DG1010P7 ;ALB/REW - PRINT 1010 CONT'D PART VII ; 18 MAR 92
;;5.3;Registration;;Aug 13, 1993
;;1
PARTVII S DGBLANK=1
W !!?48,"PART VII - INELIGIBLE/MISSING DATA",!,DGLUND
K DGP,DGCHECK,DGDEPINC,DGCT,DGDEP,DGRDOB,DGDREL,DGRNAM,DGRSEX,DGRSSN,DGSP,DGSPOINC,DGTOTINC,DGTYPE,DGVETINC,DGNODE,DGREL,DGGTOT,DGINC,DGINR,DGISDT,DGPCE,DGTOT,DGDEF,F,INCTEXT
F I="INE",.15,.3,.32,.361,.372 S DGP(I)=$G(^DPT(DFN,I))
W !,"1. INELIGIBLE DATE",?32,"| ","2. TWX SOURCE",?66,"| ","3. TWX CITY",?98,"| ","4. TWX STATE"
S X=$P(DGP("INE"),U,1),DGSOURCE=$S((X=""):"",(X=1):"VAMC",(X=2):"REGIONAL OFFICE",(X=3):"RPC",1:"INVALID")
W !?5,$$DATENP^DG1010P0(DGP(.15),2,0,DGBLANK),?32,"| ",?39,$$UNK^DG1010P0(DGSOURCE,0,DGBLANK),?66,"| ",?72,$$DISP^DG1010P0(DGP("INE"),3,0,DGBLANK),?98,"| ",?105,$$POINT^DG1010P0(DGP("INE"),4,5,1,0,DGBLANK),?131,$C(13),DGLUND
W !,"5. REASON: ",$$DISP^DG1010P0(DGP(.3),7,0,DGBLANK),!,DGLUND
W !,"6. VACO DECISION: ",$$DISP^DG1010P0(DGP("INE"),6,0,DGBLANK),!,DGLUND
S X=$P(DGP("INE"),U,7),DGSOURCE=$S((X=""):"",(X=1):"VAMC",(X=2):"REGIONAL OFFICE",(X=3):"RPC",1:"INVALID")
W !,"7. MISSING DATE",?32,"| ","8. TWX SOURCE",?66,"| ","9. TWX CITY",?98,"| ","10. TWX STATE"
W !?5,$$DATENP^DG1010P0(DGP(.15),3,0,DGBLANK),?32,"| ",?39,$$UNK^DG1010P0(DGSOURCE,0,DGBLANK),?66,"| ",?72,$$DISP^DG1010P0(DGP("INE"),8,0,DGBLANK),?98,"| ",?105,$$POINT^DG1010P0(DGP("INE"),9,5,1,0,DGBLANK),?131,$C(13),DGLUND
W !,"11. REASON: "
F I=0:0 S I=$O(^DPT(DFN,.16,I)) W:(I'>0) ! Q:I'>0 W:(I'=1) ! W ?13,^(I,0)
W ?131,$C(13),DGLUND
D FOOTER^DG1010P2
G:$G(DGSTOP) CLEANUP^DG1010P7
D HEADER^DG1010P2
PAGE4 ;
W !,$P(($T(REPLACE+1)),";;",2),!,DGLDOUBL
S DGBLANK=0
W !,"1. ELIGIBILITY STATUS",?53,"| ","2. STATUS DATE",?88,"| ","3. STATUS ENTERED BY"
S X=$P(DGP(.361),U,1),DGSOURCE=$S((X=""):"UNANSWERED",(X="P"):"PENDING VERIFICATION",(X="R"):"RE-VERIFY",(X="V"):"VERIFIED",1:"INVALID")
W !?4,DGSOURCE,?53,"| ",?59,$$DATENP^DG1010P0(DGP(.361),2),?88,"| ",?94,$$POINT^DG1010P0(DGP(.361),6,"^VA(200,"),?131,$C(13),DGLUND
W !,"4. VERIFICATION METHOD",?53,"| ","5. SERVICE VERIFICATION DATE"
W !?4,$E($$DISP^DG1010P0(DGP(.361),5),1,48),?53,"| ",?59,$$DATENP^DG1010P0(DGP(.32),2)
;;?88,"| ","6. RATED DISABILITIES"
;;?88,"| "
;;S I=0 F J=1:1 S I=$O(^DPT(DFN,.372,I)) W:(J=1)&(I'>0) ?94,"UNANSWERED" Q:I'>0 W:(I'>0) ! S X=$G(^(I,0)) W:(I'=1) !,?53,"| ",?88,"| " W ?94,$P($G(^DIC(31,+X,0)),U,1)
W ?131,$C(13),DGLUND,!
