I have created a form with several spry tabbed panels. each tab is a series of quesitons. I would like my users to be able to click a "next" button to advance to the next panel when they have complete the questions on each panel.Each time i add code to the form I lose the tab feature. How can this be done? Here is the code for my form:
<%@LANGUAGE="JAVASCRIPT" CODEPAGE="65001"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "<html xmlns="<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>ObservationRoundsSubmit</title>
<link href="/ObservationRounds/ObservationRoundsCSS/oneColFixCtrHdr.css" rel="stylesheet" type="text/css" />
<script src="../SpryAssets/SpryTabbedPanels.js" type="text/javascript"></script>
<script src="../SpryAssets/SpryValidationTextField.js" type="text/javascript"></script>
<script src="../SpryAssets/SpryValidationSelect.js" type="text/javascript"></script>
<link href="../SpryAssets/SpryTabbedPanels.css" rel="stylesheet" type="text/css" />
<style type="text/css">
<!--
.style1 {
font-family: "Times New Roman", Times, serif;
font-weight: bold;
}
.style2 {
font-size: 24px
}
body {
background-color: #FFFFFF;
}
.style20 { font-size: 11px;
font-weight: bold;
}
-->
</style>
<link href="../SpryAssets/SpryValidationTextField.css" rel="stylesheet" type="text/css" />
<link href="../SpryAssets/SpryValidationSelect.css" rel="stylesheet" type="text/css" />
<style type="text/css">
<!--
.style21 {
color: #FFFFFF;
font-weight: bold;
font-size: 12px;
}
.style22 {color: #FFFFFF}
-->
</style>
<script type="text/javascript">
<!--
//-->
</script>
</head>
<body class="oneColFixCtrHdr">
<div id="container">
<div id="header">
<h1 align="center"><a href="/HOME_PAGE/index.html"><img src="/ObservationRounds/OB_ROUNDS_IMAGES/FPG Banner.gif" alt="FPGBanner" width="743" height="99" /></a></h1>
<!-- end #header --></div>
<div id="mainContent">
<h1 align="center" class="style2">Patient Safety Practice Observation Rounds</h1>
<p align="center" class="style2">Data Submission Form</p>
<form action="" method="post" name="form1" id="form1" >
<div id="TabbedPanelsObsRounds" class="TabbedPanels">
<ul class="TabbedPanelsTabGroup">
<li class="TabbedPanelsTab" tabindex="0">1 Survey Data</li>
<li class="TabbedPanelsTab" tabindex="0">2 Medical Record Components</li>
<li class="TabbedPanelsTab" tabindex="0">3 Health Screening Guidelines/Coordination of Care</li>
<li class="TabbedPanelsTab" tabindex="0">4 Compliance/Environment of Care</li>
<li class="TabbedPanelsTab" tabindex="0">5 Medication Management</li>
<li class="TabbedPanelsTab" tabindex="0">6 Patient Experience/Staff Development</li>
</ul>
<div class="TabbedPanelsContentGroup">
<div class="TabbedPanelsContent">
<table width="1110" border="1">
<tr bgcolor="#000066">
<td width="218" height="23"> </td>
<td colspan="2"> </td>
</tr>
<tr bgcolor="#FFFFFF">
<td height="26" class="style1"><p>Evaluation Date:</p></td>
<td colspan="2"><span id="spryEvaluationDate">
<input type="text" name="EvaluaionDate" id="EvaluaionDate" tabindex="1" />
<span class="textfieldRequiredMsg">A value is required.</span><span class="textfieldInvalidFormatMsg">Invalid format.</span></span></td>
</tr>
<tr bgcolor="#FFFFFF">
<td height="29" class="style1">Clinic Name:</td>
<td colspan="2"><span id="spryClinicName">
<select name="Clinic_Name" class="style20" id="Clinic_Name" tabindex="2">
<option selected="selected">Please Select a clinic</option>
<option value="Anes-SM Pain">Anesthesiology - SM Pain Mgmt </option>
<option value="Bowyer Oncology">Bowyer Oncology </option>
<option value="100 MP Comprehensive Health Program">Comprehensive Health Program </option>
<option value="CPN-Brentwood">CPN Brentwood </option>
<option value="CPN-Malibu">CPN Malibu </option>
<option value="CPN-ManhattanBch">CPN Manhattan Beach </option>
<option value="CPN-SM 12th">CPN SM 12th </option>
<option value="CPN SM 15th">CPN SM 15th </option>
<option value="CPN SM Park">CPN SM Park </option>
<option value="CPN-SM Peds">CPN SM Peds </option>
<option value="CPN-West Wash">CPN West Washington </option>
<option value="CPN-WLA Peds">CPN WLA Pediatrics </option>
<option value="Cardiodiagnostics">Kurlan Heart Center </option>
<option value="PCP-Les Kelley">Les Kelley </option>
<option value="Med-Oncology 100 MP 5th flr">Med 100 MP Hem Oncology </option>
<option value="Cardiomyopathy">Med Ahmanson Cardiomyopathy </option>
<option value="Med-CARE">Med CARE </option>
<option value="Med-SM Spec East/West">Med- East West Med </option>
<option value="100 MP Cardiology 545">Med-100 MP Cardiology 545 </option>
<option value="Med-Derm-SM">Med-Derm SM </option>
<option value="Med-Derm-WW">Med-Derm WW </option>
<option value="Med-100MPDigestive Disease">Med-Digestive Disease </option>
<option value="Med-Gonda Diabetes">Med-Gonda Diabetes </option>
<option value="Med-Hem/Onc Santa Clarita">Med-Hem/Onc Santa Clarita </option>
