
          Edit field                     /                    BP DIA ST#2
          Text                           mm Hg                
          Edit field                     HR                   PULSE 3
          Edit field                     Both:                SNELLENBOTH
          Text                                                
        Multi-item row                                        
          Text                           *                    
          Radio button                   Postural dizziness?  PSTRALDIZZY
          Text                                                
        Text                                                  
        Multi-item row                                        
          Check box                      Skip further assessm FULLNONEED
          Edit field                     reason for skip      WHYNONEED
      Visibility region                                       {(OBSNOW("FALLSLST12MO") == "Yes" AND (obsnow("TUG") == "Failed" OR obsnow("BALANCE TEST") == "Failed" OR obsnow("30SECPASFAIL") == "Failed")) AND (VAL(OBSNOW("FALL#LST12MN")) > 1 OR OBSNOW("FALLSINJURY") == "yes")  AND (Val(DOCUMENT.HOLD_SIZE_OF) > 0 OR CompileMedAnswers() <> "") AND obsnow("DEFRFALLRISK") == ""}
        Text                                                  
        Multi-item row                                        
          Text                           Patient is at        
          Text                           HIGH RISK            
          Text                            for falls.          
        Multi-item row                                        
          Text                                                
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
          Text                                                
        Text                                                  
        Check box                                             DEFRFALLRISK
        Text                                                  
        Text                             Additional Assessmen 
        Multi-item row                                        
          Text                           Postural Hypotension 
          Action Button                  ?                    RUNPROCESS {userok("Measuring Orthostatic Blood Pressure" + hret + hret + "1. Have the patient lie down for 5 minutes." + hret + hret + "2. Measure blood pressure and pulse rate." + hret + hret + "3. Have the patient stand." + hret + hret + "4. Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes." + hret + hret + "*** A drop in bp of >19 mm Hg, or in diastolic bp of >9 mm Hg, or experiencing lightheadedness or dizziness is considered abnormal.")}
          Text                           Vision               
          Text                           Mobility             
        Multi-item row                                        
          Edit field                     Supine               BP SYS LYING
          Edit field                     /                    BP DIA LYING
          Text                           mm Hg                
          Edit field                     HR                   PULSE 1
          Check box                      Wears glasses/contac VISUALAIDEYN
          Dropdown list                  Mobility aid:        MOBILITYDEV
        Multi-item row                                        
          Edit field                     Standing (1m)        BP SYS STAND
          Edit field                     /                    BP DIA STAND
          Text                           mm Hg                
          Edit field                     HR                   PULSE 2
          Edit field                     Right:               SNELLENRIGHT
          Edit field                     Left:                SNELLENLEFT
          Text                                                
        Multi-item row                                        
          Edit field                     Standing (3m)        BP SYS ST#2
          Edit field                     /                    BP DIA ST#2
          Text                           mm Hg                
          Edit field                     HR                   PULSE 3
          Edit field                     Both:                SNELLENBOTH
          Text                                                
        Multi-item row                                        
          Text                           *                    
          Radio button                   Postural dizziness?  PSTRALDIZZY
          Text                                                
      Visibility region                                       {(OBSNOW("FALLSLST12MO") == "Yes" AND (obsnow("TUG") == "Failed" OR obsnow("BALANCE TEST") == "Failed" OR obsnow("30SECPASFAIL") == "Failed")) AND (VAL(OBSNOW("FALL#LST12MN")) > 1 OR OBSNOW("FALLSINJURY") == "yes")  AND Val(DOCUMENT.HOLD_SIZE_OF) == 0 AND CompileMedAnswers() == "" AND obsnow("DEFRFALLRISK") == ""}
        Text                                                  
        Multi-item row                                        
          Text                           Patient is at        
          Text                           HIGH RISK            
          Text                            for falls.          
