;Entry point to print signature block and special notes
; Set category, status and type of care variables from means test file.
; These are initially set in DGMTP with the call to SET^DGMTSCU2, but
; are calculated by the data available. For this portion of the
; printout they should be set to the means test file entry.
Prompt: $$UL^DGMTSCU1(DGUL,DGLNE1),!?30,"Completion of this form with signature of veteran is certification",!?30,"that the veteran has received a copy of the privacy act statement."
Line Location: SIG+1
Function Call: WRITE
Prompt: $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"THE ABOVE INFORMATION IS CORRECT",?63,"| Signature of Veteran or Designee",?109,"| Date",!?1,"TO THE BEST OF MY KNOWLEDGE.",?63,"|",?109,"|"
Line Location: SIG+2
Function Call: WRITE
Prompt: $$UL^DGMTSCU1(DGUL,DGLNE1),!,?37,"F. TO BE COMPLETED BY DISCRETIONARY VETERANS WHO",!,?41,"ARE REQUIRED TO MAKE COPAYMENTS"
Line Location: SIG+3
Function Call: WRITE
Prompt: $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"Eligibility Category",?30,"| Veterans in Category C must agree to pay VA a Deductible not to exceed the Medicare"
Line Location: SIG+4
Function Call: WRITE
Prompt: !?30,"| Deductible plus a per diem for Hospital and Nursing Home care. A per Visit",!
Line Location: SIG+5
Function Call: WRITE
Prompt: ?30,"| Deductible is required for Category C Veterans to receive Outpatient care."
Line Location: SIG+7
Function Call: WRITE
Prompt: !?30,"| The Billing Period and Rates are specified in 38 U.S.C."
Line Location: SIG+8
Function Call: WRITE
Prompt: $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"I AGREE TO PAY THE VA THE APPLICABLE",?63,"| Signature of Veteran or Designee",?109,"| Date"
Line Location: SIG+9
Function Call: WRITE
Prompt: !?1,"DEDUCTIBLE FOR MY MEDICAL CARE.",?63,"| ",$S(DGTYC'="D":"NOT APPLICABLE",'$P(DGMT0,"^",11):"HAS NOT AGREED",1:""),?109,"|"
Line Location: SIG+10
Function Call: WRITE
Prompt: !,DGLNE,!?1,"Special Note(s):"
Line Location: NOTE+1
Function Call: WRITE
Prompt: ?30,"This means test was administered by the ",$S(X<4:"IVM",1:$$SR^DGMTAUD1(DGMT0,DGMTI)_" Medical")," Center.",!
Line Location: NOTE+2
Function Call: WRITE
Prompt: ?30,"Patient's means test is Pending Adjudication.",!
Line Location: NOTE+3
Function Call: WRITE
Prompt: ?30,"Patient's means test is No Longer Required.",!
Line Location: NOTE+4
Function Call: WRITE
Prompt: ?30,"Patient has declined to provide income information.",!
Line Location: NOTE+5
Function Call: WRITE
Prompt: ?30,"Previous years thresholds were used to determine the patient's eligibility for care.",!?30,"The means test must be re-applied once the correct thresholds are available.",!
Line Location: NOTE+6
Function Call: WRITE
Prompt: ?30,"Copay Exemption Test Status is: "_$S($P(DGMT0,U,3)=7:"EXEMPT",$P(DGMT0,U,3)=8:"NON-EXEMPT",$P(DGMT0,U,3)=9:"INCOMPLETE",$P(DGMT0,U,3)=10:"NO LONGER APPLICABLE",$P(DGMT0,U,3)=11:"PENDING ADJUDICATION",1:"")