<option value="Med-Hem/Onc Westlake">Med-Hem/Onc Westlake </option>
<option value="Med-IM-100MP 455/490">Med-IM 100 MP 455 </option>
<option value="Med-IM-100MP 455/490">Med-IM 100 MP 490 </option>
<option value="Med-IM-WHC 250">Med-IM WHC 250 </option>
<option value="Med-IM-WHC-290">Med-IM WHC 290 </option>
<option value="Med-IM-200MP IM Primary Care">Med-IM-200 MP Primary Care </option>
<option value="MSS-Allergy/Immunology">Med-MSS Allergy/Immuno </option>
<option value="MSS-Asthma/Cough center">Med-MSS Asthma/Cough </option>
<option value="MSS-Cardiology">Med-MSS Cardiology </option>
<option value="MSS-Clinical Nutrition">Med-MSS Clinical Nutrition </option>
<option value="MSS-Digestive Disease">Med-MSS Digestive Disease </option>
<option value="MSS-Endocrinology">Med-MSS Endocrhinology </option>
<option value="MSS_Infect. Disease">Med-MSS Infectious Disease </option>
<option value="MSS-Internal Med">Med-MSS Internal Med </option>
<option value="MSS-Internal Medicine">Med-MSS Internal Medicine </option>
<option value="MSS-Nephrology">Med-MSS Nephrology </option>
<option value="MSS-Pulmonary">Med-MSS Pulmonary </option>
<option value="MSS-Rheumatology">Med-MSS Rheumatology </option>
<option value="MSS-Travel/Tropical Med">Med-MSS Travel/Tropical </option>
<option value="Med-Hem/Onc Pasadena">Med-Pasadena Hem/Onc </option>
<option value="Med-Hem/Onc SM">Med-SM Hem/Onc </option>
<option value="Med-SM IM 125">Med-SM IM #125 </option>
<option value="Med-SM-Spec-#204">Med-SM Spec #204 </option>
<option value="Med-SM-Spec-Wilshire">Med-SM Spec Wilshire </option>
<option value="Med-SM Spec-1245 16th #309">Med-SM Spec-1245 16th #309 </option>
<option value="Med-SM Spec-Cardio">Med-Sm Spec-Cardio </option>
<option value="Med-SM Spec - Nepherology">Med-SM Spec-Nepherology </option>
<option value="Med-WW Geriatrics">Med-WW Geriatrics</option>
<option value="Neuro-SM">Neuro-SM</option>
<option value="Neuro-WW">Neuro-WW</option>
<option value="OB/GYN-SM Tabash">OB/GYN - SM Tabash </option>
<option value="OB/GYN-Northridge Tabash">OB/GYN Tabash Northridge </option>
<option value="OB/GYN West Medical">OB/GYN West Medical</option>
<option value="OB/GYN 200 MP 4th floor">OB/GYN-200 MP 4th floor</option>
<option value="Ophth-JSEI">Ophth - JSEI</option>
<option value="Peds-CHC">Peds Childrens Health Center </option>
<option value="Pediatric Surgery">Peds Surgery</option>
<option value="Peds_Cardiology">Peds_Cardiology</option>
<option value="Peds_Neurology">Peds_Neurology</option>
<option value="Psych 300 MP">Psych 300 MP </option>
<option value="Rad Onc">Radiation Oncology</option>
<option value="Risk Factor Obesity clinic">Risk Factor Obesity</option>
<option value="Ortho-SM">SM Ortho</option>
<option value="SM_Spine">SM_Spine</option>
<option value="Surg-Cardiac">Surg - Cardiac</option>
<option value="Surg Plastic">Surg Plastic</option>
<option value="Surg-Uro/SM Gen Surg/Uro/Vasc">Surg Uro-SM Gen Surg/Vasc Surg</option>
<option value="Surg-Surgical Oncology">Surg_ Surg Oncology </option>
<option value="Surg-Head & Neck">Surg_Head and Neck</option>
<option value="Surg_Neuro">Surg_Neuro</option>
<option value="Surg-General PLI">Surg-General PLI</option>
<option value="Surg-Gonda Vasc">Surg-Gonda Vascular</option>
<option value="Surg-WW_Thoracic">Surg-WW_Thoracic</option>
<option value="URO - Peds">Urology </option>
</select>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
</tr>
<tr bgcolor="#FFFFFF">
<td height="34" class="style1">Evaluator Name:</td>
<td colspan="2"><span id="spryEvaluatorName">
<input type="text" name="EvaluatorName" id="EvaluatorName" tabindex="3" />
<span class="textfieldRequiredMsg">A value is required.</span></span></td>
</tr>
<tr bgcolor="#000066">
<td height="23" class="style1"> </td>
<td width="760"> </td>
<td width="92"> </td>
</tr>
</table>
</div>
<div class="TabbedPanelsContent">
<table width="1110" border="1" class="style1">
<tr bgcolor="#000066">
<th width="512" class="style20" scope="col"> </th>
<th width="271" scope="col"> </th>
<th width="353" scope="col"> </th>
</tr>
<tr bgcolor="#FFFF99" class="style1">
<td><div align="center"><strong>Medical Records Components</strong></div></td>
<td>Effective Practice</td>
<td>Comments</td>
</tr>
<tr bgcolor="#FFFFFF">
<td><p>Problem Summary List</p> </td>
<td><span id="spryProbSumList">
<label>
<select name="ProbSumList" id="ProbSumList" tabindex="1">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="ProbSumListCom" id="ProbSumListCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td><p>Medication Reconcilliation</p> </td>
<td><span id="spryMedRecon">
<label>
<select name="MedRecon" id="MedRecon" tabindex="2">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="MedReconCom" id="MedReconCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Patient Demographics (Two Patient Identifiers)</td>
<td><span id="spryPatDemo">
