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HA-22 (HMDS) Form

The HA-22 (HMDS) form is an electronic smart form within MMEx that is the equivalent of the Western Australia Department of Health HA-22 form.
HA-22 (HMDS) has been set up to work from the Satellite Haemodialysis tab within the Chronic Kidney Disease module.

Using the form

From the Chronic Kidney Disease module within a patient record, navigate to the Satellite Haemodialysis tab.

Create a new Dialysis Session by clicking “Add New Dialysis Session”

Enter the Date and Time, and finalise the session by adding a Time Off and click Add, the system will ask if you want to create a new HA-22 form.

Once in the form your Admission Date/Time and Separation Date/Time fields will be pre-populated from the haemodialysis session.

The other demographic details will be pulled from the details of the patient record.

These fields include:

  • Client Identifier (URN)
  • Surname
  • First Forename
  • Second Forename
  • Residential Address
  • Medicare Number
  • Date of Birth
  • Sex
  • Indigenous Status
  • DVA number

Begin by filling out the required information for the form. Each field corresponds to a field on the HA-22 form and will either present as a free-text box, drop down selection, lookup or radio button selection.

Note: You will only need to complete most fields on the form once per patient, as the HA-22 form has been designed to remember the last used settings from any previous HA-22 form related to the same patient.

Clinical Details:

The Clinical Details area of the form appear at the base and include a ICD-10-AM and ACHI Code picker.

The Principal Diagnosis and Principal Procedure fields are mandatory for the purpose of the HA-22 form.
You are able to add a Co-Diagnosis and another other Additional Diagnoses as required by clicking Add button to add a new row.
You can also remove an added row by clicking the “Remove” button.

The Principal Procedure will default to 13100-00 Haemodialysis session. You can also add additional procedures and remove additional procedures using the same method as above.

Saving the form

At the bottom of the form are two options:

  • Save – this saves the form
  • Save and Export Multi-Liner File – this saves the form and exports an MLF file for the one session that can be used to upload directly to the WA Department of Health Portal.

Any empty mandatory fields will appear in red when you save the form and will need to be completed before proceeding.

Backdated Entry

From the Satellite Haemodialysis page you will see an added column HA-22 Form Created.

If no form exists, you will be able to click and create one retrospectively by selecting Create HA-22 Form.

By clicking on Create HA-22 Form you will create a form for that session.

Open a Saved Form

From the Haemodialysis page you will see an added column “HA-22 Form Created”.

To open a previously saved form click on Open HA-22 form.


In order to edit and/or archive a previously entered HA-22 form you will first need to have the relevant user permissions configured for your account. Speak with your Organisation Administrator to organise this.

To archive a form click on a previously completed HA-22 form and scroll to the bottom.

You will find an Archive button.

When you click it a pop-up dialogue will appear. Click OK to continue and the form will now be archived.

When you return to the Satellite Haemodialysis screen the row entry for the form you archived will now display that a HA-22 Form has not been created. You will then be able to retrospectively re-create a form.

Reporting and MLF Output

To report a MLF output of all forms for your organisation you will need to go to the Reports page on MMEx.

Find the Hospital Morbidity Report.

The report will show a total count based on all forms entered by your organisation including a total count.

To export you will first need to filter based on:

  • Date From
  • Date To
  • Establishment

Note: You will not be able to report on forms entered by other organisations. Only those entered by your organisation.

As you update the filter the results will also update in real time.

Once you have set your filters, click Export to export the data on the screen into an MLF file.

The MLF file will present as a text-based line by line code file that can be uploaded to a Department of Health Portal.

Organisation Settings

In the organisation centre you can configure the default (Hospital) Establishment for your HA-22 forms as well as the Account Number starting Index.

To change the Default Establishment simply begin to type a name or four-digit establishment code.

The Account Number is the starting index for HA-22 form for your organisation.

Note: The unique count is recorded across all of MMEx to ensure each form has a unique number. So even though you may begin with 100000000001 the next form you complete may be 100000000022 because 21 other HA-22 forms were created by other organisations in between.

User Permissions

In order to edit and/or archive a previously entered HA-22 form you will first need to have the Edit Hospital Morbidity Forms After Creation user permission set to Allow.

If this permission is set to Allow then as a user you will be able to do two things:

  • Edit – open a previously saved form and edit contents
  • Archive – open a previously saved form and archive the form

If this permission is set to Deny then as a user you will still be able to create new HA-22 forms through the Chronic Kidney Disease module, however you will not be able to Edit or Archive.

AHPRA field

In the profile of a user you will now see an added field for AHPRA number. The HMDS form will use this for any Clinician on Admission (MBRN) lookup and this will need to be pre-populated for all clinical staff.


In the event that a row does not present the option to Create HA-22 Form on the Satellite Haemodialysis page, this will be likely for one of two reasons:

  • No Time Off recorded: Ensure the Post-Dialysis Time Off has been entered
  • Missed Dialysis session: The HA-22 is not required for Missed Dialysis sessions
manual/forms_hmds.txt · Last modified: 2019/07/09 03:31 by sarahb