{"text_format":"1","workbook":"xlsx","n_sheets":3,"sheets":["Form","Lookups","Data"],"not_rendered":{"charts":0,"images":1,"macros":1,"external_links":0,"defined_names":57,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Form","index":0,"n_rows":65,"n_cols":5,"rows_kept":65,"cut":false,"hidden":false,"merged":[[61,1,61,3],[64,2,64,3],[62,2,62,3],[40,2,40,4],[41,2,41,4],[42,2,42,4],[43,2,43,4],[44,2,44,4],[49,1,52,1],[53,2,57,7],[45,2,45,4],[40,1,43,1],[1,1,1,3],[2,1,2,3],[23,2,23,3],[7,2,9,3],[5,2,5,3],[11,2,11,3],[21,2,21,3],[19,2,19,3],[28,2,28,3],[34,2,34,3],[26,2,26,3],[36,2,36,3],[38,2,38,3],[30,2,32,3]]}
[]
[null,"Adverse events Part B submission form"]
[null,"To be uploaded to the Health Quality & Safety Commission website within 70 working days from the date the event is notified to the provider"]
[null,null,"Mandatory fields"]
[]
[null,"Provider",null,null,{"$f":"IF(AND(Data!$A$2<>\"Other\",Data!$B$2<>\"\"),\"! ... Please make sure the 'Other' provider is specified\",\"\")","v":""}]
[]
[null,"        If Other, please specify",null,null,{"$f":"IF(AND(Data!$A$2<>\"Other\",Data!$B$2<>\"\"),\"! ... Please make sure the 'Other' provider is specified\",\"\")","v":""}]
[]
[]
[]
[null,"Internal reference code"]
[]
[]
[null,"SAC rating"]
[]
[]
[null,"Contact"]
[]
[null,"        Name"]
[]
[null,"        Phone number"]
[]
[null,"        Email"]
[]
[null,null,"Date"]
[null,"Date review completed"]
[]
[null,"Review methodology used"]
[]
[null,"        If Other, please specify",null,null,{"$f":"IF(AND(Data!$A$2<>\"Other\",Data!$B$2<>\"\"),\"! ... Please make sure the 'Other' provider is specified\",\"\")","v":""}]
[]
[]
[]
[null,"Final WHO event code 1"]
[]
[null,"Final WHO event code 2",null,null,{"$f":"IF(AND(Data!$A$2<>\"Other\",Data!$B$2<>\"\"),\"! ... Please make sure the 'Other' provider is specified\",\"\")","v":""}]
[]
[null,"Final WHO event code 3"]
[]
[null,"List of review recommendations, including changes to systems and processes"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Confirm review findings and recommendations have been shared with the consumer involved and their whānau."]
[]
[]
[]
[]
[null,"        If no, please explain why"]
[]
[]
[]
[]
[]
[null,"Sign off details"]
[null,"This adverse event brief: part B 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"]

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[null,"Provider",null,null,null,"Methodology",null,"WHO codes",null,null,"Yes/No",null,"Macro to enable control boxes"]
[1,null,null,null,1,null,null,null,null,0,null,null,"Sub HideControlGroups()"]
[2,"Acurity _ Royston Hospital",null,null,2,"Learning review",null,"_01_Clinical_Administration",null,1,"Yes",null,"    Form.GroupBoxes.Visible = False"]
[3,"Ascot Hospitals and Clinics",null,null,3,"London Protocol",null,"_02_Clinical_Process_or_Procedure",null,2,"No",null,"End Sub"]
[4,"Auckland DHB",null,null,4,"Root Cause Analysis",null,"_03_Documentation"]
[5,"Avonlea Rest Home",null,null,5,"Desk/file review",null,"_04_Healthcare_Associated_Infection"]
[6,"Bay of Plenty DHB",null,null,6,"Restorative practice",null,"_05_Medication_or_IV_Fluids"]
