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Patient Last Updated: , by Patient Info Patient Information Clinical Info Clinical Information Research Research Clinical Information Save Save changes Tracking/Score Referral EvaluationEvaluation Evaluation Comments Vitals ListingListing Listing Comments Vitals Pre-TransplantClinic Visits Vitals TransplantTransplant Info Surgery Details Donor Info Transplant Comments Vitals Post-TransplantClinic Visits Vitals Rejection Graft Death Immunosuppression Outside Admissions Exit Patient Tracking/Current Score (if on W/L) Patient Status MELD or PELD Calculated Score Match Score Status 1 Exception points included in this score Reasons for Exceptions Specify Other Error with field [Patient Status] : Ensure that the data conforms to the data type [text] View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Multi-valued Epic Value View Audit History If other reason for exception points, specify Modify Epic Value View Audit History Referral Information Date of Referral Referring Physician Referring Physician City Referring Physician State Referring Physician Zip Referral Comments Error with field [Referral Date] : Ensure that the data conforms to the data type [date] Cannot be before Date of Birth Cannot be in the Future View Audit History Error with field [Referring Physician] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Referring Physician City] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Referring Physician State] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Referring Physician Zip] : Ensure that the data conforms to the data type [text] Invalid/Malformed zipcode. Ensure format is ##### or #####-#### or ######### View Audit History Error with field [Referral Comments] : Ensure that the data conforms to the data type [textarea] View Audit History Evaluation Information Add [Evaluation] var scrollableId = "formdata_1_2_8_8"; synchronizeScrollerWidthsDiv(scrollableId); var scrollableId = "formdata_1_2_8_9"; synchronizeScrollerWidthsDiv(scrollableId); var scrollableId = "formdata_1_2_8_10"; synchronizeScrollerWidthsDiv(scrollableId); Evaluation(s) Evaluation Evaluation Comments Vitals Delete [Evaluation] Evaluation Date : View var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "8", "8", repeatKey); View var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "8", "9", repeatKey); View var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "8", "10", repeatKey); Evaluation Information Add [Evaluation] var scrollableId = "formdata_1_2_8_8"; synchronizeScrollerWidthsDiv(scrollableId); var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "8", "8", repeatKey); Date of Evaluation Date of Team Discussion Outcome of Team Discussion If Deferred, reason for deferral Organs evaluated for Additional Organs Evaluated Primary Liver Disease at Evaluation Secondary Liver Disease at Evaluation CCHMC Surgeon at Evaluation   Delete [Evaluation] **New** Hide Error with field [Evaluation Date] : Field is required Ensure that the data conforms to the data type [date] Cannot be before Date of Birth Cannot be in the Future View Audit History Error with field [Team Discussion Date] : Field is required Ensure that the data conforms to the data type [date] Cannot be before Date of Birth Cannot be in the Future View Audit History Error with field [Team Discussion Outcome] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Deferral Reason] : Ensure that the data conforms to the data type [text] View Audit History Modify Multi-valued Field View Audit History Error with field [Additional Organs Evaluated] : Ensure that the data conforms to the data type [text] View Audit History Modify Multi-valued Field View Audit History Modify Multi-valued Field View Audit History Error with field [Evaluation Surgeon] : Ensure that the data conforms to the data type [text] View Audit History Show Comments at Evaluation Add [Evaluation] var scrollableId = "formdata_1_2_8_9"; synchronizeScrollerWidthsDiv(scrollableId); var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "8", "9", repeatKey); Comment   Delete [Evaluation] **New** Hide Error with field [Evaluation Comments] : Ensure that the data conforms to the data type [textarea] View Audit History Show Vital Signs at Evaluation Add [Evaluation] var scrollableId = "formdata_1_2_8_10"; synchronizeScrollerWidthsDiv(scrollableId); var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "8", "10", repeatKey); Weight Date of Weight Height Date of Height BMI Date of BMI Head Circumference Date of Head Circumference Blood Pressure Date of Blood Pressure Pulse Date of Pulse Oxygen Saturation Date of Oxygen Saturation   Delete [Evaluation] **New** Hide View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History Show Listing Information Add [Listing] var scrollableId = "formdata_1_2_9_11"; synchronizeScrollerWidthsDiv(scrollableId); var scrollableId = "formdata_1_2_9_12"; synchronizeScrollerWidthsDiv(scrollableId); var scrollableId = "formdata_1_2_9_13"; synchronizeScrollerWidthsDiv(scrollableId); Listing(s) Listing Listing Comments Vitals Delete [Listing] Listing Date : View var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "9", "11", repeatKey); View var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "9", "12", repeatKey); View var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "9", "13", repeatKey); Listing Information Add [Listing] var scrollableId = "formdata_1_2_9_11"; synchronizeScrollerWidthsDiv(scrollableId); var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "9", "11", repeatKey); Date of Associated Team Discussion Date of Listing Organs Listed Additional Organs Listed UNOS Score MELD or PELD Calculated Score Match Score Status 1 Exception points included in this score Reasons for Exceptions Specify Other Date of Wait List Removal Reason for removal from Wait List   Delete [Listing] **New** Hide Evaluation team discussion date. Evaluation must have outcome of "Approve" Error with field [Date of Associated Team Discussion] : Field is required Ensure that the data conforms to the data type [date] View Audit History Error with field [Listing Date] : Field is required Ensure that the data conforms to the data type [date] Cannot be before Date of Birth Cannot be in the Future View Audit History Modify Multi-valued Field View Audit History Error with field [Additional Organs Listed] : Ensure that the data conforms to the data type [text] View Audit History Error with field [UNOS Score] : Ensure that the data conforms to the data type [text] View Audit History Error with field [MELD/PELD] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Calculated Score] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Match Score] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Status 1] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Exceptions Included] : Ensure that the data conforms to the data type [text] View Audit History Modify Multi-valued Field View Audit History If other reason for exception points, specify Error with field [Other Exception] : Ensure that the data conforms to the data type [textarea] View Audit History Error with field [Date removed from Wait List] : Ensure that the data conforms to the data type [date] Cannot be before Date of Birth Cannot be in the Future View Audit History Error with field [Reason for Wait List Removal] : Ensure that the data conforms to the data type [textarea] View Audit History Show Comments at Listing Add [Listing] var scrollableId = "formdata_1_2_9_12"; synchronizeScrollerWidthsDiv(scrollableId); var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "9", "12", repeatKey); Comment   Delete [Listing] **New** Hide Error with field [Listing Comments] : Ensure that the data conforms to the data type [textarea] View Audit History Show Vital Signs at Listing Add [Listing] var scrollableId = "formdata_1_2_9_13"; synchronizeScrollerWidthsDiv(scrollableId); var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "9", "13", repeatKey); Weight Date of Weight Height Date of Height BMI Date of BMI Head Circumference Date of Head Circumference Blood Pressure Date of Blood Pressure Pulse Date of Pulse Oxygen Saturation Date of Oxygen Saturation   Delete [Listing] **New** Hide View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History Show Pre-Transplant Clinical Information Date of Clinic Visit Date of Associated Listing MELD or PELD Calculated Score Match Score Status 1 Exception points included in this score Reasons for Exceptions Specify Other Mid Arm Circumference (cm) Mid Arm Circumference Percentile Tricepes Skinfold Triceps Skinfold Percentile Oxygen Saturation at rest Oxygen Saturation with exercise Last Vitamin Levels Dexa Scan Immunizations up to date Anesthesia Consult completed Hepatopulmonary Syndrome History of variceal bleed Encephalopathy Ascites present History of SBP   Hide Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Multi-valued Epic Value View Audit History If other reason for exception points, specify Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Show Vital Signs at Pre-Transplant Weight Date of Weight Height Date of Height BMI Date of BMI Head Circumference Date of Head Circumference Blood Pressure Date of Blood Pressure Pulse Date of Pulse Oxygen Saturation Date of Oxygen Saturation View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History