AGMSPI6 ; IHS/SD/EFG - MSP INTERVIEW PART 6 ;
;;7.1;PATIENT REGISTRATION;**8**;AUG 25, 2005
;
EN ;EP -
W !,"PART VI - ESRD"
W !
QUES1 ;ASK QUESTION NUMBER 1
S DR=".54 Do you have group health plan (GHP) coverage ? (Y/N) "
D ^DIE
K DIE("NO^")
Q:$D(Y) ;AG*7.1*8
S PARTVI1=X
I X="Y" D Q:$D(Y)
. S DR=".55 Name of GHP : "
. D ^DIE
. Q:$D(Y) ;AG*7.1*8
. S DR=".56 Policy identification number : "
. D ^DIE
. Q:$D(Y) ;AG*7.1*8
. S DR=".57 Group identification number : "
. D ^DIE
. Q:$D(Y) ;AG*7.1*8
. S DR=".58 Name of policy holder : "
. D ^DIE
. Q:$D(Y) ;AG*7.1*8
. S DR=".59 Relationship to patient : "
. D ^DIE
. Q:$D(Y) ;AG*7.1*8
. S DR=".61 Name of employer, if any, from which you receive GHP coverage : "
. D ^DIE
. Q:$D(Y) ;AG*7.1*8
E D Q ;AG*7.1*8
. S DIR(0)="E"
. S DIR("A")="STOP. Medicare is primary. Press any key to exit."
. D ^DIR ;AG*7.1*8
. K DIR
. Q
;
QUES2 ;ASK QUESTION NUMBER 2
S DR=".62 Have you received a kidney transplant ? (Y/N) "
D ^DIE
K DIE("NO^")
Q:$D(Y) ;AG*7.1*8
S PARTVI2=X
I X="Y" D Q:$D(Y) ;AG*7.1*8
. S DR=".63 Date of transplant : "
. D ^DIE
QUES3 ;ASK QUESTION NUMBER 3
S DR=".64 Have you received maintenance dialysis treatments ? (Y/N) "
D ^DIE
K DIE("NO^")
Q:$D(Y) ;AG*7.1*8
S PARTVI3=X
I X="Y" D Q:$D(Y)
. S DR=".65 Date dialysis began : "
. D ^DIE
. Q:$D(Y) ;AG*7.1*8
. S DR=".66 If you participated in a self dialysis training program, provide date training started : "
. D ^DIE
QUES4 ;ASK QUESTION NUMBER 4
S DR=".67 Are you within the 30 month coordination period ? (Y/N) "
D ^DIE
K DIE("NO^")
Q:$D(Y) ;AG*7.1*8
S PARTVI4=X
I X="N" D Q ;AG*7.1*8
. S DIR(0)="E"
. S DIR("A")="STOP. Medicare is primary.ENTER <RETURN> TO CONTINUE"
. D ^DIR
. K DIR
. Q
;
QUES5 ;ASK QUESTION NUMBER 5
S DR=".68 Are you entitled to Medicare on the basis of either ESRD and age or ESRD and disability ? (Y/N) "
D ^DIE
K DIE("NO^")
Q:$D(Y) ;AG*7.1*8
S PARTVI5=X
I X="N" D Q ;AG*7.1*8
. S DIR(0)="E"
. S DIR("A")="STOP. The group health plan (GHP) is primary during the 30-month coordinator period. Press <ENTER> to continue."
. D ^DIR
. K DIR
. Q
;
QUES6 ;ASK QUESTION NUMBER 6
S DR=".69 Was your initial entitlement to Medicare (insluding simultaneous entitlement) based on ESRD ? (Y/N) "
D ^DIE
K DIE("NO^")
Q:$D(Y) ;AG*7.1*8
S PARTVI6=X
I X="Y" D Q ;AG*7.1*8
. S DIR(0)="E"
. S DIR("A")="STOP. The GHP continues to pay primary during the 30-month coordination period. ENTER <RETURN> TO CONTINUE"
. D ^DIR
. K DIR
. Q
W !,"Initial entitlement is based on age or disability."
QUES7 ;ASK QUESTION NUMBER 7
S DR=".71 Does the working aged or disability MSP provision apply (i.e., is the GHP primary based on age or disability entitlement ? (Y/N) "
D ^DIE
K DIE("NO^")
Q:$D(Y) ;AG*7.1*8
S PARTVI7=X
I X="Y" W !,"The GHP continues to pay primary during the 30-month coordination period."
E W !,"Medicare continues to pay primary."
S DR=".05////^S X=DUZ"
D ^DIE
Q
AGMSPI6 ; IHS/SD/EFG - MSP INTERVIEW PART 6 ;
+1 ;;7.1;PATIENT REGISTRATION;**8**;AUG 25, 2005
+2 ;
EN ;EP -
+1 WRITE !,"PART VI - ESRD"
+2 WRITE !
