Downtime
Upcoming IT Downtimes
Click each item to expand for more details.
Saturday, Dec. 28 (10-11 p.m.): LMS
LMS will be unavailable due to maintenance.
Tuesday, Jan. 7 (9 p.m.) to Wednesday, Jan. 8 (2 a.m.): Provation MD
Leave endo and GIQUiC workstations on overnight, so the upgrade can occur.
Forms for Downtime
Review and download these resources. Click to expand the list of available forms.
Blood
Pre-Transfusion
- Blood Bank (HMH409-09)
- Uncrossmatched Blood-Emergency Issue Record (HM2561)
Post-Transfusion
- Transfusion Record (HM2562)
- Investigation of Suspected Blood Transfusion Reaction (HM1065)
Cardiology
- Cardiology Discharge Progress Note (HM2750)
Cardiac Rehab
Case Management/Social Worker
Consent
- Acknowledgement and Consent for Do-Not-Resuscitate Orders and Modified Orders (HM2332)
- Against Medical Advice – English (HM 2711)
- Against Medical Advice – Spanish (HM 2711-S)
- Anesthesia and/or Perioperative Pain Management (HM1729 English)
- Anesthesia and/or Perioperative Pain Management (HM1729-S Spanish)
- Authorization for Display and Use of Informatio9n – English (HM1664)
- Consent for Unsecured Messaging – English (HM 2672)
- Consent for Unsecured Messaging – Spanish (HM 2672-s)
- COVID-19 Vaccine Consent – English (HM 2506)
- COVID-19 Vaccine Consent – Spanish (HM 2506-S)
- Disclosure and Consent for Hysterectomy – English (HM 2696)
- Disclosure and Consent for Hysterectomy – Spanish (HM 2696-S)
- Medical Care and Surgical Procedures-English (HM 2227)
- Medical Care and Surgical Procedures-Spanish (HM 2227)
- Risk Addendum to Disclosure and Consent – Women’s Services- English (HM 2697)
- Risk Addendum to Disclosure and Consent – Women’s Services- Spanish (HM 2697-S)
- Statement of Refusal or Consent/Release for Non Blood Management – English (HM 1833)
- Statement of Refusal or Consent/Release for Non Blood Management – Spanish (HM 1833-S)
Dialysis
- Dialysis Assessment/Treatment Record (HM 2689)
ED Nursing
- Against Medical Advice – English (HM 2711)
- Against Medical Advice – Spanish (HM 2711-S)
- Chain of Custody (HM2310)
- Discharge Instructions (HM354)
- Dysphagia Screening (HM 2617)
- ECG Rhythm Log (238)
- ED Nursing Record (HM 2677)
- Home Medication History Form (HM14768)
- Medication Administration Record (HM2602)
- NIH Stroke Scale (HM 2495)
- Nursing Notes (HM051)
- SANE Chain of Custody Form (HM2310)
- Stroke Thrombolytic Monitoring (HM 1774)
Endoscopy
No forms at this time.
Global
Heart and Vascular
- Post Angio Monitoring Tool
- STS Aortic Valve Worksheet (HM 2703)
- STS Atrial Fibrillation Worksheet (HM 2705)
- STS CABG Worksheet (HM 2704)
- STS Mital Valve Worksheet (HM 2706)
- STS Tricuspid/Pulmonic Valve Worksheet (HM 2707)
Imaging
- Fall Risk Assessment – English (HM 2688)
- Fall Risk Assessment – Spanish (HM 2688-S)
- MRI Safety Patient Questionnaire – English (HM 2699)
- MRI Safety Patient Questionnaire – Spanish (HM 2699-S)
- Pregnancy Radiation Consent/Release – English (HM 2512)
- Pregnancy Radiation Consent/Release – Spanish (HM 2512-S)
Inpatient Nursing
- Acute Care Flow Record (373)
- Admission Medication Reconciliation (HM14768)
- Critical Care Flow Sheet (189)
- Discharge Instructions (HM354)
- Dysphagia Screening (HM 2617)
- ECG Rhythm Log (238)
- Invasive and Non-invasive Ventilation Record (HM2455)
- Medication Administration Record (HM2602)
- Nursing Notes (HM051)
- Patient Personal Property Belongings List (HM13071)
- Patient Record of Bedside Insulin Pump and Blood Glucose (HM2183)
- Patient Supplied Insulin Pump and/or Sensor (HM2182)
- Restraint RN-Initiationn/Continuation Non-Violent/Non-Self-Destructive Behavior (HM 2731)
- Restraint RN-Initiation/Continuation Violent/Self-Destructive Behavior (HM 2732)
