Appendix C

Identification and Diagnosis Sheets

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PUBLIC AND PRIVATE IDENTIFICATION AND DIAGNOSIS SHEETS

Appendix C

Identification and Diagnosis Sheets

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How to Order Identification and Diagnosis (I&D) Sheets & Patient Activity Forms The QH Identification and Diagnosis Sheet and the QH Patient Activity Form are forms which have been developed by the Data Collections Unit and the Clinical Forms Management Project. They are only required for use by those facilities which provide inpatient facilities but do not have direct access to the HBCIS system. The back copy of the form enables data entry to HBCIS at another location. These forms are produced under a Standing Offer Arrangement between Queensland Health and Corporate Express Australia Ltd (SOA113-Clinical Forms). The details that need to be provided to identify the forms on a purchase order are as follows:

Form Title QH Identification & Diagnosis Sheet

QH Patient Activity Form

Form Number SW018 SW038

Material (FAMMIS) Number 10197143 10202672

Vendor part/Model Number 87130117 87200289

The forms are supplied in packs of 50 forms. In deciding how many forms to order, districts/facilities should bear in mind that the forms may be subject to annual review by mid-2011. They should also know that it is not necessary to order expected annual requirements in a single order if storage space is at a premium locally. Submitting the purchase order The supplier of the forms is Corporate Express Australia Ltd (CEAL) which is located in Richlands, Brisbane. Orders should be faxed to CEAL on fax number 3365 0899. For matters relating to ordering (but not for actually placing an order), CEAL’s phone number is 13 26 44 (Monday-Friday 0800-1730).

Appendix C

Identification and Diagnosis Sheets

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Public Hospitals

Appendix C

Identification and Diagnosis Sheets

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Appendix C

Identification and Diagnosis Sheets

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Private Hospitals

Appendix C

Identification and Diagnosis Sheets

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