<select name="PatDemo" id="PatDemo" tabindex="3">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="PatDemoCom" id="PatDemoCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Advance Directives</td>
<td><span id="spryAdvDirec">
<select name="AdvDirec" id="AdvDirec" tabindex="4">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="AdvDirecCom" id="AdvDirecCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Allergy Status</td>
<td><span id="spryAllerStat">
<label>
<select name="AllerStat" id="AllerStat" tabindex="5">
<option>Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="AllerStatCom" id="AllerStatCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Functional Assessment</td>
<td><span id="spryFuncAsses">
<label>
<select name="FuncAsses" id="FuncAsses" tabindex="6">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="FuncAssesCom" id="FuncAssesCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>History (Health Maintenance records displayed in a prominent location)</td>
<td><span id="spryHistory">
<label>
<select name="History" id="History" tabindex="7">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="HistoryCom" id="HistoryCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Lifestyle Indicators (Lifestyle habits are assessed and patient is counseled</td>
<td><span id="spryLifeInd">
<label>
<select name="LifeInd" id="LifeInd" tabindex="8">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="LifeIndCom" id="LifeIndCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Physical Examination</td>
<td><span id="spryPhysExam">
<label>
<select name="PhysExam" id="PhysExam" tabindex="9">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="PhysExamCom" id="PhysExamCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Review of Systems</td>
<td><span id="spryRevSyst">
<label>
<select name="RevSyst" id="RevSyst" tabindex="10">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="RevSystCom" id="RevSystCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Signatures and Dates (AMA Authentication of notes)</td>
<td><span id="sprySignDate">
<label>
<select name="SignDate" id="SignDate" tabindex="11">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="SignDateCom" id="SignDateCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Health Counseling</td>
<td><span id="spryHealthCounsel">
<label>
<select name="HealthCounsel" id="HealthCounsel" tabindex="12">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="HealthCounselCom" id="HealthCounselCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Health Education</td>
<td><span id="spryHealthEdu">
<label>
<select name="HealthEdu" id="HealthEdu" tabindex="13">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="HealthEduCom" id="HealthEduCom" />
</label></td>
</tr>
<tr bgcolor="#000066">
<td> </td>
<td> </td>
<td><div align="right" class="style22"></div></td>
</tr>
</table>
</div>
<div class="TabbedPanelsContent">
<table width="1110" border="1" class="style1">
<tr bgcolor="#000066">
<th width="575" scope="col"> </th>
<th width="262" scope="col"> </th>
<th width="291" scope="col"> </th>
</tr>
<tr bgcolor="#FFFF99">
<td><div align="center">Health Screening Guidelines</div></td>
<td>Effective Practice</td>
<td>Comments</td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Health Screening Tracking Systems</td>
<td><span id="spryHealthScreen">
<label>
<select name="HealthScreen" id="HealthScreen" tabindex="1">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="HealthScreenCom" id="HealthScreenCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Immunizations</td>
<td><span id="spryImmun">
<label>
<select name="Immun" id="Immun" tabindex="2">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
<option value="N/A">N/A</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="ImmunCom" id="ImmunCom" />
</label></td>
</tr>
<tr bgcolor="#FFFF99">
<td><div align="center">Coordination Of Care</div></td>
<td> </td>
<td> </td>
</tr>
<tr bordercolor="#999999" bgcolor="#FFFFFF">
<td>A system for coverage review of test results in the absence of the ordering provider</td>
<td><span id="sprySystCovRev">
<label>
<select name="SystCovRev" id="SystCovRev" tabindex="3">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="SystCovRevCom" id="SystCovRevCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Evidence in the medical record that a follow-up plan is established with the patient for abnormal findings</td>
<td><span id="spryEvidFUAbFind">
<label>
<select name="EvidFUAbFind" id="EvidFUAbFind" tabindex="4">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="EvidFUAbFindCom" id="EvidFUAbFindCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>A system to reconcile ordered imaging tests</td>
<td><span id="sprySystReconImag">
<label>