- Restraint Non-Violent/Non-Self-Destructive Behavior Assessment Flowsheet (HM 2729)
- Restraint Violent/Self-Destructive Behavior Assessment Flowsheet (HM 2730)
- Restraint Non-Violent/Non-Self-Destructive Behavior Physician Order (HM 2733)
- Restraint Violent/Self-Destructive Behavior Physician Order and Face-to-Face (HM 2734)
- Stroke Thrombolytic Monitoring (HM 1774)
Lab
- Blood Bank (HM2027)
- Cytology Requisition (HM 797)
- Lab Services Order Form (HM2680)
OR / Surgery
- Caring for Your Surgical Wound at Home (HM2695)
- Operating Room Downtime Form (HM2460)
- History and Physical Update (HM 805)
- Implant Device Data Sheet (HM2305)
- PACU Downtime Form (HM2578)
- Pre/Post OP Downtime Forms (HM2510)
Patient Access Services
- Appeal Authorization (HM 2655)
- Appeal Authorization (HM 2655-S)
- Appointment of Representative for Denials Processing – English (HM 2725)
- Appointment of Representative for Denials Processing – Spanish (HM 2725-S)
- Consent for Medical Treatment & Financial Responsibility
- Consent for Treatment – English (HM 339)
- Consent for Treatment – Spanish (HM 339)
- Notice of Nondiscrimination (HM 2709)
- Patient Alias (HM 2534)
- Request for Restriction of the Disclosure of Health Information to Your Health Insurance Plan – English (HM 2108)
- Request for Restriction of the Disclosure of Health Information to Your Health Insurance Plan – Spanish (HM 2108-S)
- Surprise Billing Protection – English (HM 2535)
- Suprise Billing Protection – Spanish (HM 2535-S)
Immunization Registry (ImmTrac2) Information and Consent Forms:
- Adult Consent – English
- Adult Consent – Spanish
- Benefits of Participating in the Texas Immunication Registry
- Disaster Informaton Retention Consent – English
- Disaster Informaton Retention Consent – Spanish
- Minor Consent – English
- Minor Consent – Spanish
- Withdrawl of Consent and Confirmation – English
- Withdrawl of Consent and Confirmation – Spanish
HMB
- HMB Billing and Insurance Information – English (HMB 1642)
- HMB Billing and Insurance Information – Spanish (HMB 1642-S)
- HMB Important Message for Medicare – English (HMB 1511)
- HMB Important Message for Medicare – Spanish (HMB 1511-S)
HMCCH
- HMCCH Billing and Insurance Information – English (HMCC 184)
- HMCCH Billing and Insurance Information – Spanish (HCC 184-S)
- HMCCH Important Message for Medicare – English (HMCC 179)
- HMCCH Important Message for Medicare – Spanish (HMCC 180)
HMCL
- HMCL Billing and Insurance Information – English (HMCL 290)
- HMCL Billing and Insurance Information – Spanish (HMCL 290-S)
- HMCL ECC Billing and Insurance Information – English (HMCL 146)
- HMCL ECC Billing and Insurance Information – Spanish (HMCL 146-S)
- HMCL Important Message for Medicare – English (HMCL 147)
- HMCL Important Message for Medicare – Spanish (HMCL 147-S)
HMH
- HMH Billing and Insurance Information – English (HMH 1693)
- HMH Billing and Insurance Information – Spanish (HMH 1693-S)
- HMH ECC Billing and Insurance Information – English (HMH 1692)
- HMH ECC Billing and Insurance Information – Spanish (HMH 1692-S)
- HMH Important Message for Medicare – English (HMH 2618)
- HMH Important Message for Medicare – Spanish (HM 2618SP)
HMSL
- HMSL Billing and Insurance Information – English (HMSL 1264)
- HMSL Billing and Insurance Information – Spanish (HMSL 1264-S)
- HMSL ECC Billing and Insurance Information – English (HMSL 1117)
- HMSL ECC Billing and Insurance Information – Spanish (HMSL 1117-S)
- HMSL Important Message for Medicare – English (HMSL 142)
- HMSL Important Message for Medicare – Spanish (HMSL 142-S)
HMTW
- HMTW Billing and Insurance Information – English (HMTW 209)
- HMTW Billing and Insurance Information – Spanish (HMTW 209-S)