        Text                                                  
        Check box                                             DEFRFALLRISK
        Text                                                  
        Text                             Additional Assessmen 
        Multi-item row                                        
          Text                           Postural Hypotension 
          Action Button                  ?                    RUNPROCESS {userok("Measuring Orthostatic Blood Pressure" + hret + hret + "1. Have the patient lie down for 5 minutes." + hret + hret + "2. Measure blood pressure and pulse rate." + hret + hret + "3. Have the patient stand." + hret + hret + "4. Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes." + hret + hret + "*** A drop in bp of >19 mm Hg, or in diastolic bp of >9 mm Hg, or experiencing lightheadedness or dizziness is considered abnormal.")}
          Text                           Vision               
          Text                           Mobility             
        Multi-item row                                        
          Edit field                     Supine               BP SYS LYING
          Edit field                     /                    BP DIA LYING
          Text                           mm Hg                
          Edit field                     HR                   PULSE 1
          Check box                      Wears glasses/contac VISUALAIDEYN
          Dropdown list                  Mobility aid:        MOBILITYDEV
        Multi-item row                                        
          Edit field                     Standing (1m)        BP SYS STAND
          Edit field                     /                    BP DIA STAND
          Text                           mm Hg                
          Edit field                     HR                   PULSE 2
          Edit field                     Right:               SNELLENRIGHT
          Edit field                     Left:                SNELLENLEFT
          Text                                                
        Multi-item row                                        
          Edit field                     Standing (3m)        BP SYS ST#2
          Edit field                     /                    BP DIA ST#2
          Text                           mm Hg                
          Edit field                     HR                   PULSE 3
          Edit field                     Both:                SNELLENBOTH
          Text                                                
        Multi-item row                                        
          Text                           *                    
          Radio button                   Postural dizziness?  PSTRALDIZZY
          Text                                                
      Visibility region                                       {(OBSNOW("FALLSLST12MO") == "Yes" AND (obsnow("TUG") == "Failed" OR obsnow("BALANCE TEST") == "Failed" OR obsnow("30SECPASFAIL") == "Failed")) AND (VAL(OBSNOW("FALL#LST12MN")) > 1 OR OBSNOW("FALLSINJURY") == "yes")  AND Val(DOCUMENT.HOLD_SIZE_OF) > 0 AND obsnow("DEFRFALLRISK") <> ""}
        Text                                                  
        Multi-item row                                        
          Text                           Patient is at        
          Text                           HIGH RISK            
          Text                            for falls.          
        Check box                                             DEFRFALLRISK
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Data display                   Med Risk Review iden Val(DOCUMENT.HOLD_SIZE_OF)
          Text                           medications linked t 
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
        Text                                                  
        Text                             Additional Assessmen 
        Multi-item row                                        
          Text                           Postural Hypotension 
          Action Button                  ?                    RUNPROCESS {userok("Measuring Orthostatic Blood Pressure" + hret + hret + "1. Have the patient lie down for 5 minutes." + hret + hret + "2. Measure blood pressure and pulse rate." + hret + hret + "3. Have the patient stand." + hret + hret + "4. Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes." + hret + hret + "*** A drop in bp of >19 mm Hg, or in diastolic bp of >9 mm Hg, or experiencing lightheadedness or dizziness is considered abnormal.")}
          Text                           Vision               
          Text                           Mobility             
        Multi-item row                                        
          Edit field                     Supine               BP SYS LYING
          Edit field                     /                    BP DIA LYING
          Text                           mm Hg                
          Edit field                     HR                   PULSE 1
          Check box                      Wears glasses/contac VISUALAIDEYN
          Dropdown list                  Mobility aid:        MOBILITYDEV
        Multi-item row                                        
          Edit field                     Standing (1m)        BP SYS STAND
          Edit field                     /                    BP DIA STAND
          Text                           mm Hg                
          Edit field                     HR                   PULSE 2
          Edit field                     Right:               SNELLENRIGHT
          Edit field                     Left:                SNELLENLEFT
          Text                                                
        Multi-item row                                        
          Edit field                     Standing (3m)        BP SYS ST#2
          Edit field                     /                    BP DIA ST#2
          Text                           mm Hg                
          Edit field                     HR                   PULSE 3
          Edit field                     Both:                SNELLENBOTH
          Text                                                
        Multi-item row                                        
          Text                           *                    
          Radio button                   Postural dizziness?  PSTRALDIZZY
          Text                                                
      Visibility region                                       {(OBSNOW("FALLSLST12MO") == "Yes" AND (obsnow("TUG") == "Failed" OR obsnow("BALANCE TEST") == "Failed" OR obsnow("30SECPASFAIL") == "Failed")) AND (VAL(OBSNOW("FALL#LST12MN")) > 1 OR OBSNOW("FALLSINJURY") == "yes")  AND Val(DOCUMENT.HOLD_SIZE_OF) == 0 AND CompileMedAnswers() <> "" AND obsnow("DEFRFALLRISK") <> ""}
        Text                                                  
        Multi-item row                                        
          Text                           Patient is at        
          Text                           HIGH RISK            
          Text                            for falls.          
