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Sub-Field: 9000041.0101

Package: IHS Patient

THIRD PARTY LIABILITY(#9000041)-->9000041.0101

Sub-Field: 9000041.0101


Information

Parent File Name Number Package
THIRD PARTY LIABILITY(#9000041) DATE OF INJURY 9000041.0101 IHS Patient

Details

Field # Name Loc Type Details
.01 DATE OF INJURY 0;1 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  MAR 26, 2004
  • HELP-PROMPT:  (No range limit on date)
  • CROSS-REFERENCE:  9000041.0101^B
    1)= S ^AUPNTPL(DA(1),1,"B",$E(X,1,30),DA)=""
    2)= K ^AUPNTPL(DA(1),1,"B",$E(X,1,30),DA)
.02 INSURER 0;2 POINTER TO INSURER FILE (#9999999.18) INSURER(#9999999.18)

  • INPUT TRANSFORM:  S DIC("S")="I $$ITS^AUTINS(Y,""T"")" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  MAY 02, 2016
  • HELP-PROMPT:  Enter a Third Party Liability type insurer
  • DESCRIPTION:  
    Enter the person's insurance company involved in this incident.
  • SCREEN:  S DIC("S")="I $$ITS^AUTINS(Y,""T"")"
  • EXPLANATION:  ONLY THIRD PARTY LIABILITY INSURERS ALLOWED
.03 POLICY NUMBER 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>45!($L(X)<3) X
  • LAST EDITED:  AUG 23, 2004
  • HELP-PROMPT:  Answer must be 3-45 characters in length
  • DESCRIPTION:  
    Enter the policy number.
.04 EFFECTIVE DATE 0;4 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  AUG 23, 2004
  • HELP-PROMPT:  (No range limit on date)
  • DESCRIPTION:  
    Enter the effective date of this coverage.
.05 ENDING DATE 0;5 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  MAR 26, 2004
  • HELP-PROMPT:  (No range limit on date)
.06 GROUP NAME 0;6 POINTER TO EMPLOYER GROUP INSURANCE FILE (#9999999.77) EMPLOYER GROUP INSURANCE(#9999999.77)

  • LAST EDITED:  MAR 26, 2004
101 RESPONSIBLE PARTY NAME 1;1 FREE TEXT

  • INPUT TRANSFORM:  D NAME^AUPNPED
  • LAST EDITED:  AUG 23, 2004
  • HELP-PROMPT:  NAME IN THE FORM 'LASTNAME,FIRSTNAME'
  • DESCRIPTION:  
    Enter the responsible party's name.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
102 RESPONSIBLE PARTY SSN 1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>11!($L(X)<9) X
  • OUTPUT TRANSFORM:  S:$L(Y)=11 Y=$E(Y,1,11) I 1 S:$L(Y)=9 Y=$E(Y,1,3)_"-"_$E(Y,4,5)_"-"_$E(Y,6,9)
  • LAST EDITED:  AUG 23, 2004
  • HELP-PROMPT:  ENTER SSN WITH OR WITHOUT DASHES
  • DESCRIPTION:  
    Enter the responsible party's SSN
103 PATIENTS ATTORNEY 1;3 FREE TEXT

  • INPUT TRANSFORM:  D NAME^AUPNPED
  • LAST EDITED:  AUG 23, 2004
  • HELP-PROMPT:  ENTER NAME IN FORM "LASTNAME,FIRSTNAME"
  • DESCRIPTION:  
    Enter the patient's attorney.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
104 CAUSE OF INJURY 1;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  AUG 23, 2004
  • HELP-PROMPT:  Answer must be 3-30 characters in length
  • DESCRIPTION:  
    Enter the cause of this injury.
105 DESCRIPTION OF INJURY 1;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>45!($L(X)<3) X
  • LAST EDITED:  AUG 23, 2004
  • HELP-PROMPT:  Answer must be 3-45 characters in length
  • DESCRIPTION:  
    Enter a short description of this injury.
106 NOTES 1;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>45!($L(X)<3) X
  • LAST EDITED:  AUG 23, 2004
  • HELP-PROMPT:  Answer must be 3-45 characters in length
  • DESCRIPTION:  
    Enter pertinent notes concerning this incident.
201 CLAIM NUMBER 2;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<3) X
  • LAST EDITED:  SEP 09, 2010
  • HELP-PROMPT:  Answer must be 3-15 characters in length.
202 DATE LAST WORKED 2;2 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  SEP 09, 2010
203 DISABILITY START DATE 2;3 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  SEP 09, 2010
204 DISABILITY END DATE 2;4 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  SEP 09, 2010
205 WORK RETURN AUTH DATE 2;5 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  SEP 09, 2010
  • HELP-PROMPT:  Enter date authorized to return to work.
206 CONTACT INFO 2;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  SEP 09, 2010
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
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