- DGMTP4 ;ALB/RMO,CAW,LD - Print Means Test 10-10F Cont. ;16 APR 1992 2:35 pm
- ;;5.3;Registration;**33,182,300,1015**;Aug 13, 1993;Build 21
- ;
- EN ;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.
- N DGCAT,DGMTS,DGTYC,X
- S DGMTS=$P(DGMT0,"^",3),DGCAT=$P($$MTS^DGMTU(DFN,$S(DGMTS=2:6,1:DGMTS)),"^",2),DGTYC=$P($G(^DG(408.32,DGMTS,0)),"^",3)
- D SIG,NOTE
- Q Q
- ;
- SIG ;Print signature block
- W $$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."
- W $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"THE ABOVE INFORMATION IS CORRECT",?63,"| Signature of Veteran or Designee",?109,"| Date",!?1,"TO THE BEST OF MY KNOWLEDGE.",?63,"|",?109,"|"
- W $$UL^DGMTSCU1(DGUL,DGLNE1),!,?37,"F. TO BE COMPLETED BY DISCRETIONARY VETERANS WHO",!,?41,"ARE REQUIRED TO MAKE COPAYMENTS"
- W $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"Eligibility Category",?30,"| Veterans in Category C must agree to pay VA a Deductible not to exceed the Medicare"
- W !?30,"| Deductible plus a per diem for Hospital and Nursing Home care. A per Visit",!
- W:DGMTYPT=1 ?11,DGCAT
- W ?30,"| Deductible is required for Category C Veterans to receive Outpatient care."
- W !?30,"| The Billing Period and Rates are specified in 38 U.S.C."
- W $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"I AGREE TO PAY THE VA THE APPLICABLE",?63,"| Signature of Veteran or Designee",?109,"| Date"
- W !?1,"DEDUCTIBLE FOR MY MEDICAL CARE.",?63,"| ",$S(DGTYC'="D":"NOT APPLICABLE",'$P(DGMT0,"^",11):"HAS NOT AGREED",1:""),?109,"|"
- Q
- ;
- NOTE ;Print any special notes
- W !,DGLNE,!?1,"Special Note(s):"
- S X=+$P(DGMT0,"^",23) I (X>1) W ?30,"This means test was administered by the ",$S(X<4:"IVM",1:$$SR^DGMTAUD1(DGMT0,DGMTI)_" Medical")," Center.",!
- I DGMTS=2 W ?30,"Patient's means test is Pending Adjudication.",!
- I DGMTS=3 W ?30,"Patient's means test is No Longer Required.",!
- I $P(DGMT0,"^",14),DGMTS=6 W ?30,"Patient has declined to provide income information.",!
- I $P(DGMT0,"^",16) W ?30,"Previous years thresholds were used to determine the patient's eligibility for care.",!?30,"The means test must be re-applied once the correct thresholds are available.",!
- I $P(DGMT0,"^",4)'=DGINT W ?30,"Patient's annual income does not match the income associated with the means test." W:DGTYC'="N" !?30,"Please edit and complete the means test again.",!
- I $P(DGMT0,"^",19)=2 W ?30,"Copay Exemption Test Status is: "_$S($P(DGMT0,U,3)=7:"EXEMPT",$P(DGMT0,U,3)=8:"NON-EXEMPT",$P(DGMT0,U,3)=9:"INCOMPLETE",$P(DGMT0,U,3)=10:"NO LONGER APPLICABLE",$P(DGMT0,U,3)=11:"PENDING ADJUDICATION",1:"")
- W ! S DGPGE=2 D FT^DGMTP ;end of second page of form
- Q
- DGMTP4 ;ALB/RMO,CAW,LD - Print Means Test 10-10F Cont. ;16 APR 1992 2:35 pm
- +1 ;;5.3;Registration;**33,182,300,1015**;Aug 13, 1993;Build 21
- +2 ;
- EN ;Entry point to print signature block and special notes
- +1 ; Set category, status and type of care variables from means test file.