        Check box                                             DEFRFALLRISK
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Text                            Consider further ev 
          Action Button                  ?                    RUNPROCESS {userok("*The patient answered 'yes' to one or more of the following questions:" + hret + hret + " * I take medicine that sometime makes me feel light-headed/more tired than usual" + hret + "    ->  These side effects can increase the chance of falling." + hret + hret + " * I take medicine to help me sleep or improve my mood" + hret + "    ->  These medicines, including OTC agents, can increase the chance of falling." + hret + hret + " * I often feel sad or depressed" + hret + "    ->  Symptoms of depression are linked to falls.")}
          Text                                                
          Action Button                  Go to Med Review     RUNPROCESS JUMP_TO_TAB("Med Review")
        Text                                                  
        Text                             Additional Assessmen 
        Multi-item row                                        
          Text                           Postural Hypotension 
          Action Button                  ?                    RUNPROCESS {userok("Measuring Orthostatic Blood Pressure" + hret + hret + "1. Have the patient lie down for 5 minutes." + hret + hret + "2. Measure blood pressure and pulse rate." + hret + hret + "3. Have the patient stand." + hret + hret + "4. Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes." + hret + hret + "*** A drop in bp of >19 mm Hg, or in diastolic bp of >9 mm Hg, or experiencing lightheadedness or dizziness is considered abnormal.")}
          Text                           Vision               
          Text                           Mobility             
        Multi-item row                                        
          Edit field                     Supine               BP SYS LYING
          Edit field                     /                    BP DIA LYING
          Text                           mm Hg                
          Edit field                     HR                   PULSE 1
          Check box                      Wears glasses/contac VISUALAIDEYN
          Dropdown list                  Mobility aid:        MOBILITYDEV
        Multi-item row                                        
          Edit field                     Standing (1m)        BP SYS STAND
          Edit field                     /                    BP DIA STAND
          Text                           mm Hg                
          Edit field                     HR                   PULSE 2
          Edit field                     Right:               SNELLENRIGHT
          Edit field                     Left:                SNELLENLEFT
          Text                                                
        Multi-item row                                        
          Edit field                     Standing (3m)        BP SYS ST#2
          Edit field                     /                    BP DIA ST#2
          Text                           mm Hg                
          Edit field                     HR                   PULSE 3
          Edit field                     Both:                SNELLENBOTH
          Text                                                
        Multi-item row                                        
          Text                           *                    
          Radio button                   Postural dizziness?  PSTRALDIZZY
          Text                                                
      Visibility region                                       {(OBSNOW("FALLSLST12MO") == "Yes" AND (obsnow("TUG") == "Failed" OR obsnow("BALANCE TEST") == "Failed" OR obsnow("30SECPASFAIL") == "Failed")) AND (VAL(OBSNOW("FALL#LST12MN")) > 1 OR OBSNOW("FALLSINJURY") == "yes")  AND Val(DOCUMENT.HOLD_SIZE_OF) == 0 AND obsnow("DEFRFALLRISK") <> "" AND CompileMedAnswers() == ""}
        Text                                                  
        Multi-item row                                        
          Text                           Patient is at        
          Text                           HIGH RISK            
          Text                            for falls.          
