User Guide - Government of Manitoba
Contents
1. High Sequrity Zone 1433 Trusted Zone Cae a alee HE L Application Server Hosts For Retrieval Web Services i Internal Clients Private Kay Tt Boudemke 77777 Data Flows gt Tust Laval None Lo Mid H SQL Server 2005 ee Page 1 Page 4 of 15 Chronic Disease Management Tariffs eForm User Guide 2014 Completing the Chronic Disease Management Tariff e Form Fillable Non Fillable Sections 1 When you open the eForm select all the patient care treatment forms you wish to complete on an individual For example if you wish to complete Diabetes and Hypertension click both of these options The information specific to each form will appear on the computer screen Use the scroll bar on the right to move up and down in the eForm Forms may be unselected if selected in error 2 All fields outlined in red are required and must be completed in order to submit the eForm 3 Areas shaded in blue indicate where information can be entered If n a or not applicable is selected as a value the fillable or blue shaded area changes to white and becomes inactive because the information is no longer required 4 Items shaded in grey specify section headings and or target information for reference E O e http www gov mb ca health primary File Edit Goto Favorites Help 32. 2014 Not Applicable or N A Responses Certain questions become not applicable under certain conditions For example a blood pressure measurement is not applicable if a patient is less than 18 years old When n a or not applicable is selected the previously available soace becomes inactive See screen shot below where space is now white and no longer outlined in red Oe e http www gov mb ca health primarycare chronicdisease docs patientcaretre O File Edit Goto Favorites Help amp gov mb ca 3 Colleen v Pursuing Excellence portal Manitoba Shortcuts v Diagnostic Services Of Ma Free Hotmail x fh L3 mb v Pagey Safetyy Toos Patient Sumame Patient Given Name Sex Date of Birth To select year Dateofbirth click on year in header bar when calendar is opened Registration 6 digits Personal health ID 9 Wi B Height cm Date completed eae FE Blood Pressure Measurement Fasting Lipid Profile patients age from 18 to 74 years Target lt 20mmoV L Congestive Heart Failure Patient Care Treatment Form Has the patient been treated with ACEor ARB If no select the reason s No CI contraindicated NT not tolerated financial barrier PR patient refused Target Fasting blood sugar test fasting glucose Not tested patient has diabetes 70 mmol L for patients who do not have diabetes Diabetes Patient Care Tre
3. Care Treatment Form X Hypertension Patient Care Treatment Form BR S O Physician Information Sumame Given Name Billing Number Patient Sumame Patient Given Name Sex Date of Birth To select year Date of birth click on year in header bar when calendar is opened Registration 6 digits Personal health ID 9 zs Wi Height cm Date completed N Blood Pressure Measurement Date completed Target 140 90 or N A Patient Age lt 18 130 80 with renal disease and or diabetes Fasting Lipid Profile patients age from 18 to 74 years L 1 Congestive Heart Failure Patient Care Treatment Form Has the patient been treated with ACE or ARB If no select the reason s od BN E oe E CI contraindicated NT not tolerated financial barrier PR patient refused Target Y TE uan ml ninm dem n nl whan 1 04 PM 2014 04 04 B gne Page 9 of 15 Chronic Disease Management Tariffs eForm User Guide 2014 Auto filled Fields 1 The eForm has been programmed to complete or automatically fill certain fields based on information entered by the user For example as per screen shot below when patients have diabetes a fasting blood sugar test fasting glucose is no longer required for patients who also have congestive heart failure The response will be automatically prefilled for the user based on the guideline and programmed rule OO File Edit G
4. LDL Date completed E Target 2 0 mmol L 1 01 PM 2014 03 28 Ne NOE D Page 14 of 15 Chronic Disease Management Tariffs eForm User Guide 2014 Manitoba Help Desk e f you encounter technical issues with the e Form please contact the Manitoba Help Desk at Manitoba Help Desk Phone 204 786 7200 Email HLTHD gov mb ca Hours of Operation Monday to Friday 8 30 a m 4 30 p m Page 15 of 15 Chronic Disease Management Tariffs eForm User Guide 2014
