IBDEI00W ; ; 18-MAR-1994
;;Version 2.0 ; INTEGRATED BILLING ;; 21-MAR-94
Q:'DIFQR(358.5) F I=1:2 S X=$T(Q+I) Q:X="" S Y=$E($T(Q+I+1),4,999),X=$E(X,4,999) S:$A(Y)=126 I=I+1,Y=$E(Y,2,999)_$E($T(Q+I+1),5,99) S:$A(Y)=61 Y=$E(Y,2,999) X NO E S @X=Y
Q Q
;;^UTILITY(U,$J,358.5)
;;=^IBE(358.5,
;;^UTILITY(U,$J,358.5,0)
;;=IMP/EXP DATA FIELD^358.5I^338^293
;;^UTILITY(U,$J,358.5,1,0)
;;=Subjective:^1^2^^^Subjective:^^^^0^0^10^2^132
;;^UTILITY(U,$J,358.5,2,0)
;;=OBJECTIVE^1^2^^^Objective:^^^^0^8^10^2^132
;;^UTILITY(U,$J,358.5,3,0)
;;=ASSESSMENT/DIAGNOSIS^1^2^^^Assessment/Diagnosis:^^^^0^18^8^2^132
;;^UTILITY(U,$J,358.5,4,0)
;;=PLAN^1^2^^^Plan:^^^^0^26^4^2^132
;;^UTILITY(U,$J,358.5,5,0)
;;=HEADER^2^3
;;^UTILITY(U,$J,358.5,5,2,0)
;;=^357.52I^2^2
;;^UTILITY(U,$J,358.5,5,2,1,0)
;;=**DOCTORS ORDERS**^^^50^0
;;^UTILITY(U,$J,358.5,5,2,2,0)
;;=Nurs. Sig^^^118^0
;;^UTILITY(U,$J,358.5,6,0)
;;=DOCTORS ORDERS^2^2^^^^^^^0^2^18^2^110
;;^UTILITY(U,$J,358.5,7,0)
;;=NURSE'S SIGNATURE^2^2^^^^^^^118^2^18^2^13
;;^UTILITY(U,$J,358.5,8,0)
;;=APPT DATE^3^4
;;^UTILITY(U,$J,358.5,8,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,8,2,1,0)
;;=Appt Date:^^^60^0^0^71^12^2
;;^UTILITY(U,$J,358.5,9,0)
;;=PAGE NUMBER^3^3
;;^UTILITY(U,$J,358.5,9,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,9,2,1,0)
;;=PAGE: 1^^^110^0
;;^UTILITY(U,$J,358.5,10,0)
;;=CLINIC^3^5
;;^UTILITY(U,$J,358.5,10,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,10,2,1,0)
;;=Clinic:^^^0^0^0^8^30^1
;;^UTILITY(U,$J,358.5,11,0)
;;=SIGNATURE^4^3
;;^UTILITY(U,$J,358.5,11,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,11,2,1,0)
;;=Signature of Provider^^^60^4^3^60^40^1
;;^UTILITY(U,$J,358.5,12,0)
;;=CLINIC^4^5
;;^UTILITY(U,$J,358.5,12,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,12,2,1,0)
;;=Clinic:^^^0^4^4^8^30^1
;;^UTILITY(U,$J,358.5,13,0)
;;=VITALS^5^2^^^BP ________ Wt ________ Pulse ________^^^^0^0^4^2^132
;;^UTILITY(U,$J,358.5,14,0)
;;=PATEINT NAME^6^6
;;^UTILITY(U,$J,358.5,14,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,14,2,1,0)