- +2 ; These are initially set in DGMTP with the call to SET^DGMTSCU2, but
- +3 ; are calculated by the data available. For this portion of the
- +4 ; printout they should be set to the means test file entry.
- +5 NEW DGCAT,DGMTS,DGTYC,X
- +6 SET DGMTS=$PIECE(DGMT0,"^",3)
- SET DGCAT=$PIECE($$MTS^DGMTU(DFN,$SELECT(DGMTS=2:6,1:DGMTS)),"^",2)
- SET DGTYC=$PIECE($GET(^DG(408.32,DGMTS,0)),"^",3)
- +7 DO SIG
- DO NOTE
- Q QUIT
- +1 ;
- SIG ;Print signature block
- +1 WRITE $$UL^DGMTSCU1(DGUL,DGLNE1),!?30,"Completion of this form with signature of veteran is certification",!?30,"that the veteran has received a copy of the privacy act statement."
- +2 WRITE $$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,"|"
- +3 WRITE $$UL^DGMTSCU1(DGUL,DGLNE1),!,?37,"F. TO BE COMPLETED BY DISCRETIONARY VETERANS WHO",!,?41,"ARE REQUIRED TO MAKE COPAYMENTS"
- +4 WRITE $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"Eligibility Category",?30,"| Veterans in Category C must agree to pay VA a Deductible not to exceed the Medicare"
- +5 WRITE !?30,"| Deductible plus a per diem for Hospital and Nursing Home care. A per Visit",!
- +6 IF DGMTYPT=1
- WRITE ?11,DGCAT
- +7 WRITE ?30,"| Deductible is required for Category C Veterans to receive Outpatient care."
- +8 WRITE !?30,"| The Billing Period and Rates are specified in 38 U.S.C."
- +9 WRITE $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"I AGREE TO PAY THE VA THE APPLICABLE",?63,"| Signature of Veteran or Designee",?109,"| Date"
- +10 WRITE !?1,"DEDUCTIBLE FOR MY MEDICAL CARE.",?63,"| ",$SELECT(DGTYC'="D":"NOT APPLICABLE",'$PIECE(DGMT0,"^",11):"HAS NOT AGREED",1:""),?109,"|"
- +11 QUIT
- +12 ;
- NOTE ;Print any special notes
- +1 WRITE !,DGLNE,!?1,"Special Note(s):"
- +2 SET X=+$PIECE(DGMT0,"^",23)
- IF (X>1)
- WRITE ?30,"This means test was administered by the ",$SELECT(X<4:"IVM",1:$$SR^DGMTAUD1(DGMT0,DGMTI)_" Medical")," Center.",!
- +3 IF DGMTS=2
- WRITE ?30,"Patient's means test is Pending Adjudication.",!
- +4 IF DGMTS=3
- WRITE ?30,"Patient's means test is No Longer Required.",!
- +5 IF $PIECE(DGMT0,"^",14)
- IF DGMTS=6
- WRITE ?30,"Patient has declined to provide income information.",!
- +6 IF $PIECE(DGMT0,"^",16)
- WRITE ?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.",!
- +7 IF $PIECE(DGMT0,"^",4)'=DGINT
- WRITE ?30,"Patient's annual income does not match the income associated with the means test."
- IF DGTYC'="N"
- WRITE !?30,"Please edit and complete the means test again.",!
- +8 IF $PIECE(DGMT0,"^",19)=2
- WRITE ?30,"Copay Exemption Test Status is: "_$SELECT($PIECE(DGMT0,U,3)=7:"EXEMPT",$PIECE(DGMT0,U,3)=8:"NON-EXEMPT",$PIECE(DGMT0,U,3)=9:"INCOMPLETE",$PIECE(DGMT0,U,3)=10:"NO LONGER APPLICABLE",$PIECE(DGMT0,U,3)=11:"PENDING ADJUDICATION",1:""
- )
- +9 ;end of second page of form
- WRITE !
- SET DGPGE=2
- DO FT^DGMTP
- +10 QUIT