F I=1:1:9 W !,$P($T(WARNING+I),";;",2)
W !,DGLUND
W !,"SIGNATURE OF APPLICANT OR APPLICANT'S REPRESENTATIVE",?88,"| ","DATE"
F I=1:1:4 W !,?88,"| "
W !,$E(DGLUND,1,88),"|",$E(DGLUND,90,132)
W !?8,"FOR VA USE ONLY",?32,"| ","VA FACILITY NUMBER",?65,"| ","ADMISSION DATE",?93,"| ","AUTHORITY FOR ADMISSION OR TREATMENT"
F I=1:1:2 W !,?32,"| ",?65,"| ",?93,"| "
W !,?32,"| ",?42,$P(DGSITE,U,3),?65,"| ",?93,"| "
F I=1:1:2 W !,?32,"| ",?65,"| ",?93,"| "
D FOOTER^DG1010P2
G:$G(DGSTOP) CLEANUP^DG1010P7
D:'FREE ^DG1010S1
CLEANUP ;
K BL,DGUNK,DGP,DGD,P2,DGBLANK,DGAP,DGDMAX,DGDPC,DGI,DGL2,DGLDASH,DGLDOUBL,DGLUND,DGNA,DGNAM,DGNOTMAR,DGPAGE,DGSITE,DGSPACES,DGSS,N,NA,P,ROOT,WARNING,DGSOURCE,DGCLK
Q
WARNING ;
;;* WARNING: If you knowingly make a false statement of any material fact in or in connection with this
;; application, you are subject to prosecution in a U.S. Court.
;;
;;* Completion of this form with signature of the veteran is certification that the veteran has received a copy
;; of the Privacy Act Statement.
;;
;;* I UNDERSTAND THE QUESTIONS, AND ALL THE ANSWERS ARE TRUE TO THE BEST OF MY KNOWLEDGE
;; AND BELIEF. I AGREE TO ACCEPT TRANSFER TO ANOTHER FACILITY IF, IN THE OPINION OF THE MEDICAL
;; STAFF, SUCH TRANSFER IS DEEMED APPROPRIATE.
REPLACE ;
;; THIS PAGE MAY BE REPLACED BY PAGE #4 OF VA FORM 10-10 WHICH CONTAINS PRIVACY ACT NOTICE & CONSENT TO RELEASE INFORMATION
DG1010P7 ;ALB/REW - PRINT 1010 CONT'D PART VII ; 18 MAR 92
+1 ;;5.3;Registration;;Aug 13, 1993
+2 ;;1
PARTVII SET DGBLANK=1
+1 WRITE !!?48,"PART VII - INELIGIBLE/MISSING DATA",!,DGLUND
+2 KILL DGP,DGCHECK,DGDEPINC,DGCT,DGDEP,DGRDOB,DGDREL,DGRNAM,DGRSEX,DGRSSN,DGSP,DGSPOINC,DGTOTINC,DGTYPE,DGVETINC,DGNODE,DGREL,DGGTOT,DGINC,DGINR,DGISDT,DGPCE,DGTOT,DGDEF,F,INCTEXT
+3 FOR I="INE",.15,.3,.32,.361,.372
SET DGP(I)=$GET(^DPT(DFN,I))
+4 WRITE !,"1. INELIGIBLE DATE",?32,"| ","2. TWX SOURCE",?66,"| ","3. TWX CITY",?98,"| ","4. TWX STATE"
+5 SET X=$PIECE(DGP("INE"),U,1)
SET DGSOURCE=$SELECT((X=""):"",(X=1):"VAMC",(X=2):"REGIONAL OFFICE",(X=3):"RPC",1:"INVALID")
+6 WRITE !?5,$$DATENP^DG1010P0(DGP(.15),2,0,DGBLANK),?32,"| ",?39,$$UNK^DG1010P0(DGSOURCE,0,DGBLANK),?66,"| ",?72,$$DISP^DG1010P0(DGP("INE"),3,0,DGBLANK),?98,"| ",?105,$$POINT^DG1010P0(DGP("INE"),4,5,1,0,DGBLANK),?131,$CHAR(13),DGLUND
+7 WRITE !,"5. REASON: ",$$DISP^DG1010P0(DGP(.3),7,0,DGBLANK),!,DGLUND
+8 WRITE !,"6. VACO DECISION: ",$$DISP^DG1010P0(DGP("INE"),6,0,DGBLANK),!,DGLUND
+9 SET X=$PIECE(DGP("INE"),U,7)
SET DGSOURCE=$SELECT((X=""):"",(X=1):"VAMC",(X=2):"REGIONAL OFFICE",(X=3):"RPC",1:"INVALID")
+10 WRITE !,"7. MISSING DATE",?32,"| ","8. TWX SOURCE",?66,"| ","9. TWX CITY",?98,"| ","10. TWX STATE"
+11 WRITE !?5,$$DATENP^DG1010P0(DGP(.15),3,0,DGBLANK),?32,"| ",?39,$$UNK^DG1010P0(DGSOURCE,0,DGBLANK),?66,"| ",?72,$$DISP^DG1010P0(DGP("INE"),8,0,DGBLANK),?98,"| ",?105,$$POINT^DG1010P0(DGP("INE"),9,5,1,0,DGBLANK),?131,$CHAR(13),DGLUND
+12 WRITE !,"11. REASON: "
+13 FOR I=0:0
SET I=$ORDER(^DPT(DFN,.16,I))
IF (I'>0)
WRITE !