;;=NAME^^I^^^0^0^30^1
;;^UTILITY(U,$J,358.5,15,0)
;;=PID^6^7
;;^UTILITY(U,$J,358.5,15,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,15,2,1,0)
;;=PID^^I^^^1^0^15^1
;;^UTILITY(U,$J,358.5,16,0)
;;=ELIGIBILITY^6^8
;;^UTILITY(U,$J,358.5,16,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,16,2,1,0)
;;=Elig:^^^0^2^2^6^30^1
;;^UTILITY(U,$J,358.5,17,0)
;;=ADDRESS LINE 1^6^9^0^1
;;^UTILITY(U,$J,358.5,17,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,17,2,1,0)
;;=LINE1^^I^^^0^39^45^1
;;^UTILITY(U,$J,358.5,18,0)
;;=ADDRESS LINE 2^6^9^0^2
;;^UTILITY(U,$J,358.5,18,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,18,2,1,0)
;;=LINE2^^I^^^1^39^45^1
;;^UTILITY(U,$J,358.5,19,0)
;;=DATE^6^10
;;^UTILITY(U,$J,358.5,19,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,19,2,1,0)
;;=Date Printed:^^^90^1^1^104^12^1
;;^UTILITY(U,$J,358.5,20,0)
;;=CHECK IF SC^6^3
;;^UTILITY(U,$J,358.5,20,2,0)
;;=^357.52I^2^2
;;^UTILITY(U,$J,358.5,20,2,1,0)
;;=*** NOTE: IF THE PATIENT'S TREATMENT WAS FOR ANY CONDITION RELATED TO THE FOLLOWING SERVICE-CONNECTED^^^7^4
;;^UTILITY(U,$J,358.5,20,2,2,0)
;;=DISABILITIES, CHECK BELOW TO THE LEFT OF THE LISTED CONDITON(S). ***^^^11^5
;;^UTILITY(U,$J,358.5,21,0)
;;=SC DISABILITY 1^6^11^0^1
;;^UTILITY(U,$J,358.5,21,2,0)
;;=^357.52I^3^3
;;^UTILITY(U,$J,358.5,21,2,1,0)
;;=Disabilities:^^^8^7
;;^UTILITY(U,$J,358.5,21,2,2,0)
;;=(__)^^^0^8^8^5^45^1
;;^UTILITY(U,$J,358.5,21,2,3,0)
;;=% - SERVICE CONNECTED^^I^^^8^51^24^5
;;^UTILITY(U,$J,358.5,22,0)
;;=SC DISABILITY 2^6^11^0^2
;;^UTILITY(U,$J,358.5,22,2,0)
;;=^357.52I^2^2
;;^UTILITY(U,$J,358.5,22,2,1,0)
;;=(__)^^^0^9^9^5^45^1
;;^UTILITY(U,$J,358.5,22,2,2,0)
;;=% - SERVICE CONNECTED^^I^^^9^51^24^5
;;^UTILITY(U,$J,358.5,23,0)
;;=SC DISABILITY 3^6^11^1^3
;;^UTILITY(U,$J,358.5,23,2,0)
;;=^357.52I^2^2
IBDEI00W ; ; 18-MAR-1994
+1 ;;Version 2.0 ; INTEGRATED BILLING ;; 21-MAR-94
+2 IF 'DIFQR(358.5)
QUIT
FOR I=1:2
SET X=$TEXT(Q+I)
IF X=""
QUIT
SET Y=$EXTRACT($TEXT(Q+I+1),4,999)
SET X=$EXTRACT(X,4,999)
IF $ASCII(Y)=126
SET I=I+1