        Check box                                             DEFRFALLRISK
        Text                                                  
        Multi-item row                                        
          Dropdown list                  Vitamin D:           RECOMVITD
          Action Button                  Add Vit D to Med lis ADD_MEDICATION 
        Multi-item row                                        
          Text                                                
          Action Button                  Go to: Exam / Plan T RUNPROCESS JUMP_TO_TAB("Exam / Plan")
          Text                                                
        Text                             Additional Assessmen 
        Multi-item row                                        
          Text                           Postural Hypotension 
          Action Button                  ?                    RUNPROCESS {userok("Measuring Orthostatic Blood Pressure" + hret + hret + "1. Have the patient lie down for 5 minutes." + hret + hret + "2. Measure blood pressure and pulse rate." + hret + hret + "3. Have the patient stand." + hret + hret + "4. Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes." + hret + hret + "*** A drop in bp of >19 mm Hg, or in diastolic bp of >9 mm Hg, or experiencing lightheadedness or dizziness is considered abnormal.")}
          Text                           Vision               
          Text                           Mobility             
        Multi-item row                                        
          Edit field                     Supine               BP SYS LYING
          Edit field                     /                    BP DIA LYING
          Text                           mm Hg                
          Edit field                     HR                   PULSE 1
          Check box                      Wears glasses/contac VISUALAIDEYN
          Dropdown list                  Mobility aid:        MOBILITYDEV
        Multi-item row                                        
          Edit field                     Standing (1m)        BP SYS STAND
          Edit field                     /                    BP DIA STAND
          Text                           mm Hg                
          Edit field                     HR                   PULSE 2
          Edit field                     Right:               SNELLENRIGHT
          Edit field                     Left:                SNELLENLEFT
          Text                                                
        Multi-item row                                        
          Edit field                     Standing (3m)        BP SYS ST#2
          Edit field                     /                    BP DIA ST#2
          Text                           mm Hg                
          Edit field                     HR                   PULSE 3
          Edit field                     Both:                SNELLENBOTH
          Text                                                
        Multi-item row                                        
          Text                           *                    
          Radio button                   Postural dizziness?  PSTRALDIZZY
          Text                                                
Page                                     Med Review           
  Section                                Current Medications  
    Multi-item row                                            
      Text                               Medications          
      Text                               Problems             
    Multi-item row                                            
      Data display                                            
      Data display                                            
    Text                                 Vitamin D Assessment 
    Multi-item row                                            
      Text                               *                    
      Dropdown list                      Vitamin D:           RECOMVITD
      Action Button                      Add Vit D to Med lis ADD_MEDICATION 
    Edit field                           Note:                DOCUMENT.VIT_D_NOTE_
  Section                                High Risk Medication 
    Multi-item row                                            
      Heading                            Medications Linked T 
      Action Button                      ?                    RUNPROCESS {userok("The medications most likely to cause falls include:" + hret + hret + "**    Central nervous system or psychoactive medications:" + hret + "    *    Anticonvulsants" + hret + "    *    Antidepressants" + hret + "    *    Antipsychotics" + hret + "    *    Benzodiazepines" + hret + "    *    Opioids" + hret + "    *    Sedatives-hypnotics" + hret + hret + "**    Prescription drugs, over-the-counter medications (OTC), and supplements which can cause dizziness, sedation, confusion, blurred vision, or orthostatic hypotension. For example:" + hret + "    *    Antihistamines" + hret + "    *    Medications affecting blood pressure" + hret + "    *    Muscle relaxants" + hret + hret + "Determine if medications can be changed:" + hret + "  ->    Stop medications, when possible." + hret + "  ->    Switch to safer alternatives." + hret + "  ->    Reduce medications to the lowest effective dose." + hret + hret + "Develop a patient action plan that includes:" + hret + "  ->    Medication changes" + hret + "  ->    Monitoring plan for medication side effects" + hret + "  ->    Non-pharmacologic options" + hret + "  ->    Solutions to identified patient barriers" + hret + "  ->    Additional strategies to reduce fall risk")}