IF I'>0
QUIT
IF (I'=1)
WRITE !
WRITE ?13,^(I,0)
+14 WRITE ?131,$CHAR(13),DGLUND
+15 DO FOOTER^DG1010P2
+16 IF $GET(DGSTOP)
GOTO CLEANUP^DG1010P7
+17 DO HEADER^DG1010P2
PAGE4 ;
+1 WRITE !,$PIECE(($TEXT(REPLACE+1)),";;",2),!,DGLDOUBL
+2 SET DGBLANK=0
+3 WRITE !,"1. ELIGIBILITY STATUS",?53,"| ","2. STATUS DATE",?88,"| ","3. STATUS ENTERED BY"
+4 SET X=$PIECE(DGP(.361),U,1)
SET DGSOURCE=$SELECT((X=""):"UNANSWERED",(X="P"):"PENDING VERIFICATION",(X="R"):"RE-VERIFY",(X="V"):"VERIFIED",1:"INVALID")
+5 WRITE !?4,DGSOURCE,?53,"| ",?59,$$DATENP^DG1010P0(DGP(.361),2),?88,"| ",?94,$$POINT^DG1010P0(DGP(.361),6,"^VA(200,"),?131,$CHAR(13),DGLUND
+6 WRITE !,"4. VERIFICATION METHOD",?53,"| ","5. SERVICE VERIFICATION DATE"
+7 WRITE !?4,$EXTRACT($$DISP^DG1010P0(DGP(.361),5),1,48),?53,"| ",?59,$$DATENP^DG1010P0(DGP(.32),2)
+8 ;;?88,"| ","6. RATED DISABILITIES"
+9 ;;?88,"| "
+10 ;;S I=0 F J=1:1 S I=$O(^DPT(DFN,.372,I)) W:(J=1)&(I'>0) ?94,"UNANSWERED" Q:I'>0 W:(I'>0) ! S X=$G(^(I,0)) W:(I'=1) !,?53,"| ",?88,"| " W ?94,$P($G(^DIC(31,+X,0)),U,1)
+11 WRITE ?131,$CHAR(13),DGLUND,!
+12 FOR I=1:1:9
WRITE !,$PIECE($TEXT(WARNING+I),";;",2)
+13 WRITE !,DGLUND
+14 WRITE !,"SIGNATURE OF APPLICANT OR APPLICANT'S REPRESENTATIVE",?88,"| ","DATE"
+15 FOR I=1:1:4
WRITE !,?88,"| "
+16 WRITE !,$EXTRACT(DGLUND,1,88),"|",$EXTRACT(DGLUND,90,132)
+17 WRITE !?8,"FOR VA USE ONLY",?32,"| ","VA FACILITY NUMBER",?65,"| ","ADMISSION DATE",?93,"| ","AUTHORITY FOR ADMISSION OR TREATMENT"
+18 FOR I=1:1:2
WRITE !,?32,"| ",?65,"| ",?93,"| "
+19 WRITE !,?32,"| ",?42,$PIECE(DGSITE,U,3),?65,"| ",?93,"| "
+20 FOR I=1:1:2
WRITE !,?32,"| ",?65,"| ",?93,"| "
+21 DO FOOTER^DG1010P2
+22 IF $GET(DGSTOP)
GOTO CLEANUP^DG1010P7
+23 IF 'FREE
DO ^DG1010S1
CLEANUP ;
+1 KILL BL,DGUNK,DGP,DGD,P2,DGBLANK,DGAP,DGDMAX,DGDPC,DGI,DGL2,DGLDASH,DGLDOUBL,DGLUND,DGNA,DGNAM,DGNOTMAR,DGPAGE,DGSITE,DGSPACES,DGSS,N,NA,P,ROOT,WARNING,DGSOURCE,DGCLK
+2 QUIT
WARNING ;
+1 ;;* WARNING: If you knowingly make a false statement of any material fact in or in connection with this
+2 ;; application, you are subject to prosecution in a U.S. Court.
+3 ;;
+4 ;;* Completion of this form with signature of the veteran is certification that the veteran has received a copy
+5 ;; of the Privacy Act Statement.
+6 ;;
+7 ;;* I UNDERSTAND THE QUESTIONS, AND ALL THE ANSWERS ARE TRUE TO THE BEST OF MY KNOWLEDGE
+8 ;; AND BELIEF. I AGREE TO ACCEPT TRANSFER TO ANOTHER FACILITY IF, IN THE OPINION OF THE MEDICAL
+9 ;; STAFF, SUCH TRANSFER IS DEEMED APPROPRIATE.
REPLACE ;
+1 ;; THIS PAGE MAY BE REPLACED BY PAGE #4 OF VA FORM 10-10 WHICH CONTAINS PRIVACY ACT NOTICE & CONSENT TO RELEASE INFORMATION