SET Y=$EXTRACT(Y,2,999)_$EXTRACT($TEXT(Q+I+1),5,99)
IF $ASCII(Y)=61
SET Y=$EXTRACT(Y,2,999)
XECUTE NO
IF '$TEST
SET @X=Y
Q QUIT
+1 ;;^UTILITY(U,$J,358.5)
+2 ;;=^IBE(358.5,
+3 ;;^UTILITY(U,$J,358.5,0)
+4 ;;=IMP/EXP DATA FIELD^358.5I^338^293
+5 ;;^UTILITY(U,$J,358.5,1,0)
+6 ;;=Subjective:^1^2^^^Subjective:^^^^0^0^10^2^132
+7 ;;^UTILITY(U,$J,358.5,2,0)
+8 ;;=OBJECTIVE^1^2^^^Objective:^^^^0^8^10^2^132
+9 ;;^UTILITY(U,$J,358.5,3,0)
+10 ;;=ASSESSMENT/DIAGNOSIS^1^2^^^Assessment/Diagnosis:^^^^0^18^8^2^132
+11 ;;^UTILITY(U,$J,358.5,4,0)
+12 ;;=PLAN^1^2^^^Plan:^^^^0^26^4^2^132
+13 ;;^UTILITY(U,$J,358.5,5,0)
+14 ;;=HEADER^2^3
+15 ;;^UTILITY(U,$J,358.5,5,2,0)
+16 ;;=^357.52I^2^2
+17 ;;^UTILITY(U,$J,358.5,5,2,1,0)
+18 ;;=**DOCTORS ORDERS**^^^50^0
+19 ;;^UTILITY(U,$J,358.5,5,2,2,0)
+20 ;;=Nurs. Sig^^^118^0
+21 ;;^UTILITY(U,$J,358.5,6,0)
+22 ;;=DOCTORS ORDERS^2^2^^^^^^^0^2^18^2^110
+23 ;;^UTILITY(U,$J,358.5,7,0)
+24 ;;=NURSE'S SIGNATURE^2^2^^^^^^^118^2^18^2^13
+25 ;;^UTILITY(U,$J,358.5,8,0)
+26 ;;=APPT DATE^3^4
+27 ;;^UTILITY(U,$J,358.5,8,2,0)
+28 ;;=^357.52I^1^1
+29 ;;^UTILITY(U,$J,358.5,8,2,1,0)
+30 ;;=Appt Date:^^^60^0^0^71^12^2
+31 ;;^UTILITY(U,$J,358.5,9,0)
+32 ;;=PAGE NUMBER^3^3
+33 ;;^UTILITY(U,$J,358.5,9,2,0)
+34 ;;=^357.52I^1^1
+35 ;;^UTILITY(U,$J,358.5,9,2,1,0)
+36 ;;=PAGE: 1^^^110^0
+37 ;;^UTILITY(U,$J,358.5,10,0)
+38 ;;=CLINIC^3^5
+39 ;;^UTILITY(U,$J,358.5,10,2,0)
+40 ;;=^357.52I^1^1
+41 ;;^UTILITY(U,$J,358.5,10,2,1,0)
+42 ;;=Clinic:^^^0^0^0^8^30^1
+43 ;;^UTILITY(U,$J,358.5,11,0)
+44 ;;=SIGNATURE^4^3
+45 ;;^UTILITY(U,$J,358.5,11,2,0)
+46 ;;=^357.52I^1^1
+47 ;;^UTILITY(U,$J,358.5,11,2,1,0)
+48 ;;=Signature of Provider^^^60^4^3^60^40^1
+49 ;;^UTILITY(U,$J,358.5,12,0)
+50 ;;=CLINIC^4^5
+51 ;;^UTILITY(U,$J,358.5,12,2,0)
+52 ;;=^357.52I^1^1
+53 ;;^UTILITY(U,$J,358.5,12,2,1,0)
+54 ;;=Clinic:^^^0^4^4^8^30^1
+55 ;;^UTILITY(U,$J,358.5,13,0)
+56 ;;=VITALS^5^2^^^BP ________ Wt ________ Pulse ________^^^^0^0^4^2^132
+57 ;;^UTILITY(U,$J,358.5,14,0)
+58 ;;=PATEINT NAME^6^6
+59 ;;^UTILITY(U,$J,358.5,14,2,0)
+60 ;;=^357.52I^1^1