<select name="SystReconImag" id="SystReconImag" tabindex="5">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="SystReconImagCom" id="SystReconImagCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>A system to reconcile ordered lab tests with outstanding requests</td>
<td><span id="sprySystReconOrdOut">
<label>
<select name="SystReconOrdOut" id="SystReconOrdOut" tabindex="6">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="SystReconOrdOutCom" id="SystReconOrdOutCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>A system is in place to notify all patients of test results and document the notification in the medical record</td>
<td><span id="sprySystNotifyPtsResu">
<label>
<select name="SystNotifyPtsResu" id="SystNotifyPtsResu" tabindex="7">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="SystNotifyPtsResuCom" id="SystNotifyPtsResuCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td bordercolor="#CCCCCC">Evidence to indicate that the provider has reviewed all test results</td>
<td><span id="spryProvRevTestRes">
<label>
<select name="ProvRevTestRes" id="ProvRevTestRes" tabindex="8">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="ProvRevTestResCom" id="ProvRevTestResCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Anticoagulation Patient Management Medication Dosage and Testing Process</td>
<td><span id="spryAntiCoagPtMngt">
<label>
<select name="AntiCoagPtMngt" id="AntiCoagPtMngt" tabindex="9">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
<option value="N/A">N/A</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="AntiCoagptMngtCom" id="AntiCoagptMngtCom" />
</label></td>
</tr>
<tr bgcolor="#000066">
<td> </td>
<td> </td>
<td> </td>
</tr>
</table>
</div>
<div class="TabbedPanelsContent">
<table width="1110" border="1" class="style1">
<tr bgcolor="#000066">
<th width="580" class="style1" scope="col"> </th>
<th width="260" scope="col"> </th>
<th width="297" scope="col"> </th>
</tr>
<tr bgcolor="#FFFF99">
<td><div align="center">Compliance</div></td>
<td>Effective Practice</td>
<td>Comments</td>
</tr>
<tr bgcolor="#FFFFFF">
<td>HIPPA</td>
<td><span id="spryHIPPA">
<label>
<select name="HIPPA" id="HIPPA" tabindex="1">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="HIPPACom" id="HIPPACom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Confict of Interest/Pharmaceutical, Medical Device, Marketing, and Gifts</td>
<td><span id="spryConflictIntPharmGift">
<label>
<select name="ConflictIntPharmGift" id="ConflictIntPharmGift" tabindex="2">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="ConflictIntPharmGiftCom" id="ConflictIntPharmGiftCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Red Flag - Medical Identity Protection (Patient Identification)</td>
<td><span id="spryRedFlagMedID">
<label>
<select name="RedFlagMedID" id="RedFlagMedID" tabindex="3">
<option selected="selected">Choose One</option>
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<th width="269" scope="col"> </th>
<th width="303" scope="col"> </th>
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<td><div align="center">Medication Management</div></td>
<td>Effective Practice</td>
<td>Comments</td>
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<td>Drug Information</td>
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</div>
</div>
</div>
</form>
<p> </p>
<p> </p>
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<p class="style1">Please contact webmaster at <a href="mailto:dquarles@mednet.ucla.edu">dquarles@mednet.ucla.edu</a> for questions or comments.</p>
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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "<html xmlns="<head>
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<h1 align="center" class="style2">Patient Safety Practice Observation Rounds</h1>
<p align="center" class="style2">Data Submission Form</p>
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<li class="TabbedPanelsTab" tabindex="0">2 Medical Record Components</li>
<li class="TabbedPanelsTab" tabindex="0">3 Health Screening Guidelines/Coordination of Care</li>
<li class="TabbedPanelsTab" tabindex="0">4 Compliance/Environment of Care</li>
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<option value="Bowyer Oncology">Bowyer Oncology </option>
<option value="100 MP Comprehensive Health Program">Comprehensive Health Program </option>
<option value="CPN-Brentwood">CPN Brentwood </option>
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<option value="CPN SM 15th">CPN SM 15th </option>
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<option value="CPN-West Wash">CPN West Washington </option>
<option value="CPN-WLA Peds">CPN WLA Pediatrics </option>
<option value="Cardiodiagnostics">Kurlan Heart Center </option>
<option value="PCP-Les Kelley">Les Kelley </option>
<option value="Med-Oncology 100 MP 5th flr">Med 100 MP Hem Oncology </option>
<option value="Cardiomyopathy">Med Ahmanson Cardiomyopathy </option>
<option value="Med-CARE">Med CARE </option>
