AGMSP3.m

AGMSP3 ; IHS/ASDS/EFG - PRINT PAGE 3 OF MSP FORM ;   

 ;;7.1;PATIENT REGISTRATION;;AUG 25,2005

 ;

 ;I AG("MSPPRINT") EXISTS, MAP DATA FROM AUPNMSP TO THE FORM

EN ;EP

 W !,"PART III",!

 I '$D(AG("MSPPRINT")) D BLANK1

 I $D(AG("MSPPRINT")) D MAP1

 W !!

 W !,?50,"Continued on next page ==>"

 W !,AGLINE("EQ")

 W !,$P($G(^DIC(4,DUZ(2),0)),U),?73,"PAGE 3"

 Q

BLANK1 ;THIS SECTION IS USED TO PRINT THE BLANK PAGE 3

 W !,?2,"1. Are you entitled to Medicare based on : ",!

 W !,?5,"[ ] Age - GO TO PART IV",!

 W !,?5,"[ ] Disability _ GO TO PART V",!

 W !,?5,"[ ] ESRD - GO TO PART VI",!

 W !,"PART IV - Age",!

 W !,?2,"1. Are you currently employed ? ",!

 W !,?5,"[ ] YES",!

 W !,?14,"Name and address of your employer : ",!

 W !,?14,$E(AGLINE("_"),1,50),!

 W !,?14,$E(AGLINE("_"),1,50),!

 W !,?14,$E(AGLINE("_"),1,50),!

 W !,?5,"[ ] NO  Date of retirement : _______________",!

 W !,?2,"2. Is your spouse currently employed ? ",!

 W !,?5,"[ ] YES",!

 W !,?14,"Name and address of spouse's employer : ",!

 W !,?14,$E(AGLINE("_"),1,50),!

 W !,?14,$E(AGLINE("_"),1,50),!

 W !,?14,$E(AGLINE("_"),1,50),!

 W !,?5,"[ ] NO. Date of retirement : _______________",!

 W !?2,"If the patient answered no to both questions 1 and 2, Medicare is primary"

 W !?2,"unless the patient answered yes to questions in part I or II."

 W !?2,"STOP. DO NOT PROCEED ANY FURTHER."

 Q

MAP1 ;THIS SECTION IS USED TO PRINT THE PATIENT'S DATA ON THE FORM

 W !,?2,"1. Are you entitled to Medicare based on : ",!

 I $P(MSPRES(9000037,AG("DA"),.25),U)="AGE" D

 . W !,?5,"[X] Age - GO TO PART IV",!

 E  W !,?5,"[ ] Age - GO TO PART IV",!

 I $P(MSPRES(9000037,AG("DA"),.25),U)="DISABILITY" D

 . W !,?5,"[X] Disability _ GO TO PART V",!

 E  W !,?5,"[ ] Disability _ GO TO PART V",!

 I $P(MSPRES(9000037,AG("DA"),.25),U)="ESRD" D

 . W !,?5,"[X] ESRD - GO TO PART VI",!

 E  W !,?5,"[ ] ESRD - GO TO PART VI",!

 ;

 W !,"PART IV - Age",!

 W !,?2,"1. Are you currently employed ? ",!

 I $P(MSPRES(9000037,AG("DA"),.26),U)=""!($P(MSPRES(9000037,AG("DA"),.26),U)="NO") D

 . W !,?5,"[ ] YES",!

 . W !,?14,"Name and address of your employer : ",!

 . W !,?14,$E(AGLINE("_"),1,50),!

 . W !,?14,$E(AGLINE("_"),1,50),!

 . W !,?14,$E(AGLINE("_"),1,50),!

 . I $P(MSPRES(9000037,AG("DA"),.26),U)="" W !,?5,"[ ] NO  Date of retirement : _______________",!

 . I $P(MSPRES(9000037,AG("DA"),.26),U)="NO" D

 .. W !,?5,"[X] NO  Date of retirement : "

 .. W $P(MSPRES(9000037,AG("DA"),.28),U),!

 I $P(MSPRES(9000037,AG("DA"),.26),U)="YES" D

 . W !,?5,"[X] YES",!

 . W !,?14,"Name and address of your employer : ",!