QUES1 ;ASK QUESTION NUMBER 1
+1 SET DR=".54 Do you have group health plan (GHP) coverage ? (Y/N) "
+2 DO ^DIE
+3 KILL DIE("NO^")
+4 ;AG*7.1*8
IF $DATA(Y)
QUIT
+5 SET PARTVI1=X
+6 IF X="Y"
Begin DoDot:1
+7 SET DR=".55 Name of GHP : "
+8 DO ^DIE
+9 ;AG*7.1*8
IF $DATA(Y)
QUIT
+10 SET DR=".56 Policy identification number : "
+11 DO ^DIE
+12 ;AG*7.1*8
IF $DATA(Y)
QUIT
+13 SET DR=".57 Group identification number : "
+14 DO ^DIE
+15 ;AG*7.1*8
IF $DATA(Y)
QUIT
+16 SET DR=".58 Name of policy holder : "
+17 DO ^DIE
+18 ;AG*7.1*8
IF $DATA(Y)
QUIT
+19 SET DR=".59 Relationship to patient : "
+20 DO ^DIE
+21 ;AG*7.1*8
IF $DATA(Y)
QUIT
+22 SET DR=".61 Name of employer, if any, from which you receive GHP coverage : "
+23 DO ^DIE
+24 ;AG*7.1*8
IF $DATA(Y)
QUIT
End DoDot:1
IF $DATA(Y)
QUIT
+25 ;AG*7.1*8
IF '$TEST
Begin DoDot:1
+26 SET DIR(0)="E"
+27 SET DIR("A")="STOP. Medicare is primary. Press any key to exit."
+28 ;AG*7.1*8
DO ^DIR
+29 KILL DIR
+30 QUIT
End DoDot:1
QUIT
+31 ;
QUES2 ;ASK QUESTION NUMBER 2
+1 SET DR=".62 Have you received a kidney transplant ? (Y/N) "
+2 DO ^DIE
+3 KILL DIE("NO^")
+4 ;AG*7.1*8
IF $DATA(Y)
QUIT
+5 SET PARTVI2=X
+6 ;AG*7.1*8
IF X="Y"
Begin DoDot:1
+7 SET DR=".63 Date of transplant : "
+8 DO ^DIE
End DoDot:1
IF $DATA(Y)
QUIT
QUES3 ;ASK QUESTION NUMBER 3
+1 SET DR=".64 Have you received maintenance dialysis treatments ? (Y/N) "
+2 DO ^DIE
+3 KILL DIE("NO^")
+4 ;AG*7.1*8
IF $DATA(Y)
QUIT
+5 SET PARTVI3=X
+6 IF X="Y"
Begin DoDot:1
+7 SET DR=".65 Date dialysis began : "
+8 DO ^DIE
+9 ;AG*7.1*8
IF $DATA(Y)
QUIT
+10 SET DR=".66 If you participated in a self dialysis training program, provide date training started : "
+11 DO ^DIE
End DoDot:1
IF $DATA(Y)
QUIT
QUES4 ;ASK QUESTION NUMBER 4
+1 SET DR=".67 Are you within the 30 month coordination period ? (Y/N) "
+2 DO ^DIE
+3 KILL DIE("NO^")
+4 ;AG*7.1*8
IF $DATA(Y)
QUIT
+5 SET PARTVI4=X
+6 ;AG*7.1*8
IF X="N"
Begin DoDot:1
+7 SET DIR(0)="E"
+8 SET DIR("A")="STOP. Medicare is primary.ENTER <RETURN> TO CONTINUE"
+9 DO ^DIR
+10 KILL DIR
+11 QUIT
End DoDot:1
QUIT
+12 ;
QUES5 ;ASK QUESTION NUMBER 5
+1 SET DR=".68 Are you entitled to Medicare on the basis of either ESRD and age or ESRD and disability ? (Y/N) "
+2 DO ^DIE
+3 KILL DIE("NO^")
+4 ;AG*7.1*8
IF $DATA(Y)
QUIT
+5 SET PARTVI5=X
+6 ;AG*7.1*8
IF X="N"
Begin DoDot:1
+7 SET DIR(0)="E"
+8 SET DIR("A")="STOP. The group health plan (GHP) is primary during the 30-month coordinator period. Press <ENTER> to continue."
+9 DO ^DIR
+10 KILL DIR
+11 QUIT
End DoDot:1
QUIT
+12 ;
QUES6 ;ASK QUESTION NUMBER 6
+1 SET DR=".69 Was your initial entitlement to Medicare (insluding simultaneous entitlement) based on ESRD ? (Y/N) "
+2 DO ^DIE
+3 KILL DIE("NO^")
+4 ;AG*7.1*8
IF $DATA(Y)
QUIT
+5 SET PARTVI6=X
+6 ;AG*7.1*8
IF X="Y"
Begin DoDot:1
+7 SET DIR(0)="E"
+8 SET DIR("A")="STOP. The GHP continues to pay primary during the 30-month coordination period. ENTER <RETURN> TO CONTINUE"
+9 DO ^DIR
+10 KILL DIR
+11 QUIT
End DoDot:1
QUIT
+12 WRITE !,"Initial entitlement is based on age or disability."
QUES7 ;ASK QUESTION NUMBER 7
+1 SET DR=".71 Does the working aged or disability MSP provision apply (i.e., is the GHP primary based on age or disability entitlement ? (Y/N) "
+2 DO ^DIE
+3 KILL DIE("NO^")
+4 ;AG*7.1*8
IF $DATA(Y)
QUIT
+5 SET PARTVI7=X
+6 IF X="Y"
WRITE !,"The GHP continues to pay primary during the 30-month coordination period."
+7 IF '$TEST
WRITE !,"Medicare continues to pay primary."
+8 SET DR=".05////^S X=DUZ"
+9 DO ^DIE
+10 QUIT
