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  • #2272344

    Edited out

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    by ontheropes ·

    Edited out

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    • #3141673

      Nursing and Technology

      by tig2 ·

      In reply to Edited out

      First, NB, Thanks for the heads up that you will be out for awhile. Don’t forget to walk during recovery- it really will help. Peck out something (pencil between teeth?) to let us know that you are okay and healing.

      I know from previous posts, how hard this has all been for you. You are in my thoughts and prayers (I know… eeeww!).

      Case Management tends to show up whenever there is a lengthy treatment/recovery issue. When Case Mgmt first started, it caught out a lot of “back injury” BS. The theory is that by identifying cases that are fraudulent, care costs can be controlled.

      The problem that Case Mgmt initialy ran into was that a single person’s judgement determined if a person NEEDED a level of care. This is a problem in that a single person’s judgement may be insufficient to determine reality of need. Most insurance companies now assign reviewers in pairs. Because they use BSNs, there is more latitude to get things moving in the event of bureaucratic hold up. In general, monitored cases are also reveiwed regularly by a Medical Review board that is comprised of the Case Mgmt nurses as well as MDs in that particular discipline. The goal is to avoid cases where a person is denied care because of a mistaken belief that the case is fraudulent.

      The problem is that the people in Case Management are very frequently, although qualified, not direct care providers. Generally they have moved to this kind of role because they prefer to not provide care in a standard hospital setting.

      The issue of good patient communication has been around forever. The patient presents in a more ill condition than ever, there is frequently insufficient time or communication from MD to nurse for the nurse to communicate to the patient, there is frequently an assumption that proper communication has occurred, and frankly, personality is everything.

      I went to nursing school with people that should not be permitted to be around people. I have known both MDs and nurses that have ZERO people skills. On the other hand, I have seen caring and committed people that simply changed as a result of caring for patients that you can’t fix. Caring too much can cause people to get out of the field.

      IT is its own problem. Striking the careful balance between IT SLA and medical SLA is difficult at best. Many healthcare organisations place too little value on their IT systems. And there aren’t many like me- Licensed Nurse but geek off the job. And even I got out of nursing to do IT full time.

      The battle that you have been facing is compounded by the fact that any MD anywhere will use progressively more severe approaches to fix the problem instead of going directly to the solution. And they do that to avoid malpractice. The Oath says “First, do no harm”. That to an MD means do the least first, the next most aggressive second, etc.

      So personal opinion time- I have long thought that the best approach is tort reform. Both MDs and nurses carry personal malpractice insurance because they don’t dare treat a patient without it. Guess where that cost goes? And the most common approach in malpractice is to sue EVERYONE in the patient care line. You almost don’t want to take a patient’s vitals because you could find yourself drawn into a suit. While completely ridiculous, this is the way the country deals with medical malpractice. And until it changes, the frustrations that you have dealt with will continue.

      I don’t honestly know if nationalising the system is the right answer. There has to be a system of checks and balances- they call it “practicing medicine” for a reason. But it doesn’t help the system one iota when your MD and nurse fear you- you could be the next lawsuit, after all. The system MUST be re-examined but will only get there through the Lawyer’s lobby and the Insurance lobby. And those two groups wield a lot of power.

      I understand your frustrations. I am glad to know that you are at least scheduled now and can hopefully see a light at the end of this tunnel.

      • #3141601

        Edited out

        by ontheropes ·

        In reply to Nursing and Technology

        Edited out

        • #3271112

          Procedures X-(

          by rob mekel ·

          In reply to Edited out

          I still get angry over the procedures my GF got into while recovering from her cancer-surgery.

          The physiotherapist had to go to tons of paper work, filling in plans on how to proceed to her recovery. She asked him how much of his time he was spending on filling in the forms. The answer was: more then 40% !!! on the forms. That is if his plan was approved right away. On the average it was about 60% of his time. Taken into account that it took her 4 weeks to get an appointment, @#$%@# X-( , well she should have gotten an appointment with in 2 weeks so the physio could treat her the right away. It would have saved her probably 6 weeks of treatment of the 12 weeks she needed now. And that is because early treatment does help on speeding up the recovery.
          In totally if she had the right and proper treatment right away then she only would have needed half the recovery time she spend now.

