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[]
[null,"Adverse events Part A submission form"]
[null,"To be uploaded to the Health Quality & Safety Commission website within 15 working days from the date the event is notified to the provider"]
[null,null,"Mandatory fields"]
[]
[null,"Provider",null,null,{"$f":"IF(AND(Data!A2<>\"Other\",Data!B2<>0),\"! ... Please make sure the 'Other' provider is specified\",\"\")","v":""}]
[]
[null,"        If Other, please specify",null,null,{"$f":"IF(AND(Data!A2<>\"Other\",Data!B2<>0),\"! ... Please make sure the 'Other' provider is specified\",\"\")","v":""}]
[]
[]
[]
[null,"Internal reference code"]
[]
[null,null,"Date"]
[null,"Event date",null,null,{"$f":"IF(AND($C$15>$C$18,$C$15<>0,$C$18<>0),\"! ... Please make sure the dates are in the correct order\",\"\")","v":""}]
[]
[null,null,"Date"]
[null,"Internal notification date",null,null,{"$f":"IF(AND($C$15>$C$18,$C$15<>0,$C$18<>0),\"! ... Please make sure the dates are in the correct order\",\"\")","v":""}]
[]
[null,"Type of organisation"]
[null,"(Please select all that apply)"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,{"$f":"IF(AND(Data!O2<>0,NOT(Data!N2)),\"! ... Please select 'Other'\",\"\")","v":""}]
[]
[null,"Provisional event code (WHO code)"]
[]
[null,"Provisional SAC rating"]
[]
[]
[null,"On Always Report and Review list?",null,null,null,null,{"$f":"IF(AND(Data!U2=\"No\",Data!V2<>\"\"),\"! ... If the event is not on the Always Report and Review list, please select the blank category\",\"\")","v":""}]
[]
[null,"        If Yes, what was the Always Report and Review category?",null,null,null,null,{"$f":"IF(AND(Data!U2=\"No\",Data!V2<>\"\"),\"! ... If the event is not on the Always Report and Review list, please select the blank category\",\"\")","v":""}]
[]
[]
[null,"Other providers involved in the event (if any)"]
[]
[]
[null,"Description of event"]
[]
[]
[]
[]
[]
[null,"Did the patient die?",null,null,{"$f":"IF(AND(Data!AA2<>0,AND(Data!Z2=\"No\",Data!AA2=\"Death\")),\"! ... Please make sure these two answers match\",\"\")","v":""}]
[]
[null,"Patient outcome",null,null,{"$f":"IF(AND(Data!AA2<>0,AND(Data!Z2=\"No\",Data!AA2=\"Death\")),\"! ... Please make sure these two answers match\",\"\")","v":""}]
[]
[null,"        If Other, please specify",null,null,{"$f":"IF(AND(Data!AA2<>\"Other\",Data!AB2<>0),\"! ... Please make sure 'Other' is specified if there is a description of the patient outcome\",\"\")","v":""}]
[]
[]
[]
[null,"Clinical area",null,null,{"$f":"IF(AND(Data!AC2<>\"Other\",Data!AD2<>0),\"! ... Please make sure these two answers match\",\"\")","v":""}]
[null,"(Please select the area of care in which this event occurred. If the area is not provided, select \"Other\" and specify.)"]
[]
[null,"If Other, please specify",null,null,{"$f":"IF(AND(Data!AC2<>\"Other\",Data!AD2<>0),\"! ... Please make sure the 'Other' clinical area is specified\",\"\")","v":""}]
[]
[]
[]
[]
[null,"Age (years)"]
[]
[null,"Gender"]
[]
[null,"Ethnicity 1"]
[]
[null,"Ethnicity 2"]
[]
[null,"Ethnicity 3"]
[]
[]
[null,"This adverse event brief: part A has been approved for transmission to the Health Quality & Safety Commission by the organisation’s chief executive (or equivalent) or senior delegate who endorses the accuracy and content of the document on their behalf."]