[7,"Boulcott Hospital",null,null,7,"Other",null,"_06_Blood_or_Blood_Products"]
[8,"Canopy Cancer Care",null,null,null,null,null,"_07_Nutrition"]
[9,"Canterbury DHB",null,null,null,null,null,"_08_Oxygen_or_Gas_or_Vapour"]
[10,"Capital and Coast DHB",null,null,null,null,null,"_09_Medical_Device_or_Equipment_or_Property"]
[11,"Central PHO",null,null,null,null,null,"_10_Behaviour"]
[12,"Counties Manukau DHB",null,null,null,null,null,"_11_Patient_Accidents"]
[13,"Diaverum NZ",null,null,null,null,null,"_12_Falls"]
[14,"Forte Health",null,null,null,null,null,"_13_Infrastructure_or_Building_or_Fixtures"]
[15,"Hauora Tairāwhiti",null,null,null,null,null,"_14_Resources_or_Organisational_Management"]
[16,"Hawke's Bay DHB"]
[17,"Hospice West Auckland"]
[18,"Hutt Valley DHB"]
[19,"Lady Joy"]
[20,"Lakes DHB"]
[21,"Mary Potter Hospice"]
[22,"Mercy Ascot",null,"_01_Clinical_Administration","_02_Clinical_Process_or_Procedure","_03_Documentation","_04_Healthcare_Associated_Infection","_05_Medication_or_IV_Fluids","_06_Blood_or_Blood_Products","_07_Nutrition","_08_Oxygen_or_Gas_or_Vapour","_09_Medical_Device_or_Equipment_or_Property","_10_Behaviour","_11_Patient_Accidents","_12_Falls","_13_Infrastructure_or_Building_or_Fixtures","_14_Resources_or_Organisational_Management"]
[23,"MidCentral DHB"]
[24,"Nelson Bays Primary Health",null,"_01___01_Process","_02___01_Process","_03___01_Process","_04___01_Type_of_Organism","_05___01_Medication_or_IV_Fluid_Involved","_06___01_Blood_or_Blood_Product_Involved","_07___01_Nutrition_Involved","_08___01_Oxygen_or_Gas_or_Vapour_Involved","_09___01_Type_of_Medical_Device_or_Equipment_or_Property","_10___01_Staff","_11___01_Blunt_Force","_12___01_Type_of_Fall","_13___01_Structure_or_Building_or_Fixture_Involved","_14___01_Matching_of_Workload_Management"]
[25,"Nelson Marlborough DHB",null,"_01___02_Problem","_02___02_Problem","_03___02_Problem","_04___02_Type_or_Site_of_Infection","_05___02_Medication_or_IV_Fluid_Use_Process","_06___02_Blood_or_Blood_Product_Use_Process","_07___02_Nutrition_Use_Process","_08___02_Oxygen_or_Gas_or_Vapour_Use_Process","_09___02_Problem","_10___02_Patient","_11___02_Piercing_or_Penetrating_Force","_12___02_Fall_Involving","_13___02_Problem","_14___02_Bed_or_Service_Availability_or_Adequacy"]
[26,"New Zealand Defence Force",null,null,null,null,null,"_05___03_Problem","_06___03_Problem","_07___03_Problem","_08___03_Problem",null,null,"_11___03_Other_Mechanical_Force",null,null,"_14___03_Human_Resource_or_Staff_Availability_or_Adequacy"]
[27,"Northland DHB",null,null,null,null,null,null,null,null,null,null,null,"_11___04_Thermal_Mechanism",null,null,"_14___04_Organisation_of_Teams_or_People"]
[28,"Nurse Maude Hospice",null,null,null,null,null,null,null,null,null,null,null,"_11___05_Threat_to_Breathing",null,null,"_14___05_Protocols_or_Policy_or_Procedure_or_Guideline_Availability_or_Adequacy"]
[29,"Other",null,null,null,null,null,null,null,null,null,null,null,"_11___06_Exposure_to_Chemical_or_Other_Substance"]
[30,"Palms Aged Care",null,null,null,null,null,null,null,null,null,null,null,"_11___07_Other_Specified_Mechanism_of_Injury"]