          Her income insurance company is now suing her health-insurance company for lacking her recovery.
          But this is 1 of the first times they ever do this. I guess in the end lawyers will benefit of this.

          I hope it will not be the case in neither of the cases of all of you. In fact I hope none of you will need any recovery whatsoever. 🙂

          Rob

          [i]Edited because of emoticon mal-treatment by me[/i]

        • #3271099

          There is no question…

          by tig2 ·

          In reply to Procedures X-(

          That reforms are needed everywhere. I don’t know that any country has 100% of the answer but I will bet that IF we worked together we could find improvements.

          I personally believe that the lion’s share of the problem is that everyone wants to sue. What silliness! Certainly there are cases that are legitimate but not the majority. If tort reform- at least in the US doesn’t happen, costs will continue to rise as healthcare professionals have to have more to protect themselves from… their patients!

          Rob, I sincerely hope that your GF is better. Cancer surgery is NO fun and has more impacts in recovery than just one’s health. She will join NB in my prayers.

        • #3271057

          Tnx TT :)

          by rob mekel ·

          In reply to There is no question…

          She has and still is recovering fine. Alltho the power in her leg still isn’t as it should be, she play’s tennis and does fitness-training just great. 🙂

          I’m very happy for her that the chondrosarcoom (don’t know if this is the right name in English) she had was of the right type (alltho malicious but not spread, that is as can been told/seen) and on the right spot (if you can speak of a cancer being on the right spot, just down her knee between the bone-membrame (is it called that way?) and her Tibia) so she could be helped by surgery.

          Thanks again for the best wishes TT 😡

          Rob

      • #3271130

        IT Training for Nurses

        by dmambo ·

        In reply to Nursing and Technology

        Tigger’s right that there aren’t too many like her. My wife is an Advance Practice Nurse, she’s got 12+ years acute care experience and now she’s a primary care provider in the VA system. She’s wicked smart, and a great person to see if you need medical care. But she has a little “issue” with “the computer stuff”. Her main complaints are that the systems take her away from the patient care (although she understands the need and benefits of electronic documentation) and that the system training is not adequate. Add to that the fact that most nurses are in the profession because they have some sort of sick, twisted inclination to help other people, and you’ll probably find that many do not enjoy the isolated screen time that we all cherish so much.

        Further, in most settings, the training needs to be done on 3 shifts, weekends, etc. The systems have to be user friendly, intuitive and secure. It’s a stretch for any IT dept.

        As far as the costs, I think it was Maxwell who posted the question looking for the 5 words of why health care in the US is so expensive. He was looking for “someone else pays for it” as I recall, and I agree that’s a big chunk of the answer, along with the cover-every-possibility mentality that malpractice suits engender.

        Well, if you’re still reading, good luck with everything, Never. I hope you’re back to form quickly. Get off that Oxy as quick as you can. It’s nasty stuff.

        • #3271101

          Edited out

          by ontheropes ·

          In reply to IT Training for Nurses

          Edited out

        • #3271073

          HIPPA and Standardisation

          by tig2 ·

          In reply to Edited out

          NB- First, the OxyContin- Mambo is absolutely correct, that stuff is unholy dangerous. While I DON’T want you in pain, I do want you to remember that you aren’t relieving pain, you need to MANAGE it. If you are resistant to lesser drugs, ask your MD if there is a median between Ibuprophen and the Oxy. You are likely to be resistant because you have been managing to a pain level for so long. No easy answers but let me know if I can help in any way.

          It was thought at one time that HIPPA would lead to record standardisation. The road block is that no one can define an adequate standard AND get industry buy in. This is key because care providers have had for years rules for how records are created, stored, and referenced. Nursing school taught me how to chart on a patient and correct charting was an element of licensure. The transition from a paper standard to an electronic standard is difficult. I know of multiple web-enabled databases that will provide diagnostic paths to determine ailment and treatment but know of few that are a paperless trail of patient care.

          Keep in mind that I have not provided patient care in more years than I am willing to admit to…

          When I WAS nursing, I had a notebook and pen in my pocket constantly. I often had little or no time to capture my impressions at the point of patient care in any formal fashion. I jotted notes that I referenced when I charted. Today I would use my PDA to take notes. But I am a geek. In today’s world, the nurse would be transcribing from notes to chart and from chart to electronic file. Not so good as the room for error has just increased. In a written chart, if I made an error, I drew a line through it, initialed it, and wrote my correction- where possible, on the same line. Note that the error HAD to continue to be readable. How do we do that electronically? There is a legal rationale for the line out.