5. double click on the year Double clicking on the year will display yearly ranges for you to choose from After selecting the year you may select the specific month and day from the calendar provided OC e http www gov mb ca health primarycare chronicdisease docs patientcaretre O File Edit Goto Favorites Help L Colleen v 8 Pursuing Excellence portal a Manitoba Shortcuts v Diagnostic Services Of Ma Free Hotmail E c 3 mp v Page Safetyv Toos x B e amp SNC sh 116 LE EB e Sign Comment ET Please select the form s you would like to complete gt rpm C Coronary Artery Disease Patient Care Treatment Form X Diabetes Patient Care Treatment Form C Congestive Heart Failure Patient Care Treatment Form Hypertension Patient Care Treatment Form 1 Surname z Given Name m Number Patient Information Patient Surname Patient Given Name Sex Date of Birth To select year Date of birth click on year i when calendai 4 E Registration 6 digits Personal health ID amp 9 digits E a m Um 2049 2059 Weight Kg Height cm Date completed 5 2080 2090 2100 Fesser E ae AR C Today 2014 03 28 Blood Pressure Measurement Date completed Target lt 140 90 or 3 N A Patient Age lt 18 130 80 with renal disease and or diabetes Fasting Lipid Profile patients age from 18 to 74 years
6. Colleen v Pursuing Excellence portal Manitoba Shortcuts v E Diagnostic Services Of Ma 8 Free Hotmail care chronicdisease docs patientcaretre O th gt 3 mp v Page Safetyy Toos Sign Comment Please select the form s you would like to complete C Coronary Artery Disease Patient Care Treatment Form C Congestive Heart Failure Patient Care Treatment Form Physician Information Patient Given Name Date of Birth To select year Date of birth click on year in header bar when calendar is opened C__ Registration 6 digits Personal health ID 9 a Weight Kg Height cm Date completed one Oee ee 0 0 Blood Pressure Measurement Date completed Target 140 90 or 3 N A Patient Age lt 18 lt 130 80 with renal disease and or diabetes Fasting Lipid Profile patients age from 18 to 74 years Target 2 0 mmol L Date completed 12 43 PM EN amp 4 f 245 Wf 2014 03 28 Page 5 of 15 Chronic Disease Management Tariffs eForm User Guide 2014 Field Rules The following field rules are embedded in the e Form to protect data integrity 1 Information common to all forms need only be entered once ex demographics blood pressure measurement 2 Date Completed various measurements require the user to enter a da
7. Manitoba 9 Health User Guide Chronic Disease Management Tariffs e Form Page 1 of 15 Chronic Disease Management Tariffs eForm User Guide 2014 Table of Contents Computer Requ lrements 3 n oer oen er e roten tue scene ae Wea ee reo Ee ee rae aeieea ii eeii re 3 Accessing the esFORITIG coiere reete retro RR rU SPEED nee E ASEE EAEE EE xs Etras eo ee engen Rese k 3 Du I dgentkllec lec 4 Completing the Chronic Disease Management Tariff e Form sess enne enhn enne 5 Fillable Non Fillable S CtiOnS cccccsccccccssecsssscsccecececsessnnececececessensaececsesesesenesaececececsesenneaeeeeesessesenteaeesesees 5 Field R l s 2 cite teet eese De een Teen ve exeo Ee dave Rae Re e Ta ERE deve exe a evo Ex eua 6 Error ZI CETERI IUD LM 7 Yes NO ReSpOTISeS iint eoo rir visio edid ed erbe kao Cede ee ED o ee Ee eR cH b e odo gelo Uu vg aee erede Eee ENT 8 Auto filled Fields 5 cr eterne dre eoe ipe E a en eee tree eae eue eee ve cede HERREN 10 Not Applicable or N A RESPONSES csccccsssceessecesseecsseeecsseceseecsaseeessececaeecesseecsaeeeeaaeceeseeesseeeesaeeeeasecesees 11 Chronic Disease Management Tariff e Form Functions eeesesesssseeeseee nennen nennen nnns nnne 13 SPART FONN m 13 uc C Rm 13 Millet el EDI LI LE ILE 13 nei BET M 14 Manitoba Help DESK teeosa eree eter be rm Ge rivi Ge attri i a
8. ars LDL TC HDL Date completed Target 2 0 mmol L Target 40 Coronary Artery Disease Patient Care Treatment Form 18to 74 years of age who have had an acute myocardial infarction do not have asthma and have been prescribed with a beta blocking medication 10 39 AM i EN a B i W oO 2014 04 07 Page 12 of 15 Chronic Disease Management Tariffs eForm User Guide 2014 Chronic Disease Management Tariff e Form Functions Print Form This function allows you to print a hard copy of the e Form NOTE If you would like a completed copy for your records please complete the form and print before submitting You cannot save a completed copy of this form on your computer Reset Form This function clears the form of the previously entered information so you can enter and submit an eForm for another patient Submit Form Once the e Form is complete click Submit A prompt will appear which directs the user to enter the verification code on the page prior to submission The verification code is not case sensitive Once the e Form has been successfully submitted you will see the following message thank you for submitting your information along with a confirmation number for future reference Record your confirmation number for future reference Page 13 of 15 Chronic Disease Management Tariffs eForm User Guide 2014 Helpful Tips e When entering Date of Birth select the calendar and