<option value="Med-SM Spec East/West">Med- East West Med </option>
<option value="100 MP Cardiology 545">Med-100 MP Cardiology 545 </option>
<option value="Med-Derm-SM">Med-Derm SM </option>
<option value="Med-Derm-WW">Med-Derm WW </option>
<option value="Med-100MPDigestive Disease">Med-Digestive Disease </option>
<option value="Med-Gonda Diabetes">Med-Gonda Diabetes </option>
<option value="Med-Hem/Onc Santa Clarita">Med-Hem/Onc Santa Clarita </option>
<option value="Med-Hem/Onc Westlake">Med-Hem/Onc Westlake </option>
<option value="Med-IM-100MP 455/490">Med-IM 100 MP 455 </option>
<option value="Med-IM-100MP 455/490">Med-IM 100 MP 490 </option>
<option value="Med-IM-WHC 250">Med-IM WHC 250 </option>
<option value="Med-IM-WHC-290">Med-IM WHC 290 </option>
<option value="Med-IM-200MP IM Primary Care">Med-IM-200 MP Primary Care </option>
<option value="MSS-Allergy/Immunology">Med-MSS Allergy/Immuno </option>
<option value="MSS-Asthma/Cough center">Med-MSS Asthma/Cough </option>
<option value="MSS-Cardiology">Med-MSS Cardiology </option>
<option value="MSS-Clinical Nutrition">Med-MSS Clinical Nutrition </option>
<option value="MSS-Digestive Disease">Med-MSS Digestive Disease </option>
<option value="MSS-Endocrinology">Med-MSS Endocrhinology </option>
<option value="MSS_Infect. Disease">Med-MSS Infectious Disease </option>
<option value="MSS-Internal Med">Med-MSS Internal Med </option>
<option value="MSS-Internal Medicine">Med-MSS Internal Medicine </option>
<option value="MSS-Nephrology">Med-MSS Nephrology </option>
<option value="MSS-Pulmonary">Med-MSS Pulmonary </option>
<option value="MSS-Rheumatology">Med-MSS Rheumatology </option>
<option value="MSS-Travel/Tropical Med">Med-MSS Travel/Tropical </option>
<option value="Med-Hem/Onc Pasadena">Med-Pasadena Hem/Onc </option>
<option value="Med-Hem/Onc SM">Med-SM Hem/Onc </option>
<option value="Med-SM IM 125">Med-SM IM #125 </option>
<option value="Med-SM-Spec-#204">Med-SM Spec #204 </option>
<option value="Med-SM-Spec-Wilshire">Med-SM Spec Wilshire </option>
<option value="Med-SM Spec-1245 16th #309">Med-SM Spec-1245 16th #309 </option>
<option value="Med-SM Spec-Cardio">Med-Sm Spec-Cardio </option>
<option value="Med-SM Spec - Nepherology">Med-SM Spec-Nepherology </option>
<option value="Med-WW Geriatrics">Med-WW Geriatrics</option>
<option value="Neuro-SM">Neuro-SM</option>
<option value="Neuro-WW">Neuro-WW</option>
<option value="OB/GYN-SM Tabash">OB/GYN - SM Tabash </option>
<option value="OB/GYN-Northridge Tabash">OB/GYN Tabash Northridge </option>
<option value="OB/GYN West Medical">OB/GYN West Medical</option>
<option value="OB/GYN 200 MP 4th floor">OB/GYN-200 MP 4th floor</option>
<option value="Ophth-JSEI">Ophth - JSEI</option>
<option value="Peds-CHC">Peds Childrens Health Center </option>
<option value="Pediatric Surgery">Peds Surgery</option>
<option value="Peds_Cardiology">Peds_Cardiology</option>
<option value="Peds_Neurology">Peds_Neurology</option>
<option value="Psych 300 MP">Psych 300 MP </option>
<option value="Rad Onc">Radiation Oncology</option>
<option value="Risk Factor Obesity clinic">Risk Factor Obesity</option>
<option value="Ortho-SM">SM Ortho</option>
<option value="SM_Spine">SM_Spine</option>
<option value="Surg-Cardiac">Surg - Cardiac</option>
<option value="Surg Plastic">Surg Plastic</option>
<option value="Surg-Uro/SM Gen Surg/Uro/Vasc">Surg Uro-SM Gen Surg/Vasc Surg</option>
<option value="Surg-Surgical Oncology">Surg_ Surg Oncology </option>
<option value="Surg-Head & Neck">Surg_Head and Neck</option>
<option value="Surg_Neuro">Surg_Neuro</option>
<option value="Surg-General PLI">Surg-General PLI</option>
<option value="Surg-Gonda Vasc">Surg-Gonda Vascular</option>
<option value="Surg-WW_Thoracic">Surg-WW_Thoracic</option>
<option value="URO - Peds">Urology </option>
</select>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
</tr>
<tr bgcolor="#FFFFFF">
<td height="34" class="style1">Evaluator Name:</td>
<td colspan="2"><span id="spryEvaluatorName">
<input type="text" name="EvaluatorName" id="EvaluatorName" tabindex="3" />
<span class="textfieldRequiredMsg">A value is required.</span></span></td>
</tr>
<tr bgcolor="#000066">
<td height="23" class="style1"> </td>
<td width="760"> </td>
<td width="92"> </td>
</tr>
</table>
</div>
<div class="TabbedPanelsContent">
<table width="1110" border="1" class="style1">
<tr bgcolor="#000066">
<th width="512" class="style20" scope="col"> </th>
<th width="271" scope="col"> </th>
<th width="353" scope="col"> </th>
</tr>
<tr bgcolor="#FFFF99" class="style1">
<td><div align="center"><strong>Medical Records Components</strong></div></td>
<td>Effective Practice</td>
<td>Comments</td>
</tr>
<tr bgcolor="#FFFFFF">
<td><p>Problem Summary List</p> </td>
<td><span id="spryProbSumList">
<label>
