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REGION EXAMINED
CHEST X-RAY
Indications: SOB
CHEST: There is mild to moderate pulmonary vascular congestion. There is mild bilateral interstitial
edema. The findings are less prominent than on 1-1-xx. No focal consolidation is seen in
the lungs.
WCR/smb
Instructions: Please follow the instructions given below. This is an important part of your continued
recovery. If, after reading the instructions, you have any questions please ask your physician/nurse for
clarification.
Medications: Diazepam 20 mg p.o. q.h.s., albuterol and Atrovent nebulizers q.d. and p.r.n., Lasix 160
mg p.o. b.i.d.; Theo-Dur 200 mg q.a.m., 300 mg q.h.s.; Imdur 30 mg (1/2 tab) q.h.s., Pilocarpine 4% 1
drop O.D. q.i.d., nitroglycerin 0.4 mg sublingual p.r.n. chest pain, oxygen 2 to 4 liters per minute per nasal
cannula. Diabetes meds will be: Humulin N 64 U a.m., Humulin N 36 U p.m. and Humalog sliding scale:
Activity: As tolerated.
two weeks for recheck. He should call or come in sooner if he has any questions or
I have read the above instructions and received a copy of them. They were explained to me and all my
questions were answered satisfactorily.
a.m.
Edward C. Newman 8/14/xx 6:45 p.m. William J. Wainwright
Patient's Signature Date Time Attending Physician
8/16 @ 0650
MOM 30 cc p.o. QP p.r.n.
S.O. Dr. Wainwright, A. May, RN
William J. Wainwright
8/16 Discharge
Meds: Humulin N 64 U a.m.
Humulin N 36 U p.m.
Humalog sliding scale
Accu-Chek
William J. Wainwright
Units
< 100 = 0
101 - 130 = 3
131 - 170 = 5
171 - 220 = 8
221 - 300 = 12
301 - 400 = 15
> 400 = 18
Diazepam 20 mg p.o. q.h.s.
albuterol & Atrovent SVN’s q.i.d. & p.r.n.
Lasix 160 mg p.o. b.i.d.
Theo-Dur 200 mg q.a.m., 300 mg q.h.s.
Imdur 30 mg (1/2 tab) q.h.s.
Pilocarpine 4% 1 drop O.D. q.i.d.
nitroglycerin 0.4 mg SL p.r.n. chest pain
O2 2 to 4 L/m N.C.
Appt. my office - 2 wks
William J. Wainwright
0900 Lisinopril 20 mg p.o. now given per order, Lasix 80 mg IV now given per order.
Brenda Kellye, RN
1900 Summary Appetite good. Denies pain. Resting quietly. Wife @ bedside. Rhythm unchanged.
Leslie Scorch, RN
2200 Summary Uneventful evening, denies pain. Does become SOB with activity, respirations
easy @ rest. No c/o. Leslie Scorch, RN
8/15/xx
0115 SOB Resting awake in bed, had “Charley Horse” in leg. Better now, but dyspneic, resp
30/m et breathing rapidly, feels winded. LS dim throughout with left base crackles. Patient
quite anxious. Robert K. Russo, RN
0130 Breathing easier, increased air exchange throughout. Lungs fields with bibasilar crackles now.
Feeling better, remains anxious. Robert K. Russo, RN
0600 Awakened for assessment, had been sleeping. Becomes dyspneic on exertion with mild
dyspnea with rest. LS remains dim throughout. Crackles lower 1/2 left and 1/4 left.
Admits to feeling SOB, wants treatment. Robert K. Russo, RN
0625 Feeling better after treatment. Increased air exchange to lung fields though crackles remain,
still has c/o feeling slightly SOB. Robert K. Russo, RN
0800 Resting well. Upon awakening slightly SOB. Sats 91-92% on 2 liters. Dim LS with faint
bibasilar crackles. BS pos, Abd. neg. Ext. no edema. VS stable. Patient alert & oriented.
Brenda Kellye, RN
1030 Explained new S.S. insulin to patient and wife. No c/o, questions.
Brenda Kellye, RN
1300 Tried pt on 1L O2/NC, sats decrease to 87%. Increased to 2L/NC, sats 95%. Amb with
2LO2, 2 assist & Sat monitor on, 100 Fahrenheit. Sats to 92%. Back to room & up in chair.