+61 ;;^UTILITY(U,$J,358.5,14,2,1,0)
+62 ;;=NAME^^I^^^0^0^30^1
+63 ;;^UTILITY(U,$J,358.5,15,0)
+64 ;;=PID^6^7
+65 ;;^UTILITY(U,$J,358.5,15,2,0)
+66 ;;=^357.52I^1^1
+67 ;;^UTILITY(U,$J,358.5,15,2,1,0)
+68 ;;=PID^^I^^^1^0^15^1
+69 ;;^UTILITY(U,$J,358.5,16,0)
+70 ;;=ELIGIBILITY^6^8
+71 ;;^UTILITY(U,$J,358.5,16,2,0)
+72 ;;=^357.52I^1^1
+73 ;;^UTILITY(U,$J,358.5,16,2,1,0)
+74 ;;=Elig:^^^0^2^2^6^30^1
+75 ;;^UTILITY(U,$J,358.5,17,0)
+76 ;;=ADDRESS LINE 1^6^9^0^1
+77 ;;^UTILITY(U,$J,358.5,17,2,0)
+78 ;;=^357.52I^1^1
+79 ;;^UTILITY(U,$J,358.5,17,2,1,0)
+80 ;;=LINE1^^I^^^0^39^45^1
+81 ;;^UTILITY(U,$J,358.5,18,0)
+82 ;;=ADDRESS LINE 2^6^9^0^2
+83 ;;^UTILITY(U,$J,358.5,18,2,0)
+84 ;;=^357.52I^1^1
+85 ;;^UTILITY(U,$J,358.5,18,2,1,0)
+86 ;;=LINE2^^I^^^1^39^45^1
+87 ;;^UTILITY(U,$J,358.5,19,0)
+88 ;;=DATE^6^10
+89 ;;^UTILITY(U,$J,358.5,19,2,0)
+90 ;;=^357.52I^1^1
+91 ;;^UTILITY(U,$J,358.5,19,2,1,0)
+92 ;;=Date Printed:^^^90^1^1^104^12^1
+93 ;;^UTILITY(U,$J,358.5,20,0)
+94 ;;=CHECK IF SC^6^3
+95 ;;^UTILITY(U,$J,358.5,20,2,0)
+96 ;;=^357.52I^2^2
+97 ;;^UTILITY(U,$J,358.5,20,2,1,0)
+98 ;;=*** NOTE: IF THE PATIENT'S TREATMENT WAS FOR ANY CONDITION RELATED TO THE FOLLOWING SERVICE-CONNECTED^^^7^4
+99 ;;^UTILITY(U,$J,358.5,20,2,2,0)
+100 ;;=DISABILITIES, CHECK BELOW TO THE LEFT OF THE LISTED CONDITON(S). ***^^^11^5
+101 ;;^UTILITY(U,$J,358.5,21,0)
+102 ;;=SC DISABILITY 1^6^11^0^1
+103 ;;^UTILITY(U,$J,358.5,21,2,0)
+104 ;;=^357.52I^3^3
+105 ;;^UTILITY(U,$J,358.5,21,2,1,0)
+106 ;;=Disabilities:^^^8^7
+107 ;;^UTILITY(U,$J,358.5,21,2,2,0)
+108 ;;=(__)^^^0^8^8^5^45^1
+109 ;;^UTILITY(U,$J,358.5,21,2,3,0)
+110 ;;=% - SERVICE CONNECTED^^I^^^8^51^24^5
+111 ;;^UTILITY(U,$J,358.5,22,0)
+112 ;;=SC DISABILITY 2^6^11^0^2
+113 ;;^UTILITY(U,$J,358.5,22,2,0)
+114 ;;=^357.52I^2^2
+115 ;;^UTILITY(U,$J,358.5,22,2,1,0)
+116 ;;=(__)^^^0^9^9^5^45^1
+117 ;;^UTILITY(U,$J,358.5,22,2,2,0)
+118 ;;=% - SERVICE CONNECTED^^I^^^9^51^24^5
+119 ;;^UTILITY(U,$J,358.5,23,0)
+120 ;;=SC DISABILITY 3^6^11^1^3
+121 ;;^UTILITY(U,$J,358.5,23,2,0)
+122 ;;=^357.52I^2^2