      Text                                                    
      Action Button                      Ref                  RUNPROCESS {userok("This tool includes the CNS-active medications that have the strongest evidence for increased fall risk.*" + hret + hret + "Classes include anticonvulsants, antidepressants, antipsychotics, benzodiazepines, opioids, and sedatives-hypnotics. "+ hret + hret + "* Based on the 2015 American Geriatrics Society Beers Criteria")}
      Heading                            Patient said 'Yes' t 
      Action Button                      ?                    RUNPROCESS {userok("*The following questions from the patient self-assessment relate to medications." + hret + hret + " * I take medicine that sometime makes me feel light-headed/more tired than usual" + hret + "    ->  These side effects can increase the chance of falling." + hret + hret + " * I take medicine to help me sleep or improve my mood" + hret + "    ->  These medicines, including OTC agents, can increase the chance of falling." + hret + hret + " * I often feel sad or depressed" + hret + "    ->  Symptoms of depression are linked to falls.")}
    Multi-item row                                            
      Data display                                            GetRiskList()
      Data display                       Self-Assessment:     {CompileMedAnswers()}
    Visibility region                                         CompileMedAnswers() <> "" and Val(DOCUMENT.HOLD_SIZE_OF) == 0
      Text                               Consider further eva 
    Multi-visibility                                          
      Visibility region                                       Val(DOCUMENT.HOLD_SIZE_OF) == 1 OR Val(DOCUMENT.HOLD_SIZE_OF) == 2
        Text                             Your patient is pres 
        Text                             Evaluate the current 
        Text                             Stop, switch, or red 
      Visibility region                                       Val(DOCUMENT.HOLD_SIZE_OF) > 2
        Text                             Your patient is pres 
        Text                             Consider reducing us 
        Text                             Stop, switch, or red 
    Visibility region                                         1 == 2
      Multi-item row                                          
        Edit field                       hold size of high ri DOCUMENT.HOLD_SIZE_OF
        Edit field                       hold high risk med l DOCUMENT.HOLD_HIGH_RISK_MED_LIST
        Multi-line edit field            HOLD_REASON_TO_RETAI DOCUMENT.HOLD_REASON_TO_RETAIN
    Multi-item row                                            
      Text                                                    
      Visibility region                                       MED_LIST_CHANGES() <> "" AND MED_LIST_CHANGES() <> NULL
        Action Button                    Refresh Meds Linked  RUNPROCESS {JUMP_TO_TAB("Exam / Plan") JUMP_TO_TAB("Med Review")}
      Action Button                      Update Medications   ADD_MEDICATION 
    Visibility region                                         {obsnow('FALLMEDREV') == ""}
      Text                               Please answer 'Revie 
    Multi-item row                                            
      Radio button                                            FALLMEDREV
      Visibility region                                       MED_LIST_CHANGES() <> ""
        Check box                                             DOCUMENT.WRITE_CHANGE
    Multi-item row                                            
      Data display                       Last Reviewed on:    {LAST_SIGNED_OBS_DATE('FALLMEDREV')}
      Action Button                      Print Medication Sum RUNPROCESS {OBSNOW("FALLRISKMED",DOCUMENT.HOLD_HIGH_RISK_MED_LIST)}{printhandout("Handouts\STEADI\Fall Risk Medication Review Summary")}
    Multi-item row                                            
      Text                               *                    
      Dropdown list                      Were medications a c MEDFALLFACTR
      Text                                                    
    Check box                                                 DOCUMENT.VIEW_EDIT_NOTE
  Section                                                     
    Multi-visibility                                          
      Visibility region                                       DOCUMENT.VIEW_EDIT_NOTE <> ""
        Multi-item row                                        
          Heading                        Additional Documenta 