9. atment Form Chooseone of the following C Footexamination Date completed C N A Bilateral Amputation Management of document peripheral neuropathy HGRAiCtos Date comnleted Target 140 90 or 130 80 with renal disease and or diabetes 1 05 PM 2014 04 04 Ne a te Page 11 of 15 Chronic Disease Management Tariffs eForm User Guide 2014 In cases where age makes a question not applicable n a will be selected as soon as the date of birth is completed See example below patient is less than 18 years old and therefore blood pressure measurement and use of beta blocking medication on the coronary artery disease patient care treatment form become not applicable http www gov mb ca health primarycare chronicdisease docs patientcaretre JO S bet a primary ont File Edit Goto Favorites Help x J Colleen Pursuing Excellence portal J Manitoba Shortcuts Diagnostic Services Of Ma Free Hotmail m gt 3 d v Pagev Safetyv Tool v v Hl le Sign Comment Patient Given Name Sex Date of Birth To select year Date of birth click on year in header bar B ee eres Weight Kg ig H Date completed Blood Pressure Measurement Date completed Target 140 90 or 130 80 with renal disease and or diabetes Fasting Lipid Profile patients age from 18 to 74 ye
10. e isse be v diets 15 Page 2 of 15 Chronic Disease Management Tariffs eForm User Guide 2014 Computer Requirements e Adobe Reader and Internet Explorer The Chronic Disease Management Tariff e Form must be opened in an Internet browser in order to submit a completed form Note When accessing the e Form from Manitoba Health s website the e Form automatically opens in an Internet browser window Accessing the e Form 1 To access the e Form go to the following web address http Avww gov mb ca health primarycare chronicdisease cdmtariffs html 2 Click on the icon titled Patient Care Treatment Forms eForm Version B 3 The eForm will open and be ready for use when you click the icon 4 No password is required 5 Once the e Form is opened you can proceed to enter client data Page 3 of 15 Chronic Disease Management Tariffs eForm User Guide 2014 Are eForms Secure The Government of Manitoba Information Communication and Technology Services have developed a secure environment to collect information submitted through the internet Data is encrypted and flows through secure firewalls to the government repository Data is then retrieved by staff within the Department of Health and integrated into the database designed to house the CDM Patient Care Treatment data Network Architecture for Electronic Form Application Component Deployment Untrusted Zone External IIS Server Hosts Web Application
11. mation CC rm Patient Information Patient Given Name Sex Dateof Birth To selectyear Dateofbirth PF click on year in header bar when calendar is opened Registration 6 digits Personal health ID 9 Wei d Height cm Date completed INI 0 0 0 00 Blood Pressure Measurement Date completed Target 140 90 or IX N A Patient Age 18 130 80 with renal disease and or diabetes Fasting Lipid Profile patients age from 18 to 74 years Date Q g amp Patient Sumame LOL C Target lt 20mmoV L Congestive Heart Failure Patient Care Treatment Form Has the patient 1 03 PM 2014 04 04 Page 8 of 15 EN a id m D Chronic Disease Management Tariffs eForm User Guide 2014 The screen shot below illustrates the additional information that must be provided if no is selected in response to the same question i e whether the patient has been tested with ACE or ARB gov mb ca health primarycare chronicdisease docs patientcaretre JO S9ie File Edit Goto Favorites Help Colleen v E Pursuing Excellence portal p Manitoba Shortcuts v E Diagnostic Services Of Ma E Free Hotmail k a My v 3 v Pagev Safetyv Tools v e RBSM OL OSSh e B di Sign i Comment Coronary Artery Disease Patient Care Treatment Form Diabetes Patient Care Treatment Form X Congestive Heart Failure Patient