          In my personal opinion, one’s drivers license or ID would be the optimal place to put one’s medical history. The problem is that I do not have a sense that my medical history would be safe in that data store. The VA recently had to admit the loss of data on 26 million veterans and current military. Without improvements in data security, I don’t think that we can get to a place of standardisation or any robust history access.

        • #3270825

          Edited out

          by ontheropes ·

          In reply to HIPPA and Standardisation

          Edited out

    • #3141631

      Before you go …..

      by gadgetgirl ·

      In reply to Edited out

      look at alternatives! You don’t always have to type – how about downloading a trial version of ViaVoice or Dragon Dictate or something of that ilk?

      Hey, I’m just trying to keep you online here! Oh, and just because you can’t type too well doesn’t mean you can’t still READ the posts, you know!

      The time before last that I broke my right wrist (nope, NB, don’t go there and ask how many breaks I’ve had…. it’s tooooo embarrassing!) I actually found that I could type if I pushed a crotchet needle up the plaster – hits the keys just nicely…. Ok, so you don’t have one already, that I understand!

      NB, I work in the medical profession in IT. It stinks. I’m a security pro in the NHS. The Trust I work in has just merged, which means that we now have 100+ locations, 5000 staff, no merged policies, procedures or processes even though both halves of the merged Trust provide the same services – for the Mental Health side of things. And yes, we have “Secure Units” too.

      And for all that, there is me. I’m it. I’m the only security pro in the Trust.

      Just from what I see from my side of things, there is a distinct lack of communication on every level here in the UK. I’d love to give you examples, but professional conduct forbids. There is a degree of apathy that I’ve never bashed heads with before, and an extreme aversion to change, even when change is proved to be better both for the profession and the patients.

      I’d love to go on; I’d especially love to tell you about the particular excrement which hit the oscillator this morning, but that would be sub judacae now. (It’s a doozy. Take my word, it’s the best one yet)

      However. Thanks for the partial ability for a sound off….

      Now then. How long are you expecting to be off line? Are you in hospital for long, or just the day/overnight? Got physio booked?

      Have you told the dogs? They’re sure to tell you that there is no greater physio for a broken arm than playing with, squishing and throwing a soft dog ball. And they should know – every cat or dog I’ve known thinks they were born with medical knowledge of humans….!!!

      I’ll start sending the healing thoughts over the pond now, so that they gather strength in time for the 19th and after. I could get a bit busy between now and then, so have a 😡 better to stash ready for after the op.

      All the luck, babz

      GG

      • #3141501

        Edited out

        by ontheropes ·

        In reply to Before you go …..

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        • #3164553

          Another “obvious” for you

          by gadgetgirl ·

          In reply to Edited out

          Medical history – if you think you should be carrying info around with you that people should know in emergencies, try an SOS Talisman.

          http://www.medicaltags.co.uk/sos-talisman.html

          Although these aren’t waterproof, the way around that is to get a dog tag engraved with your info, and insert it in the talisman. Most jewellers will also change the ring on the pendant to fit any necklace etc. already worn, so that it just adds on.

          HOB has had one for years (yes, I bought it for him) as he has an extreme intolerance to any type of anaesthetic – brings on immediate respiratory arrest.

          And nope, he’s never worn it………

          Men.

          As you’re in on Monday, I assume the weekend will be spent in your own type of anaesthesia ??!!

          ]:)

          GG

        • #3271117

          Edited out

          by ontheropes ·

          In reply to Another “obvious” for you

          Edited out

        • #3271115

          Very Cool Solution

          by tig2 ·

          In reply to Another “obvious” for you

          We use Medical Alert- red on silver flat tag- over here most commonly but the talisman is even better.

          I am allergic to bee and wasp sting. I have that information on the “Welcome” screen on my cell phone as well as in my PDA where it can be seen without having to enter my password. I also have the letters ICE (In Case of Emergency) in front of my partner’s cell number on the phonebook menu on my cell.