<select name="ProbSumList" id="ProbSumList" tabindex="1">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="ProbSumListCom" id="ProbSumListCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td><p>Medication Reconcilliation</p> </td>
<td><span id="spryMedRecon">
<label>
<select name="MedRecon" id="MedRecon" tabindex="2">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="MedReconCom" id="MedReconCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Patient Demographics (Two Patient Identifiers)</td>
<td><span id="spryPatDemo">
<select name="PatDemo" id="PatDemo" tabindex="3">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="PatDemoCom" id="PatDemoCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Advance Directives</td>
<td><span id="spryAdvDirec">
<select name="AdvDirec" id="AdvDirec" tabindex="4">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="AdvDirecCom" id="AdvDirecCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Allergy Status</td>
<td><span id="spryAllerStat">
<label>
<select name="AllerStat" id="AllerStat" tabindex="5">
<option>Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="AllerStatCom" id="AllerStatCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Functional Assessment</td>
<td><span id="spryFuncAsses">
<label>
<select name="FuncAsses" id="FuncAsses" tabindex="6">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="FuncAssesCom" id="FuncAssesCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>History (Health Maintenance records displayed in a prominent location)</td>
<td><span id="spryHistory">
<label>
<select name="History" id="History" tabindex="7">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="HistoryCom" id="HistoryCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Lifestyle Indicators (Lifestyle habits are assessed and patient is counseled</td>
<td><span id="spryLifeInd">
<label>
<select name="LifeInd" id="LifeInd" tabindex="8">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="LifeIndCom" id="LifeIndCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Physical Examination</td>
<td><span id="spryPhysExam">
<label>
<select name="PhysExam" id="PhysExam" tabindex="9">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="PhysExamCom" id="PhysExamCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Review of Systems</td>
<td><span id="spryRevSyst">
<label>
<select name="RevSyst" id="RevSyst" tabindex="10">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="RevSystCom" id="RevSystCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Signatures and Dates (AMA Authentication of notes)</td>
<td><span id="sprySignDate">
<label>
<select name="SignDate" id="SignDate" tabindex="11">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="SignDateCom" id="SignDateCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Health Counseling</td>
<td><span id="spryHealthCounsel">
<label>
<select name="HealthCounsel" id="HealthCounsel" tabindex="12">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="HealthCounselCom" id="HealthCounselCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Health Education</td>
<td><span id="spryHealthEdu">
<label>
<select name="HealthEdu" id="HealthEdu" tabindex="13">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="HealthEduCom" id="HealthEduCom" />
</label></td>
</tr>
<tr bgcolor="#000066">
<td> </td>
<td> </td>
<td><div align="right" class="style22"></div></td>
</tr>
</table>
</div>
<div class="TabbedPanelsContent">
<table width="1110" border="1" class="style1">
<tr bgcolor="#000066">
<th width="575" scope="col"> </th>
<th width="262" scope="col"> </th>
<th width="291" scope="col"> </th>
</tr>
<tr bgcolor="#FFFF99">
<td><div align="center">Health Screening Guidelines</div></td>
<td>Effective Practice</td>
<td>Comments</td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Health Screening Tracking Systems</td>
<td><span id="spryHealthScreen">
<label>
<select name="HealthScreen" id="HealthScreen" tabindex="1">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="HealthScreenCom" id="HealthScreenCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Immunizations</td>
<td><span id="spryImmun">
<label>
<select name="Immun" id="Immun" tabindex="2">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
<option value="N/A">N/A</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="ImmunCom" id="ImmunCom" />
</label></td>
</tr>
<tr bgcolor="#FFFF99">
<td><div align="center">Coordination Of Care</div></td>
<td> </td>
<td> </td>
</tr>
<tr bordercolor="#999999" bgcolor="#FFFFFF">
<td>A system for coverage review of test results in the absence of the ordering provider</td>
<td><span id="sprySystCovRev">
<label>
<select name="SystCovRev" id="SystCovRev" tabindex="3">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="SystCovRevCom" id="SystCovRevCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Evidence in the medical record that a follow-up plan is established with the patient for abnormal findings</td>