Did get slightly dyspneic with amb. More rested in chair. Sats back up 95% when sitting.
Anne Odinson, RN
1400 Back to bed with 2LO2. Sats 98%. No c/o. Restful. Lights out for a bit. Call light placed.
Anne Odinson, RN
1450 Resting with easy, snoring like resp. Wife in room. Anne Odinson, RN
1600 Pt awake & talkative. Denies any discomfort. Resp easy at rest. Still has coarse rales in bases
bilaterally. Color pink. Sats in mid 90’s on 2L. No pedal edema. C/o some weakness.
Leslie Scorch, RN
1930 VSS, resting quietly, denies physical c/o. Lungs diminished BS, O2 decreased 1/4 lit with
some crackles, dec 1/4 lit SO2 96% @ 2L/NC. Re AP, inc pulses x 2, no c/o. Soft abd,
Pos BS x 4, Foley patent with clear yellow urine. Leslie Scorch, RN
2105 SVN SVN with V.S. Albuterol & Atrovent given, tolerated well.
Leslie Scorch, RN
8/16/xx
0200 Sleeping in bed, breathing easily. Robert K. Russo, RN
0130 Breathing easy, good air exchange. Lungs fields with only minor crackles. No c/o at
this time. Robert K. Russo, RN
0640 Feels better after treatment. Improving air flow in all lung fields. Foley catheter removed.
IV discontinued. Robert K. Russo, RN
0800 Dr. Wainwright visits, discharge order written and discharge instructions given. Patient resting
well. Blood sugar 130, vital signs stable. Ext. no edema. VS stable. Patient alert & oriented.
Brenda Kellye, RN
0830 Wife here. Patient eating. No c/o. Breakfast, eats well, somewhat short of breath while
eating, otherwise no dyspnea, no c/o. Brenda Kellye, RN
24 Hour Urine 0 - 30
for Microalbumin
Medication and Hosp Day Hosp Day Hosp Day Hosp Day
Date of Order Route 8/14 #1 8/15 # 8/16#3 #4
1. Lisinopril 40 mg p.o. q.a.m. 08 SMB SGA
3. 21 nmr kl
12. 21 taf ko
15.
16.
17.
18.
19.
20.
MEDICATION PROFILE
© 2003. American Health Information Management Association. All rights reserved.
Sundance HealthCare Systems Painted Valley, USA
Patient Family Name First Name Age Room No. Hosp. No.
Newman, Edward C. 78 CCU #2 # 012502
Attending Physician Date Lab. No.
Dr. William J. Wainwright 8/14/xx 7734-2002
Chemistry 10
Sodium 135 - 145 143 143
Potassium 3.5 - 5.3 4.4 3.8
Chloride 100 - 110 100 100
CO2 23 - 29 35 H 36 H
Glucose 80 - 116 238 H 91
BUN 12 - 20 27 H 35 H
Creatinine 0.6 - 1.3 1.5 H 1.6 H
Total Bili 0.0 - 1.3 0.7
Albumin 3.5 - 5.0 3.9
Calcium 8.2 - 10.1 9.8 9.4
ALP 56 - 112 58
AST 0 - 27 21
ALT 14 - 26 18
Total Protein 6.0 - 8.0 6.6
Lipid Profile
Total Choles 100 - 200
HDL 40 - 80
LDL 66 - 130
Triglycerides 50 - 150
Hematology
WBC (x 103) M/F 4.3 - 11.0 10.4 H
RBC (x 103) M 4.6 - 6.2 4.25
F 4.2 - 5.4
Hgb (g/dl) M 12 - 18 13.6
F 12 - 16
HCt (%) M 40 - 54 40.6
F 36 - 47
MCV (x 103) M 80 - 94 95.7
F 82 - 100
MCH (x 103) M/F 26 - 33 32.0
MCHC (%) M/F 31 - 36 33.4
PLT (x 103) M/F 150 - 375
Differential
Band 0 - 6%
Seg 46 - 82% 76
Lymph 13 - 37% 15
Mono 4 - 12% 4
Eosin 0 - 5% 3
Baso 2 - 2% 3 H
NRBC
Atyp Lymph
Meta
Myelo
Pros
Blast
HISTORY OF PRESENT ILLNESS: This patient is a 78-year-old resident of Podunk Center. He has a
long-standing history of severe COPD, insulin-dependent diabetes mellitus and ASHD and status post MI’s.