          For the 3-Day walk, I will carry, along with my insurance card and an epi pen, a laminated card with important medical info. That way if anything were to happen, I can self-treat, call for help (carrying cell phone- I train with it in my pack), call for help to other walkers and provide basic info regardless of situation.

          And yes, GG- I understand completely that HOB has all the stuff he needs and refuses to carry. Offer to have his medical needs tattooed on his chest. I will bet he would be more willing to carry his talisman! 🙂

        • #3270925

          Pardonnez mon ignorance, GG

          by dmambo ·

          In reply to Another “obvious” for you

          but just what exactly is an HOB?? It it your Hop-On Boy?? Your Husband OverBoard?? Your Hound Of Baskerville?? Your Ham Omelette with Bacon??

          I guess I don’t get this leetspeak all the time.

        • #3270175

          ………sheesh………

          by gadgetgirl ·

          In reply to Pardonnez mon ignorance, GG

          you’re gone a while, and your memory leaves permanently. This started last year when we were getting Phoebe (the boat, remember? that 30ton, 42′ ex Dunkirk vessel….yeah?) ready for the Tall Ships coming…..

          HOB: Him On Board

          Remember now?! 😀

          GG

    • #3155564

      You’re going to have to change your alias from [b]Never[/b]Busted to……

      by sleepin’dawg ·

      In reply to Edited out

      just plain Busted. Watch that Oxy Contin stuff, it can be damn dangerous even when taken as prescribed. They say they don’t like giving you Demerol or Morphine because they can be addictive but so is Oxy and the side effects are more dangerous, affecting the liver and the heart. You will be kind of dopey on Morphine or Demerol but they are more effective as pain killers than Oxy and I don’t give a damn what the doctors say.

      There will be no excuses for not posting; they’re only doing one wrist, you’ll still have the other hand to hunt and peck with, just a bit slower. You’ll have to let us know how it goes.

      [b]Dawg[/b] ]:)

      • #3155529

        Edited out

        by ontheropes ·

        In reply to You’re going to have to change your alias from [b]Never[/b]Busted to……

        Edited out

        • #3270171

          Hey, at least you only did one thing badly…..

          by gadgetgirl ·

          In reply to Edited out

          I did lots of them exceptionally well. “Busted” applied to me for an entire eight years, then intermittently till 1995.

          So, just to make you feel a little better, I will actually post my running total: (sheesh, the things I do for morale around here 😉 )

          Left leg: 7 breaks
          Right leg: 9 breaks
          Left arm: 2 breaks
          Right arm: 3 breaks
          Collar bone: twice
          Shoulder: dislocated once, stayed dislocated two years….

          There. Feel better now?!

          All the “legs” were done within an eight year period, hence the reduction in height from 5-4″ to “five foot and an important little bit” At one stage I was out of plaster for a whole three weeks within one year….

          I broke alternate legs three times just by stepping off the pavement…..

          last break (1995, right arm – a-bloody-gain)I was told it wouldn’t have happened had I had another few drinks as I would have just bounced….
          (no, I wasn’t falling down drunk…. I was half way down the first Tia Maria and Coke when the carpet came up and hit me)

          So from one “Busted” to another – keep ya pecka rup, marra, aahm rootin’ fa yez!

          GG

        • #3270164

          Edited out

          by ontheropes ·

          In reply to Hey, at least you only did one thing badly…..

          Edited out

        • #3269853

          Between the two of US…

          by x-marcap ·

          In reply to Hey, at least you only did one thing badly…..

          We could keep an Orthopedic Surgeon busy.

          I have been had about 30 breaks that required the attention of an orthopedist. Once I left the Corps, I stopped having my body treated so roughly…

          I had my right shoulder dislocated at age 14. It didn’t hurt as bad going out as being pout back in… Getting hit by a Duece and a half truck at low speed is much worse than getting hit by a car at 2X the speed. That’ll get ya for walking on a base at night rather than taking a jeep.

        • #3154761

          Edited out

          by ontheropes ·

          In reply to Between the two of US…

          Edited out

        • #3154687

          Semper Fidelis

          by x-marcap ·

          In reply to Edited out

          One point is this: many people have no clue about any kind of fidelity.