 . S AG("EMPPTR")=$P($G(^AUPNMSP(AG("DA"),4)),U,2)

 . I $G(AG("EMPPTR"))'="" D

 .. S AG("EMPADDR")=$G(^AUTNEMPL(AG("EMPPTR"),0))

 .. W !,?14,$P(AG("EMPADDR"),U),!  ;EMPLOYER

 .. W !,?14,$P(AG("EMPADDR"),U,2),!  ;EMPLOYER STREET

 .. W !,?14,$P(AG("EMPADDR"),U,3)  ;EMPLOYER CITY

 .. I $P(AG("EMPADDR"),U,4)'="" D

 ... W ", ",$P($G(^DIC(5,$P(AG("EMPADDR"),U,4),0)),U,2)  ;EMPLOYER STATE

 .. W ", ",$P(AG("EMPADDR"),U,5),!  ;EMPLOYER ZIP

 . I $G(AG("EMPPTR"))="" D

 .. W !,?14,$E(AGLINE("_"),1,50),!

 .. W !,?14,$E(AGLINE("_"),1,50),!

 .. W !,?14,$E(AGLINE("_"),1,50),!

 . W !,?5,"[ ] NO  Date of retirement : _______________",!

 ;

 W !,?2,"2. Is your spouse currently employed ? ",!

 I $P(MSPRES(9000037,AG("DA"),.29),U)=""!($P(MSPRES(9000037,AG("DA"),.29),U)="NO") D

 . W !,?5,"[ ] YES",!

 . W !,?14,"Name and address of spouse's employer : ",!

 . W !,?14,$E(AGLINE("_"),1,50),!

 . W !,?14,$E(AGLINE("_"),1,50),!

 . W !,?14,$E(AGLINE("_"),1,50),!

 . I $P(MSPRES(9000037,AG("DA"),.29),U)="" W !,?5,"[ ] NO  Date of retirement : _______________",!

 . I $P(MSPRES(9000037,AG("DA"),.29),U)="NO" W !,?5,"[X] NO  Date of retirement : ",$P(MSPRES(9000037,AG("DA"),.32),U),!

 I $P(MSPRES(9000037,AG("DA"),.29),U)="YES" D

 . W !,?5,"[X] YES",!

 . S AG("EMPPTR")=$P($G(^AUPNMSP(AG("DA"),4)),U,5)

 . I $G(AG("EMPPTR"))'="" D

 .. S AG("EMPADDR")=$G(^AUTNEMPL(AG("EMPPTR"),0))

 .. W !,?14,$P(AG("EMPADDR"),U),!  ;EMPLOYER

 .. W !,?14,$P(AG("EMPADDR"),U,2),!  ;EMPLOYER STREET

 .. W !,?14,$P(AG("EMPADDR"),U,3)  ;EMPLOYER CITY

 .. I $P(AG("EMPADDR"),U,4)'="" D

 ... W ", ",$P($G(^DIC(5,$P(AG("EMPADDR"),U,4),0)),U,2)  ;EMPLOYER STATE

 .. W ", ",$P(AG("EMPADDR"),U,5),!  ;EMPLOYER ZIP

 . I $G(AG("EMPPTR"))="" D

 .. W !,?14,$E(AGLINE("_"),1,50),!

 .. W !,?14,$E(AGLINE("_"),1,50),!

 .. W !,?14,$E(AGLINE("_"),1,50),!

 . W !,?5,"[ ] NO  Date of retirement : _______________",!

 ;

 W !,?2,"3. Do you have group health plan (GHP) coverage based on your own, or a"

 W !,?5,"spouse's current employment ? ",!

 I $P(MSPRES(9000037,AG("DA"),.33),U)="" D

 . W !,?5,"[ ] YES",!

 . W !,?5,"[ ] NO",!

 I $P(MSPRES(9000037,AG("DA"),.33),U)="YES" D

 . W !,?5,"[X] YES",!

 . W !,?5,"[ ] NO",!

 I $P(MSPRES(9000037,AG("DA"),.33),U)="NO" D

 . W !,?5,"[ ] YES",!

 . W !,?5,"[X] NO",!

 K AG("EMPPTR"),AG("EMPADDR")

 Q

AGMSP3    ; IHS/ASDS/EFG - PRINT PAGE 3 OF MSP FORM ;   

 +1       ;;7.1;PATIENT REGISTRATION;;AUG 25,2005

 +2       ;

 +3       ;I AG("MSPPRINT") EXISTS, MAP DATA FROM AUPNMSP TO THE FORM

EN        ;EP

 +1        WRITE !,"PART III",!

 +2        IF '$DATA(AG("MSPPRINT"))

               DO BLANK1

 +3        IF $DATA(AG("MSPPRINT"))

               DO MAP1

 +4        WRITE !!