[31,"South Canterbury DHB",null,null,null,null,null,null,null,null,null,null,null,"_11___08_Exposure_to__Effect_of__Weather___Natural_Disaster__or_Other_Force_of_Nature"]
[32,"Southern DHB"]
[33,"St George's",null,"_01___01_Process","_01___02_Problem","_02___01_Process","_02___02_Problem","_03___01_Process","_03___02_Problem","_04___01_Type_of_Organism","_04___02_Type_or_Site_of_Infection","_05___01_Medication_or_IV_Fluid_Involved","_05___02_Medication_or_IV_Fluid_Use_Process","_05___03_Problem","_06___01_Blood_or_Blood_Product_Involved","_06___02_Blood_or_Blood_Product_Use_Process","_06___03_Problem","_07___01_Nutrition_Involved","_07___02_Nutrition_Use_Process","_07___03_Problem","_08___01_Oxygen_or_Gas_or_Vapour_Involved","_08___02_Oxygen_or_Gas_or_Vapour_Use_Process","_08___03_Problem","_09___01_Type_of_Medical_Device_Equipment_Property","_09___02_Problem","_10___01_Staff","_10___02_Patient","_11___01_Blunt_Force","_11___02_Piercing_or_Penetrating_Force","_11___03_Other_Mechanical_Force","_11___04_Thermal_Mechanism","_11___05_Threat_to_Breathing","_11___06_Exposure_to_Chemical_or_Other_Substance","_11___07_Other_Specified_Mechanism_of_Injury","_11___08_Exposure_to__Effect_of__Weather___Natural_Disaster__or_Other_Force_of_Nature","_12___01_Type_of_Fall","_12___02_Fall_Involving","_13___01_Structure_or_Building_or_Fixture_Involved","_13___02_Problem","_14___01_Matching_of_Workload_Management","_14___02_Bed_or_Service_Availability_or_Adequacy","_14___03_Human_Resource_or_Staff_Availability_or_Adequacy","_14___04_Organisation_of_Teams_or_People","_14___05_Protocols_or_Policy_or_Procedure_or_Guideline_Availability_or_Adequacy"]
[34,"St John Ambulance"]
[35,"Taranaki DHB",null,"_01_Handover","_01_Not_Performed_When_Indicated","_01_Screening_or_Prevention_or_Routine_Checkup","_01_Not_Performed_When_Indicated","_01_Orders_Requests","_01_Document_Missing_or_Unavailable","_01_Bacteria","_01_Bloodstream","_01_Medication_List","_01_Prescribing","_01_Wrong_Patient","_01_Cellular_Products","_01_Pre_Transfusion_Testing","_01_Wrong_Patient","_01_General_Diet","_01_Prescribing_or_Requesting","_01_Wrong_Patient","_01_Oxygen_or_Gas_or_Vapour_List","_01_Cylinder_Labeling_or_Colour_Coding_or_PIN_Indexing","_01_Wrong_Patient","_01_Medical_Device_or_Equipment_or_Property_List","_01_Poor_Presentation_or_Packaging","_01_Noncompliant_or_Uncooperative_or_Obstructive","_01_Noncompliant_or_Uncooperative_or_Obstructive","_01_Contact_with_Object_or_Animal","_01_Scratching_or_Cutting_or_Tearing_or_Severing","_01_Struck_by_Explosive_Blast","_01_Excessive_Heat_or_Fire","_01_Mechanical_Threat_to_Breathing","_01_Poisoning_by_Chemical_or_Other_Substance","_01_Exposure_to_Electicity_or_Radiation",null,"_01_Trip_or_Stumble","_01_Cot","_01_Structure_List","_01_Non_Existent_or_Inadequate"]
