Introduction
The AIC-HOME report page allows you to raise
a referral for the patient to be admitted to the AIC-HOME
service. AIC-HOME provides end-of-life
medical and nursing care, psychosocial support for patients and caregivers.
Prerequisites
- The AIC-HOME service is available
at certain hospitals only. These hospitals are listed at the time
of service selection, at the bottom-left corner of the page. For
more information, see Consent
for Creating Referral.
- The AIC-HOME
page is enabled when you select AIC-HOME
(palliative) service type.
Entering the AIC-HOME
Report Details
Proceed as follows:
| 1 |
On the
AIC-HOME tab,
enter the details as described in the table:
With a clinical diagnosis
of at least 1 of the following disease conditions:
Check
box name |
Description |
HEART FAILURE |
You
can select from the following (if applicable):
a) NYHA Class III/IV despite
maximal tolerated medical or surgical therapy AND
b) Any one of the following:
- Severe pulmonary hypertension
- Deteriorating clinical and functional status
as assessed by cardiologist
- 2 or more hospital admissions foe acute decompensated
heart failure within past 12 months
|
Respiratory Failure |
You
can select from the following (if applicable):
a) Dyspnoea at rest despite optimal treatment with
bronchilators
b) Repeated ED Visits or hospitalization for exacerbations
or pulmonary infections
c) Hypoxaemia on room air (PaO2 << 55mmHg or
O2 saturation < 88%) or hypercapnia (PCO2 >
50 mmHg) at baseline (in
between exacerbations)
d) FEVI < 30% (predicted)
and fulfils criteria for LTOT
- for COPD patients |
RENAL FAILURE |
You
can select from the following (if applicable):
a) GFR
<= 10lml/min per 1.73
m2; AND
b) Patient declines renal replacement
therapy or decision made to stop dialysis because
of medical reasons. |
Diagnosis |
Enter
the diagnosis in the textarea. |
Other
fields |
a)
Under Present Condition,
select one of the following:
- Stable
- Last days or hours
Select Yes
or No for
the following:
- Patient aware of diagnosis
- Family aware of diagnosis
- Patient aware of prognosis
- Family aware of prognosis
|
Additional
Information Section |
Enter
the following information pertaining to the doctor:
*Referring
Doctor
*Contact
Number
Consultant in Charge |
|
2
|
After
completing the AIC-HOME page, in the Completed
By section, you can update the name, designation, telephone,
email and date, accordingly.
 |
|
Note |
| |
By
default, the information of the user logged into IRMS
is populated. The information (name, telephone
number and so on) is based on the details available
in the user’s profile. |
|
3
|
When
the AIC-HOME page is ready,
you can do one of the following:
- Save -- to
save the AIC-HOME page
as draft.
You may want to use the save option, if the page is partially
populated or you do not want to submit it immediately.
- Ready -- to
save and mark the draft as ready to submit (indicated
by flag in orange).
|
|
Note |
| |
The
mandatory fields that are not entered properly are
indicated with asterisks (**). A message is displayed
on the top of the page to enter the required fields.
You cannot submit the page without completing the mandatory
fields. Once the page is submitted (indicated
by flag in green), you cannot modify the details. |
|
Related Tasks
Consent
for Creating Referral
Entering
the Service Application Details (Palliative)