          Visibility region                                   DOCUMENT.MEDICATION_DROPDOWN <> "" AND (DOCUMENT.OVER_RIDE_REASON <> "" OR DOCUMENT.OVER_RIDE_NOTES <> "")
            Action Button                Press to Save to Not RUNPROCESS {IF DOCUMENT.HOLD_REASON_TO_RETAIN == "" THEN 
        Multi-item row                                        
          Dropdown list                  Medication:          DOCUMENT.MEDICATION_DROPDOWN
          Dropdown list                  Reason to Retain:    DOCUMENT.OVER_RIDE_REASON
        Multi-line edit field            Note:                DOCUMENT.OVER_RIDE_NOTES
        Data display                                          OBSANY("MEDALERTOVRD")
        Action Button                    Go to: Exam / Plan T RUNPROCESS JUMP_TO_TAB("Exam / Plan")
        Multi-item row                                        
          Action Button                  American Geriatrics  RUNPROCESS {runshellopen("http://www.ncbi.nlm.nih.gov/pubmed/26446832")}
          Action Button                  CDC STEADI Resources RUNPROCESS {runshellopen("www.cdc.gov/STEADI")}
      Visibility region                                       DOCUMENT.VIEW_EDIT_NOTE == ""
        Action Button                    Go to: Exam / Plan T RUNPROCESS JUMP_TO_TAB("Exam / Plan")
        Multi-item row                                        
          Action Button                  American Geriatrics  RUNPROCESS {runshellopen("http://www.ncbi.nlm.nih.gov/pubmed/26446832")}
          Action Button                  CDC STEADI Resources RUNPROCESS {runshellopen("www.cdc.gov/STEADI")}
Page                                     Exam / Plan          
  Section                                Medication Review    
    Multi-item row                                            
      Action Button                      * PQRS 154 - Screeni RUNPROCESS {userok("PQRS 154 - Screening and assessment (CPT II codes 1100F and 3288F)" + hret + hret + "Screening (CPT II 1100F):  Positive if a patient has had two or more falls or any fall with an injury in the past year."+ hret + hret + "Assessment (CPT II 3288F): A balance and gait assessment (such as the Timed Up & Go Test) and one or more of the following assessments:" + hret + hret + "postural blood pressure, visual acuity, home fall hazards, and documentation on whether medications were or were not a contributing factor to falls within the past 12 months." )}
      Visibility region                                       obsnow("PQRS MEAS154") <> ""
        Data display                     PQRS 154:            PQRS MEAS154
    Multi-item row                                            
      Action Button                      * PQRS 155 - Falls P RUNPROCESS {userok("If the falls risk assessment indicates the patient has documentation of two or more falls in the past year or any fall with injury in the past year (CPT II code 1100F is submitted), #155 should also be reported." + hret + hret + "PQRS 155 - Falls Plan of Care (CPT II code 0518F)" + hret + hret + "After a falls risk assessment is completed, a falls plan of care should be developed."+ hret + hret + "To satisfy the requirements for PQRS 155, a plan of care must include:" + hret + hret + "1. Consideration of vitamin D supplementation. It must be documented in the medical record that vitamin D supplementation was advised or considered or documentation that patient was referred to his/her physician for vitamin D supplementation advice" + hret + hret + "   AND" + hret + hret + "2. Balance, Strength, and Gait Training - The medical record must include: documentation that balance, strength, and gait training/instructions were provided OR referral to an exercise program, which includes at least one of the three components: balance, strength or gait OR referral to physical therapy. " + hret + hret + "All components do not need to be completed during one patient visit, but should be documented in the medical record as having been performed within the past 12 months." )}
      Visibility region                                       obsnow("PQRI MEAS155") <> ""
        Data display                     PQRS 155:            PQRI MEAS155
    Text                                 Focused Physical     
  Section grouping                                            
    Section                              group 1              
      Section                                                 
        Multi-item row                                        
          Heading                        Postural Hypotension 
          Data display                   Results:             {CFMT(OBSNOW("BP SYS LYING"), "", "Supine: ", "", "/" + OBSNOW("BP DIA LYING")) + hret + CFMT(OBSNOW("BP SYS STAND"), "", "Stand (1 min): ", "", "/" + OBSNOW("BP DIA STAND")) + hret + CFMT(OBSNOW("BP SYS ST#2"), "", "Stand (3 min): ", "", "/" + OBSNOW("BP DIA ST#2"))}
        Edit field                       Notes:               DOCUMENT.POST_HYPO_NOTE
        Multi-item row                                        
          Text                           *                    
          Radio button                   Postural dizziness?  PSTRALDIZZY