 +5        WRITE !,?50,"Continued on next page ==>"

 +6        WRITE !,AGLINE("EQ")

 +7        WRITE !,$PIECE($GET(^DIC(4,DUZ(2),0)),U),?73,"PAGE 3"

 +8        QUIT 

BLANK1    ;THIS SECTION IS USED TO PRINT THE BLANK PAGE 3

 +1        WRITE !,?2,"1. Are you entitled to Medicare based on : ",!

 +2        WRITE !,?5,"[ ] Age - GO TO PART IV",!

 +3        WRITE !,?5,"[ ] Disability _ GO TO PART V",!

 +4        WRITE !,?5,"[ ] ESRD - GO TO PART VI",!

 +5        WRITE !,"PART IV - Age",!

 +6        WRITE !,?2,"1. Are you currently employed ? ",!

 +7        WRITE !,?5,"[ ] YES",!

 +8        WRITE !,?14,"Name and address of your employer : ",!

 +9        WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +10       WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +11       WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +12       WRITE !,?5,"[ ] NO  Date of retirement : _______________",!

 +13       WRITE !,?2,"2. Is your spouse currently employed ? ",!

 +14       WRITE !,?5,"[ ] YES",!

 +15       WRITE !,?14,"Name and address of spouse's employer : ",!

 +16       WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +17       WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +18       WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +19       WRITE !,?5,"[ ] NO. Date of retirement : _______________",!

 +20       WRITE !?2,"If the patient answered no to both questions 1 and 2, Medicare is primary"

 +21       WRITE !?2,"unless the patient answered yes to questions in part I or II."

 +22       WRITE !?2,"STOP. DO NOT PROCEED ANY FURTHER."

 +23       QUIT 

MAP1      ;THIS SECTION IS USED TO PRINT THE PATIENT'S DATA ON THE FORM

 +1        WRITE !,?2,"1. Are you entitled to Medicare based on : ",!

 +2        IF $PIECE(MSPRES(9000037,AG("DA"),.25),U)="AGE"

               Begin DoDot:1

 +3                WRITE !,?5,"[X] Age - GO TO PART IV",!

               End DoDot:1

 +4       IF '$TEST

               WRITE !,?5,"[ ] Age - GO TO PART IV",!

 +5        IF $PIECE(MSPRES(9000037,AG("DA"),.25),U)="DISABILITY"

               Begin DoDot:1

 +6                WRITE !,?5,"[X] Disability _ GO TO PART V",!

               End DoDot:1

 +7       IF '$TEST

               WRITE !,?5,"[ ] Disability _ GO TO PART V",!

 +8        IF $PIECE(MSPRES(9000037,AG("DA"),.25),U)="ESRD"

               Begin DoDot:1

 +9                WRITE !,?5,"[X] ESRD - GO TO PART VI",!

               End DoDot:1

 +10      IF '$TEST

               WRITE !,?5,"[ ] ESRD - GO TO PART VI",!

 +11      ;

 +12       WRITE !,"PART IV - Age",!

 +13       WRITE !,?2,"1. Are you currently employed ? ",!

 +14       IF $PIECE(MSPRES(9000037,AG("DA"),.26),U)=""!($PIECE(MSPRES(9000037,AG("DA"),.26),U)="NO")

               Begin DoDot:1

 +15               WRITE !,?5,"[ ] YES",!

 +16               WRITE !,?14,"Name and address of your employer : ",!

 +17               WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +18               WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +19               WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +20               IF $PIECE(MSPRES(9000037,AG("DA"),.26),U)=""

                       WRITE !,?5,"[ ] NO  Date of retirement : _______________",!

 +21               IF $PIECE(MSPRES(9000037,AG("DA"),.26),U)="NO"

                       Begin DoDot:2

 +22                       WRITE !,?5,"[X] NO  Date of retirement : "

 +23                       WRITE $PIECE(MSPRES(9000037,AG("DA"),.28),U),!

                       End DoDot:2

               End DoDot:1

 +24       IF $PIECE(MSPRES(9000037,AG("DA"),.26),U)="YES"

               Begin DoDot:1

 +25               WRITE !,?5,"[X] YES",!

 +26               WRITE !,?14,"Name and address of your employer : ",!

 +27               SET AG("EMPPTR")=$PIECE($GET(^AUPNMSP(AG("DA"),4)),U,2)

 +28               IF $GET(AG("EMPPTR"))'=""

                       Begin DoDot:2

 +29                       SET AG("EMPADDR")=$GET(^AUTNEMPL(AG("EMPPTR"),0))

 +30      ;EMPLOYER

                           WRITE !,?14,$PIECE(AG("EMPADDR"),U),!

 +31      ;EMPLOYER STREET

                           WRITE !,?14,$PIECE(AG("EMPADDR"),U,2),!