Transplant Information Transplant(s) Transplant Info Surgery Details Donor Info Transplant Comments Vitals Transplant Number : Transplant Date : View var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "11", "16", repeatKey); View var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "11", "17", repeatKey); View var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "11", "18", repeatKey); View var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "11", "21", repeatKey); View var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoFormInstance("1", "2", "11", "22", repeatKey); Transplant Information Date of Associated Listing Transplant Number Transplant Date Patient Age at Transplant Transplant Location Other location of transplant Discharge Date Discharge Diagnosis Total Length of Stay Initial ICU Days Total ICU Days ICU Days in first 30 days Intubation Days CCHMC Surgeon at Transplant UNOS Score MELD or PELD Calculated Score Match Score Status 1 Exception points included in this score Reasons for Exceptions Specify Other Primary Liver Disease Secondary Liver Disease Organs Received Additional Organs Transplanted Procedure Type Organ Type Specify Other   Hide Error with field [Date of Associated Listing] : Ensure that the data conforms to the data type [date] View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History View Audit History Unit: Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Multi-valued Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Multi-valued Field View Audit History View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Multi-valued Epic Value View Audit History If other reason for exception points, specify Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Multi-valued Epic Value View Audit History Modify Epic Value View Audit History Error with field [Procedure Type] : Ensure that the data conforms to the data type [text] View Audit History Modify Epic Value View Audit History If other organ type, specify Modify Epic Value View Audit History Show Surgery Details Graft Weight Length of Operation (hours) Length of Operation (minutes) Cold Ischemia Time (hours) Cold Ischemia Time (minutes) Warm Ischemia Time (minutes) Induction Therapy Biliary Stent Venovenous Bypass Primary Closure at Surgical Site Date of Primary Closure Secondary Closure at Surgical Site Date of Secondary Closure RBC Cryo FFP Platelets Cell Saver (cc) Arterial Anastomotic Type Arterial Anastomotic Interposition Type Specify Other Venous Anastomotic Type Portal Vein Anastotic Interposition Type Specify Other Donor Arterial Anastomosis Specify Other Recipient Arterial Anastomosis Specify Other Recipient Vascular Anomolies Specify Other Biliary Reconstruction Specify Other Splenectomy Patient Blood Type ABO compatible   Hide Error with field [Graft Weight] : Ensure that the data conforms to the data type [float] View Audit History Error with field [Length of Operation (hours)] : Ensure that the data conforms to the data type [float] View Audit History Error with field [Length of Operation (minutes)] : Ensure that the data conforms to the data type [float] View Audit History Error with field [Cold Ischemia Time (hours)] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Cold Ischemia Time (minutes)] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Warm Ischemia Time (minutes)] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Induction Therapy] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Biliary Stent] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Venovenous Bypass] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Primary Closure at Surgical Site] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Primary Closure Date] : Ensure that the data conforms to the data type [date] Cannot be before Date of Birth Cannot be in the Future View Audit History Error with field [Secondary Closure at Surgical Site] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Secondary Closure Date] : Ensure that the data conforms to the data type [date] Cannot be before Date of Birth Cannot be in the Future View Audit History Error with field [RBC] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Cryo] : Ensure that the data conforms to the data type [text] View Audit History Error with field [FFP] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Platelets] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Cell Saver (cc)] : Ensure that the data conforms to the data type [text] View Audit History Modify Epic Value View Audit History Modify Multi-valued Epic Value View Audit History If other Arterial Interposition reason, specify Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Multi-valued