[36,"Te Oranganui Trust",null,"_02_Appointment","_02_Incomplete_or_Indadequate","_02_Diagnosis_or_Assessment","_02_Incomplete_or_Inadequate","_02_Charts_or_Medical_Records_or_Assessments_or_Consultations","_02_Delay_in_Accessing_Document","_02_Virus","_02_Surgical_Site","_02_IV_Fluid_List","_02_Preparation_or_Dispensing","_02_Wrong_Drug","_02_Clotting_Factors","_02_Prescribing","_02_Wrong_Blood_or_Blood_Product","_02_Special_Diet","_02_Preparation_or_Manufacturing_or_Cooking","_02_Wrong_Diet",null,"_02_Prescription","_02_Wrong_Gas_or_Vapour",null,"_02_Lack_of_Availability","_02_Inconsiderate_or_Rude_or_Hostile_or_Inappropriate","_02_Inconsiderate_or_Rude_or_Hostile_or_Inappropriate","_02_Contact_with_Person","_02_Puncturing_or_Stabbing","_02_Contact_with_Machinery","_02_Excessive_Cooling_or_Freezing","_02_Drowning_or_Survived_drowning","_02_Corrosion_by_Chemical_or_Other_Substance","_02_Exposure_to_Sound_or_Vibration",null,"_02_Slip","_02_Bed","_02_Building_List","_02_Damaged_or_Faulty_or_Worn"]
[37,"The Salvation Army Homecare",null,"_03_Waiting_List","_03_Unavailable","_03_Procedure_or_Treatment_or_Intervention","_03_Unavailable","_03_Check_Lists","_03_Document_for_Wrong_Patient_or_Wrong_Document","_03_Fungus","_03_Abscess",null,"_03_Presentation_or_Packaging","_03_Wrong_Dose_or_Strength_of_Frequency","_03_Albumin_or_Plasma_Protein","_03_Preparation_or_Dispensing","_03_Wrong_Dose_or_Frequency",null,"_03_Supply_or_Ordering","_03_Wrong_Quantity",null,"_03_Administration","_03_Wrong_Rate_or_Flow_or_Concentration",null,"_03_Inappropriate_for_Task","_03_Risky_or_Reckless_or_Dangerous","_03_Risky_or_Reckless_or_Dangerous","_03_Crushing","_03_Biting_or_Stinging_or_Invenomating",null,null,"_03_Confinement_to_Oxygen_Deficient_Place",null,"_03_Exposure_to_Air_Pressure",null,"_03_Collapse","_03_Chair","_03_Fixture_List"]
[38,"Totara Hospice",null,"_04_Referral_or_Consultation","_04_Wrong_Patient","_04_General_Care_or_Management","_04_Wrong_Patient","_04_Forms_or_Certificates","_04_Unclear_or_Ambiguous_or_Illegible_or_Incomplete_Information_in_Document","_04_Parasite","_04_Intravascular_Cannulae",null,"_04_Delivery","_04_Wrong_Formulation_or_Presentation","_04_Immunoglobin","_04_Delivery","_04_Wrong_Quantity",null,"_04_Presentation","_05_Wrong_Frequency",null,"_04_Delivery","_04_Wrong_Delivery_Mode",null,"_04_Unclean_or_Unsterile","_04_Problem_with_Substance_Use_or_Abuse","_04_Problem_with_Substance_Use_or_Abuse","_04_Abrading_Rubbing","_04_Other_Specified_Piercing_or_Penetrating_Force",null,null,null,null,"_04_Exposure_to_Low_Gravity",null,"_04_Loss_of_Balance","_04_Stretcher"]
[39,"Waikato DHB",null,"_05_Admission","_05_Wrong_Process_or_Service","_05_Tests_or_Investigations","_05_Wrong_Process_or_Treatment_or_Procedure","_05_Instructions_or_Information_or_Policies_or_Procedures_or_Guidelines",null,"_05_Protozoa","_05_Infected_Prosthesis_or_Site",null,"_05_Administration","_05_Wrong_Route",null,"_05_Administration","_05_Wrong_Dispensing_Label_or_Instruction",null,"_05_Dispensing_or_Allocation","_06_Wrong_Consistency",null,"_05_Supply_or_Ordering","_05_Contraindication",null,"_05_Failure_or_Malfunction","_05_Harrassment","_05_Harrassment",null,null,null,null,null,null,null,null,null,"_05_Toilet"]
[40,"Wairarapa DHB",null,"_06_Discharge",null,"_06_Specimens_or_Results","_06_Wrong_Body_Part_or_Side_or_Site","_06_Labels_or_Stickers_or_Identification_Bands_or_Cards",null,"__06_Rickettsia","_06_Urinary_Drain_or_Tube",null,"_06_Supply_or_Ordering","_06_Wrong_Quantity",null,"_06_Storage","_06_Contraindicated",null,"_06_Delivery","_07_Wrong_Storage",null,"_06_Storage","_06_Wrong_Storage",null,"_06_Dislodgement_or_Misconnection_or_Removal","_06_Discrimination_or_Prejudice","_06_Discrimination_or_Prejudice",null,null,null,null,null,null,null,null,null,"_06_Therapeutic_Equipment"]