<td><span id="spryEvidFUAbFind">
<label>
<select name="EvidFUAbFind" id="EvidFUAbFind" tabindex="4">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="EvidFUAbFindCom" id="EvidFUAbFindCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>A system to reconcile ordered imaging tests</td>
<td><span id="sprySystReconImag">
<label>
<select name="SystReconImag" id="SystReconImag" tabindex="5">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="SystReconImagCom" id="SystReconImagCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>A system to reconcile ordered lab tests with outstanding requests</td>
<td><span id="sprySystReconOrdOut">
<label>
<select name="SystReconOrdOut" id="SystReconOrdOut" tabindex="6">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="SystReconOrdOutCom" id="SystReconOrdOutCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>A system is in place to notify all patients of test results and document the notification in the medical record</td>
<td><span id="sprySystNotifyPtsResu">
<label>
<select name="SystNotifyPtsResu" id="SystNotifyPtsResu" tabindex="7">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="SystNotifyPtsResuCom" id="SystNotifyPtsResuCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td bordercolor="#CCCCCC">Evidence to indicate that the provider has reviewed all test results</td>
<td><span id="spryProvRevTestRes">
<label>
<select name="ProvRevTestRes" id="ProvRevTestRes" tabindex="8">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="ProvRevTestResCom" id="ProvRevTestResCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Anticoagulation Patient Management Medication Dosage and Testing Process</td>
<td><span id="spryAntiCoagPtMngt">
<label>
<select name="AntiCoagPtMngt" id="AntiCoagPtMngt" tabindex="9">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
<option value="N/A">N/A</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="AntiCoagptMngtCom" id="AntiCoagptMngtCom" />
</label></td>
</tr>
<tr bgcolor="#000066">
<td> </td>
<td> </td>
<td> </td>
</tr>
</table>
</div>
<div class="TabbedPanelsContent">
<table width="1110" border="1" class="style1">
<tr bgcolor="#000066">
<th width="580" class="style1" scope="col"> </th>
<th width="260" scope="col"> </th>
<th width="297" scope="col"> </th>
</tr>
<tr bgcolor="#FFFF99">
<td><div align="center">Compliance</div></td>
<td>Effective Practice</td>
<td>Comments</td>
</tr>
<tr bgcolor="#FFFFFF">
<td>HIPPA</td>
<td><span id="spryHIPPA">
<label>
<select name="HIPPA" id="HIPPA" tabindex="1">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="HIPPACom" id="HIPPACom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Confict of Interest/Pharmaceutical, Medical Device, Marketing, and Gifts</td>
<td><span id="spryConflictIntPharmGift">
<label>
<select name="ConflictIntPharmGift" id="ConflictIntPharmGift" tabindex="2">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="ConflictIntPharmGiftCom" id="ConflictIntPharmGiftCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Red Flag - Medical Identity Protection (Patient Identification)</td>
<td><span id="spryRedFlagMedID">
<label>
<select name="RedFlagMedID" id="RedFlagMedID" tabindex="3">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="RedflagmedIDCom" id="RedflagmedIDCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Rights and Responsibilities Posters</td>
<td><span id="spryRightRespPost">
<label>
<select name="RightRespPost" id="RightRespPost" tabindex="4">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="rightRespPostCom" id="rightRespPostCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Patient Privacy Posters</td>
<td><span id="spryPatPrivPost">
<label>
<select name="PatPrivPost" id="PatPrivPost" tabindex="5">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="PatPrivPostCom" id="PatPrivPostCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Release of Medical Record Information</td>
<td><span id="spryReleaseMedRec">
<label>
<select name="ReleaseMedRec" id="ReleaseMedRec" tabindex="6">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="ReleaseMedrecCom" id="ReleaseMedrecCom" />
</label></td>
</tr>
<tr bgcolor="#FFFF99">
<td><div align="center">Environment of Care</div></td>
<td> </td>
<td> </td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Hazardous Materials (Current MSDS Binder available)</td>
<td><span id="spryHazmat">
<label>
<select name="HazMat" id="HazMat" tabindex="7">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="HazMatCom" id="HazMatCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Fire Safety</td>
<td><span id="spryFireSafe">
<label>
<select name="FireSafe" id="FireSafe" tabindex="8">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="FireSafeCom" id="FireSafeCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Aisles and exits clear and unabstructed</td>