 +32      ;EMPLOYER CITY

                           WRITE !,?14,$PIECE(AG("EMPADDR"),U,3)

 +33                       IF $PIECE(AG("EMPADDR"),U,4)'=""

                               Begin DoDot:3

 +34      ;EMPLOYER STATE

                                   WRITE ", ",$PIECE($GET(^DIC(5,$PIECE(AG("EMPADDR"),U,4),0)),U,2)

                               End DoDot:3

 +35      ;EMPLOYER ZIP

                           WRITE ", ",$PIECE(AG("EMPADDR"),U,5),!

                       End DoDot:2

 +36               IF $GET(AG("EMPPTR"))=""

                       Begin DoDot:2

 +37                       WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +38                       WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +39                       WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

                       End DoDot:2

 +40               WRITE !,?5,"[ ] NO  Date of retirement : _______________",!

               End DoDot:1

 +41      ;

 +42       WRITE !,?2,"2. Is your spouse currently employed ? ",!

 +43       IF $PIECE(MSPRES(9000037,AG("DA"),.29),U)=""!($PIECE(MSPRES(9000037,AG("DA"),.29),U)="NO")

               Begin DoDot:1

 +44               WRITE !,?5,"[ ] YES",!

 +45               WRITE !,?14,"Name and address of spouse's employer : ",!

 +46               WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +47               WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +48               WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +49               IF $PIECE(MSPRES(9000037,AG("DA"),.29),U)=""

                       WRITE !,?5,"[ ] NO  Date of retirement : _______________",!

 +50               IF $PIECE(MSPRES(9000037,AG("DA"),.29),U)="NO"

                       WRITE !,?5,"[X] NO  Date of retirement : ",$PIECE(MSPRES(9000037,AG("DA"),.32),U),!

               End DoDot:1

 +51       IF $PIECE(MSPRES(9000037,AG("DA"),.29),U)="YES"

               Begin DoDot:1

 +52               WRITE !,?5,"[X] YES",!

 +53               SET AG("EMPPTR")=$PIECE($GET(^AUPNMSP(AG("DA"),4)),U,5)

 +54               IF $GET(AG("EMPPTR"))'=""

                       Begin DoDot:2

 +55                       SET AG("EMPADDR")=$GET(^AUTNEMPL(AG("EMPPTR"),0))

 +56      ;EMPLOYER

                           WRITE !,?14,$PIECE(AG("EMPADDR"),U),!

 +57      ;EMPLOYER STREET

                           WRITE !,?14,$PIECE(AG("EMPADDR"),U,2),!

 +58      ;EMPLOYER CITY

                           WRITE !,?14,$PIECE(AG("EMPADDR"),U,3)

 +59                       IF $PIECE(AG("EMPADDR"),U,4)'=""

                               Begin DoDot:3

 +60      ;EMPLOYER STATE

                                   WRITE ", ",$PIECE($GET(^DIC(5,$PIECE(AG("EMPADDR"),U,4),0)),U,2)

                               End DoDot:3

 +61      ;EMPLOYER ZIP

                           WRITE ", ",$PIECE(AG("EMPADDR"),U,5),!

                       End DoDot:2

 +62               IF $GET(AG("EMPPTR"))=""

                       Begin DoDot:2

 +63                       WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +64                       WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

 +65                       WRITE !,?14,$EXTRACT(AGLINE("_"),1,50),!

                       End DoDot:2

 +66               WRITE !,?5,"[ ] NO  Date of retirement : _______________",!

               End DoDot:1

 +67      ;

 +68       WRITE !,?2,"3. Do you have group health plan (GHP) coverage based on your own, or a"

 +69       WRITE !,?5,"spouse's current employment ? ",!

 +70       IF $PIECE(MSPRES(9000037,AG("DA"),.33),U)=""

               Begin DoDot:1

 +71               WRITE !,?5,"[ ] YES",!

 +72               WRITE !,?5,"[ ] NO",!

               End DoDot:1

 +73       IF $PIECE(MSPRES(9000037,AG("DA"),.33),U)="YES"

               Begin DoDot:1

 +74               WRITE !,?5,"[X] YES",!

 +75               WRITE !,?5,"[ ] NO",!

               End DoDot:1

 +76       IF $PIECE(MSPRES(9000037,AG("DA"),.33),U)="NO"

               Begin DoDot:1

 +77               WRITE !,?5,"[ ] YES",!

 +78               WRITE !,?5,"[X] NO",!

               End DoDot:1

 +79       KILL AG("EMPPTR"),AG("EMPADDR")

 +80       QUIT