12. ng C Footexamination Date completed a N A Bilateral Amputation Management of document peripheral neurgetffhy 2014 02 26 HGB A1C test Date completed Target 2014 02 26 s B NA PatientAge lt 13 ONE igj p 10 5 fR Sign Comment 1 08 PM EN amp fis 7 4 Page 6 of 15 Chronic Disease Management Tariffs eForm User Guide 2014 2014 03 28 Error Messages 1 If an error is made when entering data the e Form will prompt you to fix the error See example below Qe Oss http www gov mb ca health primarycare chronicdisease docs patientcaretre JO B Chronic Disease Management gov mb ca x t ke 50 File p Colleen v ae Pursuing Excellence portal Manitoba Shortcuts Diagnostic Services Of Ma Free Hotmail i n7 v 3 d v Pagev Safety Toos y gBem ej eemr Ba g 2M Comment di E C Coronary Artery Disease Patient Care Treatment Form Diabetes Patient Care Treatment Form Congestive Heart Failure Patient Care Treatment Form X Hypertension Patient Care Treatment Form i amp Physician Information B Surname ES Given Name E Number Patient Sumame Registration 6 dits i n Ge in header bar wem 1 0 Registration 6 digits cannot be left blank NIE Blood Pressure Measurement EDU e m lt i rd ndor a
13. oto Favorites Help http www gov mb ca health primarycare chronicdisease docs patientcaretre JO 3 Colleen Pursuing Excellence portal J Manitoba Shortcuts Diagnostic Services Of Ma Free Hotmail z hy v 3 d v Pagev Safetyv Toos y B et 1 2 e amp 100 8 B ie Sign Comment is Coronary Artery Disease Patient Care Treatment FO XI Diabetes Patient Care Treatment Form X Congestive Heart Failure Patient Care Treatment Form C Hypertension Patient Care Treatment Form Physician Information Surname Given Name Number Patient Sumame Patient Given Name Sex Date of Birth To select year Date of birth click on year in header bar wecmemee Registration 6 digits Personal health ID 9 sas Height cm Date co INL EMI MEN a Blood Pressure Measurement Date com Saws 3 N A Patient Age 18 130 80 with renal disease and or diabetes Fasting Lipid Profile patients age from 18 to 74 years Ss S L 20mmol L L 4 mee Congestive Heart Failure Patient Care Treatment Form Has the patient been treated d S D with ACE or ARB C Yes C No Target Fasting blood sugar test fasting glucose Not tested patient has diabetes lt 10 mmol L bg SN A OW 2 14 PM 2014 04 04 Page 10 of 15 Chronic Disease Management Tariffs eForm User Guide
14. te to reflect when the test or measurement was performed The first date you enter will automatically populate the other required dates If you need to change the dates simply do so by clicking in the field to insert an alternate date A calendar is provided for all date fields eE http www gov mb ca health primary care chronicdisease docs patientcaretre JO f File Edit Goto Favorites Help J Colleen v Pursuing Excellence portal Manitoba Shortcuts Diagnostic Services Of Ma Free Hotmail i fh E d ov Pager Safety Took v Qv gBed 3 Coronary Artery Disease Patient Care Treatment Form Diabetes Patient Care Treatment Form C Congestive Heart Failure Patient Care Treatment Form Hypertension Patient Care Treatment Form Q G Ei Dateof birth Target 40 Patient Information Patient Given Name Sex Date of Birth To select year click on year in header bar when calendar is opened pinu Fasting Lipid Profile patients age from 18 to 74 years md TOHDL Diabetes Patient Care Treatment Form Physician Information LE a REREEEEEN Patient Sumame CNET eR FP mena c9 ne PR SE Blood Pressure Measurement Date completed Target 2010226 140 90 or C N A Patient Age 18 130 80 with renal disease and or diabetes LOL Date completed aa Target 20 mmol L Choose one of the followi
15. tt Fasting Lipid Profile patients age from 18 to 74 years LOL TCHDL Date completed L LL Ee Target 20mmol L Target 40 Diabetes Patient Care Treatment Form Choose one of the following C Foot examination Eu i N A Bilateral Amputation C Management of document peripheral neuropathy beans 73 HGB AIC test Date completed 2014 02 26 A C N A Patient Age lt 13 E Gu ou 1 11 PM EN a yas L D 2014 03 28 Page 7 of 15 Chronic Disease Management Tariffs eForm User Guide 2014 Yes No Responses Note both yes and no cannot be selected as a response to the same question 1 Additional information may be required when yes or no is selected in response to a question See example below related to Congestive Heart Failure When yes is selected in response the question Has the patient been tested with ACE or ARB the user is required to specify whether it was ACE or ARB and provide a date completed gov mb ca File Edit Goto Favorites Help Colleen v Pursuing Excellence portal J Manitoba Shortcuts v Diagnostic Services Of Ma amp Free Hotmail i hy vE dh v Pagev Safety Tool v Qv d Betm tei as eeir BB d Sign Comment Coronary Artery Disease Patient Care Treatment Form Diabetes Patient Care Treatment Form X Congestive Heart Failure Patient Care Treatment Form Hypertension Patient Care Treatment Form Physician Infor
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