Taking a Military History from Your Patients (2 of 4)

General Questions

 Would it be Ok if I talked to you about your military experience?

 When and where did you/do you serve and in what branch?
 What type of work did you/do you do while in the service?
 Did you have any illnesses or injuries while in the service?

If your patient answers affirmatively to any of the general questions, ask:

"Can you tell me more about that?"

 Did you see combat, enemy fire, or casualties?

 Were you or a buddy wounded, injured or hospitalized?
 Did you have a head injury with loss of consciousness, loss of memory, "seeing stars" or being
temporarily disoriented?
 Did you ever become ill while you were in the service?
 Were you a prisoner of war?

Compensation and Benefits

 Do you have a service–connected condition?

 Would you like assistance in filing for compensation for injuries/illnesses related to your service?
(Call VA at 1–800–827–1000 or
844–MyVA311 (698–2311))

Living Situation

 Would it be OK to talk about your living situation?

 Where do you live and who do you live with?
 Is your housing safe?
 Are you in any danger of losing your housing?
 Do you need assistance in caring for yourself and/or dependents?

Sexual Harassment, Assault and Trauma

 Would it be OK to talk about sexual harassment or trauma that you might have experienced?
 Have you ever experienced physical, emotional, or sexual harassment or trauma?
 Is this experience causing you problems now?
 Would you like a referral? Many people find it helpful to get some support.
Blood Borne Viruses (Hepatitis & HIV)
 Do you have tattoos?
 Have you ever injected or snorted drugs such as heroin, cocaine, or methamphetamine?
 Have you ever been tested for Hepatitis C or HIV? Would you like a test?

Behavior
Would it be OK if we talked about emotional responses during your service?

PTSD: Have you been concerned that you might suffer from Post–Traumatic Stress Disorder? Symptoms
can include:

 Numbing
 Re–experiencing symptoms
 Hyperarousal/being on guard
 Avoiding situation that reminds you of trauma

Depression: Have you been experiencing:

 Feeling of hopelessness/helplessness
 Lack of energy
 Difficulty concentrating
 Poor sleep

Risk Assessment: Have you had thoughts of harming yourself or others?

Veterans Crisis Line 1–800–273–8255 (Press 1) or 1–844–MyVA311 (698-2311)

VA has seen a wide range of common service–connected medical injuries. Health risks associated with
specific military actions or periods include:

Select each item for more information.

 Gulf War/Southwest Asia (Afghanistan, Kuwait, Iraq)

 Animal Bites/Rabies
 Blunt Trauma, and Burn Injuries (Blast Injuries)
 Chemical or Biological Agents
 Chemical Munitions Demolition
 Combined Penetrating Injuries
 Depleted Uranium (DU)
 Dermatologic Issues
 Embedded Fragments (shrapnel)
  Malaria Preventiom: Mefloquine — Lariam
 Mental Health Issues
 Multi–Drug Resistant Acinetobacter
 Oil Well Fires
 Reproductive Health Issues
 Spinal Cord Injury
 Traumatic Amputation
 Traumatic Brain Injury (TBI)
 Vision Loss

 Vietnam, Korean DMZ, and Thailand
 Agent Orange exposure
 Hepatitis C Risks
 Cold Injuries

 Cold War

 Nuclear weapons testing or cleanup

 Chemical warfare agent experiments

 WWII and Korean War
 Cold Injuries
 Biological Warfare Agents
 Nuclear weapons testing or cleanup
 Chemical warfare agent experiments

All Eras

 Military Environmental Exposures

 Burn Pit Smoke
 Cold Injuries
 Contaminated Water (benzene, trichloroethylene, vinyl chloride)
 Endemic Diseases
 Heat Stroke/Exhaustion
 Hexavalent Chromium
 Mustard Gas
 Nerve Agents
  Pesticides
 Radiation (Ionizing and Non–Ionizing)
 Sand, Dust, Smoke and Particulates
 TCDD, Herbicides, and other dioxins
 Occupational Hazards: Asbestos, Industrial Solvents, Lead, Radiation, Fuels, PCBs,
Noise/Vibration, Chemical Agent Resistant Coating (CARC)


Consult Status and Lifecycle

A newly signed consult order will have a status of Pending.

 Consults should leave the Pending status as soon as possible

 Consults should not be in Pending status for more than 2 business days

Active means efforts are underway to Schedule the consult appointment.

Partial Results means that a Consult note has been initiated but not yet completed

.
There are 2 ways to link the progress note to the consult:

1. Consults Tab — Action, Consult Results…, Complete/Update Results…; and

2. Notes Tab — New note, Select a Consult note title, link to consult request.

Complete means that a Consult note has been linked and completed or the consult has been
administratively completed.

E–Consults do not require a face–to–face visit. E–consults should be received or moved from pending
status within 2 business days. Any consult may be completed as an E–consult if and appointment is not
needed. Use an E–consult when the sending provider does not complete necessary prerequisite tests
or treatments.

Future Care Consults request care more than 90–days in the future. Future care consults should not be
used to address issues of access or availability.

Mistakes to Avoid:

 Don’t forget to determine whether the patient you are seeing has an open consult
 Don’t choose a note title that will not close the consult
 Don’t leave an unsigned note in CPRS linked to a consult (e.g. if a patient cancels or no–shows
the appointment)

Discontinuing Consults: Consults should not be discontinued if action would cause risk to the patient.
Any discontinued consult must contain a reason for discontinuation.

Receiving providers can discontinue:

 If the patient does not respond to the minimum scheduling effort of two phone calls, one letter,
followed by a 14 day wait of no response from the patient
 If the patient refuses the service, has two or more cancellations or two or more no shows, or
passes away
 Care provided or scheduled to be provided in the community
 After a single no show for consults to Low Risk Clinics

Consults may be discontinued by the Sending Provider, at any point, after clinical review, with proper
documentation. See E–Consults for care not requiring a face–to–face visit.

Cancelling Consults: Consults should only be cancelled under limited circumstances where the sending
provider did not ask an appropriate consult question or if there is an
error within the consult. The sending provider may resubmit the consult with appropriate
information without having to start over.