According to the patient he has been severely short of breath over the past several months. Apparently this has
increased over the past two days and yesterday it severely limited his ability to get up and walk around. During
the night last night, at approximately 5:00 a.m., he had a severe episode of shortness of breath. He received
two nebulizer treatments and his wife turned his home oxygen up wide open. Despite this, however, he re-
mained severely short of breath. His wife then called 911 and he was brought to the ER via ambulance.
The patient denies substernal chest pain. He states that he has gained approximately five pounds over the past
couple of weeks. He also admits to swelling of both ankles at the end of the day.
PAST MEDICAL HISTORY: Several episodes of COPD in the past. He has also been admitted with MI’s
at age 66 and again in September, three years ago. He has had congestive heart failure and long-standing
insulin-dependent diabetes mellitus. He has glaucoma and chronic blindness in his right eye. He has a history of
long-standing noncardiac chest pain. He has also had peptic ulcer disease.
MEDICATIONS: Humulin N 64 units in the morning and 64 units in the evening. Humalog sliding scale t.i.d.,
usually taking 14 to 16 units at mealtimes. He also takes Theo-Dur 200 mg b.i.d., Lasix 160 mg a.m. and 80
mg at noon q.d. Ecotrin 325 mg q.d. Pilocarpine 4% ophthalmic drops 1 drop right eye q.i.d., Imdur 60 mg
q.h.s., Diazepam 10 mg q.h.s., Clorazepate 15 mg q.h.s., nitroglycerin 0.4 mg sublingual p.r.n. chest pain,
albuterol and Atrovent nebulizer q.i.d. and p.r.n. He is on home O2 routinely at 2 liters per minute per nasal
cannula.
HABITS: 150 pack year history of cigarette smoking. He is currently a nonsmoker, does not drink alcohol.
FAMILY HISTORY: The patient is married and is a retired teacher. He lives in Podunk Center with his wife
who also has had some health problems, including atrial fibrillation. They have three children in the area.
REVIEW OF SYSTEMS:
General: No seizures or syncope. He has had the weight gain as mentioned above.
HEENT: No recent change in hearing or vision. He does have the glaucoma as mentioned above.
Dr.
Signature
Respiratory: As above.
Cardiac: See HPI.
GI: No nausea, vomiting, diarrhea, constipation, hematochezia or melena.
GU: No burning, hematuria or recent UTI. He states that he does have nocturia one to two times per night.
Musculoskeletal: Negative.
Neurologic: He has been depressed over his breathing difficulties.
PHYSICAL EXAMINATION:
General: This is a well-developed, well-nourished 78-year-old white male, sitting up on the examining table
with oxygen running. He appears in no acute distress at this time.
Vital Signs: Blood pressure 144/72, pulse 108, respirations 38, temperature 96.4 degrees Fahrenheit. Weight
190 pounds.
Skin: Anicteric, warm and dry. Face is slightly flushed at this time.
Heent: Shows clear TMs. Pupils equal, round and reactive to light on the left. There is evidence of corneal
dystrophy on the right. Oropharynx is clear.
Neck: Supple, no cervical lymphadenopathy.
Chest: Lungs have slight crackles in the right mid-lung field and base, clear on the left.
Heart: Regular rate and rhythm without murmur or gallop.
Abdomen: Normal bowel sounds, soft and nontender. No masses, hernias or organomegaly noted.
Genitalia: External genitalia is normal.
Extremities: Warm and well perfused. There is trace edema bilaterally. Pedal pulses are palpable.
Neurologic: Motor and strength are 5/5 bilaterally. DTRs are symmetrical.
Psych: Affect is more flat than typically seen. Recent and remote memory are good. Judgement and insight
are intact. Does seem to be slightly depressed.
LABS: Chest x-ray shows cardiomegaly and evidence of vascular redistribution consistent with CHF. EKG
shows normal sinus rhythm at a rate of 94 beats per minute. There is evidence of an old anterior MI and an old
inferior MI. No acute appearing ST-T wave changes. Sodium is 143, potassium 4.4, BUN 27, creatinine 1.5,
glucose 238. CBC shows white count 10,400 with a normal differential, hemoglobin 13.6, hematocrit 37.9.