- HMTW ECC Billing and Insurance Information – English (HMTW 344)
- HMTW ECC Billing and Insurance Information – Spanish (HMTW 344-S)
- HMTW Important Message for Medicare – English (HMTW 153)
- HMTW Important Message for Medicare – Spanish (HMTW 154)
HMW
- HMW Billing and Insurance Information – English (HMW 460)
- HMW Billing and Insurance Information – Spanish (HMW 460-S)
- HMW ECC Billing and Insurance Information – English (HMW 344)
- HMW ECC Billing and Insurance Information – Spanish (HMW 344-S)
- HMW Important Message for Medicare – English (HMW 005)
- HMW Important Message for Medicare – Spanish (HMW 006)
HMWB
- HMWB Billing and Insurance Information – English (HMWB 914)
- HMWB Billing and Insurance Information – Spanish (HMWB 914-S)
- HMWB ECC Billing and Insurance Information – English (HMWB 965)
- HMWB ECC Billing and Insurance Information – Spanish (HMWB 965-S)
- HMWB Important Message for Medicare – English (HMWB 179)
- HMWB Important Message for Medicare – Spanish (HMWB 180)
Patient Education
To select patient education tools during a downtime.
Physician Organization
- PO Consent for Treatment – English (HM 339)
- PO Consent for Treatment – Spanish (HM 339)
- Medication Administration Record (HM 2716)
- Office Visit (HM 2717)
- Patient Encounter (HM 2718)
- Patient Follow-Up Instructions (HM 2715)
- Phone Log (HM 2714)
- Preferred Telephone Contacts and Permission for Discussion with
Family Members and Others (HM 2723) - Procedure Note (HM 2719)
- Review of Symptoms (HM 2708)
Physician Organization - Ambulatory Surgery Center
- Billing and Insurance Information (ASC2698)
- Billing and Insurance Information Spanish (ASC2698)
- ASC Consent for Treatment – English (HM 339)
- ASC onsent for Treatment – Spanish (HM 339)
Psychiatric Behavior Health
- Inpatient Psychiatric Services (HM2686)
- Patient Safety Plan Template (HM2688)
Privacy
- Consent for Unsecured Messaging – Spanish (HM 2672-s)
- Requests for Medical Records
- Photographing and Recording Consent
- Authorization for Display and Use of Information
- Authorization for Display and Use of Information (HM1664) English
- Authorization for Display and Use of Information (HM1664) Spanish
- Direct Access
- Access for Direct Access (HM2435)
- My Chart
- Consent for Electronic Communication
- Confidential Communication
- Self-Pay Restriction
- Health Information Exchange (Care Everywhere)
- HIE Reinstatement (HM2135)
- HIE Opt out (HM2136)
- Amendment of PHI
- Request for Amendment of Health Information (HM2541)
- Notification of Extension to Respond to Patient’s Request for Amendment (HM2735)
- Patient’s Request for Amendment Form is Incomplete (HM2736)
- Patient’s Request for Amendment is Accepted (HM2737)
- Denial of Patient’s Request for Amendment
- Accounting of Disclosure of Protected Health Information
- Notification of Extension to Respond to Patient’s Request for an Accounting of Disclosures (HM2744)
- Request for an Accounting of Disclosures (HM397)
- Patient’s Request for Accounting of Disclosures Form is Incomplete (HM2743)
- Accounting of Disclosures Provided (HM2742)
- Internal Disclosure Accounting
- Internal Accounting of Disclosure (HM 1394)
- Authorization, Access and Denial Letters (HIM Use Only)
- Invalid Patient Authorization Received (HM2740)
- Extension Needed for Access Request (HM2741)
- Request for Access Granted (HM2749)
- Denial of Patient Access – Not Subject to Denial Review (HM2748)
- Denial of Patient Access – Subject to Denial Review (HM2745)
- Access Granted After Review of Denial (HM2747)
- Denial of Patient Access After Review of Denial (HM2746)
PT / OT/ Speech
No forms at this time.
Respiratory
No forms at this time.
Sports Medicine
No forms at this time.
