ACHSRP3D ; IHS/ITSC/PMF - PRINT CHS (57 - DENTAL) FORMS ;
Source file <ACHSRP3D.m>
| Package | Total | Call Graph | 
|---|---|---|
| Contract Health Management Information System | 3 | $$PARM^ACHS (CSUPLA,KILLNULS)^ACHSRP3 $$SSV^ACHSTX3 | 
| IHS Patient | 1 | $$GETMBI^AUPNMBI | 
| Package | Total | Caller Graph | 
|---|---|---|
| Contract Health Management Information System | 2 | ACHSRP1 ACHSRP2 | 
| Name | Comments | DBIA/ICR reference | 
|---|---|---|
| TESTPRNT | ;EP. | |
| REFTYPE | ; | |
| MCD | ; | |
| AGESEX | ; | |
| OBLGAMT | ; | |
| PADRS | ; | |
| SIG | ; | |
| FROMTO | ; | |
| END | ; | |
| DT | ; | |
| EIN | ; | |
| CONTNO | ; | |
| PVT | ;*******LOOP THRU PRIVATE INSURANCE ELIGIBLE FILE | |
| RRE | ; | |
| PTYPE | ; | |
| E | ;;SPECIFIC REFERRAL, TYPE E:  Emergency examination and;treatment not to exceed above obligation.  Services;limited to Levels I-III of the IHS Schedule of Oral;Health Services. | |
| SSN | ; | |
| NO3 | ; | |
| DCR | ; | |
| B | ;;SPECIFIC REFERRAL, TYPE B:  Examination and treatment;limited to Levels I-III of the IHS Schedule of Oral;Health Services.  Treatment plans exceeding $300 must;be returned for predetermination. | |
| PTADRS | ; | |
| G | ;;GENERAL REFERRAL: Before providing services other than;examination, radiographs, or emergency services, this;claim form must be returned for predetermination. | |
| DEST | ; | |
| L | ;;REFERRAL TYPE L:  Authorization for dental laboratory;services for fabrication of _________________________. | |
| S | ;;SPECIFIC REFERRAL, TYPE S:  Specialty Services:  Services;limited to *_____________, not to exceed above obligation.;;*In the above blank, give a brief description of the;services ordered, including ADA code(s), if possible. | |
| SUCODE | ; | |
| DESC | ; | |
| ORDADRS | ; | |
| CANOBJ | ; | |
| NAME | ; | |
| DOBSEX | ; | |
| FACHRN | ; | |
| PROV | ; | |
| SSV | ; | |
| PONUM | ; | |
| COMCODE | ; | |
| MCR | ; | |
| ORDOFF | ; | 
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| Name | Line Occurrences (* Changed, ! Killed) | 
|---|---|
| ^ACHSF - [#9002080] | ACHSRP3D+5, ACHSRP3D+8, REFTYPE+2 | 
| ^AUPN3PPH - [#9000003.1] | PVT+10, PVT+11, PVT+12 | 
| ^AUPNMCD - [#9000004] | MCD+5, MCD+6, MCD+7, MCD+8, MCD+11, MCD+12 | 
| ^AUPNMCD("B" | MCD+2, MCD+3 | 
| ^AUPNMCR - [#9000003] | MCR+2, MCR+5, MCR+8, MCR+9, MCR+10, MCR+13, MCR+15, MCR+16, MCR+17 | 
| ^AUPNPRVT - [#9000006] | PVT+1, PVT+5, PVT+6 | 
| ^AUPNRRE - [#9000005] | RRE+2, RRE+4, RRE+5, RRE+6, RRE+7, RRE+15, RRE+16, RRE+19, RRE+20 | 
| ^AUTNINS - [#9999999.18] | PVT+9 | 
| ^AUTTMCS - [#9999999.32] | MCR+5 | 
| ^AUTTPIC - [#9999999.65] | PVT+12 | 
| ^AUTTRRP - [#9999999.33] | RRE+15 | 
| ^DIC(5 - [#5] | MCD+11 | 
| Name | Line Occurrences | 
|---|---|
| END | OBLGAMT+2, REFTYPE+4 | 
| MCD | MCR+2 | 
| NO3 | MCR+2, PVT+1 | 
| PVT | RRE+2, RRE+9 | 
| RRE | MCD+2 | 