ASSESSMENT:
1. A 78-year-old white male with cor pulmonale and congestive heart failure secondary to his severe
chronic obstructive pulmonary disease and coronary artery disease.
2. Arteriosclerotic heart disease with history of previous myocardial infarctions and congestive heart failure.
3. Chronic glaucoma with right eye blindness.
4. Chronic insomnia.
5. Insulin-dependent diabetes mellitus.
6. Benign prostatic hypertrophy, status post transurethral resection of prostate.
PLAN: The patient will be admitted to the CCU. Monitor his O2 saturations, provide oxygen as necessary
and diurese him.
Dr. William J. Wainwright
Signature
D&T: 8/14/xx
Form 9427 (8/00) mr HISTORY & PHYSICAL
© 2003. American Health Information Management Association. All rights reserved.
Sundance HealthCare Systems
Painted Valley, USA Newman, Edward C.
Dr. Dr. William J. Wainwright
Coronary care unit
# 012502
Date 08/14
_____________ 08/15
_____________ 08/16
_____________ _____________
Time 3 6 9 12 15 18 21 24 3 6 9 12 15 18 21 24 3 6 9 12 15 18 21 24 3 6 9 12 15 18 21 24
105 ...................................................................................................................................................
104 ...................................................................................................................................................
103 ...................................................................................................................................................
102 ...................................................................................................................................................
101 ...................................................................................................................................................
100 ...................................................................................................................................................
99 ...................................................................................................................................................
98 ...................................................................................................................................................
97 ...................................................................................................................................................
96 ...................................................................................................................................................
95 ...................................................................................................................................................
Pulse 93 102 89 88 86 76
Resp. 38 20 21 24 20 18
In ______| ______| ______ ______| ______| ______ ______| ______| ______ ______| ______| ______
Out ______| ______| ______ ______| ______| ______ ______| ______| ______ ______| ______| ______
Weight: 195.7
______ 194.9
| _______ 193.3
______ 192.6
| _______ 190.4 | _______
______ ______ | _______
ADA ______
Diet ______| ______| ADA ADA ______|
______| ADA ADA______ ADA ______| ______
______| ______| ______| ______
Appetite ______|Good ______
______| Fair Fair
______| Good Good
______| ______ Fair
______| ______| ______ ______| ______| ______
GRAPHIC SHEET
© 2003. American Health Information Management Association. All rights reserved.
Sundance HealthCare Systems
Painted Valley, USA
Patient's Name Street Address Hospital Number
Newman, Edward C. 2720 Mountain View # 012502
Birth Date Age City Phone Number
04/01/xx 78 Devils Lake 701 801-7734
Sex Marital Status State Zip County Room
M Married N.D. 58301 Ramsey CCU #2
Soc. Sec. # Religion Race
504-59-3132 Methodist W
Patient's Occupation Ethnicity
Teacher (Retired) Non-Hispanic
Notify In Name Relationship Responsible for Account
Emergency Mildred Wife Self
Address Phone No.
2720 Mountain View, Devils Lake 701 801-7734
Date Admitted Time AM Date Discharged Time AM
8/14/xx 0645 PM 08/16/xx 1111 PM
Date of Last Admission Name & Address of Any Institution From Which Discharged in Last 60 Days
2/29/xx N/A
Admitting Physician Consultant
Dr. William J. Wainwright
Aitemding Physician
Dr. William J. Wainwright
Cor pulmonale and congestive heart failure secondary to severe chronic obstructive
pulmonary disease and coronary artery disease.
Principal Diagnosis
Secondary Diagnoses
I acknowledge that no guarantees have been made to me as to the effect of such examination or treatment on my
condition.
3. ASSIGNMENT OF BENEFITS
In consideration of the services received or to be received for this admission to St. Jude’s Medical Center, I assign all
insurance benefits due me. I further warrant that the hospital shall be entitled to the full amount of its charges. Any
credit balance resulting for any reason will be applied to other existing accounts. This also assigns benefits to
Anesthesia Consultants, PC.
I hereby agree to pay any and all hospital charges that exceed or that are not covered by my hospitalization insur-
ance coverage. This assignment shall be irrevocable.
