Patient Comments Section

The Patient Comment(s) section is used to display, add, delete, or update any comments associated with a patient.

This section describes how to add a new comment to a patient record. Read the following instructions for an explanation on how to do this.

At the bottom of the patient comments section, click on the 'Patient Comment' pick list to display the available comments.
Select a comment from the list.
You may enter a Start Date if you wish. This would be a data that applies to the comment. Although this is not a required field, if it s not entered for a contraindication or immunity, the vaccine group will still be recommended.
You may enter an 'End Date' if you wish. This would be a date that the comment is no longer applicable. This is not a required field.
To add additional comments, click on the Add Comment button to add the current comment and select a new comment.
You must save the record to save any added comments. Click on the Save button in the upper right hand corner to save the record with the new comments.

This section describes how to delete an unwanted or incorrect comment. Read the following instructions for an explanation on how to do this.

The comment you would like to delete is listed in the patient comments Section.
Click on the 'Select' circle next to the comment you would like to delete to select it.
The information for he comment will appear at the bottom of the screen.
Next click on the Remove button to delete the comment.
You must save the record to save any deleted comments. Click on the Save button in the upper right hand corner to save the record.

Patient comments may affect the vaccines recommended in the patients selected tracking schedule.

Contraindication: Patient comments that indicate the patient should not receive a vaccine due to a previous reaction to the vaccine or vaccine component, a medical condition, such as an allergy, or if the patient or immediate family member is immunodeficient are called contraindications. When a certain type of vaccine is contraindicated because of an assigned comment, that vaccine should not be given to the patient. The contraindication will display "Contraindicated" on the Immunization History screens recommendation section for any vaccine group it is associated with the comment and the current date falls on or in between the comments start date and end date.

Precautions: Patient comments that note medical conditions, such as an allergy, or previous reactions that the clinician should be aware of but don't necessarily contraindicate vaccination are called precautions. Precautions will have no affect on the tracking schedule.

Serology Confirmed Immunity: Serology Confirmed immunity comments indicate that the patient has been laboratory tested and verified to have immunity to the disease. When an immunity comment is entered the vaccine group that is affected by the selected comment will show “IMMUNE to <antigen name>” in the recommendation section on the Immunization History screen and the current date falls on or in between the comments start date and end date.

History of Disease: History of Disease comments indicate the patient's has had the disease. A history of disease may infer immunity for some diseases but not for all. Some diseases have different types or the patient's immunity to a disease wanes over time, so the vaccine is still recommended as it provides additional protection against the disease. A history of disease for Hepatitis A, Hepatitis B, Varicella (chicken pox) or Measles, Mumps and Rubella will result “IMMUNE to <antigen name>” in the recommendation section on the Immunization History screen if the current date falls on or in between the comments start date and end date.

Note for MMR: Serologic confirmed immunity OR a history of disease comment for EACH of three antigens (Measles, Mumps and Rubella) comments must be entered for the patient to show immunity for MMR. IRIS follows the ACIP guidelines and considers patients born before January 1, 1957 are considered to be immune to Measles, Mumps and Rubella and are not routinely recommended for MMR vaccination.

Special Indication to Immunize: Vaccine Group may be recommended based on the patient having been exposed to the disease or other special indication. The special indication to immunize comment is entered, any vaccine group that is affected by the selected comment will be recommended as of the comment Start Date. In IRIS, the Patient has been exposed to Rabies comment will determine that a rabies post exposure series is recommended.

Clinician has Decided to Repeat Series: Providers can determine that a patient needs to restart a vaccine series. This may happen if the patient has received treatment for a disease in which the patient's previous immunity was compromised. When an repeat comment is entered any vaccine group that is affected by the selected comment will restart the series as of the comment Start Date. Only immunizations given on or after the Start Date will be applied to the series.

It is imperative to check a patients record for assigned comments before giving them any immunizations.

Comments with a Start Date are taken into consideration with the Reminder/Recall report.

Refusal: Patients may refuse to receive an immunization. The refusal may be for all immunizations or for a specific vaccine group. Refusals to not affect the vaccine groups recommended by the patient's selected tracking schedule.

Record Multiple Refusals: You now have the ability to record multiple refusals of the same vaccine group, provided you give each refusal its own Start Date If you attempt to record two refusals for the same vaccine group with the same Start Date, then the system will only file one. Also, if you attempt to record two refusals for the same vaccine group, one with an Start Date and the other without, then just the one with the Start Date will be saved. You should record a refusal for each dose refused. You have the option of generating the Assessment Report and Benchmarking Report with the 'Assess Patient s wit Sufficient Refusal History as Covered.'

Waiver comments will exempt the student from Idaho's school or childcare vaccine eligibility requirements for a school or childcare organization. Only users with a School/Childcare role can able to view, add and remove these Waiver comments. Waivers for a student are applicable to the organization that entered the waiver. A waiver owned by one organization cannot be viewed by other organizations and will not affect that patients eligibility status when viewed or reported by another organization.

School/Childcare users with the Enhanced role can view, add and remove all patient comments as well as waivers owned by the organization. School/Childcare users with a Standard role can view, add and remove Waiver comments owned by the organization, but can only view non-waiver comments.

Note: Users with a Non-School role can only view, add and remove non-waiver comments; they will not be able to view waiver comments.

The following waiver comments can be entered. Note the school or childcare must follow the Immunization School/Childcare guidelines for the approval and documentation of waivers.

Field Name	Description
Start Date	This is the date which the selected comment applies to. Assign or change the start date by typing the desired date into the 'Start Date' text box using the format MM/DD/YYYY, or click on the calendar icon to set the date.
End Date	This is the date which the selected comment ends. Assign or change the end date by typing the desired date into the 'End Date' text box using the format MM/DD/YYYY, or click on the calendar icon to set the date.