| Name | Field # of Occurrence | 
|---|---|
| ^(0 | ACHSRP3D+5, MCR+5, MCD+11, MCD+12, RRE+20 | 
| ^(11 | PVT+1 | 
| >> | Not killed explicitly | 
| * | Changed | 
| ! | Killed | 
| ~ | Newed | 
| Name | Field # of Occurrence | 
|---|---|
| >> A(1 | FACHRN+2 | 
| >> A(11 | SSN+2 | 
| >> A(2 | NAME+2 | 
| >> A(3 | PTADRS+2 | 
| >> A(4 | DOBSEX+2, AGESEX+2 | 
| >> A(5 | COMCODE+1 | 
| >> A(7 | DESC+2 | 
| >> A(9 | MCR+2 | 
| >> ACHSDCR | DCR+1 | 
| >> ACHSDIEN | ACHSRP3D+5, ACHSRP3D+8, REFTYPE+2 | 
| >> ACHSEDOS | MCR+9, MCR+10, MCD+6, MCD+8, RRE+5, RRE+7, PVT+7, PVT+8 | 
| >> ACHSLCA | ACHSRP3D+5*, ACHSRP3D+7 | 
| ACHSLREF | REFTYPE+2*, REFTYPE+3, END+2! | 
| >> ACHSMBI | MCR+4*, MCR+5*, MCR+14, RRE+12*, RRE+13, RRE+14*, RRE+15*, RRE+16*, RRE+17 | 
| >> ACHSORDN | PONUM+1 | 
| >> ACHSSF | ACHSRP3D+5*, ACHSRP3D+6*, ACHSRP3D+7*, PONUM+1 | 
| >> ACHSSIG | SIG+1 | 
| >> ACHSTAB | FACHRN+2, FROMTO+1, PONUM+1, NAME+2, DCR+1, PTADRS+2, SIG+1, DT+1, DOBSEX+1, ORDOFF+1 , SUCODE+1, AGESEX+1, AGESEX+2, ORDADRS+1, DEST+1, SSV+2, SSN+1, PROV+1, EIN+1, PADRS+1 , PADRS+2, DESC+2, OBLGAMT+1, REFTYPE+3, MCR+12, MCD+11, RRE+17, PVT+9, NO3+1 | 
| >> ACHSTIEN | ACHSRP3D+5, ACHSRP3D+8, REFTYPE+2 | 
| >> ACHSTOPM | TESTPRNT+1 | 
| >> ACHSTPRT | CANOBJ+1, OBLGAMT+2 | 
| >> ACHSTYPE | ACHSRP3D+5*, ACHSRP3D+8, REFTYPE+4 | 
| >> ACHSTYPV | PONUM+1 | 
| >> B(1 | ORDOFF+1 | 
| >> B(3 | ORDADRS+1 | 
| >> B(4 | SUCODE+1 | 
| >> C(4 | FROMTO+1 | 
| >> D(1 | PROV+1 | 
| >> D(2 | PADRS+1 | 
| >> D(3 | PADRS+2 | 
| >> D(4 | EIN+1* | 
| >> D(5 | DEST+1 | 
| >> D(7 | PTYPE+1 | 
| >> DFN | SSV+2, MCR+2, MCR+4, MCR+5, MCR+8, MCR+9, MCR+10, MCR+13, MCR+15, MCR+16 , MCR+17, MCD+2, MCD+3, RRE+2, RRE+4, RRE+5, RRE+6, RRE+7, RRE+12, RRE+15 , RRE+16, RRE+19, RRE+20, PVT+1, PVT+5, PVT+6 | 
| DT | MCR+4, RRE+12 | 
| DUZ(2 | ACHSRP3D+5, ACHSRP3D+8, REFTYPE+2 | 
| >> E(11 | ACHSRP3D+8* | 
| >> E(7 | ACHSRP3D+8*, DT+1 | 
| >> E(9 | OBLGAMT+1 | 
| >> F(6 | CONTNO+2 | 
| >> F(7 | CANOBJ+1 | 
| >> F(8 | CANOBJ+1 | 
| >> F(9 | CANOBJ+1 | 
| >> I | TESTPRNT+1*, REFTYPE+3*, MCR+7*, MCR+8*, MCR+9, MCR+10, MCR+13, MCR+15, MCR+16, MCR+17 , MCD+5*, MCD+6, MCD+7, MCD+8, MCD+12, RRE+4*, RRE+5, RRE+6, RRE+7, PVT+3* , PVT+5*, PVT+6 | 
| >> I2 | PVT+6*, PVT+7, PVT+8, PVT+9, PVT+10, PVT+11, PVT+12, PVT+13 | 
| IOF | END+1 | 
| >> JJ | MCR+7*, MCR+8, MCR+11*, MCD+4*, MCD+5, MCD+7*, MCD+9*, MCD+10, RRE+3*, RRE+4 , RRE+6*, RRE+8*, RRE+9, RRE+18*, RRE+19*, RRE+20 | 
| >> LS | ACHSRP3D+5*, ACHSRP3D+6 | 
| >> R | MCD+3* | 
| U | ACHSRP3D+5, ACHSRP3D+8, REFTYPE+2, MCR+5, MCR+9, MCR+10, MCR+13, MCR+15, MCR+16, MCR+17 , MCD+6, MCD+7, MCD+8, MCD+11, MCD+12, RRE+5, RRE+6, RRE+7, RRE+15, RRE+16 , RRE+20, PVT+7, PVT+8, PVT+9, PVT+10, PVT+11, PVT+12, PVT+13 | 
| >> X | ACHSRP3D+8*, SSV+2*, MCD+3*, MCD+5, MCD+6, MCD+7, MCD+8, MCD+11, MCD+12 | 
| Name | Field # of Occurrence | 
|---|---|
| $T(@ACHSLREF | REFTYPE+3 |