Epic Value View Audit History If other Portal Vein Interposition, specify Modify Epic Value View Audit History Modify Multi-valued Field View Audit History If other Donor Arterial Anastomosis reason, specify Error with field [Donor Arterial Anastomosis Other] : Ensure that the data conforms to the data type [textarea] View Audit History Modify Multi-valued Field View Audit History If other Recipient Arterial Anastomosis reason, specify Error with field [Recipient Arterial Anastomosis Other] : Ensure that the data conforms to the data type [textarea] View Audit History Modify Multi-valued Field View Audit History If other Recipient Vascular Anomolies, specify Error with field [Recipient Vascular Anomolies Other] : Ensure that the data conforms to the data type [textarea] View Audit History Modify Epic Value View Audit History If other Billiary Reconstruction, specify Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Error with field [ABO compatible] : Ensure that the data conforms to the data type [text] View Audit History Show Donor Information ID Age Gender Race Ethnicity Type Blood Type Weight (kg) Height (cm) CMV IgG EBV IgG OPO Match ID Cause of Death Name Relationship Procurement   Hide Error with field [Donor ID] : Ensure that the data conforms to the data type [text] View Audit History Modify Epic Value View Audit History Error with field [Donor Gender] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Donor Race] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Donor Ethnicity] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Donor Type] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Donor Blood Type] : Ensure that the data conforms to the data type [text] View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Error with field [Donor OPO] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Donor Match ID] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Donor Cause of Death] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Donor Name] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Donor Relationship] : Ensure that the data conforms to the data type [text] View Audit History Modify Multi-valued Field View Audit History Show Comments at Transplant Comments   Hide Error with field [Transplant Comments] : Ensure that the data conforms to the data type [textarea] View Audit History Show Vital Signs at Transplant Weight Date of Weight Height Date of Height BMI Date of BMI Head Circumference Date of Head Circumference Blood Pressure Date of Blood Pressure Pulse Date of Pulse Oxygen Saturation Date of Oxygen Saturation   Hide View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History Show Post-Transplant Clinical Information Annual Visit Date of Liver Transplant Systolic BP Diastolic BP Most recent measured GFR Random urine protein/creatinine ratio Patient Peds QOL psychosocial score Patient Peds QOL physical score Parent Peds QOL psychosocial score Parent Peds QOL physical score Tacrolimus MMF CSA (cyclosporine) Sirolimus Corticosteroids Azathioprine Other Immunosuppressive Medication Asplenia prophylaxis Last liver biopsy Chronic hepatitis Grade Fibrosis Fibrosis Stage Chronic rejection Steatosis History of PTLD History of skin cancer Portal Hypertension Splenomegaly Esophageal varices Thrombocytopenia (platelet < 100K) Hepatic artery thrombosis Biliary tract complications Pubertal stage-breast development Pubertal stage-pubic hair Alopecia Eczema Sleep Disturbance Tremors If Tremors, what frequency   Hide Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Show Vital Signs at Post-Transplant Weight Date of Weight Height Date of Height BMI Date of BMI Head Circumference Date of Head Circumference Blood Pressure Date of Blood Pressure Pulse Date of Pulse Oxygen Saturation Date of Oxygen Saturation   Hide View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History Show Rejection Add [Rejection] var scrollableId = "itemgroupdata_1_2_12_25"; synchronizeScrollerWidthsDiv(scrollableId); var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoGroupInstance("1", "2", "12", "25", repeatKey); Date of Associated Transplant Date of Rejection Type of Rejection   Delete [Post-Transplant] **New** Hide Error with field [Date of Associated Transplant] : Ensure that the data conforms to the data type [date] View Audit History Error with field [Rejection Date] : Ensure that the data conforms to the data type [date] Cannot be before Date of Birth Cannot be in the Future View Audit History Error with field [Rejection Type] : Ensure that the data conforms to the data type [text] View Audit History Show Graft Death Add [Graft Death] var scrollableId = "itemgroupdata_1_2_12_26"; synchronizeScrollerWidthsDiv(scrollableId); var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoGroupInstance("1", "2", "12", "26", repeatKey); Date of Associated Transplant Graft Death Date Graft Death Reason Specify Other   Delete [Post-Transplant] **New** Hide Error with field [Date of Associated Transplant] : Ensure that the data conforms to the data type [date] View Audit History Error with field [Graft Death Date] : Ensure that the data conforms to the data type [date] Cannot be before Date of Birth Cannot be in the Future View Audit History Error with field [Graft Death Reason] : Ensure that the data conforms to the data type [text] View Audit History If other Death Reason, specify Error with field [Graft Death Reason Other] : Ensure that the data conforms to the data type [textarea] View Audit History Show Liver Transplant Immunosuppression Most recent measured GFR value Current Immuno-suppression drug Current dose (mg/dose) Current dosing frequency Drug level - lower limit of desired range Drug level - upper limit of desired range Is target range correct per protocol If not per protocol, reason for variation Is there excessive variation If so, reason for drug level variation Specify Other New dose (mg/dose) Is current drug level in desired range Comments   Hide View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History View Audit History If other reason for drug level variation, specify View Audit History View Audit History View Audit History View Audit History Show Outside Hospital Admissions Add [Outside Admissions] var scrollableId = "itemgroupdata_1_2_14_28"; synchronizeScrollerWidthsDiv(scrollableId); var repeatKey=event.target.parentNode.getAttribute("repeatKey"); gotoGroupInstance("1", "2", "14", "28", repeatKey); Admission Date Discharge Date Discharge Diagnosis Location Specify Other LOS   Delete [Outside Admissions] **New** Hide Error with field [Admission Date] : Ensure that the data conforms to the data type [date] Cannot be before Date of Birth Cannot be in the Future View Audit History Error with field [Discharge Date] : Ensure that the data conforms to the data type [date] Cannot be before Date of Birth Cannot be in the Future View Audit History Error with field [Discharge Diagnosis] : Ensure that the data conforms to the data type [text] View Audit History Error with field [Location] : Ensure that the data conforms to the data type [text] View Audit History If other Location, specify Error with field [Other Location] : Ensure that the data conforms to the data type [textarea] View Audit History Length of Stay (days) View Audit History Show Exit Exit Date Exit Reason Specify Other Cause of Death Was death Transplant Related Where was patient transferred Exit Comments Modify Epic Value View Audit History Modify Epic Value View Audit History If other Exit Reason, specify Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Modify Epic Value View Audit History Clinical Information Save Save changes Confirm Please give a reason for deleting this section? Delete Reason is required Cancel Modify Value Error with field [] Please ensure that it conforms to datatype [] Warning with field [] : Warning with field [] : Add Remove None Supplied Close Modify Value Form Definition incorrect. Unable to locate codelist for item [] Error with field [] Please ensure that it conforms to datatype [] Add Remove None Supplied Close Override EPIC Value Error with field [] Please ensure that it conforms to datatype [] Warning with field [] : Warning with field [] : Add Remove Reason for change? Previous Values: Apply Changes Reason is required Cancel Override EPIC Value Form Definition incorrect. Unable to locate codelist for item [] Error with field [] Please ensure that it conforms to datatype [] Add Remove None Supplied Reason for change? Previous Values: Apply Changes Reason is required Cancel Override EPIC Value : Error with field [] Please ensure that it conforms to datatype [] Warning with field [] : Warning with field [] : : Error with field [] Please ensure that it conforms to datatype [] Warning with field [] : Warning with field [] : Unit: Reason for change? Previous Value: Apply Changes Reason is required Cancel Override EPIC Value : Error with field [] Please ensure that it conforms to datatype [] Reason for change? Previous Value: Error with field [] Please ensure that it conforms to datatype [] Reason for change? Previous Value: Apply Changes Reason is required Cancel Value History Date Source User Old Value New Value Reason Epic Last Updated Is Newer Value Use Epic Value Close Errors exist in the form Please correct the following errors: Close