        • #3268509

          Edited out

          by ontheropes ·

          In reply to Semper Fidelis

          Edited out

    • #3269988

      Insurance and Medical are in bed together

      by maxwell edison ·

      In reply to Edited out

      The ONLY WAY to start reducing medical costs is to have to user pay for it. This third-party payer system makes it MORE expensive, not less.

      • #3269982

        taking a little responsibility

        by too old for it ·

        In reply to Insurance and Medical are in bed together

        Maxwell, nice to see you out here again.

        I agree with you in part. Since I am uninsured (two years now) I’ve had to get creative with the medical care, especially for the chronic illnesses.

        Every so often, I fax around the current “geezer list” of medications and dosages I am taking to the pharmacies in the area. Strangely, the locally owned pharmacy has my meds cheaper, and the big box place has my wife’s cheaper. (On the plus side, the local guy hires HS students part time, giving them very valuable work experience, and the owner is fun to talk to.)

        Our doctor has gotten very good about not loading up the tests unless something appears really out of whack. Generally we can get out of a semi-annual check up for $120 or so. (More if I have to do a glucose tolerance test, but the added bonus of working to avoid [b]that[/b] test is that the orange syrup tastes like pure death in a bottle.)

        He also doesn’t take pharmaceutical reps word at face value. Just had a meeting with him and a very nervous rep as we called around the get retail pricing on a new compound. Turns out it is a little cheaper than the alternatives, so I am giving it a go.

        The only real downside I can see is that if something really bad happens, I can’t afford to be sick or injured, and so would just have to die instead.

        Trust me, really decent medical insurance will be a discussion point in future job and contract hunts.

        • #3269966

          If we could snap our fingers. . . . . .

          by maxwell edison ·

          In reply to taking a little responsibility

          …..and suddenly force two things to happen, the cost of purchasing medical care would plummet, perhaps as much as 90 percent. A current $10,000 procedure, for example, could cost as little as $1,000, or even less (a guestimates, to be sure).

          What are the two things?

          One: Put a stop to the frivolous lawsuits, exorbitant settlements, and outrageous malpractice costs. The costs are simply passed onto everybody else.

          Two: Eliminate ALL insurance companies, at least in as much as being relied upon to pay for absolutely everything, perhaps limited to catastrophic cases, and keep insurance and medical separate.

          Okay, a third thing: Get government OUT of the medical provider business.

          If medical care was purchased like car care, computer care, or home care, costs would fall like a boulder dropped into the ocean.

        • #3269918

          Addendum (Addition)

          by maxwell edison ·

          In reply to If we could snap our fingers. . . . . .

          That’s the problem, however; we can’t just snap our fingers and automatically create the perfect and preferred system. We have to start from where we are now. We can’t go back to the beginning and start all over again. Unfortunately, most (or all?) of the proposed solutions are only more of the same thing — get somebody else to somehow pay for it. Well guess what we’ll get if we keep doing the same thing? More of the same outcome perhaps?

          It’s true, we can’t afford to keep doing what we’re doing now. But we damn sure can’t afford to expand the current system even more, and do more of the same thing. That’s not a solution. That’s crazy!

          Any “third-party payer” system, and I don’t care what the service or product is, will always cost more to deliver, not less; and it will always result in an inferior product, not a better one.

          It’s madness, if you ask me. But I’ll be honest, I don’t know how to get it done.

          It’s the camel’s nose scenario illustrated to the extreme.

        • #3154924

          Edited out

          by ontheropes ·

          In reply to Addendum (Addition)

          Edited out

        • #3154707

          You didn’t add to the problem

          by maxwell edison ·

          In reply to Edited out

          When the doctor gets sued (or a hospital or pharmaceutical company, etc.), the doctor doesn’t pay for it in the long run, all the other patients do.

          If the person responsible for the damage is to be held culpable, and should be held culpable, then that fine; do it. But passing the real burden of punishment onto innocent bystanders is not only unfair, but it’s crazy. And that’s exactly what our tort system does today.

    • #3269984

      Before you can adequately train doctors and nurses

      by too old for it ·

      In reply to Edited out

      … you have to get them to put aside the notion that everyone other than a MD or a RN (IT staff inbcluded) are only fit to change messy bedpans.