[41,"Waitemata DHB",null,"_07_Transfer_of_Care",null,"_07_Detention_or_Restraint","_07_Retained_Product","_07_Letters_or_E_mails_or_Records_of_Communication",null,"_07_Causative_Organism_Not_Identified","_07_Soft_Tissue",null,"_07_Storage","_07_Wrong_Dispensing_Label_or_Instruction",null,"_07_Monitoring","_07_Wrong_Storage",null,"_07_Administration",null,null,null,"_07_Failure_to_Administer",null,"_07_User_Error","_07_Wandering_or_Absconding","_07_Wandering_or_Absconding",null,null,null,null,null,null,null,null,null,"_07_Stairs_or_Steps"]
[42,"Wellington Free Ambulance",null,"_08_Patient_Identification",null,null,null,"_08_Reports_or_Results_or_Images",null,null,null,null,"_08_Monitoring","_08_Contraindication",null,"_08_Presentation_or_Packaging","_08_Ommitted_Medicine_or_Dose",null,"_08_Storage",null,null,null,"_08_Contamination",null,null,"_08_Intended_Self_Harm_or_Suicide","_08_Intended_Self_Harm_or_Suicide",null,null,null,null,null,null,null,null,null,"_08_Being_Carried_or_Supported_by_Another_Individual"]
[43,"West Coast DHB",null,"_09_Consent",null,null,null,null,null,null,null,null,null,"_09_Wrong_Storage",null,"_09_Supply_or_Ordering","_09_Expired_Blood_or_Blood_Product",null,null,null,null,null,null,null,null,"_09_Verbal_Aggression","_09_Verbal_Aggression"]
[44,"Whanganui DHB",null,"_10_Task_Allocation",null,null,null,null,null,null,null,null,null,"_10_Ommitted_Medicine_or_Dose",null,null,"_10_Adverse_Effect",null,null,null,null,null,null,null,null,"_10_Physical_Assault","_10_Physical_Assault"]
[null,null,null,"_11_Response_to_Emergency",null,null,null,null,null,null,null,null,null,"_11_Expired_Medicine",null,null,null,null,null,null,null,null,null,null,null,"_11_Sexual_Assault","_11_Sexual_Assault"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"_12_Adverse_Drug_Reaction",null,null,null,null,null,null,null,null,null,null,null,"_12_Aggression_towards_an_inanimate_object","_12_Aggression_towards_an_inanimate_object"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"_13_Death_Threat","_13_Death_Threat"]

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["Provider","Other provider","Internal reference code","Provisional SAC rating ref","Part B SAC rating","Contact name","Contact phone number","Contact email address","Date review completed","Review methodology used","Other review methodology","Final WHO event code 1","Final WHO event code 2","Final WHO event code 3","Review recommendations 1","Review recommendations 2","Review recommendations 3","Review recommendations 4","Review recommendations 5","Review recommendations 6","Recommendations total","Consumer Participation Shared findings with consumer and whānau Response","Consumer Participation Shared findings with consumer and whānau","P2c No, explain why","Part B Name","Part B Position"]
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[]
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["Actual values"]
["Reference values"]