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Routine: AGMSP7

AGMSP7.m

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  1. AGMSP7 ; IHS/ASDS/EFG - PRINT PAGE 7 OF MSP FORM ;
  1. ;;7.1;PATIENT REGISTRATION;;AUG 25,2005
  1. ;
  1. ;I AG("MSPPRINT") EXISTS, MAP DATA FROM AUPNMSP TO THE FORM
  1. EN ;EP
  1. W !,"PART VI - ESRD (con't)",!
  1. I '$D(AG("MSPPRINT")) D BLANK1
  1. I $D(AG("MSPPRINT")) D MAP1
  1. W !!!!!!!!!
  1. ;W !,?50,"Continued on next page ==>"
  1. W !,AGLINE("EQ")
  1. W !,$P($G(^DIC(4,DUZ(2),0)),U),?73,"PAGE 7"
  1. Q
  1. BLANK1 ;THIS SECTION IS USED TO PRINT THE BLANK PAGE 7
  1. W !,?2,"4. Are you within the 30 month coordination period ? ",!
  1. W !,?5,"[ ] YES",!
  1. W !,?5,"[ ] NO. STOP. Medicare is primary.",!
  1. W !,?2,"5. Are you entitled to Medicare on the basis of either ESRD and age or ESRD"
  1. W !,?5,"and disability ? ",!
  1. W !,?5,"[ ] YES",!
  1. W !,?5,"[ ] NO. STOP. The group health plan (GHP) is primary during the 30-month"
  1. W !?19,"coordination period.",!
  1. W !,?2,"6. Was your initial entitlement to Medicare (including simultaneous"
  1. W !,?5,"entitlement) based on ESRD ? ",!
  1. W !,?5,"[ ] YES. STOP. The GHP continues to pay primary during the 30-month"
  1. W !?19,"coordination period.",!
  1. W !,?5,"[ ] NO. Initial entitlement is based on age or diability.",!
  1. W !,?2,"7. Does the working aged or disability MSP provision apply (i.e., is the GHP"
  1. W !,?5,"primary based on age or disability entitlement) ? ",!
  1. W !,?5,"[ ] YES. The GHP continues to pay primary during the 30-month"
  1. W !?14,"coordination period.",!
  1. W !,?5,"[ ] NO. Medicare continues to pay primary.",!
  1. W !!!
  1. W !,?2," SIGNATURE : ______________________________"
  1. W !,?2," SIGNATURE DATE : __________________"
  1. W !,?2,"DATE SURVEY GIVEN : __________________"
  1. Q
  1. MAP1 ;THIS SECTION IS USED TO PRINT THE PATIENT'S DATA ON THE FORM
  1. W !,?2,"4. Are you within the 30 month coordination period ? ",!
  1. I $P(MSPRES(9000037,AG("DA"),.67),U)=""!($P(MSPRES(9000037,AG("DA"),.67),U)="NO") D
  1. . W !,?5,"[ ] YES",!
  1. . I $P(MSPRES(9000037,AG("DA"),.67),U)="" W !,?5,"[ ] NO",!
  1. . I $P(MSPRES(9000037,AG("DA"),.67),U)="NO" W !,?5,"[X] NO",!
  1. I $P(MSPRES(9000037,AG("DA"),.67),U)="YES" D
  1. . W !,?5,"[X] YES",!
  1. . W !,?5,"[ ] NO",!
  1. ;
  1. W !,?2,"5. Are you entitled to Medicare on the basis of either ESRD and age or ESRD"
  1. W !,?5,"and disability ? ",!
  1. I $P(MSPRES(9000037,AG("DA"),.68),U)=""!($P(MSPRES(9000037,AG("DA"),.68),U)="NO") D
  1. . W !,?5,"[ ] YES",!
  1. . I $P(MSPRES(9000037,AG("DA"),.68),U)="" W !,?5,"[ ] NO",!
  1. . I $P(MSPRES(9000037,AG("DA"),.68),U)="NO" W !,?5,"[X] NO",!
  1. I $P(MSPRES(9000037,AG("DA"),.68),U)="YES" D
  1. . W !,?5,"[X] YES",!
  1. . W !,?5,"[ ] NO",!
  1. ;
  1. W !,?2,"6. Was your initial entitlement to Medicare (including simultaneous"
  1. W !,?5,"entitlement) based on ESRD ? ",!
  1. I $P(MSPRES(9000037,AG("DA"),.69),U)=""!($P(MSPRES(9000037,AG("DA"),.69),U)="NO") D
  1. . W !,?5,"[ ] YES",!
  1. . I $P(MSPRES(9000037,AG("DA"),.69),U)="" W !,?5,"[ ] NO",!
  1. . I $P(MSPRES(9000037,AG("DA"),.69),U)="NO" W !,?5,"[X] NO",!
  1. I $P(MSPRES(9000037,AG("DA"),.69),U)="YES" D
  1. . W !,?5,"[X] YES",!
  1. . W !,?5,"[ ] NO",!
  1. ;
  1. W !,?2,"7. Does the working aged or disability MSP provision apply (i.e., is the GHP"
  1. W !,?5,"primary based on age or disability entitlement) ? ",!
  1. I $P(MSPRES(9000037,AG("DA"),.71),U)=""!($P(MSPRES(9000037,AG("DA"),.71),U)="NO") D
  1. . W !,?5,"[ ] YES",!
  1. . I $P(MSPRES(9000037,AG("DA"),.71),U)="" W !,?5,"[ ] NO",!
  1. . I $P(MSPRES(9000037,AG("DA"),.71),U)="NO" W !,?5,"[X] NO",!
  1. I $P(MSPRES(9000037,AG("DA"),.71),U)="YES" D
  1. . W !,?5,"[X] YES",!
  1. . W !,?5,"[ ] NO",!
  1. ;
  1. W !!!
  1. S $P(SIGLINE,"_",30)=""
  1. W !,?2,"SIGNATURE : ",SIGLINE ;,$P(MSPRES(9000037,AG("DA"),.02),U)
  1. S Y=$P($G(^AUPNMSP(AG("DA"),7)),U)
  1. X ^DD("DD")
  1. W !?2,"SIGNATURE DATE : ",Y
  1. W !!?2,"DATE SURVEY GIVEN: ",$P(MSPRES(9000037,AG("DA"),.01),U)
  1. Q