Unit Logs
- Blanket & Fluid Warmer Temperature Log
- Blanket Warmer Temperature Log
- Computer On Wheels (COW) Registry
- Contrast Media Warmer Temperature Log
- Eyewash Station Weekly Test Log
- Food Freezer Temperature Log
- Food Refrigerator Temperature Log
- Medication Freezer Temperature Log
- Medication Refrigerator Temperature Log
- Monthly Modality Inspection Log
- Paraffin/Hydrocollator Freezer/Fridge Temperature Log
- Procedural Area Daily Narcotic Pyxis Checklist
- Radial Access Post Angio Monitoring Tool
- Solution Warmer Temperature Log
- Temperature and Humidity Log
Women's Services
- Advance Care Birth Plan (HM 2334)
- Care by Parent Agreement (HM 2694)
- Caring for Your Surgical Wound at Home (HM2695)
- Elective (Non-medically Indicated) Cesarean Birth with First Pregnancy (HM2754)
- Infant Safety Agreement – English (HM2524)
- Infant Safety Agreement – Spanish (HM2524)
- Neonatal Discharge Summary (HM2753)
- Neonatal Resuscitation/Stabilization Record (HM1307)
- Newborn Identification (HM 2720)
- Risk Addendum to Disclosure and Consent (HM 2697)
Wound Care
No forms at this time.
Epic Downtime Resources
Epic Downtime Manual
Comprehensive role- and service-line based processes and functions required to maintain patient care during a downtime and recovery process.
Downtime Order Sets
Printable versions of order sets available in Epic. Intended as a guide during downtime when handwriten orders on blank order forms are needed.
Learn more.
During the downtime:
Use Epic Read-Only to view data. Access Epic Read-Only from your desktop or through access.houstonmethodist.org. If you don’t see the Epic Read-Only icon, click here for instructions on how to add it to your desktop.
Document the following on paper (click each button to expand):
Lab
Use downtime requisitions.
Pharmacy
Use paper orders.
Radiology and Cardiology
- No orders will process to PACS or the transcription system.
- Use paper requisitions and log procedures performed on the downtime documentation form.
- Interpretation of studies will be managed per each department’s defined downtime process.
Medical Devices
Data will not flow into Epic from mobile vital signs machines, dialysis machines, bedside monitors, ventilators and anesthesia carts.
VICU
- Epic Read-Only will not receive Caregility alerts and camera links will not be available. Use the Caregility portal.
- Sickbay risk scores that include lab data will be impacted and the New Admission Queue will not be available.
- MultiMon will continue to display bedside monitor and vent data, but new admits will not display the patient name.
HMW CTM
Sickbay will not display names of new patients until after the downtime.
Epic Downtime Quick Reference Checklist
A condensed snapshot of the most essential information you need to know in the event of scheduled or unscheduled Epic downtime.
Epic Downtime CSN Numbers
Pre-designated CSN number ranges, that flag if a patient was admitted/arrived during a downtime, are assigned by your facility’s Downtime CSN site administrator.
Contact your administator for more information.
After the downtime:
Radiology and Cardiology:
- Enter orders in Epic based on the downtime paper requisitions/downtime log.
- Process orders using standard workflows and prepare them for interpretation.
- Downtime studies will be read using the defined interpretation method for each department.
Medical Devices:
- Manually enter all vital sign data captured during the downtime when Epic is back up.
- Any new vital sign data collected after the downtime will automatically integrate with Epic.
Online Downtime Resources
Epic Read-Only
Available on most Epic-enabled workstations and through the Apps Portal. This is a view-only system, so new documentation or orders can’t be added. Data is up to date as of the time when Epic went down. You’ll have limited access to patient data, but can still view active orders and the MAR, print patient labels and arm bands.
BCA Web
Access essential downtime reports from any workstation when you have internet access but Epic and Epic Read-Only are not available. View and print a current census or limited clinical summaries with data for each patient, including active orders, recent results and vitals. Also provides a printable downtime MAR for each patient and a respiratory patient summary.
Reports are automatically updated every 30 minutes for ICU patients and every two hours for non-ICU patients. Department Appointment Reports (including patient schedules for the next four weeks) for outpatient and PCG/SPG clinics are updated daily.
BCA Printing / Downtime Computer
Similar reporting functionality as BCA Web, but available from your unit’s designated downtime computer when internet access is not available. Your unit’s device will also have access to reports for sister units above and below you, in the event their system has issues. Because the computer is hardwired to a designated printer, you can mass print all reports for your unit and distribute patient data to the appropriate clinicians or staff.