<td><span id="spryAisleExit">
<label>
<select name="AisleExit" id="AisleExit" tabindex="9">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="AisleExitCom" id="AisleExitCom" />
</label></td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Infection Control: Hand washing</td>
<td><span id="spryInfectCont">
<label>
<select name="InfectCont" id="InfectCont" tabindex="10">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</label>
<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="InfectContCom" id="InfectContCom" />
</label></td>
</tr>
<tr bgcolor="#000066">
<td> </td>
<td> </td>
<td> </td>
</tr>
</table>
</div>
<div class="TabbedPanelsContent">
<table width="1107" border="1" bgcolor="#FFFFFF" class="style1">
<tr bgcolor="#000066">
<th width="555" scope="col"> </th>
<th width="269" scope="col"> </th>
<th width="303" scope="col"> </th>
</tr>
<tr bgcolor="#FFFF99">
<td><div align="center">Medication Management</div></td>
<td>Effective Practice</td>
<td>Comments</td>
</tr>
<tr bgcolor="#FFFFFF">
<td>Drug Information</td>
<td><span id="spryDrugInfo">
<label>
<select name="DrugInfo" id="DrugInfo" tabindex="1">
<option selected="selected">Choose One</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
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<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
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<td>Emergency Medication</td>
<td><span id="spryEmergMed">
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<option value="Yes">Yes</option>
<option value="No">No</option>
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<td><label>
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<td>Medication Safety and Security</td>
<td><span id="spryMedSafeSecu">
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<option value="No">No</option>
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<td>Sample Medications* Sample Labeling, Documentation and Education</td>
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<span class="selectRequiredMsg">Please select an item.</span></span></td>
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<td>Narcotics</td>
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<option value="Yes">Yes</option>
<option value="No">No</option>
<option value="N/A">N/A</option>
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<td> </td>
<td> </td>
<td> </td>
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<th width="592" scope="col"> </th>
<th width="261" scope="col"> </th>
<th width="283" scope="col"> </th>
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<tr bgcolor="#FFFF99">
<td><div align="center">Patient Experience</div></td>
<td>Effective Practice</td>
<td>Comments</td>
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<tr bgcolor="#FFFFFF">
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<td>Posted Hours of Operations</td>
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<td><label>
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<td><span id="spryBusHrsAfterHrs">
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<td><div align="center">Staff Development</div></td>
<td> </td>
<td> </td>
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<td>Emergency Preparedness - HICS, Kits and E-Notify</td>
<td><span id="spryEmergPrep">
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<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
<input type="text" name="EmergPrepCom" id="EmergPrepCom" />
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<td>Staff Education - Skills, Competencies and Orientation</td>
<td><span id="spryStaffEdu">
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<select name="Staff Edu" id="Staff Edu" tabindex="10">
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<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
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<td>Staff Meetings (Agenda, Minutes)</td>
<td><span id="spryStaffMtg">
<label>
<select name="StaffMtg" id="StaffMtg" tabindex="11">
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<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
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<tr bgcolor="#FFFFFF">
<td>Emergency Medical Response (who to call)</td>
<td><span id="spryEmergMedResp">
<label>
<select name="EmergMedResp" id="EmergMedResp" tabindex="12">
<option selected="selected">Choose One</option>
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<span class="selectRequiredMsg">Please select an item.</span></span></td>
<td><label>
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</table>
</div>
</div>
</div>
</form>
<p> </p>
<p> </p>
</div>
<div id="footer">
<p class="style1">Please contact webmaster at <a href="mailto:dquarles@mednet.ucla.edu">dquarles@mednet.ucla.edu</a> for questions or comments.</p>
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