        Text                             ____________________ 
      Section                                                 
        Multi-item row                                        
          Heading                        Vision               
          Data display                   Results:             {CFMT(OBSNOW("SNELLENRIGHT"), "", "R ", "", "; L " + OBSNOW("SNELLENLEFT") + "; Both " + OBSNOW("SNELLENBOTH"))}
        Edit field                       Notes:               DOCUMENT.VISION_NOTE
        Multi-item row                                        
          Text                           *                    
          Radio button                   Visual impairment    VISUAL ACUIT
        Text                             ____________________ 
      Section                                                 
        Multi-item row                                        
          Heading                        Cognition            
          Edit field                     Notes:               DOCUMENT.COG_NOTE
        Multi-item row                                        
          Text                                                
          Radio button                   Cognitive impairment FALLCOGSCREN
        Text                             ____________________ 
        Multi-item row                                        
          Heading                        Mobility             
          Dropdown list                  Uses aid:            MOBILITYDEV
        Text                             ____________________ 
      Multi-item row                                          
        Heading                          Home Hazards         
        Text                             *                    
        Check box                        Discussed home hazar FALLHOMSFETY
      Edit field                         Notes:               DOCUMENT.HOME_HAZARD_NOTE
    Section                              group 1              
      Heading                            Patient said 'Yes' t 
      Data display                       Self-Assessment:     {CompileAnswers()}
      Listbox                            Muscle strength & to MUSCTONESTRN
      Multi-item row                                          
        Listbox                          Check feet:          FOOTINSPECTN
        Action Button                    ?                    RUNPROCESS {userok("Ask about and note patient's indoor and outdoor footwear. Recommend wearing a supportive shoe even when indoors and avoid walking barefoot or in socks. Consider referral to a podiatrist or pedorthist.")}
  Section                                                     
    Multi-line edit field                Notes:               PE COMMENTS
  Section                                Referrals            
    Multi-item row                                            
      Text                               *                    
      Text                               Refer patient to one 
      Text                               Also consider referr 
    Multi-item row                                            
      Check box                                               FALLBALGTSTR
      Check box                                               REF_OT
      Check box                                               DOCUMENT.REFER_TO_PHA
    Multi-item row                                            
      Check box                                               REF2FALLPROG
      Check box                                               REF_EYE
      Check box                                               REFER PODIAT
    Multi-item row                                            
      Text                                                    
      Check box                          mental health specia REF_MH
    Action Button                        Add Referral Order   ADD_ORDERS 
  Section                                Patient Education    
    Multi-item row                                            
      Listbox                            Gave to patient:     STEADI EDUC
      Action Button                      Print 'Check for Saf RUNPROCESS {printhandout("Handouts\Check for Safety: A Home Fall Prevention Checklist")}
    Multi-item row                                            
      Text                               More than 50% of tod 
      Dropdown list                                           FALLINFOGIVN
      Text                               minutes was counseli 
    Action Button                        CDC Patient Handouts RUNPROCESS {runshellopen("http://www.cdc.gov/steadi/patient.html")}
    Section                              Fall Intervention Ca 
      Multi-line edit field                                   FALLCAREPLAN
      Multi-item row                                          
        Dropdown list                    Follow-up in:        FALLFOLLTIME
        Dropdown list                    with                 FALLFOLLTYPE
    Section                              Follow-up Notes      
      Multi-line edit field              Follow-up notes:     FALL FU NOTE