4. VALUABLES DISCLAIMER
I understand that St. Jude’s Medical Center maintains a safe for the safekeeping of money and valuables. I, also,
understand that I assume full responsibility for any and all of my valuables, money, clothing, dentures, and other
personal items while a patient in the hospital unless deposited with the Hospital for safekeeping.
This document has been fully explained to me, and I certify that I understand its contents and agree to it freely.
Aitemding Physician
Principal Diagnosis
Secondary Diagnoses
Complications
Physician Signature
Patient's Name: Last Name First Name Middle Initial Home Phone Admission Date a.m. Med.Rec. Number
Newman, Edward C. 701 801-7734 08/14 p.m. # 012502
Address: State Zip Age Sex Date of Birth Civil Status Religion
Devils Lake N.D. 58301 78 M 04/01 S M W D Sep Methodist
Employer: Retired Occupation: Teacher Soc. Sec. # 504-59-3132
Address: Tokyo, ND Phone No: Notify Press Yes No
Responsible Party: Alfred E. Newman Occupation: Teacher Family Doctor: Dr. Wainwright
Address: Devils Lake, ND Phone No: 801-7734 Notified Yes No
Brought In By: xx
___ Self
Name of Insurance Company Medicare Policy No. AP 504-39-3132 ___ Police ___ Fire
Address of Insurance Co. Hooterville, ND ___ Relative ___ Other
Notified: Relative Mildred Relationiship: Wife By Whom Agathie Chrsty Race:
BRIEF HISTORY: (If accident, state where, when & how injured; if illness describe)
:
78-year-old male to ER per ambulance. Awoke at 0600 with acute respiratory distress. Hx COPD. Did home nebulizers
without relief. Ambulance called for transport. Second neb started et finished en route. Accu ü done also “200”. Currently
mildly dyspneic, respirations 38, lungs slightly et moderate diminished. SAO2 98% on 2 liter p.m. NC. ??? Rhythm NS without
ectopics. 0725 Saline lock 22 g 28 mm Jelco started L hand - Lasix 80 mg IV push. Lock flushed per protocol NUB.
0730 Dr. Wainwright in to examine patient.
0740 Admit Coronary care unit .
0810 Patient to floor in W/C per RN
Allergies: Penicillin Patient Medications: See attached sheet.
Condition on Admission:
PHYSICIAN'S REPORT: History & Physical Findings:
Good ____ Fair xx
____ Increasing shortness of breath 6:00 a.m. No chest pain. No cough. Has been on
Poor ____ Shock ____
home O2. O2 sat on 2LNC 96% Pulse increased,
Coma ____ Hemorrhage ____
Vital Signs: Adm H: CHF RR 28 pm
Temp. 96.4
____ Height: 72" ASHD Heart: WNL.
Pulse 108
____ Weight: 190 Diagnosis: Lungs: Expiratory wheezes bilaterally.
Resp. 48
____ SAO2 96%
B.P. 143 72
____/____ Lower extremity edema 1+.
Normal Other System Inventory: Treatment (including medications):
o o Mental/Emotional
o o Status:
ü
o o Skin Disposition of Case: Admitted to CCU, LAB: CXR, EKG, CBC, PO2 (Theo Old charts
o ü
o Respiratory per Dr. Wainright / Ries RN) A: Acute exacerbation of asthma / LVF.
ü
o o Cardiovascular. Referred to Dr. Lasix 20 mg IV Date:
ü
o o Musculoskeletal: Instructions to Patient: P: Admit to CCU.
ü
o o Gastrointestinal
ü
o o Genitourinary
ü
o o Neurological
ü
o o EENT Edward C. Newman 8/14/xx 6:45 William J. Wainwright
Form # _ _ _ _ Patient's Signature Date Time Attending Physician
Simulated record. ©2003. American Health Information Management Association. All rights reserved.
PATIENT:
A.M.
DATE: DATE: P.M.
knowing that I, (or ) am (is) suffering from a condition requiring emergency or out patient care do hereby
voluntarily consent to such care encompassing diagnostic procedures and medical treatment by Dr.
his assistants or his designees as is necessary in his judgement.
2. I am aware that the practice of medicine and surgery is not an exact science and I acknowledge that no guarantees have been made to me as to the result
of treatments or examination in the hospital.
3. This form has been fully explained to me and I certify that I understand its contents.
Simulated record. ©2003. American Health Information Management Association. All rights reserved.