[null,"Name"]
[]
[null,"Position"]
[]
[]
[null,"Any other information"]

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[null,"Provider","Type of organisation",null,"Age",null,"Sex",null,"Ethnicity",null,"Ethnicity 2",null,"Patient Outcome",null,"WHO codes",null,"Clinical Area",null,"ARR category","Macro to enable control boxes"]
[1,null,null,1,null,1,null,1,null,1,null,1,null,1,null,1,null,1,null,"Sub HideControlGroups()"]
[2,"Acurity _ Royston Hospital","Aged Care",2,"Not stated",2,"Female",2,"European",2,"European not further defined",2,"Death",2,"01 Clinical Administration",2,"Aged Residential Care",2,"Child/infant abduction or discharge to wrong family/whānau","    Form.GroupBoxes.Visible = False"]
[3,"Ascot Hospitals and Clinics","Ambulance Service",3,"Under 12 months",3,"Male",3,"Māori",3,"NZ European",3,"Fracture",3,"02 Clinical Process/Procedure",3,"Ambulance",3,"Retained foreign object post-procedure","End Sub"]
[4,"Auckland DHB","DHB",4,1,4,"Gender diverse",4,"Pacific Peoples",4,"Other European",4,"Head injury",4,"03 Documentation",4,"Cancer",4,"Wrong blood component"]
[5,"Avonlea Rest Home","Disability Services Provider",5,2,null,null,5,"Asian",5,"NZ Maori",5,"Hypoxic Ischemic Encephalopathy (HIE)",5,"04 Healthcare Associated Infection",5,"Cardiothoracics",5,"Wrong consumer/patient"]
[6,"Bay of Plenty DHB","Mental Health",6,3,null,null,6,"Middle Eastern/Latin American/African",6,"Pacific Island not further defined",6,"Other",6,"05 Medication/IV Fluids",6,"Community Mental Health",6,"Wrong implant/prosthesis"]
[7,"Boulcott Hospital","NGO",7,4,null,null,7,"Other Ethnicity",7,"Samoan",7,"Paralysis",7,"06 Blood/Blood Products",7,"Dental",7,"Wrong site"]
[8,"Canopy Cancer Care","PHO",8,5,null,null,8,"Residual Categories",8,"Cook Island Maori",8,"Pressure injury",8,"07 Nutrition",8,"Disability"]
[9,"Canterbury DHB","Private Medical/Surgical",9,6,null,null,null,null,9,"Tongan",9,"Progression of disease",9,"08 Oxygen/Gas/Vapour",9,"Emergency Department"]
[10,"Capital and Coast DHB","Other (please specify)",10,7,null,null,null,null,10,"Niuean",10,"Transferred to higher level care",10,"09 Medical Device/Equipment",10,"General Practice"]
[11,"Central PHO",null,11,8,null,null,null,null,11,"Tokelauan",null,null,11,"10 Behaviour",11,"Gynaecology"]
[12,"Counties Manukau DHB",null,12,9,null,null,null,null,12,"Fijian",null,null,12,"11 Patient Accidents",12,"Hospice"]
[13,"Diaverum NZ",null,13,10,null,null,null,null,13,"Other Pacific Island",null,null,13,"12 Falls",13,"ICU",null,null,null,"Yes/No"]
[14,"Forte Health",null,14,11,null,null,null,null,14,"Asian not further defined",null,null,14,"13 Infrastructure/Building/Fixtures",14,"Inpatient Mental Health",null,null,0]
[15,"Hauora Tairāwhiti",null,15,12,null,null,null,null,15,"Southeast Asian",null,null,15,"14 Resources/Organisational Management",15,"Laboratory",null,null,1,"Yes"]
[16,"Hawke's Bay DHB",null,16,13,null,null,null,null,16,"Chinese",null,null,null,null,16,"Maternity",null,null,2,"No"]
[17,"Hospice West Auckland",null,17,14,null,null,null,null,17,"Indian",null,null,null,null,17,"Medical"]
[18,"Hutt Valley DHB",null,18,15,null,null,null,null,18,"Other Asian",null,null,null,null,18,"Neonatal"]
[19,"Lady Joy",null,19,16,null,null,null,null,19,"Middle Eastern",null,null,null,null,19,"Ophthalmology"]
[20,"Lakes DHB",null,20,17,null,null,null,null,20,"Latin American / Hispanic",null,null,null,null,20,"Orthopaedic"]
[21,"Mary Potter Hospice",null,21,18,null,null,null,null,21,"African",null,null,null,null,21,"Other"]
[22,"Mercy Ascot",null,22,19,null,null,null,null,22,"Other",null,null,null,null,22,"Outpatient"]
[23,"MidCentral DHB",null,23,20,null,null,null,null,23,"Not stated",null,null,null,null,23,"PACU"]
[24,"Nelson Bays Primary Health",null,24,21,null,null,null,null,null,null,null,null,null,null,24,"Paediatrics"]
[25,"Nelson Marlborough DHB",null,25,22,null,null,null,null,null,null,null,null,null,null,25,"Perioperative"]
[26,"New Zealand Defence Force",null,26,23,null,null,null,null,null,null,null,null,null,null,26,"Radiology"]
[27,"Northland DHB",null,27,24,null,null,null,null,null,null,null,null,null,null,27,"Rehabilitation"]
[28,"Nurse Maude Hospice",null,28,25,null,null,null,null,null,null,null,null,null,null,28,"Surgical"]
[29,"Other",null,29,26,null,null,null,null,null,null,null,null,null,null,29,"Urology"]
[30,"Palms Aged Care",null,30,27,null,null,null,null,null,null,null,null,null,null,30,"Women's Health"]
[31,"South Canterbury DHB",null,31,28]
[32,"Southern DHB",null,32,29]
[33,"St George's",null,33,30]
[34,"St John Ambulance",null,34,31]
[35,"Taranaki DHB",null,35,32]
[36,"Te Oranganui Trust",null,36,33]
[37,"The Salvation Army Homecare",null,37,34]
[38,"Totara Hospice",null,38,35]
[39,"Waikato DHB",null,39,36]
[40,"Wairarapa DHB",null,40,37]
[41,"Waitemata DHB",null,41,38]
[42,"Wellington Free Ambulance",null,42,39]
[43,"West Coast DHB",null,43,40]
[44,"Whanganui DHB",null,44,41]
[null,null,null,45,42]
[null,null,null,46,43]
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[null,null,null,57,54]
[null,null,null,58,55]
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[null,null,null,71,68]
[null,null,null,72,69]
[null,null,null,73,70]
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[null,null,null,75,72]
[null,null,null,76,73]
[null,null,null,77,74]
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["Actual values"]
["Reference values"]