    • #3268506

      Edited out

      by ontheropes ·

      In reply to Edited out

      Edited out

      • #3146032

        I know that this is hard

        by tig2 ·

        In reply to Edited out

        I can relate. Oh Lord, I can relate.

        I know that this will be okay. I have been ther, done that. I have faith and… eeewww, prayer.

        For all of that, it is different when it’s YOU. I understand that completely.

        You aren’t alone. And I will be thinking of you at 0-dark-thirty on Monday.

        And keep this in mind- the birds will sound sweeter, the air will be fresher, life will be more robust around lunchtime on Monday.

        You will be okay. You ARE okay. But it’s okay if it is hard.

        I send you hugs!

    • #3142007

      Edited out

      by ontheropes ·

      In reply to Edited out

      Edited out

      • #3141985

        I can see that your computer is online

        by tig2 ·

        In reply to Edited out

        But realise that you may not be. Other than typing with one hand- always a pain in the tail- how are you feeling? And yes, rotten is an answer.

        Hope all is well and went well. Let us know as you are able. 🙂

        • #3141825

          Edited out

          by ontheropes ·

          In reply to I can see that your computer is online

          Edited out

        • #3269816

          Good to know that you are okay

          by tig2 ·

          In reply to Edited out

          Let us know what we can do to help… a lively discussion? Any preferred topics?

          Thank you for letting us know that it went okay. Give us updates as you are able. I am interested in knowing how your spider works for you.

          Tig

        • #3269570

          Edited out.

          by ontheropes ·

          In reply to Good to know that you are okay

          Edited out

    • #3269819

      Argh, Ahhh, Hey, Yeah, Whohhh

      by wingedmonkey ·

      In reply to Edited out

      The thing about this topic, it represents several issues that I could write about extensively, and yet not contribute much in the way of meaningfullness.

      So in brief,

      Doctors and Ego’s:
      Some Docs think they are Royalty because they are Docs. I have found more who were born with their Egos and became Docs to justify they self imposed importance.

      Doctors and Decisions:
      No matter which specialty, I usually find several Docs who are dedicated to one or two conditions. They diagnose every single patient they meet with some form of that condition no matter how unrelated it is to the presenting symptoms.
      Good times. Watching two highly regarded Psychiatrists evaluate the same patient, decide on two completely different diagnosis and get in a shouting, abusive fight over eachothers finding.

      Nurses:
      Nurses eat their young. Not their bio children, but the Nursing students, recent graduates, fresh hires.

      Nursing Job Opportunities:
      Oh my lord, the field is so huge and there are so many choices to pick from. You do not even have to see patients if you pick the right job. I just wish I could remeber why I dropped out my BN program 18 credits and two practical short of graduation back in ’96…

      Nurse and Informatics:
      I am biased, the DC area has a couple of Masters Degree programs in Informatics and I work/have worked with several of the graduates. Most are clueless when it comes to hardware, but they are the well needed connection between application development and usage. The two I work with now have advanced our application usage at the medicval center to the front lines of the National Capitol Area. I can not speak highly enough of their work and vision.

      Hospital Applications and Documentation Systems:
      Please, somebody, anybody develop an intergrated suite of apps that can pull all the data togeather from the patented, highly specialized medical apps out their that use propiertary data storage.
      HL7 Standard, Not! More like HL7 Highly Suggested.
      Seriously, the US Goverment is granting huge chunks of money to make this happen.
      Citrix has well handled the Single Sign on solution. Sentillion has done one better with its context management. Context Management is where you open up patient data in one app, and all other apps that have that patient automatically bring thier data chunks to the front as well. It is not an Electonic Chart by strict definition but it does create a virtual chart and is the best option to have been presented yet.

      HIPAA:
      It exists, full speed ahead. It is a good thing.

      Government Healthcare:
      Must be preserved at all costs, no one else will hire me.

    • #3112965

      Edited out

      by ontheropes ·

      In reply to Edited out

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      • #3112943

        Cool Beans

        by wingedmonkey ·

        In reply to Edited out

        I did some looking up in the Ortho sections for Spyders and your procedure. Thats great that you are able to type and post.

        Sounds like a real fright the way they keep messing up your documentation. Do you have any drug alleriges? And if yes, feel free to take a huge red marker and write them all over your record as much as you feel necessary. I have worked with the stickers before they peel away to easily.

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