Sundance HealthCare Systems
EMERGENCY ROOM / OUTPATIENT RECORD
Painted Valley, USA Account Number:
Patient's Name: Last Name First Name Middle Initial Home Phone Admission Date a.m. Med.Rec. Number
p.m.
Address: State Zip Age Sex Date of Birth Civil Status Religion
S M W D Sep
Employer: Occupation: Soc. Sec. #
Address: Phone No: Notify Press Yes No
Responsible Party: Occupation: Family Doctor:
Address: Phone No: Notified Yes No
Brought In By: ___ Self
Name of Insurance Company Policy No. ___ Police ___ Fire
Address of Insurance Co. ___ Relative ___ Other
Notified: Relative Relationiship: By Whom Race:
BRIEF HISTORY: (If accident, state where, when & how injured; if illness describe)
:
Condition on Admission:
PHYSICIAN'S REPORT: History & Physical Findings:
Good ____ Fair ____
Poor ____ Shock ____
Coma ____ Hemorrhage ____
Vital Signs:
Temp. ____
Pulse ____ Diagnosis:
Resp. ____
B.P. ____/____
Normal Other System Inventory: Treatment (including medications):
o o Mental/Emotional
o o Status:
o o Respiratory
o o Gastrointestinal
o o Genitourinary
o o Neurological
o o EENT
Form # _ _ _ _ Patient's Signature Date Time Attending Physician
Simulated record. ©2003. American Health Information Management Association. All rights reserved.
Sundance HealthCare Systems
Painted Valley, USA
Age 78 CCU
COMPLEXES: Normal voltage. Left ventricular hypertrophy with QRS widening. Left atrial
enlargement. QT/Qtc 317/398 ms. QRS interval is 118 ms.
COMMENT: Abnormal EKG, possible lateral ischemia. Old anterior MI. No change from
previous EKG.
DJW/bg
St. Luke’s
D&T: 8-14-xx
Donald J. Wagner
Cardiologist Signature
DISCHARGE SUMMARY:
This patient is a 78-year-old gentleman from Podunk Center. He was admitted because of increasing problems
associated with his chronic congestive heart failure, COPD, diabetes and ASHD. The patient was experiencing
increasing dyspnea associated with the CHF. He was given an IV and increased dose of Lasix. Following this
the patient diuresed approximately five pounds during his hospitalization. Both his O2 saturations and breathing
steadily improved.
Two days after admission he was feeling much better. He had been up walking and was having no chest pain.
DISCHARGE MEDICATIONS:
Diazepam 20 mg p.o. q.h.s., albuterol and Atrovent nebulizers q.i.d. and p.r.n., Lasix 160 mg p.o. b.i.d.; Theo-
Dur 200 mg q.a.m., 300 mg q.h.s.; Imdur 30 mg (1/2 tab) q.h.s., Pilocarpine 4% 1 drop O.D. q.i.d., nitroglyc-
erin 0.4 mg sublingual p.r.n. chest pain, oxygen 2 to 4 liters per minute per nasal cannula. For his diabetes he
will be on Humulin N 64 U a.m., Humulin N 36 U p.m. and Humalog sliding scale as follows:
Accu-Chek less than 100 = 0,
Accu-Chek 101 - 130 = 3,
Accu-Chek 131 - 170 = 5,
Accu-Chek 171 - 220 = 8,
Accu-Chek 221 - 300 = 12,
Accu-Chek 301 - 400 = 15,
Accu-Chek more than 400 = 18.
FOLLOW-UP: Mr. Newman has an appointment to see me in the office in approximately two weeks for
recheck. He should call or come in sooner if he has any questions or problems prior to that appointment. He is
to check his weights on a daily basis at home and if he gains more than two pounds from his discharge weight he
is to call me at once or come into the ER or walk-in clinic.
FINAL DIAGNOSIS:
1. Congestive heart failure complicating severe chronic obstructive pulmonary disease.
2. Arteriosclerotic heart disease with history of myocardial infarctions.
3. Insulin-dependent diabetes mellitus.
4. Glaucoma.
PROCEDURES: None.
COMPLICATIONS: None.
DJW/sgs
D&T: 8/16/xx William J. Wainwright
Form 9055 (3/98) him DISCHARGE SUMMARY
© 2003. American Health Information Management Association. All rights reserved.